Industrial Medicine

The Industrial Revolution and Medicine

Section I: Edward Jenner & the Smallpox Vaccine

Edward Jenner, born in 1749, was a doctor who spent most of his career in Berkeley, Gloucestershire. In 1796, he conducted an experiment to test the theory that people who had contracted cowpox were immune to smallpox. The experiment involved inserting pus from a cowpox pustule into an incision on a young boy's arm. When the boy was later exposed to smallpox, he did not contract the disease, proving Jenner's theory. Jenner submitted his findings to the Royal Society in 1797 but was asked to provide more proof. He continued his experiments and published his results in 1798, coining the term "vaccine" from the Latin word for cow, "vacca". Jenner's work was initially met with resistance, particularly from the clergy, who considered using material from a diseased animal to be ungodly. However, the effectiveness of the vaccine eventually won over the public, and vaccination became widespread.

Section II: Pasteur and the Development of Germ Theory

Prior to the nineteenth century, the prevailing belief was that diseases were caused by miasma or bad air. Louis Pasteur, a French biologist, challenged this notion through his research on fermentation. While investigating why beer spoiled, Pasteur discovered that microorganisms, which he called "germs", were responsible. He found that heating the beer killed these microorganisms and prevented spoilage, a process now known as pasteurisation. In 1861, Pasteur conducted experiments using swan-necked flasks to demonstrate that decay was caused by germs in the air, not spontaneous generation. Germ theory posits that the air contains living microorganisms, microbes are not evenly distributed in the air, microbes in the air cause decay, and microbes can be killed by heating. Pasteur's work had a profound impact on medicine, leading to the development of germ theory, which proposed that germs could also cause diseases in humans, inspiring further research to identify specific germs responsible for illnesses. Notably, Joseph Lister, influenced by Pasteur's findings, began investigating ways to prevent germs from entering wounds during surgery. Despite its significance, germ theory was initially met with scepticism as people struggled to comprehend the concept of invisible microorganisms causing disease. Furthermore, germ theory did not offer immediate solutions for treating diseases. Pasteur continued his research, successfully identifying germs responsible for diseases in silkworms and chickens. He published his Germ Theory of Infection in 1878 and developed the first vaccine created from a weakened form of a disease, building on Jenner's work. Pasteur and his team created vaccines for anthrax in 1881 and rabies in 1885. Germ theory laid the foundation for understanding disease causes, paving the way for research into prevention and treatment methods, with significant contributions from other scientists, including Robert Koch, in identifying specific disease-causing germs.

Section III: Robert Koch and His Research Team

Robert Koch, a German scientist, made significant contributions to germ theory by focusing on identifying specific bacteria responsible for various diseases. Koch and his research team developed innovative techniques to study microbes more effectively, such as creating a dye that could stain a single microbe for easier observation under a microscope, introducing the Petri dish as a fundamental laboratory tool, and employing agar jelly as a solid medium for cultivating bacteria. These advancements revolutionised the study of microbes and facilitated the identification of disease-causing bacteria. In 1882, Koch discovered the bacteria that caused tuberculosis (TB) and published his methods for identifying these microbes. He subsequently identified the microbes responsible for cholera and diphtheria in 1883 and definitively proved cholera was spread through contaminated water in 1884, confirming John Snow's earlier theories. Koch's research inspired further scientific exploration to discover the bacteria responsible for various diseases, including pneumonia, meningitis, plague, and tetanus. His identification of bacteria paved the way for vaccine development, as Louis Pasteur also focused on finding vaccines for animal diseases. In 1885, Pasteur successfully tested a rabies vaccine on a boy bitten by a rabid dog, marking the first successful vaccine since Jenner's smallpox vaccine and inspiring further research into vaccines for other diseases like typhoid, tuberculosis, and diphtheria.

