Medicine 3
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| Which *old idea* about the *cause* of illness finally *faded* away in the *18th Century*? (By 1800) | During the 18th Century the *Four Humours* was finally *discarded* as a theory, so imbalance of the humours was no longer seen as a *cause* of illness |
| Which other *old idea* about the cause of illness mostly *faded* away by the end of the 18th century? | People still believed in *miasma* to some extent, but this was becoming *less popular* by the end of the 18th century |
| Which *new idea* developed about the cause of illness in the 18th century? | The theory of *spontaneous generation* developed in the early *18th century* |
| What was the theory of *spontaneous generation*? | When they saw something like *rotten food* they assumed that the *mould and decay* were spontaneously generated from *within* the decaying matter itself. |
| How did the theory of spontaneous generation *hold back* understanding of the real causes of diseases? | Because the theory was *wrong* - the decay that they were seeing was caused by microbes and bacteria *in the air*, but this would not be discovered until the *19th century* |
| Why were scientists able to make important discoveries about *germs* in the 19th century? | By the middle of the 19th century, *microscopes* were even more *powerful*, so it was possible to see tiny *micro organisms* in much more detail |
| Who was *Louis Pasteur*? | Louis Pasteur was a *French scientist* - he worked in France in the second half of the 19th century. He is famous for developing *germ theory* |
| How did Louis Pasteur use more powerful *microscopes* to develop his *germ theory*? | In *1860* Pasteur was asked by the *French government* to investigate why *wine* was going bad. He used a powerful *microscope* to observe *microbes* in the wine and he proved that these made the wine *go off* |
| How did Pasteur prove that *microbes* were transmitted *through the air*? | Pasteur *sterilised* the liquid and showed that it could be *kept fresh* so long as it was not exposed to the *air* |
| Why was Pasteur's discovery about germs *so important*? | This *proved* that microbes did *not* grow from within the liquid, so *spontaneous generation must be wrong*. |
| Why was Pasteur's *immediate* impact on medicine quite *limited* at first? | Pasteur suspected that the germs which made the wine go off *might* also be the *cause of illness*, but he could not *prove* this, and he did not publish his ideas until *1878* |
| Why did many scientists continue to believe in *spontaneous generation*, even after Pasteur published his *germ theory*? | Most *English* Doctors and scientists continued to believe in spontaneous generation until the *1870s*. This was mainly because *Dr Henry Bastian,* one of the most powerful doctors in England, *refused* to accept Pasteur's theory. |
| Who was *Robert Koch*? | Robert Koch was a *German scientist* |
| Why was Robert Koch *important*? | Robert Koch was the first scientist to prove that *different germs* caused many common diseases. In *1882* he discovered the specific bacteria which caused *tuberculosis* |
| Describe Robert Koch's *methods* | He showed it was possible to *grow* specific types of bacteria in a *culture dish* outside the body, and then *reproduce* it in test *animals*. |
| How did Robert Koch use *dies* in his work? | He developed a way to *stain* different bacteria using coloured *dies*. This made it easier to *single out and study* each type of bacteria |
| What important discoveries did Robert Koch make in *1882 and 1883*? | In *1882* he discovered the bacteria that caused *tuberculosis*. In *1883* he discovered the *cholera* microbe, and a year later he proved that it was *spread in water.* (This confirmed the earlier work of *John Snow*) |
| Why was *Koch's* work so important for the *future* development of medicine? | Koch's discoveries made it easier for future scientists to *study bacteria* by developing a new method for growing them in a *petri dish*. This made it easier to study them under a *microscope* |
| What was the *main improvement* in terms of understanding the *cause* of disease by *1900*? | By 1900 the mystery about what *caused* illness and disease had been *solved*, and Doctors were able to work with *accurate scientific knowledge* about what caused illness. |
