1. Medical Science in the Nineteenth Century Lecture 13 Medicine, Disease and Society in Britain, 1750 - 1950

2. Important Questions What impact does science have on medicine? How swiftly and to what extent is change accepted? Does science change medical practice in general? How does it change the image of the medical profession? How does it influence the public understanding of medicine? i.e. How does science filter down? Did it impact on the general practitioner or was it restricted to hospital medicine? Did it lead to a separation of ideas between lay people and medical men on illness?

3. Lecture themes/outline New ‘developments’ –The rise of surgery and medical science (new ideas about disease and the body) –The rise of the modern hospital –Increase in status of ‘modern medicine’ Social and Cultural History of Medicine –The importance of social and cultural context in the reception and adoption of innovation –The complex relationship between new theories of disease and the development of effective therapies. –Effect on the patient/ practitioner relationship

4. Definition of Science from the Latin scientia, meaning "knowledge" An enterprise that builds and organizes knowledge in the form of testable explanations and predictions about the world

5. Paris medicine Hospital medicine in Paris was based on the clinico-pathological method. Means hands-on clinical experience and the examination of the diseased and later their bodies. Emphasis on observation and practical anatomy rather than learning from books. Analysis of organs and tissues – localisation of disease.

6. Theophile Hyacinthe Laennec (1781-1826)

7. An early operation under anaesthesia, c. 1847.

8. Martin Pernick: Sudden increase in the number of operations at the Massachusetts General Hospital. The growth in the number of operations was greatest among those groups who were most likely to receive anaesthetics. Anaesthesia thus brought about a sort of levelling up, where the groups of patients previously thought too weak or too sensitive to stand surgery could be operated on. Anaesthesia allowed surgeons to perform different types of operation. Mortality rates from surgery did not increase with the arrival of anaesthetics. The greater numbers of victims of serious accidents – receiving surgery as a last resort – helped to push up the number of deaths. Martin Pernick, A Calculus of Suffering: Pain, Professionalism and Anaesthesia in Nineteenth-Century America (New York: Columbia University Press, 2004).

9. Antisepsis: Destruction of disease-causing micro-organisms to prevent infection. Asepsis: Prevention of contamination with infectious agents. Joseph Lister: Technique consisted of disinfecting the wound, surgical instruments, the surgeon’s hands, and even the air around the operation using a machine to spray a mist of carbolic acid.

10. The use of the Lister carbolic acid spray

11. Opposition to Carbolic Spray Difficult to carry out procedure - complicated Relied on germ theory that many still resisted- based on ‘too much’ science - significant that it was adopted by the Germans. Threatened old surgery- would open up new procedures- threatened status and incomes of guard. More immediately, the spray smelt vile and could irritate skin Hospital politics- where medical men made the decisions – and this would bring surgeons greater autonomy. Some management committees got cold feet due to deaths.

12. Photograph of operating theatre, 1904.

13. The Germ Theory of Disease Louis Pasteur –Micro organisms enter the body in a number of ways. –Specific diseases are caused by specific micro- organisms. –Natural immunity is an inherited resistance to infection. Justus von Liebig –The body as a chemical system, measure what comes in and goes out Rudolph Virchow –Disease arises due to abnormal changes in cells

14. Koch’s postulates: The organism suspected of causing a particular disease could be discovered in every instance of the disease. When extracted from the body, the germ could be grown in the laboratory and maintained for several generations. When this culture was injected into animals, it should induce the same disease observed in the original source. The organism could then be retrieved from the experimental animal and cultured again.

15. Chemistry laboratory, Glasgow University, 1864. A very early photograph of a chemistry laboratory.

16. The Pasteur Institute, Paris, 1888. The institute was built in Paris in 1888 both to honour the work of Louis Pasteur and to provide a base for his further research.

17. The Lister Institute of Preventive Medicine was an independent, non- profit-making organisation established in 1893. 1893-1914 the only institute of its kind in Britain, ranking internationally with the Pasteur Institute in Paris and the Rockefeller Institute in New York. Focus on microbiology (bacteriology and virology). Worldwide renown working on smallpox, typhoid and diphtheria in the 19th century; cancer, rheumatism and nutritional disorders in the 20th century. Invaluable work was done on viruses and genes, on blood and disinfection, vitamins and nutrition. 1914 National Institute for Medical Research Set up Almroth Wright at St Mary’s London- work on vaccines Research in Britain

18. The Anti-Vivisection and Humanitarian Review vol 9 (1930) no 1.

19. Conclusion Slow uptake of theories and associated practices Nonetheless, bedside medicine had become more ‘scientific’. By 1900, possible to monitor the patient by pathological signs and physiological monitoring. Increased safety (antisepsis/anaesthesia) permitted surgeons to go into anatomical regions previously unexplored. By the 1930s surgery had reached its golden age – operations on all parts of the body; operating theatres the centre of modern hospital.