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Dr Bastian. Some scientists did use Pasteur's work, such as Lister who linked Germ Theory to surgical infection. Tyndall also used Germ Theory to look at link between microbes and ase. However Tyndall was not a Doctor and many still followed Bastian. Attitudes amongst Doctors made it very difficult for Pasteur's work to be recognised. Impact of Koch Idea was an enormous breakthrough Doctors now studied the disease. Identifying microbes allowed scientists to find treatment for a range of serious issues such as Diphtheria in 1883, Cholera in 1883 and others going into the 20th century. 28 Essay Practice: There was rapid change in ideas about the causes of illness and disease in the period 1700-1900. How far do you agree? 16 marks Colour code the following statements according to if they represent Rapid change Not rapid The idea of Spontaneous Generation believed that microbes were the product of decay NOT the cause of decay Due to improved microscopes, Louis Pasteur was able to publish his Germ Theory. This proved that the idea of S.G was wrong. Pasteur's work had no impact to begin with as his work focused on decay and rotten food, not disease. People disagreed with Tyndall as he was not a doctor and people favoured Dr Bastian.. Koch published ideas in 1882 that different germs caused different diseases, such as tuberculosis. In took until the 19th century for scientists to prove whether spontaneous generation was correct. Pasteur's theorised that germs caused disease in the human body. He proved this as showing that one type of microorganism killed off France's silkworm population Scientist John Tyndall made links with Pasteur's Germ Theory and Lister's work on wound infection. Lister used Pasteur's work and linked it with surgery infection. However, people doubted his work as there was no proof what microbes did while in the blood In 1860, French Academy of Science challenged scientists to come up with evidence to prove or disprove S.G Pasteur did not publish his germ theory of infection until 1878 S.G was important until 1870 due to Dr Bastian, who was o powerful that many disagreed with him. Pasteur's theory had limited impact because of attitudes among doctors. This meant people refused to recognise the link between germs and disease 29 Koch discovered a range of links between germs and disease, such as cholera in 1883 and 1884 when he proved that cholera was spread in water supplies Koch made it easy for future scientists to find the cause of disease as he used agar Kelly in a petri dish. This made it easier to study bacteria under a microscope. Dozens of scientists used Pasteur's ideas to try to develop understanding cause of disease Improvement in technology allowed rapid improvement due to higher magnification. While the development of the Petri Dish was important also Koch's proof was able to prove other theories such as John Snows. At the beginning of the 1700's bleeding and purging were still used which suggested that cause of disease was totally unknown due to old methods of treatment. Government did not help to promote the understanding of disease. They wanted practical solutions, not theorised Due to severe spread of disease in busy cities, people were more enthused than ever to solve the problems of epidemics. Koch's ideas allowed future scientists to find the microbes responsible for disease such as pneumonia, meningitis, the plague, tetanus The Enlightenment during the 18t century encouraged people to think of themselves and challenge traditional authority. Scientific Revolution encouraged scientists to use each other's theories to prove the understanding of disease 30 Treatment of disease - Nightingale and Hospitals Exam question: Explain one way in which hospital care was different in the 18th and 20th centuries (4) Hospitals in 18th century Hospitals in 1900 Hospitals began to reappear thanks to donations from members of the Middle Class (Lawyers and businessmen). As more people started to attend, hospitals became less sanitary. Doctors went from patient to patient and ward to ward without washing hands, or changing their clothes. Disease spread quickly. Started to become places where sick people were treated, rather than places in which people rested and prayed. Doctors visited daily and there was a small staff of untrained nurses. Birmingham Hospital was opened. It was built on open ground with separate isolation wards. This idea was favoured by Florence Nightingale. Doctors were a common sight, especially junior doctors who were getting training and more hands-on experience. Cleanliness was the most important thing! Hospitals cleaned up germs using antiseptics and they focused on not letting germs in at all. Nightingale - Background Nightingale and the Crimean War Nightingale and Impact on British Hospitals Change in wards, they split up infectious patients from those requiring surgery. Some doctors offered their services free of charge so they could practice their skills New hospitals were built and they were made in a modern way. Every hospital wanted to attract the best student doctors. Patients at hospital tended to be the 'deserving poor', working class people who could not pay their bills Trained nurses lived in nearby houses provided for them by the hospital. Rich would not attend hospital, they would rather have treatment and surgery at home, which was safer. When she was 17 she had a religious vision telling her that her mission was to serve mankind. In 1854, Nightingale convinced government to send her and 38 other nurses to the Crimean War. Nightingale made changes to the nursing in the Crimea, including getting rid of dirt near patients being treated, changing organisation of nurses to treat 2,000 people and ensuring clean bedding. Nightingale effort showed as mortality rate went from 40% to only 2% Nightingale came back to Britain in 1856 a hero. 31 Improvement in surgical treatment Problems with surgery Nightingale wrote notes for nursing in 1859 setting out key roles of nurses. Promoted pavilion style hospitals to separate infectious patients. In 1860, set up the Nightingale School for Nurses. Nurses were trained here on Many patients died of shock Surgery had to be quick to prevent blood loss Patients were awake and had to be held down by dressers Extremely dirty conditions - Surgeons wore dirty clothes to show experience. Infection killed patients after most of the time as it was not in a germ-free environment. sanitary matters. Nursing was now seemed like a respectable occupation. Nightingale nurses were Middle-Class women who went against the low standard of drunks and flirts before this. Exam Practice: Explain why there was rapid change in surgical treatments in the period 1700-1900 (12) You may use the following in your answer: • Chloroform • Lister Chloroform and Simpson Chloroform allowed for longer and more in depth surgeries to happen. This was founded by Simpson when him and his friends were sniffing chemicals trying to find an alternative to laughing Gas. You must use information of your own in your answer Surgery before Chloroform would have a significant impact on people. Many Lister and Carbolic Spray Carbolic spray dealt with the issue of infection after surgery. It was used in the sewers and Lister used the idea of Germ Theory to state that if germs caused vinegar to rot when left, then they must make skin rot. Carbolic spray allowed for ASEPTIC SURGERY - Making Nightingale Nightingale helped make nursing a more respected career, allowing nurses to help in surgeries. Before this they were seen as unprofessional and drunks who flirted with patients. Nightingale wrote the book notes for nursing which enabled nurses to train constantly which would 32 people dying due to shock with dressers holding them down. Patients would die of shock and surgeons would have to do the operation as quickly as possible due to the fact that if they did not the patient could bleed out. Chloroform replaced laughing gas which was a significant change as laughing gas made people vomit in their sleep and cause a severe irritation. Chloroform allowed for successful surgeries. sure germs did not get into the operation theatre. Even though the spray stopped being used in 1890, it allowed for surgeons to make their hospitals a lot cleaner. By 1900, doctors steam cleaned equipment, they developed hygiene in regards to rubber gloves and surgeons wore gowns and face masks. Summarise how Simpson changed surgery Summarise how Lister change approaches to surgery Summarise how Nightingale changed nursing have been a change in improved surgery, allowing them to help doctors rather than hinder. Nightingale also focused on cleanliness in hospitals, which would aid surgery as less people would die of infections after a war wound or surgery. Prevention of disease 1) Why was smallpox such a terrible threat to the health of the British population? There were constant epidemics. In 1722,1723 and 1740-42. Problem was bad in London where there were 11 epidemics in the 18th century. Worst of the epidemics was in 1796 where 3,548 people died. 2) What were people still unaware of in the 18th century? GERMS WERE NOT FOUND UNTIL 1861 33 3) Explain how inoculation works. Inoculators would infect people with a mild dose of smallpox to try and build their immune system 4) What were the risks and limitations of inoculating against smallpox? Inoculation led to deaths of some people. The disease affected people in some ways