| Why did these improvements *not* completely revolutionise medicine by 1900 | These discoveries explained what *caused* disease, but this did not mean that they were able to develop better and more effective *treatments* |
| Who was *Edward Jenner*? | *Edward Jenner* was a doctor in the late 18th century. He had studied the use of *inoculations* |
| What is Jenner *famous* for? | Jenner is famous for developing a *vaccine* against *smallpox* |
| How *serious* was the disease of smallpox | There were *regular epidemics* of smallpox, and the worst one, in *1796*, killed *3548* people in London |
| What was an *inoculation* | *Inoculation *was where a *weak version* of a disease was given to a patient, for instance by grinding up a *smallpox scab* and blowing the dust up their nose. |
| How did inoculation *work*? | Inoculation gave the patient a *weak version* of a disease like smallpox. This made their body develop *immunity* to the disease, so they could not catch it *in the future* |
| How *successful* was inoculation? | Inoculation often worked, but the patient did actually have to *catch* smallpox. This was very *unpleasant*, and some *died*. |
| How did *Jenner* make the discovery which led to the invention of *vaccination*? | In his work as a GP, Jenner observed that *milk maids* often caught a disease called *cowpox*, which was not deadly, but they hardly ever caught *smallpox*. He decided to *test* this theory |
| How did Jenner *test* his theory about *cowpox*? | He tested his theory in *1896* by infecting a boy with *cowpox*, and then a few weeks later tried to infect him with *smallpox*, but he did *not* catch it. He wrote and published a detailed study of this method, which he called *'vaccination'* |
| Give one reason why many people were *reluctant* to use Jenner's vaccination method | People who made money from *inoculations* tried to *discredit* him because they feared being *put out of business* |
| Give a *second reason* why Jenner's vaccination method was *slow to catch on* | Many people were *nervous* about being given an *animal disease*, so it was slow to catch on in Britain. It also did not help that Jenner could not really explain *why* his method worked, he just knew that it did |
| Why did vaccination against smallpox *eventually* become *popular* in England? | Following a *smallpox epidemic* in 1837-40, the British government *banned inoculation* and in *1852* they made smallpox vaccination *compulsory*. However, this was not strictly *enforced* until *1872*. |
| How *widespread* was the use of vaccination in Britain by *1900*? | By *1900* it was *normal* for people in Britain to be vaccinated against smallpox and the number of smallpox cases *dropped dramatically* after compulsory vaccination began in *1872* |
| How *important* was Jenner's discovery of a vaccination for smallpox? | Jenner's work was eventually very effective against smallpox, but it was a *one-off*. No *human vaccinations* were found for any *other* diseases until the very *end of the 19th century*. (In 1896 vaccinations against *tetanus* and *diptheria* were developed) |
| How did *Pasteur* try to develop Jenner's work on *vaccinations*? | In 1879 Pasteur created a vaccine for *cholera in chickens*, and later for *anthrax in animals*. However, he was not able to explain *how* this worked |
| What was the *attitude* of the *British government* to *public health and prevention* in *1700*? | In 1700 the British government did *not* accept that it had the *responsibility* to *interfere* too much in the lives of the people, so they did not see that it was their job to deal with the problems which caused *illness* |
| Why did the British government *have* to become *more involved* in public health and prevention *by 1800*? | By 1800, many more people had the right to *vote*, so the government could not so easily *ignore* the problems that people faced |
| Who was *Edwin Chadwick*? | Edwin Chadwick was a lawyer, but he also published *studies* into *health and social problems* in towns and cities |
| What did Edwin Chadwick's studies *prove*? | He *proved* that people in *large cities* had *shorter lives* than the rest of the population, and that the main reason for this was their *filthy living conditions*. |
| How did the *British government* respond to Chadwick's studies? | *At first* the government did *not* take much notice, but when *cholera* outbreaks became increasingly severe they began to *accept* that they might have to take action. (Cholera had first arrived in *1831*) |
