Medicine c1848-c1948

Barriers to Progress

• poor understanding of disease

• many doctors believed in miasma theory (disease caused by bad air)

• little knowledge of germs and how infections spread → treatments were ineffective and harmful

Florence Nightingale

• Nightingale improved nursing standards during the Crimean War

• emphasised cleanliness, ventilation, and organisation in hospitals

• trained nurses professionally, improving the quality of care

→ her work changed attitudes towards hygiene in medicine, using statistics to demonstrate the importance of sanitary conditions

Scutari Hospital

• Nightingale worked at the military hospital in Scutari during Crimean War, where conditions were initially poor with overcrowding, dirt, and diseases

• she introduced better sanitation: clean water, waste removal, ventilation

→ death rates fell significantly

Problems in surgery

• Surgery in the mid 19th century was extremely dangerous

• patients suffered severe pain as anaesthetics were not yet developed or widely used

• infection was common due to unclean instruments and poor hygiene

• blood loss was a major risk, as techniques to control bleeding was limited

James Simpson’s introduction of chloroform in 1847

• a form of anaesthetic to reduce pain during surgery

→ made operations more tolerable for patients, allowed surgeons to take on longer and more complex procedures

• however, early use had risks such as incorrect dosage and occasional death

Public Health problems

• rapid industrialisation led to overcrowded cities with poor living conditions

• housings were cramped, limited access to clean water and proper sewage systems

• diseases such as cholera were common due to contaminated water and waste

Edwin Chadwick 1842

• investigated living conditions in towns and cities to form a report in 1842

• he argued that disease was linked to poor sanitation and poverty

• suggested to improve drainage, sewage, and clean water

→ his work influenced public health reform and government action

(he still supported miasma theory rather than germ theory)

Public Health Act 1848

• first attempt to improve public health

• set up a Central Board of Health to oversee improvements

• local authorities were encouraged but not forced to improve sanitation

• measures included better drainage, sewage systems, and a clean water supply

→ its impact was limited as it was not compulsory and faced resistance

Cholera threat

• caused widespread death in overcrowded industrial cities

• exposed major weaknesses in public health systems

• governments faced increasing pressure to act

John Snow 1854

• investigated the cholera outbreak, mapped cases and linked to the Broad Street pump

• he removed the pump handle and it reduced the spread of disease → proved that cholera was water-borne, challenging miasma theory

(his ideas were not widely accepted)

Extent of improvements (benefits)

• anaesthetics (chloroform) reduced pain in surgery

• increased public health awareness due to work of individuals like Chadwick and Snow

• some government action began (1848 Public Health Act)

• hospital conditions improved through Nightingale’s reforms

Extent of Improvements (limitations)

• miasma theory remained dominant, limiting understanding

• germ theory had not yet been accepted

• public health reforms were not compulsory

• surgery still faced problems like infection

Louis Pasteur 1860s

• carried out experiments that proved microorganisms caused decay and disease

• showed that germs in the air caused contamination → germ theory developed

• his ideas challenged miasma theory

Impact of Germ theory

• transformed understanding of disease by identifying microorganisms as the cause

• provided scientific explanation for infection & illness

→ acceptance was slow, but still laid the foundation for later medical advances

Jospeh Lister

• applied Pasteur’s germ theory to surgery and used carbolic acid to clean wounds, instruments, and operating theatres

• this reduced the number of germs entering surgical sites, preventing infections

Impact of Antiseptic Surgery

• significantly reduced infection rates after surgery

• death rates fell

• surgeons are more confident to perform longer, more complex procedures

→ however, antiseptic methods were difficult and unpleasant to use

Public Health Act 1875

• made public health improvements compulsory for local authorities

• councils were required to provide clean water, sewage systems, street cleaning

• improved living conditions, showed stronger commitment from government

Increased government involvement by the 1870s

• laws become more enforced than optional

• local authorities were given the responsibility to improve sanitation

→ reflected growing acceptance of the need for intervention

Later work of Florence Nightingale

• improved hospital design, focusing on ventilation and cleanliness

• established professional nurse training programme → raised standards in British hospitals

Elizabeth Garrett Anderson

• first woman to qualify as a doctor in Britain

• established opportunities for women in medicine → opened a hospital for women and children staffed by women

Importance of Technology

• supported developments such as improved surgical tools and antiseptic methods

• better equipment made it easier to apply new medical knowledge into practice

→ Technology was not the main driver of change, it was supportive

Robert Koch

• Koch built on Pasteur’s work to identify specific bacteria that caused particular diseases

• He discovered the microbes responsible for tuberculosis, cholera, and anthrax

• developed methods for staining and growing bacteria → allowed scientists to link specific pathogens to specific illnesses

