Medicine in 18th and 19th Century Britain

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Jenner's Vaccination

  • He heard milkmaids saying how they couldn't get smallpox as they had had cowpox. Using scientific methods, he discovered that this was true. 
  • In 1796, he tested his theory on James Phipps by injecting the young boy with pus from the sores of Sarah Nelmes, a milkmaid with cowpox.
  • After this, Jenner infected the boy with smallpox and he didn't get the disease. 
  • His findings were published in 1798 and he coined the term 'vaccination' using the Latin word for cow 'vacca'
  • Some people resisted the vaccination and some doctors thought that this new vaccination (they were used to doing old inoculations) threatened their livelihood and many were worried about giving themselves a disease from cows
  • Jennner's dicovery got Parliament approval in 1802 when he recieved £10,000 to open a vaccination clinic - he was then given an extra £20,000 a few years later
  • In 1840, smallpox vaccinations became free for children and in 1853, it was made compulsory.
  • This vaccine contributed to a big fall in the number of smallpox cases in Britain
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Inoculation

  • Before Jenner's smallpox discovery, smallpox was one of the most deadly diseases (in the 1700s) and over 3500 people died of smallpox in London alone
  • The only way to prevent smallpox at the time was through inoculation, which was introduced from Turkey by Lady Mary Wortley Montagu in 1718.
  • Inoculation involved making a cut in a patient's arm and soaking it in pus taken from the swelling of somebody who already had a mild form of smallpox
  • Inoculation was successful in preventing the disease, but it meant that people had to experience the disease before they became immune to it; this meant that some people died from the inoculation experience
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Louis Pasteur

  • Employed in 1857 to find the explanation for the souring of sugar beet used in fermenting industrial alcohol. He blamed germs.
  • He proved that there were germs in the air by showing that sterilised water in a closed flask stayed sterile, while sterilised water in an open flask bred germs
  • In 1861, he published the Germ Theory in which he argued that microbes in the air caused decay, not the other way round. Also suggested that some germs caused disease.
  • In 1879, his team was studying chicken cholera microbes and injecting the chickens with the disease. Someone accidentally left a culture of the bacteria on the side and when it was used  a couple of weeks later, it had become a weakened version. He realised that this could be used as a vaccine to create immunity from that disease for chickens
  • (Leeuwnhoek invented the microscope in the 17th century and they were developed further in the 1800s, so this helped Pasteur massively)
  •  He was supported by John Tyndall, but Henry Bastian disagreed with him
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Robert Koch

  • This German scientist built on Pasteur's Germ Theory by linking specific diseases to particular microbes that caused them
  • He discovered anthrax spores in 1876
  • He discovered the septicaemia bacteria in 1878
  • Discovered the bacteria causing tuberculosis in 1882
  • Dicovered the cholera bacteria in 1883
  • He used agar jelly to create solid cultures, allowing him to breed lots of bacteria and also used dyes to stain the bacteria so that they were more visible under the microscope
  • He also employed the newly-invented photography to record his findings
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Impacts of the Germ Theory

  • It took some time for any impact to occur 
  • It was met with scepticism as people couldn't believe that tiny microbes caused disease. It also took time for the theory to become useful due to the fact that it took many years to discover individual germs linking to specific diseases
  • It soon gained popularity in Britain 
  • It inspired Joseph Lister to develop antisceptics
  • Proved John Snow's cholera findings
  • Linked disease to poor living conditions (like squalor) and this put pressure on the government to introduce the Public Health Act in 1875
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Florence Nightingale

  • She was invited to to go to Scutari during the Crimean War with 38 hand-picked nurses to sort out the hospital's nursing care
  • Using her experience from Europe, she made sure that all the wards were clean and hygienic, that water supplies were clean and that the patients were fed properly
  • Before she arrived the death rate in the hospital was 42% and two years later while she was there, it had fallen to 2%.
  • She brought a new discipline and professionalism to nursing (which had a bad reputation at the time) despite the military opposing female nurses as they believed that they were inferior to male nurses and could distract the soldiers
  • In 1859, she published a book 'Notes on Nursing' describing her methods and emphasised the need for hygiene and a professional attitude. It became a textbook for generations.
  • The public raised £44000 to help her train nurses and she opened up the 'Nightingale School of Nursing' in St Thomas' Hospital, London. Nurses had 3 years of training before qualifying
  • By 1900, there were 64000 trained nurses in Britain and in 1919, the Nurses Registration Act was passed making training compulsory for all nurses
  • She helped to make nursing a respectful profession, particularly for women
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Mary Seacole

