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History > Medicine Through Time > Flashcards

Medicine Through Time Flashcards

1
Q

Explanations for causes of disease in the Medieval Period?

A

Rational:
- Bad smells

Supernatural:
- God
- Position of the planets
- Witches

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2
Q

When was the medieval period?

A

1250 - 1500

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3
Q

Explanations for prevention of disease in the Medieval Period?

A

Supernatural:
- Lucky objects (can make you feel as though you’re getting better - placebo)
- Praying (doesn’t work for everything e.g. broken arm)

Rational:
- Relaxation (Sometimes the body is overworked and that’s why you’re ill)

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4
Q

Treatment of disease in the Medieval Period?

A

Supernatural:
- Praying
- Magic

Rational:
- Relaxation
- Bleeding (makes you feel lightheaded which can temporarily make you feel better)
- Herbs

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5
Q

What were Hippocrates beliefs in the causes of disease?

A

An imbalance in the Four Humours; blood, phlegm, yellow bile and black bile

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6
Q

What were Hippocrates beliefs in the prevention of disease?

A

He believed in rational preventions such as rest and a good diet (still used today because it is not false)

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7
Q

What were Hippocrates beliefs in the treatment of disease?

A

He believed the Four Humors needed to be balanced by bleeding, vomiting or purging.
Bloodletting was a treatment because the humours were unbalanced so they needed to let blood out
He also believed in rational treatments such as a good diet and rest
Bloodletting is not used today because we know the Four Humours theory to be false

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8
Q

What was Galen’s theory?

A

The Theory of Opposites - if you had a cold eat something hot etc.

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9
Q

Who cared for the sick in the medieval period?

A

Physicians
Apothecary
Barber Surgeon
Hospitals
House-wife Physician

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10
Q

What did physicians do in the medieval period?

A

They had medicals degrees.
Diagnosed people by studying urine and consulted star charts
Prescribed remedies to be mixed by the apothecary
For richer people only

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11
Q

What did the apothecary do in the medieval period?

A

Mixed remedies using herbs and spices

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12
Q

What did house-wife physicians do in the medieval period?

A

They were the local wise woman or lady of the manor
Cheap
Mixed herbal remedies
Helped with childbirth and broken bones

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13
Q

What did barber surgeons do in the medieval period?

A

They were hairdressers who would perform basic ‘operations’: amputation
They removed rotten teeth
They performed bloodletting

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14
Q

What did hospitals do in the medieval period?

A

They were run by the church
Monks and nuns cared for the patients
‘Care not cure’
Good diet, prayer and rest were treatments
People with infectious diseases were taken to leper houses

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15
Q

What was the role of religion in medicine in the medieval period?

A
  • Controlled the publishing of books and teaching in universities - they placed emphasis on Galen’s writing
  • They ran hospitals where monks and nuns would provide care so they didn’t interfere with God’s plan
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16
Q

What was the role of attitudes in society in medicine in the medieval period?

A
  • Most people were religious so supported the idea of disease being a punishment from God
  • There was little emphasis on trying to find a cure - “Galen had proved everything”
  • Few people could read or write to challenge or spread ideas
  • No experimentation to get proof - no “scientific method”
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17
Q

What was the role of key individuals in medicine in the medieval period?

A
  • Galen had written many books on medicine and anatomy, his ideas fitted with Christian ideas of the soul, so he had support of the church
  • Church had banned dissection so no-one could disprove Galen’s wrong ideas
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18
Q

When was the Black Death?

A

1348-1351

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19
Q

Causes of the Black Death?

A

Irrational/supernatural:
- Astronomical events
- Punishment from God
- Jewish people poisoning water supply
- Imbalance on the humors

Rational:
- Bad smells / air (miasma)
- Touching people

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20
Q

Treatments for the Black Death

A
  • Hugging a living thing because people though you could transfer the disease to it
  • Bursting the boils
  • Praying to God to make you better
  • Herbs
  • Bloodletting - imbalance in humours, bloodletting would let disease out
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21
Q

Preventions for the Black Death

A
  • Whipping yourself to show God you are sorry for your sins so he doesn’t give you the Black Death
  • Burning Jewish people as they believed they were spreading the disease, so they killed them
  • Quarantine as they believed you could get it from touching other people
  • Fires to keep the bad air moving
  • Smelling nice things so you can smell the bad air
  • Pray for God to not give you the plague
  • Lucky charms to protect you
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22
Q

When was the Renaissance Era?

