Medicine 1700-1900

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  • Created by: B.Dave
  • Created on: 02-12-17 17:50

Jenner and Vaccination

  • In the 1700s smallpox was one of the most deadly diseases.
  • Before Jenner the only way to prevent Smallpox was inoculation, which involved giving people a mild form of smallpox to become immune, (sometimes died from this).

Edward Jenner (b.1749) used scientific methods he proved that people with cowpox didn't get smallpox. 

  • In 1796 he tested his theory by injecting a boy with the pus from the sores of a cowpox sufferer, then later tried to infect him with smallpox, he didn't contract the disease.
  • He published his findings in 1798, he coined the term vaccination

Opposition and Change

  • Jenner was important because experiments were unusual at the time
  • Some people resisted vaccination; doctors who performed inoculation (threat to their livelihood) and many were worried about getting a disease from cows
  • His discovery got the approval of parliament who funded Jenner to open a vaccination clinic.
  • In 1840 vaccination= free for infants, 1853 = compulsory
  • The vaccine was a success but Jenner didn't know why it worked so he couldn't develop any more, this was only possible after the Germ Theory.
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The Germ Theory and Koch

Before the Germ Theory scientists believed that microbes were caused by decaying matter, this theory was known as spontaneous generation, it led people to believe disease caused germs. People also still thought Miasma was the main cause of disease.

Louis Pasteur was the first to suggest that Germs caused disease, he proved there were germs in the air. In 1861 he published his Germ Theory in which he argued that microbes in the air caused decay and that some microbes caused disease.

It was first met with scepticism, as people couldn't believe tiny, invisible microbes could cause disease and the fact the germ responsible for each disease had to be identified individually. However the Germ Theory soon gained popularity in Britain:

  • The theory inspired Joseph Lister to develop antiseptics
  • It proved John Snow's findings about cholera
  • It linked disease to poor living conditions (made government pass the 1875 Public Health Act)

The German scientist Robert Koch built on Pasteur's work by linking specific diseases to the certain microbes that casue them.

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Anaesthetics

Nitrous Oxide - Humphry Davy identifies as possibility in 1799 was ignored, American Horace Wells demonstrated it in 1845 but it was uneffective so it was ignored

Ether - Crawford Long in 1842, demonstated publicly in 1846 by a dental surgeon (Morton). It is an irritant and explosive so using it was risky.

Chloroform- James Simpson (+team) sniffed things themselves for anaesthetic for use in childbirth and found chloroform's effects in 1847. It became widely used after being used by Queen Victoria in 1853. However it sometimes caused heart failure.

Early Anaesthetics actually led to a rise in deaths, because it meant longer, more ambitous operations were attempted, leading to deaths from infection as surgeons didn't know that sterilising and cleaning would save lives.

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Antiseptics and Aseptic

Joseph Lister pioneered the use of antiseptics with carbolic acisd sprays after seeing it used in sewage to reduce the smell. After hearing about the Germ Theory he started using it on instruments, hands and bandages and saw reduced infection rates.

Antiseptics allowed surgeons to operate with less faer of the patient dying. Operations increased tenfold between 1867 and 1912 as a result. And the death rate went from 50% in 1864 to 15% in 1870.

Asepsis is the practice of stopping any germs getting near the wound.

  • Instruments carefully sterilised before use
  • Sterilise hands, gowns, masks, hats and surgical gloves were invented by William Halsted in 1889
  • Theatres kept clean with sterile air, with specail tents to maintain an area of stricter hygiene in high risk cases
  • Reduced need for carbolic spray, which was unpleasant to use
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Developments in Nursing

Before the 1800s hospitals were often dirty places that people associated with death and infection. Florence Nightingale helped change that by improving hospital hygiene and raising nursing standards.

She served as a nurse at the Barrack Hospital (Scutari) in the Crimean War, at a time when women nurses were opposed to by the military and seen as inferior to male nurses. She, with her 38 hand-picked nurses, used methods she learnt from her training in Europe to make sure the wards were clean and hygienic and that patients were watered and fed properly.

She improved the death rate at the hospital from 42% to 2% in 2 years.

In 1859 Nightingale published a book 'Notes on Nursing' explaining her methods, this became the standard textbook for generations of nurses. Also the public raised £44k to help her train nurses at a new school of nursing.

By 1900 there were 64,000 trained nurses in Britain and in 1919 the Nurses Registration Act was passed meaning training was compulsory.

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Case Study- Cholera in London

Before the Germ Theory was published, people didn't understand the need for clean water and good sewerage systems. Water pumps were often contaminated by cess pits

Cholera reached Britain in 1831. There were various epidemics in the decades afterwards. It's waterborne and causes extreme diarrhoea causing people to die from loss of water and minerals. People mostly blamed miasma so the government starting regulating burial of the dead but this did little to stop the spread.

John Snow was a London doctor who had a theory that cholera was waterborne but he had no proof. However when cholera broke out in the Broad Street area of London, he proved his theory by making a map of cholera sufferers according to which water pump they used. He tracked the disease back to the same water pump on Broad Street. He convinced the council to remove the handle and the cholera outbreak ended.

His findings took a while to make an impact, it was not until the Germ Theory that his theory became widely accepted. Eventually his findings did lead to a change in attitudes and people realised that a government response was needed to clean up the streets and waterways (contributed to 1875 Public Health Act).

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The Public Health Acts

For most of the 19th century people believed in a laissez-faire style of government = wouldn't intervene in public health. In 1842 Ethan Chadwick published a report suggesting that poor living conditions caused poor health. This led to the 1848 Public Health Act. The Act set up a central Board of Health and let local councils set up their own health boards. However the impact was limited as very few towns chose to set up boards and those that did often refused to invest any money.

Public opinion began to change because

  • Snow's and Pasteur's work showed that cleaning up towns could stop the spread of disease
  • In 1867, the Second Reform Act was passed, giving 1 million more men the vote (mostly industrial workers) meaning the government had to listen to the working class to stay in power.
  • People like Charles Dickens helped change attitudes towards the poor, who suffered the worst.
  • Also sewage in the Thames made a 'Great Stink' in London this made the MPs plan a new sewer system which opened in 1865

In 1875 the government passed the compulsory 1875 Public Health Act, it forced councils to appoint health/sanitary inspectors, maintain sewerage systems and to keep ther towns clean

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