Changes in Medicine c1845-1945

Exam Questions (Paper 2, Part B)

• Consists of 25 marks and focuses on change over time
• Question a) Source comprehension is 3 marks - give 3 detailed examples
• Question b) Explanation of key features is 7 marks - write 2 PEE paragraphs and link them together
• Question c) Change over time is 15 marks - write 2 or more PEEL paragraphs and a conclusion with a reasoned judgement

Changes in Medicine, c1845-1945: Medical Knowledge and Understanding in the Mid-19th Century

• There was a lack of understanding of disease causes
• Surgery was dangerous
• There were poor attitudes to women in medicine, nursing and public health provision

Lack of Understanding Causes of Disease

• Before the 1800s, medicine saw little progress between 1750-1800
• The specific causes of illnesses remained unknown
• Illness was believed to be caused by miasma which is a poisonous cloud with germs
• Others believed God was punishing people

Dangers in Surgery

• 80% of surgeries resulted in death
• Common surgeries included Caesarean sections, amputations, and removal of kidney stones
• Main issues included blood loss, pain, shock, and infection
• Doctors did not perform surgeries in clean environments, reusing equipment and uncleaned clothes

Attitudes to Women and Medicine, Nursing and Public Health Provision

• Women were mostly involved as mothers or "wise women"
• Access to university was needed to become a doctor
• Women's education was uncommon and not allowed at university
• Some women - Elizabeth Blackwell, Elizabeth Garrett, Sophia Jexblake - became doctors
• Women gained equal rights to university education in 1876, so they could train as doctors
• Nurses were not respected and were often dirty or drunk (before Florence Nightingale)
• Nursing did not require training and was badly paid
• Nurses were considered drunks who caused deaths

Problems in Public Health

• Terrible conditions in towns caused the spread of disease
• The 19th-century conditions included poverty, homelessness and overcrowded dampness and overcrowding

Changes in Surgery and Understanding the Causes of Disease: Anaesthetics and Antiseptics

• Includes work of Lister and Simpson and early opposition
• Covers impact of surgery in the nineteenth century
• Addresses the battle against germs with Pasteur, Lister, Koch, Ehrlich, Fleming, Florey, and Chain
• Penicillin importance is addressed

Joseph Lister

• Lister was an antiseptic proponent
• He experimented with carbolic acid after publication of Pasteur's Germ Theory
• He found carbolic acid was an effective antiseptic in 1867
• He was a professor of Surgery at Glasgow University and belived washing hands could stop infection
• Lister was one of the most outstanding out of the 19th century surgeons

James Simpson

• Simpson was an anaesthetics inventor
• He discovered chloroform in 1847 as an effective anaesthetic
• He experimented with ether and hydrochloric acid
• Within fourteen days of discovery, Simpson completed 50 successful operations using Chloroform
• In 1852 Queen Victoria used it, then it became completely accepted

Lister and Surgery

• Lister's methods significantly improved surgery despite opposition
• In 1877 he moved to London to train surgeons
• Robert Koch discovered the bacterium causing septicaemia in 1878
• By the late 1890s Lister's antiseptic methods became aseptic surgery
• Operating theatres and hospitals were rigorously cleaned in order to ensure cleanliness
• From 1887, instruments were steam-sterilized
• Surgeons stopped operating in ordinary clothes, and instead wore surgical gowns and face masks
• Sterilized rubber gloves were used from 1894 onwards

The Battle Against Germs

• Key figures in the battle against germs include Louis Pasteur, Robert Koch, Paul Ehrlich, Alexander Fleming, Howard Florey, and Ernst Chain

Pasteur and Germ Theory

• Germs cause disease
• Micro-organisms had been seen through 18th-century microscopes but were believed to appear because of illness
• Diseases were believed to be through spontaneous generation
• People looked for noxious gases instead of blaming microbes

Louis Pasteur

• He identified germs in the air in 1857 when hired to explain the souring of sugar
• He proved germs existed by sterilizing water in flasks that didn't allow airborne particles to enter, keeping it sterile
• Open flasks, however, bred micro-organisms

