History of medicine - Industrial 1700-1900

Industrial change

Significant changes during the industrial era were mainly due to the scientific and industrial revolutions

What was the Enlightenment?

It was an intellectual movement of the 18th and 19th centuries which spread and impacted widely across Europe. It was underpinned by a major challenge to religious authority and a commitment to the spirit of rationality and scientific enquiry.

Ideas about causes of disease that stopped

• Four Humours theory was no longer believed as a cause of disease

• Supernatural and superstitious such as astrology were no longer used in diagnosis

• With the decline in the Church, people no longer believed that God was the cause of disease

Continuity in cause of disease

Miasma theory remained popular amongst the population

There was an influx of people moving to cities and there was a big population boom. Big slum areas with overcrowding and lack of sanitation with dirty water. People thought that the waste in the streets produced miasma.

Spontaneous generation (new idea on believed cause of disease)

New theory in the 1700s as new microscopes allowed scientists to see bacteria on decaying items (technology aided this)

Scientists thought that these germs were spontaneously generated by the decay and then spread the disease further

Louis Pasteur and the Germ theory

In 1861 French scientist Louis Pasteur came up with the Germ theory which challenged the idea of spontaneous generation

His theory claimed:

1. microbes cause disease and decay

2. The air is full of miscobed

3. Microbes can be killed by heating them (pasteurisation)

He was so significant because he proved that germs were all around us and some were harmful and could cause disease

Short term impact of Louis pasteur

In the short term, pasteur and the germ theory had very little impact as other doctors refused to accept that microbes like bacteria made people make people ill - spontaneous generation was still accepted until the 1870’s

What was the long term impact of Pasteur?

• He proved that germs were always present in everyday life and linked them to disease

• His work inspired other such as Koch (who continued working on germ theory) and Joseph Lister who made links to infection

• Pasteurisation was invented which was used for sterilisation - cleaning things reduced disease

Robert Koch and the germ theory

Able to develop Pasteur’s germ theory and discovered the bacteria which caused anthrax in 1876 - a major breakthrough

Koch published his methods of identifying bacteria which caused disease:

• it involved growing bacteria using agar jelly and a Petri dish

• This would grow cultures of pure bacteria, allowing Koch to identify specific bacteria caused disease

• He also developed the method of staining them so that you could see them - proving existence

Koch’s impact

• He invented a method to grow and stain bacteria to make them easier to identify

• Doctors now began to seek ways to attack the microbe that caused disease, rather than just the symptoms - a huge turning point

• He inspired other scientists to discover the causes of pneumonia and tetanus

• His methods are still used today

• He encouraged doctors and scientists to study disease (and general study)

• People can now develop vaccines and treatments

Impact of germ theory (overall)

1. The germ theory solved the ideas on what caused disease which was a huge breakthrough despite not everyone, including the British government. By the 20th century, the germ theory was widely accepted and developed

2. Scientists now look at preventing disease causing microbes through Jenner’s vaccinations and antiseptics, whilst new treatments could be developed with this new understanding

Impact of germ theory on cause of disease

• Germ theory dimply identified that germs/bacteria caused disease

• The work of Pasteur and Koch ended ideas of miasma and spontaneous generation, but we must remember they it took 50 years went by until it was accepted

• Loch was able to prove that John Snow’s theory on cholera, identifying the bacteria that caused it

• The study of bacteriology, which Koch founded, in the 20th century had enormous impact on our understanding of the cause of disease

Impact of germ theory on treatment

• whilst there was e short term impact of treating diseases as there was no way to directly treat diseases, the understanding of the Germ theory impacted surgery

• As Joseph Lister believed the germ theory, he directly developed carbolic acid (1865) as an antiseptic

• This directly led to a reduction in death rates from infection due to surgery, whilst it increased the development of aseptic surgery to keep operating theatres free of germs

• The long term impact is that scientists could now look at treating specific disease

Impact of germ theory on care and hospitals

• although Florence nightingale was mistrustful of the germ theory, the improving understanding of germs led to improvements in hospital design. This included large windows, well ventilated rooms, and easy clean surfaces

• Nurses and doctors now began to wash their hands, wash their clothing and use sterilised equipment and clothing in treatment and care, thus reducing the chance of infection

