industrial medicine

• industrial revolution: Large developments in technology and innovation

  • Huge numbers of people moved from the countryside to urban centres.
  • They left rural jobs in farming and agriculture, and found work in factories, mills and mines,
  • these were springing up across the country.
  • By the end of the 19th century, most people in Britain were employed in factories and workshops.
  • Cities became the main centres of production.
• By 1900, London had a population of 4.5 million. 
• Other cities also grew much larger across Britain, including Birmingham, Glasgow, Liverpool and Manchester.

  • These cities could become overcrowded, and often the growing workforce was accommodated in poor-quality housing.
  • The streets became filled with waste.

  Without fresh water and a sewerage system, disease spread easily.
• c.1750, the Church and classical ideas had lost their dominant influence and scientific ideas were much more accepted.
• science and technology

  With the growth of new technology, scientists continued to experiment and challenge old ideas.

  • The use of new instruments (such as microscopes), chemicals and scientific equipment proved many new theories.
  • Further improvements in travel - such as the development of the railways - then enabled these ideas to spread quickly throughout Britain.
• role of the government

  Throughout most of the 18th and 19th centuries, the government adopted a laissez-faire approach to medicine.

  >This means people thought it was not the government’s role to interfere in everyday life.

  However, by the late 19th century this began to change.

  People began to accept that it was part of the government’s role to look after the health of its people.

  >From this point on, the national government began to pass legislation to force local authorities to improve living conditions and prevent the spread of disease and illness.
• spontaneous generation: theory that decaying matter, things that had started to rot, created microbes. (rather than microbes causing the decay)
• spontaneous generation

  • Some people still believed in the harmful effects of miasma, or ‘bad air’, even in the 18th century.
  • However, this theory was rapidly becoming less convincing.
  • Instead, scientists developed the theory of spontaneous generation.
  • Improved microscopes meant that scientists could see microbes. 
  • Scientists observed that microbes appeared on things that had started to rot and believed that they were the product of decay.
• louis pasteur - pasteurisation

  While working at a university in Lille, he spoke with a brewer, who wanted to know more about why the drinks he made sometimes went sour.

  Pasteur’s experiments brought greater understanding of the process of fermentation and how to prevent it.

  Prevention was achieved by heating the liquid to a certain temperature, which would kill bacteria in the liquid and thereby stop it from going bad.

  >This process became known as pasteurisation.
• louis pasteur - technology which helped

  Pasteur used microscopes and other instruments in his work.

  The swan neck flask helped him to understand more about the role of bacteria in fermentation.

  • When air entered the long neck, bacteria were trapped in the long tube.
  • If they could not reach the liquid, no souring took place.
  • When the flask was tipped and the particles were able to reach the liquid, it would turn sour.
• Pasteur’s findings significantly challenged the idea of spontaneous generation
• 1861: louis pasteur published germ theory
• Pasteur argued that bacteria were the cause of disease, but he was not able to identify the specific bacteria that caused individual diseases.
• koch stepped in here and was the one who was able to identify specific bacteria with specific diseases, pasteur then took his work further by then developing vaccines
• koch's discovery of bacteria

  Koch developed a new method of growing bacteria using

  • agar jelly in a Petri dish. 
  • He then used a dye to stain the bacteria so that it could be seen clearly under a microscope.

  SEE THE IMPORTANCE OF TECHNOLOGY (he wouldn't have been able to have his discovery without agar jelly, petri dish, dye and microscope)

  Using this method, he was able to identify individual bacteria
• koch's bacteria identifications

  1876: Koch found the bacteria that cause anthrax. 

  1882: he identified the bacteria that cause tuberculosis (TB). 

  1883: discovery of the bacteria that cause cholera 
• Koch’s work greatly improved medicine in Britain, as doctors now understood that it was bacteria that caused the symptoms of disease, so it was the bacteria that needed to be removed.

  he also inspired other scientists
• koch and pasteur

  Koch’s identification of bacteria did not make an immediate difference to the prevention of disease.

  >This only happened when Pasteur took Koch’s work even further by developing other vaccines.

  Pasteur had read about Jenner’s smallpox vaccine

  Now that the individual bacteria for specific diseases had been identified, Pasteur began work on developing further vaccines.

  He knew that to prevent each disease, a weakened dose of the disease was needed to build immunity.

  Pasteur began developing animal vaccines for the diseases anthrax and chicken cholera. 
• 1885: pasteur tested a human vaccine for rabies that saved a boy’s life after he had been bitten by a dog.

  >This was the first successful vaccine since Jenner’s smallpox vaccine.
• changes in care and treatment - hospitals

  Hospitals in the early 19th century were not always safe. Many patients would die because of the conditions on the wards, such as:

  • few toilets and poor sewerage systems
  • overcrowded wards with a lack of fresh air
  • a lack of cleanliness, which led to the spread of infection
• florence nightingale

  • 1853: crimean war breaks out
  • she was asked by the government to look after injured soldiers, Nightingale accepted, took 38 nurses & 15 nuns with her.

  Nightingale was shocked at conditions.

  • overworked medical staff were not being given the proper supplies of food or medicine
  • Infections were common, soldiers could come in with a wound or injury but catch an illness such as typhus, typhoid, cholera or dysentery.

  The no. of deaths from infection shocked Nightingale & her staff.
• florence nightingale

  Immediately, with her nurses, Nightingale worked hard to improve hospital conditions and establish better practices of cleanliness.

