Medicine – Part Eight

how medicine developed in the 19th century

Jonathon Davies, Going Postal

From around the 1750s the process known as the industrial revolution was taking shape. This brought new innovations and technologies, but also brought new challenges. The telegraph and railways expanded communications and transport. Improved production processes created more powerful microscope lenses. War in the Crimea with Russia (omg Russia!) led to improvements in nursing and hospitals. Alongside these squalid conditions arose in towns, with packed communal housing which led to disease outbreaks such as cholera and typhoid. Often there were shared toilets or no sanitation. Families lived in a single room. Many shared the same water supply which helped to spread disease. As populations grew rapidly new medical breakthroughs were needed to keep pace and avoid a modern-day plague scenario.

Small pox was a disease that had been around a long time. Symptoms included the highly recognisable pustules on the skin and a rash. Survivors were often left with many scars. There were three variants of the disease, ordinary, malignant and haemorrhagic. Malignant and haemorrhagic were nearly always fatal and there was no known cure. However, there was inoculation. This was also an old practice, thought to have originated in China and India. It involved taking a small amount of material from a smallpox sore and transferring it to a healthy patient, often in a small scratch or cut. It worked because the there was a smaller amount of the virus, and often from a weaker strain, so the body’s immune system had time to respond. This meant the patient could build up immunity and then fight off the weaker form of the disease and would be resistant to smallpox in future. At the time people did not know why this worked, just that it did. Clearly it could come with big risks as it involved deliberately infecting a patient with a potentially lethal disease.

It was Edward Jenner who made the process of vaccination widely known in 1796. He had noted several cases where milkmaids who had caught cowpox and later been found to be immune to smallpox. Jenner tested out his idea on a young lad called James Phipps, transferring pus from a milkmaid with cowpox. Later, Jenner then twice injected James with infectious smallpox material and both times he did not contract smallpox. His findings were later accepted by the Royal society and there was now a safe way to prevent smallpox. Later in 1853 the vaccine was made compulsory (the last recorded case of smallpox was in 1977). There was now potentially a way to rid the world of killer diseases and a future where many of them would no longer exist. Jenner didn’t know why vaccination worked, but he proved that it did. This was a world away from the idea of the four humours from earlier times.

Ignaz Semmelweis is a little known practitioner who made some important discoveries. He is also a testament to why you should never believe “the science is settled” and should be open to new ideas if the evidence is pointing to it. He worked in Vienna General Hospital and was involved in the maternity wards. One ward had a death rate of 10%, the other 4%. Semmelweis decided to investigate the difference. One was a ward for midwives only, the second for students. He had a breakthrough when one of his friends was poked with a scalpel and died. The autopsy showed up as similar to the women dying on the ward.

Semmelweis concluded that some sort of particles were being transferred from the autopsy room to the ward with the higher death rate. The ward with midwives had a lower death rate as they did not perform autopsies. He instituted a hand washing regime using chlorinated lime and death rates fell 90%. Unfortunately, his ideas met with indifference, despite the evidence.  Semmelweis was before Pasteur, so the ideas of germ theory were not widespread or accepted. Semmelweis didn’t know why his ideas really worked, but he knew they did. His findings went directly against the idea of the four humours. He received much criticism and spite, with many of his findings misunderstood. Later in his life he suffered from depression, wrote scathing letters to his critics and his behaviour was erratic. He was lured to an insane asylum. Inside he was beaten by guards and later died.

It was only after the later work of Pasteur that the significance of Semmelweis’ work was realised. He was recognised as a pioneer of antiseptic policy, as well as giving rise to the “Semmelweis reflex,” which was:

a metaphor for a certain type of human behaviour characterized by reflex-like rejection of new knowledge because it contradicts entrenched norms, beliefs, or paradigms — is named after Semmelweis, whose ideas were ridiculed and rejected by his contemporaries.“-Infogalactic

Louis Pasteur is credited with using his white privilege to come up with germ theory and make the link between germs and disease. Due to advances in technology, microscopic organisms were already known about. What they did and where they came from was debated. One of the ideas around was spontaneous generation. It had been challenged several times, but still persisted. Pasteur is recognised as having ended the debate once and for all. Pasteur was studying in Lille University in 1856. He went to investigate why drink was souring in a local business owned by M. Bigot (lol). Pasteur theorised that the yeast microbes were producing lactic acid after feeding on sugar. This led Pasteur to think about microbes infecting people.