  • She also nursed in the Crimea like Nightingale
  • She learnt nursing from her mother, who ran a boarding house for soldiers in Jamaica
  • In 1854, she came to England to volunteer as a nurse in the Crimea, but was rejected (possibly on racist grounds), but instead paid her own way and went anyway
  • She financed herself by selling goods to soldiers and travellers. She nursed soldiers on the battlefields.
  • She built the British Hotel, which was a small group of makeshift buildings that served as a hospital, shop and canteen for soldiers. 
  • When she returned to England, she couldn't find work as a nurse and therefore went bankrupt, though she did receive support due to the press interest in her story
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Chloroform - Anaesthetics

  • James Simpson, a Professor of Midwifery at Edinburgh University, discovered it in 1847
  • He was looking for a safe alternative to ether that women could use in childbirth. He experimented on himself
  • Him and some of his colleagues inhaled some chemicals and collapsed. This was when he discovered that he had found chloroform, a powerful anaesthetic. 
  • In 1853, Queen Victoria used it to give birth to her 8th child and from then on, it became widely used in operating theatres and to reduce labour pains. 
  • It sometimes affected the heart, causing patients to suddenly die.
  • Some people opposed the use of anaesthetics like the army, who believed that it was better for a man to go to the grave screaming as they believed it should be
  • The Church also disagreed as they believed that women should suffer pain during childbirth because it was what God had intended for women
  • Some doctors also argued that it was a new and untested gas and no one was sure of its long-term effects (this was backed up as some people died using it)
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Early Anaesthetics - Nitrous Oxide and Ether

  • Nitrous oxide (a.k.a. 'laughing gas') was identified as a possible anaesthetic by Humphry Davy in 1799; he was ignored by surgeons at the time
  • However, in 1845, American dentist Horace Wells suggested its use in dentistry and he did a public demostration, but had the bad luck to pick a patient who was unaffected by the gas; it was ignored again
  • In 1842, American doctor Crawford Long discovered ether and its anaesthetic qualities, but he didnt publish his findings. 
  • In 1846, the first public demonstration of ether was carried out by American dentist William Morton
  • Ether was an irritant and is fairly explosive, so was quite risky. It could also make the patient cough a lot making the surgery increasingly dangerous
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Early Anaesthetics and Surgery

  • When anaesthetics were introduced, surgeons found that they could take longer to operate on a patient as unconscious patients were easy to operate on
  • These longer operating times led to higher death rates from infection.
  • They used very unhygienic methods
  • They often wore the same coats for years, which was covered in dried blood and pus from previous operations as they didn't know that they were meant to wear clean clothes
  • Operations were often carried out in unhygienic conditions, including at the patient's house
  • Operating instruments also weren't sterilised and were used from operation-to-operation, so they carried infection because they were unwashed and dirty
  • The attempts at more complicated surgery actually led to increased death rates amongst patients. This is the reason that the period between 1846 and 1870  is known as the 'Black Period' of surgery
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Joseph Lister and Antiseptics

  • Before Joseph Lister, Ignaz Semmelweis showed that doctors could reduce the spread of infection by washing their hands with chloride of lime solution between patients, but it was unpleasant to wasn't widely used
  • Joseph Lister had seen carbolic acid sprays being used in sewage works to keep down the smell and he tried this in the operating theatre in the early 1860s 
  • When the Germ Theory was published, 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 50% in 1864-66 to about 15% in 1867-70
  • Antiseptics allowed surgeons to operate with less fear of patients dying from infection. The number of operations increased between 1867 and 1912 as a result.
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Asepsis

  • Aseptic methods aim to stop any germs getting near the wound
  • Since the 1800s, surgeons have changed their approach from killing germs to making a germ-free (aseptic) environment
  • Instruments are carefully sterilised before use with high temperature steam
  • Theatre staff sterilise their hands and wear sterile gowns, masks, gloves and hats. (Surgical gloves invented by William Halsted in 1889)
  • Theatres are kept scrupulously clean and fed with sterile air. In high risk cases, a tent can be placed around the operating table to maintain an area of even stricter hygiene
  • Aseptic surgery reduced the need for carbolic spray, which is unpleasant and many nurses and doctors didn't like to use it
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Cholera in London

  • It reached Britain in 1831 and by 1832, it was an epidemic with over 21000 people dying that year in Britain. The epidemics continued in 1848, 1853-54 and 1865-66.
  • Cholera spreads when infected sewage gets into drinking water causing bad diarrhoea
  • At the time, people didn't know what caused cholera and the best theory was miasma. The government regulated the burial of the dead, but this didn't really halt the spread
  • Both rich and poor got the disease
  • Most houses at the time had no bathroom and many people would share an outside toilet called a privy. Privys were built above cesspits, of which the waste would be collected at night and dumped into rivers. 
  • Water companies set up water pumps in the streets, which were shared, and these were often contaminated by waste from cesspits, causing cholera.
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John Snow

