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Medicine History - Coggle Diagram

- - - - mobile x-ray machines used to treat soldiers in the home front efficiently, this allows injured soldiers to be treated quickly as any shrapnel can be located and taken out
      - techniques where x-rays were taken at two angles were developed to locate shrapnel efficiently
    - - the glass tubes used for x-rays would overheat after about an hour of use, and extreme doses of radiation was also harmful and could cause skin burns
      - the patient would have to stay still for some time as the x-ray was taken, this was difficult for soldiers in extreme pain
      - x-rays can't identify bits of clothing
  - - - but the demand for blood increased and blood still can't be stored for prolonged periods of time
  - - - Harvey Cushing developed a technique using two magnets to draw out pieces of metal so now soldiers with bullets or metal shrapnel in their head can be taken out
      - it was found that using local anaesthetic was better when working on the brain as general anaesthetic made the brain swell
      - little had been done on brain surgery before this
      - limitations
        
        now along with the problems of infection and blood loss, there was also the problem that patients would be confused or unconscious
    - - Gillies experimented with using bits of bone or cartilage to construct features of the face
        He also developed a technique called pedicle tubes --> a flap of skin would be grown on so blood supply is maintained before attaching the skin transplant fully, this meant that the chances of rejection would be low and the transplant would succeed
      - this meant that soldiers now had a chance of having a normal appearance as the war caused lots of damage to the face
      - limitations
        
        anaesthetics weren't fully developed yet at this point so it was difficult to operate on the face as a chloroform mask couldn't be used
  - - - but the solution only lasted 6 hours and so had to be made as and when it's needed, which is a problem when there are hundreds of wounded men needing treatment
- - - - Scutari
        
        Conditions
        
        Many men were sharing beds or lying on the floors in the corridors
        
        Their clothes were infested with lice and fleas
        
        Disease such as typhoid fever and cholera were common
        
        Many patients had diarrhoea
        
        It was difficult to get enough medical supplies such as bandages and medicine to the hospital
        
        Food supplies were limited and of poor quality
        
        Roof leaked
        
        Wards were dirty and infested with rats and mice
        
        The hospital was actually built on the site of an underground cesspool, where human waste collected. This effected both the water supply and the air in the hospital
        
        What did Nightingale achieve
        
        Scutari: what did Nightingale do when she arrived at Scutari Hospital (Crimean War 1854) and what was the impact?
        
        Her habit of making a final round at night, checking on all the patients, gained her the nickname of ‘The Lady with the Lamp’ and made her very popular with the patients and back in Britain
        
        She immediately cleans the place with her team when she arrives, opening windows for ventilation, improving food,
        
        Nursing and training: what impact did Nightingale have on nursing and training? (School for Nurses in 1860, Notes on Nursing in 1859):
        
        Wrote Notes on Nursing in 1859
        
        In this book, she gave advice on the importance of ventilation, light, bedding, cleanliness and food for the patient.
        
        She also discussed the nurse’s personal cleanliness and the nurse’s role in observing the patient and reporting to the doctor.
        
        This book was translated into 11 languages which shows that her ideas about practical care and the importance of training for nurses had great influence even outside Britain
        
        In 1860, the Nightingale School for the training of nurses was established at St Thomas’s Hospital in London.
        
        Nightingale also helped to set up a training school for midwives at King’s College Hospital, London, in 1861.
        
        Nightingale wrote over 200 books on hospital design and nursing
        
        Gave evidence to parliament and met Queen Victoria
        
        Inspired many others to copy her ideas and high standards
        
        What impact did she have on conditions in hospitals? (Notes on Hospitals in 1859):
        
        She felt it was important to keep everything clean, to have lots of fresh air, and to have space between the patients’ bed
        
        These ideas were used when new hospitals or new wards were built (these wards were often called nightingale wards)
        
        Limitations
        
        There are a number of reasons why Nightingale’s significance has been questioned. Explain why for each of the following:
        
        Miasma and Germ Theory (what did she believe and how did this influence her actions?):
        
        The miasma theory was proved wrong however it still improved the cleanliness of the area and decreased the rate of infections
        
        The death rate at Scutari (when did this reduce and why?):
        
