Medicine in 18th and 19th century britain c1700-c1900 topic 3

What were the main explanations of disease in Britain c1700 and why did they continue?

• Four Humours from Galen – illness caused by imbalance of blood, phlegm, yellow bile, black bile

• Miasma Theory – disease was caused by bad air
  Why they continued:

• Backed by tradition and medical training

• No microscopes to see microbes

• Seemed logical (bad smells linked to illness)

Who was Edward Jenner and what problem was he trying to solve?

• English doctor working in rural Gloucestershire

• Wanted to prevent smallpox - a deadly disease killing thousands in the 1700s

• At the time, people used inoculation, which was risky and could cause death - introduced by Lady Mary Wortely Montagu in 1718

How did Jenner develop vaccination?

• In 1751 over 3500 people died of smallpox in London

• Noticed milkmaids who caught cowpox did not get smallpox

• In 1796 Jenner tested this theory - injected cowpox into a child and then after injected him with smallpox. The child didn’t develop smallpox

• Published his findings in 1798, calling it ‘vaccination’

What problems did Jenner face?

• Some people resisted vaccination - worried about giving themselves a disease from cows

• Royal Society rejected his first report

• Religious opposition (interfering with God’s will)

How did Jenner overcome these problems?

• Jenner’s soon discovery got Parliament approval, which gave Jenner £10,000 in 1802 to open up a vaccination clinic

• Then later got £20,000

• In 1840, vaccination was made free for infants and in 1853, it was made compulsory

• The vaccine was successful

• Napolean made his whole army get vaccinated with the vaccine that Jenner created in 1805

What theory did people and scientists start to believe?

The spontaneous generation theory - decaying matter created microbes

Who was Louis Pasteur and what was his discovery?

• A french chemist who was employed in 1857 to find out the explanation for the sourcing of sugar beet used in fermenting alcohol

Discovery:

• Pasteur proved there were germs in the air - showed that sterile water in a closed flask stayed sterile, while sterilisied water in open flask bred germs

• In 1861, he published Germ Theory

• He argued that microbes in the air caused disease and decay

Why was Pasteur’s Germ Theory not immediately accepted in Britain?

• British doctors strongly believed in miasma

• Pasteur was a chemist, not a doctor

• No clear proof that specific germs caused specific diseases

• Public Health reforms (e.g 1848 Act) were based on removing bad smells

How did Robert Koch strengthen Germ Theory?

Proved specific microbes cause specific diseases:

• Injected bacteria into mice

• Injected cholera into chickens and found out they did not die, they just got immunity

• Grew bacteria in a petri dish and stained the bacteria with dye so that he could identify individual bacteria

Identified:

• Anthrax (1876)

• Tuberculosis (1882)

• Cholera (1883)

How did Germ Theory influence medical treatment in Britain?

• Influenced antiseptic surgery (e.g. Lister)

• Encouraged development of vaccines

• Changed hospital cleanliness practices

• Shifted focus from “bad air” to killing bacteria

What were hospitals like in the early 1700s?

• Dirty, overcrowded, high death rates

• Overcrowding led to an icrease in spread of infections

• Poor ventilation and sanitation

How did hospitals change?

Florence Nightingale treated soldiers in the Crimean War in 1853

• She improved handwashing, sewage and ventilation

• The death rate went form 40% to 2%

• In 1859 she published her book, ‘Notes on Nursing’

• The public raised £44,000 to help her train nurses

• Nurses were given 3 years of training

• In 1919 the Nurses Registration Act was passed - made training compulsory for nurses

Why were anaesthetics a huge solution?

• Pain was a problem for surgeons, patients could die from trauma of extreme pain

• Natural drugs like alcohol, opium and mandrake had been used

What anaesthetics were discovered before chloroform?

• Nitrous oxide - identified by Davy in 1799 but was ignored

• Ether - discovered by Crawford Long in 1842 but it was explosive and too risky

What was the impact of the anaesthetic chloroform on surgery?

