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Changes in Medicine (1848-1948), How was WWI a catalyst for change? -…
Changes in Medicine (1848-1948)
Public Health
Context:
Though there were vaccines available, few people had been vaccinated and diseases such as Typhoid fever, Influenza or Cholera had no cure.
The belief that disease was spread by miasma made people believe that Cholera only affected poor people who were living in unhygienic conditions. As a result, MPs didn't take much action and left the local authorities to deal with it.
The
1948
PHA:
Edwin Chadwick was a civil servant who worked for the poor law commissions (1830s -40s)
In his 1842 report,
The Sanitary Conditions of the Labouring Population
, Chadwick called for more of taxpayers money to be spent on improving the housing and living conditions to keep them healthy
A General Board of Health was set up for 5 years
Limitations
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Local Councils were encouraged to make public health improvements
3 commissioners were put in charge of the Board of Health (including Chadwick)
Organised removal of rubbish
Built a sewer system
Context:
The
1866 Sanitary Act
made local authorities responsible for sewers
The
1875
PHA:
The 1875 Public Health Act went further, making local councils responsible for a range of public health measures which impacted housing and hygiene.
Impact of the 1875 PHA:
Local authorities had to appoint a Medical Officer who would be in charge of PH
Street hygiene & housing:
Keeping the streets clean reduced the number of mice, rats and flies, and reduced the chance of passing on disease.
Lighting the streets meant people could avoid rubbish and dirt.
Inspecting new houses ensured there was sufficient lighting and ventilation to be healthy. Slum houses could be demolished.
Food:
Inspecting the quality of food for sale reduced the chance of people being made ill by poor quality or infected goods.
Water hygiene and sewage:
Providing clean water meant there was less chance of catching waterborne diseases such as cholera or typhoid.
It was made illegal for factories to dump their waste into rivers.
Ensuring sewage was properly treated and couldn't contaminate the water supply which reduced the chance of passing on disease
The NHS:
Early 20th century:
New laws had been passed that gave the government a role in keeping individuals healthy.
1939:
Emergency Medical Service
created tto help co-ordinate hospitals and healthcare
Beveridge's report identified 5 key problems, named the 'Giant Evils:'
Want -
Problems of poverty and not having enough money or food
The Welfare State
1945:
at the end of the war, the labour government was elected. PM Clement Attlee announced that a
welfare state
would be set up to ensure everyone had an acceptable standard of living
Welfare system would be funded by National Insurance contributions (founded
1911
by
Lloyd George
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Disease
Ignorance -
Lack of education, meaning people were unlikely to get better jobs or to develop a better understanding of society
Squalor -
Living in dirty and unhygienic conditions
Idleness -
Unemployment, meaning people were more likely to become depressed and possibly turn to alcoholism or crime
The London Sewer System
1858:
'The Great Stink'
exposed the rubbish and excrement that had accumulated on the river banks of the Thames. MPs decided whether their meetings should be held in a different location but later realised that action needed to be taken
18 days later,
an Act provided £3 million to the
London Metropolitan Board of Works
to improve the sewage system
Chief engineer Joseph Bazalgette put in charge
Bazzalgette's ideas
Design of sewers:
Large, oval & made out of brick as sewage was less likely to get stuck in oval tunnels
Move the exit further down:
Waste should be brought down to the lower stretches of the Thames so sewage would be washed out to the sea
The Broad Street Pump
1849:
John Snow (Chloroform inhaler guy) suggested that Cholera was being spread by polluted water
1854:
Another Cholera outbreak
Snow investigated the outbreak in Soho, London and found that most of the deaths centred around a pump on Broad Street
Handle was removed from the pump and deaths from Cholera stopped
Later found that there was a crack in the brick wall lining the cesspool which leaked into the Broad Street Pump
Effects
Snow had proved the relationship between Cholera and infected water
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Role of Authorities
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Disease
Previous myths
The 4 humours
developed based on what Ancient Greeks could see (symptoms)
The 4 humours:
Blood, Yellow bile, Black bile, Phlegm
Believed that disease was caused by imbalance in these humours. Treatments were based on
theory of opposites
Miasma
Disease was carried by unpleasant smells and harmful fumes in the air
People understood that there was a higher rate of disease in dirty, unhygienic places.
Spontaneous Generation
Idea that rotting material created maggots, then fleas, then disease
Scientists at the time knew microorganisms existed but little research had been done on them
Doctors'' knowledge
Understanding of the body was also limited
Doctors would observe the body through a few dissections during training but they weren't common
This made it difficult to do any thorough research pm the syptoms of disease
Pasteur &
Germ Theory
1854:
Pasteur was asked to investigate why beer was turning sour
He found that the beer contained microorganisms
According to the theory of spontaneous generation, microorganisms should have only appeared while the mixture was decaying. Pasteur didn't believe this
He suggested that microorganisms were the ones that were making the beer go sour
Theory was proved when he discovered that the microorganisms could be killed by heating the liquid. If this was done, the beer did not go sour
Further experiments showed that mixtures turned bad when left in the open air, showing that microorganisms were carried in the air.
