c.1700-c.1900 Medicine

• • 18-19TH CENTURY: VACCINATION - inoculation - introduced from Turkey by Lady Mary Montagu 1718, used to prevent smallpox in 1700s (deadliest disease killing over 3,500 people in London during 1751) done by making a cut in a patient's arm and soaking it in pus taken from the swelling of somebody who already had a mild form of smallpox, gave people a mild version of smallpox so they could become immune but some people's bodies react differently and they died
• • 18-19TH CENTURY: VACCINATION - Edward Jenner 1749 - country doctor in Gloucestershire, treated milkmaid for cowpox but found when there was an outbreak of smallpox in the area they would not catch it, tested his theory in 1796 by injecting small town boy, James Phillips, with the pus from the sores of milkmaid, Sarah Nelmes, who was infected with cowpox then he injected Phillips with smallpox which he did not catch, tested his theories further and published his work in 1798, unusual for doctors to test their theories at the time 
• • 18-19TH CENTURY: VACCINATION - success of Jenner - government gave him £10,000 to set up a vaccination clinic 1802 and more money a few years later, gov made inoculation a crime in 1840, gov provided free vaccination for infants 1840, gov made vaccination compulsory in 1853, government action was surprising as a ‘laissez-faire’ attitude usually done
• 18-19TH CENTURY: VACCINATION - opposition - worried about giving themselves a disease from a cow (thought they could grow horns) and it was ‘against God’s law’ to give themselves a disease from an animal to human, jenner could not explain why it worked making people sceptical
• • 18-19TH CENTURY: ANAESTHETICS - early anaesthetics (e.g. alcohol, opium + mandrake) could make patients very ill and not reliable
• 18-19TH CENTURY: ANAESTHETICS - nitrous oxide - identified by Humphrym Davy, found it numbed pain, ignored by surgeons at the time until 1844 when dentist Horace Wells did a public demonstration in 1845, Wells picked a patient who was unaffected by nitrous oxide so nitrous oxide was ignored again
• • 18-19TH CENTURY: ANAESTHETICS - ether - discovered by American doctor Crawford Long in 1842, used in public demonstration in 1846 by american dental surgeon William Morton, irritant and explosive so risky to use
• 18TH-19TH CENTURY: ANAESTHTICS -chloroform

  A) James Simpson

  B) ether

  C) childbirth

  D) chloroform

  E) Queen Vicotria

  F) complex and longer surgeries

  G) infection

  H) experience

  
• 18-19TH CENTURY: ANTISEPTICS - chloroform solved pain in surgery but infection still cause high death rates after surgery
• 18-19TH CENTURY: ANTISEPTICS - antiseptic - methods used to kill germs that get near surgical work
• 18-19TH CENTURY: ANTISEPTICS - aseptic - methods aimed to stop any germs getting near the wound
• 18-19TH CENTURY: ANTISEPTICS - Joseph Lister - seen carbolic acid used in sewage works to stop bad smells, tried carbolic acid sprays in the early 1860s in the operating there, heard about germ theory in 1865 and released germs could be airborne and therefore get on surgical instruments and peoples hands, started using carbolic acid sprays on instrument and bandages, mad peoples eyes water and instruments slippery
• 18-19TH CENTURY: ANTISEPTICS - success Lister - reduced death rates after surgery from 50% in 1864-66 to 15% in 1867-70, no more fear of death after surgery
• 18-19TH CENTURY: CHOLERA - waste and water facilities - no understanding clean water or proper sewage systems were needed, most houses had no bathroom instead there was a shared outdoor toilet called a privy was built above a cesspit, cesspit waste collected by night men who piled it into rivers or left it for the rain to wash away, water pumps were set up and used by many houses (often contaminated by water from cesspits or rivers)
• 18-19TH CENTURY: CHOLERA - Britain in 1831, became an epidemic in 1832 killing over 21,0000 people that year, reappeared as epidemic in 1848, 1853-54, 1865-66, spread when infected sewage gets into drinking water, caused severe diarrhoea often killing people due to dehydration and minerals, didn't know what caused it so guess miasma
• 18-19TH CENTURY: CHOLERA - John Snow - London doctor discovered link between cholera + contaminated water, in 1854 when there was outbreak of cholera he interviewed people living in and around the Broadstreet area and mapped the cases of disease , published his reports in 1855 ‘On the mode of communication of cholera’, showed that all the victims used the same pump on broad street, he confided the council to remove its handle stopping the outbreak, later discovered there was a leaking cesspit near the pumps water supply, not widely accepted until Germ Theory became popular
• 18-19TH CENTURY: THE PUBLIC HEALTH ACT 1875 - Edwin Chadwick - 1842 published ‘Reports on the sanitary conditions of the labouring classes’ stating poor living standards caused poor health, lead to optional public health act of 1848 which encouraged local councils up their own board of health, was not compulsory so no large effect
• 18-19TH CENTURY: THE PUBLIC HEALTH ACT OF 1875 - change of public opinion