Impact of germ theory on prevention

• Germ theory allowed the development of vaccinations from the work of Jenner, who previously could not prove his work

• Once Koch began to identify specific diseases such as Cholera, TB, smallpox and anthrax, the development of vaccinations began

• In the long term, the development of vaccines continued into the 20th century which the government supported, and they remain common practice to this day

• Germ theory encouraged the government to spend more on public health

Hospitals in 18th century

Early industrial hospitals had a variety of problems and dangers:

• high death rates from infection

• Few toilets and sewage systems

• Untrained nurses

• Uncleaned equipment wards and operating theatres

• Doctors and nurses did not wash their hands

Often founded by wealthy donors and only treated a few ‘respectable’ poor - many people still chose not to go to hospitals

Significance of Florence Nightingale

Was sent to Scutari in 1854 by government during Crimean war to revolutionise hospitals

When she arrived, she was appalled and the dirty hospitals and high death rates among wounded soldiers

She focused on cleaning the hospitals, improving hygiene and eating good food

As a result, the death rate dropped from 40% to 2% over 6 months

Impact of nightingale on hospitals

1.The design of hospitals:

• Sanitation - clean water, sewage systems and toilets

• Ventilation - fresh clean air as she believed in miasma

• Supplies - more food and clothing for soldiers

She promoted pavilion style hospitals with large rooms, more windows, tiled floors and isolation wards for infectious patients

2.The training of nurses:

• In 1859 she wrote notes on nursing and in 1863 notes on hospitals. Both books provided the basis and importance for training nurses

• She also established the nightingale school for nurses in 1860 it train nurses, turning nursing into a respectable profession, increasing the amount of nurses in hospitals

What were some changes made to hospitals as a result of Florence Nightingale?

By 1900, hospitals had changed significantly to the start of the Industrial Period (1700) with a key focus on treatment of the sick in clean and sanitised hospitals, which now used aseptic surgery after the discovery of bacteria in the Germ Theory. Patients could also receive greatly improved surgery by trained doctors which ended pain and infection due to anaesthetic and antiseptics.

What new hospitals emerged in the Industrial Period?

• Small, local Cottage hospitals spread from 1859 and there were 300 by 1900. They provided nursing care and treatments.

• There were also 18 voluntary hospitals in London with 4000 beds where local doctors worked for free. Working people used these only if they paid into a fund each week - it was an early form of medical insurance

• From 1857, infirmaries were built in workhouses where the poor, old, sick, blind, deaf or disabled lived. Local taxes paid for these to have treatment, the first time ever.

• Specialist hospitals like asylums for the mentally ill and fever houses for those with infectious diseases were buily

What was some continuity in hospital care?

• The rich could afford to be treated and even surgery in their own homes, which they continued to do

• Hospitals remained expensive and small for the working classes to afford, so many were still treated at home

Pharmacies and new medicines

• Apothecaries were now known and pharmacies and the famous Boots pharmacy opened in 1849, selling cures

• New ‘alternative’’ cured began to include electrical shocks, injections with animal hormones and a range of harmful substances including cocaine and mercury - not exactly progress

What was surgery in the 18th century like?

At the start of the 18th century, surgery was dangerous due to 3 main problems: pain, bleeding and infection.

• Pain: there was no anaesthetic to stop pain, although some did use opium. Pain caused death by shock, or by bleeding out after a quick surgery

• Bleeding: there were no effective ways to stop bleeding out on the surgery table. This problem continued into the period

• Infection: Despite some talented surgeons, most surgery was completed in dirty conditions, with the tools and clothing never being cleaned

As a result of this, surgery was basic and the most common type was amputation as other types were too risky

Surgery in the 19th century: anaesthetics

• During the 1800s, attempts had been made to find a suitable anaesthetic

• Ether was used in 1846 but it was risky and highly flammable (ineffective as surgeries were performed in candle light)

• In 1847, James Simpson discovered Chloroform. It could make patients unconscious during surgery

• Simpson promoted it, and Queen Victoria popularised it after using it for the birth of her son in 1853. Chloroform now allowed doctors to perform deeper, more intricate and complex surgery and solved the issues of pain

• However chloroform had some serious risks (imperfect). Overdoses could kill, the problem of blood loss continued (especially during complex surgery, many refused to use chloroform

