Treatments for Disease in the 18th & 19th Century (Edexcel GCSE History): Revision Note

Advances in 18th and 19th century treatments - Summary

• By 1900, Germ Theory was accepted by most medical professionals

• This caused treatments to become more scientific

  • Hospitals had clean wards, staffed by professionally trained nurses

  • Joseph Lister reduced infection rates by using antiseptics

  • James Simpson found chloroform, an effective anaesthetic with reduced side effects

• Despite these advances, treatments were not fully effective

  • Diseases like syphilis were still untreatable

  • Many people could not afford to pay hospital bills

  • Surgery remained dangerous because:

    • Aseptic surgery took time to implement

    • Patients could die from an overdose of anaesthetics

    • Blood loss continued to kill patients until the development of effective blood transfusions in the 20th century

What were hospitals like in the 18th century?

Positives of 18th-century hospitals

• Hospitals cured patients through doctors, apothecaries and surgeons

• More people could access hospital care, such as the Deserving Poor

• Infectious patients were isolated in wards

• By the mid-19th century, hospital numbers had increased 

Negatives of 18th-century hospitals

• Rich people were treated at home due to concerns over safety

• Hospitals turned away the Idle Poor who could not pay their medical bills

• Lack of cleanliness meant that diseases spread easily

• The locations and number of hospitals depended on where wealthy donors built them

Florence Nightingale and Nursing Improvements

Who was Florence Nightingale?

• Nightingale was a wealthy woman who became superintendent of nurses at King’s College, London, in 1853

  • The public thought nurses were drunk and uncaring

• She worked in the Crimean War, reducing mortality rates from 40% to 2%

• She did this by:

  • Cleaning areas near patients

  • Training nurses to provide more efficient treatment

  • Insisting on clean bedding, ventilation and good meals

The impact of Florence Nightingale in Britain

• Nightingale wrote Notes on Nursing (1859)

• In 1860, Nightingale established the Nightingale School for Nurses at St Thomas’ Hospital in London

  • Nurse education included training on good hygiene and sanitation

  • Nursing became a respected, skilled profession for women

• Hospitals were redesigned in pavilion style, with:

  • Separate wards for diseases

  • Plenty of windows for fresh air and light

Improvements in hospitals

• By 1900, hospitals:

  • Established specialist departments

    • This attracted the best student doctors

  • Used antiseptics and aseptic methods to become cleaner

• However, hospitals still had issues with:

  • Patients paying for medical treatment

  • Coverage, as many people did not have hospitals in their local area

The development of anaesthetics

Early anaesthetics 

• Laughing gas (nitrous oxide) was used for small procedures like tooth extraction from 1795

• American surgeon Dr Crawford Long used ether in 1846

• However, there were problems with ether

  • It made patients vomit

  • It irritated the lungs, causing the patient to cough even when they were unconscious

  • The chemical was flammable

    • This was dangerous in an operating theatre lit by gas lamps or candles

James Simpson and chloroform

• Simpson gathered his friends in 1847 to discover a better anaesthetic than laughing gas

• After smelling chloroform, Simpson and his friends passed out for some time

  • This confirmed the potential of chloroform as an anaesthetic

Risks of chloroform

• It was easy to overdose and kill a patient

• Chloroform affected the heart

  • Hannah Greener was 14 years old when she died under chloroform during a toenail removal

• Longer, more complicated surgeries caused more issues with infection and bleeding

Rewards of chloroform

• It provided better pain relief than other anaesthetics

• Became popular after Queen Victoria used it in childbirth (1853)

• Longer, more complex surgeries forced advancements in antiseptics

Lister & antiseptics

Surgery in the 18th century

• Surgeons in the 18th century did not wash:

  • The operating theatre

  • Their hands before or after surgery

  • Their aprons

  • Their surgical equipment

• Operating theatres were busy

  • Medical students watched the surgeon to gain practical knowledge

  • People saw surgery as a performance

    • Robert Liston, known as ‘the fastest knife in the West End,’ became famous for amputating a leg in just under 3 minutes

• Many patients died post-surgery

  • Issues like gangrene and sepsis were to blame for a lot of deaths

Joseph Lister and carbolic acid

• Pasteur’s Germ Theory inspired Lister

  • He wanted to develop an antiseptic which would stop the flesh from rotting

• Carbolic acid was a pre-existing product, used to remove bad smells from sewers

• In 1865, Lister soaked a bandage with carbolic acid and applied it to a broken leg wound

  • It healed without infection

• He began spraying carbolic acid into the air to monitor the impact

  • He published his findings in the medical journal The Lancet

Risks of carbolic acid

• Dried out the skin and had a bad smell

• Surgeons did not understand the science behind Germ Theory, so they were unwilling to use it

• Lister stopped using carbolic acid in 1890

Rewards of carbolic acid

• Death from surgery fell from 40% to 15%

• Led to new antiseptic methods and later aseptic surgery

Opposition to antiseptics and anaesthetics

Aseptic methods

• Surgery became germ-free through:

  • Sterilising equipment

    • This was done by boiling steam using an autoclave

  • Heating the air of the operating theatre

  • Ensuring the surgeons wore face masks, gloves and gowns

  • Hand and arm washing before surgery

• These methods increased the safety of surgery in the 1900s