Medicine in the industrial revolution

Surgeons thought that microbes were caused by disease in something called “spontaneous generation”. The microbes were a symptom and diseases developed randomly, creating bacteria.

• The two main groups were contagionists and anti-contagionists. Contagionists believed disease could spread through contact and anti-contagionists believed disease spread through the miasma.
• In 1857, Pasteur tried to explain why the sugar beet used to ferment alcohol soured. Pasteur thought that germs in the air were responsible. He found that sterilised water was still sterile if the flask was closed, but was not sterile if the flask was open. This suggested that there were germs in the air.
• In 1861, he published his Germ Theory – germs were causing infections. Microscopes (invented in the 17th century) eventually allowed Pasteur to see the micro-organisms that he described. Pasteur faced serious opposition for his theory. A famous doctor called Charlton Bastian supported the theory of spontaneous generation, which contradicted Pasteur’s Germ Theory. 

Pasteur’s research focussed on how liquids, such as milk went sour (pasteurisation). Many did not see the connection to humans. Doctors did not believe that small germs could cause such harm to humans.

• People gradually began to believe (and treat people in accordance with) Germ Theory.
• Most of the gains from the Germ Theory came in the 20th century. It proved that disease was not spread by miasma. It proved that spontaneous generation was wrong. It proved that an imbalance of the Four Humours did not cause disease, thus meaning the Four Humours were wrong.
• In the 19th century Britain, medical treatments became safer. The survival rate in surgery increased, hospitals became cleaner and vaccinations became more popular.
• Technological developments meant that diseases could be identified and stopped more effectively. Following the Germ Theory, drugs were developed and became far more popular.

• Koch showed that germs were not all the same. He identified the different microbes that caused anthrax in 1876, septicaemia in 1878, tuberculosis in 1882 and cholera in 1883 by injecting animals with diseases. He then dyed bacteria and viewed them using microscopes. Other scientists then discovered typhus in 1880, pneumonia in 1880, tetanus in 1884, diphtheria in 1884 and the plague in 1890.
• Koch and Pasteur’s studies were picked up by many scientists in Britain. John Tyndall gave lectures on Germ Theory to British doctors. He disagreed with Bastian’s ideas of spontaneous generation.
• Dr William Roberts created a medical version of Germ Theory.
• William Cheyne translated Koch’s work and highlighted that not all microbes caused harmful disease.
• Koch and Pasteur inspired a generation of scientists who were called ‘microbe hunters’.These scientists became interested in diseases and how to prevent them.

• In 1879, Pasteur accidentally showed that vaccinations could prevent disease. After a researcher Charles Chamberland left out a cholera culture over the weekend, they discovered that weakened (attenuated) cholera germs could make a chicken immune from later stronger bouts of cholera.
•  In 1881, Pasteur produced a weakened (attenuated) vaccine for anthrax in sheep. 
• By 1884, Pasteur created a vaccine for rabies. A year later this was applied to human subjects. Pasteur’s contribution to vaccines is so significant because it allowed some of the world’s deadliest diseases to be eradicated.
• In 1871, the Franco-Prussian war (between France and Germany) ended. Some historians think the national rivalry between Pasteur and Koch drove developments. Scientific advances were propelled forward by competition.
• There was an internal rivalry to understand a germ called diphtheria. By 1890, Pierre Roux had shown that diphtheria produced a poison. Later in 1890, Emil Behring showed that if diphtheria was diluted it could produce an antitoxin.

• The Public Health Act set up a Central Board of Health to improve public health. Towns were asked to set up their own Local Board of Health. Town councils were given the power to spend money on improving street cleanliness. The result of the act was mixed because councils had their own autonomy. Some cleaned their streets but some didn’t. In 1854 the Central Board of Health was shut down as it was seen as a violation of the government’s laissez-faire approach.
• In 1858 London was struck by the ‘Great Stink’. The River Thames was so full of sewage and the weather was so hot that London smelt very bad. Parliament (located right on the Thames) noticed the smell. This prompted them to improve London’s hygiene and sewage systems. Politicians funded an engineer called Joseph Bazalgette to build a new sewer system for London. Over 1300 miles of sewers were built to take sewage out of Central London. Bazalgette completed this within a year and these are still used today.

• In 1867, more working-class men won the right to vote. This shift in the voting population helped to improve living conditions across the UK. 
• The 1848 act was voluntary, but the 1875 Act was mandatory. It forced local authorities to: Provide clean water Provide proper sewage systems to collect rubbish on the street and appoint a Medical Officer of Health

• The 1867 Reform Act gave more working-class men the vote. This meant that politically to stay in power, improving living conditions for this group was more important.
• The Chadwick Report of 1842 could have had an effect on increasing awareness but most of the change came a lot later than 1842.
• The Great Stink of 1858 was only really created by unusually hot weather. The smell from the Thames reached parliament and it took this to lead to Bazalgette’s reforms of the London sewage system.
• Pasteur’s Germ Theory and advances in medical surgery showed that disease and illness were more preventable than they had previously been perceived. Previously supernatural factors had been blamed. 
• Statistics collected around deaths and death rates also showed the differences in living conditions and this may have shamed the government into action.

