Post by Mr Modica on Sept 26, 2015 20:29:46 GMT
In the early 1800s, people believed in miasma.
Surgery in the early 1800s often killed the patients. They suffered from shock as there was no painkiller, they often bled to death and there were no anaesthetics to knock people out. The biggest problem was infection as there were no medicines to stop blood poisoning, those that survived surgery often died after as the surgeons didn’t clean their instruments or wash their hands.
Public health in the 1800s was also a struggle. Because of the Industrial Revolution, lots of people had moved from the countryside into the towns. As the industrial population exploded, housing and working conditions deteriorated, with a massive impact on the health of the population. Epidemics spread, water carried disease and houses were overcrowded and damp. The government also practiced ‘laissez-faire’, the belief that they should ‘leave alone’ the health of the population because it wasn’t their responsibility (they thought their responsibility was things like the country’s economy and the army).
1677 – microscopes invented
Anthony van Leeuwenhoek developed single lens microscopes that could see ‘animalcules’ (tiny organisms). In 1830, Joseph Lister invented a microscope that could magnify 1000 times.
1796 – Jenner discovers smallpox
Smallpox was a major problem for people in the 17th and 18th century. It was very infectious and if it didn’t kill you would leave scars all over your body from blisters. Before Jenner, inoculation (adding a small amount of pus from a smallpox blister from a mild case of smallpox to an uninfected person to try to build a resistance to the disease) was used in China and Turkey. An English woman, Lady Mary Wortley Montagu had her children inoculated in Turkey during a smallpox epidemic in 1721 and they survived. She was very influential and so within ten years, the rich in England were having themselves and their children inoculated, but it was very expensive and unpredictable, if the dose was too large the person caught smallpox. Edward Jenner, a country doctor in Gloucestershire had trained with a brilliant surgeon who encouraged his students to push the boundaries. Jenner realised that if you had cowpox, as many milkmaids had, you wouldn’t get smallpox. In 1796, Jenner injected James Phipps with cowpox and then six weeks later gave him smallpox, he survived. He did his experiment 23 times before publishing it as ‘vaccination’ (after the Latin for cow) in 1798. Parliament gave him £30 000 to open a vaccination clinic and in 1852 the British government made vaccination against smallpox compulsory. Jenner couldn’t explain why his vaccination worked so it took a long time for people to be able to replicate his ideas with different diseases.
Many people didn’t like Jenner’s ideas and he was often ridiculed in newspapers. Some people didn’t understand Jenner’s evidence so didn’t trust his experiment, he couldn’t explain how a disease from a cow stopped a disease in a person so didn’t trust him. Doctors didn’t always want to start vaccinating people because they were making so much money out of inoculation. Also, doctors didn’t do the vaccinations properly, sometimes mixing up needles and sometimes using infected needles instead. When Jenner submitted his paper to the Royal Society, they rejected it and when government made it compulsory to be vaccinated, people hated it even more. People didn’t like being told what to do by doctors and some refused to have their children vaccinated.
1847 – Simpson discovers chloroform
In 1799 Sir Humphry Davy discovered laughing gas as a way of numbing pain and suggested it could have a medical use. In 1846 in America, ether was used to put patients to sleep and it became popular in England too. But, ether made people cough and vomit whilst in surgery so it was not very practical.
In 1847, James Simpson from the School of Midwifery at Edinburgh University discovered chloroform. He had been experimenting with different anaesthetics when he invited some of his colleagues to test out different chemicals. They were all knocked out after sniffing chloroform. He mostly used it when women were in labour, which people didn’t like because they believed women were supposed to suffer during childbirth. Chloroform was unpredictable and correct doses were difficult to administer, for example in 1848 Hannah Greener died after inhaling too much chloroform during an operation. Chloroform didn’t make surgery safer as with patients unconscious, doctors performed more complex operations that took infection deeper into the body. However, in 1857, Queen Victoria used chloroform during childbirth, helping it to become more widely accepted.
