19th Century Medicine

• In the mid-19th century, the cause of disease was unknown
• It was often blamed on problems in the body or miasma (bad air), hindering effective prevention and treatment

Hospital Care

• Hospital care was basic, with most people nursed at home
• Florence Nightingale improved care at British army hospitals during the Crimean War (1854-56)
• Improved hygiene reduced deaths from infection

Surgery

• Surgery involved quick, basic operations with no pain relief
• High death rates occurred due to infection, even if patients survived the operation

Anesthetics

• The discovery of ether and Simpson's use of chloroform provided pain relief during surgery
• Ether was first used as anesthetic, then chloroform

Housing Conditions

• Poor housing quality and overcrowding led to rapid disease spread
• Chadwick advocated improvements, but implementation was limited
• Snow's work demonstrated the importance of hygiene and clean water in preventing cholera

Limited Medical Progress by 1848

• Medical understanding was based on inaccurate ideas like the Four Humours
• This prevented a correct understanding of disease and hindered progress

Four Humours

• The Four Humours theory, developed by the Ancient Greeks, lasted a long time due to its seemingly logical nature
• Illness was thought to be caused by an imbalance in the body's humours
• Treatments based on the Theory of Opposites were used to restore balance

Miasma Theory

• An alternative explanation for disease was based on miasma, which proposed that disease was carried in unpleasant smells and harmful fumes in the air
• This explanation aligned with observations of high disease rates in poor areas and the spread of diseases in hot weather

Spontaneous Generation

• Instead of microorganisms being linked to diseases, scientists followed the theory of spontaneous generation

Limited Knowledge of the Body

• Doctors had limited opportunities for dissection due to beliefs about life after death
• Bodies used for dissection were mainly those of executed criminals
• Research on disease symptoms and specific conditions was difficult to conduct

Factors Affecting Progress

• Limited technology, such as weak microscopes, hindered scientific research
• Insufficient funding for research and development
• Resistance from doctors to new methods and unwillingness to change practices

Florence Nightingale at Scutari

• Florence Nightingale came from a wealthy background, but trained as a nurse, which was a low-status job at the time
• There was no formal training, so she visited hospitals during the 1840s
• She became superintendent of a small nursing home in London called the 'Institution for Sick Gentlewomen in Distressed circumstances'

Crimean War

• During the Crimean War she took a team of 38 nurses to the military hospital at Scutari
• The death rate was caused more by infection than the original injuries

Conditions at Scutari

• The hospital was crowded with ~10,000 patients in poor conditions
• Multiple men were sharing beds or lying on the floor
• They were infested with lice and fleas and had diseases such as typhoid fever and cholera

Nightingale's Actions

• Nightingale and her nurses cleaned the surfaces and equipment
• She believed in miasma and the importance of fresh air, so windows were opened
• Nightingale and her nurses improved the quality of the food

Impact of Nightingale's Work

• Army medical staff resisted nurses because of their limited medical knowledge
• Nightingale's habit of checking patients at night earned her the nickname 'The Lady with the Lamp'

Limited Improvement

• The death rate at Nightingale's hospital was higher than at other hospitals, even with all her improvements
• After a government sanitary commission repaired the drains, the death rate decreased dramatically

Surgery in 1848

• In the mid 1840s medical degrees became 4 years long
• Course included lectures on illness and treatment, and practical experience of midwifery and surgery
• Operations were basic (cutting a boil) or life-threatening (cutting out tumours)

The Problem of Pain

• Pain relief was limited to alcohol, opium, or being knocked unconscious
• Patients were often awake during operations and had to be held down
• The "best" surgeon was the quickest, not the most skillful

Blood Loss and Infection

• Blood loss was a problem, so tourniquets were used to reduce the flow of blood
• Many operations were carried out at home, which was unhygienic
• There was a lack of understanding of infection and surgeons would wear old blood-stained clothes

The Use of Ether

• Scientists began to investigate gases and nitrous oxide
• William Morton experimented and found that ether had a stronger effect
• Robert Liston used ether and people watching were astonished that the patient did not need to be held down

Problems with Ether

• Sometimes ether caused vomiting and irritated the lungs, making the patient cough
• It also led to the patient sleeping for hours or days
• Ether was highly flammable

Simpson and the Use of Chloroform

• James Simpson wanted to find an anaesthetic
• Inhaling gases caused Simpson to be reckless
• Simpson discovered chloroform was an effective anaesthetic
• Chloroform did not seem to have the same side effects as ether
• Simpson used it in 1847 for women in childbirth, and became the official physician to Queen Victoria

Royal Approval

• As a result of newspaper publicity and royal approval, patients began to ask for chloroform in their operations and it became much more widely used
• When Simpson died people lined the route of his funeral and money was collected to put up a statue in his honour

The Impact of Chloroform

• Chloroform seemed to have solved the problem of pain in surgery, but there were problems associated with its use
• The Christian Church was opposed to the use of chloroform in childbirth
• Many doctors were opposed to its use because it was not known whether chloroform might affect the baby

Dose Problems

• It was difficult to get the dose of chloroform right and some doctors felt that a patient who was unconscious was more likely to die
• By using chloroform, surgeons felt confident enough to attempt longer and more complicated operations deeper inside the body
• John Snow invented a chloroform inhaler to control the dose but the death rate rose, to the extent that it was called the 'Black Period' of surgery

The Problem of Infection

• Chloroform gave surgeons more time to work, so they could carry out more complicated operations
• They still did not understand hygiene and infection, and unhygienic equipment now took germs right into the body
• Equipment/bandages/ bedsheets had usually been used before, and they also passed infection to the patient
• Some patients developed gangrene which often developed into sepsis, until the patient died.
• Increased length of operations also caused other problems, for example; if the blood supply to a part of the body was cut off for too long during an operation, this increased the risk of gangrene.

Problems and Improvements in Public Health

• Changes in farming and the rapid development of factories during the Industrial Revolution had caused overcrowding the industrial towns
• Houses were poor because landlords knew factory workers had low wages
• Groups of houses in the poorer areas of industrial towns were arranged in dark narrow streets, called "courts"

Poor water

• Often a family would live in a single room and 50 people or more might live in one house
• houses were damp and poorly ventilated.
• A single privy might be used by 100 people and water was collected from a local pump that was only available for a few hours three to five times a week

Killer Diseases

• Diseases included typhus, typhoid fever, and influenza
• If patients survived these diseases, they might die if they caught another illness such as pneumonia
• Cholera killed quickly, within a single day by dehydration

Dealing with Cholera

• Lack of understanding is shown by the parliamentary discussion about prayer when there was a cholera epidemic in 1848
• Instead left matters to local authorities, who adopted measures based on miasma
• Barrels of tar were burned in the street and people were told to keep warm but also keep clean
• Cholera seemed to affect unhygienic poor people

Dr Robert baker's report

• Many of the streets were bare earth, so they became muddy and collected filth
• many street had no sewer and other only had a sewer the covered part of the street

Edwin Chadwick

• Edwin Chadwick had been involved with the workhouses and then published a report on how it would be better to help the poor
• At first, Chadwick's ideas had little support - but further cholera epidemics drew attention to the issues
• There was an 1848 epidemic where over 50000 people were died
• At first Chadwick's ideas had little support, eventually the 1848 Public Health act was put forward, but the impact was limited

John Snow

• A Cholera outbreak in 1854 was linked to John Snow's reaserch
• The work of Revrend Henry Whitehead was critical to understanding the cause of Cholera
• The level of the river Thames began to drop the rubbish and excrement was taken to the river by the sewers which was exposed
• In 1861 significant improvements in public health were not seen until the germ theory