History Revision notes by Anna SerrichioMedicine in the 19th Century

Why did Galen lose importance by the 19th Century?

• The creation of scientific equipment allowed doctors and scientists to gain more accurate information on what caused disease

• New explanations for what caused disease immerged

• The training of doctors improved, and the Catholic Church no longer had control over this.

• Knowledge of the world changed. This led to new ideas in health.

What factors helped the development of Medicine in the 19th Century?

• Urbanization: This led to a rise in disease in towns and cities, and so more demand for medicine and doctors

• New technology: New technology was invented, such as the microscope

• Changes in attitude: It changed from religious to secular

• Politics: The government started to provide funding and legalized change

• War: War caused more injuries, and so again there was more demand for medicine and doctors

Edward Jenner and Smallpox

• Edward Jenner discovered the vaccine for smallpox.

• Watch this video: http://www.youtube.com/watch?v=jJwGNPRmyTI

Jenner observed that milkmaids got a disease called cowpox, but they never got smallpox.He did an experiment with an 8-year-old boy…

1. Inoculation: He injected pus from the scar of cowpox to the little boy

2. The boy suffered from cowpox3. The boy was injected with pus from the scar of

smallpox, twice4. He never got smallpox

• At first, the World Society refused to publish his work

• So Jenner funded it on his own with the help of the government. This was the first time the government got involved in health issues.

Hospitals before Florence Nightingale

• The wards were cramped and stuffy, and this helped spread infections easily

• Wards were not cleaned often enough or effectively enough, this also spread infections.

• Nursing staff were not trained. • There were few toilets and the

sewage system was poor • The nurses were often dirty or

drunk!

Florence Nightingale

• Florence Nightingale became a nurse – something to which her parents were opposed because it was a job that was associated with working-class women and she came from a wealthy family.

• In 1853, during the Crimean War, soldiers began going down with cholera and malaria. Nightingale volunteered her services and went to turkey.

She wrote two books: • Notes on Nursing in 1859• Notes on Hospitals in 1863

1859 1863

She concentrated on improving: • Sanitation in hospitals – clean water supplies,

sewers, toilets and total cleanliness• Ventilation in hospitals – to make sure patients got

clean and fresh air to breathe • Good supplies, clothing and washing facilities for

patients. This dramatically reduced the number of deaths.

• She became known as “The Lady with the Lamp” for going around with a lamp at night and making sure the patients were doing ok

• She didn’t pay attention to Louis Pasteur’s Germ Theory because she thought that nurses should concentrate only on sanitation and making the hospitals clean.

Discovering the causes ofdisease in the 1860s and 1870s

Louis Pasteur and the Germ Theory

• Louis Pasteur was called by the Brewing Industry to find out why their alcohol was going bad. He found that a microbe was growing in the liquid.

• Pasteur solved the problem by showing them how to kill the microbes by boiling the liquids.

• He was called by other industries.

• In 1860 the French Academy of Science organized a competition to approve or disprove of the old theory of what caused disease, ‘spontaneous generation’.

• Pasteur won and published his germ theory in 1861.

• Pasteur was called in by the French Silkworm Industry to investigate a disease that was affecting the silkworms.

• He found that a microbe was causing the disease.

Robert Koch • Robert Koch applied Pasteur’s ideas to human

diseases. • He proved that there were specific microbes that

caused certain diseases.

• Koch found the microbe that was causing anthrax. 1. He got the organs a sheep that died of anthrax. 2. He injected a mouse with it. 3. He got the bacteria from a mouse and grew it again4. He repeated this same experiment with 20

generations of mice.

• Koch also made a better medium got growing and observing bacteria.

• He developed a staining process were he stained microbes with a purple dye so that he could see them better.

Louis Pasteur (Again) • In 1879 he discovered the vaccine for chicken cholera. • During that summer, some chicken cholera was accidently

left out unused in the lab.• On returning to work, Charles Chamberland injected the

chickens with these old germs. The old solution had immunized the chickens: leaving the germs out in contact with air had weakened them.

• In 1881 Pasteur was invited by The Agricultural Society of Melun to prove to do a public display to prove his ideas on anthrax. He succeeded and developed the vaccination for anthrax.

Problems with Surgery in the 1800s• Pain: The doctor had no control

over the pain that the patient suffered because there were no pain killers, and often the patient would suffer so much pain he/she would die.

• Bleeding: Bleeding happened to quickly and doctors couldn’t control it either.

• Infections: Surgeons didn’t know how to prevent infections.

Surgeon pictured in USA 1882, wearing an apron,

but without surgical gloves or face mask

• Pitch was boiling tar the was used on wounds.

• Cauterising was using a hot iron to seal wounds.

• Ambois Pare made developments in surgery. He invented tourniquets.

