History- The Industrial Revolution


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Factors Leading to Change in Medicine during the I

Rapid growth of towns- The rapid growth of towns increased the dangers of epidemic disease and made people realise that they must work together to improve health

Attitude to Change- People's attitudes to poverty and sickess changed. The wealthy wanted reforms that would improve everyone's health.

Improved Technology- Scientific Knowledge and technology improved rapidly

Developed Skills- There were many huge engineering projects, such as the building of canals and railways. These developed the skills and experience that could be used in public health schemes

Government- Government's attitude changed. It began to force councils to improve sewers and clean water

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Reasons Why People were Unhealthy During the Indus

  • Big towns had less access to fresh food
  • Poor factory conditions e.g. poor ventilation created breathing problems
  • Housing was of poor quality
  • Living conditions were cramped- houses often contained more than one family
  • Sewers ran into rivers where people got their 'clean water'
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What Ideas did People have About the Causes of Dis

miasma- disease was caused by bad air that was fulled with poisonous fumes from rotting matter

spontaneous generation- disease was caused by germs that were produced by flesh and vegetables as they rotted

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What is the Difference between Inoculation&Vaccina

Inoculation- pus from a sufferer was taken and then a non-sufferer made a cut between the thumb and forefinger the pus was spread in the wound then a mild version of smallpox develops, the person is immune to further attacks

Vaccination- a safe way of stimulating the bodies immune system against a particular disease

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Edward Jenner's discovery of Vaccination

1) The technique of inoculating someone with smallpox for immunity was used in China and Turkey became widespread in the UK after Lady Montague had her children innoculated in 1721

2)Dr Jenner was surprised that farmers in Gloucestershire did not want to be inoculated, they said if they had cowpox they were immune to smallpox 

3)In 1796 Jenner decided to test the idea that cowpox created immunity to smallpox and took cowpox matter from Sarah Nelmes and inserted it into a cut on a young boy.

4) James Phippes (young boy) was slightly unwell but quickly recovered. James didn't develop the disease but developed immunity to smallpox  

5) Jenner vaccinated 23 people in the sameway to check his findings

6) However the royal society refused to publish his reports albeit his experiments and his findings so Jenner paid for it to be published in 1798

7) Jenner spent a lot of time suggesting cowpox matter to other doctors. In 1802 the British gov awarded him £10,000 in recognition of importance in his work

8) Towards the end of 1802, the Jennerian society was set up in London to provide free vaccination against smallpox- within two years over 12,000 people had been vaccinated.

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Edward Jenner's discovery of Vaccination 2

9) Jenner received worldwide recognition for his work, honors from a number of cities and universities a special medal from Napoleon, ring from the Empress of Russia , a letter from Thomas Jefferson and statues erected in various cities including London and Tokyo

10) In 1852 the British Gov made vaccination against smallpox compulsory- not enforced till 1972. In 1980 the world health organisation declared that smallpox had been eradicated and Jenner's work saved more lives than anyone else

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Biography: Lady Mary Wortley Montague

Background Info: Caught smallpox and was keen that her children should not suffer it to.


  • Observed inoculation in Turkey
  • 1721- she had her children inoculated
  • influential women, had doctors who saw potential in preventing smallpox and making money from inoculation


  • Not everyone could have inoculation and it was not always safe
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Reasons why People Opposed Vaccination

  • Jenner could not explain how the link between cowpox and smallpox worked
  • In 1852 the government made it compulsory to be vaccinated 
  • Vaccination was not always successful and some people did develop smallpox because some doctors did not carry it out carefully enough
  • Didn't work for any other diseases
  • When the government provided a grant to have free vaccination doctors lost money because people no longer paid for inoculation. 
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Biography: Edward Jenner

Background Info: Was a doctor from Gloucestershire 


  • Discovered from farmers that if you put cowpox matter into a cut of a healthy person they become immune
  • Discovered cowpox protects humans from the infection of smallpox
  • Vaccination
  • 1803 doctors were using the technique in america


  • Didn't make vaccinations compulsory until 50 years after his death
  • Inoculation was not always safe or effective
  • No one could take it further because he didn't know why it worked

Judgement: Made a huge contribution to the treating of cowpox and smallpox also made medical discoveries 

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Outside Events that Affected Jenner's Work