1854 – Florence Nightingale goes to the Crimea
Before Nightingale, hospitals had not been pleasant. Nurses in hospitals were untrained and often paid in gin and the poor who went there were not treated well, whilst the rich went to voluntary hospitals that they paid a subscription to. Nightingale’s family were rich and influential and didn’t want her to become a nurse. She believed that being a nurse was God’s plan for her and she wanted to help the poor. She had trained in Germany and been a nurse in a London hospital for rich women but when war between Britain and Russia was declared in 1854, a member of the government asked Nightingale to go out to Scutari hospital in the Crimea and sort out the appalling conditions in military hospitals. She took 38 nurses with her and took 6 months to clean the hospital. The nurses fed the patients, cleaned the bedding, hired builders to rebuild part of a ward and reduced the death rate from 40% to 2%. To pay for all the changes, she wrote to the government and friends of her family and offered to pay for the work herself. She returned to Britain after 2 years a national hero (The Lady With The Lamp) and gave an 800 page report to the government explaining the changes she could make in hospitals in Britain. In 1860, she wrote ‘Notes on Nursing’ and set up Britain’s first training school for nurses at St Thomas’ Hospital using the money raised in her name while she had been in the Crimea, making nursing a respected profession. In 1863 she wrote ‘Notes on Hospitals’ and showed them how to make wards airy and bright to stop miasma.
Mary Seacole also worked in the Crimea. She was Jamaican and went to Britain hoping to go to the Crimea with Florence Nightingale. She didn’t get an interview so paid to go out there herself. When there, she set up the British Hotel where soldiers could sleep, be given hot food and looked after. She also went onto the battlefield and treated dying soldiers. Seacole and Nightingale did not get on.
1842 – Edwin Chadwick’s report
After a series of cholera epidemics, the Poor Law Commission employed Edwin Chadwick to make a report on the conditions of the workers in towns and the people in the countryside. He questioned thousands of people before releasing ‘The Report on the Sanitary Conditions of the Labouring Population of Great Britain’. He believed that miasma was making the workers ill and spreading disease and made some recommendations, such as:
- appointing medical officers
- cleaning the water and improving removal of waste from streets
- improving housing
The government didn’t believe this was something they should be involved in and did nothing until 1848 when a new cholera epidemic hit England. They also didn’t feel they could ask local ratepayers (tax payers) to pay more money to improve the position of the poor. Under the 1848 Public Health Act, they recommended:
- setting up a Board of Health to improve living and housing conditions
- building houses with drains and toilets
They could improve their towns by borrowing money from the government, rather than making ratepayers pay for the improvements.
However, they were not compulsory and most towns chose to ignore the suggestions.
1854 – John Snow links cholera to water
In 1831, 1832, 1848 and 1854, cholera epidemics hit overcrowded towns like Liverpool and Leeds. In 1831, it killed 50 000 people. People with cholera turned black just before they died and thousands would died in days. Towns cleaned up the streets hoping that it would stop miasma spreading disease, but it didn’t work because cholera is spread by water being infected with sewage. John Snow was a doctor working in Soho, London. In the area around Broad Street, over 700 people died of cholera in a few days. Snow researched and discovered that the link between all the victims was the Broad Street water pump (which you can visit today!). One of the ways he worked this out was by a woman who died of cholera a long way from Broad Street because she was having water delivered to her from the pump every day because she preferred the taste, another was because the local brewery gave their employees free beer to drink and they all survived. Snow removed the handle from the pump and discovered that a pipe from a toilet was leaking sewage into the water supply, causing cholera. This proved that cholera was not caused by miasma, but by being in contact with people who were ill. The government still didn’t act on this information.
1858 – the Great Stink
The summer of 1858 was particularly hot. During the heat wave, the River Thames, which was full of rubbish, dead animals and chemicals from factories, smelt dreadful. The government were meeting on the banks of the Thames at the Houses of Parliament and asked to be moved because the smell was so bad. This caused the government to act on the advice they had been given by Snow and Chadwick and employed Joseph Bazalgette, an engineer, to build sewers around London. He designed pumps to push the sewage to the sea and Bazalgette was given the equivalent on £1 bn to build the sewers.
The government then went into action improving the lives of the poor in the cities by introducing:
1870 – compulsory education
1875 – Public Health Act making Chadwick’s earlier suggestions compulsory, Housing Act making it possible for the cities to take down the worst of the slum housing
1876 – food and drug regulation
This was especially important for the government as working class men had been given the vote in 1867 and the government needed to think of ways to get their support. All these caused the death rate to fall and people’s general health to slowly improve.
