Changes in Medicine, C1845-C1945

Changes in Medicine, c1845-c1945

Revision Guide

Part 1: Exam questions

Paper 2, Part B (25 marks in total)

Focus: change over time…

a)Source comprehension (3 marks)

b)Explanation of key features (7 marks)

c)Change over time (15 marks)

a)3 marks / Give 3 detailed examples from the source – you don’t need to quote the source. Just tell the examiner what you have learnt from the source itself.
b)7 marks / A key feature is a CAUSE, EVENT, RESULT of something. In this question you are to write 2 PEE paragraphs and then link your PEE paragraphs together (just think of your structure for an 8 mark question in paper 1)
c)15 marks / In this question you are to write 2 or more PEEL paragraphs about change over time. You will also need to write a conclusion that will have a reasoned judgement about change
Question (a)
3 marks / 1 mark / 2 marks / 3 marks
I give 1 example / I give 2 examples / I give 3 examples
Question (b)
7 marks / 1-2 marks / 3-4 marks / 5-6 marks / 7 marks
I have made simple POINTS in my answer about the key features. / I have made a clear PEE paragraph about the key features. The evidence will show the 5W’s clearly and the explanation of the key features. / I have made 2 clear PEE paragraph about the key features. The evidence will show the 5W’s clearly and the explanation of the key features. / I have linked both my PEE paragraphs together in my conclusion.
Question (c)
15 marks / 1-4 marks / 5-8 marks / 9-12 marks / 13-15 marks
I have made a clear PEE paragraph about change. The evidence will show the 5W’s clearly and the explanation of why things have changed. / I have made 2 clear PEE paragraph about change. The evidence will show the 5W’s clearly and the explanation of why things have changed. / I have made 2 or more PEEL paragraph about change. The evidence will show the 5W’s clearly and the explanation of why things have changed and linking these paragraphs together. / My conclusion has a reasoned judgement about the change in the investigation

Part 2: Content

B2 Changes in medicine, c1845-c1945

1. Medical knowledge and understanding in the midnineteenth century
2. Changes in surgery and in understanding the causes of disease
3. Changes in hospital treatment and the role of women in medicine
4. Developments in public health provision
5. The importance of the two world wars in bringing about change

1. Lack of understanding of causes of disease. Dangers in surgery. Attitudes to women and medicine, nursing and public health provision. Problems in public health.
2. Anaesthetics and antiseptics: the work of Simpson and Lister, early opposition, impact of surgery in the nineteenth century. The battle against germs: work of Pasteur, Lister, Koch, Ehrlich, Fleming, Florey and Chain. Importance of penicillin.
3. Florence Nightingale and Scutari. Changes and improvements in nursing. Elizabeth Garrett and the progress of women in medicine. Improvements in hospitals. Work of Lister. Influence of the two world wars on the role of women in medicine.
4. Impact of cholera. The work of Chadwick and Snow and public health reform in the nineteenth century: The Public Health Acts of 1848 and 1875 and their impact. Liberal measures 1906-11.
5. Importance of the First World War for medicine, surgery, X-rays, blood transfusion and fighting infection. Importance of Second World War for the development of penicillin, treatment of burns and skin grafts, blood transfusion and public health.

B2 Changes in medicine, c1845-c1945
Medical knowledge and understanding in the mid nineteenth century
Lack of understanding of causes of disease. Dangers in surgery. Attitudes to women and medicine, nursing and public health provision. Problems in public health.

• Lack of understanding of causes of disease

Medicine before 1800’s:

•There was little progress in medicine between 1750-1800.

•No one at this time knew what caused illness…

•Some people believed that illness was caused by MIASMA – a poisonous cloud containing germs.

•Others believed God was punishing them.

• Dangers in surgery

•80% of surgeries resulted in death

•The most common surgeries were:

•Caesarean sections

•Amputations

•Removal of kidney stones

•The main issues were:

•Blood loss

•Pain and Shock

•Infection

•Doctors did not perform surgeries in clean environments; some used the same equipment between patients without cleaning them and they did not clean their clothes between operations.