Different samples were collected from different locations. He found that air was 'cleaner' in mountains than in cities as they contained less micro organisms. This showed that microorganisms weren't evenly distributed
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Koch &
Anthrax
Anthrax was a disease in farm animals that was spread through infected blood
Koch was interested in Pasteur's ideas and wanted to prove that the anthrax microorganism was the one that caused the disease Anthrax
1876:
Koch discovered the anthrax microorganism caused Anthrax and published his work
He developed methods of staining and photographing microorganisms
1878:
Published his work on bacterial infections of wounds
Significance of Koch's work
Showed that his lab test techniques could be used to investigate a number of diseases and could lead to new ways of preventing disease
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Though he was a doctor, he focused on the cause rather than treating the symptoms of the disease. Investigated microorganisms in lab tests
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Developed idea of using industrial chemical dyes to stain microorganisms. This made they easier to study under the microscope
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Identified microorganisms responsible for tuberculosis and cholera
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Developed the use of agar jelly to grow cultures
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Fleming &
Penicillin
Pasteur &
Cholera
Pasteur & his scientists studied chicken cholera by injecting chickens with a culture of the bacteria
When Pasteur's assistant went on holiday, a culture of the bacteria was left on the side and not used until a few weeks later
The chickens injected with this culture didn't develop chicken cholera
They were then injected with a fresh culture, but they still didn't catch cholera
They realised that the bacteria had been weakened while it had been left out. So the chicken knew how to fight the Cholera.
This provided understanding on how to use vaccines in the future
Pasteur &
Anthrax vaccine
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Mary Curie &
Radiation
1891:
Moved to Paris and married physicist, Pierre Curie
Henri Becquerel discovered radioactivity. Marie and Pierre began to work together on radioactive material.
1898:
They announced the discovery of Polonium and Radium
1903:
Becquerel and Curies awarded Nobel Prize for Physics due to their work on radiation
1910:
Radium Institute was created for Marie Curie in the University of Paris so she could continue researching on radium
Curie led research into using radioactivity to shrink or kill tumours
How it works
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Surgery
Pain
Before 1840s:
Most patients were awake while operating
Only types of pain relief were alcohol or being knocked unconcious
The best surgeon was the one who cut the quickest
Robert Liston was famous for his 28 second long amputation
1844-5
Nitrous oxide (laughing gas) was known to make people unaware of the pain
Was used in dentistry by Horace Wells but not considered suitable for surgical operation
1846
Dentist William Morton (USA) experimented with ether and found it had a stronger effect
Robert Liston heard about Morton's work. He used ether in a leg amputation which amazed the audience as the patient didn't need to be held down and was unaware of the operation
Drawbacks
irritated lungs, could leave the patient asleep for hours or days, Gas was flammable
James Simpson experimented on other various gasses until he discovered chloroform.
1847:
Chloroform didn't have the same side effects as ether. First used it for women in childbirth.
Drawbacks:
Doctors were unsure how chloroform would affect the baby
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1848
1853
Queen Victoria used chloroform on her 8th child. Simpson was her official physician
Newspaper publicity and royal approval increased popularity of chloroform. More patients requested for it during surgeries
1884
Cocaine was used
before
this but not very suitable as it was addictive
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1905
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John Snow invents chloroform inhaler
Blood loss
1840s
Tourniquet would be used to reduce blood flow in the artery
Blood vessels that were cut were sealed painfully by
cauterisation.
This involved placing a hot iron against the vessel and sealing the ends by heat.
1848
The extended operations after chloroform increased risk of gangrene if blood supply was cut for too long
1881
Lister had been experimenting with ways to reduce blood loss
Ligatures were threads tied to the end of blood vessels but they could become hard and prevent the wound from healing or be a source of infection
Lister experimented with silk ligatures soaked in carbolic acid but they weren't always effective
Lister and catgut
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1901-07
Blood transfusions in the past often lead to death but people couldn't understand why
1901:
Austrian doctor Karl Landsteiner discovered blood types A,B & O (
AB
discovered in
1902
).
