3. The Industrial Period c1750-c1900

What does laissez-faire mean?

Government "hands-off" approach to public health.

Name preventions of disease.

Preventions:

• Jenner's vaccinations

• Snow's removal of Broad Street pump.

• Before gov Acts, people still used strong smells.

• Chadwick triggered gov 1848 & 1875 Acts.

What is inoculation?

Deliberately infecting someone with a disease to protect against a more severe form.

Give two problems with inoculation.

Problems:

• expensive.

• some patients died.

What is vaccination?

Prevention, using a vaccine to create artificial immunity.

What percentage of smallpox victims died?

About 30%.

When did Edward Jenner develop the smallpox vaccine?

1796.

Why did Edward Jenner investigate cowpox?

Milkmaids who caught cowpox rarely caught smallpox, and Jenner wanted a safer alternative to inoculation.

Who did Edward Jenner vaccinate in 1796?

James Phipps, 8 year old boy.

What disease did Jenner first give James Phipps?

Cowpox.

What happened when James Phipps was exposed to smallpox?

He did not catch it, as he was immune.

Why did some doctors oppose vaccination?

They feared losing income from inoculation.

How did the government promote vaccination?

Banned inoculation in 1840 and made vaccination compulsory in 1853.

When was smallpox vaccination made compulsory?

1853.

What was the long-term impact of the smallpox vaccine?

Smallpox cases fell dramatically and the disease was eradicated.

Limitations of Jenner?

Limitations:

• lack of scientific understanding on germs.

• limited protection, only smallpox.

• anti-vaccine opposition.

• unsanitary vaccination spread syphilis.

How did Jenner inspire Pasteur?

To develop vaccines for many other diseases by identifying disease-causing germs.

When was Edwin Chadwick's report published?

1842.

What did Edwin Chadwick's report discover?

A link between poor living conditions and low life expectancy.

How did his findings persuade the government to take action?

Workers better health, factories run better, more profit as more efficient.

What did the government do?

Triggered 1848 Public Health Act, but did little, voluntary, no one wanted to spend money on sanitary measures.

Limitation to Chadwick's positive impact?

Believed in miasma, suggested waste dumped in Thames, worsened cholera.

Name treatments of disease.

Treatments: not much change in general population

• Anaesthetics - Simpson & Lister.

• Better hospitals and nursing - Nightingale.

• Aseptic surgery in 19th century.

What gas was used for small operations during the 1790s?

Nitrous oxide (laughing gas).

What was surgery like before anaesthetics?

Patients concious, held down by force, speed most important skill for surgeon, high death rates due to shock by intense pain.

What was used before anaesthetics?

Alcohol & opium - numb or calm patients, easy to overdose, addictive.

What was ether?

First successful anaesthetic, later replaced by chloroform.

Why was ether unpopular?

It caused vomiting (choking), irritated the lungs and was flammable (candle-lit rooms).

How did James Simpson discover chloroform?

While testing chemicals with friends in 1847.

Why did some doctors avoid chloroform?

Could cause fatal overdoses, encouraged longer operations with greater infection risk.

How did the discovery of chloroform lead to the "Black Period" of surgery?

Patients felt less pain, surgeons went deeper into wounds, so germs went deeper.

Negative impact of longer, deeper surgeries that caused "Black Period" of surgery?

Before antiseptic surgery, more died from infection. Surgeons kept bloody aprons and hands as "badge of honour".

Which monarch did John Snow give chloroform to?

Queen Victoria in 1853 in childbirth.

What did Snow do to make chloroform safer?

Invented inhaler which regulated dosage, less risk of fatal overdose.

Impact of Queen Victoria using anaesthetics?

Made it popular, removed religious and moral oppositions.

Who gained greater access to hospitals in the 18th century?

The deserving poor.

Why did hospitals introduce separate wards?

To isolate patients with infectious diseases.

Name three ways Florence Nightingale improved hospitals during the Crimean War.

Ways:

• cleanliness.

• organisation.

• proper treatment.

What did she change about how hospitals were designed?

The Pavilion Plan:

• improved ventilation, more windows.

• larger rooms.

• separate isolation wards.

What effect did Florence Nightingale's improvements have?

Reduced mortality rates.

Mortality rates before and after from infectious diseases (e.g. typhus, cholera)?

Mortality rate: in six months

40% to 2%.

What book did Nightingale publish?

"Notes on Nursing" in 1859.

Limitation of Nightingale?

Still believed in miasma, not Germ Theory.

When was the Nightingale School for Nurses established?

1860.

Where was the Nightingale School for Nurses established?

St Thomas' Hospital, London.

Impact of Nightingale School for Nurses?

Made nursing into a respectable profession, improved reputation of nurses.

Name believed causes of disease.

Causes:

• Miasma (later declined due to Germ Theory).

• Spontaneous Generation.

• Germ Theory.

What is Spontaneous Generation theory?

Decaying matter produces microorganisms that spread through miasma.

When was Spontaneous Generation theory developed?

The early 18th century.

What did Louis Pasteur discover?

Germ Theory in 1861.

What does Germ Theory state?

Microbes in the air cause decay, aren't evenly distributed, killed by heating.

How did Pasteur disprove Spontaneous Generation?

Used a swan-necked flask to show that keeping airborne dust out kept the liquid sterile.

Why did the British government not initially support Germ Theory?

It offered no practical solution and the government believed in laissez-faire.

Why did British doctors not intially support the Germ Theory?

Pasteur was a French chemist, not a doctor, and couldn't prove which germ caused which human disease. Trusted a British doctor more, Dr. Bastian promoted Spontaneous Generation.