• The below all contributed to change: 
• Pasteur’s discovery of germs/microbes as a cause of disease.
•  Edwin Chadwick’s report and recommendations
• .Dr Snow’s findings around cholera.

• Pain – Patients often died from clinical shock because of the pain of surgery.
• Infection – Before the Germ Theory, people did not know that microbes could cause infections. Surgeons wore the same outfit and used the same equipment for multiple patients.
• Bleeding – Patients often died during surgery because they lost too much blood.
• In 1800, physicians and surgeons gave patients alcohol (made them drunk) or gave them opium to numb the pain.
• Humphrey Davy was the first to use nitrous oxide (laughing gas) to stop patients from feeling pain. Horace Wells then used it in 1844 to numb the pain in dental surgery.
• Dr James Simpson first used Chloroform in surgery in 1847. It was effective but it led to death in high doses. It killed Hannah Greener in 1848. Queen Victoria used Chloroform in childbirth in 1853.

• Ether was first used by the American dentist William Clark in 1842 and then by Robert Liston for leg amputation in 1846. Ether was effective but hard to inhale (it also led to vomiting) and was explosive.
• Anaesthetics initially increased the number of deaths in surgery. People did more complex operations and hygiene was still bad in surgeries. Doing more complex surgery for longer in an unhygienic place increased the risk of infection and fatal blood loss.
• Some army surgeons thought that soldiers should endure the pain.
• Some religious people thought that the pain suffered during surgery was God’s will.
• After Queen Victoria used anaesthetics in childbirth, anaesthetics became more popular.
• Public demonstrations of the drugs also helped to make anaesthetics more widely accepted.

• A British surgeon called Joseph Lister applied Pasteur’s Germ Theory to surgery. He thought that germs explained why wounds from surgery got infected. Lister used carbolic acid as a chemical which could kill bacteria. This stopped germs from infecting wounds in surgery. The death rate in Lister’s patients fell from 46% to 15%.
• Covering surgical instruments, bandages and the surgeon’s hands in carbolic acid reduced the chance of infection.
• Lister heard about Germ Theory in 1865. He tested his ideas on a boy called Jamie Greenlees who had a broken leg. Instead of amputation, Lister healed Greenlees’ fracture and the wound was not infected. Lister published the results of Greenlees and ten other patients’ surgery in 1867, proving Pasteur’s Germ Theory. Lister was heavily criticised. Most doctors still believed that chemicals caused infections rather than germs. Pasteur’s ideas were not yet accepted and people still believed in spontaneous generation. Carbolic acid was unpleasant for doctors to use because it irritated their lungs and skin. 

• Many surgeons tried to copy Lister’s methods but did not do it properly. This made them think that the theory was wrong.
• 10x more surgeries were performed in the UK in 1912 relative to 1867 because the chance of survival increased so much.

Aseptic surgery methods tried to completely eliminate bacteria before and during an operation, rather than trying to kill microbes on a specific wound.

• By 1880, Pasteur’s Germ Theory was widely accepted by British doctors.
• By 1900, aseptic surgery had become very common.
• In aseptic surgery, surgeons were scrubbed clean, wore new clothes and thin rubber gloves.
• Surgeons used sterilised instruments and operating theatres got smaller to reduce the chance of infection.
• These developments were largely advanced by wars, such as the Crimean War.
• War provided test cases for surgeons to try out these new techniques.

Aseptic surgery methods tried to completely eliminate bacteria before and during an operation, rather than trying to kill microbes on a specific wound.

• By 1880, Pasteur’s Germ Theory was widely accepted by British doctors.
• By 1900, aseptic surgery had become very common.
• In aseptic surgery, surgeons were scrubbed clean, wore new clothes and thin rubber gloves.
• Surgeons used sterilised instruments and operating theatres got smaller to reduce the chance of infection.
• These developments were largely advanced by wars, such as the Crimean War.
• War provided test cases for surgeons to try out these new techniques.

• The College of Physicians was set up in 1518. Most British doctors were trained here and they were still learning Galen’s works. In the 18th century, most doctors still believed in the four humours or that disease was spread through ‘bad air’ (miasmas). Doctors got a license if they were trained at the college of physicians. Quack doctors did not receive this license, but some unlicensed doctors were also good doctors.
• Florence Nightingale (born in 1820) helped nursing to become professional. Her work with 38 nurses (chosen by her) in the Crimean War in 1854 reduced death rates hugely because of her improvements in the hygiene of wards. When Nightingale got back from war, she published the book “Notes on Nursing”. The status of nursing was enhanced as they were expected to care for patients and assist doctors. The Nightingale School of Nursing was set up in St Thomas’ Hospital in London.