Robert Koch

• Koch was a German scientist who linked diseases to causative microbes
• Koch developed solid medium to grow cultures and used dyeing techniques to view them through high-powered microscopes
• Inspired by Koch, Pasteur competed to find new microbes
• Pasteur looked for cures to anthrax and chicken cholera
• Pasteur's theory was a huge turning point, as it allowed others to identify microbes and ways to combat them

Paul Ehrlich

• Ehrlich made a breakthrough in drugs, naming naturally produced antibodies "magic bullets"
• Began looking for synthetic "magic bullets" to cure disease after trying to extract them
• He used dyes to stain microbes as part of Koch's team
• He searched for a chemical "magical bullet" to cure syphilis in 1906
• Sahachiro Hata joined and found dye 606 worked in 1909, known as Salvarsan 606
• Syphilis was first tested on a human in 1911 and faced opposition as it was difficult/painful and it was believed it would encourage promiscuity

Alexander Fleming and Penicillin

• Fleming became interested in treating infected wounds because of the ineffective antiseptics
• In 1928, he noticed mould, which he grew more of, killed germs on Petri dishes
• The mould was identified as belonging to the penicillium family
• The chemical skills for purification were unavailable
• Fleming tested on animals, tried it on a colleague's eye infection, and it didn't harm body tissue
• Fleming named his mould juice penicillin

Florey and Chain

• Florey and Chain researched germ-killing substances in 1938
• Successfully tested penicillin on a human in 1940 but the patient died and they had no supplies
• Florey got United States chemical firms to give financial help once the war broke out
• Mass production began in 1943
• By 1944, there was enough to treat all allied forces who were injured
• Methods of mass production led to reduced costs after the war was over

Importance of Penicillin

• Development and subsequent use is one of the most important breakthroughs in medical history
• Penicillin prevents germs from growing and can be used on the human body because it is organic
• The drug was quickly developed and prevented the war wounds from Allied soldiers becoming infected

Changes in Hospital Treatment and the Role of Women in Medicine: Includes Florence Nightingale and More

• Addresses improvements in nursing and Elizabeth Garrett
• Improvements in hospitals
• Influence of the two world wars is covered

Florence Nightingale and Scutari and Changes and Improvements in Nursing

• Florence Nightingale, during the Industrial Revolution, saw that poorer classes relied on informal midwives
• Work during the Crimean War was the first sign of change in nursing
• Death rate in Scutari fell from 43% to 2% because she believed disease was caused by miasma
• Her work was reported in British newspapers
• Mary Seacole played an important role but was not given much credit as she wasn't allowed to work in England as a nurse
• Nursing became a respectable profession after these developments
• Notes on Nursing was published in 1859, and a public fund was launched to raise money for a nursing school
• The Nightingale School of Nursing was set up at St Thomas' Hospital in London
• By 1900 there were 64,000 trained nurses
• Nightingale wrote over 200 books about hospital design and organisation

Impact of Nightingale

• Concentrated on hygiene and cleanliness
• Insisted on sanitation in hospitals, clean water, good drains etc
• Insisted on ventilation in hospitals - fresh clean air and food for the patients
• Nursing schools concentrated training on nurses in practical skills

Elizabeth Garrett Anderson Progress of Women in Medicine

• Inspired by Elizabeth Blackwell, the first woman in the United States to qualify as a doctor
• Garret repeatedly was turned away by medical schools
• In 1865 Set up a medical practice in London after she was accepted by the Society of Apothecaries
• In 1876 Elizabeth Garret became the first woman physician in Britain after an act of parliament

Hospitals Changed

• Nightingale helped improve in hospital buildings and sanitation using new engineering techniques and public health
• Surgery increased, requiring better trained nurses
• Lister helped change surgery and hospitals despite opposition
• Lister's carbolic spray caused surgeons discomfort

