Progress in the mid 19th century Flashcards
What were the three theories of disease before the progress of the mid-19th century?
- Four Humours - the four bodily fluids; phlegm, blood, black bile and yellow bile have to be balanced to stay healthy.
- Miasma - disease is carried by bad smells
- Spontaneous Generation - rotting material causes disease
What were the methods to prevent blood loss before the 19th century?
- ligatures - tying off open arteries - often caused infection as they had no knowledge of antiseptics
- Cauterisation - using a hot metal rod to seal off arteries - usually effective but extremely painful for the patient
- tourniquets - wrapping a piece for cloth tightly around the limb to prevent blood flow
What were living conditions like before the 1848 Pubilc Health Act?
Sanitary levals and living conditions were very poor.
E.g. streets were filthy,
food was sometimes tampered with (flour + sand) (meat + paint), water was collected by many families from the same pump this water might have been from polluted rivers,
cramped living - many families to one room,
no ventilation,
What was Public Health like before the 1848 Public Health Act?
Had to pay for every doctor visit and every prescribed medicine, this meant many did not go or left it too late as they could not afford it.
Instead they relied on homemade remedies and the care from women in their family
When was chloroform first discovered and by who?
1831 - by Samuel Guthrie in USA and Eugene Soubeiran in France
When did the first cholera epidemic begin?
1831
Why were there previously little advancements in medicine?
- little funding - hospitals had tor ely on finding from charities as the government did not view finding for research as a priority
- attitudes - doctors were reluctant to accept new discoveries as they had no evidence that what they were doing was wrong
- Religion - believed in the after life so their were limited dissections
- Technology - hadn’t advanced enough to be a blessing to see microorganisms
Who made a cholera epidemic report from Leeds? When and what did they find?
1832 - John Baker
1. streets were filthy
2. 19 streets had no sewer
3. stagnant and smelly water
What were the causes of the Cholera outbreak?
In poor condition disease could spread easily:
- industrialisation - mass rural-urban migration meant that many new homes had to be built in a short amount of time - low housing standards and cramped living
- lack of understanding - believed in miasma
- laissez-faire - matters were left to local authorities, all that was done was burning barrels of tar in the streets
- 20 -30 families collected from the same local pump which carried potentially infected water form polluted rivers
Who made the report, “The Sanitary Conditions of the Labouring Population”
Edward Chadwick, who was involved in workhouses (where people went if they had no money to support themselves) and saw the dire conditions that people lived in
What did Chadwick’s report suggest?
spend taxes on improving the living and housing conditions of the poor to keep them healthy as otherwise when they became ill they would have to be supported
- clean water
- remove rubbish
- remove sewage
What was the first discovered anaesthetic, who discovered it and when?
1846 - William Morton discovered ether as an effect anaesthetic
Who used ether in a leg amputation and what did they discover?
1846 - Robert Liston used ether in a leg amputation
Pros : patient was unaware that the operation had taken place
Cons: ether was flammable (dangerous in gas lit operating theatres), irritated the lungs, caused vomiting, difficult to dose
When did the black period in surgery begin and what was the cause?
1846 - black period in surgery began
Now that the problem of pain had been solved, surgeons completed longer, more complicated and deeper operations which meant there was more risk of infection.
Who when and how does someone discover chloroform as an effective anaesthetic?
1847 - James Simpson after waking up slumped on the ground after inhaling various gases the night before (CHANCE)
What was chloroform used for?
1847 - Simpson starts using chloroform as a pain relief as he is the Professor of Medicine and Midwifery at Edinburgh University
Who famously used chloroform and what effect did it have?
After Simpson becmae Queen Victorias personal physician she used it during the birth of her 8th child.
Drew publicity to the miracle pain relief and had the royal stamp of approval which led to it being widely used as an anaesthetic
Pros about Chloroform?
- not flammable
- did not cause vomiting or lung irritation
- miracle pain relief
Cons about Chloroform?
- difficult to dosage (although this is solved with the chloroform inhaler in 1848 by John Snow)
- Church opposition - Eve was told childbirth would be painful
- Doctor opposition - doctors though that a patient away was more likely to survive than one asleep
- Doctor opposition - unknown effects on the baby
- Surgeons felt more confident to complete longer, more complicated and deeper operations and problems of infection and blood loss meant that death rate rose (Black Period in Surgery)
How was dosage solved for Chloroform?