1861 – Germ Theory discovered
Before Pasteur, scientists had found germs inside blood from sick people. It was believed that the disease caused the germs and the theory was called ‘spontaneous generation’ because the germs appeared of their own accord when someone was ill. Pasteur, a scientist not a doctor, started to question these ideas.
In the 1850s, Pasteur developed Pasteurisation to stop alcohol turning sour. He found a micro-organism that he called a germ and discovered that if you boiled the alcohol the germs would die. He used this method with beer, milk, wine and vinegar.
To prove spontaneous generation wrong, Pasteur put identical liquid in two glass containers and boiled them to kill all the germs. He bent the spout of one of the containers so air couldn’t reach the liquid, whilst leaving the other open. He used this to prove that germs are only found in places they could reach and that the germs infected the liquid and turned it sour. He published this in 1861 as Germ Theory. In 1865, Pasteur proved that silk worms were killed by a disease caused by a germ in the air, proving that what happened in alcohol also happened in animals. Many doctors struggled to believe that something as small as a germ could harm something as big as a human so the tests stopped there until Koch came along.
1867 – Lister invents carbolic spray
Before doctors accepted Germ Theory, they didn’t worry about infection, leaving wounds open and not washing their hands or equipment. In 1847, Ignaz Semmelweiss made the link between dirty hands and infection after noticing that women whose babies were delivered by medical students who had been performing dissections were more likely to die. He told doctors to wash their hands but they didn’t believe him.
Joseph Lister was working at Glasgow Royal Infirmary and thought that germs might be making patients die after operations. He had previously worked at researching infections like gangrene. Carbolic spray had been used to treat sewage and Lister experimented with spraying carbolic spray during surgery. He used a pump spray that soaked everything in the room in antiseptic acid. This started a revolution in cleaning in hospitals. But, carbolic spray wasn’t accepted straight away. It cracked surgeons hands, was expensive and often surgeons tried to copy Lister but were not so systematic with their cleaning so the patient still got an infection and the doctors blamed it on carbolic spray not working. Lister was also not as charming as Pasteur and wouldn’t do big showy demonstrations so people didn’t find it as easy to accept his ideas.
But, after Koch discovered the germ that caused blood poisoning, aseptic surgery was accepted. From 1887 instruments were steam sterilised and from 1894, rubber gloves began to be used. This made the surgeons more daring and led to an operation to fix a stab wound to the heart in 1896.
Lister also pioneered the use of sterilised catgut as new ligatures.
1875 – Koch finds anthrax germs
Robert Koch had been intrigued by Pasteur’s work on Germ Theory and so in 1871 his wife bought him a microscope for his birthday. He used this to look at anthrax bacteria from a dead sheep. He found the bacteria, grew it, gave anthrax to a mouse and then proved that diseases could replicate in different mice by repeating the process 20 times. Koch was given a permanent job by the German government and a team of assistants to help him. They then found the bacteria that caused TB, cholera, typhoid and tetanus. Koch also developed a way of staining bacteria purple so you could easily see it.
1879 – Pasteur and chicken cholera
France and Germany were rivals during this period. France had lost the Franco-Prussian war in 1871 and Pasteur had a severe stroke, spurring Pasteur to work harder. He got money from the French government and a team of scientists and vets to deal with chicken cholera, a problem for the French farming industry. The team were struggling to make a weakened form of the disease. When Pasteur’s team went on holiday, some chicken cholera was left out. Charles Chamberland, one of Pasteur’s team, accidentally used this on his return and discovered that exposure to the air had killed the disease but injecting it into the chicken had made it immune. Pasteur named this ‘vaccination’ in Jenner’s memory.
Pasteur then moved on to making a weak form of anthrax in 1881. He did a public demonstration to show the vaccine worked. In 1882 he made a rabies vaccine that worked.
The 19th century undoubtedly saw massive improvements in medicine. However, many people couldn’t afford to see a doctor, infant mortality was still high and doctors frequently couldn’t cure their patient.
