Changes In Medicine 1848-1948

Question 1

Lack of Understanding of Causes of Diseases

Answer 1

• in 1848, idea of 4 humours were widely accepted (yellow bile, black bile, blood, phlegm)
• limited understanding of the body, as doctors were unable to dissect humans for legal + religious reasons
• miasma theory - bad smells spread disease
• spontaneous generation - rotting material causes disease

Question 2

Florence Nightingale at Scutari

Answer 2

• born into wealthy middle class background
• went to a hospital in Scutari during the Crimean war
• implemented many sanitation measures, e.g. cleaning all surfaces, increasing bed spacing
• her actions did not reduce the death rate, the removal of the cesspit underneath the hospital did
• invented the rose diagram

Question 3

Problems in Surgery

Answer 3

• Pain - no concrete solution to prevent patient from experiencing pain during operation, caused surgeries to occur kicking and screaming, were often carried out in a rush
• Blood Loss - tourniquet would be used in order to reduce the flow of blood in an artery before amputation, surgeries would be carried out in a rush
• Infection - Despite successful surgeries, many patients would die after wards due to infection of a wound during surgery, result of poor understanding infection and hygiene.

Question 4

Impact of Simpson and Chloroform

Answer 4

• Chloroform discovered to be a useful anaesthetic by James Simpson in 1847
• used in 1847 for childbirth, used by queen Victoria for childbirth in 1853
• by using chloroform, surgeons were more confident to attempt longer and more difficult surgeries, led to black period in surgery
• John Snow invented chloroform inhaler in 1848, allowed accurate dosing of chloroform

Question 5

Work of Chadwick

Answer 5

• wrote a report stating that taxes should be used to improve housing and living conditions for the poor, instead of supporting them in a workhouse (The Sanitary Conditions of the Labouring Population, 1842)
• recommendations included providing of clean water. And removing rubbish from sewage
• his work led to the passing of the 1848 public health act
• was a difficult person, often arrogant and aggressive, found it difficult to get his ideas accepted

Question 6

1848 Public Health Act

Answer 6

• passed due to recent cholera outbreaks and work of Edwin Chadwick
• limited impact, policies were opt-in, and measures were temporary
• set up general board of health, allowed towns to set up local boards also (some took no action)

Question 7

Cholera and John Snow

Answer 7

• John Snow suggested Cholera was spread by polluted water in 1849
• conducted research to prove theory in 1854, in an outbreak in Soho, London
• worked with Reverend Henry Whitehead to determine the source of the outbreak to be the broad street pump, which was contaminated by a nearby cesspool
• brewery workers were not contaminated as they drank mostly beer

Question 8

Work of Pasteur

Answer 8

• asked to investigate why beer turned sour in 1854, suggested that microorganisms affected the beer
• disproved spontaneous generation with germ theory (1861), microorganisms spread disease, and can be killed by heat
• took many years to be widely accepted, and many more to be linked to medicine
• published germ theory’s application to medicine in 1878
• impact on surgery and infection

Question 9

Lister and Antiseptics

Answer 9

• discovered carbolic acid killed microorganisms - developed carbolic acid spray to be used in surgeries to prevent infection during surgeries
• used carbolic acid to clean equipment, wounds and bandages in all his operations, became known as antiseptics, greatly reduced death rate from infection
• carbolic acid would cause the skin of doctors hands to become cracked and sore
• Lister began implementing antiseptics in 1867

Question 10

Joseph Bazalgette

Answer 10

• work of John Snow and 1858 great stink convinced government that the London sewer system needed to be improved
• Appointed Joseph Bazalgette as chief engineer
  -very expensive (£6.5 million) however worthwhile, finished in 1875

Question 11

1875 Public Health Act

Answer 11

• made local authorities responsible for supplying clean water
• dealing with sewage in a non-polluting way
• significant because it showed changing attitudes in the government’s laissez-faire approach
• shows increased role of govt. in public health

Question 12

Nightingale - Improvement in Hospitals and Nursing

Answer 12

• regarded as an expert in nursing after returning to Britain in 1856
• published ‘Notes on Nursing’ and ‘Notes on Hospitals’ in 1859
• ideas made hospitals more hygienic, reducing infection

Question 13

Elizabeth Garrett - Progress of Women in Medicine

Answer 13

• Joined Society of Apothecaries in 1865
• Opened St. Mary’s Dispensary in London to provide medical treatment for women with the help of her father
• the dispensary was later renamed to the New hospital for women, and then the London school of medicine for women (focus shift to education), then the Elizabeth Garrett Anderson Hospital in 1918, after she died.
• Became member of the BMA (British Medical Association) in 1873
• inspired other women to become doctors, e.g. Sophia Jex-Blake, Edith Pechey, Frances Hoggan

