History | B2 Changes in medicine, c1848–c1948

Welcome to B2: Changes in Medicine, c1848–c1948

Hello Historians! This chapter is one of the most exciting in the whole course because it covers the time when doctors finally figured out how diseases worked and stopped guessing! This century (1848 to 1948) saw more medical breakthroughs than all previous centuries combined.
We are studying how science completely transformed surgery, hygiene, and public health. Understanding these changes is vital for seeing how our modern healthcare system developed.

What We Will Achieve in This Chapter:

• Understand the critical role of the Germ Theory.
• See how pain and infection were finally beaten in surgery.
• Learn about the first specific cures, including "Magic Bullets" and Penicillin.
• Examine how the government stepped in to improve public health for everyone.

Section 1: The Germ Revolution – Pasteur, Koch, and the Germ Theory

Before this period, many people still believed in the Miasma Theory (that disease was spread by bad air or smells) or Spontaneous Generation (that living things like microbes could pop into existence from non-living matter). This made fighting disease incredibly difficult.

1.1 Louis Pasteur and the Death of Miasma

Louis Pasteur, a French chemist, was the key figure. He wasn't a doctor, but his work on why beer and wine went sour led to the discovery of microscopic life forms (microbes) in the air.

Key Discovery: Pasteur’s Germ Theory (1861)

Pasteur proved that decay (and later, disease) was caused by these tiny organisms (germs). His famous swan-necked flask experiment showed that if air was sterilised and dust prevented from reaching the liquid, the liquid would not go bad. This destroyed the idea of spontaneous generation.

• Crucial Insight: Germs are everywhere, but they must land on something to cause infection or decay.
• Impact: Although doctors were slow to accept it, this theory gave them the reason why people got sick. It was the crucial turning point.

Analogy: Imagine you are trying to stop a leak (disease), but you think the leak is caused by bad luck (miasma). Pasteur showed you that the leak is caused by a burst pipe (germs). Now you know what to fix!

1.2 Robert Koch: Linking Germs to Specific Diseases

Once Pasteur proved germs exist, the next step was proving which germ caused which disease. This is where German doctor Robert Koch came in.

Koch's Methods and Discoveries

Koch developed ground-breaking laboratory techniques that allowed scientists to study germs properly:

1. He used dyes (staining) to make specific bacteria visible under a microscope.
2. He developed ways to grow bacteria in a solid culture (like Petri dishes).

Using these methods, Koch identified the specific microbes responsible for:
    •   Anthrax (1875)
    •   Tuberculosis (TB) (1882)
    •   Cholera (1883)

Quick Review: Pasteur proved germs cause disease; Koch proved which specific germ causes which specific disease.

Section 2: The Battle Against Pain and Infection in Surgery

Before 1848, surgery was a terrifying last resort. Surgeons faced two massive problems: Pain (making the patient move) and Infection (the patient dying a few days later).

2.1 Conquering Pain: Anaesthetics

The use of gases to knock a patient out was the first major step.

Important Anaesthetics:

• Nitrous Oxide (Laughing Gas): Used by dentists.
• Ether: Effective, but highly flammable, irritating to the lungs, and caused vomiting.
• Chloroform (1847): Discovered by James Simpson. It was portable, quick, and very effective. It became widely popular after Queen Victoria used it during childbirth (1853).

Common Mistake to Avoid: Anaesthetics solved pain, but they initially made infection rates worse! Why? Because surgeons could take longer and perform deeper, more complex operations, introducing more germs. This period (c. 1850s–1860s) is often called the "Black Period" of surgery.

2.2 Conquering Infection: Antiseptics and Aseptic Surgery

This step was the direct result of Pasteur's Germ Theory.

Joseph Lister and Antiseptic Surgery

Joseph Lister, a British surgeon, was horrified by the death rates from infection (often called 'hospitalism'). After reading Pasteur’s work, he theorised that germs were causing the infections in wounds.

1. The Solution: Lister used Carbolic Acid (phenol), which was used in sewage systems, to treat bandages and sterilise the operating environment.
2. First Use (1865): He successfully used Carbolic Acid to treat the compound fracture of a boy, proving the theory worked.
3. Initial Resistance: Surgeons complained Carbolic Acid made their skin crack and smelled awful. It took time for Lister’s ideas to catch on, especially in Britain.

Definition Tip: Antiseptic means using chemicals to kill germs in the wound or on surfaces.

Moving to Aseptic Surgery

By the 1890s, medical professionals realised it was better to prevent germs from entering the operating room in the first place, rather than trying to kill them once they were already there.

• This is Aseptic Surgery (meaning "free from infection").
• New practices included sterilising all instruments using heat (autoclaves), wearing sterilised gowns and masks, and using rubber gloves.

