Causes of improvements in physiology and pathology

Th-century Medicine

During the 18th century there was a quickening in economic activity in the western world. Historians call this the time of the Industrial Revolution. The process continued during the 19th century, with an even greater quickening of invention and scientific discovery.

Huge progress was made in identifying and preventing many diseases. People felt that humankind was becoming god-like in its knowledge and achievements, and that nothing was impossible except the cure of infectious disease - a problem that continued to cause much misery.

Ten key developments

Some knowledge of 19th-century civilisation will help you understand 19th-century medicine.

Developments in the 19th-century included:

1. A great explosion of industry (and industrial diseases such as dermatitis, lung disease and 'phossy jaw').

2.Urbanisation (and public health problems that included 'filth diseases' such as cholera and typhus).

3. The growth of empires (and contact with new diseases such as yellow fever).

4. The growth of immense wealth, based on trade and industry (which created the money to spend on medical research and public health).

5. Great advances in technology (which led to medical machines such as the electrocardiograph).

6.Improved communications (allowed medical knowledge to spread - doctors gained information from all over the world).

7. The growth of science and research (which led to medical breakthroughs).

8.Democracy and socialism (people believed they had the right to good health). The right to health was one of the 'rights of man' claimed by working people during the French Revolution (which was why the medical revolution of the 19th century started in France).

9. New ideas about evolution (Darwin) and genetics (Mendel) - broke the control of the Church over medicine and medical ethics.

10.Wars were waged on a greater scale (creating mass injuries that were hitherto unknown, and required new medical and surgical techniques).

 

 

There was a general atmosphere of scientific research and advance throughout the 19th century, and this was reflected in the fast build-up of medical knowledge. Pasteur's discovery that germs cause disease was a crucial turning point.

Knowledge about the body

Knowledge about the body increased greatly in the 19th century:

1. William Beaumont (America: 1822) studied the digestive system of Alexis St Martin, a Canadian who had an open hole into his stomach.

2. Theodor Schwann (Germany: 1839) realised that animal matter was made up of cells, not 'humours'. This was the vital breakthrough of knowledge that at last destroyed belief in the old 'humoral' pathology of the Greeks.

3. Henry Gray (Scotland: 1858) wrote 'Gray's Anatomy', which had over 1,000 illustrations. Many people bought a copy to own at home. After the 1870s, pupils started studying anatomy in schools.

4. Starling and Bayliss (England: 1902) discovered the first hormone.

5.Casimir Funk (Poland: 1912) discovered the first vitamins, and realised that some diseases were caused simply by poor diet.

Knowledge about disease

Knowledge about disease also increased greatly in the 19th century.

Louis Pasteur (France: 1860s) discovered (by using a swan-necked flask) that germs cause disease. Before he made this discovery, doctors had noticed bacteria, but they believed it was the disease that caused the bacteria (the so-called theory of 'spontaneous generation') rather than the other way round.

One of the spin-offs of Pasteur's discovery was the pasteurisation of milk, which prevented it from going sour by killing the germs and sealing it from the air.

Other scientists also made crucial discoveries, among them:

1.Robert Koch (Germany: 1878), who discovered how to stain and grow bacteria in a Petri dish (named after his assistant Julius Petri). He was thus able to find which bacteria caused which diseases:

·septicaemia (1878)

·TB (1882)

·cholera (1883).

2. In the same period other bacteria were discovered, including those that caused:

·typhoid (1880s)

·pneumonia (1880s)

·plague (1894)

3. Patrick Manson (Britain: 1876) discovered that elephantiasis was caused by a nematode worm, and that mosquitoes were the vector (carrier). This was a breakthrough discovery, because researchers soon found out that other tropical diseases were transmitted by vectors such as mosquitoes (malaria and yellow fever) or tsetse flies (sleeping sickness).

4.Charles Chamberland (France: 1884) found that there are organisms even smaller than bacteria that also cause disease - he had discovered viruses.

Causes of improvements in physiology and pathology

1.The Industrial Revolution / inventions

·There was a general atmosphere of scientific research and advance.

·Louis Pasteur's first commission was to find a cure for sour wine, which set him off on his revolutionary course.

·Joseph Jackson Lister (Britain: 1826) invented the multi-lens microscope, which allowed doctors to see very tiny things accurately.

·Carl Ludwig (Germany: 1847) invented the kymograph, which allowed more accurate measurement of the pulse.

·Wilhelm Roentgen (Germany: 1895) discovered x-rays.

·Willem Einthoven (Holland: 1900) invented the electrocardiograph (measured heart activity).

Scientific knowledge

·Jan Purkinje (Czechoslovakia: 1836) set up the first university department of physiology (science of how the body works).

·Louis Pasteur started as a research chemist. He set up a team of researchers at the Pasteur Institute (1888).

·Robert Koch developed his Postulates of how researchers should find a disease. These led to four basic procedures- make sure the germ in question is present in the sick specimen- grow a culture of that germ - inject it into a healthy specimen - see if the disease develops.

Social factors

·Nationalism - eg the rivalry of Pasteur and Koch. Shibasaburo Kitasato (Japan) and Alexandre Yersin (France) raced to discover the plague bacterium in 1894.

·The deaths of his two daughters motivated Louis Pasteur to redouble his efforts in the fight against disease.

Before the 19th century operations were horrific procedures, and most patients died from post-operative shock, infection, or loss of blood. In some London hospitals the death rate after operations was over 80 per cent.

The 19th-century up-turn in surgery actually pre-dated anaesthetics and antiseptics. Many new ideas were trialled in America (eg Dr Thomas McDowell performed an ovariotomy in 1809), with some success. One suggestion is that American surgeons were happier to try out new techniques on Black slaves.

The improvements in anaesthetics (to protect patients from pain) and antiseptics (to protect patients from infection) occurred because surgery without them was too traumatic, and patients couldn't survive it. New blood transfusion techniques also saved many lives.

Anaesthetics for pain

·1842: Crawford W Long (America) used ether as an anaesthetic while operating on a neck tumour (but did not publish details of his operation).

·1845: Horace Wells (America) tried unsuccessfully to demonstrate that laughing gas would allow him to extract a tooth painlessly.

·1846: Dr JC Warren (America) removed a tumour from the neck of Gilbert Abbott using ether.

·1846: Robert Liston (Britain) removed a leg using ether - 'this Yankee dodge'.

·1847: James Simpson (Britain) discovered chloroform.

·1884: Carl Koller (Germany) discovered that cocaine is a local anaesthetic.