A

1500-1700

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23
Q

Beliefs in causes of the Great Plague?

A

Same as Black Death:
- God
- Imbalance of humors
- Miasma
- Movement of planets
- Rotting waste/food, stagnant water

Different:
- Cats and dogs spread it

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24
Q

Beliefs in treatments of the Great Plague?

A
  • Praying
  • Religious charms
  • Bursting buboes
  • Traders medicine
  • Make the person hot so buboes swell, then apply live pigeons cut in half or plaster made of egg yolk, honey, herb of grace and wheat flour
  • Bleeding and purging
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25
Q

Beliefs in preventions of the Great Plague?

A

Same as Black Death:
- smelling sweet air
- public prayer and fasting
- bedding hung in fire smoke
- victims and families locked in homes
- clean streets

Different:
- soak coins in vinegar
- large crowds banned (showed government gaining control)
- animals were banned in cities

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26
Q

Changes in the time of Vesalius and Harvey

A
  • Ban on human dissection ended
  • Catholic church was being challenged by Protestants
  • Printing press was invented so books became widely read
  • Artists were very interested in what the body looked like and made excellent drawings
  • New engineering inventions like the pump made Harvey think the heart might be like a pump
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27
Q

Who was Vesalius?

A

He studied human anatomy, did human dissection and corrected over 300 mistakes with Galen’s work, published ‘The Fabric of the Human Body”

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28
Q

Who was Harvey?

A

He developed Vesalius’ dissection work to challenge Galen. Proved that veins had one-way valves and the blood passed through these, also proved that the heart was pump, published ‘On the Movement of the Heart’

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29
Q

What mistakes of Galen did Harvey and Vesalius correct?

A
  • Men don’t have fewer ribs than women (Vesalius)
  • Human jaw is in one part, not two (Vesalius)
  • Human liver doesn’t create blood (Harvey)
  • Blood isn’t used up by the body, it circulates (Harvey_
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30
Q

What were the consequences of Galen and Harvey’s findings?

A
  • More medical students inspired by them to correct their mistakes, so knowledge kept improving
  • Some people realised that if Galen and the church were wrong about anatomy, they could be wring about other medical things too
  • Ideas of observation and experiment became popular
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31
Q

Sydenham?

A

Scientific method: emphasised detailed observations and maintaining of records.
Theorised diseases could be categorised like plants and animals, so the symptoms of each disease could be treated
Categorised measles and scarlet fever as different diseases, found treatments for anaemia and Malaria. Published “Observations of Medicine’ in 1628

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32
Q

Who cared for the sick in the Renaissance period?

A

Physicians
Apothecary
Community care
Pest houses
Hospitals

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33
Q

What did the apothecary do in the renaissance period?

A

Continued to mix remedies and surgeons carried out simple operations.
There was guild system for training
Had to have a licence to practice the trade

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34
Q

What did the physician do in the renaissance period?

A

Training courses didn’t change
Learnt from books, not experience
Wider access to books

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35
Q

What did community care do in the renaissance period?

A

Most people were still cared for at home
Women played an important role
Prosecuted by London College of Physicians for practicing without a licence

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36
Q

What did pest houses do in the renaissance period?

A

Understood that disease was transmitted from person to person, but not why
Pest houses were for people suffering from the plague so they wouldn’t infect families

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37
Q

What did hospitals do in the renaissance period?

A

People received a good diet, a visit from a physician and medication
There were very few open after dissolution of monasteries
Relied on charitable donations

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38
Q

What was the role of institutions in medicine in the Renaissance period?

A
  • The Royal Society was set up in 1660 with King Charles II’s approval. Educated men met regularly to exchange ideas and report experiments, but still no real developments
  • The authority of the church declined after the Reformation and medical ideas began to move away from Galen
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39
Q

What was the role of attitudes in society in medicine in the Renaissance period?

A
  • Some were not keen to change their ideas, physicians still used the ideas of Galen because this is what people understood, but also much more of the ‘scientific method’ - challenging, questioning, experimenting for proof.
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40
Q

What was the role of science and technology in medicine in the Renaissance period?

A
  • New technology like the printing press meant multiple copies of books were produced quickly and accurately
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41
Q

What beliefs and methods did Sydenham use?

A
  • Only careful observations of diseases could lead to medical progress
  • Accepted the idea that disease cam from an imbalance in the Humors
  • Believed detailed study of the natural history of any disease would eventually show what medicine should be used
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42
Q

What new things did Sydenham do?