Limitations of Pasteur?

Limitations:

• no immediate cures, limited impact on treatment, work on spoiled food not disease.

• lack of public understanding, acceptance was gradual.

• could not see viruses that caused common diseases like common cold or influenza.

Did the theory of miasma become more or less popular by the end of the 19th century?

Less popular (due to Koch, proved link to human disease.)

Why did miasma become less popular?

Germ Theory provided a more scientific explanation.

How did Joseph Lister use Germ Theory?

Linked it to infection after surgery.

Were operating theatres cleaned before surgery in the 18th century?

No.

How were operating theatres unhygienic?

Surgeons did not wash hands, aprons or equipment.

When did Joseph Lister begin using carbolic acid?

1865.

How did Joseph Lister first use carbolic acid?

He soaked a bandage and applied it to a patient's leg.

How did he then use it?

Ways: Antiseptic

• spray the room.

• wash hands.

• clean surgical tools.

How did carbolic acid help?

Amputation mortality rate from 45% to 15%.

Why did some surgeons reject carbolic acid?

Dried their skin, smelled unpleasant and many doubted Germ Theory.

Limitations of Lister?

Limitations:

• carbolic acid highly unpleasant, doctors argued it couldn't be good for patient.

• slowed down operations when speed was key.

• Lister stopped using it, replaced by aseptic surgery (Koch's steam sterilisation.)

What is the difference between Antiseptic and Aseptic surgery?

Antiseptic: Killing germs that are already there (Lister's spray).

Aseptic: Preventing germs from entering the room at all (creating a sterile environment).

What did Robert Koch discover?

Specific bacteria cause specific diseases.

Which disease did Koch identify in 1882?

Tuberculosis (TB).

Which disease did Koch identify in 1883?

Cholera.

Name techniques Robert Koch used to study bacteria.

Agar jelly to grow bacteria, staining bacteria with dye.

Impact of Koch?

Created standard method, easier to study bacteria, took photos as evidence, others could copy method to find more.

Limitations of Koch?

Limitations:

• found cause, not cure.

• viruses much smaller, did not identify causes to common diseases, just like Pasteur.

How did Pasteur, Koch and Lister build on each other's work?

Pasteur - Germ Theory.

Koch - specific bacteria caused specific diseases.

Lister - reduce infection in surgery with Germ Theory.

What was the most important factor in improving understanding of disease in the 19th century?

Individuals, science and technology.

What is aseptic surgery?

Surgery carried out free from bacteria.

How was surgery made aseptic by the 20th century?

Ways:

• staff washed thoroughly.

• steam sterilisation of equipment.

• staff wore protetcive clothing (surgical gowns, gloves).

Name public preventions in response to epidemics or events.

Public Preventions:

• Drinking beer and boiling water for tea - no cholera. (by accident.)

• Increased Government intervention, improved public health. (After the Great Stink, 1858.)

When did cholera first arrive in Britain then London?

Britain - 1831.

London - 1832.

(Don't memorise just for chronology.)

Soho case study - 1854. (memorise this.)

How is cholera spread?

Contaminated water or contact with an infected person.

How long did cholera symptoms usually last before death?

Two to five days.

Name four symptoms of cholera.

Symptoms:

• vomiting.

• dehydration.

• diarrhoea.

• burst blood vessels under the skin.

What was cholera called?

"Blue Death", skin turned blue due to severe dehydration.

How many people died of cholera in London by the end of 1832?

Over 5000.

When was the first Public Health Act passed?

1848.

How did the Public Health Act of 1848 try to prevent cholera?

Ways:

• encouraged cleaner towns

• public health boards

• clean water.

What did the Public Health Act of 1875 make compulsory?

Must have:

• clean water.

• waste disposal.

• public toilets.

• public health officers.

• better housing.

• parks.

Along with being an anaesthetist, what did John Snow do?

Investigate cause of the cholera outbreak in Soho in 1854.

What did John Snow believe caused cholera?

Contaminated drinking water.

How was the Broad Street pump water contaminated?

Nearby cesspit (underground sewage pit) leaked human waste through broken brickwork directly into pump's drinking well.

Why did John Snow reject miasma as the cause of cholera?

Cholera affected the guts not lungs.

Why did John Snow remove the Broad Street pump handle?

Over 500 deaths in 10 days, linked nearby cholera deaths to the pump using spot map.

What evidence made him conclude contaminated water was due to Broad Street pump?

Evidence:

• no workers at local brewery died - drank beer from boiled water, had private well.

• near pump, little workers from workhouse died - own water source.

• woman died far from pump, had servants bring exact pump water to her "liked the taste", wealthy clean area, disproved miasma.

When did John Snow remove the Broad Street pump handle?

1854, stopped cholera cases in Soho slums.

Did the government accept John Snow's findings in 1855?

No, still believed miasma caused cholera.

Limitations of Snow?

Limitations:

• no scientific proof (no Germ Theory until 1861).

• localised evidence, only in Soho, critics thought was anomaly.

• lack of government support.

How did Pasteur and Koch later prove John Snow was right?

Pasteur's Germ Theory disproved miasma and Koch identified the cholera bacterium.

What was the Great Stink of 1858?

Thames full of human waste, lack of sewage system, heatwave heated waste up, had to evacuate Houses of Parliament due to stink.

Impact of the Great Stink?

Impacts:

• end of laissez-faire.

• sewage system put in place (wrong reason, believed in miasma) politicians worried for own health.

• eradicated cholera.