Fighting Disease After 1800 Flashcards

1
Q

Who invented a microscope so that it magnified things by 300 times?

A

Anthony van Leeuwenhoek in the 1600s.

He found tiny living organisms in food, water and human waste. He called them ‘animacules’.

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2
Q

Who invented a microscope that could magnify things by 1000 times?

A

Joseph Lister in the 1800s.

Now scientists could study these animacules in detail.

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3
Q

What was believed to be the cause of disease in the early 1800s?

A

Fading Beliefs: supernatural explanations and the theory of the four humours.
Popular: Miasma, towns were filthiest than ever and this became the most logical explanation to disease.
Latest Theory: scientists used newly invented microscopes to study microorganisms and came up with the theory of spontaneous generation.

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4
Q

What was the theory of spontaneous generation?

A

Microorganisms are automatically created by the process of decay in , for example, meat, and then the organisms spread disease.

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5
Q

Who was Louis Pasteur (1822-1895)?

A

A french university scientist (not a doctor) that loved to demonstrate his experiments in public, especially if he could show that he was right and someone else was wrong.
He was a hugely determined man: he suffered a stroke in 1868 that left him paralysed on the left hand side of his body but kept working.

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6
Q

How did Pasteur first develop his method of pasteurisation?

A

In Lille Pasteur helped the alcohol industry and discovered that the alcohol was going sour. When Pasteur studied the liquid under his microscope he saw differently shaped microorganisms in both the fresh liquid and the sour liquid. This also occurred in wine and milk.
Pasteur suggested that by gently heating the liquids the organisms could be killed and the liquids made safe to drink.

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7
Q

What did Pasteur conclude from his work with liquids?

A

He became convinced that germs in the air were causing the liquids to go sour and cause disease, which seriously challenged the current idea of spontaneous generation.

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8
Q

What factors enabled Pasteur to develop his germ theory?

A

He had the support of the emperor of France and the government. They believed that Pasteur’s success was making France respected abroad. They paid for his research assistants and a new laboratory to carry out his experiments with specially designed equipment.

Improvements in technology made it possible to have much more precisely designed flasks.

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9
Q

What experiments did Pasteur carry out in 1864 to convince scientists that his germ theory was correct?

A
  1. Proved the air contains living microorganisms by opening briefly and resealing two sterile flasks in Paris, finding that bacteria grew in them.
  2. Proved microbes are not evenly distributed in the air by repeating experiment 1 in various places (e.g. High mountains) and found that the number of bacteria varied.
  3. Proved that microbes in the air cause decay through filling one flask with stale air and another with ordinary air. In the first there was no decay.
  4. Proved that microbes can be killed by heating through heating two broths… The flask with the curved neck remained sterile even 100 years later.
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10
Q

What was important about Pasteur’s work with silkworms in 1865?

A

He proved that the disease which was killing the silkworms was being spread by germs in the air.
This was the first time it was proved that germs were causing disease in animals.

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11
Q

What led to Pasteur investigating human diseases?

A

His young daughter’s death in 1865 and a cholera outbreak.

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12
Q

What problem did Pasteur fail to solve?

A

Which bacteria caused which particular disease.

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13
Q

Who was Robert Koch? (1843-1910)

A

A German doctor who became interested in Pasteur’s work and began to study bacteria himself.
He was just as ambitious as Pasteur and just as brilliant at detailed, painstaking work in the laboratory with a team of assistants.

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14
Q

When did Koch discover the specific bacterium that causes anthrax?

A

1876

It was the final proof of Pasteur’s germ theory.

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15
Q

How did Koch improve methods of studying bacteria?

A

He developed ways of staining bacteria so that they could be photographed using a new high quality photographic lens and studied in detail.
He also discovered how to grow bacteria on potatoes, which made them easier to study than in liquid.

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16
Q

Which of koch’s discoveries did Pasteur use when investigating chicken cholera?