A
  • Rejected traditional remedies
  • Used quinine to treat malaria, iron compounds for anaemia and opium for pain relief, all things that modern doctors agree with
  • Wanted to study and classify specific diseases
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43
Q

What things did Sydenham do that weren’t new?

A
  • Believed patients symptoms should be closely observed and recorded
  • Believed in science, not superstition
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44
Q

What did Jenner do? (1796)

A
  • In 1796, he offered smallpox inoculation to some farmers, who said they didn’t need it because they’d already had cowpox
  • Jenner deliberately infected James Phipps with cowpox pus, then later injected him with smallpox and he didn’t become ill
  • He experimented on 23 others and no one became ill
  • This was the first vaccination
45
Q

What were the positives of Jenner’s discovery?

A

Jenner does experiments for proof and self-publishes research – scientific method
Gov gives Jennerian Society money, then vaccination made compulsory in 1872 – was an important step forward in the government accepting responsibility for public health
Jenner proved smallpox could be effectively prevented
Smallpox was eradicated by 1979

46
Q

What were the negatives of Jenner’s discovery?

A

Great deal of opposition – seen as unnatural
Doctors opposed as profits from inoculation were taken away
Jenner could not explain how his idea worked, there was no link for other diseases so this technique could not be developed

47
Q

What improvements to care did Florence Nightingale make?

A

1854 during the Crimean War, Nightingale along with 38 nurses made changes to the care of wounded soldiers:
Demanded 300 scrubbing brushes to get rid of dirt near patients being treated
Clean bedding and good meals were provided
These methods had a positive effect – within 6 months the death rate from infection had fallen from 42% to 2%.
Insisted on keeping records of admission, illness, treatment and discharge/death
Improved sanitation and water supply
Gave an 800 page report to the government on nursing and hospitals

However – her ideas were based on miasma.

48
Q

What was the effect of Florence Nightingale’s work on hospitals?

A

Hospitals were built out of materials which could be easily cleaned
‘Pavilion style’ hospitals – separate wards to keep infectious patients separate
Improved ventilation, more windows, larger rooms to stop spread of disease

49
Q

What was the effect of Florence Nightingale’s work on nursing?

A

Wrote Notes on Nursing in 1859 – setting out the role of a nurse and the importance of thorough training
1860 – set up Nightingale School for Nurses at St Thomas’ Hospital in London – nurses were trained on sanitary matters
Made nursing seem like a respectable occupation and a skilled job

50
Q

What did John Snow do that helped understanding about prevention of disease?

A

Snow observed the cholera epidemic of 1848-9 and concluded that it was caused by dirty drinking water.
1854 cholera broke out in Soho where Snow lived, this prompted him to investigate the 93 deaths and prove it was not caused by miasma.
Snow used a spot map to record deaths occurring around Broad Street.
This highlighted that the problem was the Broad Street water pump. He removed the handle from this and there were no more deaths.

51
Q

What were the positives of Snow’s discovery?

A

Had an immediate impact on residents of Soho
Eventually the 1875 Public Health Act was passed due to Snow (among other factors)
Presented his work to the government
First scientific evidence that miasma not true

52
Q

What were the negatives of Snow’s discovery?

A

Government eventually agreed to invest in a sewer system planned by Bazalgette – but this was not just due to Snow
Many rejected his work – some argued that cases still occurred among people who lived further away from the pump
People clung onto ideas of miasma
Steps to provide clean water were very costly and the board argued there was no scientific proof this would work

53
Q

What did Pasteur do that helped understanding of causes of disease?

A

1860 Pasteur entered a government competition to prove or disprove the theory of Spontaneous Generation.
Pasteur conducted experiments to prove that bacteria was in the air and this led to decay (and infection.) The Germ Theory 1861 proved that Spontaneous Generation was wrong since germs were in the air and not created by decaying matter.

54
Q

What were the positives of Pasteur’s discovery?

A

Led to focus on hygiene & improvements in prevention
Pasteur developed a way to isolate and weaken the bacteria causing chicken cholera (1880 he found by chance that giving chickens a dose of the weakened bacteria created immunity). This was a new vaccine.
Scientists did start to look for links between microbes and disease, i.e. Robert Koch and Joseph Lister

55
Q

What were the negatives of Pasteur’s discovery?

A

To begin with his work had no impact because it focused on decay and spoiled food, not disease
Spontaneous Generation continued to be important until 1870s
Limited impact because attitudes among doctors meant people refused to recognise the link between germs an disease this improved from 1878 when the Germ Theory of Infection was published.