Make sure you cross reference this information with your course booklet's topic map (some information might only be applicable to OCR exam board, not ours)
Make sure this is just the basis for your revision, using your class notes too!
www.springwoodgcsehistory.blogspot.co.uk/p/medicine-through-time-overview.html
Surgery in the early 1800s often killed the patients. They suffered from shock as there was no painkiller, they often bled to death and there were no anaesthetics to knock people out. The biggest problem was infection as there were no medicines to stop blood poisoning, those that survived surgery often died after as the surgeons didn’t clean their instruments or wash their hands.
Public health in the 1800s was also a struggle. Because of the Industrial Revolution, lots of people had moved from the countryside into the towns. As the industrial population exploded, housing and working conditions deteriorated, with a massive impact on the health of the population. Epidemics spread, water carried disease and houses were overcrowded and damp. The government also practiced ‘laissez-faire’, the belief that they should ‘leave alone’ the health of the population because it wasn’t their responsibility (they thought their responsibility was things like the country’s economy and the army).
1677 – microscopes invented
Anthony van Leeuwenhoek developed single lens microscopes that could see ‘animalcules’ (tiny organisms). In 1830, Joseph Lister invented a microscope that could magnify 1000 times.
1796 – Jenner discovers smallpox
Smallpox was a major problem for people in the 17th and 18th century. It was very infectious and if it didn’t kill you would leave scars all over your body from blisters. Before Jenner, inoculation (adding a small amount of pus from a smallpox blister from a mild case of smallpox to an uninfected person to try to build a resistance to the disease) was used in China and Turkey. An English woman, Lady Mary Wortley Montagu had her children inoculated in Turkey during a smallpox epidemic in 1721 and they survived. She was very influential and so within ten years, the rich in England were having themselves and their children inoculated, but it was very expensive and unpredictable, if the dose was too large the person caught smallpox. Edward Jenner, a country doctor in Gloucestershire had trained with a brilliant surgeon who encouraged his students to push the boundaries. Jenner realised that if you had cowpox, as many milkmaids had, you wouldn’t get smallpox. In 1796, Jenner injected James Phipps with cowpox and then six weeks later gave him smallpox, he survived. He did his experiment 23 times before publishing it as ‘vaccination’ (after the Latin for cow) in 1798. Parliament gave him £30 000 to open a vaccination clinic and in 1852 the British government made vaccination against smallpox compulsory. Jenner couldn’t explain why his vaccination worked so it took a long time for people to be able to replicate his ideas with different diseases.
Many people didn’t like Jenner’s ideas and he was often ridiculed in newspapers. Some people didn’t understand Jenner’s evidence so didn’t trust his experiment, he couldn’t explain how a disease from a cow stopped a disease in a person so didn’t trust him. Doctors didn’t always want to start vaccinating people because they were making so much money out of inoculation. Also, doctors didn’t do the vaccinations properly, sometimes mixing up needles and sometimes using infected needles instead. When Jenner submitted his paper to the Royal Society, they rejected it and when government made it compulsory to be vaccinated, people hated it even more. People didn’t like being told what to do by doctors and some refused to have their children vaccinated.
1847 – Simpson discovers chloroform
In 1799 Sir Humphry Davy discovered laughing gas as a way of numbing pain and suggested it could have a medical use. In 1846 in America, ether was used to put patients to sleep and it became popular in England too. But, ether made people cough and vomit whilst in surgery so it was not very practical.
In 1847, James Simpson from the School of Midwifery at Edinburgh University discovered chloroform. He had been experimenting with different anaesthetics when he invited some of his colleagues to test out different chemicals. They were all knocked out after sniffing chloroform. He mostly used it when women were in labour, which people didn’t like because they believed women were supposed to suffer during childbirth. Chloroform was unpredictable and correct doses were difficult to administer, for example in 1848 Hannah Greener died after inhaling too much chloroform during an operation. Chloroform didn’t make surgery safer as with patients unconscious, doctors performed more complex operations that took infection deeper into the body. However, in 1857, Queen Victoria used chloroform during childbirth, helping it to become more widely accepted.
