Industrial Medicine, c. 1800-1900

Question 1

Why was surgery such a terrifying prospect in 1800?

Answer 1

Surgeons could not control or stop pain during an operation, while some pain deadening substances such as hashish, mandrake and opium existed it was difficult to give an effective dose.

Question 2

What was wrong with using alcohol as a painkiller ?

Answer 2

It stimulated the heart and caused heavy bleeding in a wound. This meant that surgeons had to operate quickly to reduce pain and avoided complicated internal surgery!

Question 3

When, by who was Nitrous Oxide/Laughing gas discovered/used as a anaesthetic?

Answer 3

Humphrey Davy published an account in 1800 which described the effects of hysterical laughter and no pain but it WASN’T USED UNTIL 1844 when Horace Wells used it to remove teeth

Question 4

When and by who was Ether discovered and used as an anaesthetic?

Answer 4

In 1842 William Clark used Ehther for tooth extraction and in March that year Dr Crawford Long removed a neck growth using it. It was difficult to inhale and caused vomiting as well as being highly flammable.

Question 5

When and by who was chloroform discovered and used as an anaesthetic?

Answer 5

A safe and effective anaesthetic discovered by James Simpson in 1847.

Question 6

Why was there opposition to anaesthetics?

Answer 6

1) Surgeons were used to operating quickly and on a conscious patient
2) Some army surgeons during the Crimean War (1853-56) thought that soldiers should dutifully put up with the pain
3) In the early days of using chloroform, some patients died because it was not understood that patients of different sizes needed different amounts of chloroform. Hannah Greener died from an overdose in 1848 during an operation to remove her toenail.
4) There were religious objects as pain in childbirth was thought to be God’s will.

Question 7

What helped to overcome objections to anaesthetics?

Answer 7

In 1853, Queen Victoria used anaesthetics for childbirth which made it acceptable and fashionable.

Question 8

Why did anaesthetics at this point not revolutionise surgery?

Answer 8

There was still a high death rate from infections and still issues with blood loss for more complex operations.

Question 9

What was spontaneous generation and what was it replaced by?

Answer 9

The theory of spontaneous generation was that decaying matter, things that had started to rot, created microbes. Microbes could be seen under new microscopes but they were thought to all be the same. This was replaced by Louis Pasteur’s Germ Theory

Question 10

What did contagionists believe?

Answer 10

Infection was spread by contact and could be controlled by quarantine. This was challenged in 1864 by Thomas Wells who first suggested infection was non-chemical and referred to Pasteur’s discoveries.

Question 11

What did Anti-Contagionists believe?

Answer 11

Infection was caused by the environment: epidemics such as cholera could be controlled by cleaning. James Simpson and other doctors wanted hospitals relocated or rebuilt as they thought infection was in their walls or atmosphere (miasma)

Question 12

What was Louis Pasteur’s Germ Theory?

Answer 12

French chemist, Pasteur disocvered the idea that disease is spread by tiny organisms he called germs rather than infection create germs/microbes.

Question 13

What did Pasteur contribute to medicine?

Answer 13

1) Germ Theory
2) Rabies vaccination
3) Invented the process of pasteurisation to preserve liquids and stop them from spoiling.

Question 14

How does Joseph Lister link to Germ Theory?

Answer 14

Lister thought that Germ Theory might explain surgical infection after he was shown Pasteur’s work by Thomas Anderson. Anderson also recommended carbolic acid as a chemical that killed bacteria

Question 15

What was Lister’s antispetic approach to surgery?

Answer 15

1) Spray carbolic acid on the surgeon’s hands and operating area
2) Soak instruments and bandages in carbolic acid

Question 16

What case study shows Lister’s work in action?

Answer 16

In August 1865, he mended Jamie Greenlees fractured leg which would have otherwise been amputated due to infection. Instead Lister set his bones and used dressings soaked in Carbolic acid. 6 weeks later, Jamie walked out of hospital.

Question 17

What did Lister conclude from his research?

Answer 17

1867 he published the results of 11 cases of fractures and explained his methods. He publicised Pasteur’s germ theory through the antiseptic method.

Lister said that microbes in the air caused the infection, not spontaneous generation.

Question 18

What was the reaction ot Lister’s work?

Answer 18

His ideas were criticised, public health debate focused on chemical causes of infection, British surgeons offered alternative explanations and Spontaneous generation was supported by influential doctors like Dr Bastian

Question 19

Why was there opposition to antiseptic surgery?