  • When cholera broke out in the Broad Street area in London in 1854, Snow wanted to test his theory which said that there was a connection between contaminated water and cholera.
  • He interviewed people living in Borad Street and made a map of the area showing where each case of the disease had been. He published some of this in his report 'On the Mode of Communication of Cholera' in 1855. 
  • His research showed that all the victims used the same water pump and he convinced the local council to remove the handle from the pump. The cholera outbreak ended.
  • It was later discovered that a nearby cesspit had leaked its waste into the pump's water supply
  • He still couldn't explain why cholera was caused though because the Germ Theory hadn't been published yet so it took a while for his findings to make an impact
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The Public Health Act, 1875

  • Edwin Chadwick published a report in 1842 saying that poor living conditions=poor health
  • His report led to the 1848 Public Health Act, but it didn't make much of an impact as not many towns set up their own boards of health. 
  • In 1858, the River Thames made a 'Great Stink' causing the government to have to plan a new sewer system, opening in 1865.
  • John Snow, the Second Reform Act of 1967 (which gave an extra 1 million men the vote most of whom were industrial workers) and writers like Charles Dickens pushed for the new health act
  • In 1871-72, the government formed the Local Government Board and divided Britain into 'sanitary areas' administered by officers for public health.
  • In 1875, the government of Benjamin Disraeli passed another Public Health Act in which councils were forced to: appoint health inspectors to make sure all laws on hygiene were being followed, maintain sewerage systems to prevent further cholera outbreaks and keep their town's streets clean.
  • This Public Health Act was a lot more effective as a lot of places with poor living conditions were rebuilt and improved, increasing health
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Changing Public Opinion of Health

  • Before the Public Health Act of 1875, people believed in a laissez-faire type government, where they didn't get involved in public health, but it began to change
  • Snow's discovery of the link between dirty water and cholera and Pasteur's Germ Theory showed that cleaning up towns could stop the spread of disease. They now understood the causes of disease and how to prevent it.
  • In 1867, the Second Reform Act was passed giving an additional 1 million men the right to vote. Most of these men were industrial workers. This meant that workers could put pressure on the government to listen about the state of the health. For the first time, the government had to address workers' concerns in order to stay in power
  • Writers like Charles Dickens and philantrophists like Octavia Hill helped to change attitudes towards the poor, who suffered the worst conditions and were at a higher risk of disease
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Opposition to Lister's Antisceptics

  • Some doctors hadn't accepted the idea that microbes could cause infection because microbes couldn't be seen without a microscope
  • Lister kept changing his methods to improve his work, which made many doctors think that he wasn't sure of his ideas
  • The idea of soaking the whole operating theatre in carbolic acid seemed extreme
  • Using carbolic solutions slowed down operations, leading to increased blood loss etc.
  • Equipment was expensive
  • Some doctors argued that using carbolic acid stopped the bodies own defence systems working properly
  • Doctors using Lister's ideas didn't always copy them properly, so blamed Lister if a patient died
  • Some surgeons had good results without carbolic acid
  • Surgeons became defensive and believed that Lister was criticising their methods as it had become the norm that people died during surgery
  • Nurses disliked the extra work of emphasised hygiene
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Public Health in the Industrial Period

  • There was a huge population growth so, cheap back-to-back houses were built to accomodate the 1000s of men and women working in factories and mills. This led to squalor, increasing likelihood of diseases
  • Communal wells provided water to streets, but there were few facilities for sewage, so waste products were thrown onto the streets, often polluting the wells and waterways
  • Factories polluted the air and rivers with their by-products
  • Smallpox, TB and typhoid fever were joined by cholera, due to the poor, dirty living conditions
  • Doctors had no idea what caused disease and often just blamed miasma
  • By the mid-1830s, over 21000 people had died in England of the cholera epidemic. This was stopped by the 1848 Public Health Act
  • The cause of cholera was still unknown, but John Snow made the link between dirty water and cholera in 1854
  • The second Public Health Act in 1875 compelled local authorities to provide sewage disposal facilities and clean water to all
  • By 1900, the death rate had fallen dramatically and most towns had effective, hygienic sewers and water systems
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Hospitals in the 19th Century

  • The middle class and the rich just paid for private doctors to attend to them at home
  • Local hospitals were cottage hospitals with the first one opening in 1859
  • There were over 300 cottage hospitals by 1900, but they were very small with limited facilities
  • Voluntary hospitals were opened in London where doctors gave their time for free and workers could use them if they paid into a sick club Wealthy people sometimes donated to these. 
  • If you were too poor or disabled, you were often sent to the workhouses built from the 1830s and run by the Poor Law Unions. 
  • The sick were not separated and in 1867, the government made the unions build infirmaries to care for the sick from the workhouses in separate buildings with doctors and asylums for the mentally ill
  • These workhouses were funded by local taxes and these infirmaries began to grow in size by the 1900s
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