Why had medicine not made more progress by
1848?
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Understand that medical knowledge is linked to scientific knowledge and technology.
Analyse the role of factors affecting progress in medicine.
Evaluate the standard of medicine in 1848.
the Four humors.
Miasma
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Belief that disease was carried in unpleasant smells and harmful fumes.
It was understood more disease was in dirty unhygienic areas.
o And knew disease spread more in the heat.
This made logical sense: the hot weather causes more bad smells, and more disease comes as a
result.
Spontaneous Generation
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We know nowadays that microorganisms exist.
But back then people knew they existed but with no great amount of scientific evidence and no
microscope.
o A new explanation was made.
Spontaneous Generation: claiming that anything rotting (excrement or the remains of food)
created maggots flies and disease.
Doctors’ knowledge
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Understanding of the body was limited.
Dissection were mostly observed during training.
o Many belived in the afterlife so decided they would rather be buried.
o This made it harder for doctors to learn more about hinges like diabetes and arthritis.
They could only use the bodies of criminals who had been executed.
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This all limited the progress, with understanding being faulty, training also being faulty and ideas
about treatment was probably ineffective.
Factors affecting progress.
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The understanding can be linked to the lack of technology at the time.
o e.g., if scientists had stronger microscopes, then they might have looked into germs
more.
Another reason was funding and the government’s unwillingness to support hospitals as they
did not feel responsible for issues like health.
o Hospitals were ussualy funded by charities.
The attitude of the doctors was important with them not wanting to learn new and innovative
ways of treating patients.
o There was no proof that their methods were wrong.
Why did Florence Nightingale go to Scutari?
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Understand the actions of Florence Nightengale at the hospital in Scutari.
Analysis the impact of her work
Evaluate the importance of her work.
Florence Nightengale
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She came from a wealthy middle-class family.
They were amazed that she wanted to work and even more surprised that she wanted to work
as a nurse.
o It was looked at as a low status job.
 With no formal training from nurses in Britan
o She spent 3months in 1851 at a center in Germany.
 Where training for nurses begun in 1853
In 1853 she started to manage a small nursing home
o Called ‘Institution for sick Gentlewomen in distressed circumstances.
she was asked by Sydney Herbet asked her to take 38 nurses to a military hospital in Scutari.
Britan was fighting against Russia in the Creman Peninsula, in the black sea.
Many soldiers were injured.
o But not from war but instead infection after wounds \
Conditions at Suctari
Hospital had over 10,000 people
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Many men were sharing beds or lying on the floor.
Clothes infested with lice and fleas.
Diseases like typhoid and cholera were commen.
Many patients had diarrhea.
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It was difficult to get enough medical supplies.
Food supplies were limited and poor supplies.
The roof leaked and wards were dirty and infested with lice.
Florence Nightingale had no idea that the hospital was built over a cesspool where human waste is
collected. This affected both air in the hospital and water supplies.
Nightingale’s action
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Nightengale and her nurses scrubbed the surfaces clean and washed all towels, sheets,
bandages, and equipment.
She belived in miasma and importance of fresh air so she opened windows for fresh air.
She improved the quality of food.
A lot of money was raised by Times newspaper.
o She could now buy new supplies, including 200 towels , clean shirts, soap, plates, and
cutlery.
Anagela Burdett-Courts provided a 150 drying closet machine that could wash 1000 pieces of
wet linin in less than half an hour.
The Impact of Nightengals work
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Army medical staff did not like the idea of nurses coming out to war.
o This was because they belived that they would not be able to cope with the conditions.
Th4ey also felt that the medical knowledge of women were limited.
o And took all the comments from Florence as criticism and resented her.
She always had a final round where she checked up on evreyone.
o She got the name ‘The lady of the Lamp.’
o She was also loved by patients and people black in Britan.
Nightingale hospital had the highest death rate.
o It was not until 1855 when a government sanitary commission repaired the drains and
improved supply of drinking water.
 Only then did the death rate began to fall dramatically.