  This led to a fall in the death rate from 40 per cent to 2 per cent.

  Some of the changes included:

  • ensuring there was regular hand washing
  • making improvements to sewerage
  • making improvements to ventilation
• nightingale's improvement dropped death rates:

  40% ---> 2%
• On her return to Britain, Nightingale continued to improve the care given in hospitals and the training of nurses:

  • She wrote two books that influenced improvements across the world.
  • 1859: Notes on Nursing  
  • 1863: Notes on Hospitals
  • 1860: She opened her first Nightingale School for Nurses
• florence nightingale

  Nightingale had always believed that disease was caused by miasma. 

  Therefore, she concentrated on keeping the wards and patients clean to remove the substances that would cause 'bad air'.

  She passed these ideas on to the nurses who trained in her schools
• mary seacole

  Mary Seacole was a Jamaican businesswoman and healer who had helped with treating those with diseases such as cholera.

  She volunteered to travel to Crimea to help the war effort there.

  but, she was refused passage by several powerful figures.

  • Nightingale was reluctant to meet with her or appoint Seacole to her nursing staff.
  • Seacole paid for her own travel to Crimea and set up a hostel there, having met with Nightingale briefly.
  • The ‘British Hotel’ offered rest and recovery for British officers and Seacole was affectionately known as Mother Seacole by the soldiers.
• developments in hospitals

  Hospitals in the 19th century could vary in size, funding and organisation.

  • There was an increase in small cottage hospitals and voluntary hospitals during this period.
  • They were paid for by charity from the wealthy, while doctors worked there for free.
  • Some working people would be treated in these hospitals if they paid into a fund to cover the cost of their treatments.

  Rich people continued to pay for doctors to treat them at home.
• developments in hospitals

  The very poor were assessed by the authorities.

  > If their situation was considered desperate, they were admitted to a workhouse. 

  After 1867: most workhouses had an infirmary to treat the sick and elderly.

  • Hospitals where patients could be isolated, known as fever hospitals, were established for those suffering with infectious diseases such as smallpox and scarlet fever.
  • Their aim was to treat those suffering while separating them from the general public.
• surgery in 1800

  Operations were very dangerous in the early 19th century.

  Common surgeries included amputations and the removal of growths.

  Surgeons had to work quickly because these surgeries caused pain as there was no anaesthetic. 

  >Patients could die from shock and infections spread in the operating theatre.
• In the early 19th century, surgeons experimented with chemicals to find an effective anaesthetic:

  • Laughing gas (nitrous oxide) was used but could not get rid of pain completely.
  • Ether had side effects that irritated the eyes and lungs, causing coughing and sickness.

  these were previous anaesthetics before james simpson
• james simpson (anaesthetic)

  1847: first effective anaesthetic found by James Simpson,

  • he was a professor of midwifery at the University of Edinburgh.
  • He wanted to find a better anaesthetic to ease the pain women experienced in childbirth.
  • One evening he was experimenting at home with his colleagues by inhaling different chemicals. Simpson realised very quickly that 

  chloroform was an effective anaesthetic.
• james simpson

  Simpson wrote about his discovery so that other surgeons could use it when operating.

  However, there was some opposition to the use of chloroform:

  • Some surgeons preferred their patients to stay awake so that they could fight for their lives.
  • Religious people believed God intended for humans to experience pain, especially in childbirth.
  • Some people were worried when Hannah Greener died during an operation on her toenail after being given too much chloroform.
• developments in chloroform as an anesthetic

  1848: John Snow (who also discovered that cholera spread in dirty water) invented an inhaler to measure the dosage given.

  1854: Queen Victoria used chloroform during the birth of one of her children

  >This led to its usage being more accepted.
• black period of surgery

  • With pain relief now available during surgery, some surgeons carried out longer and more complex operations.
  • However, this could have a negative impact: When procedures were longer and more complicated, infections could develop deeper within the body and there could be more blood loss.

  The number of deaths from surgery may have increased between the 1850s and 1870s. This is known as the ‘black period’ of surgery.
• joseph lister (antiseptic)

  Surgeons sometimes still wore dirty clothes to the operating theatre. Handwashing before operating was not always done (was not known that bacteria caused infections).

  1867: forst antiseptic discovered by lister

  Lister knew about Pasteur’s germ theory and went on to discover that carbolic acid killed the bacteria in open wounds.

  Lister recommended that:

  • doctors and nurses should wash their hands in carbolic acid before an operation
  • bandages and ligatures should be soaked in carbolic acid
  • a carbolic spray should be used to clean the area of an operation
• using these methods Lister's death rate in operations fell from:

  46% ---> 15%
• By the late 19th century, Lister’s antiseptic methods of killing the germs on a wound had led to the introduction of aseptic surgery.

  > more germs were removed from the operating theatre, with the aim of creating a totally germ-free environment.

  Aseptic surgery included many aspects:

  • the thorough cleaning of operating theatres before and after surgery
  • the frequent cleaning of other areas of a hospital
  • surgeons wearing sterilised gowns, masks and gloves
  • all surgical instruments being sterilised using steam
• 1796: edward jenner developed the first vaccine (smallpox)
• inoculation: Putting a low dose of a disease into the body to help it fight against a more serious attack of the disease.
• inoculation had been witnessed first-hand by Lady Mary Wortley Montagu on her travels in Turkey earlier in the 18th century.

  > She returned to Britain and held smallpox parties, where inoculations would take place.