Answer 19

Doctor’s did not accept Pasteur’s Germ Theory or the role of microbes in wounds.

Lister’s methods were not revolutionary at the time even though he claimed they were superior.

Carbolic acid dried the skin and irritated lungs and it took time to prepare his methods.

Lister changed his techniques which surgeons said was due to ineffectiveness.

Question 20

What did people think of Germ Theory?

Answer 20

Most doctors did not believe that something as small as a microscopic germ could harm something as large and advanced as a human.

Pasteur’s research related to the spoiling of liquid foods i.e. milk. It did not relate to those that might make people ill.

Dr Bastian, an influential doctor, had written articles that supported spontaneous generation and many did not want to challenge him.

Question 21

What did people change their minds about Germ Theory?

Answer 21

1) The Cattle Plague of 1866 - when vets imposed quarantines and the slaughter of cattle, the disease was halted.
2) John Tyndall, a famous physicist, argued in favour of Germ Theory and demonstrated the existence of tiny microbes in ordinary air
3) Typhoid fever was proven to be linked to specific germs in 1876 thanks to Robert Koch’s work and Tyndall lectured doctors about Koch’s work

Question 22

What was ‘Aspetic surgery’?

Answer 22

Developed by the 1890s this aimed to remove microbes before an operation began rather than killing them as it progressed.
- Surgeons had to be scriubbed, wearing gowns.
- Instruments needed to be sterilised
- Berkeley Moyniham was the first British surgeon to wear rubber gloves in the 1890s.
- Facemasks, rubber gloves, surgical gowns were used
- Old, huge public operating theatres were replaced with smaller rooms to reduce infection

Question 23

Who was Robert Koch and what did he contribute to medicine?

Answer 23

A German doctor who used germ theory to explain human diseases and the founder of microbiology (the study of bacteria). He showed specific bacteria was responsible for specific diseases by injecting and retrieving bacterium from animal experiments.

He discovered dyes to stain specific microbes and photographed them.

He identified specific microbes and bacteria for anthrax (1876), cholera (1884) and tuberculosis (1882).

Question 24

Who were Dallinger and Drysdale?

Answer 24

The conducted microscope research into the life cycle of germs in 1874

Question 25

What factors aided the struggle to develop vaccines?

Answer 25

1) War - France and Germany were rivals - France had lost the Franco-Prussian War in 1871. 2) Government and finance - Both Pasteur and Koch had a laboratory and a scientific team paid for by their governments 3) Teamwork - between 1880 and 1884, Pasteur and his team developed a vaccine for rabies; in 1885 they proved it worked on humans as well as animals 4) Individual character - Pasteur was determined despite suffering a stroke and Pasteur was was motivated by Koch's success in identifying anthrax 5) Competition - There was research rivalry over diphtheria 6) Communication - Pasteur's vaccine against anthrax was demonstrated public to an audience in 1881 and news spread by electric telegraph 7) Luck - in 1879, the accidental use of weakened chicken cholera germs gave the chickes immunity when injected with fresh strong germs. So Pasteur accidentally showed how vaccines could give immunity and prevent disease

Question 26

By 1905 what happened to the diptheria death rate and why?

Answer 26

It had halved because Lister had used the diptheria anti-toxin discovered by Behring in 1890.

Question 27

By 1880s what had happened with Germ Theory?

Answer 27

Most British doctors accepted it.

Question 28

In 1909 what did Paul Ehrlich, Koch's former assistant, develop?

Answer 28

The first 'magic bullet' or chemical cure for a disease. In this case it was Salvarsan 606 which cured syphilis. Prior treatments included injections of mercury!!

Question 29

What happened with industrialisation and public health?

Answer 29

Britain's cities had grown. By 1880 80% of the population lived in urban areas like cities and towns. The population had increased threefold from 1750 to 1850 to 18 million. By 1841 London had 1.8 million people in it.

Question 30

What were conditions in cities like?

Answer 30

1) A single factor would employ hundreds and so quickly built rows of back to back housing cropped up. 2) You could have five or more people living in one small room. Many of the worst housing situations were a single room for a family or more. 3) Few houses had toilets, most were outside and shared with other families 4) Water for drinking and cooking came from a pump fed by a local pond or river, which would also take away sewage 5) There was no rubbish collections, no street cleaners or sewers and no fresh running water

Question 31

What health problems existed in the 19th century city?