Section 3: Developing Cures – Vaccines, Magic Bullets, and Penicillin

Once doctors knew what caused diseases (Germ Theory), they could try to find cures and ways to prevent them.

3.1 Advances in Vaccination

Building on the work of Jenner (Smallpox vaccine), Pasteur applied the Germ Theory to develop new vaccines. He created vaccines for Chicken Cholera and, most famously, Rabies (1885).

Did you know? Pasteur had never treated a human before he reluctantly gave the rabies vaccine to a young boy bitten by a rabid dog. It worked, making Pasteur a worldwide hero!

3.2 The Search for the "Magic Bullet"

In the early 20th century, scientists wanted a chemical drug that would specifically target and kill a disease-causing germ without harming the human patient. This was called the Magic Bullet concept.

The pioneer in this field was German scientist Paul Ehrlich.

Salvarsan 606 (1910)

Ehrlich and his team tested hundreds of arsenic compounds to find one that would kill the syphilis germ. On the 606th attempt, they found a successful compound: Salvarsan 606.

• Significance: Salvarsan 606 was the very first chemical drug designed specifically to treat a disease, paving the way for the pharmaceutical industry.

3.3 Penicillin: The Accidental Cure

Perhaps the most important discovery of this period was the first true antibiotic.

Discovery: Alexander Fleming (1928)

Scottish bacteriologist Alexander Fleming returned from holiday to find that a mould had contaminated a Petri dish of staphylococci bacteria. He noticed the mould (Penicillium notatum) was killing the bacteria.
He named the active substance Penicillin.

• The Problem: Fleming understood its potential, but he could not purify the penicillin, keep it stable, or mass-produce it. His work lay dormant for over a decade.

Development: Florey and Chain (1940s)

In 1939, as World War II began, two scientists, Howard Florey and Ernst Chain (working at Oxford), rediscovered Fleming’s work.

1. They found ways to successfully purify and stabilise penicillin.
2. They conducted successful tests on mice and later on humans.
3. Mass production was heavily supported by the US government during WWII, as it was desperately needed to treat battlefield wounds.

Impact: Penicillin transformed the treatment of infection and wound healing, saving millions of lives worldwide, particularly during and after WWII.

Section 4: Improving Public Health (The Government Takes Action)

Before this period, governments believed in Laissez-faire (leaving things alone) when it came to people's health. However, frequent, terrifying outbreaks of diseases like cholera forced the government to act.

4.1 Early Efforts and Changing Attitudes

In the crowded industrial cities, disease spread rapidly. The initial attempts to pass public health laws were driven mainly by the fear of Miasma and cholera epidemics, not Germ Theory.

• The 1848 Public Health Act was passed partly due to the influence of reformer Edwin Chadwick, who argued disease cost the country money. However, this act was weak and non-compulsory; local councils did not have to follow it.

4.2 The Crucial Impact of Germ Theory on Public Health

Once the scientific proof was available (Koch proving specific germs caused cholera and TB), the argument for clean water and proper sewage became undeniable—it wasn't just 'bad smells' that were dangerous, but invisible killers.

The 1875 Public Health Act: The Big One

The Second Public Health Act of 1875 was a turning point. Unlike the 1848 Act, this act was compulsory (mandatory).

This act forced local authorities to provide and maintain:

1. Clean Water: Providing fresh, uncontaminated water supplies.
2. Sewage Disposal: Ensuring proper removal of waste.
3. Housing Standards: Making sure new houses were built with proper drainage and ventilation.
4. Medical Officers: Employing Medical Officers of Health and Sanitary Inspectors.

Encouraging Note: This act showed that the government finally accepted the responsibility for the health of the population. This move away from laissez-faire was crucial for improving life expectancy in Britain.

4.3 Other Public Health Reforms (1875–1948)

Beyond the main Act, other key laws helped secure better public health:

• The Artisans’ Dwelling Act (1875) allowed local councils to demolish slums.
• Later reforms included regulations on food quality and the provision of school medical inspections (early 20th century).

Chapter Review: Summary of Major Milestones (1848–1948)

Here is a quick timeline of the biggest changes you need to remember:

• c. 1847: Discovery of Chloroform (Anaesthetics solve pain).
• 1861: Pasteur publishes the Germ Theory.
• 1865: Lister introduces Antiseptic Surgery (Carbolic Acid).
• 1875: Koch identifies the anthrax germ.
• 1875: The compulsory Public Health Act is passed.
• c. 1890s: Development of Aseptic Surgery.
• 1910: Ehrlich develops Salvarsan 606 (First Magic Bullet).
• 1928: Fleming discovers Penicillin.
• 1940s: Florey and Chain develop Penicillin for mass use.

Keep reviewing these names and dates! You’ve mastered a crucial century of medical history!