1848 - John Snow invented the Chloroform inhaler which could control dosage
1848 Public Health Act
- Set up a general board of health
- three comissioners (Chadwick was one)
- Allowed local authroities to:
- set up their own general board of health
- employ a medical officer
- organise the removal of rubbish
- build a sewer system
What was the cause of the 1848 Public Health Act?
- Cholera Epidemic which affected all classes, grew attention to the issue for hygiene
- 50,000 people had died from cholera alone between 1848 - 49
3.Chadwicks report in the “Sanitary Conditions of the Labouring Population”
What was the impact of the 1848 Public Health Act?
LIMITED
1. terms of the Act were not compolsary - many local government did not do what the act had suggested
2. terms for the temporary - General board of Health was only set up for five years
3.attitudes were slow to change - no proof that disease was linked to hygiene and people did not want increase in taxes to help the poor
What did the General Board of Health do?
Responsible for advising on public health matters such as epidemics and disease prevention
How did Dr John Snow recognise that cholera was waterborne?
- after a soho london outbreak he drew a map showing deaths
- noticed deaths were centred around a pump in Broad Street
- Broad Street Pump handle was removed - no water could be collected
- deaths from cholera stopped in that area
In what year did Dr John Snow suggest that cholera was spread via polluted water?
1849
What was the impact of discovering that cholera was waterborne?
little was done to improve public health (until 1858) although…
- put pressure on water companies, local authorities and parliment to improve the water supply
- demonstrated the link between cholera and infected water but not how other diseases was spread as the link between microbes and disease was not understood
What was the cause of the Metropolitan Sewers Act?
The sumer of 1848 was hot, the rivers dried up and all of the rubbish and excretement which had been dumped in the Thames from the sewers was exposed.
This caused, “The Great Stink” all over London
Parliament recognising the urgency, made a new act to provide money for a new sewer system designed by Joseph Bazalgette
When and why was Florence NIghtingale sent to Scutari to manage a military hospital
1854 - Florence Nightingale was sent to Scutari hospital during the Crimean War because death rates were so high.
What were the conditions of the hospital when Nightingale and her team of 38 nurses arrived?
- overcrowded - patients shared beds or slept on the floor
- unsanitary - clothes were infested with lice and fleas, common typhoid fever, cholera, wards infested with rats and mice, built on a cesspool collecting human waste
- limited funding - poor and limited food, limited medical supplies,
What impact did Florence Nightingale make at the Scutari?
Death rates dropped from 42% to just 2%
- improved sanitation levels - scrubbed everywhere clean, washed sheets, towels, bandages equipment
- Air quality - believed in miasma so opened windows for ventilation, created separate wards for different illnesses
- Funding - from times newspaper, improved food and bough 200 tiowels, clean shirts soap, plates and citlery
- Cleanliness - ensured hand washing
When, how and who discovered that microorganisms make beer sour?
1854 - Louis Pasteur discovered microorganisms turned beer sour after finding that heating (and killing microorganisms) meant that the beer did not go sour
What were the causes to the discovery that microorganisms caused disease?
Technology - microscopes had advanced enough to be able to see microorganisms
Individuals - Pasteur was not convinced by the theory of disease at the time of spontaneous generation
What did Pasteur experiment on to prove that liquids were being contaminated by microorganisms in the air?
Pasteur carried out experiments on milk, wine and vinegar
What were Pasteurs findings and what did they prove?
- a mixture left to open air went bad
- mixture closed from air -> not bad
- a mixture under a microscope showed microorganisms
- heated mixture -> not bad
- mixture -> bad
Proving, microorganisms were not created by the mixture as it decayed, instead, the microorganisms were carried in the air and they caused decay = GERM THEORY
What is the significance of Germ Theory?
Proved Spontaneous Generation wrong. First time that it is proven that decay only develops if the mixture is left open to the air and thus exposed to microrgansims.
Why was there opposition to germ theory?
Didn’t understand how some microorganisms caused disease and others didn’t
Hundreds of microorganisms could be seen in the blood of healthy people
Although many doctors resisted and ridiculed his work at first, as more checked his finding his theories were slowly accpeted
What did Pasteur’s later experiment find?
After collecting samples of air from various places, Pasteur discovered that some air was ‘cleaner’ than other
E.g. air had the most microorganisms in cities and was cleanest in mountains
What was the impact of Germ Theory on Medicine?