Doctors realised that patients can die if given the wrong blood type (
O
found to be universal donor in
1907
but reason was not fully understood)
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1915
American doctor Richard Lewisohn discovers that adding sodium citrate could stop blood clotting
Impact
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Richard Weil found that blood could be stored longer when refrigerated
Impact
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Lawrence Bruce Robertson pioneered use of indirect transfusion - transfusing blood
before
surgery
Impact
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1916
Francis Rous & James Turner found that adding glucose citrate increased the time blood could be stored (4 weeks max).
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Operations had to be quick to minimise blood loss
Infection
1840s
Even if patients survived the surgery, a high percentage would die from infection
Operations were carried out in the patient's home
Surgeons would wear old, stained clothes and no sterilisation of equipment or washing hands was done (some did but rarely) due to lack of understanding about infection.
1847
Florence Nightingale goes to Scutari
Nightingale and her team of nurses:
Scrubbed surfaces clean
Windows were opened to improve flow of air (she believed in miasma)
New supplies bought
Washed sheets, towels, bandages and equipment
Cleaned kitchens and improved quality of food
Conditions at Scutari:
1861
Joseph lister, Surgeon at Glasgow Royal Infirmary
He read Pasteur's work and also learned that carbolic acid was used in sewages and he linked it to microorganisms.
He used the carbolic acid to clean wounds, equipment and bandages
Death rate dropped by 30%
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1878
Robert Koch invents steam steriliser
Pasteur had shown that microorganisms could be killed by heat. Koch used this idea to sterilise equipment
Aseptic surgery -
Preventing microorganisms rather than curing them
Operations were carried out in
clean
operating theatres
No spectators
Surgeons wore clean clothes including rubber gloves and masks
1895-WWI
X-rays
Wilhelm Röntgen discovers X-rays and publishes his findings
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1915
1917
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The Thomas splint
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1846-66
'Black Period' of surgery due to how unhygienic operating conditions were.
Brain surgery
Little surgery on the brain pre-WWI
Harvey Cushing (USA) experimented with the use of magnets to draw out pieces of metal from the wound
Using local anaesthetic was also found to be better than general anaesthetic since general caused the brain to swell.
The role of women
Florence Nightingale
Elizabeth Garrett
First female physician in UK
Influenced by meetings with Elizabeth Blackwell (first female physician to receive a degree in the US)
Denied entry to medical schools
Number of schools refused to train her
Decided to train as a nurse in Middlesex Hospital
Tried to go to lectures for male doctors but was banned after complaints
Enrolled to train as a doctor at Society of Apothecaries
1865:
Passed her exams and received certificate to practice medicine
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Practising medicine
1866:
Set up a dispensary for women
1870:
Started visiting patients at East London Hospital
Gaining a degree
Studied at University of Paris
Gained degree but British Medical Register refused to recognise her qualification
Changes for other women
1872:
Garrett established the New Hospital for Women in London
1883:
Became Dean of London School of Medicine of Women
Others
How was WWI a catalyst for change?
Medical equipment
Infections
Trenches, particularly in France were dug in farmlands which had soil that was covered in manure. Wounds were frequently exposed to this.
Trench foot was a common type of fungal infection caused by damp and unclean conditions
Affected 75,000+ British soldiers
Solution
Whale oil which helped reduce the number of cases by
1917
Gas gangrene was a kind of infection caused by the bacteria in the manure
The infection often resulted in an amputation or loss of life
Solution
British bacteriologist Almroth Wright proposed revolutionary methods on how to treat war wounds.
He strongly opposed the traditional method of pouring antiseptic into an open wound and then closing it up
His research from many case studies from the European battlefields helped to persuade his peers that his method would work
His proposal was to first clean out all foreign bodies
e.g: shrapnel & soil
and leave the wound open to let the body to do its natural healing process
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Plastic surgery
Context
600 B.C:
The world's first written record of a plastic surgery operation was written by an Indian surgeon called Sutra
Sutra used a leaf as an outline to help him cut into the skin to create a flap
The flap from the cheek or forehead would be rotated to create a new nose
During the Renaissance period, many young people would get into duels sometimes even with swords drawn. As a result, many sustained major facial injuries
e.g: losing a nose
Italian surgeon Gasper Talicotsi developed a way of taking skin from the upper arm and grafting it onto the face.
The patients hand would be brought up in a harness to attach the skin to the nose for 3 weeks.
The flap with the new blood supply from the face could now be cut and the tissue on the face was reshaped into a nose
1846:
World's first operation performed under anaesthetic
WWI
Lots of sharp shrapnel caused by bombardments caused lots of cuts and facial wounds
Trench warfare meant soldiers' heads were particularly vulnerable
Surgeons first tried to sew up the large holes
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WWII
Pilots who got shot down often got serious burns if they survived the crash
At the start of the war, standard treatment of burns was to bathe them in acid, completely drying out the tissue and turning skin into leather
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