Surgery in the 19th century: antiseptics

• Until the mid 1800s, no one understood that germs and bacteria caused diseases. Therefore surgeons, equipment and theatres were filthy and not cleaned. As a result of this, germs spread to patients, causing infection and disease

• In 1865, Joseph Lister, and English surgeon who studied the Germ Theory, developed Carbolic acid as an antiseptic. Lister published his results where he showed 11 cases where his carbolic acid stopped infection, the idea spread quickly around doctors

• Antiseptics helped reduce deaths in amputations by 15% by 1870

• However, Carbolic acid did it fully take off around Britain:

  • Many surgeons didn’t believe in germ theory so they didn’t use carbolic acid

  • Carbolic acid damaged surgeons’ hands as it was poisonous

What was the impact of carbolic acid/antiseptics?

• In the short term, surgery did not change due to resistance at first

• Importantly, attitudes began to change towards germs and bacteria. They finally began to see it was their responsibility to prevent infections

• This began the move towards aseptic surgery

What is/was aseptic surgery?

Aseptic surgery is where bacteria was prevented from getting into the wound in the first place through having clean equipment and operating theatres.

The focus on aseptic surgery led to changes:

• From 1887, all instruments were steam cleaned and sterilised

• Surgeons wore rubber gloves, surgical gowns and masks, so as to reduce the amount of bacteria in the operating theatre

How much progress was there in surgery in the Industrial Period?

The major problems of pain and infection had been partially solved due to the developments of anaesthetic and antiseptics, and as a result, surgeries could become longer and more complex.

However, the problem of blood loss had not been fixed and patients continued to die during and after surgery

Why was smallpox a problem?

In the 18th century, smallpox killed more children than any other disease. Thousands of adults dies too and survivors were often left with terrible scars. Epidemics were common during the 18th century

Edward Jenner and vaccinations: timeline (PREVENTION)

• Since the 1720s doctors had been inoculating thousands of people agains smallpox. However, only the rich could afford it, and it did not always work (many people died trying)

• Jenner (a GP) was interested in this, and noted that when he treated people for the disease cowpox, the patients never caught smallpox. He thought there was a link

• In the 1790’s Jenner used scientific methods to test his theory - he infected locals with cowpox then smallpox, which none of them caught

• He wrote up his findings in 1978 but the Royal Society refused to publish it

• Published himself and set up royal Jennerian Society. However, vaccine took time to become popular in Britain due to public opposition

Why were people opposed to Jenner and vaccinations?

• People thought it was wrong to give people an animal’s disease and worried that it interfered with God’s plan for humans

• Doctors who inoculated lost money when the government offered vaccinations for free

• The government and scientists could see no scientific proof and were therefore reluctant

What was the short term impact of Jenner and vaccines?

• Smallpox vaccinations saved many lives - over 100,000 people were vaccinated by 1800

• There was a slow uptake of vaccinations at first due to opposition, incorrect use of vaccines and lack of government support (until 1840 after smallpox outbreak)

What was the long term impact of Jenner and vaccines?

• Jenner had showed that vaccines worked, he inspired Pasteur and Koch to search for more vaccines but the method could not be used for other diseases, so there were no new vaccines until 1900

• Led to eventual government enforcement of vaccinations and smallpox was wiped out by 1970s

What were living conditions in the Industrial revolution like?

• During the Industrial Revolution, Britain’s population boomed to 20 million by 1850

• The greatest change was to towns which was where 85% of people lived

• This caused overcrowding and poor sanitation with no running water, shared toilets and little sewage systems

• One result of these living conditions was frequent outbreaks of epidemics like cholera (1854)

What did Edwin Chadwick’s 1842 report on living conditions on British cities reveal?

• Life expectancy in cities was lower than in the countryside at 38 years (in liverpool it was 15 years)

• Unhealthy living conditions in cities through overcrowding, no sewage disposal and poor diet are causing ill health in the poor

• Rotting sewage in streets (they believed caused miasma)

• He recommended that the government force local councils to do something about public health by building new sewer systems, removing waste and supply water

(Why) Was Edwin Chadwick important?