        The death rate at Nightingale’s hospital was higher than at the other hospitals, even with all her improvements. It was not until 1855, when a government sanitary commission repaired the drains and improved the supply of drinking water, that the death rate began to fall dramatically
    - - officially qualified to practice medicine in 1865
      - Medical schools at the time didn't accept women, and societies that provided medical licenses didn't accept women either
        
        she paid for private lessons and even dissected corpses in her own bedroom, and attended lectures meant for her male peers until they complained and kicked her out
        
        her father threatened to sue the Society of Apothecaries if they didn't accept Garrett, but after accepting her they changed the rules so that no other women can be accepted
      - 1866: her father helped her open St Mary's Dispensary in London, which provides medical treatment for women
      - After she returned in 1872 from getting her medical degree in France, the the Dispensary added a 10 bed ward and it was staffed entirely by women
        
        the Dispensary moved site and expanded multiple times, becoming the London School of Medicine for Women
- - - - The idea of Four Humours in the body was developed by the Ancient Greeks but it lasted for a very long time as it seemed logical
      - People knew that blood was important part of the body and they could see bile when people vomited
      - They could also see watery mucus, or phlegm, when people had a cold
      - They observed illness and saw that sometimes people became hot and flushed, while other times they were pale and cold; sometimes people vomited and at other times they coughed and sneezed.
      - It made sense to think that illness was caused by an imbalance in the body’s humors but this prevented people from developing a correct understanding of disease.
      - This, in turn, prevented progress in treatment and prevention.
      - Treatments were based on the Theory of Opposites
      - Theory of Opposites
        
        The idea that your illness as caused by too much of one humour, thhe balance of your humours could be restored by eating or drinking something with the opposite qualities
        
        Four Humours
    - - An alternative explanation of disease was based on the idea of miasma
      - Miasma was the belief that disease was carried in unpleasant smells and harmful fumes in the air.
      - People understood that there was often a high rate of disease in poor areas, where people lived in dirty, unhygienic-and smelly- conditions.
      - They also knew that disease tended to spread more quickly in hot weather.
      - This made the idea of miasma logical: the bad smells (which got worse in summer) were somehow linked to the disease
    - - Disease is caused by microorrganisms and different microorganisms cause different diseases
      - However, microorganisms are too small to be seen without a microscope
      - Although scientist s knew they existed, there was little scientific research being carried out on them at this time.
      - People didnt know about the link between microorganisms and disease; instead a theory developed, called the spontaneois generation.
      - The theory claimed that rotting material (for example, the remains of food, excrement, dead animals, rotting vegetables and plants etc.) created maggots, fleas and disease
      - Problems:
        
        False
    - - Understanding of the body was limited
      - Doctors would observe a few dissections during their training but most people believed in a life after death and therefore wanted to be burried
      - The bodies that doctors could use were mainly those of criminals who had been executed.
      - This made it difficult to plan any research on the symptoms of disease or to study particular conditions such as diabetes or arthritis
      - Lack of understanding of the cause of illness was a key reason for the limited progress made in medicine.
      - Because understanding was faulty, doctors’ training was also faulty and ideas about prevention and treatment were likely to be infection
    - - Lack of understanding and the level of technology available at the time
        
        If microscopes had been stronger, perhaps scientists would have been more curious about germs
      - Lack of funding for research and the development of new ideas
        
        The government did not feel responsible for issues like this and hospitals usually relied on charity for funding
        
        This meant that little money was left over for research
      - Attitudes of Doctors
        
        Many doctors wanted to keep on doing what they had always done
        
        They didn’t want to have to learn new ways of treating patients
        
        Also there was no proof that their methods were wrong
  - - - Pasteur’s Germ Theory
        
        Germs/ microorganisms in the air land on organic matter and causes decay
        
        Pasteur published his ideas in 1861;
        
        In 1864, further experiments led other scientists to believe him;
        
        In 1865, he proved the link between germs and disease
      - 1865 Research proved that silkworms were killed by microorganisms
      - 1878 Published germ theory of infection, which linked microorganism to disease
      - 1879 Developed a way of creating a vaccine to protect against chicken cholera
      - 1881 Developed a vaccine against anthrax in sheep and cows
      - 1885 Used the rabies vaccine on a human for the first time
    - - 1875: Identified anthrax microorganism
      - 1882 Identified the tuberculosis microorganism
      - 1883 Identified the cholera microorganism
    - - Known as ‘cure-alls’ were produced and advertised by manufacturers (James Morrison and Thomas Holloway)and were massively popular between 1850 and 1900.
        