and some in others. However it was very expensive so the rich could only pay for it. In 1788 a wave of smallpox swept across the county. Jenner observed that those who worked with cattle and who had been poorly with a milder disease, cowpox, were never poorly with smallpox. Role of Edward Jenner I was born on 17th May 1749 in Berkeley. Gloucestershire. my father was a preacher for the parish - he died when I was only 5 years old. If only someone could find a cure for this awful disease. From the age of 8 I was an apprentice to Daniel Ludlow, who was a in Chipping surgeon Sodbury. One day I overheard a girl say that she could not get the smallpox because she had already had cowpox. I was keen to learn more about this theory Mrs Phipps it is very good of you to let me make two cuts on James' arm and put a small amount of cowpox on both. James may be poorly for a few days but he will then be immune to smallpox. Jenner repeated this process on other patients and was successful in reducing the number of people affected by small pox. The word vaccine comes from the Latin 'vacca' meaning I Cow Summarise Edward Jenner's discovery in this box St George's Hospital, London In 1770, I travelled to London to study anatomy and surgery with a surgeon called John Hunter. I returned to Gloucestershire to set up a medical practice. Windsor Castle Edward Jenner was recognised for his discovery of the smallpox vaccine. He was made Physician Extraordinary to King George IV and Mayor of Berkeley. 34 Support for Jenner . ● Jenner was a trained doctor. He used careful scientific method to test and prove his vaccination. Parliament supported the vaccine because it was a safer and more reliable alternative to inoculation. Vaccination was cheaper than inoculation because the people receiving vaccines did not have to be put into quarantine. People receiving inoculations were in danger of spreading the disease itself. The British government set up a society to promote the vaccine and later made it compulsory in 1852. Government Government made inoculation illegal in 1840. This was extremely important as inoculators were opposition to the vaccination as they were losing out on money. Furthermore, they were quite dangerous as the mortality rate of people who were inoculated was quite high. Opposition for Jenner Government made vaccination compulsory in 1852. This was rapid change as it allowed both the rich and poor to be prot from smallpox. Smallpox was a massive issue in England as there were a number of epidemics that wiped out up to 3,000 ● . . ● Jenner was not able to explain how or why vaccination worked and this made people suspicious. The idea of infecting someone with an animal disease was seen as extremely strange. Exam Practice: Explain why there was rapid progress in the prevention of smallpox after 1798 (12) The church felt using animal infection in humans was against God's will. Inoculators did not want to see their businesses destroyed by vaccinations and encouraged the media to say bad things about it. The Royal Society refused to publish Jenner's ideas because there was a lot of opposition to them in the medical community. Individuals Jenner helped with the development of vaccinations as he infected James Phipps with cowpox. He then infected him with smallpox 6 weeks later and realised that he did not catch it. Jenner was important as he allowed individuals such as Pasteur and Koch to look into vaccinations and find cures for other diseases that were causing a high death rate. Jenner was a doctor which was very important as people respected what he said due to his professional position in the medical world. Jenner was able to Experimentation Jenner experimented to ensure that his vaccination was not wrong. He did not just infect Phipps. Jenner observed the patients and made notes. He also made notes before his vaccination to see why inoculations did not work, this allowed him to back up his findings when he presented them. Jenner experimented on 1000's of people and noted down all the successes. This was important so he could prove that Phipps was not a joke. 35 people at one time. Given vaccinations for all allowed protection for the population, rich or poor. Government made sure that there were public vaccinators in 1871 which was important as if people could not get to a doctors then people could come to them. This could protect a range of people including the elderly. back up his findings by writing them down, this would allow many people to use his findings to make the medical world a stronger place in which more diseases could be dealt with. Summarise the role of the government Summarise the role of individuals Summarise the role of experimentation 36 Public Health Act - 1875 The government were