Medicine Unit 2 - Discovery and development, 1860-75

Question 1

Pasteur’s experiments

Answer 1

• French chemist
• 1854 - asked to investigate why vats of beer turned sour & discovered microbes in the beer - suggest microbes were affecting the beer
• Discovered microbes could be killed by heating the liquid
• Pasteur also carried out experiments on milk, wine and vinegar and convinced that liquids were contaminated with microorganisms that floated in the air
• When heating milk, wine or vinegar - didn’t go sour
• 1860 French Academy of Science set challenge to prove spontaneous generation - Pasteur published results of microorganisms causing decay and became known as ‘germ’ theory

Question 2

Pasteur’s germ theory

Answer 2

• Proved spontaneous generation was wrong
• Decay only occurred when mixture left open to microorganisms in the air
• Carried out further experiments with different airs and found mountain air was cleaner than that of cities
• Date given is 1861 - when the experiments were published
• Ideas often resisted and even ridiculed but published ideas in scientific journals so scientists could check his findings and eventually accepted his ideas

Question 3

Germ theory and medicine

Answer 3

• 1865 - Pasteur asked to investigate a problem in the sink industry - found silk worms were being killed by a disease caused by microorganisms - began to make a link with disease
• 1878 - published his Germ Theory and its Applications to Medicine - still not accepted - microorganisms were in blood yet didn’t cause disease & not clear how germ theory could help medicine
• Work had a significant impact on surgery due to reasoning how disease occurred
• His work led to vaccines being made 30 years later but took 40 years for treatments

Question 4

Joseph Lister

Answer 4

• 1859 - Professor of Surgery at Glasgow University
• 1861 - Surgeon at Glasgow Royal Infirmary - put in charge of a new building and hoped that deaths after surgery could be reduced with a greater emphasis on hygiene
• Wondered if carbolic acid could be used for infection since it was used at Carlisle sewage works to kill microorganisms responsible for decay and smell

Question 5

Lister and antiseptics

Answer 5

• 11-year-old brought to hospital w/broken leg - bone was sticking out through the skin & would lead to infection
• Lister set the broken bone, covered the wound in bandages & soaked it in a solution of carbolic acid - wound healed without infection
• Began to use carbolic acid to clean wounds, equipment & bandages in all operations - death rate dropped dramatically
• Method was called antiseptic
• Also developed a carbolic spray to use in operation to make sure no microorganisms on the surgeon’s hand or equipment would enter the wound

Question 6

Opposition to Lister’s ideas

Answer 6

• Carbolic spray made instruments slippery - slowed operation
• Spray made the skin of doctors’ hands cracked & sore
• Many doctors didn’t accept germ theory & hence saw no need for antiseptics
• Some doctors didn’t use techniques properly and hence weren’t effective
• Many nurses irritated by extra time & work to dress wounds
• Some doctors used basic soap & water which worked - no need for additional methods
• Lister frequently experimented & adjusted techniques - others thought he wasn’t confident

Question 7

Joseph Bazalgette & London sewer system

Answer 7

• John Snow’s work on cholera & Great stink in 1858 convinced the government that a new sewer system in London was needed - £3 million given to London Metropolitan Board of Works
• Joseph Bazalgette made chief engineer
• Wanted to make sewers very large, oval shaped, built of break & wanted the whole system to bring waste down to the lower stretch of the Thames where river was tidal & sewage would be washed out to sea
• 2000km of sewers built by 1865
• 4 pumping stations built 1864-1875 & two treatment works for sewage not sent out to sea
• 1875 - project was finished & £6.5 million spent

Question 8

Role of the authorities

Answer 8

• Previous attitude of ‘laissez-faire’
• Laws often not obeyed e.g. 1852 law for children to get small pox vaccine - not enforced until new act in 1871
• Many didn’t want government action due to taxes
• 1866 - Sanitary Act - towns had to employ inspectors to check on water supplies & drainage & local governments contributed e.g. Manchester w/sizes of rooms & windows in houses

