Medicine

• Industrialisation 

  • Britain’s cities grew quickly from 1800. For example, Sheffield's population of just 12,000 people in 1750 was over 150,000 by 1850.
  • Thousands of people moved from the countryside to big cities to work in the new factories of the Industrial Revolut
• Conditions in the cities

  • A single factory employed 100s of people, so factory owners quickly built rows of ‘back-to-back’ houses to accommodate them. 
  • Many workers were squeezed into each house, often with five or move people living in one small room. Few houses had toilets; most were outside and were shared with the street. 
  • Water for drinking and cooking came from a pump fed by the local pond or river, which would also take away sewage. 
  • There was no rubbish collections, no street cleaners or sewers. 
• • As a result of poor living conditions and overcrowding, diseases like typhoid, tuberculosis and cholera were common. 
  • In 1831, a cholera outbreak killed around 50,000 people. Victims were violently sick and suffered in pain before dying. 
  • There were further cholera epidemics in 1837, 1838, 1848, 1853-54 and 1865-66. 
  • Cholera was a waterborne disease but at this time many believed it was spread through the air, as a miasma or ‘infectious mist’ given off by rubbish and human waste. The importance of clean drinking water wasn’t understood and governments didn’t known how to deal with it. 
• Edwin Chadwick was put in charge of investigating the cause of the earliest cholera outbreaks.
• • Despite Snow’s findings, public health didn’t improve. City streets and water supplies remained as filthy as ever. 
  • In the summer of 1858, a heat wave cause the filthy River Thames to produce the ‘Great Stink’
  • This alarmed politicians so much that, combined with the new evidence about cholera, they agreed to pay to sanitary improvements.
  • Parliament gave the engineer Joseph Bazalgette enough money to build a new sewer system for London. By 1866, he had built an 83-mile sewer system which removed 420 million gallons of sewage a day. 
• In 1842, Edwin Chadwick published a report stating that the outbreaks were due to miasma, which was later found to be incorrect.
• Edwin Chadwick's report highlighted the need for cleaner streets and clean water.
• Despite Edwin Chadwick's report, the government adopted a 'laissez-faire' approach in which they believed it was not their job to interfere in people's lives and force them to be hygienic.
• Many MPs owned slum houses and rented them out, so they didn't want to have the expense of tearing them down and rebuilding them.
• Dr John Snow noted in 1854 that all the victims of another cholera outbreak lived near the same water pump in Broad Street, London.
• Dr John Snow removed the pump handle and the outbreak stopped.
• • After 60,000 deaths in 1848, the government had to begin to take action. They passed the 1848 Public Health Act. This would mean that A Central Board of Health was set up to improved public health in towns and local town councils were empowered to spend money on cleaning up their streets. 
  • However, despite this some cities chose to do nothing and by 1853, only 103 towns had set up local changes. 
• It was discovered that the outbreak was caused by cholera being spread through contaminated water.
• THE BIG CHANGE WAS THE 1875 PUBLIC HEALTH ACT

  • In 1867, working class men living in towns were given the vote. Political parties realised that if they promised to improve conditions, they would win votes. 
  • The Second Public Health Act in 1875 set that local councils had to appoint Medical Officers to be responsible for public health; councils were ordered to build sewers, supply fresh water and collect the rubbish.
• Christian Church approved of the knowledge of the ancient Greeks and Romans; Galen, although he lived in Roman times, believed in one God; this fitted with Christian ideas
• Wise men or women in the village gave first aid, herbal remedies, and supernatural cures with charms and spells based on tradition and word-of-mouth.
• Travelling healers in markets and fairs extracted teeth, sold potions, and mended dislocations or fractures.
• Herbalists in monasteries used herbal treatments, bloodletting, and prayer and rest in the medieval hospitals.
• Trained doctors in large towns based their treatments on the four humours.
• There were very few doctors in Medieval England and they charged high fees for services.
• Students studied for at least seven years at universities controlled by the Christian Church often doctors never treated a single patient during their education.
• Many diseases that Hippocratic and Galenic medicine could not cure; for these diseases supernatural ideas influenced doctors’ treatments. 
• Doctors used:

  • Clinical observation – checking pulse and urine 
  • Four humours
  • natural
• Doctors checked:

  • Position of the stars
  • Recommended charms and prayers.
  • supernatural
• Medieval doctors based their natural cures on the Ancient Greek theory of illness, which involved the equal baloance of the body’s four ‘humours’ – blood, phlegm, black bile and yellow bile. They believed that a person became ill when these were out of balance, and the doctor’s job was to restore this balance. 
• Smallpox was one of the biggest killer diseases in the 18th Century, killing 30 per cent of those who caught it.
• Inoculation was used to prevent smallpox, but it didn't always work as dried scabs were scratched into the skin.
• Jenner heard stories that people catching cowpox were protected against smallpox.
• Jenner decided to test his theory in 1796 by giving cowpox to an 8 year old boy as an experiment.
• When exposed to smallpox six weeks later, no disease followed.
• Jenner called the new technique 'vaccination'.
• Jenner repeated the experiment over several weeks with 16 different patients and concluded correctly that cowpox protected humans from smallpox.
• Opposition

  Jenner published his findings in 1798 but… 

  • He could not explain how vaccination worked and people still had medieval beliefs about the causes of disease e.g. miasma. 
  • Many doctors were profiting from smallpox inoculation and didn’t want to change this
  • Attempts to repeat his experiment failed 
  • Jenner was not a fashionable city doctor, so there was snobbery against his ideas. 
• Why was vaccination accepted?

  • Jenner had proved the effectiveness of vaccination by scientific experiment
  • Vaccination was less dangerous than inoculation
  • Members of the royal family were vaccinated which influenced opinion
  • Parliament acknowledged Jenner’s research with a £10,000 grant in 1802.
  • In 1853, the British government made smallpox vaccination compulsory.
• Louis Pasteur understood from his experiments that spontaneous generation was wrong and that germs, not chemicals caused decay.
• Louis Pasteur came up with the idea of Germ Theory.
• Many doctors at the time did not believe microscopic germs could harm something as large and advanced as a human.
• Joseph Lister further publicised Germ Theory through his use of carbolic acid to kill bacteria during surgery.
• Surgeons disliked the fuss and preferred to work quickly.
• Germ Theory was advanced by the 1866 cattle plague which proved that one microbe could cause illness by contact and by Robert Koch’s work on cholera and typhoid.