losing their Laissez-faire attitude. They realised dealing with illness would be more beneficial than leaving it. Public Health Act 1848 Public Health Act 1875 Case Study - Snow and the Broad Street Pump Cholera was a big killer in the Industrial period. Many people believed it was spread through Miasma, John Snow changed this in 1854 with his work on the Broad Street Pump. BEFORE THE BROAD STREET PUMP What most people thought about Cholera at Cholera the time Miasma and rotting material caused disease. • Councils and local populations focused on mess. • Government encouraged cities set up boards of health and provide clean water supplies. Work on the Broad Street Pump . What John Snow thought about Observed cholera epidemic 1848-9 and wrote theories in On the Mode of Communication of Cholera. Suggested Cholera not transmitted by miasma as effected gut not lungs. Drinking water being contaminated by cholera-ridden faeces in city's drains. • Spread by dirty drinking water. ● August 1854 Cholera outbreak in Soho. Snow created a spot map to show where deaths occurring. 37 ● ● Saw a pattern- deaths centred around the water pump on Broad Street. Snow removed handle from pump so couldn't be used and the Cholera stopped. Inspections on well under pump revealed it was close to a cesspit (under 1 metre) Brick lining of cesspit had cracked, causing waste to seep into the well. Many people rejected Snow's work, pointing out that people who hadn't drunk from the pump still caught Cholera. The General Board of Health clung onto the miasma theory. They were avoiding the cost of providing clean water! The government eventually agreed to invest in a new sewer system, which was planned by Joseph Bazalgette and completed in 1875. In 1855, Snow presented his findings to a House of Commons committee. He recommended that they make massive improvements in the sewer systems of London. Impact and significance of John Snow SHORT-TERM "The Great Stink" of 1858 (when an unusually hot summer lowered the Thames water level and exposed the sewage on the riverbanks) pushed the government into acting. They started work on new sewers in 1860. Snow had no scientific evidence to show what caused the disease. It would be another seven years before Pasteur published his Germ Theory (three years after Snow died) and another 30 years before Koch isolated the bacterium that caused the disease. By removing the handle on the pump in Broad Street, Soho, Snow saved many local lives. LONG-TERM Exam Practice: "Louis Pasteur's publication of the Germ Theory was the biggest turning point in medicine in the period c1700-c1900". How far do you agree with this statement? You may use the following information in your answer: Edward Jenner Robert Koch 38 Recall Quiz 1. What was the Enlightenment? 2. In the early 18th century, there was a development of spontaneous generation, what does this mean? 3. What is a microbe? 4. What did Louis Pasteur use to observe unwanted microbes? 5. What was Pasteur's theory called? What year was it? 6. What were the 4 basic principles to Pasteur's theory? 7. What did Pasteur theorise in 1878? 8. Summarise Pasteur's influence in Britain in 3 lines. 9. How did Koch develop the ideas of Pasteur? Write 5 bullet points about this. 10. Summarise Koch's influence on Britain in 3 lines. 11. How did the idea of Germ Theory impact Britain? Complete a spider diagram on it. 12. What were hospitals like in the 18th century? Write 5 bullet points 13. Which war did Nightingale develop her ideas in? 14. How do we know Nightingales work was successful? 15. Give 5 ways in which Nightingale changed nursing in England 16. What were hospitals like by 1900? 17. What was the problem with surgery in the 18th century? 18. How did James Simpson deal with the problem of anaesthetics? 19. How did Carbolic Acid change the problem of infections? 20. By 1900 what were hospitals doing to ensure surgery could be Aseptic? 21. Why was there some opposition to the changes in surgery? 22. Why was smallpox such a problem in England in the 18th century? 23. What was an inoculator and why were they a hinderance (problem?) 24. How did Jenner develop the vaccination of smallpox? 25. How did the following groups feel about Jenner's vaccination: Church Inoculators Royal Society 26. Which 3 factors allowed the development of the smallpox vaccine to happen? 27. What was the short-term impact of the smallpox vaccine? 28. What was the long-term impact of the vaccine? 29. How did the 1875 Public Health Act help prevent disease? Summarise in 4 sentences. 30. What was Cholera? When did it arrive in England? 31. How did John Snow help prevent the spread of Cholera by using the Broad Street Pump? Create a spider diagram with the actions and results of Snow. 39