A revolution in medicine

• Surgery (1800's): Due to pain, infection and blood loss surgery had to be quick. There were also high mortality rates, as many patients died of infection even if they survived the operation.
• Surgery (1800's): Robert Liston was a famous surgeon in the 1840s. He was able to carry out an operation to amputate a leg in under 40 seconds. This was necessary due to the lack of anaesthetics to make sure patients were still, as well as the risk of blood loss if an operation took too long.
• Surgery (1800's): Humphrey Davy - In 1799, British surgeon Humphry Davy discovered that nitrous oxide worked as an effective local anaesthetic. He gave it the name ‘laughing gas’ and wrote about its potential in surgery. However, it did not become widely used until after Davy had died.
• Surgery (1800's): Nitrous oxide - Horace Wells was an American surgeon and used nitrous oxide in a public demonstration to remove a tooth. Unfortunately, the patient wasn’t given enough of the gas. As a result, they made a noise during the procedure, which convinced people it didn’t work.
• Surgery (1800's): William Mortan - Horace Wells worked with another surgeon, William Morton. Morton experimented with using ether as an anaesthetic. It worked effectively in preventing patients from feeling pain and quickly became widely used by surgeons in England.
• Surgery (1800's): Ether - It was flammable, which meant it needed to be carefully stored. Patients often complained of a sore throat or feeling sick after a procedure when they had been given ether.
• Surgery (1800's): James Simpson - A Scottish doctor. In 1847, he and some friends experimented with chloroform. He discovered that it was an effective general anaesthetic.
• Surgery (1800's): Chloroform - Replaced ether as the most widely used anaesthetic. The discovery of chloroform meant patients were still during an operation and felt no pain. This meant surgeons could start to consider more complex operations.
• Surgery (1800's): Opposition to anaesthetics - Some people in the Church argued that pain in childbirth was sent by God, so using anaesthetics for women in labour was interfering with God’s will.
• Surgery (1800's): Opposition to anaesthetics - When not used carefully, anaesthetics could be dangerous. Hannah Greener was a 15-year-old girl who died during a procedure to remove an ingrown toenail because she was given too much chloroform.
• Surgery (1800's): Opposition to anaesthetics - The British army banned the use of chloroform. Some army surgeons argued that patients being awake and in pain helped them to understand how the patient was feeling.
• Surgery (1800's): Solving opposition to anaesthetics - John Snow devised a chloroform inhaler in the 1850s. Before the inhaler, chloroform had been poured onto a cloth and placed over the patient’s mouth and nose. The inhaler made it possible for doctors to control the amount of chloroform a patient was given. This made the use of anaesthetics safer. The inhaler mixed chloroform with water vapour, so the patient could breathe it in.
• Surgery (1800's): Solving opposition to anaesthetics - In 1853, when giving birth to her eighth child, Queen Victoria used chloroform. Her doctor was John Snow and she later spoke of that ‘blessed chloroform’ in easing the pain of childbirth. This gave the public reassurance that chloroform was safe and effective.
• Fight against disease: Spontaneous generation - Doctors were aware that germs existed in the late 17th century. However, there was not a belief that germs caused disease. People believed in spontaneous generation. This led to the belief that germs, which appeared at the site of disease or illness, were a consequence of the illness rather than the cause of the illness.
• Fight against disease: Louis Pasteur - A French chemist. In the 1850s, he was asked by a French winemaker to investigate why their wine was going off. Pasteur used a microscope to see that there were bacteria in the wine. He believed this was what was making it go off. He successfully heated the wine to kill the bacteria.
• Fight against disease: Louis Pasteur - He put some broth in two swan neck flasks and boiled it, which killed any microbes that were already there. He then broke the neck off one of the flasks. The flask that was exposed to the air went bad, but the sealed flask did not. This further proved Pasteur’s theory that microbes were in the air and caused disease in humans.
• Fight against disease: Louis Pasteur - In 1861 Pasteur published his work on germ theory. This was a hugely significant moment. It allowed further advances to take place in vaccines, surgery and antibiotics.
• Fight against disease: Robert Koch - A German doctor. He used industrial dyes to stain bacteria. This made them easier to identify when viewed under a microscope. In 1876, he identified the germ that causes anthrax. This was the first time the bacteria responsible for a specific disease had been identified. Identifying specific bacteria was crucial in being able to develop effective treatments and vaccines.
• Fight against disease: Pasteur and Koch were rivals, but their work led to significant advances in medicine.
• Fight against disease: The Chicken Cholera Vaccine - In 1879, Pasteur was working with his assistant, Charles Chamberland, to try to find a cure for chicken cholera. They were injecting chickens with cholera germs and then trying to cure them.
