1800 - 1899: a revolution in medicine

• Louis Pasteur (1822 - 1895)

  *showed microbes caused fermentation and spoilage by heating alcoholic beverages to kill disease-causing bacteria (this process is known as pasteurisation)

  *speculated that the germs from the air that were causing liquids to go sour were getting into humans and responsible for sickness

  *disproved spontaneous generation of microorganisms (theory that decaying matter was creating bacteria)

  *demonstrated what is now known as Germ Theory of Disease

  *produced vaccine for anthrax and rabies (used a vaccine that successfully worked on dogs on a boy that was bitten by a rabid dog, resulting in his survival)

  *"Chance only favours prepared minds"
• Charles Chamberland (1851 - 1908)

  *part of Pasteur's research team

  *worked with Pasteur to help the farming industry to prevent chicken cholera: he was supposed to inoculate a batch of chickens with the germ that caused chicken cholera, but he forget and then the laboratory was closed for the summer. when he came back, he finally inoculated the chickens and expected them to die from cholera but they did not - Pasteur realised that the germs left over the summer had weakened and were not strong enough to kill the chickens, but instead protected them from the cholera
• Robert Koch (1843 - 1910)

  *used the culture-plate method for isolating bacteria (by staining bacteria to make them easier to study as they could be photographed using a new, high-quality photographic lens)

  *in 1876 he found the bacterium that caused anthrax - this was the first time anyone has identified the specific microbe that caused a particular disease

  *demonstrated how cholera was transmitted by food and water

  *over the next 20 years him and other scientists identified more bacterium causing individual disease, leading to the development of vaccines to prevent them
• Pasteur and Koch


  *founders of microbiology

  *Koch showed an interest in Pasteur's work

  *they were just as ambitious as each other

  *saw each other as rivals, especially after the war because France and Germany in 1870-1 (that was won by Germany) - both men wanted to glorify their country
• Germ Theory


  *the theory that infectious diseases and the spoiling of food are caused by certain microbes

  *bacteria was not created by decaying matter, bacteria caused the decay and germs got into the decaying matter from the air as they are around us all of the time

  *Pasteur's determination and experiments, improved science and technology (e.g. better microscopes) and the government paying for his laboratories and research term all led to the development of this theory
• Germ Theory's short term impact

  *Koch was the first to link an individual bacterium to an individual disease

  *once individual bacteria had been linked to specific diseases, vaccines were developed to prevent them

  *Lister used carbolic spray to perform the first antiseptic surgery
• Germ Theory's long term impact

  *aseptic surgery: developed in the late nineteenth century with the aim of making sure operating theatres were germ free

  *improved medical understanding: discovery changed the way health departments cared for persons with infectious disease, convincing people that miasma was not the cause of disease and spontaneous generation was not real

  *new treatments: in the late 1800s, scientists developed the first chemical drugs and in the 1930s, the first antibiotic that killed bacteria in the body was discovered. by 1900, different teams had found bacteria that caused other diseases, such as typhoid, pneumonia, meningitis, plague and dysentery

  *improved public health: Pasteur's discovery encouraged councils and government t build sewers, keep streets clean and provide clean water
• Paul Ehrlich (1854 - 1915)

  *part of Koch's research team

  *in 1909, he developed a cure to syphilis with a single injection - this was Salvarsan 606, which he called a "magic bullet" because it homed in on and destroyed the harmful bacteria causing syphilis

  *unknown how it worked, but Salvarsan cured 10000 people within three years

  *before, mercury was used to cure syphilis, which was dangerous and ineffective
• Gerard Domagk


  *discovered sulphanilamide and developed the second magic bullet Prontosil, which could cure blood poisoning

  *drug companies then developed more sulphonamide cures for diseases such as pneumonia

  *magic bullets could not kill infection causing germs, so they were not a complete solution
• home remedies


  *everyday treatments were slow to develop

  *until 1900, the improvements in medical knowledge did not lead immediately to effective new treatments