• In the early 1800s the government adopted a Laissez Faire approach to public health, which meant that it did not feel it was its role to improve living conditions or public health

• However, when Chadwick’s report was published, it helped create awareness of the need for the government to do something

• As a result they passed the first public health act in 1848. The aim was to improve sanitary conditions within town in England and wales

• HOWEVER, it was not compulsory and many local councils did nothing so public health didn’t improve

What was the 1848 Public Health Act?

• National Board of Health set up

• The government could force some town councils to improve water/sewage

• Local councils were told to collect taxes to pay for public health improvements

• Councils were allowed to appoint medical officers

What were some turning points in public health?

• From the 1850s the government’s policy towards public health took a drastic turn due to a number of events and factors

• The 1854 and 1866/7 cholera outbreaks killed thousands with the government hopeless to prevent it until John Snow identified the link between water and cholera

• Pasteurised Germ theory in 1861 proved that bacteria/germs cause disease. This ended the idea that miasma caused disease. Scientific proof made people want public health reform

What changes were made to public health from 1860s onwards?

• 1300 miles of sewers were built in London after the Great Stink of 1858

• Slums were demolished in Birmingham

• In Leeds, dumping sewage into the river was banned

• Theses changes came about as the government increasingly had to appeal to voters who wanted better living conditions, as well as the deadly cholera outbreaks

What was the 1875 Public Health Act?

City authorities had to provide: clean water, sewers to dispose of waste properly, public toilets, street lighting and public parks for exercise.

As a result, cholera did not break out again

What was cholera?

• Cholera was a feared disease in Britain as it was usually fatal, due to there being no known cure to treat the disease

• The first outbreak occurred in 1831, with further outbreaks in 1849 and 1854

• During the 1854 outbreak, 20000 Londoners died

• Cholera mainly affected the poorest people, as the disease was most present in overcrowded slum areas, workhouses and prisons of towns and cities

What were ideas on the cause of cholera?

With no known cure or accurate knowledge on the causes of cholera, people believed it was causes by miasma or spontaneous generation, which we’re widely accepted theories at that time (this was before germ theory in 1861)

What were methods of preventing cholera?

• To combat the impact of miasma, people tried to keep their homes clean and tar was burnt on the streets

• Some towns and cities attempted to clean the streets of rubbish and employed people to maintain this. However, this wasn’t the case in all areas

• The Public Health Act of 1848 expected councils to be responsible for providing clean water. This was not a legal requirement however so many councils chose to ignore this so it failed to help

Who was John Snow?

• He was a surgeon working in London, so he was able to observe the impact of cholera in soho

• During the 1849 outbreak he theorised that cholera was caused by contaminated drinking water rather than miasma

• During the 1854 outbreak he used a map to plot all of the cholera victims and noticed a link to one water pump, on Broad Street

• He removed the handle to the Broad street pump to prevent it being used

• As a result, the cholera outbreak stopped almost immediately. Snow also found that the local cesspit was leaking into the water supply

Why did John Snow’s work have a small short term impact?

• Although he could prove a link between cholera and unclean water, he couldn’t explain it

• In 1855, Snow presented his findings to the government. He recommended that the government make improvements to the sewer systems to avoid another outbreak

• However, many rejected Snow’s work as he couldn’t provide any scientific proof and the Board of Health clung to the Miasma theory

What was Snow’s short term impact?

At first, Snow’s ideas weren’t widely accepted and his recommendations were ignored by the government who clung to the Miasma theory.

The population of Soho benefitted as they were able to avoid cholera

What was Snow’s big/long-term impact?

In the long term, Snow’s ideas became important when combined with Germ theory from 1861 onwards, leading to a new sewer system in 1875 and the 1875 Public Health Act which made cities and towns provide clean water for the public

How much progress was there with ideas on the cause of disease?

• The Germ Theory was a huge turning point in medicine, it finally proved what causes illness and ended ideas on Miasma and Spontaneous generation, still being used today

• The development of microscopes allowed Louis Pasteur to publish Germ Theory, proving that Spontaneous Generation was wrong and that Germans cause decay and illness

• Robert Koch furthered this work, linking specific microbes to diseases, including TB and cholera

How much continuity was there with ideas on cause of disease?

• The first half of the nineteenth century saw little progress in the knowledge of causes of disease - miasma theory remained popular along with spontaneous generation (both incorrect theories) with scientists, even after German Theory

• German Theory wasn’t published until 1861 and it took many decades to become accepted by scientists or the British government, only until Koch’s work in the 1880s

How much progress/change was there with prevention?