  • 1802- The Jennerian Society was set up in London to promote vaccination and within two years over 12,000 people were vaccinated
  • When the British government enforced compulsory vaccination in 1872, the number of cases dropped automatically. In 1979 the world health organisation announced that smallpox had been wiped out
  • Napoleon and President Jefferson in the USA both thought vaccination was a breakthrough
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Good Points About Jenner's Work

  • Jenner worked in a scientific way and did a number of tests
  • Vaccination showed that is was possible to prevent people catching disease
  • Jenner did not mind others using his ideas- he wanted lots of people to benefit from his work
  • Jenner had pamphlet printed for other scientists to read: they described his experiments very clearly 
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The Steps Towards Discovering the Causes of Diseas

1) The discovery of microorganisms,- late 1600s Antony Van Leeuwenhoek made some of the earliest microscopes. He discovered that almost everything contained tiny organisms. He described his findings in the Royal Society of London.

2)Improve Microscopes- Leeuvenhoek's discovery interested other scientists but at that time microscopes were not good enough. However by the early1800s purer glass was being produced and the science of optics was better understood. 1880 Joesph Lister developed a microscope that magnified 1000 times without distortion.

3) Louis Pasteur's germ theory- In the 1850s Pasteur a french scientist became interested in microorganisms. He discovered that a particular microorganism was growing in liquid. Pasteur killed the germs by boiling the liquid. Pasteur's research team injected chickens- leading to a breakthrough. 1860 FAS competition to prove or disprove spontaneous generation 

4) The battle between germ theory and spontaneous generation- The miasma theory of disease made scientists very interested in decaying matter. Through their microscopes they also saw microorganisms. Two theories 

5) Linking microorganisms to disease- In his germ theory he also said if wine and beer are changed by germs then the same can and must happen sometimes in men and animals. He speculated could disease be caused by the same process as wine going sour or material decaying? Harmful germs get into the body, grow rapidly and cause the disease

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The Steps Towards Discovering the Causes of Diseas

6) Pasteur was a scientist not a doctor. He carried out his early experiments with beer, wine and silkworms. Robert Koch conducted a series of experiments which proved that specific microorganisms cause specific human diseases. 

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Germ Theory and the Hunt for Microbes- the Work of

Step 1) Pasteur developed his theory while working for industries in France. His experiments suggested that beer, wine and mile were going sour because of microbes in the air. From this he suggested that microbes were also the causes of diseases. He published his findings in 1861 and 3 years later carried out a series of experiments that convinced scientists that his germ theory was correct.

So, for the first time in history scientists and doctors knew the true cause of disease. But they did not know exactly which microbes were causing which diseases. In 1865, the death of Pasteur's young daughter and an outbreak of cholera led him to investigate human diseases. He took samples of air from a cholera ward but under his microscope he could only see a confused mass of bacteria. He could not discover which one was causing cholera

Step 2)  Koch set out to find the specific microbe or bacterium that was causing an individual disease. He succeeded when he investigated anthrax, a disease common in animals that could also infect people. This was the first time anyone had identified the specific microbe that causes an individual disease.

Next, Koch investigated tuberculosis and in 1882 found a way of staining the microbe causing the disease so that it stood out under a microscope from other microbes. This breakthrough was important because now other scientists could use this method. They quickly found the microbes causing these disease: 1882 thyphoid, 1883 cholera, 1886 pneumonia, 1887 meningitis, 1894 plague. 

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Germ Theory and the Hunt for Microbes- the Work of

Step 3) Koch's work identifying microbes didn't save people's lives by itself. What were needed were more vaccines to give people weak doses of diseases to build up their immunity. Pasteur knew all about Jenner's work and that Jenner had not known exactly why vaccination worked. However, now that Pasteur knew that microbes caused diseases he carried out experiments to find more vaccines. He developed vaccines to prevent anthrax and chicken cholera in animals. Next, he investigated rabies, testing his vaccine on dogs and then, in 1885, on Joseph Meister, a boy who had been bitten by a rabid dog. Pasteur gave Joseph 13 injections over a two week period, Joseph survived. 

Other scientists developed vaccines to prevent other diseases. Their successes included: 1896 Typhoid, 1906 Tuberculosis, 1913 Diphtheria, 1927 Tetanus

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Biography: Louis Pasteur

Background Information: French Scientist. Research began in 1850 when he helped a brewing company find out why their alcohol was going bad. Used a microscope to discover tiny bacteria germinating in liquid.

