19th Century Disease - Prevention and Treatment

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Application of Science

Cold Water Treatment:

Widely believed that the waters in locations such as Buxton and Bath were beneficial to health, acting as preventative measures and cures

People recommended others to swim in the ocean

While some, had their own 'plunge pool' of cold fresh water in the garden

Later in the period, people began cold bathing indoors

People also believed drinking a litre of cold water in the morning would clear out any impurities

These measures mainly were adopted by wealthy people

Child-bed fever:

Alexander Gordon a naval surgeon was the first to notice this

While in London, Gordon studied the outbreak of child-fever and worked out what caused the deaths

Gordon noticed that women who were treated in outlying villages by the wise woman or midwife rarely caught the fever

Those treated by doctors or midwives frequently moving between patients were more likely to die

Gordon's cure was simple: people practising medicine should wash their clothes and hands frequently to limit the spread of disease

Rise of the scientific method:

A series of inventions helped to keep people healthy at this time

Microscope: seeing infections

Stethoscope: listen to a patient's breathing

Kymograph: measures a person's blood pressure

Doctors had access to all this equipment by the 19th century. Many scientific papers surfaced at this time too. In 1753, James Lind identified the cause of scurvy. During the 18th century, many texts were written of scientific investigation into illness. The publishing of these papers helped with treatment and prevention of illness.

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Edward Jenner

Smallpox:

This is an acute contagious disease that is caused by the variola virus

Smallpox was declared eradicated following a global vaccination campaign in 1980 led by the World Health Organisation

In earlier times, 30-60% of those who caught smallpox died

Smallpox had long been endemic in Britain from the 17th century

1796 - an endemic killed 35,000

1837-1840 - 42,000 were killed

Queen Mary died of smallpox in 1694

Vaccinations date from the 18th century but before that inoculationswere utilised

Lady Mary Montagu, whose husband was the Ambassador to the Ottoman Empire, introduced the inoculation to England in 1721

An inoculation involved introducing a mild form of smallpox to the body, so that the person would fight of the disease and become resistant to stronger versions

Edward Jenner:

Jenner was a country doctor from Gloucestershire who studied in London. Through his experiments on local people he found a cure for smallpox:

He chose a 9 year old boy, James Phipps, who had neither cowpox or smallpox

He injected the boy with pus from the sores of a milkmaid who had cowpox

James developed cowpox but then recovered

Jenner then gave James a dose of smallpox; turns out James was immune to the smallpox

Jenner proved that an injection of cowpox prevented smallpox

He submitted a paper to the Royal Society in 1797 but was asked for more evidence. Jenner carried out more experiments keeping detail of all that happened. In 1798, he published An Inquiry into the Causes and Effects of the Variola Vaccine, or Cow-Pox. In 1807. the Royal College of Physicians confirmed the success of the vaccine.

Impact of the vaccine:

Many felt it was wrong to inject pox into humans, while others argued this was God's punishment and people should not interfere

Others thought it should be up to the parents to decided whether to treat their children or not

1840 - as a result of the deadly epidemic since 1837, the vaccination was made free to all infants

1852 - the vaccination was made compulsory, but not strictly enforced

An anti-vaccine league was established in 1866 in opposition of compulsory vaccination

1871 - the government introduced fines for parents not vaccinating their children

1887 - once the death rate had dramatically reduced, the government introduced the right for parents to refuse vaccination

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Treatment and Prevention

James Simpson and the development of anaesthetics:

As with all surgery pain was inevitable. In this time, copious amounts of opium or alcohol were utilised in order to subdue a patient and make an operation quicker. Sir Humphrey Davy was one of the first to use nitrous oxide (laughing gas) as an anaesthetic to relieve pain during an operation. In 1846, Robert Liston used ether as an aesthetic when he successfully amputated a leg of a patient.

James Simpson (1811-70), a Scottish scientist, used chloroform to reduce pain at childbirth. He had experimented with chloroform on himself and his friends. There was opposition to these painkillers for a while, until Queen Victoria in 1853 used chloroform while giving birth. This managed to sway some opinions.

Then in the 1850's, coca leaves from Latin America were used to produce cocaine which acted as a local anaesthetic. The use of cocaine spread rapidly, especially in the 1890's when it started to be produced chemically.

Anaesthetics did not necessarily make operations safer, sometimes it was difficult to get the dose right and death would result from overconsumption.

The use of antiseptics:

It is widely known today that getting a cut requires treatment with antiseptic to prevent dirt getting on the wound and infection occurring. This knowledge is only a recent development in history though. In the 19th century, the biggest killer after surgery was sepsis ('hosptial gangrene'). This was infection caught during or after an operation. Surgeons themselves dismissed the idea that they were spreading infection through dirty clothes and unsterile equipment.

Ignaz Semmelweis pioneered antiseptics in 1847. He was the head of the maternity ward in Vienna General Hospital, Austria. The death rate in his maternity ward reduced from 35% to less than 1% through him insisting doctors wash their hands in calcium chloride before operating. However, very few hospitals introduced this procedure.

Joseph Lister:

Lister (1827-1912) was an English surgeon who advanced the chances of survival in surgery. Lister utilised an operating room sterilised with carbolic acid. This was based off his experiments on frogs. He also sterilised all surgical equipment and dressings with carbolic acid. The mortality rate in his operations reduced from 46% to 15% in three years. In 1871, he invented a device which sprayed carbolic acid over the entire operation room.

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Treatment

Aspetic surgery:

Later in the 19th century, aseptic surgery was developed

1878 - work from Robert Koch discovered majority of disease was spread through contact with an infected surface

Development in the attempts to create germ-free environments

1881 - Charles Chamberland invented a steam steriliser for medical equipment

This led to the development of simpler ways to sterilise equipment

Gustav Neuber (German surgeon) was the first to have a sterile operating theatre

Surgical clothing:

Gradual adoption of protective clothing came about

Initially gloves were worn due to allergic reaction to carbolic acid

Berkeley Moyniham was the first British surgeon to wear gloves in an operation

Later Moyniham made the point of always changing clothes for surgical gowns before entering an operating theatre