  *most common form of treatment continues to be home remedies, which has a lot in common to medieval remedies
• patent medicines


  *products that were sold, most often in the 19th century, as medicines that would cure a host of illnesses and diseases

  *there was no control over the manufacturing standards or the ingredients in patent medicines until the 1880s, so false claims about their effectiveness were made without fear of prosecution

  *addictions, deaths and illnesses resulting from overdoses were common

  *in the 1880s, governments introduced laws controlling the use f harmful ingredients, but the medicines still contained lard, wax and turpentine, all while claiming to cure all illnesses
• problems that surgeons faced in the early 1800s

  *not a respected profession as they were seen as butchers or torturers

  *painful for the patients due to lack of effective anaesthetics

  *infections could spread easily due to lack of effective antiseptics and crowded, unhygienic operating environments

  *very basic technology, surgical tools and equipment

  *high death rates due to shock of pain, blood loss and infection
• speed in surgery


  *due to the lack of effective anaesthetics, the only way to reduce pain was speed - the patient would be held or tied down by the surgeon's assistants while the surgeon operated as quickly as possible

  *in 1812, Napoleon's surgeon, Dubois, amputated 200 limbs in 24 hours

  *Liston once amputated a leg in two and a half minutes and during anther operation he accidentally amputated the fingers of his assistant and slashed the coat of a spectator that died from shock - both the assistant and patient died from infection after the operation
• improved anaesthetics


  *the late 1700s and 1800s saw an increase in the interest in chemistry, with scientists studying the properties of different chemicals and the effects they can have on humans

  *nitrous oxide, ether and chloroform
• Humphry Davy (1778 - 1829)

  *in 1799, he discovered that "laughing gas" (nitrous oxide) reduced the sensation of pain, suggesting that it might be useful in surgery or dentistry

  *did not make the patient fully unconscious and they could still feel pain: when used in a public demonstration, the patient was in agony - this damaged the reputation of laughing gas as an anaesthetic
• Robert Liston (1794 - 1847)

  *used ether an an anaesthetic for a leg amputation

  *ether worked better than anything else so far

  *however, it had drawbacks: it was difficult to inhale, it irritated the eyes and lungs, causing coughing and sickness, it was flammable, it had a vile, long-lasting smell and it was stored in large, heavy bottles so it was difficult to transport
• James Simpson (1811 - 1870)

  *Professor of Midwifery at Edinburgh University

  *discovered chloroform to be an effective anaesthetic while experimenting with different chemicals with his colleagues

  *it was faster-acting and gentler than ether and within days, he started to use it in childbirth

  *however, it was new and untested, so the dosage was unknown and long term side effects were unknown (15 year old Hannah Greener died from an overdose during a toenail extraction surgery)
• opposition to anaesthetics


  *anaesthetics initially increased the number of deaths in surgery - people did more complex operations and hygiene was still bad in surgeries, so 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

  *Queen Victoria was given chloroform during the delivery of her eighth child in 1853 and she publicly praised it - this destigmatized the usage of anaesthetics
• Black Period


  *a 20-year period between the 1850s and 1870s where the number of deaths from surgery had increased due to the usage of chloroform

  *with patients unconscious, surgeons could now take their time over operations and attempt more difficult invasive surgery

  *patients still died from blood loss or from infections picked up in the operating theatre due to unhygienic conditions
• impact of chloroform


  *short term: developments in anaesthetics allowed more complex operations, with surgeons being able to work more slowly and carefully without the fear of their patients dying from shock however, this increased the risk of infection

  *long term: chloroform's power enraged others to search for even better anaesthetics, with other chemicals being used to relax mules as well as putting patients to sleep and local anaesthetics being developed
• surgery conditions before Lister

  *surgeons did not to wash their hands before an operation

  *reused bandages, spreading gangrene and skin infections from patient to patient

  *did not sterilise equipment

  *wore pus stained and bloody aprons as a badge of honour on the wards

  *due to these, many patients died from infection after the operation, despite doctors knowing infection could be fatal
• Joseph Lister (1827 - 1912)