• By this point in the Middle Ages, there were 2 main types of surgeon. Professional surgeons, who had trained at university and were expensive and well paid and barber-surgeons, who were unqualified and not very well respected. Surgeons’ status began to improve and in 1800, the London College of Surgeons was set up. It created training standards for surgeons.

• In the 1700s, smallpox was one of the most fatal diseases in the world. Smallpox was very contagious (spread through coughing, sneezing or physical contact) and its symptoms were a fever, headache, rash and blisters filled with pus. 30% of people who got smallpox died. Those who survived were often blind or had very deep scars.
• The existing way to treat smallpox was inoculation. It was first brought to Britain by Lady Mary Wortley Montagu who observed it in Turkey. Inoculation involved putting pus from a person with a mild form of smallpox into a cut in a healthy person’s body. People believed this gave them resistance. Inoculation was popular in the 1700s with aristocrats.
• Many people did not get inoculated for religious reasons. They thought that it interfered with God’s will. The inoculation dose could be too big and kill the patient. People who had been inoculated could still pass smallpox onto other people. Inoculation was a treatment that only rich people could afford.

• Jenner thought that people who had cowpox were immune to smallpox. Jenner gave an 8-year-old boy, James Phipps, cowpox before injecting him with smallpox. James Phipps didn’t catch smallpox. Jenner tested this on 16 more patients and concluded that cowpox was an effective vaccination against smallpox. He published his research in 1798.
• Some people in the Church thought that vaccination wasn’t natural and should not be done. The level of opposition is seen by the formation of the Anti-Compulsory Vaccination League in 1866. This was 13 years after the vaccination was made compulsory. 
• Publishing his discovery in 1798, Jenner faced serious opposition. He faced criticism because he could not explain why the vaccination worked. Many doctors did not wish to use the vaccination because they profited (made money) from the smallpox inoculation. Jenner was not part of the clique of fashionable doctors in London. For this reason, he was excluded from academic favour.

• Attempts to replicate the experiment failed. Although this was because of contaminated equipment, they believed Jenner was wrong. Despite all this opposition, the vaccination came to be accepted. The vaccination was less dangerous than the traditional smallpox inoculation. Gaining the favour of the royal family helped sway popular opinion. Parliament gave Jenner £10,000 to further his research in 1802. By 1853, the vaccination was made compulsory under law.

• Lots of people moved to cities because that is where most manufacturing jobs were located. Thousands of people migrated from the countryside to cities such as London, Birmingham and Manchester. For the first time, more people lived in British cities than in the countryside.
• Most people living in cities lived in terrible living conditions. Workers lived in very small houses, houses were very close together and sometimes families lived in one small room. Workers received very low wages and they often lived in poverty. Private toilets were rare, most families used toilets outside the house which were shared with others. Sewage would fall into a cesspit, which was often washed away by rain or thrown in rivers. Water came from local rivers, which is where sewage from cesspits often went. This was sometimes a worse situation than Ancient Rome (with its aqueducts). The streets were also dirty with wastage and sewage.

• People’s health may have been worse than any other time in history. Because of these poor conditions and overcrowding, the disease was very common. Some of the worst diseases were typhoid, tuberculosis and cholera. Typhoid was caused by contaminated food or water, it was spread through unhygienic conditions. Tuberculosis was caused by germs spread by sneezing or coughing, it was spread through overcrowded areas. Cholera was caused by contaminated water or food.
• Local councils were usually responsible for these health problems. Some people thought the government should intervene but often they did not (laissez-faire approach). Local taxpayers made decisions and many of these did not want to pay more money to improve health conditions (for others) in their town.

• Cholera epidemics affected Britain every few years between 1831 and 1866. Symptoms of cholera included vomiting and having painful diarrhoea. Although governments were concerned about cholera epidemics they did not know what caused cholera and, therefore, how to prevent it.
• After the cholera epidemics, Edwin Chadwick wrote a report on living conditions for the working classes in 1842. It was called the “Report on the Sanitary Conditions of the Labouring Population”. Chadwick thought that bad health was being caused by people’s awful living conditions. He thought that the disease was being caused by bad air and damp. People were shocked by how bad living conditions were for the poor. Chadwick suggested that laws should improve drainage and sewer systems. He thought medical officers should be appointed to improve the situation for the poor.

• Dr Snow saw that all the victims of the cholera epidemic in 1854 lived near the Broad Street water pump.
• He removed the pump’s handle and forced everyone to use another pump.
• This stopped the spread of the disease in the area.
• Snow discovered that the pump’s water had been contaminated by a leaking street toilet.
• This confirmed that cholera was not airborne but waterborne.
• William Farr collected medical statistics that recorded how people died.
• Dr Snow used Farr’s statistics to see whether there was a link between water contaminated with sewage and deaths from cholera.
• His statistics showed that deaths from Cholera seemed to be linked to specific water sources.
• These statistics were very important to prove Dr Snow’s hypothesis.