Progressive Points

  • discovered germ theory
  • injected a chicken with old cholera then injected the chicken with fresh cholera, he found the fresh germs didn't work on the chicken- the old germ protected the chickens against the fresh germs.
  • Pasteur found out why Jenner's theory worked


  • Koch discovered the vaccines using Pasteur's theory
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Biography: Robert Koch

Background Information: Born in Germany in 1843. He was a doctor. He brought a microscope from 1875-78. He studied anthrax. German government gave him a full time job and a talented team of bacteriologists to continue his research.


  • Found the bacteria which caused anthrax
  • Using his methods they identified the causes of typhoid, TB, cholera, tetanus and more
  • Found chemical dyes could be used to stain specific bacteria so they could be studied more easily under the microscope. 

Judgement: Huge improvement in Knowledge of causes of disease.

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Doctors and Training


  • In 1858 the General Medical Act said that a General Medical Council had to be set up and qualified doctors has to be registered.
  • Medical Training improved in 1815 when they introduced examinations
  • Trained through apprenticeship
  • Doctors could set up practices once accepted by the Royal College of Surgeons the Royal Society of physicians or Society of Apothercaries.
  • Doctors acted as male midwifes
  • Attended medical lectures and walked the wards of a hospital as a pupil of a respected surgeon of physician
  • Learnt to use new devices such as the sthetoscope
  • As medical knowledge advanced doctors tended to divide into general practitioners and thsoe who specialised in specific areas of the body.
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Doctors and Training 2


  • carried out vaccinations
  • treated private patients
  • made up medicines
  • treated the poor in the work house
  • delivered babies

Technology and Equipment

  • termometers
  • stethoscopes


  • Wealthy patients paid them for their treatment
  • People paid for medicines
  • The local parish council paid them for treating the poor
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Doctors and Training 3

The Role of the Individual John Hunter

  • He published several important works including one about the changes that occurred in pregnancy
  • He employed a secretary to write up his notes and paid an artist to draw up the discoveries he made through dissection
  • His students included Edward Jenner, who followed Hunter's methods when investigating cowpox.
  • His lectures on anatomy helped to develop a more professional approach to medical training.
  • He emphasised the importance of observation and experiments
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Biography: John Hunter

Background Information: Studeied many aspects of anatomy. Used specimens to show body structure, the medical problems of conditions like arthritis and also progressive stages of disease. Carried out various experiments as part of a study on STI's


  • Methods been copied by Jenner
  • Published important works 
  • emphasised importance of observation and experiment


  • Didn't improve medical treatment
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Women Rights

How did women's rights to work as doctors change between the 1600s and 1850s?

  • 1700s- women were able to qualify as surgeons and midwifes, however never allowed to become physcians
  • 1800s- men succeeded in preventing women qualifying as surgeons and midwives
  • 1852- new law required all doctors to belong to one of the Colleges of Surgeons, Physicians or Apothercaries- closed to women.

Why did men think women unfit to be doctors in the 1800s?

  • Dr H. Bennett believed women as a body are sexually, constitutionally and mentally unfit for the heavy responsibilities of surgical procedure. 
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How Did Women Win the Right to Become Doctors?

1859- Elizabeth Blackwell was registered as a doctor by the British Medical Association after qualifying as a doctor in the USA.

1860- The British Medical association changed its rule saying that only people who qualified at a British university could become registered doctors.

Early 1860s- Elizabeth Garrett Anderson trained as a nurse and attended lecture for trainee doctors at the Middlesex hospital.

The colleges of Surgeons and Physicians refused to allow women members in order to try to stop Garrett working as a doctor. The college of Apothecaries also change its rule banning students getting private tuition. This means all medical students had to go to university, which did not take women,

Male students at Middlesex hospital protested that Garett should not be allowed to attend lectures.

1870- Elizabeth Garett studied privately with professors of medicine and then passed her medeical exams to become a doctor in Paris and in French. She also qualified as a midwife with the society of apothecaries. The 2 qualifications together allowed her to practice as a doctor.

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How Did Women Win the Right to Become Doctors?

1874- 6 women led by Sophia Jex-Blake, persuaded Edinburgh University to let them attend lecture from 1870 although there were lengthy protests from men who tried to stop them taking exams, hurling mud+ shooting at them. In 1874 the women completed the medical course at Edinburgh. 