Late in 1859 Pasteur conducted a series of experiments to disprove spontaneous generation.  He boiled a broth in a swan necked flask. This meant that dust and other particles could not get in unless the flask was tilted. The liquid remained clear. When tilted and dust got in it soon became discoloured as microbes fed on the broth. This showed that the microbes had to have come from outside. He also helped invent to method of pasteurisation by showing microbes would be killed by boiling water or liquid. He said:

Never will the doctrine of spontaneous generation recover from the mortal blow of this simple experiment. There is no known circumstance in which it can be confirmed that microscopic beings came into the world without germs, without parents similar to themselves.”-Infogalactic

Pasteur had helped establish the link between microbes and disease. This was a big change from the idea of the four humours causing disease. This idea could then be applied to Jenner’s previous work on vaccination. Pasteur made headway with chicken cholera. He tried to infect chickens with a bad batch of the culture he had received from Jean Toussaint. One of the batches had spoiled and did not produce the disease. When Pasteur tried to reinfect them they still did not develop it. He concluded that the chickens were now immune. Pasteur later cultivated anthrax from the blood of animals that had died from it. He then infected other animals using this culture. Once again this helped prove the link between microbes and diseases. Pasteur discovered that growing anthrax at 42 degrees made it unable to produce spores. Using this and other methods meant that artificially weak forms of the disease could be made for vaccines. Pasteur also developed a vaccine for rabies after treating a young boy. Pasteur could have been in trouble because he was not licensed as a medical practitioner. However, the boy survived and the indiscretion was forgotten.

Robert Koch provided many notable contributions. Really he should be as well known as Pasteur. Koch isolated the bacteria that caused anthrax. He used a technique to dye the bacteria which he could then observe through a microscope. Koch was therefore the first to link a specific microbe with a disease. Koch came up with four postulates to help identify the microbe causing a disease. These were:

  1. The microorganism must be found in abundance in all organisms suffering from the disease, but should not be found in healthy organisms.
  2. The microorganism must be isolated from a diseased organism and grown in pure culture.
  3. The cultured microorganism should cause disease when introduced into a healthy organism.
  4. The microorganism must be reisolated from the inoculated, diseased experimental host and identified as being identical to the original specific causative agent.

Through trial and error Koch began using agar to grow bacteria in his lab. In this way he was able to successfully grow pure cultures. Koch travelled abroad to study diseases and was able to isolate the bacteria causing cholera. Koch conducted further research in to tuberculosis and also able to isolate that. This won him the Nobel prize in 1905. In 1908 the Robert Koch Medal was introduced in his honour, for the greatest physicians of the time.

Joseph Lister was a Professor of Surgery at Glasgow University when he read about the work of Pasteur. Pasteur had written that one way to destroy microbes was by chemical solution. Lister began testing carbolic acid on wounds and later surgical instruments and dressings. He found that the risk of gangrene was greatly reduced. In 1865 he published is findings in the Lancet. He instructed those he was in charge of to wash their hands with carbolic solution, spray it around the operating theatre and use it to wash instruments.

Lister is hailed by many as the father of modern surgery. He was created a Baronet by Queen Victoria. Lister had ended the idea that infection was caused by bad air. He had made surgery a lot safer for many and paved the way for sterile surgery and more complex operations.

James Simpson is credited with discovering the anaesthetic qualities of chloroform. The problem of pain meant that operation were difficult and some could not be attempted. Severe stress and shock may further injure or even kill a patient. Surgeons also needed to keep patients immobile to perform delicate procedures. So called “laughing gas,” better known as nitrous oxide, was already known and in use. Simpson discovered chloroform’s properties by experimenting with friends. They would try various doses of different things to see if they worked. He got lucky and hit the right dose. Too little and it would have no effect. However, there is a lethal dose and too much would have killed him.

