1700-1900

• What were the enlightenment and scientific revolution?

  By 1700 the influence of the Church had declined significantly and people focused on developing scientific explanations.

  - The Enlightenment was an intellectual movement which made it fashionable to seek answers to questions.

  - The Scientific Revolution came in two parts:

  1) First half - discrediting of old theories

  2) Second half - new ideas replacing old.

  
  

  Society itself was also changing... new cities grew which were poorly planned and therefore dirty and disease ridden. Tuberculosis, typhus and smallpox were rife.
• Causes of disease: continuity

  Very little continuity because four humours had been totally discarded, however, people still believed in miasma (this gradually becoming less popular)
• Causes of disease: change

  - Early 18th century: Theory of spontaneous generation developed using improved microscopes which stated that microbes were the product of decay.

  - 19th century: Pasteur and Koch make the first solid link between microbes and disease: Germ Theory.
• Pasteur: work


  - In 1860, Louis Pasteur was challenged by the French Academy of Science to come up with evidence to either prove or disprove spontaneous generation

  - Used newly high tech microscope to prove that microbes in wine and vinegar turned the liquids 'bad'

  - Published germ theory in 1861.

  - Published germ theory of infection, looking at silkworm populations, in 1878

  - Developed vaccines for fowl cholera, anthrax and rabies.
• Pasteur: impact

  - Initially, almost no impact because his work focused on decay... spontaneous generation remained dominant.

  - Powerful doctors such as Henry Bastian promoted spontaneous generation until the 1870s.

  - Inspired others e.g. Joseph Lister to look for a link between decay and infection.

  - John Tyndall published further ideas in English.

  - Attitudes from doctors prevented people recognising germ theory.
• Koch


  - German who successfully identified different germs cause many common diseases - built on Pasteur's findings.

  - Koch discovered the bacteria that caused tuberculosis in 1882 and cholera in 1883.

  - Research inspired other scientists, who then discovered microbes for diphtheria, pneumonia etc

  - Received Nobel Prize for Medicine in 1905 and is considered the father of bacteriology.

  - Enormous breakthrough as doctors now studied the disease itself, rather than treating symptoms and medical profession recognised the microbe was to blame.
• Impact of Germ Theory


  - Short term, was difficult to find treatments quickly, even if scientists could begin research.

  - Publication of Germ Theory proved earlier scientists like Joseph Lister and John Snow were correct

  - During the 20thC, Germ Theory has had enormous impact on our understanding of the causes of disease and many treatments were baed on this science.
• Why was Germ Theory discovered?


  - Individuals: determination and perseverance of Koch, Pasteur, (Tyndall and Lister)

  - Science: improved communications enabled scientists to share their work with each other and across different branches of scientific research// e.g. Pasteur's work on animal diseases inspired others to look at human diseases.

  - Technology: microscope was most important piece of technology because it allowed clearer images and higher magnification to see microorganisms

  - Also petri dish had been developed by Joseph Petri, allowing Koch to grow microbes in agar.
• Early changes to hospital care

  - 5 hospitals in England in 1700; all in London

  - New hospitals began to appear in the cities using donations from wealthy people and the new middle classes.

  - Increasingly became places where the sick were treated, with regular visits from doctors. However, rich people did not receive treatment there.

  - Hospitals would only admit the 'deserving poor' - those who worked, but could not afford medical bills.

  - Greater attendance led to decrease in sanitation as doctors went from patient to patient without washing their hands or changing clothes.
• Florence Nightingale in the Crimea

  - In 1853, Britain went to war with Russia in the Crimea.

  - State of hospitals there provoked an outcry (no nurses or bandages)

  - Nightingale was sent by the government to the Crimea with 38 other nurses to improve conditions.

  - Whilst there, she demanded 300 scrubbing brushes to get rid of any dirt near patients

  - Organised nurses to treat nearly 2000 patients

  - Demanded clean bedding and good meals

  - Led to a drop in mortality rate from 40%-2% within 6 months.
• Florence Nightingale: impact


  - Wrote Notes on Nursing in 1859, setting out the key role of a nurse.

  - Promoted 'pavilion style' of hospital with separate wards for infectious patients

  - In 1860, set up the Nightingale School for Nurses at St Thomas' hospital, London

  - Made nursing seem a respectable profession: they'd previously had a reputation as flirtatious drunks.
• British hospitals by 1900

  - Wards split up infectious patients from those requiring surgery

  - Operating theatres and specialist departments had developed

  - Cleanliness was now of utmost importance, base on cleaning germs using antiseptics

  - Doctors were a common sight, training junior doctors.

  - Nurses lived in nearby houses to provide for everyone

  - Hospitals were much airier, with improved ventilation based on new pavilion design.
• Early 19th century surgery

  Three big problems to overcome: bleeding, pain and infection

  - No effective anaesthetics (herbs e.g. mandrake, or alcohol would numb pain)

  - No infection control (doctors took bloody instruments and dirty aprons as a sign of experience)

  - Crowds would watch operations as entertainment
• Development of anaesthetic


  Anaesthetic: pain relief

  - 1795: Laughing gas is developed by Humphry Davy, who discovers it can numb pain

  - 1846: Robert Liston, a famous Scottish surgeon successfully anaesthetises a patient using ether and amputates his leg: "when are we going to begin, doctor?"