A

The ability to identify specific bacteria.

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17
Q

How did Pasteur discover the science behind vaccinations?

A

In summer 1880, Pasteur left one of his research team (Charles chamberland) that was helping the farming industry to fight an epidemic of chicken cholera to inoculate a batch of chickened with the germs.
However, chamberland forgot and the laboratory closed for the summer. Chamberland did so when he returned, but the germs were old and the chickens did not die as expected. Pasteur injected the chickens with fresh germs, yet these did not kill them either.
Pasteur realised that the germs left over the summer had weakened and were not strong enough to kill the chickens but had protected them from a strong dose of chicken cholera.

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18
Q

What did Pasteur say in response to those that said his work on chicken cholera was a lucky discovery?

A

‘No! Chance only favours prepared minds.’

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19
Q

Now that Jenner knew the science behind vaccinations, what did he do?

A

He could create other vaccines. He produced a vaccine against anthrax, which he tested successfully in a public experiment and the news spread rapidly around Europe.

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20
Q

How did Koch react to Pasteur’s discovery of vaccines?

A

He was angry. He thought Pasteur had stolen some of his research on anthrax.
He decided to get ahead by becoming the first man to discover the specific germ that causes a human disease.

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21
Q

How did Koch discover the bacterium that causes tuberculosis in 1882?

A

He found a way of staining the bacterium causing the disease that made it stand our from other bacteria and human tissue. It was so small that it had been missed by other scientists.

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22
Q

What other bacteria were discovered using koch’s methods?

A
1882- typhoid
1883- cholera
1884- tetanus
1886- pneumonia
1887- meningitis
1894- plague
1898- dysentery
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23
Q

How did Pasteur test out his vaccine for rabies in 1885, which he had already tested out successfully on dogs?

A

A boy called Joseph Meister had been bitten by a rabid dog. Pasteur gave Joseph 13 injections overs a two week period. Joseph survived. Pasteur had produced the second vaccination for a human disease.

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24
Q

What other vaccinations were developed against human diseases following Pasteur’s success?

A

1896- typhoid
1906- tuberculosis
1913- diphtheria
1927- tetanus

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25
Q

How did war play a part in Pasteur and koch’s discoveries?

A

They saw each other as rivals, especially after the war between France and Germany in 1870-71, which was own by Germany. Both men wanted to be successful to glorify their countries.

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26
Q

When was penicillin originally discovered and by whom?

A

In 1872 by Joseph Lister.

He used it in 1884 to treat a nurse who had an infected wound but did not use it again.

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27
Q

What encouraged Fleming to begin finding a way of dealing with streptococci and staphylococci bacteria?

A

During ww1 he was sent to France to study soldiers’ wounds infected with these. They were not healed by chemical antiseptics and many soldiers died from them.

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28
Q

How did Fleming discover penicillin?

A

In 1928 whilst working at st. Mary’s hospital in London, Fleming went on holiday and left some Petri dishes containing bacteria on his laboratory bench. On his return he noticed mould on one dish around which no bacteria had survived.
The mould had probably been grown by another scientist in the room above Flemings, and spores had floated in through Flemings window before landing on the one place they could have an effect and be noticed.

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29
Q

To what extent did Fleming develop his discovery of penicillin?

A

He carried out experiments with the mould on living cells. He discovered that if it was diluted it killed bacteria without harming the cells. He made a list of the germs it killed and used it to treat another scientists eye infection.

However, it did not seem to work on deeper infections and in any case it was taking ages to create enough penicillin to use.
Fleming had not used penicillin on animals to heal infections so had no evidence of it being useful.

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30
Q

What was the name of the journal in which Fleming wrote about penicillin in 1929?

A

The Lancet

Nobody at the time thought this article was important.

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31
Q

How did Howard Florey and Ernst Chain come to know about penicillin?

A

In 1938 they read Flemings article in the Lancet

32
Q

How much funding did Florey and Chain initially receive?

