19th Century Medicine: Germ Theory & Public Health

• The second half of the 19th century was a time of rapid advancement in medicine due to developments in science, technology, changing attitudes, and the increasing role of government.

Discovery and Development, 1860-75

• The learning objectives are to understand the importance of germ theory, progress in surgery and nursing, and the government's role in public health.

Germ Theory

• Pasteur's germ theory improved the understanding of the causes of disease, providing a basis for advancements in prevention and treatment.
• Joseph Lister developed antiseptics to prevent infection, improving surgery.
• The Public Health Act in 1875 improved public health and living conditions through various measures.
• Florence Nightingale and Elizabeth Garrett helped women to play a more important role in medicine, against considerable opposition.

Louis Pasteur's Work

• Louis Pasteur, a French research chemist, investigated why beer was turning sour in 1854.
• Pasteur discovered microorganisms (microbes) in the beer using more powerful microscopes.
• Pasteur disproved the theory of spontaneous generation.
• Pasteur suggested that microorganisms were affecting the beer and making it sour.
• Heating the liquid killed the microorganisms, preventing the beer from going sour.
• Pasteur experimented on milk, wine, and vinegar, concluding that liquids were contaminated by airborne microorganisms.
• Pasteur showed that mixtures left open to the air would spoil and contain microorganisms visible under a microscope.
• Heating the mixture and preventing air contact kept the mixture from spoiling, showing that microorganisms cause decay.
• Pasteur's ideas became known as the "germ theory".

Pasteur's Germ Theory Principles

• Germ theory states the air contains living microorganisms, disproving spontaneous generation.
• Microorganisms are not evenly distributed in the air.
• Microorganisms in the air cause decay.
• Microorganisms can be killed by heating.
• Pasteur proved the idea of spontaneous generation was incorrect, and decay only occurs when mixtures are exposed to air and microorganisms.
• Pasteur collected air samples from different locations, finding that mountain air was "cleaner" and city air contained more microorganisms.
• Pasteur's germ theory is usually dated to 1861, when he published his experiments; however, his ideas developed over years and initially did not connect to disease.
• Pasteur's ideas faced resistance but were published in scientific journals, allowing other scientists to check his findings, leading to gradual acceptance.

Germ Theory and Medicine

• Pasteur was asked to investigate a disease affecting the silk industry in 1865, finding that microorganisms caused the disease killing silkworms, linking microorganisms and disease.
• Pasteur published his Germ Theory and its Applications to Medicine in 1878, but many scientists did not accept his ideas initially.
• It was not clear how the germ theory could help medicine or how this knowledge could be used to cure disease.
• Pasteur's work led to an understanding of why infection developed after surgery, contributing to Joseph Lister's antiseptic techniques.
• The germ theory impacted public health by explaining the link between hygiene and health, leading to the identification of microorganisms causing disease.
• 30 years after the germ theory, vaccinations were produced.

Joseph Lister

• In 1859, Joseph Lister became Professor of Surgery at Glasgow University.
• In 1861, Lister became Surgeon at Glasgow Royal Infirmary.
• Lister was put in charge of a new building and hoped to reduce deaths after surgery through hygiene.
• Lister read Pasteur's work and was informed that carbolic acid was used at the Carlisle sewage works to treat sewage.
• Carbolic acid was observed to kill the microorganisms responsible for decay and smell.
• Lister realized the smell from infected wounds was similar to the smell of sewage.
• Lister wondered if carbolic acid could prevent infection.

Lister and Antiseptics

• Lister treated an 11-year-old boy with a broken leg, using a solution of carbolic acid to soak bandages applied to the wound.
• Lister began using carbolic acid to clean wounds, equipment, and bandages in operations.
• The death rate from infection decreased dramatically due to Lister's antiseptic methods.
• Antiseptic techniques fight (anti) infection (sepsis).
• Lister developed a carbolic spray to ensure no microorganisms contaminated the surgeon's hands or equipment that could enter the open wound.

Opposition to Lister's Ideas

• The carbolic spray made surgical instruments slippery and difficult to grip and slowed down operations.
• The spray caused skin cracking and soreness on doctors' hands.
• Many doctors didn't accept Pasteur's germ theory.
• Some doctors did not use Lister's techniques properly and found them ineffective.
• Nurses were irritated by the extra time and work in dressing patients' wounds.
• Some doctors relied on simple hygiene with soap and water, which worked well.
• Lister frequently experimented with adjustments to his techniques.

Government Action on Public Health

• In 1848-60, Chadwick and Snow showed the link between hygiene and health, and the 1848 Public Health Act was passed.
• However, local councils weren't forced to make improvements, and progress was limited.
• John Snow's work on cholera and the Great Stink in 1858 convinced the government to improve London's sewer system.
• £3 million was allocated to the London Metropolitan Board of Works, with Joseph Bazalgette as chief engineer.

