History- Changes in medicine, c1848-
c1948
The 4 humours-
- Blood, yellow bile, black bile, phlegm
- Medical understanding of what caused disease in 1948.
- People observed illness and saw that sometimes people became hot and flushed,
while other times they were pale and cold.
- It made sense that illness was caused by an imbalance in the body’s humours.
- Treatments were based on the theory of opposites.
Theory of opposites- An idea that illness was caused by an imbalance in one of the
humours and so can be cured by eating or drinking something with the opposite
qualities.
Miasma- Disease spread by bad smells.
Spontaneous generation- Disease spread by rotting material
Doctor’s knowledge-
- Doctors would barely do any dissections as most people wanted to be buried
- They mostly used criminals who had been executed which made it difficult to plan any
research on symptoms of disease.
- Doctors’ training was poor and ideas about prevention and treatment was likely to be
ineffective.
Factors affecting progress-
- Poor technology and lack of microscopes.
- Government did not feel responsible for these issues and did not want to fund the
development of ideas and research, hospitals mainly relied on charities.
- Many doctors did not want to learn new ways of treatment as there was no proof that
their ideas were wrong.
Florence Nightingale
- Came from a wealthy middle-class background.
- Wanted to be a nurse which was considered a low-status job at the time.
- There was no formal training for nurses in Britain, so she visited many hospitals in
Britain in during the 1940s.
- Spent 3 months in 1851 at a centre in Kaiserwerth, Germany, where she trained to
become a nurse.
- 1853- Became superintendent of a small nursing home in London- The institution for
sick gentlewomen in distressed circumstances.
- 1847- Met Sidney Herbert who asked her to take a team of 38 nurses to work in the
military hospital in Scutari.
- Many soldiers were being injured during the Crimean War, mainly due to infection.
Conditions in Scutari-
- 10,000 men lived in horrible conditions:
o Shared beds or had to lay on the floor
o Lice and fleas infestations
o Rats and mice ran in the wards
, o Typhoid fever and Cholera was common
o Many patients had Diarrhoea
o Difficult to get medical supplies
o Food supplies were poor quality and was limited
- The hospital was built on the site of an underground cesspool, where human waste
collected.
Nightingale’s actions
- Scrubbed all surfaces clean and washed all sheets, towels, and equipment.
- She believed in miasma, so windows were opened for fresh air.
- Cleaned the kitchens and improved the food quality.
- Raised a fund of money through the Times newspaper, so she could by new supplies
like clean shirts, towels, soap and cutlery.
Impact of Nightingale’s work-
- Army medical staff resisted the idea of nurses coming out to work in the Crimea as
they thought women could not cope with the conditions and were not knowledgeable.
- Nightingale was criticised but soon gained the nickname of ‘The Lady with the Lamp’
as she had a habit of checking on her parents at night.
- Death rate at Nightingale’s hospital was still high until 1855 when a government
sanitary commission repaired the drains and improved drinking water supply.
Surgery-
- Surgical procedures were basic, like cutting open a boil, or life threatening, such as
cutting out a tumour or amputating a limb.
- Amputation was necessary if a broken bone poked through the skin and became
infected.
Pain (before the 1840s)-
- A major problem in surgery
- Only types of pain relief were opium, alcohol or being knocked unconscious.
- In most operations, patients were awake and screaming in pain.
Blood loss and Infection-
- A tourniquet (cloth wrapped tightly around a limb) was used to reduce blood flow in
the artery
o However, many patients died after the surgery from infection.
- Many operations were carried out in the patient’s home and surgeons often wore old
clothes that were already stained with blood and pus.
- Surgeons barely washed their hands, and equipment was often just wiped clean and
never sterilised.
- Bandages were washed and reused as well.
- There were many others on the operating theatre, this made infection more likely.
The use of Ether-
- Discovered by William Morton, a dentist from USA in 1846.
- First used in Britain by Robert Liston during an operation and was successful.
- Had side effects as it often caused vomiting and irritated the lungs.
- Dosage was a problem as it could leave a patient sleeping for hours or days.
- Highly flammable which was dangerous as the operating theatre was lit by candles or
gas.
James Simpson- Chloroform-
- Discovered in 1847 and did not have the same side effects as ether,
- Simpson, who was Professor of Medicine and Midwifery used it for childbirth.
, - He became the official physician to Queen Victoria, and she used chloroform when she
delivered her 8th child.
- Chloroform became more widely used.
- When Simpson died in 1870, a statue was put up in his honour.
Impact of Chloroform-
- Many doctors refused to use it in childbirth as they did not know how it would affect
the baby.
