A time of RAPID CHANGE in medicine

Attitudes:

The end of laissez-faire which weakened from mid 19th century onwards

The enlightenment of science and rationality

Technology:

Industrial age, led to increased developments and improvements, such as, microscopes and lab equipment

Individuals:

Florence Nightingale, James Simpson, and Joseph Lister - their discoveries aided treatment

Louis Pasteur and Robert Koch - aided prevention, their work was oversees

Government:

the end of laissez-fair enhanced the role for the government giving them more power and influence

They promoted vaccination

They introduced the 1875 Public Health Act which was compulsory and focussed on sanitation, especially of streets and water.

They funded research of individuals to aid them in their experiments leading to discoveries.

Ideas about cause of disease:

Miasma

influential until late 19th century, it was very popular and widely believed as it was based on reason and observations, especially since towns were very disgusting in this period e.g. the great stink of 1858 which was when the thames was completely clogged with sewage. The foul smells produced by this led to a common sense approach that if the miasma theory was real everyone would be ill or dead.

It limited the effectiveness of the Public health act until 1875 act, it encouraged Florence Nightingale to introduce a hospital reform

John Snow - 1854 - proved that cholera was not spread by miasma but was spread in water

Germ theory - 1861 - proved the role that germs have in disease and that poinsonus fumes in the air had little effect

Ideas about prevention

Public health acts

1848 - not effective as it was voluntary

1857 - very effective as it was compulsory

Before - laissez-faire, the idea that the government had no place interfering in the welfare of people’s lives, miasma theory was still the most popular therefore of this other theories like Edwin chadwicks were ignored.

The Act - forced towns, focused on sanitation, improved water supplies, improved drainage which were very expensive and took time to put in place, they introduced medical officers of health and sanitary inspectors to ensure it was being follows

Further change - a sale of food and drugs act, river pollutions act, all called the great clean up.

Germ theory - 1861

the idea that disease was caused by microbes called germs, and was influential towards he end of the 19th century

Louis Pasteur carried out experiments to prove that milk went off because of bacteria in the air and that this concept could be applied to disease. however not many people believed this as the concept hadn’t been proven to apply to humans

However, after a decade, Robert Koch used its germ theory to carry out his own experiments and prove thatit was true, he isolated a anthrax bacteria and injected it into healthy mice, and the mice fell ill proving that it was true. this led to more people believing it as it had actual proof to support it.

This led to effective public health measures with a focus on sanitation, he was able to explain and prove how vaccination worked, popularising it, and it led to other treatment through to the 20th century such as lister’s carbolic acid

The importance on pasteur was that e proved that his theory works and used it to explain vaccinations and he created his own vaccination against rabies

The importance of Robert Koch was that he identified the first microbe for a human disease, tuberculosis, and his lab techniques managed to speed up further discoveries, staining bacteria and finding better mediums for them to grow in.

Hospitals - Florence Nightingale

Before - hospitals were increasing in number but were unsanitary and low quality, nursing had a poor reputation

development - acted as a celebrity nuse thanks to her work in the crimean war, the government used her as an advisor and used her manuals to train future nurses, government funding for hospitals increased

Impact - status and reputation of nurses rose, hospital sanitation improved too.

James Simpson - Anaesthetics

before - surgery was quick as it was brutal and extremely painful, Liston, many patients died of shock, and there were only ineffective anaesthetics such as ether or laughing gas.

Development - He was experimenting with companions when they came a across a gas called chloroform in 1847, they all passed out and realised it was because of this gas, Simpson thought this to be an effective general anesthetic and was even used by Queen Victoria, which vastly increased its popularity

Impact - there was some oppositions by the church as they didn’t think it was morally right and other surgeons were against it as it took away the need for them to perform quickly, but it allowed for more complex and slower operations and therefore death rates rose

Joseph Lister - Antiseptics

Before - high rates of mortality in operations, and post operation infections, he noticed that when doctors came from the morgue to the maternity wing there was a high rate of death and infections than with nurses who didn’t interact with other patients before,

Develpoment - he applied the germ theory to his findings and discovered that the doctors were carrying infections or diseases from the more and so he introduce the carbolic acid spray to clean hands before cross contamination.

Impact - he face some opposition as nurses and surgeons thought it was inconvenient however death rates fell dramatically, led to aseptic surgery being possible.

Edward Jenner - Vaccination

before - there was no effective or safe prevention against disease, inoculation was widely used but it was ineffective and often led to infecting patient with the disease, and there were lots of smallpox epidemics

development - he applied rural knowledge, it was local knowledge that milkmaids didn’t usually get smallpox particularly if they had already had cow pox, a weaker version, instead of putting smallpox matter into them, he put cowpox matter into people. he experimented on one boy first, recorded his findings and then repeated it 20 more times to prove that it worked. he published his findings

Impact - The government supported his work and set up vaccination clinics, smallpox was eventually eradicated, compulsory vaccination programs, there was some opposition as he didn’t have a scientific reason or evidence to prove why it worked, his work was also rejected by the royal society as they didn’t place faith in a countryside worker.

John Snow - Cholera

Before - there were regular cholera epidemics, which had been prevalent since the 1830s, cholera was blamed on miasma, there dirty water supplies

Developments - he research in soho, he interviewd residents and drew up a map of infected people in soho and saw that they were all centred arounf the broad street pump, so he removed the handle of this pump to prevent access to it, then he repeated going round interviewing residents and found that cholera had disappeared, they found that the water pump had been contaminated by a leaking sewage pipe.

Impact - proved that cholera was a waterborne disease, and wasn’t from miasma, cholera epidemics ended, water supplies slowly improved as it was expensive, but he didn’t have a scientific explanation of what was happening there for people didn’t belive him, it was only until the germ theory came out, as this theory gave an explanation for the cholera, it lead to public health acts.