• Women would die after giving birth often because of bleeding. Obstetrics and midwifery doctors dealt with this.

The discovery of Antiseptics• In 1864 Joseph Lister discovered that carbolic

acid prevented the smell of sewage and killed parasites.

• He found that when using carbolic acid in surgery the death rates were dramatically reduced.

He improved methods in three ways: • Handwashing with carbolic acid• Adding carbolic spray to the table and air• Using antiseptic ligature to tie up blood vessels

and prevent blood loss

At first, Surgeons opposed Lister’s Methods

• The carbolic spray seemed very extreme. • Surgeons were still convinced that speed was

essential.• They didn’t achieve the same results as Lister did. • Pasteur’s ideas had also been slow in spreading,

people just didn’t want to accept them. • Surgeons had lived with the fact that many

patients died for many years.

• But eventually Lister’s antiseptic methods (killing germs on the wound) turned into aseptic methods (removing germs from the operating theatre).

Improvements made were: • Theatres and hospitals were cleaned• From 1887 instruments were steam-sterilised• Surgeons started wearing surgical gowns and

face masks• From 1894 sterilised rubber gloves were used

for the first time

Why were sewers and water supplies improved in the

Nineteenth Century?

The first Outbreaks of Cholera

Conditions in British towns became worse than ever: • Growing populations meant that streets became

very crowded • There was no clean water or facilities to remove

sewage.

• The first outbreak of cholera was in 1831. The next major epidemics were in 1848 and 1854.

The Work of John Snow

• In 1854 John Snow discovered the cause of cholera.

1. Snow observed that all deaths (caused by cholera) had taken place within the area of a local water pump.

2. He found that everyone who had suffered from cholera had used that water pump

• He also noticed that the workers in the brewery had not suffered from cholera, and they had not drunk water from the water pump they only drank alcohol.

• So cholera was caused by dirty water from the local water pump.

Edwin Chadwick and the first Public Health Reform

• Edwin Chadwick was employed by the Poor Law Commission to report on living conditions and health of the poor.

• He wrote a report, called Report on the Sanitary Conditions of the Laboring Population in 1842.

• This report brought about the Public Health Act of 1848

He report said three things:

1. The poor had terrible living conditions, and the streets were very crowded.

2. The most important measure to take was to provide public drainage and clean supplies of

water. Towns had to be cleaned up.

3. A district medical officer should be appointed for the prevention of disease.

Report on the Sanitary Conditionsof the Labouring Population

Edwin Chadwick

The public Health Act of 1848Advantages Disadvantages

It was the first to challenge laissez-faire

It encouraged, didn’t force towns to clean up so many didn’t bother to.

It encouraged town councils to clean up their towns and provided money for it

Health was still not a ministerial responsibility, and therefore the power of the Central Board of health was limited.

It included the establishment of the Central Board of health

There was no compulsion to ensure that officials were suitably trained or qualified.

The improvement of Public Health

• In what year was the Public Health Act of 1875? (Hey, I’m only joking.)

• Basically what it did is that it forced local authorities to provide clean water, proper drainage and sewage facilities and the appointment of a medical officer of health.

Factors that led to the Public Health Act of 1875

• The weakening of laissez-faire• The improvement of education• Working-class men were given the right to vote in 1867 and

meant that their needs were noticed• More outbreaks of cholera, (in 1831, 1848, and 1854) together

with the work of John Snow• Scientific developments: Pasteur’s germ theory proved the link

between dirt and disease• Statistics showed high death rates in town with poor living

conditions• Towns started to compete against each other to be the cleanest• Edwin Chadwick and the Public Health of 1848.

The Role of Women in Medicine in the 1950s

• Women’s statuses in medicine were reduced because it was thought that they should stay at home and play the role of wives, mothers, and housekeepers.

• In 1852 the government introduced the Medical Registration Act that required doctors to belong to one of the colleges of physicians, surgeons, or apothecaries. But these were all closed to women!!

• Girls didn’t normally go to school. Those who did were taught to read, write and cook and stopped going to school in their mid-teens, so they couldn’t attend universities.

• Elizabeth Blackwell was the first woman to qualify as a doctor in the US in 1849.

• Elizabeth Garret followed in her footsteps and was the first woman to qualify as a doctor in Britain but had to overcome a lot of difficulties to do so.

• Mary Seacole was a black nurse who fought racial equality to establish her career.

• The Crimean War was the first time women were used as army nurses.

Useful Revision Websites

• http://www.schoolshistory.org.uk/publichealth/publichealth_industrialrevolution.htm

• http://www.schoolshistory.org.uk/infectiousdisease.htm

• http://resources.schoolscience.co.uk/ABPI/history/timeline.html

• http://www.bbc.co.uk/schools/gcsebitesize/history/shp/modern/

The End!