ReviseHive

Ideas about causes of disease and illness, c. 1700-1900: 18th and 19th centuries

Overview:

- In 1700, the influence of the church was strong, and people started to develop scientific explanations.
- Intellectual movements like the Enlightenment made it fashionable to search for answers to illness and disease.
- Understanding the causes of disease and illness became increasingly crucial as cities grew, nations became dirtier, and disease posed a significant threat to the working population. In 1815, 1/3 of smallpox victims were dying.

Continuity and Change:

- Theory of 4 humours discarded:

- People still believed in miasma, but it was becoming less popular.
The theory of spontaneous generation emerged in the 18th century as an atmospheric phenomenon.
- Microscope improvements meant scientists could see microbes on decaying matter.
Most believed it was a product of decay, not a cause.
- It took until the 19th century for scientists to make a distinction between microbes.
- In the 18th century, scientists were unable to prove that spontaneous generation was correct.

Basic principles of germ theory:
- Air contains living microorganisms—microbes can be killed by heating them.
- Microbes in the air cause decay.
- Microbes aren't evenly distributed (more in the air). (Microbes caused decay and microbes spread through the air.)
- Had little impact because of attitude—germ theory accepted but didn't change doctors' ideas—didn't believe dirty hands spread disease.

Impact of Germ Theory:
- Only after scientists discovered specific microbes causing diseases and were able to identify many of them in the 20th century did germ theory start to directly influence medical treatment.

Despite setbacks in the 20th century, we now recognise that microorganisms mimic and cause a variety of diseases. This has led to the development of methods to treat symptoms and protect individuals from specific diseases.

Extent of the treatment change:

The knowledge of how to extract the gem is inadequate.
Treatments such as tuberculosis (TB) proved ineffective until after 1900. So herbal remedies were still popular.

Prevention:

- It is crucial to prevent diseases from spreading even further.
- People realised that infections could be found everywhere due to dirty clothes and hands.
Keeping clean became crucial.
- The biggest change by 1900 was the willingness of the population and the government to take steps to prevent the spread of disease.
 
Hospitals by 1900:

- Very different from 1700, there were no different wards.
- Maintaining cleanliness was crucial, including the use of antiseptics and preventing germs from entering in the first place.
- Many doctors and trained nurses resided on-site or nearby.
- Everyone wanted the most modern hospital to attract donations and new student doctors.
- Hospitals evolved into treatment facilities for the sick.
The construction process necessitated a modification.

Hospitals in the 18th century:

- In 1700, the country had 5 hospitals and no new ones in development.
- It's increasingly evolved into a treatment centre instead of a sanctuary for rest and prayer (on-site surgery).
- People didn't frequently choose this location for treatment; the wealthy often received treatment or surgery at home, which was safer.
- Generally, the patients who were admitted were the 'deserving poor,' providing them with access to trained doctors for the first time.
- As the number of patients increased, the hygienic conditions deteriorated, leading to a lack of effort to remove infectious individuals. Despite the patients being in separate wards, the disease spread quickly as doctors would move between wards without washing their hands or changing their clothes.
- People didn't understand germs caused disease and didn't stop the spread of cleanliness.
- In the middle of the 19th century, there were numerous hospitals, but the conditions remained poor. funded by donations from wealthy people.

Florence Nightingale:

- In 1853, he served as the superintendent of nurses at King's College Hospital in London.
- In 1854, when Britain was at war with Russia in the Crimean War, the hospitals were unsuitable for treating soldiers. Nightingale persuaded the government to dispatch her and 38 other nurses to enhance these hospitals.
They requested 300 scrubbing brushes to remove dirt in the vicinity of patients.
In 6 months, the mortality rate dropped by 88% due to the provision of clean bedding and excellent meals.
Nurses coordinated the treatment of nearly 2000 injured soldiers.
Clean bedding and good meals are provided.
Efforts resulted in an 88% reduction in the mortality rate within 6 months.
- In 1856, Nightingale returned to Britain as a national hero, having made a significant impact.
This gave her the credibility to bring about changes in British hospitals.
The design of hospitals and the training of nurses underwent significant changes.
Nightingale prefers the Pavilion Plan, which involves building hospitals with improved ventilation, more windows, larger rooms, and separate isolation wards to prevent spread.
- 1860: Nightingale established the Nightingale School for Nurses; rigorous training made nursing a profession.
- It is believed that disease spread through the use of easily cleaned materials in new hospitals.