• Attitudes to women and medicine, nursing and public health provision

•Women had no place in medicine – they were only involved as mothers or ‘wise women’

•To become a doctor you needed to go to University. Women were not allowed to study at University, and even secondary education for women was uncommon.

•There were some women, who became doctors, despite the law! Such as Elizabeth Blackwell, Elizabeth Garrett and Sophia Jexblake.

•It wasn’t until 1876 that women were given the same rights to university education as men. This meant that women were now legally allowed to train as doctors.

•Nurses were NOT respected women: Nurses in the 1800s (before Nightingale changed people’s attitudes) were often dirty or drunk.

•Nursing did not require any training and was badly paid.

•Nurses frequently had reputations for being drunks and causing the deaths of patients

• Problems in public health

•Public health was appalling – then conditions in towns meant that disease and illness spread easily…

•Conditions in the 19th Century towns:

B2 Changes in medicine, c1845-c1945
Changes in surgery and in understanding the causes of disease
Anaesthetics and antiseptics: the work of Simpson and Lister, early opposition, impact of surgery in the nineteenth century. The battle against germs: work of Pasteur, Lister, Koch, Ehrlich, Fleming, Florey and Chain. Importance of penicillin.

• Anaesthetics and antiseptics: the work of Lister and Simpson

Joseph Lister / James Simpson
Antiseptics / Anaesthetics
After Pasteur published his GERM THEORY, Lister experimented with Carbolic acid and discovered an effective antiseptic in 1867. / Discovered the effective anaesthetic, Chloroform in 1847.
He experimented with ether (another anaesthetic) and hydrochloric acid and discovered chloroform.
Who was Lister?
Lister was born in 1827 and died in 1912. He was a Professor of Surgery at Glasgow University, and believed that washing your hands before operations helped stop the spread of infection. In 1865, Lister read about the work done by Louis Pasteur on Germs. Lister believed that it was microbes carried in the air that caused diseases to be spread in wards and believed that if the wounds were thoroughly cleaned, infections could be prevented.
Lister was one of the outstanding surgeons of the nineteenth century. He had researched gangrene and infection, and had a keen interest in the application of science to medicine. That was why he knew all about Pasteur’s work on germ theory, which helped to spark the idea for his own discovery.
He experimented with using carbolic in treating people who had compound fractures where the bone breaks through the skin. Infection often developed in these open wounds. Lister applied carbolic acid to the wound and used bandages soaked in carbolic. He found that the wounds healed and did not develop gangrene
How did Lister help to change surgery?
Despite opposition, Lister’s methods marked a turning point in surgery. In 1877 he moved to London to train young surgeons. Then came a link to another great name in medical history. In 1878 Robert Koch discovered the bacterium which caused septicaemia (blood poisoning). This gave a great boost to Lister's ideas.
Aseptic surgery
By the late 1890s Lister’s antiseptic methods (which killed germs on the wound) developed into aseptic surgery, which meant removing all possible germs from the operating theatre. To ensure absolute cleanliness:

• Operating theatres and hospitals were rigorously cleaned.
• From 1887 all instruments were steam-sterilised.
• Surgeons abandoned operating in their ordinary clothes and wore surgical gowns and face masks.
• In 1894, sterilised rubber gloves were used for the first time. For, however well surgeons ’hands were scrubbed, they could still hold bacteria in the folds of skin and under the nails.

/ Who was Simpson?
James Simpson was born in 1811 Edinburgh. Studying medicine at 15, Simpson watched many operations and wondered if there was a drug that would put people to sleep without harming them. He passed his exams for the Royal College of Surgeons and in 1836 became a doctor at an Edinburgh hospital. In 1840 he became Professor of midwifery at Edinburgh.
He reorganised the teaching of the subjects, and made it an essential part of every medical student’s training. Over the years he became more and more concerned about the suffering endured by women during childbirth.
How did he discover Chloroform?
Simpson started his own experiments. He decided to use Ether as a base and mix it with other substances. He tried a mixture of Hydrochloric Acid and Ether (later to be called CHLOROFORM). At dinner one night he sniffed it in from of the family and immediately passed out. On November 4th 1847 he conducted an experiment to test the usefulness of chloroform.
Why is it important?
Within fourteen days Simpson completed 50 successful operations using Chloroform. It was first given by a sponge soaked in the liquid pressed to the patient’s nose. Later special inhalers were developed. In 1852 Queen Victoria used it during the birth of Prince Leopold and it soon became completely accepted. Twenty years after it was first tired it was used throughout Europe and in 1866 Simpson was knighted. He died in 1870. Chloroform remained the chief method of anaesthesia well into the Twentieth Century.
“Infection” / “Pain and Shock”

