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- 1Inoculation? Who brought it to England? From where?The plague and leprosy were no longer a problem but smallpox was a major killer. The first successful prevention of smallpox in Britain was carried out after Lady Mary Wortley Montagu returned from Turkey, where her husband had been ambassador.
- 2Inoculation? Who brought it to England? From where? Part 2She had seen inoculation used as a way of protecting patients against smallpox. This
meant putting some pus from a smallpox sore into a cut on the arm. The patient
caught a mild form of the disease but later often survived a major epidemic - 3What did inoculation become?This became a popular practice among the well off in some areas with “smallpox parties” being held and doctors making great profits for doing inoculations but it was a dangerous process because the patient could die
- 4Edward Jenner (dates)A real breakthrough was made by Edward Jenner in 1798. He was a Gloucestershire
doctor who offered inoculation to his patients. Many refused, saying that if they had cowpox (a mild disease) which made them immune to smallpox. - 5Edward Jenner? (dates) Part 2Jenner investigated this and found it was true. He began to give people cowpox, calling it vaccination.
- 6Why was there opposition to Jenner? (people)People saw it as interfering with God’ s will and felt it was unnatural to give humans an animal disease (Gilray cartoon).
- 7Why was there opposition to Jenner? (doctors and science)Doctors who made profits from inoculation objected to Jenner taking work away from them. However, Jenner could not explain how vaccination worked & the idea didn’t work for any other disease so there was also scientific opposition and it was both a breakthrough and a dead-end.
- 8What part did the government play?Edward Jenner’s vaccination against smallpox was made compulsory by the government in 1852 (but it was not strictly enforced at first). This was an important step forward in the government accepting responsibility for the health of the public.
- 9Factors affecting Jenner?personal qualities of curiosity and
persistence, his scientific approach of testing and keeping careful records, chance (or luck/coincidence) that this link between diseases existed, government support and
funding, religion, - 10Factors affecting Jenner? part 2The church opposed his vaccination at first, and social attitudes as there was wide variation in people’s attitudes towards vaccination and it took several years before it was completely accepted.
- 11John Hunter?John Hunter, an anatomist in the 18th century, published works which helped to develop understanding of medical conditions such as arthritis, and also sexually transmitted diseases . However, even though physicians now had a better understand ing of anatomy, it did not help them to treat or prevent disease
- 12Ideas of the public?The idea of the 4 Humours was still wide ly accepted as an explanat ion of disease and many
people still a imed to prevent or treat il lness through bleeding or purging - 13More ideas of the public?Miasma which was supported by the idea of spontaneous generation and the development of stronger microscopes. They could see microbes under the microscope and saw that rotting material was covered in maggots and flies and gave off bad smells so they thought rotting material created miasma and disease
- 14Why did people move to towns?During the e ighteenth century inventions and developments in agr iculture led many
people to move to towns in search of work - 15Why were factories built?inventions and developments in
industry led to factories being built and the rapid growth of towns and cities. - 16When did the population double? By how much?The population doubled between 1801 and 1851 from 10 million to 20 million and by
1850 half lived in cities or towns. - 17Why were houses built quickly?Since factories employed thousands of people and there was no public transport, they had to live close to their place of work. This led to houses being built very quickly and cheaply for these workers.
- 18What did low wages lead to?Low wages meant that people could not afford high rents, so houses were built as
cheaply as possible and many houses were divided so that each room housed a family,
which led to terrible overcrowding. There was no access to a clean water supply or any good way of getting rid of sewage, therefore sewage built up in the streets. - 19What diseases were there?The spread of infectious disease became a major problem as more people now lived in crowded towns; smallpox was particularly a problem but also typhus, diphtheria and tuberculosis; cholera arrived in England in 1831
- 20What did low pay lead to?Low pay and little access to fresh food also meant the health of the public was poor
- 21Government help?Governments did not know the scale of the problem, or understand how to deal with it. They were not even sure the problem was anything to do with them: many saw it as a landlords and tenants problem. The attitude of ‘laissez-faire’ meant that government should not interfere in such issues
- 22Government on Gin?The government did introduce a tax on gin in 1750 because cheap gin meant workers becoming dead drunk and gin was addictive; this affected the economy.