1854 – Florence Nightingale goes to the Crimea
Before Nightingale, hospitals had not been pleasant. Nurses in hospitals were untrained and often paid in gin and the poor who went there were not treated well, whilst the rich went to voluntary hospitals that they paid a subscription to. Nightingale’s family were rich and influential and didn’t want her to become a nurse. She believed that being a nurse was God’s plan for her and she wanted to help the poor. She had trained in Germany and been a nurse in a London hospital for rich women but when war between Britain and Russia was declared in 1854, a member of the government asked Nightingale to go out to Scutari hospital in the Crimea and sort out the appalling conditions in military hospitals. She took 38 nurses with her and took 6 months to clean the hospital. The nurses fed the patients, cleaned the bedding, hired builders to rebuild part of a ward and reduced the death rate from 40% to 2%. To pay for all the changes, she wrote to the government and friends of her family and offered to pay for the work herself. She returned to Britain after 2 years a national hero (The Lady With The Lamp) and gave an 800 page report to the government explaining the changes she could make in hospitals in Britain. In 1860, she wrote ‘Notes on Nursing’ and set up Britain’s first training school for nurses at St Thomas’ Hospital using the money raised in her name while she had been in the Crimea, making nursing a respected profession. In 1863 she wrote ‘Notes on Hospitals’ and showed them how to make wards airy and bright to stop miasma.
Mary Seacole also worked in the Crimea. She was Jamaican and went to Britain hoping to go to the Crimea with Florence Nightingale. She didn’t get an interview so paid to go out there herself. When there, she set up the British Hotel where soldiers could sleep, be given hot food and looked after. She also went onto the battlefield and treated dying soldiers. Seacole and Nightingale did not get on.
1842 – Edwin Chadwick’s report
After a series of cholera epidemics, the Poor Law Commission employed Edwin Chadwick to make a report on the conditions of the workers in towns and the people in the countryside. He questioned thousands of people before releasing ‘The Report on the Sanitary Conditions of the Labouring Population of Great Britain’. He believed that miasma was making the workers ill and spreading disease and made some recommendations, such as:
- appointing medical officers
- cleaning the water and improving removal of waste from streets
- improving housing
The government didn’t believe this was something they should be involved in and did nothing until 1848 when a new cholera epidemic hit England. They also didn’t feel they could ask local ratepayers (tax payers) to pay more money to improve the position of the poor. Under the 1848 Public Health Act, they recommended:
- setting up a Board of Health to improve living and housing conditions
- building houses with drains and toilets
They could improve their towns by borrowing money from the government, rather than making ratepayers pay for the improvements.
However, they were not compulsory and most towns chose to ignore the suggestions.
1854 – John Snow links cholera to water
In 1831, 1832, 1848 and 1854, cholera epidemics hit overcrowded towns like Liverpool and Leeds. In 1831, it killed 50 000 people. People with cholera turned black just before they died and thousands would died in days. Towns cleaned up the streets hoping that it would stop miasma spreading disease, but it didn’t work because cholera is spread by water being infected with sewage. John Snow was a doctor working in Soho, London. In the area around Broad Street, over 700 people died of cholera in a few days. Snow researched and discovered that the link between all the victims was the Broad Street water pump (which you can visit today!). One of the ways he worked this out was by a woman who died of cholera a long way from Broad Street because she was having water delivered to her from the pump every day because she preferred the taste, another was because the local brewery gave their employees free beer to drink and they all survived. Snow removed the handle from the pump and discovered that a pipe from a toilet was leaking sewage into the water supply, causing cholera. This proved that cholera was not caused by miasma, but by being in contact with people who were ill. The government still didn’t act on this information.
1858 – the Great Stink
The summer of 1858 was particularly hot. During the heat wave, the River Thames, which was full of rubbish, dead animals and chemicals from factories, smelt dreadful. The government were meeting on the banks of the Thames at the Houses of Parliament and asked to be moved because the smell was so bad. This caused the government to act on the advice they had been given by Snow and Chadwick and employed Joseph Bazalgette, an engineer, to build sewers around London. He designed pumps to push the sewage to the sea and Bazalgette was given the equivalent on £1 bn to build the sewers.
The government then went into action improving the lives of the poor in the cities by introducing:
1870 – compulsory education
1875 – Public Health Act making Chadwick’s earlier suggestions compulsory, Housing Act making it possible for the cities to take down the worst of the slum housing
1876 – food and drug regulation
This was especially important for the government as working class men had been given the vote in 1867 and the government needed to think of ways to get their support. All these caused the death rate to fall and people’s general health to slowly improve.