56
Q

What did Koch do that helped understanding of causes of disease?

A

Pasteur had been the first scientist to identify microbes and their role in decay. Other scientists were then inspired to look for a link between germs and disease.
Koch invented chemical dyes and a solid medium for growing microbes to investigate microbes causing human disease as he found that the different dyes only stained specific microbes, helping him to study them under a microscope. In 1882 he discovered the bacteria causing tuberculosis.
He published his ideas on the methods that could be used to identify disease.

57
Q

Positives of Koch’s discovery

A

Koch continued to look for the microbes causing different disease, In 1883 he discovered cholera and proved it was spread in water supplies
Koch made it easier for future scientists to study bacteria by developing a method to grow them – using jelly in a petri dish – Made it easier to study bacteria under a microscope
Inspired other scientists, over the next 2 decades they discovered the microbes responsible for other diseases, such as, diphtheria, meningitis, tetanus.
Was now recognised that many diseases were caused by a microorganism – doctors now looked for symptoms and tried to match them to a specific microbe causing disease – led to magic bullets.

58
Q

Negatives of Koch’s discovery

A

British government did not listen to Koch’s discoveries in the short term as they clung onto the idea of miasma
Progress was slow as each individual microbe had to be isolated

59
Q

What were the causes for the 1875 Public Health Act?

A

John Snow and 1854 Cholera epidemic: Proved the link between water and cholera
1861 Germ Theory: showed how disease spread and why hygiene was important
1867 - Working class men had the right to vote: used their voice to put more pressure on the government and local councils to take action to improve their conditions
1866 Cholera outbreak and Sanitary Act: noticed that towns where improvements had already been made where least affected

60
Q

What did the 1875 Public Health Act do?

A

Provided clean water to stop diseases spread in dirty water
Disposing of sewage to prevent drinking and washing water becoming polluted
Building public toilets
Employing a public officer of health to monitor outbreaks of disease
Ensuring new houses were of better quality to stop damp and overcrowding
Public parks for exercise
Street lighting to prevent accidents
Quality of food checked to make sure it did not contain anything that could cause harm

61
Q

Positives of the 1875 Health Act

A

Government also became more involved in healthcare through compulsory vaccinations – campaigns encourage people to start vaccinating their children and then they made vaccinations compulsory

62
Q

Negatives of the 1875 Health Act

A

Despite this act, in many towns basic services such as: water, lighting and paving were still in the hands of private companies and individuals

63
Q

Nitrous oxide

A

Davy (1799) and Wells (1844)
Inhaling nitrous oxide made you less aware of pain
Wells used it when extracting teeth
Positive - makes it less painful, is the first anaesthetic
Negative - doesn’t knock you out, still aware of pain

64
Q

Ether

A

Morton, Lister (1846)
- Long lasting anaesthetic that causes sleep
- Used to remove a growth in a patients neck and when amputating legs
Positive - knocks you out, lasts a long time
Negative - made patients vomit, irritated lungs (caused coughing), highly flammable, sleep lasted for days, carried in large, heavy bottles

65
Q

Chloroform

A

Simpson (1847) and Snow (1848)
- Knocks you out, extremely effective
- Used in the birth of Queen Victoria’s 8th child
Positive - very effective
Negative - difficult to get right (Hannah Greener died), affected the heart
Snow developed an inhaler that regulated dosage and reduced death

66
Q

Cocaine

A

1884
Effective for pain relief
Could be used as local anaesthetic
Positive - effective pain relief, numbs one are, dont have to knock people out
Negative - highly addictive

67
Q

Novacaine (modern period)

A

1901
More effective than cocaine, used as general anaesthetic

68
Q

Positives of anaesthetics

A

Surgeons could take longer and do more complex operations

69
Q

Negatives of anaesthetics

A

Longer, more complex surgeries meant more risk of infection and death from blood loss

70
Q

What did Lister do?

A

Lister was interested in Pasteur’s ideas about microbes and decay/infection. In 1865 he experimented using carbolic acid to clean tools and soak bandages. His methods were successful as no patient suffered infection following their operation. As a result, Lister developed carbolic spray to kill infection in the wound. Also invented catgut stitches which could be disinfected.

71
Q

Positives of Lister’s discovery

A

Problem of infection was overcome in surgery
Lister published the results for 11 different cases where carbolic acid had been successful in The Lancet (a medical journal)
His work paved the way for antiseptic and aseptic surgery
Other surgeons began looking for different methods to prevent infection
By 1900, instruments were steam cleaned, operating theatres were scrubbed, rubber gloves and surgical gowns were introduced and surgeons used face masks.