        They made false claims to cure all sorts of disease and some of them were dangerous, but the government did not regulate them until the 1880s!
      - By 1900s
        
        large pharmaceutical companies – Boots, Welcome & Beechams – employed research scientists and used the latest science and technology.
        
        They identified which chemicals in herbs were beneficial, turned them into drugs on a massive scale and used experiment to work out dosage – Aspirin is one example (bark of willow tree used since Ancient Egypt).
    - - Salsavarsan 606
        
        It was significant as Salvarsan 606 was the first chemical cure for a disease
        
        It was a magic bullet for syphilis
      - How did the work of Koch and Behring help Ehrlich
        
        Behring’s work displayed that antitoxins would only attack specific microorganisms.
        
        Koch’s discovery was that certain chemicals would only dye specific microorganisms, without affecting other microorganisms
        
        Ehrlich wondered if he could combine the two ideas: a chemical could be linked to something that would kill the microorganism that was causing a specific disease.
        
        If this worked, those pathogens could be killed without harming any other microorganisms
        
        The treatment would be a ‘magic bullet’ that killed the disease but did no other harm
      - Sulphonamides and Drug Companies
        
        The second magic bullet
        
        The German scientist Gerhard Domagk tested Prontosil and later found that the chemical could kill streptococcus infections in mice
        
        Domagk’s 6-year-old daughter Hildegard became ill after an accident in which an embroidery neeedle had gone into her hand.
        
        She developed a fever, her hand became swollen and red stripes crept up her arm.
        
        Her doctor recommended amputation her arm but it was likely that she would die anyway, if the infection had poisoned her blood.
        
        Tests showed that the infection was caused by streptococcus.
        
        In desperation, Domagk gave Hildegard Protosil, which completely cured her
        
        Domagk published his laboratory results, and tests in a British hospital showed that Prontosil could cure puerperal fever (a bacterial infection associated with childbirth).
        
        The ley ingredient in Prontosil is sulphonamide; other sulphonamide drugs were now developed which could cure pneumonia, scarlet fever and meningitis
      - Limitations
        
        Specificity: Salvarsan 606 was effective against syphilis, but it was not a broad-spectrum antibiotic.
        
        Toxicity: Salvarsan 606 had a relatively narrow therapeutic window, meaning that the difference between a therapeutic dose and a toxic dose was small. As it contains arsenic.
        
        Resistance: Over time, some strains of the syphilis-causing bacterium developed resistance to Salvarsan 606.
        
        Complexity of administration: Salvarsan 606 was not easy to administer, as it had to be carefully prepared and injected intravenously. This made it less accessible and convenient compared to later antibiotics that could be taken orally.
        
        Availability and cost: Salvarsan 606 was initially expensive and not readily available to all patients. This limited its accessibility, especially for those without financial means.
        
        Side effects: Some patients experienced side effects and allergic reactions to Salvarsan 606, including fever, skin rashes, and nausea.
        
        Limited spectrum of activity: While Salvarsan 606 was effective against the bacterium causing syphilis, it did not address the other complications and health issues that can arise from untreated syphilis, such as damage to vital organs.
        
        Therefore, it was not a complete solution to the disease.
- - - - The government was laissez faire about PH – what impact did this have?
        
        Many streets were bare earth so they became muddy and filth collected in the mud
        
        Nineteen streets did not have a sewer and another 10 only had a sewer covering part of the street; the sewers had only recently been finished in an area where 30,540 people lived
        
        Stagnant water created offensive smells
        
        In poorer parts of town, human excrement was collected to sell to farmers
      - What did people believe caused diseases like cholera in the 1840s?
        
        People believed that disease was spread by miasma.
        
        Made it seem that cholera would mainly affected poor people, who lived in very unhygienic conditions
        
        Cholera spread in dirty conditions
      - What were workhouses and how were they paid for?
        
        Workhouses were places where poor people could go when they were too old or too ill to work and support themselves
        
        The money for these workhouses came from local taxes, called rates, but many people resented spending too much money on the poor
  - - - 1848 Public Health Act
        
        Sanitation Measures: The Act empowered local boards to take measures to improve sanitation, including the removal of nuisances and the regulation of offensive trades.
        