How much Progress was there in Surgery?
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Understand the key features in 1848.
Analyse the reasons why there was a lo w standard in surgery.
Evaluate the extent to which the problems of surgery had been overcome in 1860.
Section 2
Why was Louis Pastures work on microbes important for
medicine?
Louis Pasteur
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Frech scientist
Asked to check why vast of beer were going sour.
With development of technology, he found many microbes in the beer.
o According to spontaneous generation they came out as it decayed.
Pastor did not believe this and believed it was the microbes affecting the beer.
He proved his theory by heating the beer and so the microbes died.
o The beer didn’t go sour anymore.
Pasteur’s experiments
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Pasteur did this on milk wine and vinegar
In all cases when they were heated, they did not go sour.
o This showed that it wasn’t spontaneous generation instead t was carried in the air.
In an experiment he published in 1860 he exposed a mixture to thew air and a mixture in a
closed system
o And showed that when it was exposed it was going bad.
o But when it was closed away from the air and heated it was fine
 Under a microscope you could see that microbes grew in the one exposed to air
Pasteur’s work was called the ‘germ theory’.
o He described the microbes as germinated.
Pasteur’s Germ Theory
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He now proved the germ theory.
o Refer above.
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He did another experiment where he tested the
air in many different areas.
o He checked the samples under a
microscope.
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The cleaner air came from the mountains.
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The dirtier air came from the cities.
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He didn’t make the link to medicine and
disease.
o His thinking went throughout several
years.
The Germ Theory and Medicine
In 1865 he was called in to investigate an issue in the silk industry
Silkworms were being killed by worms by microbes.
This was the first link he had that disease was affected by microbes.
Lister and Improvements in Surgery
Surgery
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Chloroform solved the issue of pain.
o So, more people were willing to take surgeries.
 Increasing death rates in the process
Surgeries became longer and more complex.
o And with such unhygienic areas infection Grew and so dd the death rate
 Consequently, time period between 1846 – 66 was called the black period.
Joseph Lister
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In 1859 he became Professor of Surgery at Glasgow University
In 1861 he became Surgeon at Glasgow Royal Infremry
He was put in charge of a new building and thought that a greater emphasis on hygiene could
lower deaths after surgery.
He read Pasteur’s work.
o When he learnt that carbolic acid was used to Carlisle sewage to treat sewage
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He realised that carbolic acid was killing the microorganisms responsible for the
decay and smell.
He realised that the smell of wounds smelt the same.
 And made him wonder if carbolic acid could be used to prevent
infection.
Lister and Antiseptics
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An 11-year-old boy came in with a broken leg with the bones sticking out of the skin.
o The usual operation would have been to amputate it.
Lister covered the wound with bandages with soaked carbolic acid.
o And so, the wound was healed with no infection.
Lister started to use carbolic acid for all wounds, equipment, and bandages.
o The death rate dropped dramatically.
This method was called antiseptic.
o Fight (anti)
o Infection (Septic)
Lister also developed a spray that could be used in the room.
o This was to make sure no microbes entered the open wound keeping it clean.
Opposition to Lister
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The carbolic cid made medical instruments slippery.
o Therefore, making the procedure longer
 Blood loss was still an issue, so it caused deaths.
Doctors’ hands would get cracked when it was used.
Many doctors disagreed with the germ theory, so they didn’t believe him.
Some doctors did them but not properly making them ineffective.
Nurses were irritated by the extra time dressing the wounds.
Some doctors used simple hygiene routine-based ion soap and water.
o They saw no reason to add antiseptics to that process.
Lister frequently changed his techniques and so doctors were not confident in it.
o They also thought he wasn’t confident in it.
Why did the government decide to act in public
health?
Public health
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Between the period 1848 -60 Chadwick and snow showed the link between hygiene and health
In 1848 the government passed the public health act permitting local councils to make
improvements
o This was just an option and only 1/3 of the council made a board of health.
 Even fewer appointed medical officers
o It only existed for 5 years.