- Dosage was a problem, so John Snow invented a chloroform inhaler which controlled
the dosage of chloroform.
- Some doctors thought that unconscious patients were more likely to die.
- Many surgeons gained confidence to attempt longer and more complicated
operations.
- Problem of blood loss still remained.
Problem of infection-
- Doctors still did not understand hygiene and infection.
- Germs were still entering the body as bedsheets and bandages were being re-used.
- Gangrene- A serious condition where body tissue dies due to a lack of blood supply
or severe infection
- Sepsis- Occurs when the body's response to an infection causes widespread
inflammation, leading to tissue damage, organ failure, or death.
Living conditions-
- Groups of houses in poorer areas of industrial towns were arranged in narrow dark
streets, called ‘courts.
- 1 family would live in 1 room and more than 50 people would live in a house.
- Houses were damp, with little light or ventilation and in bad weather, the ground floor
and cellar would become flooded.
- A single privy (a wooden toilet) would be used by 100 people and water would be
collected from polluted rivers through a pump, shared by 20-30 families.
Killer diseases-
- Vaccination had been developed to prevent smallpox but was rarely used.
- There were no treatments for typhus, typhoid fever or influenza and many patients
who survived these diseased died from other illness such as pneumonia or bronchitis
as their bodies were so weak.
- Cholera was the most frightening disease and killed 20,000 people in the epidemic of
1831-32.
Cholera-
- There was another cholera epidemic in 1848 (killing 50,000 people) , and members of
parliament left matters to the local authorities, who decided to adopt measures based
on miasma.
- This made it seem like cholera would mainly affect poor people who lived in
unhygienic conditions.
- Dr Robert Baker published a report on the 1832 cholera epidemic in Leeds and
described the standard of housing in poorer parts of the cities.
o Many streets were bare earth that often became muddy.
o 19 streets did not have a sewer and 10 only had a sewer covering part of the
street.
o Stagnant water created bad smells.
, o Human excrement was collected to sell to farmers and once took 75 cart loads
to remove.
Edwin Chadwick-
- Involved with workhouses, which housed the poor who were too old or ill to work.
- Published The Sanitary Conditions of the Labouring Population in 1842.
- Argued that improving public health from tax money would be cheaper than
supporting the sick in workhouses.
- Recommended: Clean water supply and removal of sewage and rubbish
- Faced initial resistance, but repeated cholera epidemics drew attention to hygiene.
- Appointed commissioner on both the General Board of Health and London’s
Metropolitan Commission of Sewers (1848–49).
- Known for being arrogant and aggressive, which made collaboration difficult
The 1848 Public Health Act-
- The government passed the Public Health Act due to repeated cholera epidemics and
growing concern over poor sanitation, especially after Chadwick’s 1842 report.
- A General Board of Health was set up to advise on public health improvements and
encourage action.
- Towns were allowed to set up local Boards of Health, which could:
o Appoint a medical officer of health to monitor disease.
o Organise rubbish removal from streets and homes.
o Build or improve drainage and sewer systems.
o Ensure access to a clean water supply.
- Three commissioners were appointed to run the General Board; Edwin Chadwick was
one of them.
- Local authorities could raise money through local rates (taxes) to fund improvements,
but many were unwilling to increase taxes.
- The Act was temporary, and the General Board of Health was only active until 1854.
- It did not force towns to act — many chose not to.
- There was no clear understanding of germ theory, so people didn’t fully believe that
dirty conditions caused disease.
- Resistance came from taxpayers who didn’t want to pay to improve conditions for the
poor.
1854 Cholera Epidemic and John Snow-
- Cholera broke out in Soho, London, killing hundreds of people.
- Dr John Snow believed cholera was spread by polluted water, not bad air.
- He used observation and mapping to investigate the outbreak and mapped out
cholera deaths and saw they were centred around the Broad Street pump.
- Over 500 people died near the pump within 200 metres.
- Homes closer to other pumps only had 10 deaths, all had used water from Broad
Street.
- Workhouse nearby had its own water supply – only 5 deaths out of 535 people.
- Brewery workers were unaffected – drank beer and had a separate water supply.
- A woman in Hampstead died – she had water delivered from the Broad Street pump
every day.
- When the pump handle was removed, the outbreak stopped immediately.
Impact of Snow’s work-
- Proved the link between infected water and cholera.
- Put pressure on Parliament, water companies, and local councils.
- People still didn’t fully believe him – germ theory not discovered yet (Pasteur did this
in 1861).