Surgery - led to an understanding on why infection often developed after an operation and led to Joseph Lister’s antiseptic techniques
Public Health - explained the link between hygiene and health, led to the identification of each disease causing microorganism, 30 years later vaccinations could be produced to prevent the spread of some diseases
How and when did Pasteur make the link between microorganisms and disease?
1865 - Pasteur investigated disease killing silkworms, found that disease was caused by microorganisms
1878 - published “Germ theory and it’s Applications to Medicine”
A lot was unknown how the knowledge that microorganisms caused disease could help cure disease
How did Joseph Lister discover carbolic acid as an antiseptic?
- 1861 - worked as a surgeon at Glasgow Royal Infirmary
- He read Pasteurs work
- Realised that carbolic acid killed microorganisms responsible for decay and smell since it was used for sewage treatment
- realised that infected wounds smelled like sewage
- wondered if carbolic acid could be sued to fight infection
What was the first use of carbolic acid as an antiseptic?
boy with a broken leg which would have been otherwise amputated because the bone out of the skin would have caused infection. Instead, Lister set the bone and covered the wound in bandages soaked in carbolic acid. The wound healed without infection.
How was carbolic acid used in surgery?
The first anti (fighting) septic (sepsis or infection)
- clean wounds, equipment, bandages in all operations
- carbolic spray to ensure no microorganisms were on the surgeons hands or equipment that could enter an open wound
What were the causes to the discovery of carbolic acid?
- John Snow discovering cholera was waterborne - linked disease to microorganisms
- Nightingale military in Scutari - emphasised the importance of hygiene
- Louis Pasteur’s Germ Theory - linking microorganisms to causing disease
What was the opposition to using carbolic acid as an antiseptic?
- made surgical instruments slippery, difficultto griop which may have slowed down operations which was dangerous when blood loss was still a major problem
- cracked and make skin sore
- some did not accept germ theory and saw no reason for an antiseptic
- did not use carbolic spray effectively and saw no results
- nurse di dnot like the extra tim either took to dress the wounds
- saw no reaosn as soap and water had ‘good’ results
- Lister frequently experimented with his techniques which others saw as him being unconfident
Describe two features of the new Joseph Balzalgette Sewer System which was made after the 1858 Metropolitans Sewers Act
- Finished in 1875
- Cost £6.5 million
- sewers were large oval shape
- system planned to bring the waste to lower down the Thames where it is tidal so that the waste is washed into sea
What were the laissez - faire attitudes in Britain and what is an example of this
Government should only take action in emergency (e.g. the cholera epidemic - Public Health Act) but shoudl not interfere with people’s daily lives & buisinesses
Even when a law was passed it was not mandatory which meant it was not usually obeyed
E.g. 1852 a law was passed that made it cumpolsosary for children to be vaccined against smallpox but this was often ignroed and was only enforced in 1871 with a new Act.
People did not want government action if it meant a raise in taxes
Why did laissez - faire attitudes change?
- people accepted disease was carried by microorganisms because of Pasteurs germ Theory
- acknowledges that access to clean water, removal of sewage/rubbish and improved hygiene would improve public health
- some local authorities tried to take action but they needed the parliament to pass laws to create a national system of improvements
- as more people gained the right to vote, there was added pressure on the government from the working class to take action to improve public health
When and what was the Sanitary Act
caused by the word of Chadwick and John Snow which proved the importance of clean water and the removal of sewage
all towns were forced to employ medical inspectors to check water supplies and drainage
1875 Public Health Act
made local authroities responsible for:
1. supplying clean water
2. removal and organisation of sewage to prevent water being used for cooking and washing being polluted
3. building public toilets
4. ensuring new housing is built to good standards to avoid damp and overcrowding
5. inspecting conditions in lodging houses
6. employ health and sanitary inspectors to ensure regulations are being obeyed
7. street lights to prevent accidents
8. checking the quality of food for sale