        Appointment of Health Officers: The Act allowed local boards to appoint health officers responsible for overseeing public health matters and enforcing the provisions of the Act.
        
        Public Health Committees: Local boards were authorized to establish public health committees to focus on sanitation and related issues.
        
        Regulation of Buildings: The Act gave local boards the authority to regulate the construction and maintenance of buildings to ensure public health and safety.
        
        Nuisances and Offenses: The Act addressed nuisances that could pose a threat to public health and outlined penalties for offenses related to sanitation.
        
        Limitations:
        
        What couldn’t Chadwick prove and why?
        
        attitudes were slow to change and many people did not like the idea that local taxes should be increased in order to hep the poor- especially when there was no actual proof that disease was linked to hygiene
        
        What were the key limitations of the 1848 PHA?
        
        Was very limited
        
        the terms of the act were temporary
        
        The BoH was only set up for 5 years and ended in 1854
        
        allowed local authorities to improve hygiene but did not force them to do so
        
        some local authorities took no action
        
        In what way did Chadwick himself cause problems?
        
        Chadwick was a difficult person, who was often arrogant and aggressive.
        
        he found it hard to get his ideas accepted even though over 50,000 people died in the epidemic of 1848-49
      - Edwin Chadwick, a social reformer and public health advocate, played a significant role in shaping the ideas that led to the 1848 Public Health Act.
      - Chadwick's influential reports, particularly the "Report on the Sanitary Condition of the Labouring Population," highlighted the connection between unsanitary living conditions and disease outbreaks.
      - His work contributed to the growing awareness of the need for legislative action to address public health issues.
      - While not the sole cause, Chadwick's advocacy and research helped shape the discourse that ultimately influenced the creation of the Act.
    - - Before
        
        Published a book in 1849 about cholera being spread by polluted water
        
        However, he could not prove that this was the case as he only had statistics in which people who drank the water got the disease
      - After
        
        1854, John Snow set out to investigate the cause of cholera in London
        
        What did Snow work out about the 1854 cholera epidemic?
        
        Snow worked out that cholera was spread by polluted water
        
        What evidence did Snow gather?
        
        Within an area roughly 200 meters from the Broad Street pump, there had been 500 fatal cases of cholera
        
        Houses that were nearer to another water pumps only had 10 fatalities. In all of these cases, the families of the deceased confirmed that they got their water from the Broad Street pump.
        
        Workers in a factory near to the Broad Street pump had been badly affected. Eighteen workers had died
        
        Residents of a local workhouse, who had their own water supply, had not been badly affected. (5 out of 535)
        
        Workers at a local brewery, who drank free beer, were not affected. The brewery also had its own water supply
        
        A woman living in Hampstead, several miles to the north of Soho, had died of cholera. It was discovered that she had once lived on Golden square in Soho, and had a bottle of water sent up from the Broad Street pump every day because she liked the way it tasted
      - How did Snow stop the epidemic?
        
        His theory was confirmed when the handle was removed so that no water could be collected from the pump- and the deaths from cholera stopped
        
        What had Snow proven?
        
        His work had demonstrated the link between cholera and infected water and this put pressure on the water companies, local authorities and parliament to improve water supples
        
        However, people still did not know why other diseases spread, because the link between microbes and disease had not yet been understood
      - Limitations
        
        Why did Snow’s work not lead to public health reform until 1875?
        
        This was due to a lack of understanding for the cause of diseases and many scientist still clung to the ‘bad air’ theory.
        
        It was only until after Pasteur published his germ theory that anyone could begin to understand exactly why the water was causing cholera.
        
        Even another cholera outbreak in 1865, which killed 14,000 people, did not force the government to act.
        
        There were two main reasons why a new law was not passed
        
        Wealthy people did not want to pay taxes to pay the cost for water supplies, sewers, etc. That would benefit people in the poor parts of towns
        
        People did not want the government interfering in what happened in their own towns
        
        Finally, in 1875, a Public Health Act was passed making it now compulsory for local councils to improve sewers and drainage, provide fresh water supplies and to appoint medical officers and sanitary inspectors to inspect public health facilities.
    - - Great Stink in 1858 did convince the government that the sewer system in London needed to be improved.
        