• Discovered in 1847 by James Simpson

• Became widely accepted when it was used by Queen Victoria in 1854 when giving birth

Impact:

• Used in operating theatres to reduce pain during childbirth

• Pain-free surgery possible

• Patients less traumatised

What were the problems with anaesthetics on surgery?

Led to death rates:

• Led to longer and more complex operations - surgeons found out that unconscious patients were easier to operate on, meaning they could take longer

• Longer operating times led to higher death rates from infection because doctors didn’t know that poor hygiene spread disease

Why were operations unhygenic before the use of antiseptics?

Surgeons used very unhygenic methods:

• Often wore the same coats for years, which were covered in blood and pus from previous operations

• Operations were carried out in unhygenic conditions including a patient’s house

• Operating instruments also caused infections because they were usually unwashed and dirty

How did antiseptics change surgery?

• Dramatically reduced infection

• Safer operations

• Lower death rates

Who improved hygeine before Joseph Lister?

Ignaz Semmelweis showed doctors could wash their hands with chloride of lime between patients - very unpleasant

How did Lister improve surgery with the use of antiseptics?

• Lister made links between bacteria and infection - learnt from Pasteur’s Germ Theory

• Found carbolic acid killed bacteria in open wounds in 1865 - used it on instruments and bandages

• Death rate reduced from 46% to 15%

How did operations change to become more hygenic after the discovery of antiseptics?

• Late 1800s, surgeons changed their approach from killing germs already present (antiseptic) to making a germ-free (aseptic) environment

• Instruments were carefully sterilised before use with 120°C steam

• Theatre staff sterilised hands before entering, wore sterile gowns, masks, gloves and hats

• Surgical gloves were invented by William Halsted in 1889

• Theatres kept clean and fed with sterile air

• Special tents were placed around an operating table to maintain an area of even stricter hygiene

Why was cholera such a problem in 19th-century London and how did it spread?

• Reached Britain in 1831 and by 1832 it was an epidemic - over 21,000 people in Britain died that year

• Spread through open sewers, poor drainage and contaminated drinking water

• Most people believed it was caused by miasma

What attempts were made to prevent cholera before 1854?

1848 Public Health Act created a General Board of Health:

• Street cleaning, improve sewers and drainage

• Not compulsory unless death rates were high

• Many towns refused due to cost

• Based on miasma theory (cleaning smells rather than water)

Also regulated the burial of the dead

What happened in the 1854 Broad Street outbreak?

• John Snow mapped out deaths - found that in five cases people who died of cholera always went to the water pump in Broad Street because they preferred the water

• No brewer’s men died from cholera because they were drinking beer, not water from the pump

• In 1854 he ordered the handle of the pump to be removed and it resulted it no new cholera cases

• Later discovered that a nearby cesspit had a split lining - it’s waste had leaked into the pump’s water supply

• Published his findings in his 1855 report ‘On the Mode of Communication of Cholera’

Why did public health not improve before 1848?

The government had a Laissez-faire attitude so did not put forward any regulations or laws to improve public health

How did Edwin Chadwick try to improve public health?

• In 1842, Chadwick published a report suggesting that poor living conditions caused poor health

• His report led to the 1848 Public Health Act

• Councils set up their own boards of health

• However, laws were not compulsory so not many authorities took action

What happened in 1858 and what did it lead to?

• In 1558, sewage in the River Thames made a ‘Great Stink’

• Forced the government to plan a new sewage system, which opened in 1865

• In 1871 - 72 the government followed the Royal Sanitary Commissions’s proposal to form a local Governement Board and divide Britain into ‘sanitary areas’

• The government of Disraeli passed the 1875 Public Health Act

What was the 1875 Public Health Act?

Appointed health inspectors and sanitary inspectors:

• Made sure that laws on water supplies and hygiene were being followed

• Maintained sewerage systems to prevent further cholera outbreaks

• Kept town’s streets clean

Why was the 1875 Public Health Act more effective?

It was compulsory