part 3

• Problems facing surgery in the 19th century

  -pain

  -infection

  -blood loss
• Why did Nitrous oxide (laughing gas) not become very popular?

  -did not become widely used until after Davy (1800) had died.

  -Horace Wells (1844) was an American surgeon and used nitrous oxide in a public demonstration to remove a tooth. Unfortunately, the patient wasn't given enough of the gas. As a result, they made a noise during the procedure, which convinced people it didn't work.
• What did william morton experiment with?

  -Morton experimented with using ether as an anaesthetic. It worked effectively in preventing patients from feeling pain and quickly became widely used by surgeons in England. (1846)
• Who was James Simpson and what did he discover?

  James Simpson was a Scottish doctor. In 1847, he and some friends experimented with chloroform. He discovered that it was an effective general anaesthetic.
• Why did people oppose anesthetic?

  -Some people in the Church argued that pain in childbirth was sent by God, so using anaesthetics for women in labour was interfering with God's will.

  -When not used carefully, anaesthetics could be dangerous. Hannah Greener was a 15-year-old girl who died during a procedure to remove an ingrown toenail because she was given too much chloroform. (1848)

  -The British army banned the use of chloroform. Some army surgeons argued that patients being awake and in pain helped them to understand how the patient was feeling. (during the crimean war)
• How were people convinced about chloroform?

  John Snow devised a chloroform inhaler in the 1850s. Before the inhaler, chloroform had been poured onto a cloth and placed over the patient's mouth and nose. The inhaler made it possible for doctors to control the amount of chloroform a patient was given. This made the use of anaesthetics safer. The inhaler mixed chloroform with water vapour, so the patient could breathe it in.

  
  

  #In 1853, when giving birth to her eighth child, Queen Victoria used chloroform. Her doctor was John Snow and she later spoke of that 'blessed chloroform' in easing the pain of childbirth. This gave the public reassurance that chloroform was safe and effective
• What is spontaneous generation?

  Doctors were aware that germs existed in the late 17th century. However, there was not a belief that germs caused disease. People believed in spontaneous generation. This led to the belief that germs, which appeared at the site of disease or illness, were a consequence of the illness rather than the cause of the illness.
• Who was Louis Pasteur and what did he do?

  -Louis Pasteur was a French chemist. In the 1850s, he was asked by a French winemaker to investigate why their wine was going off. Pasteur used a microscope to see that there were bacteria - a type of microbe - in the wine. He believed this was what was making it go off. He successfully heated the wine to kill the bacteria. (developed germ theory in 1861)
• Who was Robert Koch and what did he do?

  Robert Koch was a German doctor. He used industrial dyes to stain bacteria. This made them easier to identify when viewed under a microscope.
• how was the chicken cholera vaccine found?

  Chamberland injected a chicken with cholera germs. It did not become ill. Pasteur told Chamberland to try again with fresh germs but the chicken still did not become ill. Pasteur realised that the old germs had caused the chicken to develop immunity to cholera. This meant that he and Chamberland had discovered a vaccine by chance.
• How did war help Pasteur and Koch?

  War

  - Franco-Prussian war made Pasteur and Koch enemies which made their governments invest in them
• Who was joseph lister and what did he do?

  -Joseph Lister was a Scottish surgeon. He read about Pasteur's work on germ theory. He experimented using a chemical, carbolic acid, to soak bandages before applying them to a wound. He found that it prevented infection and helped wounds to heal.

  -Carbolic acid spray started to be used widely in surgery. It would be sprayed from a pump at the side of the operating table. This sterilised the air and equipment being used in the surgery.

  -Carbolic acid was hugely effective. Lister reported that mortality rates in his surgery fell from 40 per cent before its use to 15 per cent afterwards he started using it. This was a huge step forward in making surgery safer.
• Why did people oppose carbolic acid?

  -Not all surgeons approved of the use of carbolic acid in surgery. Some surgeons complained that the acid irritated their eyes and hands, making it difficult to carry out delicate surgery. Instruments and equipment were soaked in the acid, making them slippery.

  -Some surgeons found the machine spraying the acid was getting in the way and making it more difficult for them to concentrate.

