Accelerating Change 1875-1905

Germ theory

now widely accepted but this has had limited impact on medicine because the link between disease and microorganism isn’t made yet. 

Robert Koch

• German doctor

• proved anthrax microorganisms causes the disease

  • this is done by the introduction of new technology

  • better microscopes 

• He publishes his work in 1876

  • This is very significant because he is studying microorganisms as a way to prevent disease 

  • Koch is given government funding and a team of researchers to research this further

Work of Pasteur

• Published his findings on Germ theory in 1878, in terms of the role of microorganisms in infection 

  • He is making the link between disease and microorganisms

• He researches with chicken cholera, a culture of bacteria

• Pasteur accidentally left the culture out for 2 weeks and injected it into chickens 

  • Chickens survived when the weakened culture was injected

  • When the second injection with live chicken cholera was injected, the chickens still survived. 

  • This is the basis of vaccination

• In 1881, Anthrax - Pasteur combines his discovery with Koch’s 

  • He creates an anthrax vaccination 

• Pasteur is not allowed to test on humans

• Pasteur works on the rabies vaccination 

  • In 1885, while he is working on it, a 9 year old, Joseph Meister comes to him when he is bitten by a rabid dog

  • Joseph is given the rabies vaccination and survives

Koch and bacteriology

• Koch is looking to identify different disease causing microorganisms 

  • He tests many different microorganisms in cultures and tries to grow them 

  • He then injects them into animals and sees if they will develop a disease. 

  • This is hugely successful 

• In 1882, he identifies the microorganism causing tuberculosis

• In 1883, he identifies the microorganism causing cholera 

• He does this by using special methods 

  • Agar jelly: to grow the cultures 

  • Use of Petri dish 

  • Development of chemical dyes: to stain microorganisms so that they are easier to study under the microscope 

• These methods are used to identify other microorganisms from the 1880s to 90s such as: 

  • Tetanus

  • pneumonia

  • meningitis 

  • dysentery 

Role of science and technology on bacteriology

• Agar jelly: to grow the cultures 

• Use of Petri dish 

• Development of chemical dyes: to stain microorganisms so that they are easier to study under the microscope 

• These methods are used to identify other microorganisms from the 1880s to 90s such as: 

  • Tetanus

  • pneumonia

  • meningitis 

  • dysentery 

Impact of Pasteur and Koch

• Slow 

  • It took time before these methods and findings to have an impact and to be accepted 

  • the public knows virtually nothing about the work of Koch and Pasteur  

• In this period, there is no new treatment developed  

• Despite these groundbreaking discoveries, impact on medicine is very small 

Aseptic surgery

• By 1877, Lister’s antiseptic techniques as well as Germ theory were being slowly accepted 

• (In 1878, Koch discovered microorganisms that caused blood poisoning) 

• In 1878, Koch develops a steam sterilizer:

  • For equipment

  • dressings 

• Aim: prevent microorganisms being present at all

• Creating sterile conditions, working in operating theatres rather than at patient’s home

  • Gloves

  • masks 

  • sterile equipment 

  • no spectators

Issue of blood loss

• Lister’s sterile catgut: replaced techniques like cauterisation, which was used to seal blood vessels 

• 1881: catgut (sheep intestine) soaked in carbolic acid introduced 

• dissolves in 2-3 weeks naturally 

  • Does not cause infections, which ligatures usually caused 

  • it isn’t rejected by the body 

Development of pain relief

• Cocaine is seen as an alternative to chloroform

  • But the issue is that cocaine is highly addictive 

• in 1884, cocaine is discovered that it can be used as a local anaesthetic 

  • Local anaesthetic is generally safer to general anaesthetic 

• Cocaine is replaced by Novocaine in 1905

Impact of public health act 1875

local councils have responsibility to improve hygiene and housing, using local rates/taxes 

• Fresh water: 

  • sewage is treated 

  • It is illegal for factories to dump waste in the rivers 

• Clean streets: 

  • rubbish was collected and treated properly 

• Medical officer, house inspectors and food inspectors for each local authorities

• Other Acts as well: 

  • 1875 Artisans dwellings act:

    •  aimed to demolish slum 

  • food and drugs act: 

    • aimed to improve quality of food being sold

  • 1889 Infectious disease notification act: 

    • infectious diseases had to be reported to the health officers

    • Leads to the building of isolation hospitals (example: park hospital in London 1897)

Role of technology on public health

• Steam powered water pumps in the pumping stations 

• portland cement developed 

  • This was used in sewer parts to make it extra strong 

  • 1000 degrees Celsius to be heated 

Government affecting public health

• Government 

  • Moving away from laissez faire 

  • attitudes are changing, reform acts take place 

Role of science and technology on public health

• Understanding of microorganisms and how diseases spread 

  • Emphasizes the Importance of hygiene, so that government can implement hygiene acts and health acts 

  • example: setting up isolation hospitals 

• Technology is used to build better pipes and sewers 

Blood transfusions

• 1901: Karl Landsteiner discover the blood groups (A, B, O) 

• 1902: discovers blood group AB as well 

  • Understanding that for transfusion to be successful, blood groups had to match

  • but in 1907, it is discovered that blood type O is universal 

  • This meant that now, blood transfusions could be carried out safely

Issue with blood transfusion

• However, only direct transfusion could happen

  • Issue of blood clotting since blood clotted the moment it left the body 

  • Sometimes, donor and patient couldn’t be in the same room at the same time

Improvements in scientific knowledge

• Despite work of Pasteur and Koch, there are no new treatments, but their ideas influence others 

Diptheria

• Diphtheria 1890: Von Behring 

  • He discovered antitoxins that are produced by the body, which are made to fight harmful microorganisms 

  • He finds that injections of these antitoxins to patients helped them fight the disease = a cure

Magic bullet

• Magic bullet: Paul Ehrlich

  • Ehrlich had previously worked with Koch 

  • 1896: he starts looking for cures for disease with his own research team. 

  • He uses Koch’s methods and had read about Von Behring’s work  

  • wonders if he could identify a chemical that can kill the microorganism causing a specific disease  

  • 1909: Salvarsan 606 to treat syphilis is developed (first chemical cure) 

X-rays

• 1895 X-rays: Rontgen 

  • Accidentally X-rays his wife’s hand while experimenting with cathode ray tubes

  • he doesn't take out a patent so that it is accessible to everyone - therefore it quickly becomes widely used

  • 1896: London Royal hospital has an x-ray machine 

  • Allos the study of skeleton and internal organs

    • important because it can see the setting of broken bones

    • seeing tumour

    • Tuberculosis can also be identified by x-rays 

Impact of Marie Curie

• 1898: discovery of 2 new elements, radium and polonium

• her and her husband get a Nobel prize in 1903 

• Uses her work on radiation to treat things like cancer and developing x-rays of her own as well

• in 1910, Curie has a new radium institute built, to continue her research, where the work on shrinking and killing tumours with radiation therapy take place

• No patent: epilepsy acne 

• In 1911, Curie gets another Nobel prize

• 1914-1918, les petite curies: mobile x-ray bands were used. They were self financed and also trains Red Cross workers on how to use them, and drove many herself