Aseptic Surgery

• Lister's antiseptic methods developed into aseptic surgery by the late 1890s
• Operating theatres and hospitals were rigorously cleaned
• Instruments were steam-sterilized from 1887
• Surgeons abandoned normal clothes and wore surgical gowns
• Sterilized rubber gloves were first used in 1894

Developments in Public Health Provision Impacts

• Covers cholera, Chadwick and Snow, Public Health Acts, and liberal measures
• Conditions in British towns worsened during the late 1700s and the first half of the 1800s
• Houses were built close together near factories which made it hard to cope with water and sewage
• The squalid conditions made easy widespread diseases

Public Health

• Some wanted the government to force local councils to clean towns, but many favored laissez-faire
• Edwin Chadwick reported on the poverty of the poor in 1842
• Chadwick concluded that poverty stemmed from ill health caused by terrible living conditions
• He recommended industrial towns organize drainage, refuse collection, provide pure water, and appoint a Medical Officer of Health
• Towns then began to build sewage and water systems

1848 Public Health Act

• The government did nothing initially about Chadwick's recommendations
• Another cholera outbreak in 1848 resulted in Parliament reluctantly passing the Public Health Act
• The government set up a Board of Health to encourage, but not to force, improvements
• Local authorities were given money if they had the support of ratepayers
• By 1872 only 50 Medical Officers of Health had been appointed, and the Board of Health was abandoned in 1854

1854 Cholera

• John Snow linked cholera and water supply using research and interviews to map the epidemic in Broad Street
• Beer was given to brewery workers and they did not have cholera
• Snow removed the handle from the Broad Street pump after collecting evidence, and there were no deaths
• It later came to light a cracked cesspool contaminated the drinking water
• Snow pressured water companies to clean their water supplies

1858 Great Stink

• Human waste made its way from latrines in London into the River Thames
• The hot weather caused a "great stink"
• Parliament sorted out London's sewage and drainage, prompting its cleanup
• Within a year Sir Joseph Bazalgette developed an extensive system of sewers

1867 act and 1875 act

• Working class men got the vote which was the first time it wasn't only the rate payers
• The new MPs were forced to improve living conditions for the poor
• The 1875 act forced provision of clean water drainage and the appointment of the medical officer

Public Health Act of 1875

• The scientific developments included louis pasteur germ theory from 1861
• New voters included the working class from 1867
• Cholera gave the ratepayers an incentive to make actions needed
• The act resulted in education, sanitation, and reduced pollution

Two World Wars

• Addressed medical progress brought about during WWI
• Addressed the importance of each wars in bringing about change

Impacts

• Surgeons had the opportunity to perform plastic surgery
• Soldiers were promised healthy slum housing when they returned
• Surgery improved of eye, ear, nose and throat
• X-rays were first discovered 20 years before the war
• Hospitals installed X-ray machines but it was the First World War which confirmed their importance
• More were manufactured to meet demand and they were installed in hospitals along the Western Front
• Harvey proved blood, which previously failed
• Blood groups were discovered in 1901
• Blood transfusions were needed in masses due the WWI
• Doctors had the blood bottled, packed in ice, which stored it for usage

Fleming penicilin

• Fleming helped find penicillin
• Chain and Florey begin research in Oxford after reading an article by Fleming, experimentation occurred
• US and britain funded penicillin production
• discovery of penicillin is a great example of a chance finding helping science
• Accidentally a fungal spore landed in 1928 which stopped the bacteria colonies

After Flemings Discovery

• Government - British government funded Florey's research, U.S. government funded mass production
• War - the growing casualties of World War Two added to the urgency to mass produce penicillin
• Blood transfusion -blood could be stored for longer, civilians donated blood
• Diet - rationing improved some people's diet, government encouraged healthy eating
• Surgery - developments in the use of skin grafts and treatment of burns
• Hygiene - government posters education people about health and hygiene

NHS introduction and info

• Sir William Beveridge published his famous Beveridge Report in 1942
• Aneurin Bevan was Minister for Health who introduced NHS
• Had to reduce funding of NHS due to dental and medical
• Governments increased the cost of the needs of elderly