  -the public debate focused on chemical causes in infection and listers biological explanation was unfamiliar

  -belief in spontaneous generation
• How did Aspetic surgery develop?

  -William Halsted, asked a tyre company to make rubber gloves for him to wear during operations. Halsted came up with the idea after speaking to a nurse who had suffered from dry skin on her hands due to the use of carbolic spray. The use of gloves helped to make surgery cleaner and therefore safer.
• How was Blood loss helped during surgery?

  The final major barrier to more complex surgery was blood loss. This problem was solved in 1901 when Karl Landsteiner discovered blood groups. This meant that blood transfusions could now successfully be carried out. As a result, longer operations were made safer.
• What was the Opposition to germ theory?

  -Bastian was an English surgeon. He did not believe in Pasteur's germ theory. Bastian argued that germs came from spontaneous generation, so they appeared as a symptom of disease rather than a cause.

  -Bastian wrote several books and articles where he spoke out against germ theory.
• Who Supported germ theory?

  - John Tyndall

  -William Roberts

  - William Cheyne
• What is industrialisation?


  a movement of people from rural to urban areas due to the Industrial Revolution.
• How was outbreak of disease impacted by housing and sanitation?

  -Factory owners often built cheap houses for their workers.

  -Back-to-back terraced housing was common, with families living in a single room.

  -There was a lack of clean running water, proper sanitation and sewage systems.

  - Toilets were normally shared between several houses.

  -Water came from pumps in the street with water supplied from a river that was often heavily polluted.

  -Cracked pipes could also lead to contamination of the water with human waste from cesspits.

  -If there was an outbreak of a disease, it would spread rapidly due to overcrowding and poor sanitation.
• How did air pollution impact health?

  Huge amounts of coal were being burned to power new factories and mills in towns and cities. Air pollution caused significant damage to health, as a thick smog hung over towns and cities where people had moved to in order to live and work. It caused breathing difficulties and led to many deaths as it damaged people's lungs.
• What was Cholera?


  Cholera first arrived in England in 1831 and caused an outbreak that killed around 50,000 people. It was spread by contaminated water or food. It caused diarrhoea and vomiting, which often led to severe dehydration and death. There were further cholera epidemics in 1848, 1854 and 1866.
• What was Typhoid?


  Typhoid was also spread by contaminated food or water. It caused a high temperature and fatigue, and could also be fatal.
• chadwick report?


  -Report on the Sanitary Conditions of the Labouring Population of Great Britain in 1842.

  -public health conditions and wealth on life expectancy.

  Chadwick found that labourers who lived in northern towns and cities, such as Bolton, Liverpool and Manchester, had a life expectancy of just 15-19 years. In contrast, people living in rural northern areas, such as Rutland, and who worked in a professional trade had a life expectancy of 52 years.

  -ensure a clean water supply for everyone and invest in proper sanitation systems.
• What was the 1848 Public Health act?

  -In 1848, the government responded to Chadwick's report and passed a Public Health Act. The act set up a Central Board of Health to oversee the improvement of public health. This meant that:

  -Local authorities could set up a local board of health to oversee public health. If an area had a mortality rate higher than 23 per 1,000 people, the local authority had to set up a board.

  -The local board of health could then raise taxes to pay for clean water supplies and new sewerage systems.

  -The act was limited in that there was little funding and the local boards of health were usually not compulsory. However, it was an important first step in the government taking action to improve public health.
• Who was John Snow and what did he discover?

  -Focused on cholera cases in Soho, London.(1854)

  -Snow plotted all the places where people had died from cholera.

  -From the map, he was able to work out that they had all drunk water from the same pump on Broad Street.

  -It is believed that the drinking water was contaminated by sewage leaking into the water supply from a nearby cesspit.

  -Snow knew that none of the workers at a local brewery had been taken ill with cholera.

  -The people who worked at the brewery had been drinking beer, rather than water from the pump.

  -Snow persuaded the local council to remove the handle from the pump so it could not be used.

  -Cases of cholera in the area stopped as people were forced to go to other pumps for their water.
• What was the Significance of Snow?