A

£25 from the British government- a war was about to start and there was no proof that penicillin could help people.
Instead Florey asked for money from America and got enough to pay for 5 years research.

33
Q

What was the problem with using penicillin to treat humans?

A

3000 times as much was needed to treat one person compared to a mouse. Even large drug companies could not afford to find this quantity of work.
Florey and Chain began growing penicillin in whatever they could, including hospital bedpans, even though they were now in demand to make spitfires.

34
Q

Who did Florey and Chain first test penicillin on?

A

A policemen with septicaemia called Albert Alexander in 1941.
The penicillin worked and Alexander began to recover.
However, the penicillin ran out after 5 days, even though the pair were extracting unused penicillin from the mans urine and reusing it.
The policeman became ill again and died.

35
Q

What caused the USA to provide funding for penicillin in 1941?

A

They were attacked by the Japanese at pearl harbour and had entered the war. The government realised the potential of penicillin for treating soldiers and made interest-free loans to US companies to buy the expensive equipment needed.
Soon British forms were also mass producing penicillin, enough to treat the allied wounded on D-Day in 1944- over 2.3 million doses.

36
Q

Why did the English initially not mass produce penicillin during the war?

A

English factories were busy helping the war effort and couldn’t be used.

37
Q

What were the three big problems in surgery in the early 1800s?

A

Pain, infection and blood loss.

38
Q

In the early 1800s, what marked the sign of a good surgeon?

A

Speed

Speed was the only way of reducing pain, so surgeons had to operate as speedily as possible, and so many began to pride themselves on this.

39
Q

Why did anaesthetics begin to develop?

A

Because if improved knowledge if chemistry. Scientists were finding that certain chemicals could have an effect on the body.

40
Q

Who discovered that laughing gas (nitrous oxide) reduced the sensation of pain?

A

Sir Humphry Davy in 1799. He suggested that it might be used in surgical operations and by dentists.

41
Q

When was laughing gas first used as an anaesthetic?

A

In 1844 by Horace wells to perform a dental extraction.

42
Q

What were the problems associated with using laughing gas?

A
  1. It did not make patients completely unconscious.
  2. The American dentist, Horace Wells, used it in a public demonstration in 1845 and his patient was in agony. This killed confidence in its use as an anaesthetic.
43
Q

When was ether used as an anaesthetic?

A

1846- William Morton used it when removing teeth. It was also used in operations to remove tumours.
1847- J.R.Liston used ether in London to anaesthetise a patient during a leg amputation.

44
Q

What were the drawbacks of using ether as an anaesthetic?

A

It irritated the eyes and kings, causing coughing and sickness.
It could catch fire if close to a flame and had a vile, clinging smell that took ages to go away.
It came in large, heavy bottles that were difficult to carry around.

45
Q

What position did James Simpson hold?

A

Professor of Midwifery at Edinburgh University.

46
Q

How did James Simpson discover the anaesthetic effects of chloroform?

A

He had used ether but was searching for a better anaesthetic.
On one evening in 1847, he and several colleagues sat around a table experimenting with different chemicals to see their effects.
He wrote that “I poured some of the chloroform fluid into tumblers in front of my assistants and myself. Before sitting down to supper we all inhaled the fluid, and were all under the table in a minute or two.”
Simpson realised that chloroform was a very effective anaesthetic.
Within days he started using it to help women in childbirth and other operations.
He wrote articles about his discovery and other surgeons started to use it.

47
Q

Why was there opposition to the use of chloroform?

A

> It was a new and untested gas. People did not know the long term side effects not what dosage to give to patients.
Doctors began to attempt more complex operations, this carrying infection deeper into the body and causing greater blood loss. Some surgeons stopped using it in the 1870s due to the high death rate (1 in 2500 operations).
Some thought it was unnatural to ease the pain of childbirth.
Some thought that pain was an invention of God.
Some surgeons preferred to hear the pain of their patients rather than allow them to die silently.