Simpson then used chloroform in his work as an obstetrician. There was also controversy:

“The use of chloroform during surgery expanded rapidly thereafter in Europe. In the 1850s, chloroform was used during the birth of Queen Victoria’s last two children. In the United States, chloroform began to replace ether as an anaesthetic at the beginning of the 20th century; however, it was quickly abandoned in favour of ether upon discovery of its toxicity, especially its tendency to cause fatal cardiac arrhythmia analogous to what is now termed “sudden sniffer’s death.”-Infogalactic

War has been a theme in medicine, with advances coming in response to new and inventive ways of killing people. Between late 1853-1856 Britain, France and the Ottomans were at war with Russia (omg Russia!) in the Crimea:

The Crimean War was one of the first conflicts to use modern technologies such as explosive naval shells, railways and telegraphs. The war was one of the first to be documented extensively in written reports and photographs. As the legend of the “Charge of the Light Brigade” demonstrates, the war quickly became an iconic symbol of logistical, medical and tactical failures and mismanagement. The reaction in the UK was a demand for professionalisation, most famously achieved by Florence Nightingale, who gained worldwide attention for pioneering modern nursing while treating the wounded.“-Infogalactic

Nightingale was relatively wealthy and came from an upper class family. She went against her family’s expectations to become a nurse. She had travelled throughout Europe (how she did this without EU free movement is a mystery) and felt called by God to be a nurse. Upon hearing of the terrible conditions in Crimea she took a staff of trained nurses and Catholic nuns. She found medical facilities understaffed, unhygienic and short of supplies. Nightingale reduced the death rates by instituting hygiene regimes, such as hand washing, getting sewers flushed out, improving ventilation.

However, not everyone is a Nightingale fan:

“In 2001 and 2008 the BBC released documentaries that were critical of Nightingale’s performance in the Crimean War, as were some follow-up articles published in The Guardian and the Sunday Times. Nightingale scholar Lynn McDonald has dismissed these criticisms as “often preposterous”, arguing they are not supported by the primary sources.”-Infogalactic

Later Nightingale set up a fund and opened a training school at the St. Thomas Hospital. She also wrote the book “Notes on Nursing.” She also worked with the British army in India, where she showed that bad drainage, poor sanitation and overcrowding caused a high death rate. She lobbied in the UK for existing property owners to pay for a connection to mains drainage. This was passed in the Public health Act 1874. She set the standards for the nursing profession going forwards.

Now, you all know I love a bit of diversity. So here we have Mary Seacole:

Mary Seacole was born Mary Jane Grant in Kingston, Jamaica, the daughter of a Scottish soldier in the British Army and a free Jamaican woman. Her mother was a “doctress”, a healer who used traditional Caribbean and African herbal remedies. She ran Blundell Hall, a boarding house at 7 East Street, considered one of the best hotels in all Kingston. Here Seacole acquired her nursing skills. Seacole’s autobiography states that her early experiments in medicine were based on what she learned from her mother while ministering to a doll, then progressing to pets, before helping her mother treat humans.“-Infogalactic

Previous to going to Crimea, Seacole had nursing experience in the Caribbean and Central America. She found herself in England and tried to apply to go to the Crimea, but was refused. She later decided to get there using her own funds. When she arrived she set up a “hotel” which she describes as “a mess-table and comfortable quarters for sick and convalescent officers”. As well as officers she visited the sick and wounded under fire.

Her contribution to the welfare of the British troops in the Crimea is summed up by sociology professor Lynn McDonald:

“Mary Seacole, although never the ‘black British nurse’ she is claimed to have been, was a successful mixed-race immigrant to Britain. She led an adventurous life, and her memoir of 1857 is still a lively read. She was kind and generous. She made friends of her customers, army and navy officers, who came to her rescue with a fund when she was declared bankrupt. While her cures have been vastly exaggerated, she doubtless did what she could to ease suffering, when no effective cures existed. In epidemics pre-Crimea, she said a comforting word to the dying and closed the eyes of the dead. During the Crimean War, probably her greatest kindness was to serve hot tea and lemonade to cold, suffering soldiers awaiting transport to hospital on the wharf at Balaclava. She deserves much credit for rising to the occasion, but her tea and lemonade did not save lives, pioneer nursing or advance health care.“-Infogalactic

Medicine in the 19th Century had advanced a great deal. The real causes of disease were being discovered in repeatable experiments. The problem of pain was starting to be addressed. The eradication of major diseases could now be seen as a realistic possibility. Public health acts started to make a difference. Yet there was still some way to go. Once more wars would play a part, as well as politics. If only there was some way that everyone could get medical treatment for free…

© Jonathon Davies 2018

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