By 1860 there was little progress
Joseph Bazalgette and the London sewer system
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John snows work on the great sink in 1858 did convince the government to improve the sewer
systems in London.
3 million pounds was given to the London Metropolitan Board of works
o Bazalgette became the chief engineer.
His plans were carefully thought out, with 2 key features.
o It had to be an oval shape.
 because it wouldn’t get stuck as much in an oval shape
o The whole system was supposed to move all waste down to the lower stretches of the
Thames.
 River was tidal and it would be washed out to sea.
The project was extremely expensive and took several years.
o Approx. 2000km built by 1965.
They mainly used gravity to keep the sewage moving.
o Also built 4 plumbing station from 1864 – 75
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 And 2 treatment works that was used for swage that didn’t reach the sea.
It was completed in1875 with 6 million pounds spent.
A side effect was there was a large embankment of dirt from, the construction along the
riverbanks.
o They used the dirt to narrow the Thames and help control the flow of the river.
When it was opened there was a large railway line for people to see how it works
o You could buy souvenirs from there too.
The role of authorities
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Attitudes towards governments were changing.
o At fist people followed ‘laissiez faire’ meaning leave alone
 Only want government interference when there was a major issue like the
cholera epidemic.
Even when laws were p [passed people didn’t obey it.
o In 1851 a law was passed that people had to vaccinate their children from smallpox
 This wasn’t enforced until 1871.
Many people didn’t want the government to act if taxes would be raised.
o But the work of Chadwick and snow showed the importance of clean water and the
removal of sewage.
The sanitary act was passed in 1866.
o This would allow an inspector to come in and check drainage and water supplies.
Local governments started to improve public health.
o Manchester made regulation on room sizes and window sizes in new houses to check
for sufficient ventilation and light.
Joseph Chamberlain, the mayor of Birmingham improved water and destroyed slums.
As pastures work became more known people started to believe that disease could be carried
through polluted water
o Realized that better.
 Water supplies
 The removal of swage and rubbish
 Improved hygiene
o Would improve public health.
Local governments could act but the governments till had to pass laws for a national system.
The government wasn’t involved before, but studies were changing.
o More people gained the right to vote.
 There weas more pressure on parliament to get involved.
Reform acts
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Political began to offer polices that helped the general public and not just the rich because more
people and voting rights.
The public health act of 1875 made local authorities responsible for
o Clean water supplies
o dealing with sewage
 And make it not affect water that is used for drinking and cleaning.
o Building public toilets
o New housing built to a good standard.
 Avoiding overcrowding
o Employing health and sanitary inspectors to make sure regulations were obeyed.
o Creating streetlights for less accidents
o Checking the quality of food
This showed a shift of attitude from laissez faire.
o Parliament was finally having public health care.
Before people health was based on the key individual in the local area
This shows both an increased role of government and a change of attitude towards the
government and public health.
This also showed how the national government relied heavily on local bords for help in ensuring
regulations were met.
Local governments had to make sure all landlords were making the correct renovations, for their
accommodations.
o This is for hygiene and space.
Local governments would collect additional pay from rate payers to be able to pay for this work.
How did Florence Nightingale improve Hospitals and
Nursing?
Public health
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Lack of understanding of disease meant little progress in treatment of disease or the care in
hospitals.
Most people would have a family member caring for them.
o If they were rich enough, they would have a nurse.
A trained physician would prescribe meds.
o while the nurse or family member would make sure they take them according to
prescription
 and also try to make the patient feel comfortable.
Nurses would not have training.
o Would not keep records of the patient’s condition.
Hospitals
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These were usually small organisations, relying on charities for funding.
Only could admit small amounts of people.
o Had a letter of recommendations from someone respectful e.g., religious minster or a
wealthy businessman.
They were expected to meet a certain standard of behaviour.
o They couldn’t violent or aggressive
Local cottage hospitals were being established in 1860.
o These were run by local GP and would have 12 beds.
There were larger hospitals called infirmaries.
o Found in large towns.