  Snow's investigation proved that cholera was a waterborne disease. This was an important step forward in disproving the miasma theory.

  
  

  However, Snow could not explain that there were germs in the water that were causing the illness. Therefore, many people continued to believe that cholera was caused by miasma.

  
  

  It was not until Louis Pasteur's germ theory that there was evidence to further support Snow's work.

  This then led to further public health reforms. Action was taken to provide people across the country with a clean water supply.
• What was the The great stink?

  The summer of 1858 was warm and dry. As a result, the water level of the River Thames dropped. This meant the sewage and waste that were being dumped in the river were no longer being quickly washed away.

  
  

  The resulting smell was awful and became such a problem that the Houses of Parliament were closed. Miasma theory was still widely believed. As a result, people cleaned the walls of their homes with chloride of lime to take away the smell.
• What did Joseph Bazalgette design?

  -the government invested in the construction of a new sewerage system for London. (started 1858)

  -This was designed by Joseph Bazalgette. The new system was designed in 1858 and completed in 1875.

  -The system was built in response to the Great Stink. However, it also resulted in the end of significant cholera outbreaks in London.
• What was 1875 Public Health Act?

  -there was conclusive proof that cleaning up towns and cities would improve the health of the people who lived in them.

  - There was now clear evidence that if public health systems were improved, lives would be saved. This marked a move away from a laissez-faire attitude.

  -In 1875, Prime Minister Benjamin Disraeli's government passed a second Public Health Act. This went further than the act of 1848. It said that local authorities had to provide clean water supplies, build sewerage systems and appoint a medical officer.
• Who was Charles Booth and what did he do?

  In 1889, the social reformer Charles Booth decided to investigate the levels of poverty in London. He produced a colour-coded map that showed the divide between wealthier and poorer areas of the city.

  
  

  Booth found that 35 per cent of people lived in extreme poverty, even though many of them had full-time jobs. This number was much higher than people had previously believed. It showed that despite the reforms of public health in 1875-1876, more still needed to be done.
• How did technology help Pasteur and koch?

  Technology

  -petri dish

  -industrial dye

  -powerful microscopes
• How did chance help Pasteur and koch?


  Chance

  - Chicken cholera vaccine was discovered by chance
• What other acts were introduced in the 1870s?

  The 1875 Artisans' and Labourers' Dwellings Improvement Act brought in new standards for housing quality.

  
  

  The 1875 Sale of Food and Drugs Act tightened laws around food labelling.

  
  

  The 1876 Rivers Pollution Prevention Act aimed to clean up rivers and the water supply.
• problems with ether


  It was flammable, which meant it needed to be carefully stored. Patients often complained of a sore throat or feeling sick after a procedure when they had been given ether.
• significance of chloroform


  Chloroform replaced ether as the most widely used anaesthetic. The discovery of chloroform meant patients were still during an operation and felt no pain. This meant surgeons could start to consider more complex operations.
• pasteurs swan neck experiment

  Pasteur carried out further experiments to prove his theory. He put some broth in two swan neck flasks and boiled it, which killed any microbes that were already there. He then broke the neck off one of the flasks. The flask that was exposed to the air went bad, but the sealed flask did not. This further proved Pasteur's theory that microbes were in the air and caused disease in humans.
• what did pasteur do in 1861?

  In 1861 Pasteur published his work on germ theory. This was a hugely significant moment. It allowed further advances to take place in vaccines, surgery and antibiotics.
• what was koch the first to do?

  In 1876, he identified the germ that causes anthrax. This was the first time the bacteria responsible for a specific disease had been identified. Identifying specific bacteria was crucial in being able to develop effective treatments and vaccines.
• what happened after halsted's efforts?

  -Halsted went on to encourage aseptic surgery. The aim was to sterilise equipment and hands, so there were no germs that could cause infection during an operation. This meant there was no need for carbolic acid to be used.
• Why did people change their minds about germ theory?

  -cattle plague of 1866 (proved disease was spread by contact)

  -Tyndall lectured in support of germ theory

  -kochs work on typhoid (Tyndall lectured on this)