C7 - Advances In Medical Science In Nineteenth-century Britain

Question 1

Why was pain a problem in surgery?

Answer 1

• in 1800, surgery was a terrifying prospect because surgeons could not control or stop pain during an operation
• before 1800, there were some pain deadening substances which could be used, such as hashish, mandrake and opium, but it was difficult to judge an effective dose
• alcohol was used but it stimulated the heart and caused heavy bleeding in a wound
• the result was that surgeons had to operate quickly to reduce pain and would not attempt complicated internal surgery

Question 2

New anaesthetics - nitrous oxide

Answer 2

An account published by Humphrey Davy in 1800 described its effects - hysterical laughter and no pain. Not used until 1844 when the American dentist Horace Wells used it to remove teeth.

Question 3

New anaesthetics - ether

Answer 3

In 1842, Willian Clark, another American dentist, used ether for tooth extraction and in March that year, Dr Crawford Long removed a neck growth from a patient using it. In 1846, William Morton gave a public demonstration of ether anaesthesia. In December 1846, Robert Liston amputated a leg using it. But it was difficult to inhale, caused vomiting and was highly flammable.

Question 4

New anaesthetics - chloroform

Answer 4

A safe and effective anaesthetic, discovered by Dr James Simpson in 1847

Question 5

What were some of the reasons for opposition to anaesthetics?

Answer 5

• surgeons were used to operating quickly and on a conscious patient
• some army surgeons during the Crimean war thought that soldiers should dutifully put up with the pain
• in the early days of using chloroform, some patients died because it was not understood that patients of different sizes needed different amounts of chloroform. Famously, Hannah Greener died in 1848 from an overdose in an operation to remove her toenail
• there were religious objections to using it for childbirth as they thought that pain in childbirth was God’s will

Question 6

Why were some of the objections to anaesthetics overcome?

Answer 6

• in 1853, Queen Victoria used anaesthetics for childbirth which made it acceptable and fashionable
• however, anaesthetics did not revolutionise surgery because there was still a high death rate from infections introduced by operations

Question 7

What were some early nineteenth-century ideas about infection?

Answer 7

Surgeons believed that chemicals in wounds caused infections, but they were puzzled by why some deep wounds healed quickly, while other surface scratches proved fatal. Surgeons tried to keep the patient healthy and the wound clean. If it became infected, they would cauterise it or use acid to burn away the affected tissues.

Question 8

What were ideas about microbes in the early nineteenth century?

Answer 8

Using microscopes, scientists saw microbes. They thought they were produced by spontaneous generation (decaying material). They thought all microbes were the same.

Question 9

What did the contagionists believe?

Answer 9

They believed that infection was spread by contact and could be controlled by quarantine. In 1864, surgeon Thomas Wells first suggested infection was non-chemical and referred to Pasteur’s discoveries.

Question 10

What did the anti-contagionists believe?

Answer 10

They believed infection was caused by the environment: epidemics such as cholera could be controlled by cleaning. Doctors like James Simpson wanted hospitals relocated or rebuilt as they thought infection was in their walls or in the atmosphere (miasma).

Question 11

What did Pasteur’s Germ Theory say?

Answer 11

That spontaneous generation was wrong and that germs, not chemicals, caused decay.

Question 12

Describe Pasteur’s experiments.

Answer 12

Pasteur used a swan-necked flask to show that liquids only go off when exposed to air. He said that there was bacteria in the air which was causing the liquid to decay.

Question 13

How did Germ Theory influence Joseph Lister?

Answer 13

Pasteur’s research made Lister think that Germ Theory could explain surgical infections. Because of this, carbolic acid was recommended as a chemical that kills bacteria.

Question 14

Describe how Lister used the antiseptic approach in surgery.

Answer 14

• spray carbolic acid on the surgeon’s hands and operating area
• soak the instruments and bandages in carbolic acid
• in august 1865, Lister mended the broken leg of a young boy, Jamie Greenlees
• as the skin of Jamie’s leg had been broken, it was likely to be infected, so would usually be amputated
• instead, Lister set the bones and used dressings that had been soaked in carbolic acid
• after six weeks, Jamie walked out of the hospital

Question 15

What was Lister’s conclusion from his work?

Answer 15

In 1867, he published the results of 11 cases of compound fracture, explained his techniques in lectures, and publicised Pasteur’s Germ Theory through his explanation of the antiseptic technique. Lister said that microbes in the air caused the infection, not spontaneous generation.

Question 16

What were the reactions to Lister’s work in Britain?

Answer 16

• Lister’s ideas were criticised
• the public health debate focused on chemical causes of infection
• Lister’s biological explanation was unfamiliar
• British surgeons offered alternative explanations
• spontaneous generation was supported by influential doctors like Charlton Bastian

Question 17

Why did some people oppose antiseptic surgery?

Answer 17

• doctors at the time did not accept Pasteur’s Germ Theory and the role of microbes in wounds
• in the late 1860s, antiseptic chemicals had been used. Lister’s methods were not revolutionary, even though he claimed they were superior
• carbolic acid dried skin and irritated lungs and it took nurses a long time to prepare his carbolic methods
• Lister changed his techniques and surgeons said this was due to ineffectiveness
• in the 1870s, Lister still believed microbes were very simple things and that there might only be one type that caused disease
• he only rinsed his hands in carbolic acid and still operated in his street clothes

Question 18

Why did some people not believe Germ Theory?

Answer 18

• most doctors at the time still did not believe that microscopic germs could harm something as large and advanced as a human
• Pasteur’s research related to specific germs that might turn liquids, such as milk, sour, or give diseases to animals. It did not relate to those that might make people ill
• an influential doctor, Charlton Bastian, Professor of Anatomy at University College London, had written many articles in the late 1860s that supported spontaneous generation. Many did nit want to challenge his views.

Question 19

How did the cattle plague (1866) cause ideas about infection to change?

Answer 19

Initially it was believed that the disease started spontaneously. Farmers were reluctant to kill cattle so the disease spread quickly nationwide. When vets imposed quarantines and the slaughter of cattle, the disease was halted. The government appointed a scientist, Lionel Beale, who used the latest microscopes and identified the specific microbe responsible. The cattle plague was clearly spread by contact.

Question 20

How did John Tyndall change ideas about infection?

Answer 20

Famous physicist John Tyndall argued in favour of germ theory and against Charlton Bastian. He lectured on dust and disease, demonstrating the existence of tiny microbes in the air.

Question 21

How did typhoid fever change ideas about infection?

Answer 21

Typhoid was common throughout Britain. Anti-contagionists said that all that was needed was to clean up the towns. In 1876, German scientist Robert Koch identified specific germs that caused particular diseases such as cholera and typhoid. Tyndall lectured doctors about Koch’s work.

Question 22

What was aseptic surgery?

Answer 22

A new method of surgery, which aimed to remove microbes before an operation rather than kill them as it progressed.

Question 23

What methods were used in aseptic surgery?

Answer 23

Surgeons has to be scrubbed, wearing gowns and thin, flexible gloves and using sterilised instruments. The first British surgeon to use rubber gloves was Berkeley Moynihan in the 1890s. Face masks, rubber gloves, surgical gowns, and replacing huge public operating theatres with smaller rooms dramatically decreased infections.