Significance of the 1875 Public Health Act
- showed how the national government had to rely on local governments to implement parliament orders - local authorities had to collect money from rate payers to fund work
- showed how laissez - faire attitudes were changing - parliament was now passing laws to enforce a national standard of health, increased governmental role in public health, changing attitudes towards governments responsibility
Florence Nightingales impact on hospitals
1856 - returned to Britain as an expert in nursing and hospitals
1859 - published a book “Notes on Hospitals” with recommendations for hospitals on space, ventilation, cleanliness
1859 - published book “Notes on Nursing” with advice on the importance of ventilation, light, bedding, cleanliness and food
her books were published into 11 languages showing the international influence she had
she wrote over 200 books on hospitals and nursing inspiring other to copy her ideas and high standards
made it acceptable for women to train as nurses but not to become a doctor or carry out dissections
What were the attitudes towards women
- women were resposible for the daily care of the home
- thought of as less intelligent than men - did not recieve the smae education
- expected to play music, sew, apint and make a home for their husband
- not expected to go to university, have higher education including medical training
How did Elizabeth Garrett become a lisenced doctor
comes from a wealthy family, horrified that she wanted to be a doctor
- a nurse and attended lectures meant for male doctors
- applied to study medicine at several medical schools all refused to accept a female student
- paid for private lessons, dissecting in her own bedroom
- completed her medical training but could not be licences as none for the three medical societies would accept her
- father threatened to sue society if they did not accept her as they had no regulations against women
- 1865 - became officialy qualified to practice medicine
- society immediately changed its rules os that no other women could qualify as a doctor in this way
When were medical school forced to accept women by and act of parliment
1876
Who was Robert Koch
A german doctor interested by Pasteurs ideas who wanted to prove that anthrax (disease affecting farm animals) was spread via infected blood.
Discovered the anthrax disease cycle and the bacteria responsible for tuberculosis and cholera
What did Koch develop?
Methods of staining and photographing microorganisms
When did Koch publish his finding on anthrax
1876
When did Koch publish his, “Bacterial Infections for Wounds”
1878
What was the significance of Kochs work with photographing and staining microorganisms
discovered new techniques to investigate disease which lead to new ways of preventing disease e.g. vaccines
when did Koch discover the microorganisms responsible for tuberculosis and cholera
1882 and 1883
What was the impact of Kochs work
He made a new branch of science called bacteriology and became known as the ‘Father of Bacteriology’
His methods and discoveries led to more e.g. the microorganisms for tetanus, pneumonia and meningitis were discovered in the 1880s and 1890s
When was Pasteur’s theory that microorganisms cause decay generally accpeted
1875
When did Pasteur publish his, “Germ Theory of Infection” which linked disease to microorganisms
1878
How did Pasteur discover the first vaccine?
He was studying chicken cholera by injecting them with cultures of bacteria
- he injected a chicken with a batch which was weeks old, the delay had weakened the bacteria and stimulated natural defense when the chicken was injected with fresh cultures
this led to further research into developing vaccines
When and what did Pasteur do to prove than an anthrax vaccine vaccine could protect farm animals
1881 - Pasteur combined his own andn Kochs work
- vaccined 1/2 fo the animals,
- all animals were innoculated iwth anthrax bacilli
- 2 days later only the animals with the vaccine had survived
How did Pasteur work on a vaccine for humans?
To start with he couldn’t investigate vaccines for a human disease because he couldn’t experiment on people
worked on a vaccine against rabies
1885 - he vaccined a boy which had been bitten by a rabid dog and would have otherwise died - saved his life as the rabies hadn’t’t yet developed as the microorganisms had not yet reached his brain
What accelerated advancements for both Louis Pasteur and Robert Koch?
Pasteur and Koch were rivals since their countries were fighting each other in a WAR between 1870-71. This increased the rivalry between them to make the next scientific break through.
