Industrial Period

Germs and other micro-organisms were descoverd as early as the 17th century. Scientists thought that these microobes were created by decaying matter, like rotting food or human waste, this thoery was knowm as spontaneous generation. It led people to believe that disease caused germs.

• Spontaneous Generation
• Louis Pasteur
• Impact on medicine
• Robert Koch
• Paul Ehrlich

The French chemist Louis Pasteur was emplyed in 1857 to find the explanation for the souring of sugar beetused in fermenting idustrial alchohol. His answer was to blame germs.

Pasteur proved there were germs in the air. He showed this through the expirement of 'The Swan Neck Flask'.  He demonstrated thatsterilised water in a swan neck flask stayed sterile while sterilised water in an open flask bred germs.

In 1861, Pasteur published his Germ Theory. Within it he argued that microbes in the air caused decay, not the other way round. He also sugeested that germs caused disease.

In 1867, he published evidence proving there was a link betwwen germs and disease, demonstrating that germs caused a disease in silkworms.

The Germ Theory was first met with scepticism, people couldn't and refused to believe tiny microbes caused disease. It didn't help that the germ was responsible for each disease had yet to be identified individually, as this meant it was several years before the thoery became useful.

• The theory helped inspire Joseph Lister to develop antiseptics.
• The theory confirmed John Snow's findings about cholera.
• The theory linked disease to poor living conditions (like contaminated water supplies). This put pressure on the government to pass the 1875 Public Health Act.

The German scientist Robert Kock built on Pasteur's work by linking specific diseases to the particular microbe that caused them. This technique was called 'microbe hunting'.

Koch identified anthrax bacteria (1876) and the bactria that caused septicaemia (1878) and cholera (1883).

Koch used revolutionary scientific meathods such as;

• Agar jelly to creat colid cultures, allowing him to breed lots of bacteria.
• Dyes to stain the bacteria so they were more visable under the microscope.
• He employed the newly-invented photography to record his findings.

Koch's techniques and descovies were important as they allowed other microbe hunters to find the specific bacteria which caused other diseases.

Antibodies were identified as a natural defence mechanism of the body against germs. It was known that antibodies only attacked specific microbes, so they were nicknamed magic bullets.

In 1889, Paul Ehrlich set out to find chemicals that could act as synthetic antibodies.

First, Ehrlich descovered dyes that could kill the malaria and sleeping sickness germs.

In 1905, the bacteria that causes the STI syphilis was identified.

Ehrlich and his team decided to search for an arsenic compound that was a magic bulet for syphilis. They hoped it would target the bacteria without poisoning the rest of the body.

Over 600 compounds were tried, but none seemed to work.

In 1909, Sahachrio Hata joined the team. He recheaked the results and saw that number 606  actually appeared to work.

The Germ Theory led to the indroduction of new vaccines, antiseptics and government intervention in public health.

But it didn't really affect treatments in Britain that much.

Salvarsan 606 was only a treatment for one specific disease and the second magic bullet wasnt descovered until 1935.

It wasnt until the pharmaceutical industry took of in the 1940s that ordinary people began to feel a benifit from the Germ Theory.

Pain was a problem for surgeons, especially since patients could die from the trauma of extreme pain. Natural drugs like alchohol, opium and mandrake had been used for a long time, but effective anaesthetics that didn't kill or make the patient very ill were hard to find and produced

• Humphry Davy
• Crawford Long
• James Simpson
• Early Anesthetics

In 1877 hearing of Koch's descovery of the anthra bacteria, Pasteur started to compete in the race to find and combat new microbes.

Pasteur's assisatant, Charles Chamberland, injected some chickens with a cholera culture that had been weakened by being accidentally left out on the desk while he was on holiday.  The chickens surived.

The team then tried again with some newly cultured cholera, but the chickens still survied.

They worked out that the weakened cholera had made the chickens immune. Chamberland's error had produced a chance descovery.

The team produced a attenuated verison of the anthrax bacteria to make sheep immune. They showed his in a public experiment in 1881.

They used a simialr method to find a vaccine for rabies.

• Nitrous oxide ( laughing gas) was identified as a possible anaesthetic by British chemist Humphry Davy in 1799 - but he was ignored by surgeons at the time.

