Industrial revolution: hospitals, surgery, public health

Question 1

What was the role of physicians/doctors in the industrial Revolution?

Answer 1

They were eager to learn from experience, not textbooks. Many offered their services to hospitals for free so that they could practise their skills.

Question 2

What was the role of apothecaries in the Industrial Revolution?

Answer 2

Apothecaries were based in hospitals. There was still a reliance on herbal remedies, as chemical cures were not yet very successful, but apothecaries gradually lost influence as medicine became more sophisticated.

Question 3

What were hospitals like in the 18th century?

Answer 3

1) New hospitals were opened through donations from wealthy and middle class people.
2) Hospitals were becoming places of treatment and not just rest; physicians and apothecaries studied patients rationally.
3) There was a small number of untrained nurses there.
4) They were very unsanitary (the hospitals).
5) People didn’t like being treated in hospitals and would avoid it if they could.

Question 4

What caused Florence Nightingale go on to improve hospital conditions?

Answer 4

She was a nurse in a field hospital during the Crimean war, between 1853 and 1856. She was unhappy with the conditions there and so improved them, then returned to Britain to do the same.

Question 5

What changes did Florence Nightingale introduce while working in the Crimean war?

Answer 5

1. Had an organised schedule.
2. Made the hospital more sanitary.
3. Blanketed soldiers.

Question 6

Give 5 examples of hospital improvements during the 19th century.

Answer 6

Florence Nightingale was responsible for much of the improvement, for example:

1) Scrubbing brushes to remove dirt near patients.
2) Clean bedding and good meals.
3) 1860 Nightingale School for Nurses.
4) Nightingale promoted the pavilion layout to separate patients.

Question 7

What was Nightingale’s impact on hospitals?

Answer 7

1. She applied pressure to standards before the germ theory was published, sparking the beginning of aseptic conditions.
2. She professionalised nursing by creating the Nightingale School for Nurses in 1860.

Question 8

Nightingale had a positive effect on mortality rates, e.g. she reduced Crimean war military hospital deaths from __% to __%.

Answer 8

40% to 2%.

Question 9

What are anaesthetics?

Answer 9

Substances used to prevent patients from feeling pain.

Question 10

What did James Simpson discover and when?

Answer 10

James Simpson was a surgeon who discovered at a dinner party in 1847 that the chemical chloroform could knock people out for a duration of time.

Question 11

James Simpson was a surgeon who discovered the chemical chloroform in 1847. How was this important?

Answer 11

1. Before 1847, anaesthetics were limited, so surgeons had had to rely on opium, alcohol and even hypnotism as methods of calming patients.
2. Chloroform, once discovered, was used in surgery as an anaesthetic (as it knocked people out).

Question 12

What was the problem with chloroform when it was initially introduced to surgery?

Answer 12

An overdose of chloroform slowed down the heart too quickly, causing death.

John Snow discovered that young, extremely fit and scared people were most at risk of death from an overdose of chloroform.

Question 13

What did John Snow develop in 1848 and why was this invention significant?

Answer 13

The chloroform dispenser.

This meant that the dosage could be regulated, which was important as too much of it slowed down the heart too quickly, causing death.

He discovered that young, extremely fit and scared people were most at risk of death from an overdose of chloroform.

Question 14

Name an event which caused chloroform to become widely popular in Britain.

Answer 14

In 1853, Queen Victoria used it during the birth of her son.

Question 15

Why was there initially opposition to anaesthetics?

Answer 15

1. Fear of death.
2. Religious objections

Question 16

Why were people initially scared that anaesthetics would cause death?

Answer 16

​​Anaesthetics arguably made surgery more dangerous, as deeper surgeries were attempted in the same dirty conditions.

Infection and death rates increased; this was known as the “black period” of surgery.

Many people also believed patients were more likely to die if unconscious than if awake and screaming.

14y/o Hannah Greener was one of the first patients to die, having received chloroform in an operation.

Question 17

Why was there religious opposition to anaesthetics?

Answer 17

Religious people thought anaesthetics were interfering with the pain God intended people to face.

Question 18

What are antiseptics?

Answer 18

Infection-preventing chemicals used to dress wounds.

Question 19

Who was Joseph Lister and what did he discover?

Answer 19

Joseph Lister was an English surgeon who used the principles of germ theory to theorise, given that wounds are essentially rotting flesh, that there was a chemical which could clear them of germs.

He discovered in 1865 that carbolic acid worked, after using it on a patient’s broken leg.

This was the first antiseptic.