72
Q

Negatives of Lister’s discovery

A

Carbolic acid made surgeon’s hands painful and the tools slippery so his methods were often criticised
News of Lister’s success spread more quickly than the Germ Theory meaning the science behind the new technique was not fully understood (this meant some surgeons did not believe the air was full of germs so did not use his theory)
Lister focused on encouraging his colleagues to use the spray instead of scientifically proving his theory

73
Q

What did Semmelweis do?

A

He found that making students wash their hands with a chlorinated solution between dissecting room and delivery room reduced death rate. Other doctors made fun of him and he was sacked

74
Q

What was the role of institutions in medicine in the Industrial period?

A

The government funded individuals like Jenner with their research, made his smallpox vaccination compulsory.
The government also started having a greater impact on Public Health. Public Health Act 1875 made local councils clean up their cities and provide clean water as well as arranging for a new sewer system to be built in London.
The Royal Society continued where scientists could share ideas

75
Q

What was the role of attitudes in society in medicine in the Industrial period?

A

People were more interested in finding the reasons behind diseases, however some were still reluctant to accept new ideas immediately. For example, the Germ Theory only became widely accepted from the late 1870s onwards.
Overcrowded cities and poor living conditions led to dangerous outbreaks of disease and people now believed something needed to be done to solve the problem of epidemics.

76
Q

What was the role of science and technology in medicine in the Industrial period?

A

Improved communication enabled scientists to share their work with each other to share their work and ideas. E.g. Pasteur’s work on animal disease inspired other scientists to use his methods to diagnose human diseases.
Science was now linked to national prestige – the rivalry between the French and German governments led to funding but also competition between Pasteur and Koch’s teams.
The development of the x1000 microscope meant clearer images and high magnification making it possible to spot microorganisms.
x1000 microscope, Petri dish and staining dye allowed scientists to observe bacteria.
Pasteur and Koch showed importance of teams, not just individuals, and gov funding.

77
Q

The creation of magic bullets

A
  • Pasteur and Koch identified bacteria that caused diseases and developed vaccines, but there were still no ways of treating disease
  • Ehrlich was on Koch’s research team and wanted to combine a dye and chemical that could dye and kill microbes causing disease
  • Ehrlich researched syphilis and his team researched 600+ mixtures of arsenic funded by the government
  • Hate joined Ehrlich and retested lots of mixtures, finding mixture 606 worked. He called it Salvarsan 606 and this was the first magic bullet
  • In experiments on mice in 1932 prontosil (a red dye) killed bacteria that caused blood poisoning. He tested it on his daughter and it worked
  • Electron microscopes helped discover the chemical that killed bacteria in prontosil, suphonamide which was found to kill may types of bacteria and soon there were treatments for pneumonia, scarlet fever, gonorrhoea and meningitis, but they also caused liver damage
78
Q

The development of penicillin

A

1928: At St Mary’s Hospital, Alexander Fleming discovered penicillin when it accidentally got onto one of his Petri dishes and killed bacteria there
1929: Fleming published his findings but couldn’t get funding to develop it. It was difficult to produce pure penicillin so didn’t seem practical
1939: Florey and Chain set up an Oxford University research team to carry on Fleming’s research
1940: tested it on mice, gov gave them £25
1941: did a test on a person, it was going well but they ran out of penicillin
June 1941: Florey and Chain travelled to the USA to persuade the American government to give money for research
December 1941: USA entered WWII and was now prepared to fun mass production of penicillin as it would save many lives
- US government gave $80 million to 4 drug companies to mass produce penicillin

79
Q

Modern beliefs about causes of disease

A
  • Hereditary diseases caused by genetic factors, meaning they could be passed on from parents to their children
  • Microbes did not cause all illnesses. Some babies born with conditions which developed in the womb
  • Lifestyle factors
80
Q

How did modern beliefs about causes apply to lung cancer?

A
  • Other chemicals in the air, such as radon gas, are also sometimes to blame.
  • Small number of people develop lung cancer for no reason
  • Lifestyle factors mostly to blame. i.e. 85% of cases are people who smoke or have smoked.
81
Q

Modern beliefs about treatments for disease

A
  • Most people continued to take herbal remedies or patent medicines, e.g.. Beechams
  • Most people continued to take herbal remedies or patent medicines, e.g.. Beechams
  • Antibiotics- destroy/limit the growth of bacteria in the human body e.g. Penicillin
  • Surgical treatments
  • Advanced Medical treatments
82
Q

How did modern beliefs about treatments apply to lung cancer?