| Who was *John Snow*? | *John Snow* was a London surgeon. He studied a major outbreak of *cholera* in the *Broad Street* area of London |
| What did John Snow *prove*? | John Snow proved that *cholera* was spread in *water.* |
| *How* did John Snow prove that *cholera* was spread in *water*? | He proved that *all* of the people infected in Broad Street had drunk *water* from the *same public pump*. He had the handle of the pump *removed*, and the *outbreak* stopped. This *proved* that Cholera was caught through infected *water* |
| What was the *impact* of *John Snow's* discovery in Broad Street? | The *London Board of Health* still believed strongly in the theory that cholera was caused by *miasma*, and they were reluctant to spend the huge amounts of *money* that would be needed to ensure *fresh water supplies*. |
| *Why* did the attitude of the *British government* towards Public Health and prevention *change* by *1860*? | The summer of *1858* had been very dry and hot. This had caused the *'Great Stink'* in London when the water level in the *Thames* dropped so low that it exposed the *raw sewage* on the river bed. The smell was *unbearable* |
| How did the *government* try to *improve* Public Health *after 1860* | They built a new *sewer system* for London by *1865*. This was incredibly *expensive*, so government *money* was needed |
| What was the *1848 Public Health Act*? | This was a *law* passed by the British government to try to *improve the health of the people*. |
| *What* did the 1848 Public Health Act *do*? | This *encouraged* local authorities to set up *Boards of Health* and to provide *clean water supplies* |
| Why did the *1848 Public Health Act* only have a very *limited positive impact*? | The 1848 Public Health Act was *not compulsory*, so most local authorities *ignored* it |
| Why was the *1875 Public Health Act* better than the *1848* Act? | The *1875 Act* was better because it was *compulsory*, so local authorities *had* to improve health in their areas |
| What did the *1875* Public Health Act say? | Local authorities now *had* to ensure *clean water supplies* and effective *sewage treatment* and appoint a *public officer of health* to monitor *outbreaks* of diseases |
| What *evidence* is there that these government public health efforts were *successful*? | Because of these *improvements* there were *no more* cholera outbreaks in Britain *after 1866-67.* |
| Why did *herbal remedies* continue to be popular until *1900*? | New treatments based on *germ theory* had *not* been developed, and even by 1900 there were few *new cures* for people once they became ill, even though germ theory had proved *why* they were ill |
| How did *surgery* improved between 1700 and 1800? | *Surgeons* were much better *trained* and could be quite *skilled*, but their *success* was still very *limited* |
| *Why* was the success of *surgeons* still very *limited* in *1800* | Surgery was *limited* by the problems of *pain*, *infection* and *bleeding* |
| How did pain, infection and bleeding *limit* the *success* of surgery? | Surgery had to be done *quickly* and only as a *last resort*, and deep *internal* surgery was almost impossible. Even if they *survived* they were likely to die from *infection* |
| *Laughing gas* had been used to deal with *pain* since *1796.* How *effective* was it? | In 1796 *laughing gas* had been used to *dull the pain* during teeth extractions, but it could only take the *edge* off the pain, so it was no use for *serious surgery* |
| *Ether* was used to *anaesthatise* a patient in *1842*. How *successful* was it? | *Ether* put the patient to *sleep*, but it often made patients *cough* and *vomit*, and there was also a risk that it would *catch fire*. |
| Who was *James Simpson*? | *James Simpson* was a *professor of surgery* in Edinburgh? |
| *What* did James Simpson *discover*? | James Simpson discovered that *chloroform* could be used as an *anaesthetic* |
| *How* did Simpson discover that *chloroform* could be used as an *anaesthetic*? | James Simpson *experimented* with a group of friends, *sniffing various chemicals*. When they sniffed *chloroform* it knocked them *unconscious* so Simpson was soon using it successfully as an *anaesthetic* |
| Why was chloroform so *important* was *chloroform* as an *anaesthetic*? | The discovery was so *important* because it made it possible for surgeons to attempt *longer* and more *complicated* operations, *deeper* in the body, without worrying about the patient being in *pain* |