Question 20

Joseph Lister discovered that carbolic spray could clear wounds of germs; it was an antiseptic. How did he act on his discovery?

Answer 20

1) In the same year, he developed a carbolic spray pump.
2) His mortality rate during operations fell almost 50% from 1864-66.
3) He detailed 11 cases, in his medical journal “The Lancet”, where carbolic acid had been used successfully.

Question 21

Joseph Lister discovered that chloroform could clear wounds of germs; it was an antiseptic. In the same year, he developed a carbolic spray pump.

His mortality rate during operations fell __% from __-__ and __% from __-__.

He detailed __ cases, in his medical journal “__ __”, where carbolic acid had been used successfully.

Answer 21

1. 47% from 1864-66
2. 15% from 1867-70
3. 11
4. “The Lancet”

Question 22

What did William Watson Cheyne publish and when?

Answer 22

He “antiseptic surgery” in 1882, which championed the work of Lister, in the context of breakthroughs on germs made by Pasteur and Koch.

Question 23

Why was the short term impact of antiseptic surgery small?

Answer 23

1) The science of the germ theory was not yet widely understood, so not all surgeons were willing to accept germs as the cause of infection and therefore the concept of antiseptics.
2) Some surgeons argued that, since carbolic spray made their hands sore, it couldn’t be doing the patient any good.

Question 24

The short term impact of antiseptic surgery was small, but attitudes gradually changed. By when was it widely supported?

Answer 24

1882.

Question 25

Define aseptic surgery.

Answer 25

The process of keeping operating theatres clean from germs - for example, by sterilising surgical tools, and using rubber gloves/surgical gowns/face masks.

Question 26

By when were aseptic conditions in hospitals, and aseptic surgery, widespread?

Answer 26

1900.

Question 27

What state was public health in during the 18th century and beginning of the 19th century?

Answer 27

The overcrowding of urban environments meant that killer diseases like TB, diphtheria, typhoid and smallpox threatened the working classes. Water was not clean; the link with cholera was unknown.

Question 28

How did the government’s role in public health change throughout the 19th century?

Answer 28

The government became less laissez-faire over time, and became more invested in prevention than treatment.

Question 29

Give 8 examples of how public health improved in the 19th century.

Answer 29

• 1840: Inoculation made a crime, smallpox vaccinations introduced
• 1842: smallpox vaccines made compulsory
• 1871: public vaccinators appointed
• 1848: 1st national public health act
• 1842: Edwin Chadwick’s “report on the sanitary conditions of the labouring population of Great Britain”
• 1854: Snow proved cholera-water link
• 1858: Great Stink in London, Bazalgette employed to fix sewers
• 1875: 2nd national public health act

Question 30

How was Edwin Chadwick important to public health’s improvement in the 19th century?

Answer 30

His 1842 “Report on the Sanitary Conditions of the Labouring Population of Great Britain” stated that a local tax should be implemented and used to fund prevention, rather than treatment, of illness.

Question 31

How did John Snow improve public health in the 19th century?

Answer 31

In his 1848 text “On the Mode of Communication of Cholera”, he theorised that water was contaminated with the disease. In 1854, he published a spot map which linked 93 deaths from cholera in Soho to a water pump on Broad Street. Later inspections revealed that untreated sewage from a nearby cesspit was leaking into the water supply.

Question 32

What was the First National Public Health Law and when was it passed?

Answer 32

1848: gave town councils the option of providing clean water to its inhabitants.

Question 33

Why was John Snow’s work prevented from having an immediate impact?

Answer 33

Although he presented his findings to the government in 1855, the General Board of Health rejected Snow’s findings. Miasma was preferred as an explanation because accepting water to be the cause meant having to spend money on providing cleaner water. Additionally, since it was 7 years before the germ theory, science could not back up Snow’s findings.

Question 34

What finally caused the government to provide a cleaner water supply?

Answer 34

The Great Stink in London in 1858. Joseph Bazalgette was employed to improve the sewer systems.

Question 35

How was Joseph Bazalgette important to public health’s improvement in the 19th century?

Answer 35

As a result of the 1858 “Great Stink” in London (where the air stank of rotten sewage), Bazalgette, an engineer, was employed by the government to modernise the sewer system to ensure clean water supply to the city.

Question 36

What was the Second Public Health Law and when was it passed?

Answer 36

1875: forced councils to provide clean water + sewers, and remove nuisances. The Artisans Dwelling Law allowed local councils to buy slum areas in order to clear and rebuild them.