48
Q

Why did anaesthetics eventually become commonly used?

A
  • Pain could be fatal.
  • Simpson pointed out that Paré’s use of ligatures was at first opposed but is now regarded as a vast improvement.
  • Queen Victoria used chloroform in 1853 during the birth of her 8th child and in 1857 during the birth of her 9th child. She publicly praised it.
  • Local anaesthetics were developed as well as general anaesthetics which had fewer side effects and relaxed muscles.
  • John Snow made chloroform safe to use by inventing an inhaler.
49
Q

Who administered chloroform to queen Victoria during childbirth?

A

John Snow

50
Q

Why was infection a big problem in surgery before the 19th century?

A

Before Pasteur’s germ theory, no one knew what was causing infection in open wounds.
Surgeons reused bandages, didn’t wash their hands, nor did they sterilise their equipment, and some operated wearing old pus-stained clothes.

51
Q

What issue concerned Ignaz Semmelweiss?

A

The deaths of healthy women after childbirth, which most doctors regarded as inevitable.
Semmelweiss realised that women whose babies were delivered by midwives were less likely to die from infection than those delivered by medical students. This was because these students came straight to the delivery rooms from dissecting dead bodies.

52
Q

What did Semmelweiss suggest the solution to women dying in childbirth might be?

A

If medical students simply washed their hands, they would reduce the risk of infection to women.
In 1847 he placed a notice out side the hospital maternity ward for people to wash their hands before entering the wars with chlorinated water.
Unfortunately, he had little support and no one built on his ideas.

53
Q

Who was Joseph lister?

A

One of the outstanding surgeons of the 19th century. He had researched gangrene and infection, and had a keen interest in the application of science to medicine, so knew all about Pasteur’s work on germ theory.

54
Q

Where did the idea of using carbolic acid as an antiseptic come from?

A

Sewage.

It prevented odours and destroyed the parasites that usually infest cattle feeding on the sewage covered land.

55
Q

How did Lister test his idea of using carbolic acid?

A

In treating people with compound fractures, where infection often developed in the open wound.
He applied carbolic acid to the wound and used bandages soaked in carbolic acid. He found that the wounds healed and did not develop gangrene.

56
Q

With the use of antiseptics, how did the death rate in amputations change?

A

It decreased from a 45.7% death rate in 1864-66 to a 15% eath rate in 1867-70.

57
Q

How did Lister improve his methods?

A
  1. Hand washing with carbolic before operations to avoid infections getting into wounds.
  2. A carbolic spray to kill germs in the air around the operating table.
  3. An antiseptic catgut ligature to tie up blood vessels and prevent blood loss (1869).
58
Q

Why did some oppose the use of carbolic acid?

A

> It seemed extreme to soak the entire operating theatre. It cracked surgeons skin and made everything smell, it caused extra work and made operations more expensive.
Speed was still considered essential to reduce blood loss, and antiseptic methods slowed operations down.
Less systematic surgeons did not always achieve the same results as Lister. They argued that antiseptics stopped the body’s own defence mechanisms from operating effectively.
Surgeons found it difficult to accept germ theory.
Some felt that Lister was criticising them for allowing patients to die and letting them down in the past when death was expected.
Lister was not a showman like Pasteur. He was instead cold, arrogant and aloof, and sometimes critical of other surgeons.
Lister was always changing his techniques to find a substance that wouldn’t cause as much corrosion as carbolic. People said this was simply because his techniques did not work.

59
Q

When was the use of carbolic spray abandoned?

A

1890 when it had become clear that air-borne pathogenic organisms were not a major source of wound infection in the operating theatre.

60
Q

Which Individual helped to boost listers ideas?

A

Robert Koch

After moving to London in 1877 to train young surgeons, listers ideas were soon supported when Koch discovered the bacterium which causes septicaemia.