        With this in mind, 3 million pounds was given to the London Metropolitan Board of Works .
        
        Joseph Bazalgette became the chief engineer.
        
        His plans were carefully thought out and had two key features
        
        Large, oval shaped, built out of brick sewers instead of small, narrow, round pipes
        
        Planned to bring the waste down to the lower stretches of the Thames, where the river was tidal and the sewage would be washed out to the sea.
        
        The project was extremely expensive and took several years to complete
        
        2000km of sewers had been built by 1865
        
        Four pumping stations built between 1864 and 1875, and two treatment works to deal with sewage that was not sent out to sea.
        
        By 1875, when the project was finished, 6.5 million pounds had been spent.
        
        A side effect was the creation of the Embankment along the River Thames in London which was a way of using the earth that had been dug out of the sewers but it also narrowed the Thames and helped to control the flow of the river
    - - Ideas of a liberal government
        
        Name of a political party
        
        The government in lead by the political party, Liberal.
        
        Much less laissez-faire
        
        Modern thinking
        
        Inclusive
        
        Progressive
        
        Social justice
      - Liberal Reforms at the start of the twentieth century
        
        1906: Free school meals for children from poor families (14 million meals by 1914)
        
        1906: Board of education booklet to teach hygiene sent to schools
        
        1907: School medical service set up: children checked for illnesses (ring worm, lice). Health advisors would visit homes, but families often could not afford treatment
        
        1908: Children and Young persons act: Illegal to sell alcohol or tabacco to children, to send them begging or neglect them
        
        1908: Old age pensions for those over 70 on low income, received 1 sixth of the average weekly income
        
        1909: Labour exchange set up: unemployment could go there to look for work
        
        1911: National Insurance Act: provided help for workers who got ill. Previously they would have carried on working or not get paid. The NI act required the worker, his employer, and the government to pay into a sickness fund. A sick worker would receive ten shillings per week for up to 26 weeks and free medical healthcare. Not including workers' families, the unemployed, the elderly, or anyone with a long lasting illness
        
        The significance of the NI Act
        
        Any worker who became ill could receive free medical care from a doctor linked to the scheme; they could also claim sickness benefit
        
        A maternity grant was given to help pay for baby essentials
        
        An additional option for workers allowed them to pay into a fund which would provide unemployment benefit if they lost their job
        
        This was very significant as they could prevent a family falling below the poverty line and allow them to cope if the main wage earner became ill or lost their job
      - What is the link between taxation and Liberal reforms?
        
        The government and local authorities know that they should ensure basic standards of housing and hygiene however they were not keen to pay for it
        
        There were many complaints when the Liberal government put up taxes in 1909 to pay for its reforms
    - - The role of Authorities
        
        Previously, it had been felt that the government should take action in an emergency, such as a cholera epidemic, but should not interfere in people’s daily lives or their businesses. (Laissez-faire)
        
        Even when a law was passed, people did not always obey it.
        
        Chadwick and Snow had highlighted the importance of access to clean water and the removal of sewage.
        
        As a result, in 1866, the Sanitary Act said that all towns had to employ inspectors to check on water supplies and drain.
        
        Public Health Act 1875 made local authorities responsible for:
        
        the supply of clean water
        
        Dealing with sewage in a way that would prevent it polluting the water used for drinking and washing
        
        Building public toilets
        
        ensuring that new housing was built to good standards, to avoid problems of damp and overcrowding
        
        inspecting conditions in lodging houses
        
        employing Health Inspectors and Sanitary Inspectors to make sure regulations were obeyed
        
        Creating street lighting to prevent accidents
        
        Checking the quality of food on sale
        
        All public health acts
        
        1855 Nuisance Removal Act
        
        Made overcrowded housing illegal
        
        1864 Factory Act
        
        Made unhealthy conditions in factories illegal
        
        1866 Sanitary Act
        
        made local authorities responsible for sewers, water and street cleaning
        
        1868 Act
        
        This Act encouraged the improvement of slum housing or its demolition
        
        1871 Vaccinations Act
        
        This made sure that the previous Vaccinations Act was obeyed
        
        1875 Artisans Dwelling Act
        
        This made the house owners responsible for keeping their properties in good order and gave local authorities the right to buy and demolish slums if they were not improved
        
        1875 Public Health Act
    - - Identified five key problems:
        
        Want- the problems of poverty and not having enough money or food
        
        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 ore likely to become depress and possible turn to alcoholism or crime
        
        He felt that the state had a duty to help and protect the people as well as believed the people had a responsibility to do what they could to improve things for themselves
        
        The Beveridge Report was a best-seller
        
        Surveys of public opinion found that 95 percent of the population had heard of it and there was huge support for its proposals.
        
