1. I.                   Revolution in Health care
    • a.      Breakthroughs in health care
    • b.      First steps toward more scientific basis for medicine were taken in Paris hospitals during first half of 19th
    •                                                               i.      Clinical observation (active physical examination of patients) was combined with the knowledge gained from detailed autopsies to create a new clinical medicine
  2. Pasteur and germs
    •                                                               i.      Major breakthrough toward a scientific medicine occurred with the discovery of microorganisms as agents causing disease
    • 1.      Pasteur wasn’t a doctor but a chemist who approached medical problems in a scientific fashion
  3. Paris as director
                                                                  i.      He went to Paris as director of scientific studies at Ecole Normale, where experiments he conducted proved that microorganisms of various kinds were responsible for the process of fermentationà science of bacteriology
  4. Government and private industry 
    • a.      Government and private industry soon perceived the inherent practical value of Pasteur’s work
    •                                                               i.      His examination of a disease threatening the wine industryà pasteurization
  5. 1877
    • a.      1877: he turned attention to human diseases
    •                                                               i.      Didn’t want to just identify, but prevent diseaseà vaccine against rabies
    • 1.      1885: principle of vaccination was extended to diphtheria, typhoid fever, cholera, and plague, creating a modern immunological science
  6. work of Pasteur
    • a.      The work of Pasteur and the others who followed him in isolating the specific bacteriological causes of numerous diseases had a far-reaching impact
    •                                                               i.      By providing a rational means of treating and preventing infectious diseases, they transformed the medical world
    • 1.      Both the practice of surgery and public health experienced a renaissance
  7. a.      New Surgical Practices
    •                                                               i.      Surgeons had already achieved professionalism by end of 18th, but discovery of germs and intro of anesthesia created a new environment for surgical operations
    •                                                             ii.      Surgeons set broken bones, treated wounds, amputated limbs
    • 1.      Obstacle was postoperative infection
  8. Joseph Lister
    •                                                               i.      Joseph Lister developed antiseptic principle and was first to deal with problem of postoperative infection
    • 1.      Saw that bacteria might enter wound and cause infection
    • a.      Used carbolic acid to eliminate infections during surgery
    • 1.      His discoveries transformed surgery wards as patients no longer succumbed to infections 
  9. Second Barrier
    •                                                               i.      Second barrier was inability to lessen pain
    • 1.      Alcohol and opiates were used, but doctors still had to hurry
    • 2.      Sulfuric ether was first used successfully in an operation
    • 3.      Chloroform became a rival
  10. New Public Health Measures
    •                                                               i.      Discoveries of bacteriology furthered development
    •                                                             ii.      Based on principle of preventive rather than curative medicine, the urban public health movement of the 1840s and 1850s was largely a response to the cholera epidemic
    • 1.      One medical man called cholera “our best ally” in furthering public hygiene
  11. Prebacteriological hygiene
    •                                                               i.      The prebacteriological hygiene movement focused on providing clean water, adequate sewage disposal, and less crowded housing conditions
    •                                                             ii.      Bacterial discoveries led to greater emphasis on preventive measures, like pasteruizaiton of milk, imporved purification of water supplies, immunization against disease, and control of waterborne diseases
    •                                                           iii.      The public health movement also resulted in the government’s hiring medical doctors not just to treat people but to dea with issues of public health as well
  12. New Medical Schools
    •                                                               i.      The new scientific developments impacted training of doctors for professional careers in health care
    •                                                             ii.      Few medical schools at start of 19th, but most medical instruction was done by apprenticeship
    •                                                           iii.      In course of 19th, virtually every Western country founded new medical schools, but attempts to impose uniform standards on them through certifying bodies met considerable resistance
    • 1.      Entrance requirements were virtually nonexistent, and degrees were granted after several months of lectures
  13. Professional organizations
                                                                  i.      Professional organizations founded around midcentury, such as British Medical Association in 1832, the American Medical Association in 1847, and the German Doctors’ Society in 1872, attempted to elevate professional standards but achieved little until the end of the century 
  14. Establishment
                                                                  i.      Establishment of John Hopkins University School of Medicine in 1893, with its four-year graded curriculum, clinical training for advanced students, and use of labs for teaching purposes provided a new model for medical training that finally became standard practice in the 20th c. 
  15. Most of 19th
    • a.      During most of the 19th c., medical schools in Europe and the US were closed to female students
    •                                                               i.      EX: Harriet Hunt applied to Harvard Medical School, the male students drew up resolutions that prevented her admission
  16. Blackwell
    •                                                               i.      Elizabeth Blackwell achieved first major breakthrough for women in medicine
    • 1.      Admitted to Geneva College of Medicine in NY by mistake, Blackwell’s perseverance and intelligence won her the respect of her fellow male students
  17. European women
    • a.      European women experienced difficulties similar to Blackwell’s
    •                                                               i.      In Britain, Elizabeth Garret and Sophia Jex-Blake had to struggle for ears before they were finally admitted to the practice of medicine
    •                                                             ii.      Unwillingness of medicine schoosl to open their doors to women led to the formation of separate medical schools for women
  18. Female Medical College of PA
    • 1.      Female Medical College of PA was first in US, and the London School of Medicine for Women was founded in 1874
    • a.      Even after graduation from such institutions, women faced obstacles when they tried to practice as doctors
    •                                                                                                                                       i.      Many were denied licenses and hospitals closed their doors to them
    • 1.      In Britain, Parliament finally capiltauted to pressure and passed a billin 1876 giving women the right to take qualifying examinations
  19. Women in fields
    • a.      Some women were entering fields in larger numbers
    •                                                                                                                                                                                                               i.      By 1890s, universities in Great Britain, Sweden, Denmark, Norway, Finland, Russia, and Belgium admitted women to medical training and practice
    •                                                                                                                                                                                                             ii.      Germany and Austria didn’t until after 1900; even then, medical associations refused to accept women as equals in the medical profession
    •                                                                                                                                                                                                           iii.      Women weren’t given full membership in the American Medical Association until 1915
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