Studied by 20 people
The Theory of the 4 Humours
Ancient Greek theory about cause of disease - used in medieval times. The 4 humours were blood, yellow bile, phlegm and black bile. Any imbalance was believed to cause illness.
The Theory of Opposites
This built upon the theory of the four humours. If there was imbalanced (one humour was greater than the other), then balance was restored by eating or drinking something with opposite qualities (e.g. if you were cold and wet, you ate something hot and dry).
miasma theory
The theory that diseases were caused by unclean air. some people thought God poisoned the air - physicians described it as the "corruption of the air"
how did people prevent disease during the middle ages?
people thought only god could cure disease, so they:
- lived a sin free life
- attended church services
- prayed for God's forgiveness of their sins
- pilgrimages
- wearing religious charms
- fasting (to show they were sorry for their sins)
how did people try to prevent breathing bad air?
- carrying posies (sweet-smelling flowers)
- lighting fires to drive bad air away / burning herbs to clean the air
- ringing bells and allowing birds to fly around the house to keep air moving
- streets were cleaned by rakers and people were punished if they littered
what progress was made towards understanding disease in the middle ages?
no progress made - caused little progress in the treatment of disease. a respect for tradition, lack of education, scientific knowledge and the church's power continued these ideas.
Who treated the sick: wise women
local women with medical experience. used herbal remedies and charms / spells. they were cheap and helped with childbirth. they could be trained to become a midwife with a bishop's permission but they weren't allowed to be physicians.
Who treated the sick: apothecaries
pharmacist - trained / experienced. mixed many ingredients to make medicines for physicians (cheaper than a physician). understood herbal remedies and healing powers of plants/herbs. no medical qualifications
Who treated the sick: physicians
medically trained at university for 7 years. they had little anatomical knowledge as they didn't practice dissection. at the time, there was only 100 male physician in England. they diagnosed illness and suggested treatment by apothecaries (took clinical observation, using the 4 humours, astrology) - very expensive so only the rich could afford it
Who treated the sick: barber surgeon
pulled out teeth, removed tumours and lance boils, amputated limbs. very low success rate (cheapest surgery available).
how did technological improvements help develop medicine during the renaissance period?
during the 1450s, the printing press was invented (improvements in literacy as could read / write) so new ideas could spread more quickly as books could be mass produced at an affordable price. it became possible to make accurate photos (before, books were drawn and handwritten - normally by monks, so there was less variety and was more religious). broader perspective / free-thought (thought in a different way as more information / medical advances could be shared)
what were the dominant theories in the early 1800s?
- miasma - knew diseases spread quicker in hot weather (the air smelt worse in the summer)
- spontaneous generation
- common sense and observation of disease patterns made doctors and scientists think disease had something to do with dirt
spontaneous generation
idea that claimed rotting matter (non-living things) made maggots, fleas, disease (living things)
why did some people not believe in microorganisms / thought they were too insignificant to do harm?
didn't have microscopes (scientists knew they existed but couldn't carry out research) - they could be seen inside healthy bodies so didn't link them to disease. people didn't like the idea of dissecting dead bodies (research was hard).
what with the key problems of an operation?
no anaesthetic
people watching
wooden table
dirty room
no way to replace blood
risk of infection from dirty tools, clothes, etc
THE 3 MAIN PROBLEMS WITH SURGERY: INFECTION
1/5 amputations in hospitals ended in death as there was no understanding of infection (surgeons wore the same dirty apron. if lucky, they would wash their hands beforehand). equipment wasn't sterilised. bandages were washed and reused, causing blood poisoning. equipment like sponges to wipe away blood were just rinsed.
THE 3 MAIN PROBLEMS WITH SURGERY: PAIN
before the 1840s, patients were knocked out / given opium / made drunk. patients would be conscious, screaming in pain whilst assistants would hold them down (doctors could make mistakes if patients moved. patients could die from shock of pain so couldn't do long operations as too painful). the best surgeon was the one who got it done the fasted, not the most skillfully. some people believed pain helped to heal.
THE 3 MAIN PROBLEMS WITH SURGERY: BLOOD LOSS
tourniquets was used to restrict blood flow (which was a risk if the supply was restricted for too long). from 1829, blood transfusions were carried out but often killed patients due to lack of knowledge about different blood types. after surgery, cut blood vessels were sealed with cauterization (painful). sometimes the end of the vessel would be tied with ligatures which would stop the wound from healing properly / cause infection.
when was the "Black Period of Surgery"?
1850-1870
what would patients develop around their wounds that would cause blood poisoning and how was the risk of this increased?
gangrenes - developed into sepsis
longer length operations meant that if blood supply to part of the body was cut off for too long, the risk of gangrene increased
who was a respected surgeon in the 1800s due to his speed?
Robert Liston
who discovered nitrous oxide (and when) and what was it?