Improvements in Surgical Treatment:

- In the 18th century, surgery was dangerous and sometimes fatal due to bleeding, pain, and infection.
- Without anaesthetics, there was no way to prevent pain, which could send patients into shock.
- Before the patient bled to death, surgeries had to be quick; the most talented surgeons could operate very quickly, improving the patients' survival rate.
- Even if the patient survived, the infection frequently persisted during surgery due to unsterilised environments; typically, the procedure took place at the patient's home with the surgeon wearing the same clothes he arrived in.
- Surgeries were quite limited, the most common procedure was amputation, while others were rare due to the high risk of death.
- In the 19th century, anesthetics were developed to alleviate pain, while antiseptic surgery helped prevent infection.

Development of anaesthetic:

- In 1795, Davy, a chemist's assistant, tried inhaling laughing gas/nitrous oxide and discovered that it numbed pain.
- In 1842, Clark, a chemist and doctor, used ether to anaesthetise patients during tooth extractions. However, candles lit operating rooms, posing a flammable and dangerous risk. -Candles and gas lamps frequently caused patients to vomit, and the gas mimicked coughing when uncurled.
- In 1846, Liston successfully used ether to anaesthetize a patient and performed a leg amputation.
- In 1847, Simpson, a surgical professor, discovered the effectiveness of chloroform as an anaesthetic through the inhalation of its vapours in friends.
- In 1853, Queen Victoria used chloroform during the birth of the prince and spoke positively about it, leading to its rapid popularity.
However, doses must be carefully monitored.
- Chemicals can sometimes affect the heart, leading to the death of some healthy and fit individuals.

Development of aseptic surgery:

- Due to their lack of understanding of germs, surgeons didn't make much effort to keep their surroundings and themselves clean when operating.
The instruments were unwashed, and there were many people present.
- This indicated that numerous patients with sepsis and gangrene were present shortly after the incident.

- The use of anaesthetics made it possible for doctors to do longer/more complex surgeries.
- However, this led to an even greater issue with infection and bleeding.
Death rates increased, leading to a lack of trust in anaesthetics.

Joseph Lister and Carbolic Acid:

- Lister theorised that microbes in the air cause decay, but he did not consider whether they could also cause decay in flesh, using Pasteur's published results as support.
- In 1865, Lister operated on a patient with a brown leg and added a bandage soaked in carbolic acid to the wound, then sealed it cleanly.
- Lister then developed a series of steps to prevent the wound from becoming infected and published his results in 'The Lancet'.
- Even though it succeeded, antiseptic surgery didn't catch on quickly.
- This gained traction more quickly than germ theory, but many scientists didn't fully understand it.
- Not all surgeons were willing to use the carbolic spray.
- It was 'guilt of germs' that didn't believe air was full of germs.
- Surgeons said because of this, spray didn't outrun and left an odd smell, and it could be discouraging any good Lister found on doing patients.
- He focused on encouraging colleagues to use carbolic spray rather than scientifically proving his theory.

Impacts on aseptic surgery:

- Short term: Not much change in surgery as there was initial resistance from medical professionals.

- Long term (1860s-1890s), attitudes changed, and new antiseptic methods were developed and introduced to improve surgery.
- The key was not that they used carbolic acid, but rather that the surgeons understood that performing safe (antiseptic) aseptic surgery was their duty.
- By 1900, instruments were steamed clean, OTs were scrubbed spotless, rubber gloves and surgical masks were introduced, and face masks were used when operating.

Opposition to change:

- Victorians valued pain relief, and interference was meant to be painful, planned childbirth with dolls.
- Some doctors thought if their patients were unconscious during operation, they were more likely to die.
- It took a long time for doctors to accept that germs equated to infection, and surgeons didn't want to believe they could be responsible for the infections that killed their patients.

 

Impact of smallpox vaccine:

- Short term: It saved many lives by 1800, 100,000 people worldwide had been vaccinated.
The vaccine's popularity slowed down, but after the formation of the Royal Jennerian Society in 1803, 12,000 people received vaccinations in just two years.

- Long term: By the end of the 19th century, vaccination became customary, and smallpox cases fell dramatically from 1872.
- Normal → dramatically.

Pasteur's research:

- Jenner's vaccine inspired Koch and Pasteur to search for vaccines that treated other diseases, but no fundamental discoveries were made.
- Unlike Jenner, Pasteur used the same science-based method to develop vaccines, which worked differently for smallpox.
- Jenner's method.

