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

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

2. 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 dirty • Barber-Surgeons were called in if amputation, bleeding, or bone-setting was called for. They were skilled craftsmen

3. The Medical Profession (cont.) • The Apothecary made up prescriptions. Unlicensed ones made “quack” remedies for the poor which were often quite deadly • The Wise Woman would be visited by most poor people. They would pass on herbal remedies from mother to daughter

4. Medical Knowledge in the 18thC. • There was no understanding of what caused disease. Germs were not discovered till 1861 • Some doctors thought disease was caused by “miasmas” or bad smells so they worried about ventilation • Some believed in the four “Humours” – this led to treatments such as bleeding and purging

5. Dr Edward Jenner and Smallpox • Smallpox killed 40000 a year and maimed thousands of others • Inoculation was a dangerous treatment to build immunity by giving the patient a small dose of smallpox • But inoculation helped keep the disease alive and sometimes killed, or left the patient deaf or blind • Jenner himself was partially deaf because of this

6. Jenner and Vaccination for Smallpox 1796 • Jenner noticed by observation that milkmaids who had suffered cowpox did not get smallpox. Cowpox was a mild illness • He 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 smallpox • He called this treatment “Vaccination” after the Latin for cow, “vacca”. It was completely safe.

7. Jenner 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 work Jenner gave his discovery away – Free After a smallpox epidemic in 1871 law made vaccination compulsory Smallpox was conquered But vaccinations against other diseases did not follow until after the discovery of germs – a century after Jenner The Development ofVaccination

8. Progress in Surgery in the 19th C. • Surgery needed to overcome three main problems to make progress:- • Control of pain – development of anaesthetics • Control of infection – understanding causes of infection and development of anti-septic techniques • Control of blood loss – understanding blood groups and development of transfusions

9. Control of Pain • Before the discovery of anaesthetics patients would have to be held down • Operations had to be very quick – 30 seconds was about average for amputation of a leg • Operations would usually only happen if certain death was the alternative • Drugs like opium and alcohol were no use • Knocking a patient out was far too dangerous

10. Anaesthetics • In 1799 Sir Humphrey Davy discovered the anaesthetic quality of nitrous oxide or “laughing gas” • In 1815 Michael Faraday discovered that Ether was even more effective • These discoveries went largely unnoticed by surgeons • In 1842 an American CW Long was the first to use Ether in surgery • Another American WT Morton convinced surgeons of the value of Ether in 1846

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

12. Some doctors argued that pain was part of the healing process Some argued that God intended there to be pain Chloroform caused some deaths Ether was very unpleasant and could lead to pneumonia and death Surgeons 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 Opposition to Anaesthetics

13. Surgical Infection • Anaesthetic gave surgeons more time to do more complex ops • But, 1845-1865 is known as surgery’s “Black Period” because patients died of infection after long operations • No-one knew what caused infection until Louis Pasteur published his “Germ Theory” in 1861

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

15. 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 introduced • The work of Robert Kochhelped to develop knowledge of bacteria • Koch’s work also led to new vaccinations

16. Blood Transfusions • Patients died of “shock” when they lost too much blood in operations • Blood transfusions had been attempted with mixed results • Karl Landsteiner discovered the four Blood Groups in 1900 • Transfusions were now safe • With the addition of sodium citrate blood could be stored without clotting • Blood banks were important in World War One ,1914-18 • X-Rays were discovered in 1895 by Wilhelm Rontgen

17. Florence Nightingale(1820-1910) and Nursing • Hospitals were filthy places where poor people went to die • Nurses were very low women • Florence Nightingale became a national heroine when she led a team of “respectable” women as nurses during the Crimean War 1854 • The wounded soldiers at the Scutari hospital called her “The Lady with the Lamp”.She reduced the death rate from 42% to 2% in six months • She insisted on cleanliness, organisation and discipline among her nurses • In England she founded the “Nightingale School of Nursing” and established nursing as a trained and disciplined profession • Hospitals became much more efficient as a result