Had outpatient departments where a queue would form to see a doctor.
The most important of these were in London. E.g.
o The London dispensary of curing the eye and ear was founded at Moorfields in London
in 1805
o The royal free Hospital was founded 1828.
o The hospital for sick children was opened in Great Ormond Street in 1852
Understanding of causes of disease improved
o But hospitals standards were low.
Little progress in treatment of disease
Nurses’ sill had no training.
Florence Nightengale
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She was now famous for her work in Britan for her work in Crimea.
She came back to Britain 1856.
o She was regarded as an expert on nursing and hospitals.
 She didn’t do much nursing personally.
 Her management and organisation were elite though.
Her book Notes on Hospitals published in 1859.
o This set out recommendations on
 Ventilation
 Space
 Cleanliness
Her ideas on Miasma were still prevalent and she impended this into her book.
o These ideas were used in new hospitals or wards.
 Called Nightingale wards
Training for Nurses
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Nightengale published Notes on Nursing in1859 which discussed.
o Ventilation
o Light
o Bedding
o Cleanliness
o Food
Discussed nurse’s personal cleanliness.
Also talked about observing the patient and reporting back to the doctor
The book was translated into 11 languages.
In, 1860 Nightingale Training of nurses was established in St Thomas Hospital in London
In, 1861 training for midwives at king College Hospital in London
Wrote 200 books on hospital and nursing.
o Gave evidence to parliament.
o Met queen Victoria.
How much progress was there in the position of
Women in Medicine?
Attitudes Towards Women
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Throughout History women were the caretaker at home
o But not many became doctors.
 This might be because they thought that women werent as intelligent as men.
In wealthy families’ women were expected
o To learn from home
o Be able to play music.
o Sew and paint.
 They did this to make a comfortable home.
Girls werent expected to get any type of higher education.
Nightengale made it acceptable for women to become nurses.
o This also fit in on what women were expected to do.
People thought women could not cope with the conditions.
o Dissections
o Amputations
The desire to train as a doctor was unnatural.
Some women were dissatisfied with their role in society.
o Some joined suffragette societies and campaigned for the vote.
o Other wanted better education and employment opposition.
Many women challenged the traditional women.
o News spread faster so more women were inspired.
Elizabeth Garrett
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There were many barriers for women to become doctors.
A doctor needed.
o A medical degree from a university or a teaching hospital
The medical act in 1858 said doctors had to be registered with General Medical Councils
Elizbeth Blackwell avoided these problems.
o She was English women.
 Who traveled to USA where she became a doctor?
On a return visit to England, she gave a lecture which inspired Elizbeth Garret.
Garrett came from a wealthy family who were horrified at the prospect of her being a doctor.
She became a nurse in Middlesex Hospital.
o In her free time, she went to lectures which were offered out to male doctors.
 Until they complained
Qualifying as a doctor
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Physicians were university trained and could diagnose illness and prescribe treatment.
o Could not give out medicine.
Apothecaries needed less training, and they could give licensed to offer medical advice and
prescribe medication.
Garrett completed a medical training, but she could not be licensed.
o Both college of surgeons and college of physicians
 Had rules stating women could not join.
o But Society of Apothecaries did not have that rule.
 Her father threatened to sue them if they did not allow her in
o They were forced to let her join and she was qualified to practice medicine in 1865.
 But they changed the rule right after she joined.
Garrett’s Achievement
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Garretts father supported her again in 1866 when he helped her open St Mary’s dispensary
o This was in London to provide medical treatment for women.
A short time later she learnt French and went to Paris.
o Where she gained a medical degree
In 1872 she came back to England
o Thew dispensary added a 10-bed ward, staffed entirely by women.
 it moved site and expanded many times.
it became the New Hospital for Women
o then the London school of medicine
 then renamed Elizabeth Garret Anderson Hospital in 1918 after her death.
in 1873 she became a member of the British Medical Association (BMA)
o only women to be a member for the next 19 years.