  *belief in Pasteur's Germ Theory drove him to look for ways to kill bacteria in the wound

  *first doctor to use an antiseptic during surgery

  *in 1864, he observed how carbolic acid was used to reduce the smell of sewage, fertilise land and destroy parasites that infected cattle feeding on land

  *used bandages soaked in carbolic acid on wounds to kill germs -he found that the wounds healed and did not developed gangrene

  *went on to use carbolic acid when he performed amputations - it dramatically reduced deaths from infections

  *in 1867, he published his findings, showing value of using carbolic acid and continued to improve his method so that bacteria would be killed at every stage of an operation
• opposition to antiseptics


  *carbolic spray soaked the operating theatre and created an unpleasant smell

  *it cracked the skin of surgeons

  *the new precautions slowed down operations, and speed was still thought to be essential in surgery

  *it did not always work (usually because other surgeons were not as careful as Listr, but he still faced criticism)

  *Pasteur's ideas were still not widely accepted

  *Lister did not give impressive displays to flaunt his surgery skills

  *Lister wanted to find a substance that worked just as well as carbolic spray but without the corrosion and in response, his critics said he was changing his methods because they did not work
• overcoming of opposition to antiseptics

  *Lister's determination and teachings: in 1869, he became the Professor of Clinical Surgery at Edinburgh University and over the next eight years, he demonstrated his methods to over 1500 medical students. in 1877, he moved to King's College Hospital, London to train young surgeons

  *with the help from others: in 1878, Koch discovered the bacterium which caused septicaemia - this gave a great boost to Lister's ideas and but the end of the century, they were widely accepted
• aseptic surgery


  *the removal of all possible germs from an operating theatre, which had developed from antiseptic surgery by the late 1890s

  *Lister used carbolic acid to wash a surgeon's hands, soak bandages and ligatures, and spray the air directly around the wound

  *operating theatres and hospitals were carefully cleaned, all instruments were steam sterilised, surgeons now wore surgical gowns, face masks and rubber gloves

  *surgery became more ambitious: the first successful appendix removal surgery (in the 1880s) and heart operation (1896) came out from this

  *Simpson and Lister had made major contributions and made such operations possible, improving the status of surgery as a job with more complex and safer operations being carried out
• the Great Stink of 1858

  *an event in central London in July and August 1858 during which the hot weather exacerbated the smell of untreated human waste and industrial effluent that was present on the banks of the River Thames

  *in the Houses of Parliament, MPs fund it impossible to use the rooms overlooking the river

  *at the time, many people still believed in miasma being the cause of disease, so they treated the curtains with lime chloride - this had little impact and the awful smell still remained

  *many Londoners got their drinking water from the River Thames, despite it being where they dumped waste
• cholera outbreaks of 1831-65

  *four major epidemics during in this timeframe

  *caused by drinking contaminated water - violent sickness and diarrhoea led to severe dehydration and death, killing people in less than a day

  *the epidemic of 1848-48 killed 53000 people, 1848 killed 60000, 1854 killed 20000, 1865 killed 14000

  *cholera spread because germs from cesspits infected the water supply
• methods to prevent the spread of cholera in the 1830-40s

  *burning barrels of tar, inhaling vinegar and smoking cigars to protect against bad air

  *praying to God or wearing religious charms

  *taking patent medicines that "guaranteed' protection

  *burning the clothes and bedding of those who had the disease

  *quarantine - guards stopped people living in poverty from entering the city
• impact of cholera


  *many local tax-payers did not want to pay improvements and local councils did not want the national government interfere in in local matters

  *as cholera spread across Europe in 1847, fear of death to cholera grew in Britain, and so the government finally followed Chadwick's recommendations and passed the Public Health Act in hopes of reducing cholera's impact
• living conditions in cities

  *living conditions in industrial cities were worse than in the Middle Ages: badly ventilated houses were crammed close together and families shared privies, meaning diseases like cholera spread quickly