- In 1857, Snow studied another outbreak in West Ham – fewer cases where people
avoided dirty water.
c1948
The 4 humours-
- Blood, yellow bile, black bile, phlegm
- Medical understanding of what caused disease in 1948.
- People observed illness and saw that sometimes people became hot and flushed,
while other times they were pale and cold.
- It made sense that illness was caused by an imbalance in the body’s humours.
- Treatments were based on the theory of opposites.
Theory of opposites- An idea that illness was caused by an imbalance in one of the
humours and so can be cured by eating or drinking something with the opposite
qualities.
Miasma- Disease spread by bad smells.
Spontaneous generation- Disease spread by rotting material
Doctor’s knowledge-
- Doctors would barely do any dissections as most people wanted to be buried
- They mostly used criminals who had been executed which made it difficult to plan any
research on symptoms of disease.
- Doctors’ training was poor and ideas about prevention and treatment was likely to be
ineffective.
Factors affecting progress-
- Poor technology and lack of microscopes.
- Government did not feel responsible for these issues and did not want to fund the
development of ideas and research, hospitals mainly relied on charities.
- Many doctors did not want to learn new ways of treatment as there was no proof that
their ideas were wrong.
Florence Nightingale
- Came from a wealthy middle-class background.
- Wanted to be a nurse which was considered a low-status job at the time.
- There was no formal training for nurses in Britain, so she visited many hospitals in
Britain in during the 1940s.
- Spent 3 months in 1851 at a centre in Kaiserwerth, Germany, where she trained to
become a nurse.
- 1853- Became superintendent of a small nursing home in London- The institution for
sick gentlewomen in distressed circumstances.
- 1847- Met Sidney Herbert who asked her to take a team of 38 nurses to work in the
military hospital in Scutari.
- Many soldiers were being injured during the Crimean War, mainly due to infection.
Conditions in Scutari-
- 10,000 men lived in horrible conditions:
o Shared beds or had to lay on the floor
o Lice and fleas infestations
o Rats and mice ran in the wards
, o Typhoid fever and Cholera was common
o Many patients had Diarrhoea
o Difficult to get medical supplies
o Food supplies were poor quality and was limited
- The hospital was built on the site of an underground cesspool, where human waste
collected.
Nightingale’s actions
- Scrubbed all surfaces clean and washed all sheets, towels, and equipment.
- She believed in miasma, so windows were opened for fresh air.
- Cleaned the kitchens and improved the food quality.
- Raised a fund of money through the Times newspaper, so she could by new supplies
like clean shirts, towels, soap and cutlery.
Impact of Nightingale’s work-
- Army medical staff resisted the idea of nurses coming out to work in the Crimea as
they thought women could not cope with the conditions and were not knowledgeable.
- Nightingale was criticised but soon gained the nickname of ‘The Lady with the Lamp’
as she had a habit of checking on her parents at night.
- Death rate at Nightingale’s hospital was still high until 1855 when a government
sanitary commission repaired the drains and improved drinking water supply.
Surgery-
- Surgical procedures were basic, like cutting open a boil, or life threatening, such as
cutting out a tumour or amputating a limb.
- Amputation was necessary if a broken bone poked through the skin and became
infected.
Pain (before the 1840s)-
- A major problem in surgery
- Only types of pain relief were opium, alcohol or being knocked unconscious.
- In most operations, patients were awake and screaming in pain.
Blood loss and Infection-
- A tourniquet (cloth wrapped tightly around a limb) was used to reduce blood flow in
the artery
o However, many patients died after the surgery from infection.
- Many operations were carried out in the patient’s home and surgeons often wore old
clothes that were already stained with blood and pus.
- Surgeons barely washed their hands, and equipment was often just wiped clean and
never sterilised.
- Bandages were washed and reused as well.
- There were many others on the operating theatre, this made infection more likely.
The use of Ether-
- Discovered by William Morton, a dentist from USA in 1846.
- First used in Britain by Robert Liston during an operation and was successful.
- Had side effects as it often caused vomiting and irritated the lungs.
- Dosage was a problem as it could leave a patient sleeping for hours or days.
- Highly flammable which was dangerous as the operating theatre was lit by candles or
gas.
James Simpson- Chloroform-
- Discovered in 1847 and did not have the same side effects as ether,
- Simpson, who was Professor of Medicine and Midwifery used it for childbirth.
, - He became the official physician to Queen Victoria, and she used chloroform when she
delivered her 8th child.
- Chloroform became more widely used.
- When Simpson died in 1870, a statue was put up in his honour.
Impact of Chloroform-
- Many doctors refused to use it in childbirth as they did not know how it would affect
the baby.
