Britain: Industrial Revolution & Medicine

• Britain underwent significant transformations in the 18th and 19th centuries due to the Industrial Revolution, scientific and technological advancements, and evolving governmental roles, profoundly impacting medicine.

The Industrial Revolution

• The Industrial Revolution spurred substantial technological advancements, leading to significant societal changes.
• There was a mass migration from rural areas to urban centers for factory, mill, and mine work.
• By the late 19th century, factories and workshops became the primary employment source for the majority of Britons.
• Cities such as London, Birmingham, Glasgow, Liverpool and Manchester became production centres and grew significantly, leading to overcrowding, poor housing, waste accumulation, and disease spread due to lack of sanitation.

Science and Technology

• Scientific ideas gained prominence over traditional classical and church beliefs by 1750.
• Scientists challenged established theories through experimentation and new technologies like microscopes and chemicals.
• Improved transportation, especially railways, facilitated the rapid dissemination of scientific knowledge across Britain.

The Role of Government

• Initially, the government maintained a laissez-faire approach to medicine, avoiding intervention in public health matters.
• This approach shifted in the late 19th century, with growing acceptance of governmental responsibility for public health.
• The government initiated legislation mandating local authorities to enhance living conditions and prevent disease.

Louis Pasteur and Germ Theory

• Louis Pasteur's groundbreaking discovery in the 19th century revolutionized medicine.

Spontaneous Generation

• Spontaneous generation posited that microbes were products of decaying matter.

The Discovery of Germs and Pasteurisation

• Louis Pasteur, studying fermentation, found that heating liquids to specific temperatures killed bacteria and prevented spoilage, a process termed pasteurization.
• Through swan neck flask experiments, Pasteur demonstrated that bacteria caused fermentation and challenged spontaneous generation, publishing his germ theory in 1861, stating that bacteria cause disease.

The Influence of Pasteur’s Germ Theory

• Pasteur's germ theory initially faced resistance in Britain.
• Joseph Lister connected bacteria to surgical infections, although proving this link posed challenges.
• Microscopes became advanced enough to see bacteria.
• Separating infectious from existing bacteria was difficult.

Robert Koch and Bacteria

• Robert Koch identified specific bacteria causing diseases, complementing Pasteur's work.
• Koch developed a method using agar jelly in Petri dishes to grow bacteria and dye to stain and view them under a microscope.
• In 1876, Koch identified the bacteria causing anthrax, followed by tuberculosis in 1882 and cholera in 1883.
• Koch's research inspired the discovery of bacteria causing diseases like diphtheria, pneumonia, and meningitis, greatly improving medicine by focusing on bacteria removal.

Koch, Pasteur, and the Prevention of Disease

• Pasteur built upon Koch's work by developing vaccines, inspired by Edward Jenner's smallpox vaccine.
• Pasteur created vaccines for animal diseases like anthrax and chicken cholera.
• In 1885, he developed a human vaccine for rabies, marking the first successful vaccine since Jenner's smallpox vaccine.

Changes in Care and Treatment - Hospitals

• Hospital care and treatment experienced significant changes between 1700 and 1900.

Hospitals in the 19th Century

• Early 19th-century hospitals had unsafe conditions, marked by poor sanitation, overcrowding, and lack of cleanliness, leading to the spread of infection.
• Untrained nurses sometimes faced criticism, while female medical workers often lacked proper recognition for their work.

Florence Nightingale

• Florence Nightingale improved hospital conditions during the Crimean War by implementing better cleanliness practices.
• Nightingale reduced the death rate from 40% to 2% by ensuring regular hand washing, improved sewerage, and ventilation.

The Influence of Florence Nightingale

• Nightingale improved hospital care and nurse training, influencing global improvements.
• Her books, "Notes on Nursing" (1859) and "Notes on Hospitals" (1863), impacted healthcare globally.
• Nightingale opened the Nightingale School for Nurses in 1860.
• Nightingale believed miasma caused disease. Therefore, she focused on cleanliness to combat 'bad air'.

Mary Seacole

• Mary Seacole, a Jamaican businesswoman and healer, aided British soldiers and treated diseases like cholera.
• Despite her experience, she was denied passage to Crimea and was not appointed to Nightingale's staff.
• Seacole funded her own trip and established the 'British Hotel', offering care to officers and earning the name 'Mother Seacole.'

Developments in Hospitals

• 19th-century hospitals varied in size, funding, and organization, with an increase in cottage and voluntary hospitals funded by charity.
• While doctors worked for free, some working people paid into funds for treatment costs.
• The wealthy continued to receive at-home care.
• The poor were admitted to workhouses after assessment.
• After 1867, most workhouses had an infirmary.
• Fever hospitals were established to isolate and treat infectious diseases like smallpox and scarlet fever.