| Why were some people *reluctant* to use *chloroform*? | It was much better than *ether* for most patients, but it was difficult to get the *dose* right, and an *overdose* could *kill* a patient. A *small number* of patients also *died* because it affected the *heart* |
| How did *religious beliefs* cause some people to *reject* the idea of using *chloroform*? | Some people believed that *pain* was part of *God's plan*, so it would be *wrong* to take the pain *away*. |
| Why did the use of *chloroform* become more *accepted* after *1853*? | In 1853 *Queen Victoria* was given *chloroform* during the *birth* of her son. This convinced people that it must be OK if the *Queen* was prepared to use it |
| Why did *chloroform* only bring about a *limited* improvement in surgery *at first*? | Chloroform still left the problem of *infection*. In fact, infection became a *bigger problem* for a while because surgeons were able to operate *deeper* inside the body when they used chloroform |
| Who was *Joseph Lister*? | Joseph Lister was an *English surgeon* |
| How was *Lister* influenced by the work of *Pasteur*? | *Lister* was impressed by *Pasteur's germ theory*. He had studied *infected wounds* and suspected that they were also caused by *germs* in the air |
| How did Lister *improve* surgery? | He developed ways to use *carbolic acid* to prevent patients becoming *infected* during *surgery* |
| *Why* did Lister decide to try using *carbolic acid* in surgery? | He knew that *carbolic acid* had been used successfully to treat *sewage*, so he decided to use it in *surgery* |
| How did he *prove* that *carbolic acid* could be used to *prevent infection* during *surgery*? | In *1865* he used *bandages* which had been *soaked in carbolic acid* to dress the wound of a patient after an operation. This was *very successful* |
| How did Lister make the use of *carbolic acid* during surgery even even *more effective*? | He developed a device which *sprayed a fine mist of carbolic acid* over the *hands* of the surgeon and his *tools* and into the *open wound* during *operations*. |
| How *successful* was Lister's use of *carbolic acid*? | Lister published *results* which showed a dramatic *reduction* in *infection rates* when *carbolic acid* was used |
| Why did *some* surgeons still *not* use carbolic acid? | Not *all* people *accepted* Pasteur's *germ theory* by this time, and carbolic acid *irritated* the hands of the surgeons, so this *put them off* |
| How had *infection* been *reduced even further* by *1890*? | By 1900 *aseptic surgery* had been developed - this focused on making sure that *operating theatres* were so *clean* that *microbes* could not *get near* the wound in the first place, so the carbolic acid was *no longer necessary* |
| *How many hospitals* were there in England in *1700*? | By *1700* there were only *five* hospitals left in Britain, and all of them were in *London* |
| Why did *new hospitals* start to be set up in the *18th century*? (1799-1800) | *New hospitals* started to be set up in the *18th century* using *donations* from *wealthy* people and members of the growing *middle classes* |
| *What kind of people* did these new hospitals usually *treat*? | The new hospitals usually treated *poorer people* - *rich people* preferred treatment and surgery in their *own homes*, which were generally *cleaner* and *safer* |
| What was *wrong* with the *new hospitals* set up in the *18th century*? | They were often very *unhealthy* places because of *poor hygiene*. Doctors *rushed* from patient to patient without *washing* their hands or *changing* their clothes |
| *Why* were hospitals still very *unhygienic* in the *18th century*? | Before *germ theory* doctors did not understand the *importance* of *washing their hands* between patients, so by *1800*, although there were *more* hospitals, they were often very *unhealthy* places because of *poor hygiene*. |
| Who was *Florence Nightingale*? | *Florence Nightingale* was born into a *wealthy* family, and got involved in *nursing* against the wishes of her family |
| *What* did Florence Nightingale *do* in *1854*? | In *1854* she travelled to the *Crimea*, where Britain was fighting a *war* against Russia. |
| Why did she go to the Crimea? | The *government* sent her, with 38 other nurses, because there had been an *outcry* in Britain when the people heard about the *shocking conditions* in the hospitals for wounded soldiers |
