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

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 dirty
Barber-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
deadly
The 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 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
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
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.
The Development ofVaccination
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
Progress in Surgery in the 19th C.
1.
2.
3.
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
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
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
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 selfexperimentation (after
dinner, with his friends)
Simpson used chloroform
in childbirth
Opposition to Anaesthetics
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 painfree surgery
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
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
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 Koch
helped to develop
knowledge of bacteria
Koch’s work also led to
new vaccinations
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
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