• The gas had been dismissed as a fairground novelty before American dentist Horance Wells suggested its use in his area of work. He did a public demonstration in 1845, but had the bad luck of picking out a patient who was unaffected by nitrous oxide - it was again ignored.

• In 1842 American doctor Crawford Long discovered the anaesthetic qualities of ether, but didn't publish his work.

• The public demonstration of ether as anaesthetics was carried out in 1846 by American dental surgeon William Morton.

• Ether is an irritant and is also failry explosive so using it in this way was risky.

• James Simpson was a Professor of Midwifery at Edinburgh University who tried to find a safe alternative to ethr that women could take during childbirth,

• He began to experiment with other chemicals by testing them on himself.

• In 1847 he discovered the effects of chloroform. He found it easier to use then ether- it took effect more quickly and less was needed to achieve the same result.

• After Queen Victoria gave birth to her eighth child while using chloroform in 1853, it became widely used in operating theatres and to reduce pain during childbirth.

• Anaesthetics led to longer and more complex operations. This was because surgeons found that unconscious patients were easier to operate on, meaning they could take longer over thier work.
• Longer operating times led to higher dath rates from injection, becasue  surgeos didn't know that poor hygine spreads disease.
• Surgeons used very unhygienic meathods such as;

~ Surgeons didn't know that having clean clothes could save lives. Often they wore the same coats for years, which were covered in dried blood andpus from previoous operations.

~ Operations were often carried out in unhygienic conditions, including at the patients house.

~ Operating instruments also caused infections because they were usaly unwashed and dirty.

Anaesthetics helped solve the problem of pain but patients were still dying from infection.

This meant that the attempts at more complicated surgery actually led to increased death rates amongst patients.

The period between 1846 and 1870is sometimes known as the 'Black Period' of surgery of this reason.

There are two main approaches to reducing infection during an operation.

~ Antiseptic meathods are used to kill germs that get near surgical wounds.

~ Aseptic surgical meathods aim to stop any germs getting near the wound.

• Joseph Lister
• Asepsis

• Ignaz Semmelweis showed that doctors could reduce the spread of infection by washing their hands with chloride of lime solutionm between patients. However, it was very unpleasent so wasn't widly used.

• Lister had seen carbolic acid sprays used in sewage works to keep down the smell, He tried this in the operating theatre in the early 1860s and saw it reduced infection rates.
• Lister heard about the Germ Theory in 1865 - he realised that germs could be in the air, on surgical instruments and on people's hands. He started using carbolic acid on instruments and bandages.
• The use of antiseptics immediately reduced death rates from as high as 50% in 1864 - 1866 to around 15% in 1867-1870.
• Despite these early successes Lister faced oppostition from many doctors. They bdi8dn't like to use the carbolic spray, they found it expensive, time consuming and unpleasnt to use on their hands or breathe in;.
• In 1877 Lister used well-publicised operation at King's College Hosiptal to promote the use of his carbolic spray.
• Antiseptics allowed surgeons to operate with less fear of patients dying from infection . The number of operations was 10 times higher as a result.

Since the late 1800s surgeons have changed their approach from them killing germs to making a germ-free (aseptic) enviornment.

Aseptic surgery reduced the need for cabolic acid.

• Instruments are carefully sterilised before use, usually with high temperature steam (120*c)
• Theatre staff sterilise thier hands before entering - and wear sterile gowns, masks, gloves and hats. Surgical gloves were invented by William Halsted in 1889.
• The theatres themselves are kept extremly clean and fed with sterile air.
• Special tents can be placed around the operating table to maintain an area of even stricter hygiene in high risk cases.

Antiseptics (and later asepsis) solved the problem of infection.

This along with the use of anaesthetics to stop the pain, improved British surgery and prevented many deaths.

• Living conditions
• Cholera
• Chadwick and the 1848 Public Health Act
• John Snow
• The 'Great Stink' of 1858
• Change
• The 1875 Public Health Act

During the 18th and 19th centuries lots of people moved from the countryside to towns and cities to work ini factories.

This meant the towns grew so quickly that good housing couldn't be built fast enough- instead houses were built as close togather as possible, with little outside space and poor ventilation.

Overcrowding was a big problem. Workers had little money, so tried to live in the smallest possible space- families with four of more children often lived in a single room. The poorest lived in cellars.