- 23Chadwick?Chadwick produced a report in 1842 about the living conditions of the poor in
towns; he said it was more expensive in the long run to have poor quality living conditions because they led to poor health and people then needing to enter the workhouse. - 24What did Chadwick say?Chadwick suggested reforms in housing, access to water and removal of sewage. He did not know about the link between germs and disease – he believed in the miasma theory which said that dirt and rubbish created disease, so he wanted to do the right things but for the wrong reason.
- 25Chadwick's popularity?Unfortunately Chadwick made himself unpopular by being blunt and rude and there was considerable opposition to change. There was even a `Dirty Party', which declared that it would rather take the risk of cholera than be forced to be clean by Chadwick.
- 26Local councils?Other people objected to change because building sewers and providing fresh water would cost money. Local councils in towns were elected by the people who paid rates ( local taxes) so they were unlike ly to recommend expensive action since the voters would be the ones paying the rates
- 27First public health act?The first Public Health Act in 1848 did make provision for a lot of the things Chadwick wanted, e.g. providing clean water, removing rubbish & sewage & appointing a Medical Officer in each area, but it was a permissive act and was not enforced.
- 28What else did the first public health act set up?The Act also
set up a Central Board of Health in London, with Chadwick as the Secretary but it only lasted for 5 years and in 1854 it was ended because people did not think it was needed. - 29John snow?In 1854 there was another outbreak of cholera in Soho and John Snow mapped the deaths, proving that it was centred on the pump at Broad St; Snow proved cholera was spread through contaminated water but still could not explain . However, this did encourage measures to improve access to clean water
- 30Great stink? John Bazalgette?In the `Great Stink ' of 1858, Parliament had to be suspended because the smell from the polluted Thames during the hot summer was so bad and in 1859 a new sewage system was designed by Joseph Bazalgette which took 15 years to complete.
- 31Treatment of illness?However, there was still not progress in t reatment of illness. Understanding of disease was still based on the old ideas of the 4 Humours or miasma (although few people now believed in supernatural or religious causes of illness). The idea of spontaneous generation was also used to explain disease
- 32What was treatment based on?Therefore treatment remained based on the 4 humours (Throughout the eighteenth century 5,000,000 leeches were imported into Britain every year) or on the use of herbal remedies of ready –made preparations from apothecaries.
- 33Prevention?Prevention was also based on keeping the humours balanced or on purifying the air
- 34Medical Training?In 1815 the Royal College of Surgeons and the Society of Apothecar ies introduced
examinations and in 1858 the General Medical Act said a General Medical Council had to be set up and all physicians had to register with it. This emphasis on qualifications and control over physicians began to improve the quality of doctors - 35Medical training? Part 2Doctors began to divide into
General Practitioners and Consultants, who worked at hospitals and specialised in specific areas. Many hospitals also developed research laboratories . - 36Florance Nightingale?Florence Nightingale had trained in Germany as a nurse – at a time when
nursing was using done by poor, untrained, often drunk and slovenly women. When the appalling death rate among wounded British soldiers fighting in the Crimean War, was known. - 37What did Nightingale do in the Crimean war?Nightingale led a group of trained nurses to go to the army hospital at Scutari. They improved hygiene (Nightingale believed in miasma) and the death rate reduced.
- 38What happened when Nightingale returned to Britain?Nightingale set up a training school for nurses at St Thomas’ hospital in London . Her book ‘Notes on Nursing’ had a major influence on nurses’ training, she made reports to parliament and received a medal from Queen Victoria.
- 39Cottages? Rich people?In 1859 the first cottage hospital opened in Sussex ; this was run by local doctors and offered general treatment and operations for local people. At this point, rich people would be treated at home, paying doctors and nurses to visit them.