- Dosage was a problem, so John Snow invented a chloroform inhaler which controlled
the dosage of chloroform.
- Some doctors thought that unconscious patients were more likely to die.
- Many surgeons gained confidence to attempt longer and more complicated
operations.
- Problem of blood loss still remained.
Problem of infection-
- Doctors still did not understand hygiene and infection.
- Germs were still entering the body as bedsheets and bandages were being re-used.
- Gangrene- A serious condition where body tissue dies due to a lack of blood supply
or severe infection
- Sepsis- Occurs when the body's response to an infection causes widespread
inflammation, leading to tissue damage, organ failure, or death.
Living conditions-
- Groups of houses in poorer areas of industrial towns were arranged in narrow dark
streets, called ‘courts.
- 1 family would live in 1 room and more than 50 people would live in a house.
- Houses were damp, with little light or ventilation and in bad weather, the ground floor
and cellar would become flooded.
- A single privy (a wooden toilet) would be used by 100 people and water would be
collected from polluted rivers through a pump, shared by 20-30 families.
Killer diseases-
- Vaccination had been developed to prevent smallpox but was rarely used.
- There were no treatments for typhus, typhoid fever or influenza and many patients
who survived these diseased died from other illness such as pneumonia or bronchitis
as their bodies were so weak.
- Cholera was the most frightening disease and killed 20,000 people in the epidemic of
1831-32.
Cholera-
- There was another cholera epidemic in 1848 (killing 50,000 people) , and members of
parliament left matters to the local authorities, who decided to adopt measures based
on miasma.
- This made it seem like cholera would mainly affect poor people who lived in
unhygienic conditions.
- Dr Robert Baker published a report on the 1832 cholera epidemic in Leeds and
described the standard of housing in poorer parts of the cities.
o Many streets were bare earth that often became muddy.
o 19 streets did not have a sewer and 10 only had a sewer covering part of the
street.
o Stagnant water created bad smells.
, o Human excrement was collected to sell to farmers and once took 75 cart loads
to remove.
Edwin Chadwick-
- Involved with workhouses, which housed the poor who were too old or ill to work.
- Published The Sanitary Conditions of the Labouring Population in 1842.
- Argued that improving public health from tax money would be cheaper than
supporting the sick in workhouses.
- Recommended: Clean water supply and removal of sewage and rubbish
- Faced initial resistance, but repeated cholera epidemics drew attention to hygiene.
- Appointed commissioner on both the General Board of Health and London’s
Metropolitan Commission of Sewers (1848–49).
- Known for being arrogant and aggressive, which made collaboration difficult
The 1848 Public Health Act-
- The government passed the Public Health Act due to repeated cholera epidemics and
growing concern over poor sanitation, especially after Chadwick’s 1842 report.
- A General Board of Health was set up to advise on public health improvements and
encourage action.
- Towns were allowed to set up local Boards of Health, which could:
o Appoint a medical officer of health to monitor disease.
o Organise rubbish removal from streets and homes.
o Build or improve drainage and sewer systems.
o Ensure access to a clean water supply.
- Three commissioners were appointed to run the General Board; Edwin Chadwick was
one of them.
- Local authorities could raise money through local rates (taxes) to fund improvements,
but many were unwilling to increase taxes.
- The Act was temporary, and the General Board of Health was only active until 1854.
- It did not force towns to act — many chose not to.
- There was no clear understanding of germ theory, so people didn’t fully believe that
dirty conditions caused disease.
- Resistance came from taxpayers who didn’t want to pay to improve conditions for the
poor.
1854 Cholera Epidemic and John Snow-
- Cholera broke out in Soho, London, killing hundreds of people.
- Dr John Snow believed cholera was spread by polluted water, not bad air.
- He used observation and mapping to investigate the outbreak and mapped out
cholera deaths and saw they were centred around the Broad Street pump.
- Over 500 people died near the pump within 200 metres.
- Homes closer to other pumps only had 10 deaths, all had used water from Broad
Street.
- Workhouse nearby had its own water supply – only 5 deaths out of 535 people.
- Brewery workers were unaffected – drank beer and had a separate water supply.
- A woman in Hampstead died – she had water delivered from the Broad Street pump
every day.
- When the pump handle was removed, the outbreak stopped immediately.
Impact of Snow’s work-
- Proved the link between infected water and cholera.
- Put pressure on Parliament, water companies, and local councils.
- People still didn’t fully believe him – germ theory not discovered yet (Pasteur did this
in 1861).
- In 1857, Snow studied another outbreak in West Ham – fewer cases where people
avoided dirty water.