• The battle against germs

Louis Pasteur / Robert Koch / Paul Ehrlich / Alexander Fleming / Howard Florey and Ernst Chain
December 27, 1822 – September 28, 1895) was a French chemist and microbiologist renowned for his discoveries of the principles of vaccination, microbial fermentation and pasteurization. / Robert Koch was born in 1843. Koch worked on anthrax and tuberculosis (TB) and he further developed the work of Louis Pasteur. / German physician and scientist who worked in the fields of hematology, immunology, and antimicrobial chemotherapy.
He invented a way to identify different bacteria / Scottish biologist, pharmacologist and botanist. His best-known discovery is Penicillin (from the mould Penicilliumnotatum) in 1928, for which he shared the Nobel Prize in 1945 with Florey and Chain. / Florey was born in Australia and Chain in Germany, and they worked together at Oxford University doing research into the production of penicillin. In 1945, Florey and Chain shared a Nobel Prize with Alexander Fleming.

Pasteur and germ theory

Pasteur was the first to suggest that germs cause disease. Micro-organisms had been seen through 18th century microscopes, but scientists thought they were caused by disease and appeared because of illness. This was the theory of spontaneous generation. Instead of blaming the microbes, people looked for noxious gases called miasmas.

Louis Pasteur was employed in 1857 to find the explanation for the souring of sugar beet used in fermenting industrial alcohol. His answer was to blame germs in the air. Pasteur proved there were germs in the air by sterilising some water and keeping in a flask that didn’t allow airborne particles to enter. This stayed sterile – but sterilised water kept in an open flask bred micro-organisms again.

Robert Koch

A German scientist Robert Koch began the process of linking diseases to the microbe that caused them. Koch developed a solid medium to grow cultures and dying techniques to colour microbes, which he viewed through high-powered microscopes.

Hearing of Koch’s work, Pasteur came out of retirement in 1877 and started to compete in the race to find new microbes and combat them. Pasteur looked for cures to anthrax and chicken cholera. Both he and Koch worked with large teams of scientist in the Franco-German competition for national prestige. Pasteur’s theory was a huge turning point for medicine. His theory allowed others to build on his work and identify microbes and ways to combat them.

Paul Ehrlich and Magic Bullets

Paul Ehrlich made an important breakthrough in drugs. He called the antibodies produced naturally by the body ‘magic bullets’ as they fought specific germs without harming the rest of the body.

At first, he tried to extract them to cure ill patients, but they did not always work. So he began to look for synthetic chemical ‘magic bullets’ to cure disease. As part of Koch’s team, he had used dyes to stain microbes. After 1899, he tried to see if the dyes would kill the germs. In this, he was helped by advances in the German chemical industry, which was producing synthetic dyes. Although he found dyes that attacked malaria and sleeping sickness germs, he had only limited success at first.

In 1906, Ehrlich began to search for a chemical ‘magical bullet’ to cure syphilis. In 1909, after Ehlich’s team had tested over 600 dyes, SahachiroHata joined the team. He retested the dyes and found that dye 606 worked – this became known as Salvarsan 606. After testing it on hundreds of animals deliberately infected with syphilis, it was first tried on a human in 1911. However, there was much opposition to this discovery – it was difficult and painful to inject and some feared it would encourage promiscuity.