  *working conditions were also harmful, with twelve hour working days being common in hot dirty workshops, surrounded by dangerous machinery

  *fresh food was hard to get or expensive because it have to be brought in t town by horse and cart

  *doctors charged fees, so less affluent people could not afford to see one

  *water supply was the most fundamental problem of all: it was hard to get fresh, clean drinking water
• Edwin Chadwick (1800 - 1890)

  *public health official who wrote reports on the poor living conditions of the cities and believed that poverty was caused by illnesses

  *his report in 1842, he found those living in poverty lived in dirty and overcrowded conditions (which caused a huge amount of illness), many people were too sick to work and so became poorer and therefore, other people had to pay higher taxes to help people living in poverty

  *his solution was for the government to reform public health by improving drainage and sewers, removing waste from streets and houses, providing clean water supplies and appointing medical officers in each area to check that these reforms were being implemented
• the 1848 Public Health Act

  *towns to set up and run their own local Board of Health, appoint a local medical officer, organise rubbish removal, make improvements to water supply and build a sewer system

  *local councils were encouraged to make public health improvements by collecting taxes to pay for them, though it was not compulsory - the government could force them to however
• John Snow (1813 - 1858)

  *published a book in 1849 putting forward his view that cholera spread through water, not in "bad air"

  *observed the deaths from the cholera outbreak in 1854 and saw that many of them were around Broad Street in central London, with 500 killed in just 10 days - he mapped out the deaths in detail and linked all of them to a single water pump in the area

  *found that the deaths in the area stopped when he broke the water pump's handle, another pump nearby had virtually no cases of cholera because it had its own well and a lady from another part of London had died from cholera because she had that water delivered to her home
• John Snow's impact


  *proved that clean water was essential for preventing the spread of cholera, however he could not explain why there was a link

  *the government was still not convinced to act as many scientists still clung on the theory of miasma

  *it was not until the Germ Theory in 1861 that anyone could begin to understand why the water was causing cholera

  *laws were not passed because wealthy people did not want to pay taxes to cover the taxes of clean water that would benefit the less affluent, local councils did not want the government interfere in in how they ran towns and there was a strong belief in laissez-fair and self help: governments were not expected to play a major role in improving living/working conditions
• Joseph Bazalgette (1819 - 1891)

  *19th-century English civil engineer

  *created a sewer network for central London in the 1860s in responses to the Great Stink of 1858, which was instrumental in relieving the city from cholera epidemics, while beginning the cleansing of the River Thames

  *during the Industrial Revolution, there had been great improvements in technology, so he used what e learned in railway building to design this project

  *sewage system consisted of 83 miles of large sewers (built underground from brick), 1100 miles of smaller connecting sewers from each street and pumping stations at regular points to pump the sewage along the pipes
• the 1875 Public Health Act

  *made to enforce local authorities to build sewers, provide clean water and appoint a medical health officer and sanitary inspectors to inspect public health facilities
• 1875 Artisans' Dwelling Act

  *gave local authorities the power to purchase and rebuild slum areas if they were deemed to be unhealthy

  *put in place as a result of Octavia Hill's influence, who was appalled by the living conditions of children in poverty - she bought three London slum houses in 1865 and cleaned them up to show others how to provide healthy homes for working people and stop overcrowding. over time, she bought and improved 2000 houses, leading to similar schemes elsewhere and she went on to campaign for laws that would force local councils to improve housing to be passed
• working men get the vote

  *1867

  *if politicians wanted to win elections, they now had to promise to do things to help working men (no just the wealthy and middle classes), which involved improving working conditions

  *the 1870s and 1880s saw many new laws passed designed to improve the lives of ordinary people as a result
• 1875 - 1900 laws to improve public health

  *to stop the pollution of rivers (from which people got water)

  *working hours in factories for woman and children to be shortened

  *it was made illegal to put unhealthy additives in food

  *education was made compulsory