| *What* did she *find* when she arrived in the *Crimea*? | She found that *conditions* in hospital were *terrible* - they were *unhygienic*, with *poorly trained staff*, and *lacking* in basic supplies such as *bandages* |
| *How* did Florence Nightingale *improve* the hospitals in the *Crimea*? | She introduce *basic hygiene measures*, making sure that *floors were scrubbed* and *bedding washed* regularly |
| *What else* did she do to give the patients a *better chance* of *recovering*? | She made sure that the patients were provided with *nourishing food* to *build up their strength* |
| How *successful* were her methods? | Within *6 months* the death rate in *military hospitals* in the Crimea went down from *40% to 2%.* |
| What did this *success* mean for Florence Nightingale? | This success meant that she was a *national hero* when she returned to Britain in *1856* |
| *How* did Florence Nightingale use her *reputation* to improve *hospitals* back in Britain? | After she returned home she was *consulted on the design of new hospitals*, which she made sure were better *ventilated*, with *isolation wards* to stop *infectious* diseases *spreading* |
| How did she *improve* the standard of *nurses* back in *Britain*? | She wrote a *book* and set up a *training school* for *nurses*, so nurses received much *better training*, and the profession became much more *popular* |
| *How* were *hospital buildings better* by *1900*? | By *1900* hospitals were *clean* and *organised*, with *separate wards* and *operating theatres*, and areas for *new medical equipment* |
| How had the *staff* of hospitals *improved* by *1900*? | By *1900* hospitals were *staffed* by *professionally trained nurses and doctors*, with *junior* doctors *training* through *hands on* experience with *patients* |
| What was the *main improvement* in *hospitals* by *1900*? | By 1900 *strict hygiene rules* were *enforced*, including routine use of *aseptic surgery* |
| Why had *hygiene* become such a *vital* part of *hospital life* by *1900*? | *Florence Nightingale* proved the *value* of *good hygiene* in the *Crimea*, and by 1900 *Pasteur's germ theory* was accepted by *everyone*, so it was obvious that *patients* had to be *protected* against *germs* |
| Which *individuals* helped to bring about *progress* in the *prevention* of illness in the *Industrial Revolution*? (1700-1900) | *Edward Jenner* developed the first effective *vaccination* (against *smallpox*). *John Snow* proved that *cholera* was transmitted in *water*. *However*, both *struggled* to get their ideas *accepted* at first |
| Which *individuals* helped to bring about *progress* in the understanding of the *causes* of illness in the *Industrial Revolution*? (1700-1900) | *Louis Pasteur* developed *germ theory*, proving that *decay* was caused by bacteria, and *Robert Koch* found a way to *identify* the *specific bacteria* which caused *each illness* |
| How did the *government* influence the *development* of medicine for *most* of the *Industrial Revolution* period? | Until the *second half* of the *19th century* the *British government* mostly *held back* the development of medicine because they were *reluctant* to interfere in people's *lives* and introduce *expensive* policies. They also *distrusted new ideas* |
| How had the *attitude* of the *British government* towards medicine *changed* by *1900*? | By *1900* the *British Government* was taking a much more *active* role in *Public Health*, *passing* and *enforcing laws* to keep towns and cities *clean* and to make sure that people were *vaccinated* |
| *Why* had the *government* become *more* involved in *public health* by *1900*? | *1.* They eventually had to accept that discoveries like *germ theory* were *true*, so this *forced* them to take action. *2.* The *shocking conditions* and outbreaks of disease like *cholera* in the cities meant that they had to take action. |
| How did the *Scientific Revolution* affect the development of medicine during the *Industrial Revolution*? | The *Scientific Revolution* transformed understanding of the *causes of illness*, and opened up new possibilities for *prevention*, *but* new treatments* would not be successfully developed until the *20th century* |
| How did *improved communications* contribute to the *improvement* of medicine by *1900*? | Inventions such as the *electronic telegraph* and greatly improved *railway systems* made it easier for scientists in *different countries* to *share* their ideas and *collaborate* |