Question 14

Koch and Bacteriology

Answer 14

• identified the microorganisms responsible for different diseases
• Anthrax 1875, Tuberculosis 1882, Cholera 1883

Question 15

Aseptic Surgery

Answer 15

• different from antiseptic (fighting infections)
• preventative surgery, operations were carried out in entirely clean operating theatres to minimise risk of infection, rather than treat it when it happened
  -surgeons wore clean clothes, gloves, masks

Question 16

1875 Public Health Act Impact

Answer 16

• providing clean water meant a lower chance of catching waterborne diseases like cholera
• factories couldn’t dump waste in rivers, made rivers cleaner
• proper sewage treatment, ensured uncontaminated water supply, reduce chance of passing diseases

Question 17

Blood Transfusions

Answer 17

• all blood types discovered in 1902, realisation that patients could die if given different blood type.
• main problem was that donor had to be present in order for the transfusion to be carried out - blood could not be stored until later
• 1916, glucose citrate discovered to increase storage time up to 4 weeks
• 1915, discovery that refrigerating blood could increase storage time

Question 18

Magic Bullet + Work of Ehrlich

Answer 18

• magic bullet - a treatment that killed the disease causing microorganisms but didn’t affect any others
• 1906 - Salvarsan 606 was created to remedy Syphilis, first chemical cure for a disease

Question 19

Radioactivity + Work of Marie Curie

Answer 19

• X-rays discovered by Willian Röntgen in 1895
• Marie Curie - conducted research on Radioactivity, didn’t patent work
• equipped First World War ambulances with X ray equipment, used her own money, drove them to the frontlines herself

Question 20

Liberal Government Reforms

Answer 20

• Liberal Government elected in 1906
• reforms include:
• 1906 free school meals, 1907, school medical service, 1908 old age pensions act, 1911 national insurance act

Question 21

First World War - Role of Women

Answer 21

• 38,000 women served as volunteers in VAD’s
• women replaced men in civilian medical roles

Question 22

First World War - Surgery and X-Rays

Answer 22

• x-rays used to locate bullets and shrapnel in a patient
• Carrel-Dakin method used to clean wounds + reduce infections (salt sterilisation)
• plastic surgery techniques developed by Harold Gillies, treated 5000+

Question 23

First World War - Fighting Infections and Blood Transfusions

Answer 23

• indirect blood transfusions implemented - storing of pre-prepared blood before a battle to reduce blood loss casualties
• Carrel-Dakin method

Question 24

Penicillin

Answer 24

• Fleming discovered the mould killed bacteria accidentally due to untidy conditions in lab, named the mould penicillin
• further research carried out by Florey and Chain on penicillin, experimented on mice
• Florey went to the US to pursue funding for large scale development of Penicillin, many American institutions worked on it
• used to treat allies soldiers from D-day
• Fleming, Florey, and Chain won the Nobel prize for their endeavors

Question 25

Second World War - Surgery

Answer 25

- Plastic Surgery - Harold Gillies travelled extensively lecturing about new techniques in surgery pre-war, led to mass implementation during WWII - Burns - Archibald McIndoe implemented saline bath treatment to help with burns after observing burns from pilots who crashed in the seas healed better compared to those who crashed on land - skin grafts - technique for replacing damaged areas of skin (unable to grow) with new skin

Question 26

Second World War- Role of Women

Answer 26

- WWII caused many more women to take on new roles; no of female medical students increased from 2000-2900 (1938-1946) - less of an impact on medical profession compared to the First World War, as fewer male doctors were called up to serve - female doctors tended to be stationed at smaller hospitals away from the front lines

Question 27

NHS - Causes

Answer 27

- Beveridge Report - key report written by William Beveridge outlining ideas for the future, identified 5 key problems known as the five great evils; want, disease, ignorance, squalor, idleness. Very popular, huge support for its proposals - increasing public demand for a universal healthcare system - inaccessible healthcare for the working class and unemployed post-war, led to above factor - Labour government 1945, implementation of welfare reforms, Clement Attlee, Aneurin Bevan

Question 28

NHS - Impact

Answer 28

- caused a national increase in life expectancy - more accessible healthcare for women and children that weren’t protected by National Insurance Act - people who originally couldn’t afford non-esessential treatment (e.g. dental treatment + spectacle prescription) had access to these for free - around 8.5 million spectacles prescribed, + 8.25 million recieving dental treatment between July 1948 - October 1949