Answer 31

1) Diseases like typhoid, tuberculosis and cholera were common due to poor living conditions and overcrowding. 2) There cholera outbreaks in 1831, 1837, 1838, 1848, 1853-54, and 1865-66 3) A link between poor living conditions and the rising death rates began to be made.

Question 32

In 1831 how many people died in a cholera outbreak?

Answer 32

50,000

Question 33

What causes typhoid?

Answer 33

Contaminated water or food. Spread by poor saniation or unhygenic conditions.

Question 34

What causes Tuberculosis (TB)?

Answer 34

Germs passed in the air through sneezing or coughing, so it spread rapidly in crwonded areas. Another type of TB could also be caused by infected cows' milk.

Question 35

What causes Cholera?

Answer 35

Contaminated water or food. Cholera was a waterborne disease but people believed at the time it was spread by miasma.

Question 36

What did William Farr do?

Answer 36

He compiled medical statistics and gave greater importance to the idea that environmental factors affected health. He used life tables to show how life expectations at different ages varied based on occupation, wealth and hygiene. He concluded that overcrownding was a main factor in high mortality.

Question 37

After the cholera outbreaks in 1837-38 what did the government do?

Answer 37

They set up an inquiry into living conditions and put Edwin Chadwick in charge.

Question 38

What did Chadwick's Report (1842) say?

Answer 38

- It shocked Britain and highlighted a need for cleaner streets and water. - Chadwick said that disease was caused by bad air, damp filfth and overcrowded houses. - Medical officers should be appointed to take charge in each district. - People cannot develop clean habits until they have clean water - A healtheir workforce would work ahrder and cost the rich less - Laws should be passed to improve drainage and sewers, funded by local taxpayers.

Question 39

What was the reaction to Chadwick's Report?

Answer 39

The government did not act on his report because it believed in a 'Laissez-fair' attitude that said that it was not their job to interfere in people's lives and force them to be hygenic. MPs who rented out slum houses did not want the expense of tearing them down or rebuilding.

Question 40

What did the government believe in?

Answer 40

It believed in a 'Laissez-fair' attitude that said that it was not their job to interfere in people's lives and force them to be hygenic.

Question 41

Why did the government pass the 1848 Public Health Act?

Answer 41

The 1848 cholera epidemic killed nearly 60,000 people and pushed them to act.

Question 42

What did the 1848 Public Health Act do?

Answer 42

A centralised 'General Board of Health' was set up to improve public health in towns. Any town could set up a board of health but it was not compulsory unless then annual death rate was about 23 per 1000. The local board of health was responsible for sanitary supervision and inspection, drainage, water and gas supplies, and gave them the power to raise local taxes. By 1853, 103 towns had adopted the act. While others did nothjing. Towns such as Liverpool made massive improvement.

Question 43

What happened to the central Board of Health?

Answer 43

It closed down in 1854 because government interference was strongly resented/disliked.

Question 44

Who was Dr John Snow and what did he do?

Answer 44

The man who linked Chloera to contaminated water. In 1853, 20,000 people died and he recognised that all the victims lived near the same water pump in Broad Street, Soho in London. He removed the pump handle so that everyone used a different pump, the outbreak stopped. It was later discovered that a street toilet was leaking into the pump's water supply and he suspected that cholera was contagious and caught by infected water.

Question 45

What was the Great Stink of 1858?

Answer 45

In the summer of 1858 a heat wave caused the filthy River Thames to produce the 'Great Stink'. This alarmed politicians so much that they agreed to pay for sanitary improvements. Parliament gave engineer Joseph Bazalgette enough money to build a new sewer system for London.

Question 46

What did Bazalgette do?

Answer 46

By 1866 he had built an 83 mile swer system which removed 420 million gallons of sewage a day. Due to his forsight at the potential rise in population, he made the sewers larger than needed at the time, as a result his sewers are still the basis of London's sewage system today.

Question 47

What was the Public Health Act of 1875?

Answer 47

In 1867, the working-class man in towns got the right to vote, politicans realised that promising improved conditions would get them elected. This public health act meant that: 1) local councils had to appoint Medical Officers to be responsible for public health; 2) Councils were ordered to build sewers, supply fresh water and collect rubbish

Question 48

When was the smallpox vaccine made compulsory?

Answer 48

The government made the smallpox vaccine compulsory in 1852. This was strictly enforced from 1872.