        Many people felt that the Beveridge Report would provide a much brighter future for society in Britain
        
        At the end of the war, in 1945, a Labour government was elected.
        
        The new prime minister, Clement Attlee, announced that a welfare state would be set up to protect the people from ‘from the cradle to the grave’.
        
        This meant that everyone could have an acceptable standard of living.
        
        The welfare system would be paid for through National Insurance contributions made by employees and employers
    - - Background
        
        Came from poor background in wales
        
        Left school at the age of 13 to work in the local coal mine
        
        Knew all the problems of poverty and poor health, and became a trade union activist
        
        Won a scholarship which paid for him to study in London
        
        Became a Member of Parliament and continued to work to improve the lives of the poor
      - Contributions
        
        When the new Labour government was elected in 1945, Bevan became the Minister for Health, responsible for setting up the NHS
        
        he faced a great deal of opposition from doctors, who did not like the idea that they would be employed by the NHS, instead of running their own private medical practices.
        
        Doctors did not receive much money for their hospital work and, as a result, they relied of the fees they got from private patients.
        
        Many doctors were afraid that they would lose money because they would not be able to set their own fees.
        
        A survey by the British Medical Association found that over 40,000 medical practitioners disapproved of the NHS Act, while fewer than 5,000 approved of it
        
        Bevan agreed to pay GPs according to the number of patients they saw.
        
        he agreed that GPs could continue to run their own private practices, as well as working for the NHS
        
        A campaign to tell the public about the NHS encouraged people to put pressure on their doctors to join the NHS.
        
        Consequently, when the NHS came into operation in 1948, 90 percent of the doctors in Britain had enrolled in the new system
        
        Impacts of the NHS
        
        Life expectancy increased dramatically
        
        Statistics between 1948 and 1949
        
        number of perscriptions: 187,000,000
        
        Spectacles supplied: 8,250,000
        
        Patients receiving dental treatment: 8,500,000
        
        Life expectancy
        
        Men
        
        1901:51
        
        1930:58
        
        1950:66
        
        Women
        
        1901:55
        
        1930:62
        
        1950:70
- - - - Pain
        
        only types of pain relief available were alcohol, a form of opium, or being knocked unconscious.
        
        In most operations, the patient was awake and often screaming in pain so the surgeon’s assistants, or dressers had to hold to patient down
        
        The ‘best’ surgeon was not the one who cut most skillfully but the one who cut the quickest
      - Infection
        
        However even when patients survived the operation, a high percentage of them died afterwards as a result of infection
        
        Many operations were carried out in the patient’s home, which was not hygienic- although conditions in hospitals were often far worse
        
        There was little understanding of how infection happened and the surgeon would wear old clothes that were already stained with blood and pus, rather than spoil decent clothes.
        
        If patients were lucky, the surgeon might was his hands before the operation.
        
        Equipment was wiped clean or washed briefly between patients; it was not sterilized.
        
        The sponge used to wipe away blood was just rinsed out, and bandages were washed then reused.
        
        There were often lots of people in the operating theatre, as well as the surgeon and his assistants: medical students and wealthy people who supported the hospital with money would watch the operation, making infection even more likely
      - Blood Loss
        
        A tourniquet would be used to reduced the flow of blood in the artery.
        
        Attempts to carry out blood transfusions in the past had often caused the death of the patient but no one understood why.
  - - - Ether
        
        1846
        
        Gas for pain relief
        
        Experimented on by William Morton, a dentist in the USA in 1846,
        
        found out it had a stronger effect on the patient
        
        Used in an operation to amputate a leg later in 1846 by Robert Liston
        
        The operation went well
        
        Problems
        
        Caused vomiting and irritated the lungs
        
        Makes patients cough
        
        leave the patient asleep for either hours or even days
        
        The gas was also highly flammable which was dangerous when the operation theatre was lit by candles or gas
      - Chloroform
        
        1847
        
        Found by James Simpson
        
        James Simpson
        
        Professor of Midwifery at Edinburgh University.
        