A
  • Transplants- replace cancerous lungs with a transplant from a health donor
  • Radiotherapy- concentrated waves of radiation aimed at the tumour to try and shrink it
  • Chemotherapy- patients injected with different drugs to shrink the tumour before surgery or provide relief from the symptoms when surgery is not possible
  • Most likely to be treated using a range of these strategies i.e. surgery to remove the tumour then radiotherapy and chemotherapy
83
Q

Modern beliefs about preventions of disease

A

Compulsory vaccinations
1942: Diphtheria
1950: Poliomyelitis
1961: Tetanus
1968: Measles
1970: Rubella

Laws passed to provide a healthy environment e.g. the Clean Air Act
Gov/NHS Lifestyle campaigns to communicate health risks. I.e. British Heart Foundation encouraging people to protect their heart and Change 4 Life to encourage healthy eating, 5-a-day fruit and veg

84
Q

How did modern beliefs about preventions apply to lung cancer?

A

2012- cigarette products in shops were removed from display
Campaigns to advertise the dangers of smoking e.g. education to discourage young people from smoking included in schools
Ban on tobacco advertising entirely by 2005.
Increased taxation on tobacco
2007- the legal age for buying tobacco raised from 16 – 18.
2015- ban was extended to cars carrying children under 18.
2007- Government banned smoking in all workplaces and public areas.

85
Q

Use of Science and Technology for diagnosing lung cancer

A

Patients given a CT scan to create a detailed picture of inside the body.
Often injected with a dye before the scan to help the lungs show up clearly
If the scan shows cancer might be present the doctor would do one of 2 things.
1: If the cancer does not look advanced they would be given a PET-CT scan
Small amount of radioactive material injected into the body. Helps doctors to identify cancerous cells
2: Patients given a bronchoscopy
This uses a tool like an endoscope, called a bronchoscope
The bronchoscope is passed down into the patient’s lungs to collect a sample of cells for testing
After carrying out these tests the doctor determines what type of cancer the patients has and how far advanced it is, making it possible to draw up a treatment plan.

86
Q

Why was the NHS formed?

A

The National Insurance scheme only treated employed people meaning poor people were disadvantaged and women had to rely on their husbands. During the Great Depression, 3 million lost their jobs so couldn’t be treated. The gov. knew there would be many casualties from bombings, so set up the free National Emergency Medical Service. Bridge wrote a report that recommended free healthcare for all, which got good support. About got voted in and Britain promised doctors a good salary and that they could also treat privately

87
Q

Why was there opposition to the NHS?

A

Problem of nationalisation:
People reject gov. control, private doctors lost money and wanted paying patients
The cost problem:
they have to get money from taxes, which rich people dont want to pay when they can just pay for medical services, Britain suffering financially from WWII
British Medical Association:
doctors want private business freedom, some dont want to work for the gov

88
Q

When was DNA discovered?

A

1953 - allowed genetic diseases to be understood

89
Q

Negatives of the NHS

A
  • struggling for money because its so successful
  • modern tech costs more so puts NHS under pressure
  • hasn’t found the cure for some of the most common diseases
  • new viruses all the time which are difficult to prevent
  • bacteria becoming antibiotic resistant
  • long waiting lists and ambulance delays
90
Q

Positives of the NHS

A
  • life expectancy went up
  • infant mortality went down
  • does diagnosis, prevention and treatment for free for everyone
  • richer people may pay for private healthcare but also pay higher taxes
  • provides emergency healthcare for everyone for free
  • only organisation big and well funded enough to afford modern treatments, medicines and machines
91
Q

Role of institutions in modern medicine

A

NHS was created in 1948. This allowed access to free healthcare for all and the same level of service for everybody no matter how rich of poor they were
The US government agreed to fund Florey’s research for 5 years enabling him to develop methods to mass produce the drug

92
Q

Role of attitudes in society in modern medicine

A

There were no treatments for simple infections during WW1 so the need to find a solution to this became more important during WW2 – because of this the penicillin treatment was made available to the public quicker
The mood after during and after WW2 was that government could spend and take control for the benefit of everyone in society, so the NHS was demanded and accepted

93
Q

Role of science and tech in modern medicine

A

High powered electron microscopes allowed higher-powered images to be produced allowing scientists to identify DNA and examine how it is formed
Electron microscope developed in 1931 by Ernst Ruska – this produced magnified images up to 10,000,000 times
Leap in technology made diagnosing disease much more accurate
Led to better testing and trialling of new treatments before they were given to patients meaning less mistakes were made
Multiple new inventions – dialysis, ECG monitors, MRI scanner – a very long list!