• Vaccination was developed by Edward Jenner through the 1790’s. He published his work in 1798, showing how he was able to use cowpox to vaccinate against Smallpox

• This led to the government paying for vaccinations and its being made compulsory

• Huge long term impact into the modern period

What lack of progress/continuity was there with prevention?

• The vaccination against smallpox couldn’t be developed further to stop other diseases

• Many people believed that the vaccination was wrong as it went against God’s wil

• Jenner wasn’t able to prove why his vaccine worked, only when the Germ Theory was proved by Koch

How much progress was there with public health?

• The Public Health Act of 1875, combined with the work of John Snow in preventing cholera improved the prevention of disease

• Changes included clean water, creating new sewers, building regulations and the monitoring of diseases

• Public health was now the government’s responsibility

What lack of progress/continuity was there with public health?

• Public health didn’t become a priority until later in this period (1860’s onwards) and acts like the 1848 Public Health Act did little to improve public health as it was not enforced

• Many people such as Snow faced opposition for their ideas until Germ Theory linked disease to poor living conditions

What progress/change was there with treatment?

• Surgical improvements in the industrial period were rapid, ending the problems of pain and infection for the first time

• Antiseptics such as carbolic acid (1866) invented by Joseph Lister dramatically reduced infections, reduced surgical deaths and led to aseptic surgery

• Anaesthetics like chloroform, ester, laughing gas and cocaine meant that more complex surgery was possible

What lack of progress/continuity was there with treatment?

• Surgery was still dangerous - anaesthetic like chloroform caused deaths as doses weren’t fully understood, causing the surgery black period and stopping using chloroform

• Many opposed the use of carbolic acid as it caused a burning sensation to doctors, some thought it opposed God whilst other mistrusted the Germ Theory so refused to use it

• The third problem of surgery was still not solved, blood loss. With increasingly complex surgery, a patient could still die from the loss of blood

What progress/change was there with hospitals and care?

• Hospital care was drastically improved by Florence Nightingale with a greater emphasis on cleanliness, training for nurses and the use of wards to treat specific diseases. As a result, hospitals were designed to improve cleanliness and care

• Specialist hospitals were set up for specific diseases and asylums for the mentally ill

• The first hospitals for the poor (infirmaries) were set up

What lack of progress/continuity was there with hospitals and care?

• Many of the poorest couldn’t afford hospital care, whilst the poorest and disabled were forced into workhouses to ‘pay’ for their treatment

• A good majority of people, especially the rich, continued to be treated at home

Factors affecting change: science and technology

• New inventions such as improved microscopes and the use of agar jelly to grow microbes directly led to the creation of Germ Theory as Pasteur/Koch could see the bacteria

• The development of syringes allowed improved vaccination

• Meanwhile surgical improvements including antiseptics, aseptic surgery and anaesthetics led to reduced death rates and more complex procedures

• Improvements in engineering and construction allowed the building of sewer systems e.g 1100 miles built in London

• However, the experimental nature of the new tecnologies like chloroform caused deaths, leading to the surgery ‘black period’ and risky surgery

Factors affecting progress: work of individuals

• Many individuals affected great change in medical care, treatment and prevention. They pushed the breakthroughs of this period

• Florence Nightingale’s work revolutionised hospital care and the profession of nursing, whilst Koch, Snow and Pasteur radically changed ideas on causes of disease for good even in the face of opposition

• The persisting attitudes of Jenner, Pasteur and Simpson led them to make discoveries sometimes by chance

• However these individuals often faced huge resistance from others in society, such as religious conservatives who believed that they were working against God’s will

Factors affecting progress: government attitudes

• Changing attitudes of the government was crucial to the medical progress in the Industrial period, particularly in public health and prevention of disease

• The government were now directly responsible for the health of the public

• Government even gave 30,000 to Jenner to develop his work on vaccinations, later paying for all vaccinations in 1840 and making them compulsory from 1852

• The introduction of the Public Health Acts of 1848 and later 1875 improved the prevention of disease drastically. Councils were expected to proved clean water, build sewers and provide public toilets. Were also expected to maintain building regulations and monitor diseases. As a result cholera was eradicated