Breakthrough in preventing disease:

Pasteur's vaccination:
- In 1878, Pasteur theorised that microorganisms were responsible for diseases.
- Pasteur realised that germs could only be developed once germs were identified as specific disease-causing germs.
- In 1879, Pasteur demonstrated that it was possible to vaccinate chickens against a weakened strain of chicken cholera.
- Pasteur's research entailed preparing a diluted form of the culture for injection into the individual. The body would combat the weakened disease, the immune system would develop a resistance to the injected disease, and the body would produce antibodies to prevent recurrence.
- Pasteur's focus was on animal diseases causing economic problems, but he moved to research the human disease.
Jenner and other scientists had doubts about vaccinating humans.
In 1890, Emile Von Behring made a significant discovery by developing a vaccine against both tetanus and diphtheria.

The Public Health Act, 1875:

- The aim was to enhance the quality of life in Britain's major cities.
- The government of C 1700 had a laissez-faire attitude and believed it was not their responsibility to interfere in people's daily lives.
- Attitudes changed during the 1800s; more people were able to vote, and the government passed laws that appealed to the masses, ensuring their return to power in subsequent elections.
- There was more action in the 1860s.
- London had 1300 sewers by 1865.
- Birmingham's slums were demolished.
- The court issued an order to stop the dumping of sewage in the river where they get their water.
- In 1875, the government passed the second Public Health Act, which required city authorities to adhere to certain rules.
- Building public toilets to avoid pollution. The public health officer monitors disease outbreaks.
- Creating street lights prevents accidents. 
- Public parks are for exercise.
Providing clean water to stop diseases Spread by dirty water.
Disposing of sewage to prevent drinking and washing water from becoming polluted.
Ensuring new houses were of better quality to stop damp conditions and overcrowding.
- The government has taken effective measures to prevent the spread of disease, and it is working on this. The last cholera epidemic in Britain (1866-67) had a lower mortality rate than other epidemics.

Fighting Cholera in London, 1854:

- Cholera caused diarrhoea and sickness, which led to the victim becoming dehydrated.
- Usually fatal; would die between 2 and 6 days after being sick.
- Cholera was spread through person-to-person contact or water contaminated with the faeces of a sufferer.
- The poorest people were primarily affected by cholera, with many cases occurring in slums, workhouses, prisons, and asylums.
- Cholera arrived in the UK in 1831, and by the end of 1832, there were 6,275 deaths in London.

Cholera-related deaths in England and Wales (during epidemics)

- 1831-32: 31882
- 1848-49: 52293
- 1853-54: 20097
- 1865-66: 14378

Prevention:

- Same steps taken to try to clean up the filthiest areas and cities, it was believed that miasmata caused it.
- The government encouraged cities to set up boards of health and provided clean water supplies, but this didn't have a significant effect on people's living conditions.
- But it wasn't mandatory.
- Part of the 1st Public Health Act in 1848.

John Snow: A very well-respected scientist.

- 1836: John Snow moved to Soho.
- In 1848, Snow observed a cholera epidemic and proposed theories in his work 'On the mode of communication of cholera.' Miasma couldn't spread because it primarily affects the guts, not the lungs.
- The disposal of cholera-ridden faeces in the city's drains led to the conclusion that contaminated drinking water was the source of the disease.

When cholera broke out in Soho in 1854, Snow realised, after drawing a map, that the number of deaths centred around the water pump on Broad Street was the source of infection.

- Snow was correct, when he turned the pump off, the cholera outbreak disappeared.
- In 1854, Snow presented his findings to the government and suggested that they begin making improvements in London's sewer systems.
- In 1855, Snow presented his findings to the government and recommended that they begin improving London's water system.
- 1858: The Great Stink prompted government action.
- 1860: Wall on new sewers began.
- 1875: Bazalgette's planned new sewage system was completed.

Impact:

- There was no scientific evidence to support the spread of snow in water or the cause of cholera. The spread of cholera in water or its cause remains unknown.
- It'd be 7 years till Pasteur published Germ Theory. 
- In the short term, Snow's efforts had a direct influence on the residents of Soho Square, yet his influence remained restricted beyond his locality.
- It wasn't until much later that people acknowledged the significance of clean water.

Preventing cholera: the government's role:

- Encouraged local councils to clean up their cities & provide clear water.
- Listened to Snow's advice on cholera.
- London arranged a new sewage system.
- The 1875 Public Health Act eventually passed, compelling other cities to clean up.