61
Q

What 4 key steps were taken in aseptic surgery to ensure absolute cleanliness?

A
  1. Operating theatres and hospitals were rigorously cleaned.
  2. From 1887 all instruments were steam-sterilised.
  3. Surgeons abandoned operating in their ordinary clothes and wore surgical gowns and face masks.
  4. In 1889, William Halsted developed the idea of rubber gloves. These were used for the first time in 1894.
62
Q

With pain and infection no longer a problem, what types of more ambitious operations were attempted?

A

The first successful operation to remove an infected appendix came in the 1880s.
The first heart operation was carried out in 1896 when surgeons repaired a heart damaged by stab wounds.

63
Q

Who discovered X-Rays?

A

Wilhelm Rontgen in 1895.
He realised that rays of light in a covered tube were lighting up a far wall and could pass through black paper, wood and flesh.

64
Q

How did the First World War help the development of X-Rays?

A

Surgeons needed to locate bullets and shrapnel lodged deep within wounds and X-Rays helped this. Governments ordered the making of many more X-Ray machines and they were installed in all major hospitals on the western front.

65
Q

When were blood groups discovered?

A

In 1901 by Karl Landsteiner.

66
Q

What were the problems of blood transfusions?

A

The patient and the donor had to be in the same place.

When doctors tried to store blood it clotted and could not be used for transfusions.

67
Q

How was the problem of storing blood solved?

A

In WW1, there was a huge need for blood.
In 1914 Albert Hustin discovered that glucose and sodium citrate stopped blood clotting on contact with air.
Scientists discovered how to separate and store blood cells and pack them into bottles with ice for future use. This made the huge blood banks that supply blood today.

68
Q

When were the first radioactive isotopes discovered?

A

In 1896-98 by Becquerel and Pierre and Marie Curie. This was the beginning of the modern treatment of cancers.

69
Q

How has war led to developments in plastic surgery?

A

The use of skin grafts was developed further now that infection had been overcome.
During WW1, Harold Gillies treated burn victims and those suffering from severe facial wounds from bullet and shell damage. He was the first plastic surgeon to consider his patients appearance. Surgeons carried out over 11,000 operations, increasing experience and learning from one another.
Archibald McIndoe (Gillies’ assistant) alone carried out 4000 operations on burns cases in WW2 when tanks and aeroplanes exploded. He used drugs to prevent infection when treating airmen.

70
Q

What discoveries since 1900 helped to develop transplant surgery?

A

In 1903 the electrocardiograph was developed.
The first organ transplant was of a kidney in 1951.
The first lung machine was developed in 1953.
In 1967, the first heart transplant was carried out by Christian Barnard.

71
Q

What did Helmuth Wesse develop in the 1930s?

A

Anaesthetics that could be injected into the bloodstream.

72
Q

When was the first blood transfusion done using matching blood groups?

A

1907

73
Q

What modern surgical techniques have been developed?

A

Keyhole and Microsurgery- thanks to fibre optics and very fine needles.
Replacement surgery - joints can be replaced by plastic or metal ones.

74
Q

Who was Paul Ehrlich?

A

A member of Koch’s research team who wanted to investigate how to kill germs when a person was already ill.

75
Q

How did Erhlich develop the magic bullet?

A

He knew great certain chemicals could stain certain bacteria and that antitoxins only attacked the disease microbes. He tried to combine a dye with other chemicals to find a cure for syphilis. This would only target the disease microbe and not the rest of the body.
In 1909, they soon discovered when Hata joined the research team that there had been a mistake- the 606th compound that they had tested and dismissed had actually been effective. They called this Salvarsan 606.

76
Q

Who discovered the second magic bullet in the 1930s?

A

Gerhard Domagk.

It was called Prontosil and cured blood poisoning. It was made from a chemical called sulphonamide.

77
Q

What was the downside to the second magic bullet?

A

It also attacked the kidneys and liver so was not used unless someone was very ill.