People didn't understand the need for clean water or good sewerage systems. Most houses had no bathroom - they instead shared an outside toilet,called a privy.

Each privy was built above a cesspit. Cesspit and household waste was collected by nightmen, who threw the waste into rivers or piledit up for the rain to wash it away.

Water companies set up water pumps in the streets, which were shared between many houses and streets. The pump's water supply was often contaminated by waste from the cesspits or rivers.

Cholera reached Britain in 1831. By 1832 it was an epidemic - over 21,000 people had died from cholera that year.

Cholera spreads when infected sewage gets into drinking water. It causes extreme diarrhoea - suffers often die from loss of water and minerals.

Both rich and the poor caught it.

At the time people didn't know what caused cholera - the best theory was miasma.

The government started regulating the burial of the dead, but this did little to halt the spread of cholera.

The 1832 epidemic declined and intrest was lost.

However, cholera epidemics recurred in 1848, 1853-1854 and 1865-1866.

John snow showed that there was a connection between conatminated water and cholera in 1853 - 1854.

He studied a cholera outbreak in the Broad Street are of London and noticed that all the victims all used the same water pump.

After descoving a crack in the cesspit he removed the handle from the pump and entred the out break.

In 1842 the soical reformer Edwun Chadwick published a report on poverty and health. The reoprt showed that living conditions in towns were worse for people's health then conditions in the countryside.

Chadwick's report suggested that the government should pass laws for proper drainage and sewerage systems, funded by local taxes.

Chadwick's report and another cholera epidemic in 1848 (which killed 53,000 people) put presure on Parliment to pass a Public Health Act.

The 1848 act set up a central Board of Health ( which included Chadwick as a member) and allowed any town to set up its own local board of health as long as the towns taxpayers agreed.

However, this act was volentry.

The impact of the 1848 Act was limited - towns could set up health boards but very few chose to and those who did often refused to spend any money to improve conditons.

Chadwick annoyed a lot of people of people and was forced to retire in 1854.

The central Board of Health wax dismanteld in 1858.

As in other towns a lot of waste in London drained into watersources including the River Thames.

In the summur of 1858 the hot weather caused the river's water level to drop and bacteria to grow in the waste.

This produced a smell that was so bad it affected large parts if London and stopped Parliament from meeting.

To reduce the stink engineer Joeseph Bazalgetter was appointed in 1859 to build a new London  London sewer system.

The sewers transported waste that was normaly dumped into the Thames away from the heavily polutated areas to the Thames Estuary.

About 13000 miles of sewers were built.

The sewer system was officially opened in 1865.

Bazalgette's design became the blueprint for most cities in Western Europe.

For most the 19th century people believed in a laissez-faire style of government - they thought the government shouldn't intervene in public health. But then things began to change./

Evidence from Chadwick, Snow and Pasteur's Germ Theory showed that cleaning towns could stop the spread of disease.

In 1867 the Second Reform Act was passed giving nealy 1 million more men the vote, most of whom were industrial workers.

Now they could vote workers could put pressure on the government to listen to concerns about health.

For the first time politicians had to address workers' concerns iin orde to stay in power.

Several reformers helped chnage attitudes towards health.

William Farr was a statistician who recorded causes of death. He used his statistics to press for reforms in areas where death rates were high.

In the 1870's the government inally took action to improve public health.

In  1871 -1872 the government followd the Royal Sanitary Commission's proposal to form the Local Government Board and divide Britain into 'sanitary areas' administered by officers for public health.

In 1875 Benjamin Disraeli's government passed another Public Health Act. It forced councils to appoint health inspectors and sanitary inspectors to make sure that laws on things like water supplies and hygiene were followed. It also made councils maintain sewerage sysytems and keep thier towns' streets clean.

The 1875 Public Health Actwas more effective than the one passed in 1848 due to it being compulsory and not volentury.

Disraeli also brought in te Artisans' Dwellings Act in 1875. This let local councils buy slums with poor living conditions and rebuild them in a way that fits the new government- backed housing standards.

There were several changes to public health during the industrial revolution and the 1875 Public Health Act was the biggest.

The work of the government and indivduals like Chadwick, Snow and Farr were key to these changes.

Techonolgy (like Bazalgette's sewers), the 1867 Reform Act and the cholera epidemics were othe factors that promted improvments.