        He had used ether but was searching for a better anesthetic.
        
        He was experimenting with different chemicals with some colleague one evening when he discovered that sniffing chloroform knocks you unconscious- a general anesthetic
        
        Discovered chloroform did not seem to have the same side effects as ether
        
        Used it in 1847 for women in childbirth.
        
        After royal approval, patients began to ask for chloroform in their operations and it because much more widely used
        
        Impact of Chloroform
        
        Solved the problem of pain in surgery
        
        However there were problems associated with its use
        
        The Christian Churched was opposed to the use of chloroform in childbirth due to after Adam and Eve were made to leave Garden of Eden, Eve was told childbirth would be painful
        
        Many doctors opposed to its use on childbirth as it was not know how chloroform might affect the baby
        
        It was difficult to get the dose of chloroform right- enough to put the patient to sleep nut not so much that they died
        
        Some doctors felt that a patient who was unconscious was more likely to die than one who was kept awake by pain
        
        By using chloroform, many surgeons felt confident enough to attempt longer and more complicated operations, often deeper inside the body
        
        Problems:
        
        Chloroform gave surgeons more time to work, however they still did not understand hygiene and infection
        
        The surgeons bloody hands and unhygienic equipment took germs right into the body
        
        The bedsheets and the bandages had usually been used before, often still having stains and germs on them, passing infection to the patient
        
        Many patients would have developed gangrene around the surgery wound.
        
        This infection often developed into sepsis, until the patient died.
        
        The increased in length of operations caused more problems such as blood supply being cut off for too long which increased the risk of gangrene
    - - Joseph Lister
        
        Carbolic Acid 1876
        
        Lister would first use bandages soaked in Carbolic acid and would see wounds healing without infection
        
        Lister begun to use carbolic acid to clean wounds, equipment and bandages in all his operations, and the death rate from infection dropped dramatically (this method was called antiseptic)
        
        in 1864-66(without antiseptics), Joseph Lister had a 45.7% death rate
        
        in 1876-70(with antiseptics), Joseph Lister had a 15% death rate
        
        In 1892 Lister and Pasteur were together given an award at the Sorbonne University in Paris for their contribution to the fight against disease. Koch learned from both of them, and also spurred them on to new discoveries
        
        This improved surgery due to the decrease in deaths caused by infection
        
        Limitations
        
        Carbolic Acid spray made the surgical instruments slippery and difficult to grip
        
        Spray made the skin on surgeons’ hands cracked and sore
        
        Many doctors did not accept Pasteur’s germ theory
        
        Doctors who tried Lister’s techniques did not use them properly and did not find them effective
        
        Some doctors used a simple hygiene routine based on soap and water which had very good results. They saw no need for additional antiseptic techniques
        
        Other surgeons thought he was not confident that his ideas were effective as he often experimented with adjustments to his techniques
        
        Lister had read Pasteur’s work.
        
        When he was told that carbolic acid was used at the Carlisle sewage works to treat the sewage, he realised the carbolic acid was killing the microorganisms responsible for the decay and smell
        
        He also realised that the smell associated with infected wounds was very similar to the smell of sewage
        
        Which then made him wonder if carbolic acid could be used to prevent infection
    - - Blood Transfusions
        
        -in 1901, an Austrian doctor called Karl Landsteiner discovered that there were different blood types: A, B, and O;
        
        in 1902, he identified a fourth type, AB. Doctors realised that patients could die if they were given blood of a different type- for example, if a person with type A blood was given type B blood.
        
        Transfusions could now be carried out successfully, as long as the patient was given blood from the right group.
        
        Limitations
        
        The main problem now was that the blood donor had to be present in order for the transfusion to be carried out and it was not always possible to find a donor of the right group.
        
        furthermore, blood starts to clot as soon as it leaves the body so the tubes used in transfusion should also become blocked.
        
        The improvement in scientific knowledge about blood groups was important but progress in surgery could not really happen until scientific knowledge had developed ways to prevent blood clotting and technology had overcome the problems of storing blood and the process of transfusion