He was employed as a civil servant in the 1800s by the Poor Law Commission and was asked to produce a report on living conditions for the rich and poor in rural and "urban" areas. He discovered that the conditions for the working class in cities was awful, the worst was in Liverpool and the best was for the upper/middle classes in the countryside. He realised that the workers would be more effecient if they were healthier and this could be achieved by improving working conditions and public health; they lived in crowded areas
1842 - Report on sanitory conditions of the labouring population
1848 - Public Health Act passed which encouraged local councils to improve living conditions in inner-city areas
1854 & 1865 - Cholera returned
1875 - Public Health Act passed which made improving living conditions compuldory
The Problem of Pain
In the 1800s, there were no effective anaesthetics. Many surgeons would give their patients drugs such as opium or mandrake, some would try to get their patients drunk and some would use "mesmerism" (hypnosis) hoping the patient would ignore the pain. All surgery had to be done quickly-deep, internal operations were out of the question. Surgery was usually limited to removing growths or amputating. Even then, many patients would die from the trauma of the pain.
Traditional painkillers included alcoho, opium and mandrake. Some surgeons didn't like anaesthetics as being a skilled surgeon meant you could do operations quickly with minimum pain; however, this skill was made redundant by the elimination of pain. With the elimination of pain more complex operations could now be undertaken but this led to a higher chance of infection.
1799 - Humphry Davy indetified nitous oxide (laughing gas) as a possible anaesthetic but this was ignored by surgeons of the times
1846 - John Warren did a public demonstration of the use of ether as an anaesthic. Although it worked, it irritated the lungs, caused coughing and was unstable forcing people to search for an alternative.
1847 - James Simpson discovered that chloroform was an effective anaesthetic; however, it faced opposition as it was untested but this died down when it was used and then praised by Queen Victoria. Later, it was found to cause liver damage leading to a return to ether.
How This Was Solved
The problem of pain surgery was solved by the discovery and development of anaesthetics. Humphrey Davy experiment with nitrous oxide and discovered that it relieved toothache (1799). Robert Liston began to use ether during surgery - it was effective but had many nasty side-effects. James Simpson was experimenting with many chemicals one night and he discovered that chloroform was an effective anaesthetic. He began to use it for women during childbirth. There was a lot of opposition to chloroform when in 1848 15 year old Hannah Greener became the first person to die from chloroform. Much of this opposition was overcome when in 1853 Queen Victoria used chloroform during the birth of Prince Leopold.
The Problem Of Infection
Now that surgeons had solved the problem of pain during surgery, they felt confident about longer, more complex operations; however, this lead to the time between 1846 to 1870 being known as the 'Black Period' of surgery. Operations were still being carried out under unhygienic conditions, because this was before Louis Pasteur proved the Germ Theory correct, surgeons did not understand the need for cleanliness. As a result, many patients would die from infections developed after the operation.
How This Was Solved
1847 - Ignaz Semmelweiss reduced death rates on his maternity ward by insisting that his doctors washed their hands before operating. His discovery was mostly ignored
1861 - Louis Pasteur published his Germ Theory, which proved that germs caused disease and infection.
1865 - Joseph Lister developed and used a carbolic spray to kill germs in the operating theatre. At first he faced opposition because the spray was awkward to use and many surgeons were cynical about its effectiveness.
1866 onwards - Opposition to his work was slowly overcome.
1890 - William Halstead recommended that rubber gloves be used during surgery - this was the beginning of aseptic surgery.
1890s - Robert Koch discovered that hot steam killed more germs than carbolic acid.
The Problem Of Bleeding
The idea of transfusing blood had been considered for centuries. Jean-Baptist Deyns successfully transfused blood from a lamb to a young man in 1667. The man lived, but because the next patient died, the practice was prohibited. By 1818, doctors in London were successfully transfusing blood from human to human, but most transfusions were disastrous because the red blood cells would clot together and the patients would die. There was no knowledge of blood groups and as a result, many patients were given the wrong blood, which would then clot. There was also no way to store blood, so there had to be on-the-stop donors, which was not effective or practical.
How This Was Solved
1901 - The four blood groups were discovered by Karl Landsteiner. He realised that transfusions would only work if the donor's blood matched the receiver's blood.
1914 - Albert Hustin found that sodium citrate stopped blood clotting, making transfusions easier.
1917 - The storage of blood in blood banks began.
WWII - The Nation Blood Transfusion Service was set up.
Blood transfusions became essential in saving the lives of thousands of soldiers on the battlefield.
CHANGES IN MEDICINE THROUGH TIME
Government: There was no settled government so people lived nomadic lifestyles. Planning, intervention or funding of medicine was not possible due to the lack of a government.
Technology: Primitive tools such as flints and arrow heads.
Education and Communication: There was no written language, no schools, no records of prior knowledge of medicine or education about medicine and skills and ideas were passed along simply by word of mouth.
Religion: A belief in the spirit world was an important influence on pre-historic life. They believed that good spirits caused good things and bad things, such as disease and illnesses. Due to a strong belief in the supernatural, there was no reason for people to search for natural, rational explanations about the causes of disease and cures were restricted to supernatural ones, such as charms and amulets and chantings from the Medicine Man. Trephanny, although an early form of surgery, was carried out for religious reasons - pre-historic people believed that trephanny released the evil spirit inside somebodies skull which was the cause of illnesses such as headaches.