- 40Cottages? middle class and lower class?middle class people would
pay into a doctor’s ‘sick club’ so that he would treat them if they became ill; many working class or poor people could not afford to see a doctor – they would go to charity hospitals set up in cities, or out-patients departments of large hospitals. - 41Hospitals?A number of hospitals were set up in towns but they were usually funded by charity and there was no central control over them. In 1867 it was ordered that the Poor Law Unions which ran the workhouses should each build an infirmary and employ a doctor to care for such people. Lunatic asylums began to be built.
- 42Medical drugs?the chemical industry developed more potions and pills began to be advertised.
Pharmacies were set up selling medicine and pills which were now made in a standardized way rather than each apothecary making his own. - 43Cautions to medicinal drugs?However, many patent medicines
continued to contain harmful ingredients such as arsenic, chalk, alcohol and wax until new laws were passed at the end of the 19th century. - 44Louis Pasteur?Louis Pasteur was a French chemist who was consulted by the brewing industry about problems making the wine go sour. He showed that this was the result of bacteria, but he also showed that heat killed bacteria and that pasteurisation made liquid safe.
- 45What other experiments did he conduct?Other experiments he conducted proved that bacteria were in the air and he then
showed that bacteria led to decay (and infection). The Germ Theory, (published 1861) proved that Spontaneous Generation was wrong since germs were in the air and were not created by decaying matter - 46What was an important stage in understanding germs?Pasteur’s scientific work (experiments, recording & publishing results) together with stronger microscopes and better communications with other scientists, was an important stage in understanding that germs (bacteria/microbes) in the air caused infection and disease .
- 47Did better understanding of disease mean treatment was possible?No there was little improvement during the next 50 years.
- 48Did better understanding improve prevention?Yes, Pasteur developed a way to isolate
and weaken the bacteria causing chicken cholera and in 1880 (by chance) found that
giving chickens a dose of the weakened bacteria, created immunity. He called this
vaccination, in honour of Jenner.He went on to create a vaccination against anthrax in sheep. - 49What put pressure on the government to intervene?The work of Chadwick in identify ing poor liv ing condition s as a reason why d isease
spread, and John Snow’s work in prov ing the link between cholera and contaminated water put pressure on the government to intervene - 50Why did the Government come under pressure?working class people in the towns got the vote in 1867 and workers in the countryside in 1884 the government would aim policies to help them in order to get votes. However, the actual reforms still needed to be implemented by local governments and paid for by local taxes.
- 51Public health act 1875?Local Authorities could pull down slums. They had to provide sewers, fresh water, clean streets They had to appoint a Medical Officer of Health to make sure that all these things were done properly
- 52Artisans Dwellings act1875 This compelled local authorities to provide housing with fresh water and sewerage
- 53Public health from 1875?began to improve but the effects of poor public health were still clear thirty years later. In 1899 when the army was recruiting soldiers for the Boer War, it was found that 90% of volunteers from some areas were unfit for military service. This showed that improvements in public health were still needed.
- 54Robert Koch?German medical doctor, investigated microbes causing human disease. Koch found that different chemical dyes would only stain specific microbes helping him to study them under the microscope. This was important as each disease was caused by different microbes . One of the diseases he worked on was tuberculosis.
- 55Factors affecting Koch and Pastuer?team of scientists working with them. They were also stimulated by
national rivalry and both received support from the government. Improved
communications (the telegraph) and easier travel (railways) also made it easier for scientists to share the research. - 56More factors affecting Koch and Pastuer?There were meetings and scientific journals which published articles for other scientists to discuss . Team work was also important due to increased specialisation in the sciences.
- 57Vaccination against rabies? Who? When?Meanwhile, in 1885 Pasteur produced a vaccine against rabies, using a technique that could be used to develop other vaccines (unlike Jenner’s vaccination) and prevent disease spreading NB still prevention, not cure
- 58Behring?In 1892 Behring identified the anti-toxins produced by the body to attack diphtheria
germs and deve loped this into a cure for diphtheria
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