Both the French and Germany governments heavily funded each scientist and there was said to be a war in the labs as well as at the frontline
Impact of Listers surgery techniques
Boundaries to acceptance : slow change of attitudes, carbolic spray made surgery more difficult, but people were slowly convinced when Koch discovered the microorganism causing blood poisoning in 1878
When did Lister discover the steam steriliser
1878 - combined Pasteurs discovery that heat killed microorganisms and Listers discovery that heat could sterilise equipment
Impact of Aseptic Surgery
before: operations may have taken place at homes, dirty conditions, with surgeons wearing ordinary clothes which the more blood it had on it the better
surgeons prevented microorganisms reaching anywhere near wounds as they knew this would lead to infection
operations were always carried out in operating theatres without spectators
surgeons wore clean clothes, masks and rubber gloves
cauterisation
any arteries which were cut in the operation were sealed using a hot iron rod against the vessel (very painful)
ligatures
tying the ends of blood vessels but this prevented the wound from healing and led to infection as carbolic acid ligatures were not 100% effective
WHo discovered cat gut ligatures and why were they effective
1881 - Lister discovered that cat gut ligatures were more effective, they dissolved in the body after 2-3 weeks and did not cause infection nor prevent healing
Cocaine as a pain relief, when, imapct
Although chloroform was better than ether it did still cause random sudden deaths - searched for a better anaesthetic
1884 - cocaine was discovered as a local anaesthetic for numbing instead of a general anaesthetic (highly addictive)
1905 - a safer version called novocaine is developed
- improved conditions and techniques
- made surgery safer
- surgeons could carry out more complicated surgeries
How was the 1875 public Health Act funded
local authorities charged more tax to rate payers
Impact of the 1875 public health act
- ensured sewage was properly treated and did not contaminate the water supply -> reduced the chance of disease
- providing clean water -> less chance of catching water borne disease e.g. cholera
- keeping the streets cleaned reduced the amount of mice and rats, reducing the chance of them spreading disease
- lighting the streets -> people could avoid rubbish and dirt
- local authroities had to employ a medical officer in charge of health
- inspecting new houses ensured there was sufficient light and ventilation for health
- inspecting quality for food dropped the number of people becoming ill from poor quality and infected food
- made it illegal for factories to dump waste into the rivers
- first time that the parliament clearly stepped in to improve quality for living showed their willingness to implement latest discoveries to improve the health of the nation
When and what was the Artisans’ Dwelling Act
1875 - gave power to local authorities to buy and demolish slum housing
When and what was The Food and Drugs act
1875 - to improve the standard of food being sold because dangerous practices were common e.g. painting meat red to make it appear more fresh, mix sand with flour to make it weigh more
When and what was the River Pollution Prevention Act
1876 - made it illegal for factories to dump waste (including chemicals) in rivers
When and what was the infectious Disease Act
1889 - ordered householders and doctors in London to report any cases of infectious diseases to the local medical health officer
1899 - extended to the whole country
When and what was the Park Hospital
1 of 5 hospitals in London to cope with cases of infectious disease e.g. scarlet fever had 48 wards and 368 patients
also had isolation wards with large distances between beds
What were the factors influencing public health
- science and technology - microscopes oculd now see microorganims, sewage pipes and water systems,
- understanding about microorganisms and how disease spreads - showed teh importance of increased hygiene, proved it was neccessary to isolate patients with infectious disease and highlighted the importance of authorities to coordinate action
- government - passed a number of acts which improved hygiene and living standards, laissez - faire was lost and local authorities became responsible for implementing laws, more people gained the vote so the government had to listen to the needs of the working class
- Individuals - Edward Chadwick, Dr John Baker, Florence Nightingale, Pasteur, Lister
When and who discovered the different blood types
1901 - Karl Landsteiner discovers blood type A, B, O
1902 - discovered blood type AB
What were the boundaries to advancements using knowledge about blood types?
Knew that the donor and receiver had to be of the same blood type.
- blood donor could not always be present and it wasn’t always to find a donor of the right blood group type
- blood clots in the tubes as it leaves the body, tubes were needed for the transfusion and couldn’t become blocked
needed to develop scientific knowledge on how to store blood and prevent clotting
What did Paul Ehrlich discover
1806 - became leader for his own team after working with Koch to stain microorganisms wanted to research possible treatments to disease
could a chemical kill a specific disease causing microorganism and do no other harm?
1905 - began experimenting to find a syphillis magic bullet trying various compounds of different strengths for arsenic posion
1909 - the 606 arsenic compound = magic bullet = the first chemical to cure disease
What caused Paul Ehrlich’s doscovery of the first magic bullet
CHANCE
in 1909 Dr Hata joined the team to double check their previous experiments, he discovered that the 606 arsenic compound had been wrongly rported as ineffective in 1907
the team had continued experimenting for the magic bullet without realising they had already found it
Who and when did he discover x rays?
1895 - Wilhelm Roentgen published his findings on x rays
1896 - most hospitals had an x ray maschine
Significance of x ray maschines
- show the exact position for a piece of shrapnel or bullet which meant that the surgeon spent less time searching for it in the open wound reducing the risk of infection and damaging the blood vessels