Question 9

Reform acts

Answer 9

• Political parties began to offer policies to make them more popular w/voters & get them elected
• Public Health Act of 1875 - government responsible for:
• Supply of clean water, dealing with/sewage to prevent water from being polluted, building public toilets, ensuring new housing built to good standards, inspecting conditions in lodging houses, employing Health Inspectors & Sanitary Inspectors to make sure regulations obeyed, creating street lighting, checking quality of food on sale

Question 10

Hospitals

Answer 10

• Usually small organizations relying on charity for funding
• Could only admit a few patients & patients needed a letter of recommendation from a doctor or respected individual
• Patients had to meet standards of behaviour or could be forced to leave
• Local cottage hospitals established in 1860 - usually ran by a local GP & have 12 beds
• Large hospitals / infirmaries in cities & large towns - had outpatient departments where people would queue for a doctor
• Standard of care in hospitals was still low & little progress

Question 11

Florence Nightingale

Answer 11

• Newspapers on her work in Crimea made her famous
• Returned to Britain 1856 - regarded as expert on nursing & hospitals
• Book of ‘Notes on Hospitals’ published in 1859 - set out recommendations for space, ventilation & cleanliness

Question 12

Training for nurses

Answer 12

• Nightingale also wrote ‘Notes on Nursing’ - 1859 - have advice for nursing a patient e.g. ventilation, light bedding, food
• 1860 - Nightingale School for training of nurses established at St. Thomas’ Hospital in London - also set up midwifery school at King’s College Hospital in 1861
• Nightingale wrote over 200 books on hospital design & nursing

Question 13

Attitudes towards women

Answer 13

• Few women became doctors - thought that they weren’t as intelligent
• Many taught by families to be homemakers instead of going to university
• Nightingale made it acceptable for females to be nurses & fit traditional view
• Many thought women couldn’t cope with becoming doctors
• Women dissatisfied at this time - seen by suffragists & voting campaigns - many wanted to challenge female stereotypes

Question 14

Elizabeth Garrett

Answer 14

• Many barriers for women - doctors needed a medical degree from a university or teaching hospital
• Medical Act, 1858 - doctors needed to be officially registered w/General Medical Council
  – Elizabeth Blackwell - English woman in USA who became first woman to qualify as a doctor - returned to England & spent a year lecturing
• met Elizabeth Garrett in 1859 & inspired her
• Garrett came from a wealthy family who were horrified of her becoming a doctor
• Garrett applied to study medicine at several medical schools - all refused a female student
• Then paid for private lessons & dissected corpses in her own bedroom

Question 15

Qualifying as a doctor

Answer 15

• Complete a university medical degree
• Pass examinations
• Be accepted by one of the 3 medical societies - Royal College of Surgeons, Royal College of Physicians or Society of Apothecaries
• Be listed on medical register
• Physicians could diagnose illness & prescribe treatment but could not actually give out medicine
• Apothecaries licensed to offer medical advice & prescribe medication

Question 16

Garrett becoming a doctor

Answer 16

• Completed a course of medical training but could not be licensed - College of Surgeons & Physicians couldn’t have women but no Apothecaries
• Garrett’s father supported her & threatened to sue if she wasn’t accepted - became accepted & officially qualified to practice medicine in 1865 but society immediately changed their rules so women couldn’t join
• OpenedSt. Mary’s Dispensary in 1866 in London
• Went to Paris later & got a medical degree
• Returned to England in 1872 - Dispensary added 10-bed ward staffed by women - eventually moved site & expanded multiple times - became the New hospital for Women & then London School of medicine for Women - renamed to Elizabeth Garrett Anderson Hospital in 1918 - just a after her death
• 1873 - became member of British Medical Association (BMA) - only woman member for next 19 years - BMA voted against further women
• 1908 - first female mayor in England - mayor of Aldeburgh

Question 17

Other female doctors

Answer 17

• Sophia Jex-Blake led 4 other women who persuaded Edinburgh University to study medicine
• Had to pay additional fees to be taught separately
• Faced opposition & harassment
• Edith Pechey won a prize in Chemistry, given to second place male
• 1874 - university decided to force them to leave claiming it didn’t;t have the authority to admit female students in 1869
• Jex-Blake & Pechey gained medical degrees abroad like Blackwell, Hoggan & Garrett
• 1876 - Act of Parliament said universities & medical societies should accept women medical students & allow them to become doctors - numbers still remained low