Changes in Care and Treatment - Surgery

• Surgery advanced due to James Simpson's work on anaesthetics and Joseph Lister's antiseptics between 1800 and 1900.

Surgery in 1800

• Early 19th-century surgeries were dangerous, with common procedures including amputation and growth removal.
• Surgeries lacked anaesthesia, causing pain, shock and infections spread in operating theatres.

James Simpson and Anaesthetics

• Surgeons experimented with chemicals to find effective anaesthetics.
• James Simpson discovered chloroform in 1847 as an effective anaesthetic eased the pain women experienced in childbirth.
• Simpson's discovery faced initial opposition due to concerns about patient consciousness, religious beliefs, and dosage risks.
• John Snow invented an inhaler to measure dosage in 1848, and Queen Victoria's use of chloroform in 1854 increased its acceptance.

Black Period of Surgery

• The period saw more complex surgeries.
• Infections developed deep within the body, and blood loss increased.
• Death rates may have increased between the 1850s and 1870s.

Joseph Lister and Antiseptics

• Joseph Lister introduced antiseptics in surgery in 1867.
• Lister used carbolic acid.
• Lister recommended handwashing and the use of it on instruments.
• Lister's methods reduced death rates in operations from 46% to 15%.
• By the late 19th century, Lister’s antiseptic methods led to aseptic surgery, creating a germ-free environment.
• Aseptic surgery involved thorough cleaning procedures sterilised equipment, and sterilised gowns.

Case Study - Edward Jenner and Vaccination

• In 1796, Edward Jenner developed a smallpox vaccine influenced by inoculation practices from West Africa and the Ottoman Empire.

Smallpox

• Smallpox was a deadly disease in the 18th century, causing more child deaths than any other disease.
• Inoculation was used before Jenner’s vaccine but carried risks of causing smallpox.

Jenner and the Smallpox Vaccine

• Edward Jenner observed that milkmaids who contracted cowpox did not contract smallpox.
• Jenner tested his theory by inoculating James Phipps with cowpox and then smallpox, proving immunity.
• Jenner published his findings in 1798, naming his method vaccination.

Opposition to Vaccination

• Opposition to the smallpox vaccine came from doctors fearing income loss and the Church objecting to using cow diseases in humans.
• The Royal Society initially refused to publish Jenner's ideas.

Government Intervention

• Government intervention led to a decline in deaths due to smallpox.
• In 1852, the government made the vaccine compulsory, strictly enforced after 1872, leading to a rapid fall in deaths from smallpox.
• In 1980, the World Health Organisation announced that smallpox had been eradicated.

Case Study - John Snow and Cholera

• John Snow proved that cholera was spread in water by investigating an outbreak in 1854.

Cholera

• Industrial Revolution cities experienced population growth.
• Overcrowding and waste accumulation occurred.
• There was a lack of sanitation.
• Cholera first emerged in Britain in 1831, with many believing it was caused by bad air and trying to prevent it through various methods.

John Snow

• During the 1854 cholera outbreak, Snow investigated and mapped deaths, finding they centered around a specific water pump.
• Snow discovered contaminated water was the cause of spread.
• Snow had the pump handle removed, ceasing new cases.
• Snow had been correct, but he had not known that it was bacteria in the water that was spreading cholera.
• Despite proving contaminated water spread cholera, disbelief persisted until Pasteur's discovery of bacteria.

Changes in the Prevention of Disease - Improving Public Health

• Several late 19th-century changes, especially led by the government, improved British public health.

Edwin Chadwick and the 1848 Public Health Act

• Edwin Chadwick's 1842 report highlighted the lower life expectancy in cities due to poor living conditions, recommending clean water and waste removal.
• The 1848 Public Health Act encouraged cities to establish health boards and provide clean water, but its impact was limited due to being optional and expensive.

Joseph Bazalgette and the ‘Great Stink’

• The ‘Great Stink’ in 1858 spurred government action.
• Joseph Bazalgette constructed a sewer network under London by 1866, reducing waste and cholera risk.

1875 Public Health Act

• The 1875 Public Health Act made it compulsory for local councils to improve sewers, provide clean water, and appoint medical officers.
• Government intervention was driven by germ theory, public willingness to pay taxes for better conditions, and the need for political support from working men given the right to vote in 1867.

Vaccination Programmes

• The government was more willing to consider vaccination programmes by the late 19th century.
• Work of Jenner, Pasteur and Koch convinced that vaccinations could be successful.
• Vaccination programs targeted diseases like rabies and typhoid.