Health and the People part 3: Industrial period

Health and the People part 3: Industrial period

1. The Germ Theory

   • Discovery
     • Robert Koch (1843 - 1910)
       • Discovered specific bacteria cause specific diseases
         • Managed to stain and photograph them
         • Discovered TB and Cholera microbes
         • Identified 21 germs by 1900
       • Methods
         • Looked at blood of infected animals
           • Took some bacteria
             • Moved it into another animal
               • Other animal died
                 • Bacteria same
       • Founded the new field of biological science and microbiology
       • German government set up Institute of infectious diseases
         • Funded his research
         • Egged on by conflict with France
           • Didn't want Pasteur to be first
     • Louis Pasteur (1822 - 1895)
       • Studied microbes
         • Actually invented germ theory (1860 - 64)
       • Disproved 'Spontaneous Generation'
       • Developed vaccines for chicken cholera, anthrax and rabies
       • News of his discoveries spread quickly via telegram
       • Funded by French Government
         • Egged on by conflict with Germany
           • Didn't want Koch to be first
   • Effect on medical progress
     • Immediate
       • New vaccines discovered
         • Chicken cholera
         • Anthrax
         • Rabies
         • Lives saved
       • New medicines invented
         • Ehrlich (Koch's assistant)
           • Found cure for Syphilis
             • Only killed syphilis microbes
               • 'Magic bullet'
                 • Could there be more?
             • Salvarsan 606
       • Some diseases still incurable
       • Many drugs too expensive for most
       • Infant mortality remained high
       • Still couldn't explain
     • Long-term
       • Focused research in the right place
       • All modern disease treatments rely on this
       • Largest single imporvement to medical progress in the long term

2. Technological improvements

   • Stethoscope invented 1816
     • Widely used 1850
   • Powerful microscopes invented 1895
   • X-ray machines - 1895
   • Allowed for new discoveries and methods to be found

3. Treatment of disease

   • How?
     • Pharmaceutical remedies
       • Laudanum (alcohol and opium)
       • Aspirin
       • Alcohol
       • Arsenic
         • TOXIC!
       • Mercury
         • TOXIC!
       • Cocaine
       • Many ineffective
       • No regulations - anyone could put anything in them
       • Later on, these became based more on Germ Theory, and treatments such as Salvarsan 606 were more effective
   • Who?
     • Women
       • In the Industrial period there was still a lot of prejudice gainst women trying to join the medical profession
         • However, here are 4 notable women who managed it
           • Florence Nightingale
             • Cleaned wounds during Crimean War
               • Helped cut death rates from 40% to 2%
             • Wrote a book on it
             • Set up a nurse training school
             • Made nursing an honorable profession
           • Elizabeth Garrett Anderson
             • Made her own hospital
             • Trained as a nurse
             • Inspired by womens' rights activists
             • Problems faced
               • Father against her
               • Not allowed into medical school
               • Male students forced her out of hospital
               • Not allowed a post in any hospital
               • Everyone hated her
               • How did she overcome them?
                 • Persuaded father to change his mind
                 • Got private tuition
                   • Proved ability
                 • Found a loophole to get her credentials
                 • Started her own hospital
                 • Went to France for her degree
           • Sophia Jex-Blake
             • Studied in US
               • Met female physician there - inspired her
             • Problems faced
               • Parents didn't want her educated like that
               • Struggled to get into university as a woman
               • Men protested about her - angry mob of 200
               • She got sued while teaching
               • How did she overcome them?
                 • Wrote an essay about women being just as intellectually able as men
                 • Encouraged other women to join her
           • Mary Seacole
             • Also worked in Crimean War
               • Ran an informal clinic
             • From Caribbean

4. Surgery

   • Beginning of Industrial period
     • 1/2 of all amputees died of infection
       • No way of stopping infections
     • Blood loss still a huge problem
     • Pain badly-controlled
       • Previously used laughing gas or alcohol
         • Ineffective
         • More recently ether used
           • More effective than other methods
           • Not ideal
       • Many died of shock
   • Carbolic acid - 1871
     • Discovered by Lister
       • Based on Germ theory
     • Used to clean equipment and surfaces
       • Surgery started to become aseptic
       • Killed germs
       • Could clean ligatures
         • These can now be used - very effective
         • Blood loss problem solved
     • Significance
       • Surgery became safer
       • Started a movement leading to the totally aseptic environment of today's operating theatres
     • Opposition
       • Some didn't believe in Germ Theory
       • Many opposed to change
       • How was it overcome
         • The results said it all
           • Infection rates dropped
       • Took a long time
   • Chloroform - first used 1847
     • Discovered by James Simpson
       • Properties discovered by luck
     • Have people unconscious or semi-conscious during surgery
       • Useful for childbirth
       • Useful for difficult durgeries
     • Pros
       • Effective
       • Dose controllable via inhaler
       • Allows for more complex procedures
       • Don't die of shock
       • Less rush - fewer mistakes made
     • Cons
       • Doctors tempted to experiment with new methods
         • Some of which turned out to be fatal
         • At first death rates increased
         • Some good
       • Side effects may include death
       • Pain is a punishment from God - you must feel it
     • Why was it adopted?
       • Queen Victoria used it during childbirth
       • It worked well

5. Public Health

   • Conditions in Industrial Britain
     • Cramped workers' housing
     • Air and noise pollution from factories
     • Water still from polluted rivers
     • Fast urbanisation
     • Lots of poor people
   • Cholera epidemics
     • There were loads of these
       • 1831-32
       • 1848
       • 1854
       • 1866
       • Everyone used the same water pumps
       • Trade brought it in from elsewhere
     • John Snow
       • This dude mapped out cases of cholera during the outbreak of 1854
         • He found they were all around the same water pump
           • He got the pump's handle removed - 1854
           • Realised it travelled through water
             • Thought it was miasma, but in water
       • Significance
         • Started the statistical analysis of epidemics
         • May have saved some lives with the handle removal
           • Outbreak was already nearly over though
   • The poor and Government intervention
     • Government had a Laissez-faire attitude
       • 'Let it be'
       • Don't get involved
       • People didn't want them meddling
     • People didn't look at the conditions of the poor
       • Thought they were lazy drunkards
         • If they want better conditions they need to work
     • Then some guys came along and said hey look we should do something about the poor
       • Edwin Chadwick
         • Secretary to the 'poor law' commissioners
         • Made a report on the conditions of the poor
           • 1842
           • Showed how bad the situation was in towns
             • Blamed high death rates on these factors
               • Dirty air
               • Slum housing
               • Polluted water
               • Bad food
               • Bad sewage systems
           • Pressured the government into doing something
     • Public Health Acts
       • 1848
         • Local authorities could set up boards of health
           • Optional
             • Barely any did
           • Could raise money from taxes
           • Could manage sewers and water supply
         • Pretty useless honestly
         • Did kind of show Laissez-faire coming to an end
         • People like Chadwick pressured the government into this
       • 1875
         • Local officers HAD TO appoint medical officers
           • Maintain sewers
             • Covered underground
           • Supply fresh water
           • Collect rubbish
           • Provide street lighting
         • Great Stink caused it
         • Actually useful
         • Laissez-faire is pretty much gone
   • The Great Stink - 1858
     • Causes
       • Hot weather
       • Untreated human waste in Thames
     • Effects
       • Even the rich were badly affected
         • Government had to move elsewhere
       • Encouraged the government to build sewer system in London
         • £3 million borrowed
           • Equivalent to £1bn today
         • Some still in use today
         • Designed by Bazalgette
         • Finished by 1866
         • No more cholera outbreaks
       • Encouraged 1875 Public Health Act