medicine 1700-1900

• Germ Theory


  The theory that many diseases are caused by microbes (bacteria or germs)
• Breakthroughs had been made in the discovery of the true cause of many diseases
• There were few new ideas about the cause of disease in the 18th century, though some scientists thought that germs were produced by decaying matter - this was called spontaneous generation
• Most people still thought miasma was a cause of disease, but this was becoming a less popular theory than it was in the Renaissance
• Microscopes


  By 1700, microscopes had developed so that cloudy images of what would become known as bacteria or germs could be seen. By 1850, microscopes had further improved so that extremely tiny images could be seen clearly. This was essential in enabling the scientific breakthroughs of the later 19th century
• Social attitudes towards science were changing- there was an increasing awareness of the need for rational explanations for the cause of disease
• Louis Pasteur


  A French chemist who in 1861 published his Germ Theory, which showed that spontaneous generation was incorrect. He proved that microbes (bacteria or germs) in the air cause decay
• Robert Koch


  A German doctor and scientist who read Pasteur's work and began to study microbes himself. He proved that Pasteur's theory was right, that microbes caused disease as well as decay. He identified the specific microbes that caused TB in 1882, and cholera in 1883
• Koch's discoveries


  • He developed a new, easier way of growing bacteria on agar jelly, and also discovered that chemical dyes stained bacteria, which made them easier to see under a microscope. Other scientists used these methods to identify the microbes that caused other diseases
• Eventually, these discoveries were to have a direct impact on the prevention and cure of many diseases
• Pasteur's Germ Theory


  Had very little impact on medicine in Britain to begin with as he was not a doctor and his work focused on food and drink, not disease. Most doctors still believed in the spontaneous generation theory, but there were some (e.g. Joseph Lister) who did make the link between microbes and disease
• Koch's work had more of an impact in Britain than Pasteur's had, and he inspired others to research other microbes. However, it took time for most doctors and the British government to accept the Germ Theory of disease. Even though the real cause of many diseases had been discovered, it didn't yet have an impact on their medical treatment and prevention
• Florence Nightingale


  Was significant in influencing improvements in hospital care. Reports of her changes to hospital conditions after witnessing high death rates in military hospitals in the field had a significant impact on public opinion
• Florence Nightingale's approach


  • She believed that miasma caused disease, so emphasised hygiene, fresh air, good supplies and training for nurses. Her approach greatly improved conditions in the hospital
• Florence Nightingale's work was widely reported in newspapers in Britain. She published books on nursing and hospital organisation and set up a training school for nurses/midwives
• New hospitals (financed by charities and local councils) opened during the 19th century to look after the sick. The first cottage hospital (small buildings where nurses gave care and GPs prescribed to create a home treatment) opened in 1859
• Made and upper classes could afford doctors to treat them at home
• Due to the work of reformers like Florence Nightingale, hospital cleanliness and organisation improved, and nurses were better trained
• Pasteur's germ theory led to improved hygiene
• Nurses were given a central role caring for patients and assisting doctors
• The elderly, sick or disabled poor were forced to enter workhouses. Most hospitals tried to create a home atmosphere. Parents and visitors had to help nurses look after the patients
• Public pressure led to infirmaries (separate from workhouses) being set up for the poorest in society
• Specialist hospitals (such as asylums for the mentally ill and fever houses for infectious diseases) developed
• Before 1800, alcohol and opium had little success in easing pain during operations. Laughing gas was used in 1844 in dentistry in the USA, but failed to ease all pain and patients remained conscious
• Ether


  Used from 1846, made patients totally unconscious and lasted a long time. However, it could make patients cough during operations and sick afterwards. It was highly flammable and was transported in heavy glass bottles
• Chloroform


  Used from 1847, was very effective with few side effects. However, it was difficult to get the dose right and could kill some people because of the effect on their heart. An inhaler helped to regulate the dosage
• Cocaine


  Used as the first local anaesthetic in 1884. In 1905 a less addictive version- novocaine-was used as a general anaesthetic
• James Simpson


  Discovered chloroform when he was looking for solutions to pain during surgery. He gave lectures and wrote articles to promote its use for surgery and for childbirth. He was the first person to be knighted for services to medicine
• People worried about the long-term effects of using anaesthetics and thought that being unconscious made patients more likely to die. The Victorians were very religious and thought that God inflicted pain for a reason, so it was wrong to interfere with His plan. Also, it took a long time for doctors and surgeons to believe in the Germ Theory and therefore accept Lister's discoveries
• Joseph Lister


  A surgeon who worked at Glasgow Royal Infirmary. In 1864 he read Pasteur's Germ Theory and learned that carbolic acid kills parasites in sewage. In 1866 Lister used carbolic acid to clean wounds and equipment and invented a spray to kill germs in the air. In 1877 Lister became Professor of Surgery at King's College Hospital, London
• In 1861 half the patients in surgery died from postoperative infections. Lister starts work as a surgeon
• In 1865 Lister soaks bandages in carbolic acid to avoid wounds getting infected. In 1867 Lister states that his wards have been free from infection (pus) for 9 months. He publishes his ideas
• Lister's work inspired others to search for methods to prevent the spread of infection in hospitals. By 1900, operating theatres and wards were thoroughly cleaned using aseptic techniques, and surgeons and nurses wore sterilised clothing and used sterilised instruments
• Surgery became pain free and patients didn't struggle, so surgeons could take more time and be more careful. Deeper, more complex surgery became possible and the death rate dramatically decreased as surgery was more successful. Aseptic surgery was possible because antiseptics were used to clean wounds and operating theatres
• Pasteur's discoveries


  He carried out experiments to observe microbes and published his results in 1861, calling his discovery Germ Theory. His team of scientists discovered that a weakened version of a microbe could be used to create a vaccine
• The 19th century saw some important developments in disease prevention as the Germ Theory was used to create vaccines for some diseases. Also, the government began to play more of a role in public health and increased prevention rates by reducing the conditions that fostered disease
• Impact of anaesthetics and antiseptics

  • Surgery became pain free and patients didn't struggle, so surgeons could take more time and be more careful
  • Deeper, more complex surgery became possible
  • Death rate dramatically decreased as surgery was more successful
  • Aseptic surgery was possible because antiseptics were used to clean wounds and operating theatres
• Give three reasons why surgery was more successful by 1900
• Germ Theory


  Used to create vaccines for some diseases
• Government's role in public health

  Increased prevention rates by reducing the conditions that fostered disease