London Sewer System

• The sewers should be large, oval-shaped, made of brick to prevent sewage from getting stuck.
• The system was to bring waste to the Thames' lower stretches for tidal washing out to sea.
• The project cost £6.5 million and took several years to complete.
• Most of the 2,000 km of sewers were built by 1865, using gravity and pumping stations.
• The Embankment along the Thames was created as a side effect, using excavated earth and narrowing the river to control flow.

Changing Attitudes

• Attitudes changed regarding the government's role, previously limited to emergencies but now expanding.
• Laissez-faire meant "leave alone," but this was changing.
• Even when laws were passed, like compulsory smallpox vaccination in 1852, they were not always obeyed until enforced in 1871.

Public Health

• Many opposed government action requiring higher taxes.
• Chadwick and Snow's work emphasized clean water and sewage removal.
• The Sanitary Act of 1866 required towns to employ inspectors for water and drainage.
• Local governments made regulations for room and window sizes.
• Joseph Chamberlain in Birmingham improved water supplies and demolished slums.
• People accepted that disease could be spread by polluted water when they learned about Pasteur.
• Improved public health required clean water, sewage removal, and improved hygiene.
• Previously, the government avoided interfering, but attitudes were changing as more people gained the right to vote, creating more pressure on parliament to get involved.

Reform Acts

• Political parties offered popular policies to voters, focusing on ordinary people's wants.
• The Public Health Act of 1875 tasked local authorities with water supply, sewage management, housing standards and monitoring.
• In 1848, approximately 6% of the population could vote.
• In 1867, a parliamentary reform act doubled the number of people who could vote.
• The Public Health Act 1875 made it compulsory for local authorities to provide clean water, manage sewage, remove rubbish, and improve housing.
• Street lighting and food quality were also under supervision.
• The Public Health Act illustrates how laissez-faire attitudes were changing.
• National government relied on local authorities to implement hygiene improvements.

Improvements in Hospitals and Nursing

• Limited progress in public health and prevention of infectious diseases.
• Lack of understanding regarding the causes of disease.
• There was little progress in the treatment of disease or care offered in hospitals.

Home Care vs. Hospitals

• Most people were cared for in their homes by family and could involve a physician to prescribe medicine if they could afford it.
• The nurse made sure the medicine was taken but had no training.
• Hospitals were small organizations relying on charity funding with limited beds available.
• Patients usually needed a recommendation from a doctor to be admitted.
• Local cottage hospitals began to be established, and they would generally be run by local GPs with a small number of beds.
• Larger hospitals (called infirmaries) were usually in cities with outpatient departments.

Florence Nightingale

• Newspaper reports had made Nightingale famous.
• She was regarded as an expert on nursing and hospitals.
• Nightingale had a major impact on hospitals as an organizer and manager.
• Notes on Hospitals (1859) set out recommendations for space, ventilation, and cleanliness in hospitals.
• Nightingale believed in miasma theory.
• Miasma theory led her to believe that it was important to keep hospitals clean, have fresh air, and have space between beds.
• Her ideas made hospitals more hygienic.

Nursing

• Nightingale wrote Notes on Nursing (1859), which gave advice on ventilation, light, cleanliness, and food, as well as nurse cleanliness and their role in observing and reporting to the doctor.
• Her book was translated into eleven languages.
• The Nightingale School for the training of nurses was established in 1860 at St Thomas's Hospital in London.

Women in Medicine

• Women were traditionally responsible for the daily care of the sick in the home.
• It was thought that women were less intelligent.
• Women were excluded to a higher education.
• It accepted that women could train as nurses.
• Medicine was thought of as seen as unnatural for women.
• Suffragist was the name of people who campaigned for women to vote.

Elizabeth Garret

• An 1858 Medical Act needed doctors to be registered with the General Medical Council and have a medical degree.

• Elizabeth Blackwell was the first woman to qualify as a doctor after being inspired by an English Woman.

• They need medicine to be from a university or teaching hospital.

• Garrett came from a wealthy family who was horrified at her ideas.

• She became a nurse at Middlesex Hospital.

• She wanted to attend lectures that were provided for all the doctors but they complained.

• Students considered the mixture of sexes to have unpleasant character.

• All the medical had dismissed her application.

• She paid for private lessons and dissected corpses.

• Physicians were university trained and could diagnose.

• Apothecaries were lesser trained and could be licensed.

• In 1865, Garrett father paid for her to sit in Apothecaries exam.

• Garrett completed a course in medical training but could not he licensed because none of the three societies would accept her.

Elizabeth Garret Achievements

• Her father had to pay for her to do the societies exam
• She gained a medical degree from Paris.
• Elizabeth Garrett Anderson Hospital in 1918 was named after her.
• She joined the woman to be to a member for seventeen years.
• She became major of Aldeburgh.
• Four other doctors joined Sophias who persuaded Edinburgh University to study medicine.

University

• Had to pay additional fees.
• Were taught separately.
• They faced competition.
• Unable to do practical world.
• Sophia Jex was a write to the anatomy Examination.

Changes in medicine

• Some people were in favour of letting women medical students qualify.
• Many of the medical profession opposed this.
• 1876 the act in parliament wanted to say universities and medical societies.
• This event lead the number of female doctors increased.