Section IV: Florence Nightingale and Improvements to Hospitals/Nursing

In the 18th century, new hospitals were established through donations from wealthy individuals, transitioning their purpose toward treatment rather than just rest and prayer. However, conditions remained poor, with hygiene practices lacking, leading to the rapid spread of disease. In 1854, Florence Nightingale, then superintendent of nurses at Kings College Hospital in London, was sent to the Crimea to improve hospital conditions during the war. She implemented crucial changes, demanding cleanliness, providing clean bedding and food for injured soldiers, and successfully reducing the mortality rate from 40% to 2%. Celebrated as a national hero upon her return in 1856, Nightingale leveraged her platform to advocate for hospital care changes. She published "Notes on Nursing" in 1859, emphasizing the importance of proper nurse training and established the Nightingale School for Nurses in 1860 at St Thomas' Hospital in London, focusing on sanitation training, which elevated nursing's status and attracted more skilled women. Nightingale promoted pavilion-style hospital design, featuring improved ventilation and larger rooms while newly built hospitals utilized cleanable materials. In 1863, she published "Notes on Hospitals," outlining her vision for enhanced hospital care. Despite her contributions to hygiene, Nightingale did not accept germ theory, continuing to believe in miasma as a disease cause, and she did not allow doctors to teach nurses about germ theory, even though she proved its principles through her work.

Section V: Surgery: Anaesthetics & Antiseptics

Surgery in the 18th century posed significant dangers, often resulting in fatal consequences due to pain, infection, and bleeding. Surgeons resorted to herbal remedies for pain relief, which were often lethal in high doses, and the lack of proper anaesthesia made surgeries excruciatingly painful. In the early 19th century, nitrous oxide (laughing gas) demonstrated potential for minor procedures. Ether was used successfully as an anaesthetic in 1842 but had limited practical use due to side effects and flammability. James Simpson discovered chloroform’s anaesthetic properties in 1847, which gained popularity for various surgeries, enabling longer and more complex procedures. However, precise dosage control was crucial to avoid overdoses, and some opposed anaesthesia on religious grounds, fearing it interfered with divine intent. Additionally, Joseph Lister, observing that infected wounds were rotting, connected his findings to Pasteur's germ theory. In 1865, Lister began using carbolic acid to prevent infection during surgery, applying it through soaked bandages and a spray, alongside mandatory handwashing before operations. His techniques significantly reduced surgical deaths, but there was slow adoption of antiseptic methods due to resistance from surgeons and discomfort caused by carbolic acid. Blood loss remained a critical issue until the 20th century, when blood transfusions became possible. Lister's revolutionising work gradually made aseptic techniques standard in surgeries by 1900, including the use of steam-cleaned instruments, sterile theatres, rubber gloves, gowns, and masks.

Section VI: John Snow & Cholera

During the first cholera outbreak in 1832, the prevailing belief was that cholera was caused by miasma. John Snow, during a subsequent outbreak in 1848, observed the epidemic and theorised that cholera was transmitted through contaminated water. He argued against the miasma theory, documenting his findings in "On the Mode of Communication of Cholera". In 1854, during a cholera outbreak in Soho, Snow mapped the deaths, revealing a cluster around the Broad Street water pump, finding that 500 deaths occurred within 200 metres of the pump, while workers drinking beer from a separate water supply were unaffected. To mitigate the outbreak, Snow removed the pump handle, cutting off access to the contaminated water. His theory faced resistance from the General Board of Health, who adhered to the miasma doctrine, and fearing that acknowledging contaminated water required costly infrastructure improvements. Snow's findings gained acceptance only after Pasteur's germ theory attained scientific recognition in 1861. The "Great Stink" of 1858 further highlighted the need for improved sanitation, urging government action as voting rights expanded.

Section VII: Government Actions 1700-1900

Initially, the British government adopted a laissez-faire approach to public health, with minimal intervention in living conditions, fueled by wealthy individuals' belief in personal responsibility. Edwin Chadwick's 1842 report highlighted significant health disparities between urban and rural life, exposing urban health hazards like inadequate sanitation and overcrowding. Pressure mounted for governmental action, leading to the first Public Health Act of 1848, which established Health Boards in certain towns with high death rates, giving boards powers to appoint medical officers and oversee sanitation. However, implementation varied, with some towns refusing to comply adequately. From the 1860s, the government took more proactive measures, including demolishing slum housing and passing the Vaccination Act of 1853, which made smallpox vaccination compulsory for children, thus significantly increasing vaccination rates. The Second Public Health Act of 1875 imposed greater responsibilities on city councils, encompassing provisions for clean water, sewage management, public toilets, and health officer employment. The Act led to a notable decline in cholera deaths and improved public health, reflecting the government's commitment to ensuring adequate living conditions for its citizens.