94
Q

Main medical problems on the Western Front

A
  • Rifles, explosives and shrapnel
  • Wound infection
  • Head injuries
  • Gas attacks
95
Q

How were wounds from rifles, explosives and shrapnel dealt with? (WWI)

A

Discovered that of 200,000 wounded men admitted to CCS on the Western Front high explosive shells and shrapnel were responsible for 58% of wounds.
Shells could kill or injure a soldier immediately
They also scatted shrapnel (fragments of metal in the casing) which travelled at fast speeds.
Anyone who was in the way of shrapnel was likely to be wounded (about 60% of injuries were to arms and legs.
Bullets were responsible for 39% of wounds.
Machine guns could fire 450 rounds a minute. Their bullets could fracture bones or pierce organs.
Rifles could fire accurately at up to 500m but lacked the speed of machine guns.

96
Q

Wound infections on the western front

A

When men were injured by shrapnel or bullets the metal would penetrate their body, taking the fabric of the uniform with it.
Soil in the region had been farmed with fertiliser before the war and contained bacteria for tetanus and gas gangrene.
Gas Gangrene produced gas in gangrenous wounds and when wounds were exposed to the soil the presence of these bacteria made infection more likely.
Was no cure for gas gangrene.
The bacteria for gas gangrene spread through the body quickly and could kill a person within a day.
Impact of tetanus was reduced by the use of anti-tetanus injections from the end of 1914.

97
Q

Head injuries on the Western Front

A

Soldiers wore a soft cap at the start of the war as their headgear.
Brodie Helmet was trialled in 1915 to protect against head injuries.
This was a steel helmet with a strap that prevented it being thrown off the head in an explosion.
Is estimated that it reduced fatal head wounds by 80%.
The helmet was then provided to all soldiers fighting on the Western Front.

98
Q

Gas attacks on the Western Front

A

Only 6,000 British soldiers died as a result of gas attacks.
Prior to gas masks, soldiers developed their own by soaking cotton pads with urine and pressing them into their faces.
British army gave troops gas masks from 1915, and these developed over time.
Chlorine
First used by the Germans in 1915 at the Second Battle of Ypres
Led to death by suffocation.
Phosgene
First used at the end of 1915 near Ypres
Similar effects to Chlorine but was faster acting, killing an exposed person in 2 days
Mustard
First used in 1917 by the Germans
Was an odourless gas that worked within 12 hours
Caused internal and external blisters and could pass through clothing to burn the skin

99
Q

The chain of evacuation on the Western Front

A

Stretcher Bearers:
4-8 men would recover the dead and wounded during breaks from fighting. Carried basic medical supplies. There were 16 per battalion of 1,000.
Regimental Aid Post:
Close to the front (couple of hundred metres behind) and would move forward when casualties were expected. Would bandage light wounds with dressings and men would go back into action.
Field Ambulance and Dressing Station:
Mobile unit with medical officers, support staff and nurses. In tents or derelict buildings. Would receive wounded from RAP and triage them. Between _ and 1 mile behind the front.
Casualty Clearing Station:
7-12 miles from the fighting. Would be in large tents or schools and factories. Had 12 doctors with nurses. From 1917 started performing more operations than hospitals. Had beds for 50 and could deal with 1,000 casualties at a time, but usually had more.
Base Hospitals:
Civilian hospitals or large converted buildings near railways so patients could be moved quickly. In 1918 had 2,500 patients. Had operating theatres, labs and x-ray departments. Some had specialist centres i.e. Rouen for victims of gas attacks. Most sent back to England from here, but some did go to recovery wards and returned to fight.

100
Q

New techniques in the treatment of wounds and infection on the Western Front

A

Wound excision or debridement:
Cutting away of dead, damaged and infected tissue from around the site of the wound.
Needed to be done as soon as possible because infection could spread quickly.
After excision, the wound needed to be closed by stitching and any infected tissue had to be removed before the wound was stitched, the infection would spread again.
Amputation:
Neither wound excision nor the use of antiseptics succeeded in halting the spread of infection
Only way to deal with it was through the amputation of wounded limbs
By 1918 – 240,000 men had lost limbs because it was the only way to prevent the spread of infection and death
Carrel-Dakin Method:
Antiseptics, such as carbolic lotion, were inefficient when treating gas gangrene.
1917 – the Carrel-Dakin method involved using a sterilised salt solution in the wound through a tube.