Bacteriology

• study of bacteria and how they cause disease

• led to more targeted prevention methods (early vaccines)

• supported more accurate diagnosis of diseases

Aseptic surgery

• preventing germs from entering wounds in the first place

• sterilised instruments, wore gloves, and cleaned operating theatres

→ reduced infection rates during and after operations

Growth of laboratory-based science

• medicine increasingly relied on laboratory research and experimentation

• scientists used microscopes and controlled experiments to study bacteria

→ more accurate identification of disease causes (more evidence-based approach in science)

Paul Ehrlich

• “magic bullets” - chemicals that target specific diseases

• built on bacteriology and chemical research

• He created Salvarsan (606), an early treatment for syphilis

Blood transfusions

• doctors began to understand the importance of blood loss

• some improvements were made in transferring blood between patients

→ knowledge of blood groups was still limited until 1901

Marie Curie

• researched radioactivity

• X-rays allowed doctors to see inside the body, which improved diagnosis of fractures and internal problems

• used in early cancer treatments

Liberal Reforms 1906-11

• 1906, Education (Provision of Meals) Act - provided free school meals for poorer children

• 1907, Education (Administrative Provisions) Act - medical inspections in schools

• 1908, Children’s Act - protect children’s welfare and health

• 1908, Old Age Pensions - financial support for the elderly, improving living conditions

National Insurance Act 1911

• Provided health insurance for workers

• gave access to doctors and sickness benefits

→ it didn’t cover all groups, such as dependants

First World War

• created urgent demand for improved medical care and treatments

• developed new techniques: better surgery, blood transfusions, infection control

Advances in surgery for Wounds and Trauma

• WW1 led to new types of injuries and severe trauma

• surgeons developed new techniques to treat damaged tissues

• PLASTIC SURGERY advanced through the work of Harold Gillies

Uses of X-rays

• locate bullets, fractures inside the body → surgeons able to operate more accurately and safely

• mobile x-ray units were developed and used near the frontline

→ improved diagnosis and reduced risk of unnecessary surgery

Blood Transfusions discovery

• discovery of blood groups made transfusions safer and more reliable

• methods for storing blood were developed, allowing transfusions away from donors

→ improved survival rates for wounded soldiers

Women in Medicine

• women took on new roles in healthcare during war: nurses, doctors, ambulance drivers

• VADs trained women in medical care → helped meet demand for medical staff

(equality remained limited after the war)

Improved understanding of infection control

• antiseptics were used more effectively on the battlefield

• THOMAS SPLINT reduced deaths from infected fractures (1917)

• better organisation of casualty clearing stations

Plastic and Facial reconstructive surgery

• Harold Gillies developed skin grafts and new surgical methods to rebuild damaged faces → improved survival and quality of life

Advancements

• Thomas Splint reduced deaths from femur fractures from 80% to 20% (1917)

• Discovery of blood groups and use of stored blood (1917)

• Xrays, including mobile units

• Antispetics such as Carrel Dakin solution

• Plastic surgery using skin grafts

Limitations

• infection remained a major cause of death

• early antiseptic treatments were ineffective in heavily contaminated wounds

• blood transfusions were still risky before full standardisation of blood types and storage

• many advanced treatments were only available in better-equipped hospitals, not near front line

• plastic surgery was complex and limited to specialists

Alexander Fleming 1928

• discovered penicillin (antibiotic)

• identified its antibacterial properties but was unable to mass-produce it

• his findings were overlooked due to practical limitations

Howard Florey and Ernst Chain 1930s

• they successfully purified penicillin

• worked with US pharmaceutical companies to mass produce it

• By 1944, enough penicillin was produced to treat all Allied soldiers wounded on D-Day

Impact of Antibiotics

• penicillin reduced deaths from bacterial infections dramatically

• survival rates for wounded soldiers increased in WWII

• made surgery safer by preventing post infections

Impact of WWII

• accelerated medical advances due to urgent need and government investment

• Penicillin mass production (1943-44)

• Blood transfusion systems improved: blood banks, plasma storage

• Mobile medical units, field hospitals

Women in Medicine during WWII

• worked as doctors, nurses, specialists in organisations such as EMS

• contributed to research and hospital care

→ proved their capability in medicine yet still faced barriers

Beveridge Report

• proposed a system to tackle poverty, disease, and unemployment

• recommended a state-funded healthcare system → laid foundation for NHS in 1948

Creation of NHS 1948 by Aneurin Bevan

• provided free healthcare for all citizens

• hospitals, doctors, medical services brought under government control

• funded through taxation, ensuring access regardless of income

Importance of NHS for public health

• improved access to doctors, treatments for the whole population

• reduced inequality in healthcare between rich and poor

• vaccinations and regular check-ups became more widespread

→ long-term system for maintaining national health