Medicine Through Time

• There were separate wards for infectious patients, but doctors would often go between wards and patients without washing or changing clothes
• Florence Nightingale helped to transform hospital care in Britain
• In 1854, Nightingale and a team of 38 nurses were sent by the government to treat British soldiers in the Crimean War


  1. Thoroughly cleaning the hospital

  2. Providing clean clothes and bedding

  3. Improving sanitation

  4. Providing good ventilation
• Nightingale wrote books about her methods (Notes on Nursing, 1859) and founded the Nightingale School for Nurses in 1860
• Nursing became a respectable profession
• New hospitals were based on Nightingale's advice. They often followed a pavilion plan, with lots of windows for ventilation and separate wards for infectious patients
• Nightingale's focus on clean air suggests that she still believed miasma was the key cause of disease
• 3 key problems with surgery

  • Bleeding
  • Pain
  • Infection
• Anaesthetics


  Used to numb pain
• Ether had been used as an anaesthetic in America, but it made patients vomit and cough
• Chloroform became popular, especially after Queen Victoria used it during childbirth in 1853
• Problems with chloroform


  • An overdose could kill the patient
  • It sometimes affected the heart, causing perfectly fit people to die
  • With such an effective anaesthetic, doctors began to attempt more complex operations. This meant infection and bleeding became even bigger problems
  • Many people thought pain relief was interfering with God's plan, because procedures like childbirth were meant to be painful. Patients should be awake and screaming!
• Antiseptics


  Used to prevent infection
• Before scientists knew about germs, patients would often survive operations, but then die from infections like gangrene and sepsis
• Lister also sprayed the acid during operations, to disinfect the air in the theatre
• Reasons antiseptics were slow to catch on

  • The science behind them wasn't understood. Lister focused on getting people to use the carbolic spray, not proving why it worked
  • Carbolic spray dried out the skin. Surgeons found it uncomfortable because it made their hands sore
• By 1900, aseptic surgery (removing all germs from operating theatres before surgery) was commonplace
• Aseptic surgery practices


  • Surgical instruments were steam sterilised
  • Operating theatres were cleaned
  • Gloves, gowns and masks were worn by surgeons

  
• Many working-class people continued to use herbal remedies, often old recipes which had been passed down through generations
• People also bought patent medicines, which were mass-produced by big businesses. They were also known as "cure-alls" because it was claimed they could treat anything. These were usually made of lard, wax and soap, and had no medical benefits
• Florence Nightingale


  Worked at a British army hospital in the Crimea in 1854
• Nightingale published books on how hospitals should be run, and set up the Nightingale School for Nurses to train more women
• Anaesthetic


  Discovered by James Simpson in 1847 to numb pain during operations
• Queen Victoria used chloroform during childbirth in 1853
• Joseph Lister


  Successfully tested the first antiseptic in 1865, which aimed to reduce infection
• Companies made big money by selling patent medicines which claimed to cure anything, but in reality had no medical benefits
• Inoculation


  Involved spreading pus from a smallpox scab into a cut in the skin of a healthy person, so that that person would catch a mild case of smallpox and build up a resistance
• Inoculation was risky because the inoculated person might get a strong dose of smallpox and die, or pass the disease onto someone else
• Vaccination


  Involved infecting a person with cowpox, a disease similar to smallpox, to build up immunity without the risk of spreading the disease
• Jenner published his theory on vaccination in 1798, and encouraged other doctors to follow his technique
• Opposition to vaccination


  • The Church
  • Inoculators
  • The Royal Society
• In 1840 the government made inoculation a crime, and provided children's vaccinations at the taxpayer's expense
• In 1852 smallpox vaccination was made compulsory, though it wasn't properly enforced until 1872
• Jenner's discovery was a one-off - he couldn't explain exactly why it worked, so he couldn't use it to prevent other diseases
• Louis Pasteur developed the next vaccines, for chicken cholera, anthrax and rabies, in the 1870s. He published his germ theory of infection in 1878
• In 1842, Edwin Chadwick published his Report on the Sanitary Conditions of the Labouring Classes, which showed that poor people in cities had a much lower life expectancy
• Chadwick suggested that local governments should be responsible for public health
• First Public Health Act (1848)


  Encouraged local councils to set up a local board of health and provide clean water supplies
• Most councils didn't act because it was not compulsory
• Second Public Health Act (1875)

  Made it compulsory for city authorities to provide clean water, dispose of sewage safely, build public toilets, employ a public health officer, enforce better building standards, check food quality, and provide public parks