• Fight against disease: The Chicken Cholera Vaccine - On returning from holiday, Chamberland injected a chicken with cholera germs. It did not become ill. Pasteur told Chamberland to try again with fresh germs but the chicken still did not become ill. Pasteur realised that the old germs had caused the chicken to develop immunity to cholera. This meant that he and Chamberland had discovered a vaccine by chance.
• Fight against disease: The Chicken Cholera Vaccine - This would lead to further vaccines quickly being discovered (eg for anthrax and rabies). Unlike Jenner, Pasteur understood why his vaccine had worked, so he could replicate the process for other diseases.
• Fight against disease (Factors that helped Pasteur and Koch): Technology - Koch’s assistant, Julius Richard Petri, invented the Petri dish. This enabled Koch to grow bacteria. He could then use industrial dyes to stain the bacteria. Finally, he could use powerful microscopes to identify the bacteria.
• Fight against disease (Factors that helped Pasteur and Koch): Chance - Pasteur developed the chicken cholera vaccine when he left some cholera germs unrefrigerated before going on holiday. When his assistant, Charles Chamberland, injected these germs into a chicken on their return, the chicken did not become ill. Pasteur realised that the old germs had given the chicken immunity without making it ill.
• Fight against disease (Factors that helped Pasteur and Koch): War - In 1870-1871, France and Germany were fighting each other in the Franco-Prussian War. This led to rivalry between Pasteur and Koch. Their respective governments invested in their research to show they had more advanced science and for national pride.
• Joseph Lister: A Scottish surgeon. He read about Pasteur’s work on germ theory. He experimented using a chemical, carbolic acid, to soak bandages before applying them to a wound. He found that it prevented infection and helped wounds to heal.
• Joseph Lister: Carbolic acid spray started to be used widely in surgery. It would be sprayed from a pump at the side of the operating table. This sterilised the air and equipment being used in the surgery.
• Joseph Lister: Carbolic acid was hugely effective. Lister reported that mortality rates in his surgery fell from 40 per cent before its use to 15 per cent afterwards he started using it. This was a huge step forward in making surgery safer.
• Joseph Lister: Opposition to Carbolic acid - Not all surgeons approved of the use of carbolic acid in surgery. Some surgeons complained that the acid irritated their eyes and hands, making it difficult to carry out delicate surgery. Instruments and equipment were soaked in the acid, making them slippery.
• Joseph Lister: Aseptic surgery - Further improvements were made to deal with the problems with carbolic acid. An American surgeon, William Halsted, asked a tyre company to make rubber gloves for him to wear during operations. Halsted came up with the idea after speaking to a nurse who had suffered from dry skin on her hands due to the use of carbolic spray. The use of gloves helped to make surgery cleaner and therefore safer.
• Joseph Lister: Aseptic surgery - Halsted went on to encourage aseptic surgery. The aim was to sterilise equipment and hands, so there were no germs that could cause infection during an operation. This meant there was no need for carbolic acid to be used.
• Blood loss: The final major barrier to more complex surgery was blood loss. This problem was solved in 1901 when Karl Landsteiner discovered blood groups. This meant that blood transfusions could now successfully be carried out. As a result, longer operations were made safer.
• Germ theory: Opposition - As French scientist Louis Pasteur’s germ theory was so revolutionary, many people refused to believe it. High-profile doctors in Britain translated and promoted the work of Pasteur and Koch, while some others refused to accept and mocked the idea that germs cause disease.
• Germ theory: Opposition (Henry Bastain) - Henry Bastian was an English surgeon. He did not believe in Pasteur’s germ theory. Bastian argued that germs came from spontaneous generation, so they appeared as a symptom of disease rather than a cause. Bastian wrote several books and articles where he spoke out against germ theory.
• Germ theory: Support (John Tyndall) - An English scientist. He carried out an experiment where he placed items such as meat and fish in a wooden chamber that had sterile air in it. None of the items went off when he did this. When he put the items in non-sterile air, they went bad. This experiment helped Tyndall to prove that the idea of spontaneous generation was wrong. He had shown that microbes in the air made things go off and caused disease.
• Germ theory: Support (William Roberts) - A Welsh physician. In the 1870s, he carried out a series of experiments to prove that the idea of spontaneous generation was wrong. Roberts also spoke out in favour of Lister’s carbolic spray. He argued that it protected people from becoming seriously ill from infected wounds following surgery, when wounds were exposed to germs in the air.
• Germ theory: Support (William Cheyne) - a Scottish surgeon who worked alongside Lister. Seeing the effectiveness of Lister’s carbolic acid showed Cheyne that preventing infection in surgery would save many lives. He also studied the work of Robert Koch and translated it into English. This was important in enabling Koch’s work to be widely shared and understood by doctors in England. Cheyne went on to write books on the use of antiseptics in surgery. He also further promoted the work and research of Koch.