1799, Humphrey Davy discovered "laughing gas" (made him laugh / feel giddy). used in fairgrounds as people paid to inhale it.
who first used nitrous oxide as anaesthetic?
1844, American dentist Horace Wells thought it would work as anaesthetic and used it in the removal of his own teeth (but still didn't convince other doctors).
who first used ether (and when) and what was it?
in the UK by Robert Liston in 1846, successfully amputating a leg using it.
what were the problems were ether?
difficult to inhale, caused coughing (made patients wake up in the middle of procedure) and vomiting, highly flammable (people would have operations done at home in front of fire places to avoid hospital infections). the correct dosage was hard to determine
who discovered chloroform - what were the pros and cons
James Simpson - gave surgeons more time to carry out complex operations and could go deeper into the body. (had less problems than ether). caused dizziness, sleepiness, unconsciousness. hard to get the right dosage and affected the heart (physically fit patients died after inhaling it). caused sudden deaths.
what were the oppositions to anaesthetics?
- feared side effects
- overdosage could kill
- opposed it in childbirth as didn't know how it would affect the baby
- people complained they made surgery slow
- doctors were used to operating fast on conscious patients
- thought one was more likely to die when unconscious
when did chloroform start to be accepted?
1853, Queen Victoria was given chloroform during the birth of her 8th child. from then on, it was put in general use
How did John Snow fix the dosages for Chloroform in 1848?
chloroform inhaler which gave the right dosage
how did cocaine evolve as an anaesthetic?
used but wasn't suitable as addictive. 1884, found cocaine could be used as a local anaesthetic as it would numb only a certain area of the body. a safer version was made in 1905 - novocaine
who linked germs to disease and what nickname was he given?
Louis Pasteur (a French research chemist) - the "father of microbiology"
germ theory
the theory that infectious diseases are caused by certain microbes
how did Pasteur discover that microorganisms were the cause of disease?
1857, investigated why vats of beer turned sour. technological development meant microscopes were more powerful so he was able to find microorganisms in beer and suggested this made beer go sour. found that when he heated beer, it didn't go sour. he also tested using milk, wine and vinegar. this confirmed that heating prevented contamination.
what challenge did Pasteur enter in 1860 and what happened?
The French Academy of Science set a challenge to see if Spontaneous Generation could be proved. when he entered, he proved the opposite and showed that if liquid was heated and sealed from air, decay didn't occur.
What were the effects of Pasteur's germ theory?
- still not clear on how German Theory could help develop cures / vaccines
- provided a link between health and hygiene leading to improvements in surgery (less infection and impacts on public health)
- his ideas spread slowly and people refused to believe it
who used carbolic acid and invented carbolic spray?
Joseph Lister - used it to clean equipment, wounds and bandages. death rate from infection dropped.
why did doctors / surgeons not want to use carbolic spray?
surgeons didn't like it as it was smelly and made their hands crack so doctors refused to use it (made job unpleasant + more work + longer operation). they thought speed was most important and wanted to stick with what they knew. they equipment was also expensive.
what were the 4 principles of germ theory?
- The air contains living microorganisms
- Microbes aren't evenly distributed in the air
- Microbes in the air cause decay
- Microbes can be killed be heating them up
when did Pasteur publish his experiments?
1861
after his experiments, where did Pasteur go to work and what did he investigate?
silk industry as he wanted to know why silk worms were dying. in 1865, he proves microbes caused them to be ill and die
THE IMPACTS OF PASTEUR'S WORK (7)
1. many scientists didn't accept his claim (microbes were seen in healthy people's blood so didn't know which did and didn't cause disease)
2. in the 1860s, it was not clear on how germ theory could help develop cures (didn't help cure / prevention)
3. improved understanding = improvements in surgery
4. impact on public health (link between health and hygiene)
5. microbes linked to decay but not yet disease as doctors didn't see the relevance of his work
6. took 30 years to develop vaccines for certain diseases
7. doctors understood what caused disease due to germ theory
who discovered antiseptic and what was he nicknamed?
Joseph Lister after reading Pasteur's work ("The father of anti-septic surgery)
how did Lister discover carbolic acid could be used as antiseptic?
1864, told that it was used at Carlisle Sewage Works to treat sewage. knew it killed microbes and smell associated with infection was similar to the smell of sewage
what was a problem with carbolic acid?
killed both microbes and healthy cells
what was one of the first causes of carbolic acid usage?
11 year old boy, Jamie Greenlees, August 1865
- got a fractured leg and bones struck through his skin. the traditional procedure was to amputate above the fracture
- Lister set the bones and used dressings soaked in acid which Jamie stayed in for 4 days (he complained about irritation due to acid's strength)
- when he took off the dressings, they were heeling well. dressings were replaced
- out of hospital 6 weeks later
in 1878, who identified microbes causing blood poisoning?