  A) Laissez-faire

  B) industrial workers

  C) power

  D) pressure

  E) change attitudes towards the poor

  
• 18-19TH CENTURY: PUBLIC HEALTH ACT 1875

  A) health inspectors

  B) sewage systems

  C) build public toilets

  D) clean water

  E) hygiene requirements

  F) 1876

  G) scientific evidence

  H) disease by pests

  
• 18-19TH CENTURY: CHANGES IN CARE AND TREATMENT IN HOSPITALS - hospitals early 19th century - small number of untrained doctors, on site surgeons for daily treatments, excepted the deserving poor (respectable working class) only, some infectious patients allowed in, more people in hospitals meant disease spread more quickly as no one understood germs yet
• 18-19TH CENTURY: CHANGES IN CARE AND TREATMENT IN HOSPITALS - Florence Nightingale

  A) Crimean war

  B) Barrack Hospital

  C) infection

  D) medicine or food

  E) regular handwashing

  F) sewage systems

  G) ventilation

  H) 40%-2%

  
• 18-19TH CENTURY: CHANGES IN CARE AND TREATMENT IN HOSPITALS - Mary Seacole - Jamaican business women, wanted to travel with Florence Nightingale to Crimea but many powerful figures stopped her, instead she paid for her own travel and set up ‘British Hotel’ for rest and recovery, known as Mother Seacole to soldiers
• 18-18TH CENTURY: CHANGES IN CARE AND TREATMENT IN HOSPITALS - Florence Nightingale's influence

  A) Notes on Nursing

  B) hygiene

  C) professional attitudes

  D) St Thomas'

  E) discipline

  F) 64,000

  G) compulsory

  H) 1916

  I) 1960

  J) miasma

  
• 18-19TH CENTURY: GERM THEORY - spontaneous generation - the theory that decaying matter created microbes, microbes could now be seen with microscopes, believed that microbes were the product of decay
• 18-19TH CENTURY: GERM THEORY - Louis Pasteur - french scientist, employed in 1857 to find why a company’s beetroot alcohol was turning sour, concluded germs in the air were turning it sour and they were doing the same to water and milk, looked for a way to resolve this and discovered the gentle heating of a liquid could stop this (now called Pasteurisation),
• 18-19TH CENTURY: GERM THEORY - Louis Pasteur - proved spontaneous generation wrong by using two glass containers with liquid in each and boiled them both -> then he heated the spout of one of the containers and bent it into a curve once it had melted -> he did this to stop the movement of air into the bottle and claimed this would stop the liquid in that bottle going sour -> compared to the container with the straight spout which allowed germs in the air in very easily turning the liquid sour very quickly, he was correct
• 18-19TH CENTURY: GERM THEORY - Louis Pasteur - proved germs did not come on their own, they are only found in places they can reach, infecting things and turning them bad, disproving spontaneous generation
• 18-19TH CENTURY: GERM THEORY - Louis Pasteur - research was supported by the French government as they believed he was helping France become more respected in the medicine world, they helped fund his research
• 18-19TH CENTURY: GERM THEORY - Louis Pasteur - after his work in the beetroot alcohol company he was employed by the French silk industry to find out what disease was killing the silk worms, he found it was a disease called pebrine spread by germs in the air, proving germs caused disease in animals
• 18-19TH CENTURY: GERM THEORY - Louis Pasteur - published his work in 1861 in ‘Germ Theory’ where he said microbes in the air caused decay and published ‘germ theory of infection’ in 1878
• 18-19TH CENTURY: GERM THEORY - Louis Pasteur - theories first met with scepticism as people didn't think tiny germs could damage humans
• 18-19TH CENTURY: GERM THEORY - Louis Pasteur - later gained popularity in Britain, inspired Joseph Lister’s development of antiseptics, proved John Snow’s cholera findings, linked disease with poor living conditions putting pressure on the government topass the public health act of 1875
• 18-19TH CENTURY: GERM THEORY - Louis Pasteur - discovered the cause of illness and disease so now cures and treatments were easier to find
• 18-19TH CENTURY: GERM THEORY - Robert Koch - german doctor, identified certain disease causing germs by growing them in a petri dish of agar jelly and then using a dye so that the bacteria could be seen on a microscopes, then able to identify individual bacteria linked to individual diseases
• 18-19TH CENTURY: GERM THEORY - Robert Koch - found bacteria which caused anthrax (1876), tuberculosis (1882) and cholera (1883)
• 18-19TH CENTURY: GERM THEORY - Robert Koch - created a new method for bacteria to be seen under a microscope so more people could go on over the next 200 years and identify the bacteria responsible for: diphtheria, pneumonia, meningitis, tetanus and the plague
• 18-19TH CENTURY: GERM THEORY - Robert Koch - his discoveries meant more people were accepting of Germ Theory and led Pasteur to later on develop vaccines