1861 – Germ Theory discovered
Before Pasteur, scientists had found germs inside blood from sick people. It was believed that the disease caused the germs and the theory was called ‘spontaneous generation’ because the germs appeared of their own accord when someone was ill. Pasteur, a scientist not a doctor, started to question these ideas.
In the 1850s, Pasteur developed Pasteurisation to stop alcohol turning sour. He found a micro-organism that he called a germ and discovered that if you boiled the alcohol the germs would die. He used this method with beer, milk, wine and vinegar.
To prove spontaneous generation wrong, Pasteur put identical liquid in two glass containers and boiled them to kill all the germs. He bent the spout of one of the containers so air couldn’t reach the liquid, whilst leaving the other open. He used this to prove that germs are only found in places they could reach and that the germs infected the liquid and turned it sour. He published this in 1861 as Germ Theory. In 1865, Pasteur proved that silk worms were killed by a disease caused by a germ in the air, proving that what happened in alcohol also happened in animals. Many doctors struggled to believe that something as small as a germ could harm something as big as a human so the tests stopped there until Koch came along.
1867 – Lister invents carbolic spray
Before doctors accepted Germ Theory, they didn’t worry about infection, leaving wounds open and not washing their hands or equipment. In 1847, Ignaz Semmelweiss made the link between dirty hands and infection after noticing that women whose babies were delivered by medical students who had been performing dissections were more likely to die. He told doctors to wash their hands but they didn’t believe him.
Joseph Lister was working at Glasgow Royal Infirmary and thought that germs might be making patients die after operations. He had previously worked at researching infections like gangrene. Carbolic spray had been used to treat sewage and Lister experimented with spraying carbolic spray during surgery. He used a pump spray that soaked everything in the room in antiseptic acid. This started a revolution in cleaning in hospitals. But, carbolic spray wasn’t accepted straight away. It cracked surgeons hands, was expensive and often surgeons tried to copy Lister but were not so systematic with their cleaning so the patient still got an infection and the doctors blamed it on carbolic spray not working. Lister was also not as charming as Pasteur and wouldn’t do big showy demonstrations so people didn’t find it as easy to accept his ideas.
But, after Koch discovered the germ that caused blood poisoning, aseptic surgery was accepted. From 1887 instruments were steam sterilised and from 1894, rubber gloves began to be used. This made the surgeons more daring and led to an operation to fix a stab wound to the heart in 1896.
Lister also pioneered the use of sterilised catgut as new ligatures.
1875 – Koch finds anthrax germs
Robert Koch had been intrigued by Pasteur’s work on Germ Theory and so in 1871 his wife bought him a microscope for his birthday. He used this to look at anthrax bacteria from a dead sheep. He found the bacteria, grew it, gave anthrax to a mouse and then proved that diseases could replicate in different mice by repeating the process 20 times. Koch was given a permanent job by the German government and a team of assistants to help him. They then found the bacteria that caused TB, cholera, typhoid and tetanus. Koch also developed a way of staining bacteria purple so you could easily see it.
1879 – Pasteur and chicken cholera
France and Germany were rivals during this period. France had lost the Franco-Prussian war in 1871 and Pasteur had a severe stroke, spurring Pasteur to work harder. He got money from the French government and a team of scientists and vets to deal with chicken cholera, a problem for the French farming industry. The team were struggling to make a weakened form of the disease. When Pasteur’s team went on holiday, some chicken cholera was left out. Charles Chamberland, one of Pasteur’s team, accidentally used this on his return and discovered that exposure to the air had killed the disease but injecting it into the chicken had made it immune. Pasteur named this ‘vaccination’ in Jenner’s memory.
Pasteur then moved on to making a weak form of anthrax in 1881. He did a public demonstration to show the vaccine worked. In 1882 he made a rabies vaccine that worked.
The 19th century undoubtedly saw massive improvements in medicine. However, many people couldn’t afford to see a doctor, infant mortality was still high and doctors frequently couldn’t cure their patient.
Make sure you cross reference this information with your course booklet's topic map (some information might only be applicable to OCR exam board, not ours)
Make sure this is just the basis for your revision, using your class notes too!
www.springwoodgcsehistory.blogspot.co.uk/p/medicine-through-time-overview.html