Robert Koch
what idea did Koch develop in 1878?
heat could sterilise equipment and dressings - he developed a steam steriliser
how did surgery becomes safer? (2)
- from the late 80s, operating theatres and hospitals were cleaned. masks and closed operating theatres followed
- new industrial technology meant it was possible to manufacture steel implements (could be boiled / sterilised easily). steam steriliser could be used to clean instruments
how was the problem blood loss reduced by Lister?
- he experimented with carbolic acid soaked silk ligatures
- 1881, he published his findings on using catgut for ligatures, which were used to tie off arteries and vessels (when soaked, reduced risk of infection and helped healing process).
when were blood types discovered and who discovered them?
1901, Dr Karl Landsteiner discovered blood types A,B,D. 1902, identified AB. Matching the right type for patients was crucial to prevent death. 1906, discovered O (universal blood type).
what issues were there still with blood transfusions?
successful transfusions depended on the right blood group (the donor had to be present). clotting in tubes was an issue so needed blood storage and clot prevention methods
who developed X-rays?
Wilhelm Roentgen in 1895 (could penetrate opaque materials). in 1896, X-ray machines were common to diagnose fractures and diseases
how did people receive medical treatment in the early 1800s?
Middle-upper class people were able to pay fees to doctors to get treated at home / carry out procedures there (visit by physicians and surgeons)
The poor were looked after by a family member and if they could afford it, they would visit apothecaries (got illnesses diagnosed with no extra charge). poor people in the countryside consulted the local wise women.
GP
General Practitioner (Family doctor), a physician who is not a specialist but treats all illnesses - treated minor illnesses
what were the characteristics of hospitals in the 1800s?
- overcrowded / lack of cleanliness meant high death rates - nicknamed "Gateways to death"
- few toilets and poor sewage system
- nurses criticized for being drunk and dirty
- were used for medical training
where were old, sick, blind, disabled people sent to?
workhouse
what and when was the Crimean war?
war between Russia and Britain from 1854 -> 1856
who was Florence Nightingale?
She was the leader of the first women army nurses in the Crimean War.
what were the conditions in Scutari?
- cholera, typhoid fever, diarrhea
- limited food supplies / bad quality
- rat infestation
- roofs leaked
- hard to get medical supplies to hospital
- hospital built on site of underground cesspool which affected water supply and air
how did Florence Nightingale change conditions at Scutari during the Crimean War?
- cleaned hospital surfaces, sheets, towels, bandages, equipment
- encouraged personal hygiene
- wards organised to separate patients with different ailments
- windows kept open for air circulation as she believed in the importance of fresh air - miasma
- cleaned kitchens and improved food quality
- funds raised allowed new supplies like soap, towels, dining essentials
what drastically reduced death rates during the time of the Crimean War?
the government sanitary commission in 1855, which fixed drains and improved drinking water quality. This is the main reason for why the death rate fell by 40% (from 42% -> 2%)
Florence Nightingale became the first female member of the...
Royal Statistical Society, 1858
when Florence returned to Great Britain in 1856, how was she regarded?
Newspaper reports of her work made her famous. She was regarded as an "expert on nursing and hospitals."
what books did she write which improved nursing and hospitals?
"Notes on Nursing" 1859 - gave advice on importance of ventilation, cleanliness, etc. discussed the role of nurses instead of being cleaners and minders - argued they were a central part of treatment,
"Notes on Hospital" 1863 - detailed cleanliness, safety, ventilation. showed belief in miasma theory and advocated for hospitals to be built with easily cleanable materials and to include isolation wards. wards with windows for comfort.
how was a new era in nurse training established - what hospital was developed?
Nightingale Training School for Nurses - nursing school at St Thomas' Hospital, London, made in 1960
what were the impacts of the Nightingale Training School for Nurses?
made being a nurse an appealing career. better reputation meant a higher number of nurses and a higher quality of nursing care. highlighted the importance of women in medicine (but attitudes towards women in medicine were still slow to change)
who was Elizabeth Blackwell and how was she significant in the role of women in medicine?
An English woman whose family moved to the USA - she became the first woman doctor in the USA. She inspired Elizabeth Garret
Where did Garret become a nurse and what issues did she face with trying to attend medical school?
She became a nurse at Middlesex Hospital. Garrett applied to study medicine at several medical schools, but they all refused to accept a woman student. She then paid for private lessons and dissected corpses in her bedroom because she was not allowed to access the dissecting rooms. Garrett completed a course of medical training but she could not be licensed because none of the three societies that carried out the licensing would accept her as a member.
what did Garret open with the help of her father?
In 1866, with the help of her father, she opened St Mary's Dispensary in London to provide medical treatment for women.
Where did Garret travel to in order to obtain a degree?