101
Q

The Thomas Splint

A

In 1914-15, men with a gunshot of shrapnel wound to the leg only have 20% chance of survival because the wounds created a compound fracture (where the bone pierced the skin).
The splint in use as men were being transferred to CCS did not keep the leg rigid, so they were likely to have lost a great deal of blood and developed gas gangrene in the wound.
Robert Jones and Hugh Thomas designed a splint to stop joints from moving – the Thomas Splint.
December 1915, Jones was sent to Boulogne to instruct medical practitioners on how to use the splint.
This increased the survival rate for this type of wound from 20% to 82%.

102
Q

Mobile X-Ray units on the Western Front

A

X-rays were used to identify shell fragments and bullets in wounds which could otherwise cause infection.
Two x-rays would be taken from different angles to identify quite accurately the location of shrapnel and bullets in the body.
Problems with the use of x-rays were:
They could not detect all objects in the body. E.g. fragments of clothing.
Wounded men would have to remain still for several minutes.
Tubes used in the machines were fragile and overheated quite quickly., meaning that the machine could only be used for about one hour at a time and then had to be left to cool down.
The solution was to have 3 machines used in rotation. When a machine became too hot, it could then be replaced by another.
Base Hospitals and large CCS had static x-ray machines.
There were also 6 mobile x-ray units in the British Sector.
Setting up the mobile unit took time. A tent was attached to the back of the van with a table where stretchers could be placed. The machine was set up next to this table and linked to the engine of the van.

103
Q

Blood transfusions on the Western Front

A

Use of blood transfusions from 1915 in the British sector of the Western Front was pioneered by Robertson.
He used the indirect method, where a syringe and tube was used to transfer the donor to the patient.
Purpose of this was to stop the patient going into shock through blood loss before surgery.
Identifying blood groups and blood type O as a universal donor blood, reduced the risk of being transfused with the wrong blood
1917 – Blood transfusions were being administered in CCS
Keynes, designed a portable blood transfusion kit that was used to provide blood transfusions close to the frontline
Advances in the storage of blood:
1915 – Lewisohn discovered that by adding sodium citrate to blood, the need for donor-to-donor transfusion was removed.
Weil discovered that blood with sodium citrate could be refrigerated and stored for up to 2 days.
1916, Rous and Turner found that adding citrate glucose could store it for up to 4 weeks.
Blood Bank at Cambrai
Robertson stored 22 units of universal donor blood in glass bottles and built a carry case with ice and sawdust to store it
During the battle, he treated 20 severely wounded soldiers and 11 survived

104
Q

New methods to deal with head injuries; plastic surgery

A

This was important as head injuries that might not kill, could cause severe disfigurement.
Harold Gillies developed work into plastic surgery.
Gillies was interested in facial reconstruction – how to replace and restore parts of the face that had been destroyed.
Intricate operations and recovery that were required in plastic surgery could not be carried out in France.
Men needing plastic surgery returned to Britain.
August 1917 – key hospital providing this surgery was Queen’s Hospital in Kent.
By the end of the war, nearly 12,000 operations had been carried out.

105
Q

Positives of plastic surgery

A
  • Were able to replace and restore parts of the face that had been destroyed.
  • Just after a year after Queen’s Hospital opened, nearly 12,000 operations had been carried out.
106
Q

Negatives of plastic surgery

A

Gillies had no background in this type of surgery so had to devise new operations to deal with problems as they confronted him.

107
Q

New methods to deal with head injuries; brain surgery

A

Injuries to the brain were likely to prove fatal at the beginning of the war due to:
The issue of infection
Difficulties in moving men
Very few doctors had experience of neurosurgery before the war
Harvey Cushing developed new techniques in brain surgery. E.g. the use of a magnet to remove metal fragments from the brain.
Local anaesthetics were used when operating as the brain swelled when using general anaesthetics.
Specific CCSs became chosen as centres for brain surgery.
Patients remained at CCS for 3 weeks after brain surgery.
All head wounds were always carefully examined.
Cushing operated on 45 patients in 1917 with an operation survival rate of 71%.

108
Q

Positives of brain surgery

A
  • Improved understanding in head injuries and surgery.
  • Cushing operated with a 71% survival rate.
109
Q

Negatives of brain surgery

A

Inexperience of doctors in dealing with head wounds.

History (4 decks)

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