  - 1847: James Simpson discovered chloroform and its success meant doctors could attempt lengthier and more complex operations.
• Black Period of Surgery

  This was the period between 1847 and 1865.

  - Operations increased in complexity (e.g. stomach surgery became possible) following discovery of chloroform, but doctors still couldn't control the bleeding or infection and many patients died.

  - Additionally, there were problems with chloroform dosage... 15 y/o Hannah Greener was the first patient to die from an overdose of chloroform whilst having an infected toenail operated on in 1848.
• Development of antiseptic


  Antiseptic: infection control

  - In 1865, Joseph Lister first operated on a patient using carbolic acid soaked bandages to control the infection - the wound healed cleanly!

  - From this, Lister developed a series of steps to ensure wounds did not become infected e.g. spraying carbolic acid in the air during operations and published his findings in the Lancet (medical journal)

  - Doctors adopted this spray because it was clearly effective.
• Factors behind surgical development

  Key Individuals:

  - Simpson (anaesthetic developments)

  - Lister (antiseptic developments)

  Shifting Attitudes...

  - Celebrity mothers Queen Victoria and Kate Dickens used chloroform for the birth of their children (e.g. Prince Leopold in 1853) and helped it to catch on

  - The government knighted James Simpson for his services to medicine// the first ever person
• Opposition to change


  - Black Period of surgery meant some people became more reluctant to surgical intervention and did not trust new surgical techniques using chloroform.

  - Victorian Christians believed pain relief interfered with God's plan, especially during childbirth

  - Many doctors refused to use pain relief as they thought patients were more likely to die whilst asleep, than when awake and screaming.
• Smallpox in the 18th century

  - In 1700, smallpox was a huge public health risk.

  - Nationwide epidemics in 1722, 23 and 40-42.

  - Killed many and left others scarred for life.

  - Inoculation was a popular, but not 100% effective method, of inducing immunity by taking a small amount of smallpox pus and rubbing it into a cut on the patient.
• Jenner's work


  - Edward Jenner was a Gloucestershire doctor interested in inoculation who gathered evidence for over 1,000 cases where smallpox inoculation had failed.

  - Noticed that dairy maids who had suffered from cow pox did not develop small pox.

  - Tested this link by infecting his gardener's son, James Phipps, with cowpox. Then returned two weeks later to infect him with small pox and the boy did not all ill.

  - In 1796, wrote up his findings in An Enquiry into the Cause and Effects of the Variola Vaine - named his technique vaccination (the latin for cow).
• Opposition to Jenner


  The Church thought that using animal infection in human trials went against God's will

  Inoculators thought their businesses would be destroyed and so opposed it

  The Royal Society refused to publish Jenner's work based on all the opposition

  - From 1852 (nearly 60 years later), the government accepted and made the smallpox vaccination compulsory.
• Jenner's impact


  Short term: Became popular quickly and 100,000 people had been vaccinated by 1800

  - French commander Napoleon had entire army vaccinated in 1805.

  - By the end of the 19thC, vaccination had become normal and cases fell dramatically after vaccination was made compulsory

  - Jenner inspired other scientists e.g. Pasteur and Koch to search for other vaccines.
• Edwin Chadwick


  - Industrial cities were crowded and disease riddled, but the government took a laissez faire (leave alone) attitude.

  - Chadwick published A Report on the Sanitary Conditions on the Labouring Classes in 1842 which said that the urban poor had a much lower life expectancy that those in the countryside.

  - Campaigned for all cities to set up boards of health responsible for supplying clear water and disposing of sewage
• Public Health Acts of 1848 and 1875

  - Partly in response to Chadwick, the first Public Health Act of 1848 tried to improve sanitary conditions by encouraging cities to set up boards of health and provide clean water supplies. Was not compulsory and so had very little impact.

  - From the 1860s, the gov took more action e.g. built 1,300 miles of sewers in London by 1865 and demolished slums in Birmingham.

  - Second Public Health Act of 1875 set out clear rules on public health and made the measures compulsory this time.
• Case Study: Cholera in London


  - Cholera was a terrible disease causing diarrhoea and sickness; it was usually spread through water contaminated with the faeces of a sufferer.

  - Govs believed that it was spread through miasmata and rotting matter + First Public Health Act's measures aimed at clean water were ineffective.

  - In 1854, John Snow observed the link between cholera and dirty water, tracing a series of deaths back to the Broad Street Pump in Soho

  - Presented findings to the government who agreed to make improvements to the sewer systems of London, although others rejected Snow's work.

  - Government were encouraged to act further by the Great Stick of 1858 where the Thames was low and the stench of exposed sewage became unbearable.
• Preventing cholera: government


  - The government encouraged local councils to clean up their cities and provide clean water

  - Listened to John Snow

  - Arranged for a new sewer system

  - Eventually passed the 1875 Public Health Act
• Preventing cholera: individual


  - John Snow observed the pattern of cholera cases

  - Designed an experiment to prove that cholera was caused by dirty water

  - Prevented residents from drinking the water

  - Presented his findings to the government.