Determined to obtain a degree, she taught herself French and went to Paris where she gained a medial degree in 1870.
what happened after Garret returned to England in 1872?
the Dispensary added a 10 bed war staffed entirely by women and it became the New Hospital For Women.
what did Garret help set up along with Sophia Jex-Black?
the London School of Medicine for Women in 1874, which was the only teaching hospital in Britain to offer courses to women In 1873
what accomplishments did Garret make? (what did she become a member of?)
Dr Garrett became a member of the British Medical Association (BMA). She was the only woman to be a member for the next 19 years because the BMA then voted against any further women to be admitted. In 1908 she also became the first female mayor in England
what did Sophia Jex-Black do?
In 1869 Sophia Jex-Blake led four other women who persuaded Edinburgh University to let them study medicine. They had to pay additional fees to cover the cost of them being taught separately from the male students. They also faced opposition and harassment from other students and were not allowed to do practical work. In 1874 the university decided to force the female students to leave, claiming that it had not the authority to admit female students when they were accepted in 1869. Sophia Jex-Blake gained her medical degree
what were the effects of the campaign Sophia Jex Blake?
attracted national attention and won them many supporters like Charles Darwin. Put the rights of women to university education on notional political agenda.
what did an act of parliament do which allow women to be medical students?
1876, Act of Parliament said universities and medical societies should accept women medical students and allow them to become doctors.
what did Paul Ehlrich do?
made a magic bullet which targeted specific orgsnisms which caused disease.
what did Ehlrich call his magic bullet?
Salvarsan 606
what did John Snow use to find why people caught cholera from drinking fron the pump on Broad St.?
epidemiology
what was the Public Health Act of 1848?
Edwin Chadwick observed workhouses and published the sanitary conditions of the labouring population. He suggested to to use money from taxes to improve living conditionsof the poor. consisted of setting up general and local board of health, setting up a sewage system and organising the removal of rubbish and lighting up streets.
what was the public health act of 1875?
an important law in the UK to make sure people lived in healthy and clean places. It set up groups in towns and villages to look after public health, like making sure houses had clean water and proper toilets. The law also said that if someone made their area dirty or caused problems for others, they could get in trouble with the law. This law helped make cities cleaner and healthier for everyone.
what was the 1848 sanitary act?
all towns should employ inspectors to check on water supply & drainage. The Sanitary Act of 18 was a law in the UK that aimed to make towns cleaner and safer. It required towns to keep streets clean, well-lit, and free from things that could be harmful, like garbage or obstructions. The law also gave towns the power to make rules about these things and punish those who didn't follow them. It was an early step towards making cities healthier places to live.
who was Joseph Bazelgette?
he was employed to build a sewer systembecause of the Great Stink
who developed vaccines?
Pasteur developed vaccines for rabies
where did Pasteur link microorganisms with disease?
Germ Theory of infection
Artisans Dweliings Act 1875
gave local authoraties power to buy and demolish slum buildings
food & drugs act
helps with improving the quality of food being sold
who was Emil von Behring?
he identified antitoxins by the body to fight diphtheria in the 1890s
what did Marie Curie do?
she made important discoveries of x-rays and how it could help people. it helped doctors diagnose illnesses and injuries. she laid the foundation for radiation therapy which helped with treating cancer. she deployed mobile radiography units nicknamed “little curies” helping medical care of soldiers during ww1
infectious disease act
meant that new infectious diseases needed to be reported
national insurance act 1911
helped for when workers became ill and cant afford healthcare so they are given free health care. It made it mandatory for workers and their employers to pay into a fund called National Insurance. provided to people who were sick, unemployed or old age
children and young persons act
protected children from tobacco or alchohol, prevented children for begging and being neglected, it provides children with free school meals and check ups
what did Louisa Garrett and Flora Murray join
the Women’s hosplital corps, a medical unit staffed entirely by women providing medical care to wounded soldiers in France
what did Mairi Chisholm & Elsie Knocker join in Belgium?
they joined a small ambulance corps called “the angels of Pervyse”, they operated a first aid post near the front line during the war
who used sodium citrate to stop blood clots?
Richard Lewison
who developed the Thomas Splint?
Robert Jones so soldiers would be able to keep their broken limbs still
who first discovered pencillin?
Alexender Fleming doscovered that it could be used to fight microorganisms causing infections although he wrote articles about it he wasnt able to get the funding to mass produce it
who mass produced pencillin?
Howard Florey & Ernst Chain founded Norman Heatly who was able to make equipment cheaply to purify pencillin, before america joined the war they were able to get america to fund them and so they were able to mass produce it
who thought of using magnets as treatment?
Harvey Cushning found that they were effective to use to draw out metals from wounds
who discovered prontosil?
Gerhard Domagk found that it could be used to kill streptococcus infections, pneumonia & scarlet fever
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