Transcript Medical Science in the Nineteenth Century

Medicine, Disease and Society in Britain, 1750 - 1950
Medical Science in the
Nineteenth Century
Lecture 13
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?
• 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?
Lecture themes/outline
• New ‘developments’
– The rise of surgery and medical science (new
ideas about disease and the body)
– The rise of the modern (Paris) hospital (surgery)
– 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
Definition of Science
from the Latin scientia, meaning
‘knowledge’
An enterprise that builds and organises
knowledge in the form of testable
explanations and predictions about
the world
Paris medicine (late 18th-early 19th)
• 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.
Theophile Hyacinthe Laennec
(1781-1826)
Surgery to remove malignant tumour from man’s
armpit in Dublin drawing room, c.1817
An early operation under anaesthesia, c. 1847.
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).
• 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.
The use of the Lister carbolic acid spray
Opposition to Carbolic Spray
• Difficult to carry out procedure - complicated
• Relied on germ theory that many still resisted- based
on ‘too much’ science.
• Threatened old surgery- would open up new
procedures - threatened status and incomes of old
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 after surgery.
Photograph of operating theatre, 1904.
The Germ Theory of Disease
• Louis Pasteur
– Micro organisms enter the body in a number of
ways.
– Specific diseases are caused by specific microorganisms.
– 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
Louis Pasteur, c.1890
Robert Koch, 1890
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.
Chemistry laboratory, Glasgow University, 1864. A very early
photograph of a chemistry laboratory.
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.
Research in Britain
• The Lister Institute of Preventive Medicine was an independent, nonprofit-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
The Anti-Vivisection and Humanitarian Review vol 9 (1930) no 1.
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