Describe how medicine and surgery improved between
1870 and 1900
The late 19th century was a period of enormous medical change and progress.
Many diseases that had been fatal in 1800 were either treatable by 1900, or a
cure would be found very early in the 20th Century using techniques developed
by 19th-century scientists. Doctors, chemists, and scientists investigated medicine
using new scientific technology made available by the Industrial Revolution, and
made discoveries that changed the face of medical practice. Most important was
the development of the ‘germ’ theory (1857) by Louis Pasteur, a discovery that
gave doctors and scientists the key to understanding, treating, and preventing
disease.
There was huge progress in discovering the causes of disease in this period. For
centuries common sense had told people that there was a connection between
‘dirty’ conditions and disease but they had yet to explian what the link was. In the
early 1800’s it was explained by miasma or ‘bad air’ which was given off rubbish
and decaying matter. In the 1850’s however, French scientist, Louis Pasteur
became interested in micro – organisms and developed a theory that these
‘germs’, as he called them, were the cause of the problem. Aided by
developments such as the microscope Pasteur discovered particular
microorganisms growing in a vat of alcohol that was going bad. He was called in
by other industries who had similar problems and concluded that ‘germs’ were
responsible not only for milk turning sour, but also wine, beer etc going bad.
Building on the work of Pasteur, the German doctor, Robert Koch, found a way to
stain micro- organisms so that they could be observed more easily. Using his
methods the causes of diseases were identified very quickly. In 1882, for instance,
the bacterium that causes tuberculosis was discovered.
There was also development in the treatment of diseases. Koch’s success in the
1880’s spurred Louis Pasteur into action again. In 1879 him and his team were
able to successfully ‘vaccinate’ chickens against cholera using an attenuated
(weakened) form of the disease. In 1881 Pasteur demonstrated in a public display
the vaccination of sheep against anthrax. In 1882 he developed a vaccine that
could prevent rabies; a disease that caused certain death and suffering in the
process. Inspired by Pasteur’s work the German physiologist, Emil Von Behring
was able to develop an antitoxin that would treat cases of diptheria and tetanus
(1890). The former had been a scourge of the population, especially children,
whereas the other was a leading cause of death in wars due to infected wounds.
Such a discovery came about with the knowledge that it was certain substances,
called toxins, which some bacterium such as tetanus secrete, that cause disease.
There was also improvements in surgery in this period. Surgery in the early 1800’s
was dangerous and painful. Surgeons had to work quickly and there was no way
of completely relieving pain suffered by the patient. Infection was perhaps the
greatest danger; germs entering wounds could cause blood poisoning and
gangrene. Almost half of all patients who had leg amputations died because of
infection. Until the acceptance of the ‘germ’ theory in the 1860’s, surgeons did
not take any precautions to protect open wounds. They reused bandages, thus
spreading disease from patient to patient. Doctors did not wash their hands
before an operation, nor did they sterilise their equipment. However once they
concluded that it was the ‘germs’ that were causing complications surgeons
started developing way to prevent them entering wounds. Joseph Lister, for
example, experimented with carbolic acid (1867) which he had seen used to
treat sewage. He found a thin mist of carbolic acid sprayed over the wound during
surgery limited infection. By following this with careful bandaging the wound
would heal and not develop gangrene. While an effective antiseptic carbolic acid
was unpleasant to use so many doctors and nurses didn’t like it or use it. It was
discovered in the late 1800’s, however, that hot steam killed more germs than
the carbolic acid spray. Surgeons started steam sterilising their surgical
instruments using an aseptic method which applied to all equipment in the
theatre, creating a ‘germ free’ environment.
The problem of pain was once which was solved to a certain extent in the late
nineteenth century. In the early 1800’s there were still only three operations
which surgeons could carry out with some success: the amputation of limbs,
trephining and the removal of superficial tumours. All were carried out as swiftly
as possible to reduce the pain suffered by the patient. However, medical
knowledge was advancing rapidly and some surgeons felt that if the patient could
be ‘knocked out’, then there would be no resistance and this would give them
more time to operate and could improve their techniques. During the same
period chemistry was developing and scientists were finding that certain
chemicals could have an effect on the body. Ether was used by J.R Listoon in
London in 1800 to anaesthetise a patient during a leg amputation. However ether
had severe drawbacks. It irrated the lungs, causing the patient to cough during
the operation. It was also unstable and produced inflammable vapour. In 1847
the effects effects of chloroform were discovered and it was soon used to help
relieve women’s labour pains during childbirth. However chloroform was more
dangerous to a patient than ether especially when adminsitered by an untrained
practioner. Local anaesthetics became more widely used as these did not seem to
produce the same side effects as gas treatment. Anesthetics based on cocaine
started to be used from 1884.
The late nineteenth century marked a time of key discovery. Scientists were able
to identify the causes of and largely treat a wide range of diseases. With the
knowledge of the ‘germ’ theory surgeons made greater efforts to prevent the
spread of disease in the operating theatre by devising new aseptic and antiseptic
methods which, while not perfect, significantly improved the success rate of
operations by limiting infection.