Edinburgh University gave the women certificates but said it could only give medical degrees to men. The women had to complete the degrees in Dublin or Switzerland.

1876- Parliament opened all medical qualifications to women as part of a law giving women the same rights to university education as men.

For 5 years after 1876, the Royal College of Surgeons refused to allow anyone to take exams in midwifery as a way of getting around the law and preventing women learning alongside men. 

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Why were Elizabeth Garett Anderson and Elizabeth B

  • Elizabeth Blackwell went to America to qualify as a doctor. She also traveled to Britain to encourage other women to become doctors. 
  • Elizabeth Garrett Anderson was the first women to qualify as a doctor in Britain
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Biography: Elizabeth Blackwell

Background Information: Born in Bristol, she went to the USA to qualify as a doctor. Qualified in 1849 and later set up the New York Infirmary for Poor Women and Children. 


  • She qualified as a doctor in 1849
  • She was registered as a doctor by the British Medical Association
  • Her infirmary was staffed only by women
  • She came back to Britain to encourage women to become doctors
  • Inspirational


  • She couldn't use her qualification from 1860 because the British Medical Association changed its rule saying that only people who qualified at a doctor in a British University could become a doctor.
  • Qualified abroad
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Biography: Elizabeth Garrett-Anderson

Background Information: In the early 1860s she trained as a nurse and attended lectures for trainee doctors in the Middlesex hospital. In 1870s she studied privately with professors of medicine and then passed her exams to become a doctor in Paris. In 1872 she became a midwife. These 2 qualification allowed her to become a doctor.


  • She was the first women to qualify as a doctor in Britain
  • Became a midwife in 1872
  • 1st trained as a nurse and attended lectures for trainee doctors in Middlesex hospital.
  • Then studied with professor of Medicine
  • Then passed her exams in Paris and got her midwifery qualifications. These qualifications let her become a doctor


  • The college of surgeons and physicians refused to allow women members in order to stop her working as a doctor
  • 5 years after 1876  the royal college of surgeons refused to allow anyone to take exams in midwifery as a way of getting around the law and preventing women learning alongside men.
  • Had to qualify abroad.
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Biography: Sophia Jex-Blake


  • led 6 women to persuade Edinburgh University to let them attend lecture from 1870 
  • 1874 her and the 6 women completed the medical course in Edinburgh
  • 1876 Parliament opened all medical qualifications to women as part of a law giving women the same rights to university education as men


  • Had to go abroad to qualify- didn't have degree from Edinburgh only certificate
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In What Ways did Florence Nightingale Change Condi

  • wrote to the British government complaining about sanitation in the Scutari hospital
  • changed the death rate in the hospital from 42% to 2% 
  • talked to family friend Sidney Herbet and arranged for her to take 38 nurses to Crimea
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What Kinds of Training Did She Provide for Nurses

  • 3 years training
  • kept detailed records being kept of admission, illness, treatment, discharge and health
  • established the training of nursing as being a respectable profession
  • notes on hospitals and notes on nursing provided the best basis for training nurses and hospital design
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Which Major Breakthrough in Medical Knowledge had

  • Pasteur's germ theory- she was a believer of miasma
  • she associated disease with dirt thats why she concentrated on improving sanitation, ventilation and supplies.
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What Impact did Florence Nightingale have on Nursi

Florence Nightingale's Impact on Nursing

  • Wanted nurses to understand medical procedures in order to assist doctors properly, training took 3 years.
  • Involved in selecting nurses, organisation of school and checking training
  • Wrote book called Notes on Nursing- published 1859

Other factors impacting nursing

  • Training of nurses established it as a respectable profession and it increasingly appealed to Victorian women

Florence Nightingale' Impact on Hospitals

  • She had hospital wards scrubbed clean and windows opened to allow fresh air to circulate
  • Sanitation and water supply were improved as well as food supplies
  • Death rates in Scutari hospital went from 42% to 2%
  • Insisted on keeping records
  • wanted a design that was easy to keep clean
  • wrote book on notes on hospitals- published in 1859
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What Impact did Florence Nightingale have on Nursi

Other factors impacting hospitals

  • Heavy casualty rates in Crimean Wars (1854-1856) attracted publicity so drew attention to appalling conditions in hospitals
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How Much Progress was there in the Treatment of Il

Pre 1800s

  • The 1st cottage hospital opened in Sussex. They were small and provided nursing care while the medical treatment was prescribed by the local GP's
  • The middle and upper classes could afford to pay doctor's fees- usually treated at home
  • Some doctors set up sick clubs, where middle and working class people paid a small fee into a fund every week.
  • Working classes could not pay a doctor and might attend the dispensary or out patients department of a hospital
  • Old, sick or disabled people who could not support themselves had to enter workhouses which had been set up by the 1834 Poor Law Amendment act.


