The History of Medicine & Surgery in the 18th & 19th C.

The Medical Profession in the 18th C

Physicians were “educated” doctors. They served the wealthy and knew nothing of germs. They did not get their hands dirtyBarber-Surgeons were called in if amputation, bleeding, or bone-setting was called for. They were skilled craftsmen

The Medical Profession (cont.)

The Apothecary made up prescriptions. Unlicensed ones made “quack” remedies for the poor which were often quite deadlyThe Wise Woman would be visited by most poor people. They would pass on herbal remedies from mother to daughter

Medical Knowledge in the 18thC.

There was no understanding of what caused disease. Germs were not discovered till 1861Some doctors thought disease was caused by “miasmas” or bad smells so they worried about ventilationSome believed in the four “Humours” – this led to treatments such as bleeding and purging

Dr Edward Jenner and Smallpox

Smallpox killed 40000 a year and maimed thousands of othersInoculation was a dangerous treatment to build immunity by giving the patient a small dose of smallpoxBut inoculation helped keep the disease alive and sometimes killed, or left the patient deaf or blindJenner himself was partially deaf because of this

Jenner noticed by observation that milkmaids who had suffered cowpox did not get smallpox. Cowpox was a mild illnessHe experimented by giving a 8 year old boy (James Phipps) a dose of pus taken from a cowpox sore on the arm of Sarah Nelmes (a milkmaid)Later Jenner gave the boy a smallpox inoculation which had no effect – concluding that the cowpox had made the boy immune to smallpoxHe called this treatment “Vaccination” after the Latin for cow, “vacca”. It was completely safe.

Jenner and Vaccination for Smallpox 1796

The Development ofVaccinationJenner could not explain why vaccination worked

The “Anti-Vaccination Society” said it was dangerous

Dr William Woodville,who ran the London Smallpox Hospital, opposed it

Many were scared of this “strange” treatment

But it did workJenner gave his discovery away – FreeAfter a smallpox epidemic in 1871 law made vaccination compulsorySmallpox was conqueredBut vaccinations against other diseases did not follow until after the discovery of germs – a century after Jenner

Progress in Surgery in the 19th C.

Surgery needed to overcome three main problems to make progress:-

1. Control of pain – development of anaesthetics

2. Control of infection – understanding causes of infection and development of anti-septic techniques

3. Control of blood loss – understanding blood groups and development of transfusions

Control of PainBefore the discovery of anaesthetics patients would have to be held downOperations had to be very quick – 30 seconds was about average for amputation of a legOperations would usually only happen if certain death was the alternativeDrugs like opium and alcohol were no useKnocking a patient out was far too dangerous

AnaestheticsIn 1799 Sir Humphrey Davy discovered the anaesthetic quality of nitrous oxide or “laughing gas”In 1815 Michael Faraday discovered that Ether was even more effectiveThese discoveries went largely unnoticed by surgeonsIn 1842 an American CW Long was the first to use Ether in surgeryAnother American WT Morton convinced surgeons of the value of Ether in 1846

AnaestheticsDr Robert Liston (who could amputate a leg in 28 seconds) was the first British surgeon to use etherIn 1847 Dr James Simpson discovered Chloroform, by self-experimentation (after dinner, with his friends)Simpson used chloroform in childbirth

Opposition to AnaestheticsSome doctors argued that pain was part of the healing processSome argued that God intended there to be painChloroform caused some deathsEther was very unpleasant and could lead to pneumonia and deathSurgeons had been trained to operate quickly – this skill was no longer required

However, Queen Victoria was given chloroform during childbirth, making it respectable

Most doctors came to see the value of pain-free surgery

Surgical Infection

Anaesthetic gave surgeons more time to do more complex opsBut, 1845-1865 is known as surgery’s “Black Period” because patients died of infection after long operationsNo-one knew what caused infection until Louis Pasteur published his “Germ Theory” in 1861

Anti-Septic Surgery 1865Joseph Lister realised that bacteria on his hands and instruments were killing his patientsHe killed the germs by spraying the open wound with anti-septic Carbolic AcidDeath rates fell dramatically but other surgeons were slow to accept the need for this complicated procedure

Aseptic Surgery

Gradually surgeons realised it would be safer to sterilise the whole operating area-(ASEPTIC not ANTI-SEPTIC)Masks, gloves and sterilised instruments were introducedThe work of Robert Koch helped to develop knowledge of bacteriaKoch’s work also led to new vaccinations

Blood TransfusionsPatients died of “shock” when they lost too much blood in operationsBlood transfusions had been attempted with mixed resultsKarl Landsteiner discovered the four Blood Groups in 1900Transfusions were now safeWith the addition of sodium citrate blood could be stored without clottingBlood banks were important in World War One ,1914-18X-Rays were discovered in 1895 by Wilhelm Rontgen

Florence Nightingale(1820-1910) and Nursing

Hospitals were filthy places where poor people went to dieNurses were very low womenFlorence Nightingale became a national heroine when she led a team of “respectable” women as nurses during the Crimean War 1854The wounded soldiers at the Scutari hospital called her “The Lady with the Lamp”.She reduced the death rate from 42% to 2% in six monthsShe insisted on cleanliness, organisation and discipline among her nursesIn England she founded the “Nightingale School of Nursing” and established nursing as a trained and disciplined professionHospitals became much more efficient as a result