c1700-c1900: 18th and 19th Century

Microscopes:

• By 1850, microscopes had futher improved so that tiny images could be seen clearly. 
• This was essential in enabling the scietific breakthrough.
• Social attitudes towards science were changing- there was an increasing awareness of the need for rational explanations for the cause of disease.

Germ Theory:

• 1861, Pasteur published the Germ Theory- he proved that microbes in the air cause decay.
• He theorised that germs also caused disease but he was unable to prove this.
• Koch read Pasteur's work and began to study microbes himself.
• Koch proved that his theory was right, he identified microbes that caused TB and Cholera.
• Koch developed an easier way of growing bacteria on agar jelly and discovered that chemical dyes stained the bacteria, to see under a microscope.
• These discoveries had a direct impact on the preventation and cure of many diseases.
• The Germ Theory had little impact in medicine since it mainly focused on food.
• Koch had more of an impact and inspired others to research microbes
• However, it didn't initially have a impact in treatment,

She was significant in influencing improvements in hospital care.

She believed that miasma caused disease, so she emphasised hygiene, fresh air, good supplies and training for nurses.

Her approach lowered the death at that hospital from 42% to 2%.

Her work was widely reported in newspaper in Britain, she published books on nursing and she set up a training school for nurses and midwives.

1856:

• New hospitals were financed by charities/local councils, they opened during the 19thC to look after the sick.
• 1859, th first cottage hospital (GPs) built.
• Middle and upper classes ould afford doctors to treat them at home.
• The elderly, sick or disabled poor were forced to enter workhouses.
• Most hospitals tried to create a home atmosphere. 
• Parents and visitors helped nurses look after the patients.

1875:

• Due to the work of Nightingale, hospital cleanliness and organisation improved, and nurses were better trained.
• Pasteur's Germ Theory led to improved hygiene.
• Nurses were given a more central role for patients and assisting doctors.
• Public pressure led to infirmaries being set up for the poorest in society.
• Specialist hospitals, like asylums, developed.

• Before 1800, alcohol and opium had little success in easing pain during operations.
• 1844, laughing gas was used in dentistry USA, but failed to ease all pain and patients remianed conscious.
• 1846, ether made patients totally unconscious and lasted a long time.
• However, it did make patients cough during operations and made them sick after, also it was highly flammable.
• 1847, chlorofom was very effective with few side effects, but it was difficult to get the right dosage.
• An inhaler helped to regulate dosage, otherwise it could kill some people because of the effects on the heart.
• 1884, cocaine was used as the first local anaesthetic.
• 1905, novocaine- less addictive- was used as a local anaesthetic.

• People worried about the long-term effects of using anaesthetics, they thought that people being unconcious were more likely to die.
• Victorians were very religious and thought that it was wrong to interfer with God's plan.

• 1861, Half the patients died from postoperative infections; Lister started working as a surgeon.
• 1864, Lister read Pasteur's Germ Theory and learnt that carbolic acid kills parasites.
• 1865, Lister soaked bandages in carbolic acid to avoid wounds getting infected.
• 1866, Lister used carbolic acid to clean wounds/equipment and invented a spray to kill germs in the air.
• 1867, Lister stated that his ward had been free from infections for 9 months, he published his ideas.
• 1877, Lister became a Professor of Surgery at King's College Hospital.

• Lister's work inspried others to search for other methods to prevent the spread of infections in hospitals. 
• By 1900, operating theatres and wards were thoroughly cleaned aspetic techniques and doctor's clothing and equipment were sterillised.
• Surgery became pain free and the death rate dramatically decreased.
• Surgery was more successful and infections were reduced.

• Development of Vaccinations:
  • 1861, Pasteur, published the Germ Theory of Infection
  • Pasteur's team of scientists discovered that a weakened version of a disease causing microbe could be used to create immunity from that disease.
  • Pasteur admired Jenner and called his new discovery 'vaccination' in tribute to Jenner.
  • Pasteur developed vaccines for animals against anthrax, rabies and chicken cholera.
  • Pasteur's work inspired other scientists to develop vaccines for human diseases.
• 1875, Public Health Act:
  • The government previously believed that it had no role to improve people's living conditions.
  • The attitude changed due to several epdemics and the increading scientific evidence that these diseases were caused by poor living conditions.
  • By 1875, people recognised that it was the goverment's duty to improve living conditions in cities.
  • Clean water, Sewers, Public toilets, Street lighting, Public parks.
  • Inspect lodging houses (cleanliness), monitor new houses (dampness), Check quality of food at shops, Public health officer to monitor disease.

• Jenner's work proved that scientific methods could lead to diseases being wiped out.
• He saved millions of lives, however:
  • He didn't know why it worked.
  • The link between cowpox & smallpox was unique, so it didn't lead to other vacicnations.
  • Other diseases were still killing people.

• Many poeple opposed of Jenner's work because:
  • They they thought that it was wrong to give people and animal's disease.
  • It interfered with God's plan.
  • Drs lost money when the government offered the vaccination free.
  • Some Drs didn't vaccinate people properly so it didn't work.

• 1798, Royal Society refused to publish Jenner's ideas, so he paid to print his findings.
• By 1800, around 100,000 people worldwide were vaccinated, but ut was slow in Britain.
• 1840, the government bgan to pay for people's vaccinations which were made compulsory in 1852.
• 1979, WHO annonced that smallpox had been wiped out.

• Most people believed that Cholera was caused by miasma.
• People tried to clean the streets and the rubbish.
• Public Health Act suggested that cities should clean the water supplies, but it was not compulsory so very few complied.

John Snow:

• He discovered that a cesspit close by the pump was leaking into the well.
• After he removed the handle, the number of deaths fell dramatically.
• His finding added to the body of evidence ordering and paying for new London sewers.
• He addded to the proof that cholea was caused by dirty water.
• His effect was limited as many didn't believe.
• The government didn't act upon it until other discoveries were made.
• The lack of evidence meant that the Public health Act didn't improve the water supply until much later.