  • Lots of publicity about the level of care offered to poor people.
  • Newspapers raised concern about the number of old, sick, blind, deaf or disabled people in workhouses.
  • 1865-Louise Twining established a workhouse visiting society which campaigned for workhouse reform and improved standards of nursing in workhouses.
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How Much Progress was there in the Treatment of Il

  • Publicity, pressure and change
  • Public concern joined with the emphasis in new hospital designs on space and ventilation, to put pressure on local public authorities such as poor law unions, to improve the provision of hospital care for the poor.

Government Action

  • Starting in London in 1867 it was ordered that Poor law unions should join to build infirmaries that were separate from workhouses and had full time doctors
  • New asylums for the mentally ill and fewer houses for people with infectious diseases
  • By 1900 the poor law infirmaries, fewer hospital and asylums run by local authorities dealt with far more patients than the voluntary hospitals.
  • The new infirmaries often went on to become major general hospital with specialist doctors

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How Much Progress was there in the Treatment of Il

Other Factors

  • Nightingales work in regulating the training of nurses was a significant factor
  • Pasteur's work on germs also had an impact on hospitals. Joseph Lister began to use carbolic acid to create antiseptic conditions during operations. By 1900 most hospitals accepted the need for antiseptic conditions and equipment in the wards.
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Patent Medicine

Patent Medicine- A mixture that has been created by one person or company and is sold under a particular brand name.

Patent medicines aim to cure

  • fainting
  • anaemia
  • neuralgia
  • heart palpitations
  • head,neck and shoulder pain
  • pale faces
  • weakness
  • bloodlessness
  • torpid liver
  • constipation
  • indigestion
  • biliousness
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Biography:Florence Nightingale

Background Information: From a rich family, thought god gave her a purpose


  • Improved conditions in hospitals
  • wanted nurses to be trained properly for 3 years
  • death rate in Scutair hospital dropped from 42% to 2%
  • wrote books on hospitals and nursing


  • believed in miasma

Judgement: Improved conditions in hospitals and training standards but didn't improve knowledge or practice.

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Why Had Doctors Stopped Reading Galen in the 19th

  • Ideas were challenged- Scientists gradually discovered that many ancient ideas about the natural world were wrong
  • New explanation for disease- It was difficult to disprove the theory of the 4 humours by experiment, but by the 19th century scientists did not accept it as an explanation of disease. They developed their own ideas. The most popular in the early 1800s was 'bad air' caused disease but by 1860 scientists found a more accurate explanation.
  • New understanding of the body. 1500s Versalius began a revolution in understanding the human body. He showed Galen's descriptions were incomplete and sometimes even wrong. He encouraged doctors to do their own dissections.
  • The microscope- This invention helped to further undermine Galen's work e.g. it proved Harvey's theories were right.
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How Did Life in the 19th Century Affect Medicine?

  • Urbanisation- The growth of towns created many health problems. Poor housing and infected water supplies made killer diseases spread rapidly .
  • Entrepreneurs- Medicine became big business. Some entrepreneurs made millions of pounds from almost useless remedies. However others put money into scientific research to find drugs to cure disease. 
  • Changing political attitudes- In 1800s Parliament believed should not interfere in people's lives if people were unhealthy
  • Technology- Developments in steel produced a thin syringe needle that did not break improvements in glass making led to better microscope lenses and the 1st thermometer. Engineers gained experience of big projects when they built the canal and railway. They used this to built water pipes and the sewage systems.
  • War- Major wars during the period affected development in health e.g. The Crimean War in the 19th century led to improvements in the standards of nursing and hospitals.
  • Scientific Methods- Science helped medicine. Scientists discovered links between microorganisms and disease. Chemists researching the properties of different substances found e.g. a gas could be used as an anaesthetic.
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