Alexander Fleming and Penicillin

Fleming had become interested in how to deal with wounds that became infected. He noted that the antiseptics used were not very effective. In 1928, he began work on staphylococci. One day, by chance, he noticed that mould was growing on some Petri dishes. He noticed no germs were growing near the mould. He grew more of it and found it killed many deadly germs. A colleague identified the mould as belonging to the penicillium family. Although he tried to purify the ‘mould juice’, the necessary chemical skills were unavailable. After Fleming had tested the mould on animals, and showed it did no harm, he tried it on a colleague’s eye infection. Again, it worked, and did not harm body tissues. This was a big improvement on chemical ‘magic bullets’. Fleming wrote up his research and called the ‘mould juice’ penicillin. He did not try to make pure penicillin.

Florey and Chain and Penicillin

Howard Florey and Ernst Chain took the next important steps with penicillin. In 1938 they decided to study germ-killing substances. They came across Fleming’s article and tried to produce pure penicillin. Penicillin was successfully tested on a human for the first time in 1940. At first, the patient improved but, when the supplies were used up, he died. Florey and Chain did not have the resources to manufacture large quantities of the drug. When war broke out in 1939, Florey pointed out to the British government how the drug could cure infections in deep wounds. The government were too involved in making explosives to provide resources. Florey approached US chemical firms and after Pearl Harbour in 1941 he was given financial help. Mass production of penicillin began in Britain in 1943. By 1944, there was enough penicillin to treat all wounded Allied forces in Europe. After the war, even better methods of mass production led to reduced costs. Soon penicillin was used to treat a whole range of diseases.

Importance of penicillin

The discovery, development and subsequent use of penicillin can be considered to be one of the most important breakthroughs in medical history.

Penicillin prevents a large number of germs from growing. As it is an organic substance it can be used on, or in, the human body. This meant that for the first time something was available that could, potentially, prevent the decay of the body or infection from germs whilst operating.

The immediate impact of the discovery is clear. The drug was developed quickly in the War years by the American government. By developing the drug so readily and so quickly the US Governemtn prevented many soliers from having war wounds becoming infected: the drug therefore saved a lot of lives and, it could be argued, played a role in helping to win the war for the Allies.

B2 Changes in medicine, c1845-c1945
Changes in hospital treatment and the role of women in medicine
Florence Nightingale and Scutari. Changes and improvements in nursing. Elizabeth Garrett and the progress of women in medicine. Improvements in hospitals. Work of Lister. Influence of the two world wars on the role of women in medicine.

• Florence Nightingale and Scutari and changes and improvements in nursing.

Florence Nightingale (1820-1910): During the Industrial Revolution, the poorer classes often relied on informal midwives and ‘wise-women’. The first signs of change came in nursing following the work of Florence Nightingale during the Crimean War. During her time there the death rate in Scutari fell from 43% to 2%. She believed disease was caused by miasma and emphasised cleanliness and fresh air. Her work was reported in British newspapers.

Mary Seacole also played an important part in improving nursing care during the war. However, probably because she was a black woman from Jamaica, she was not given much credit and was not allowed to work as a nurse in England after her return.

As a result of these developments nursing started to become a respectable medical profession. In 1859 Florence Nightingale’s book Notes on Nursing was published and a public fund was launched to raise money for a proper nursing school. The Nightingale School of Nursing was based at St.Thomas’ Hospital, London. Other training schools followed. By 1900 there were 64,000 trained nurses. Florence Nightingale also wrote over 200 books about hospital design and organisation.

The impact of Florence Nightingale:

Florence Nightingale’s work had far greater impact in the long run. She was not a hands-on nurse but a great organiser, convinced that her life’s work was to improve conditions in hospitals and training of nurses for the good of the patients. Those skills and beliefs were visible in the Crimea where she concentrated on improving hygiene and cleanliness. She continued to focus on these aspects of care throughout her life. One surprising thing about her was that she paid little attention to Pasteur’s germ theory when it appeared in the decade after the CrimeanWar. Like Chadwick, she had been brought up in the early 1800s when miasma (bad air) was the main theory about what caused disease. She continued to associate disease with dirt and this is why she concentrated on improving: