I find history to be very interesting, and the amount of progress we have made since the 19th century is incredible. Because surgery and medical practice hasn’t always been safe, I wanted to write about the steps scientists and doctors took to get to where we are today. During the 19th century, doctors based their medicine and treatments solely off of old ideas such as miasma (the belief that unpleasant smells and harmful fumes in the air caused disease), and they had minimal evidence to back up their theories. So how was disease and injury treated without any proper research?
Representation of miasma (datavizblog.com)
The believed causes of disease in the 19th century
We know now that microorganisms are the cause of disease. But because of the lack of technology in the 1800s and the size of microorganisms, there was little to no research being carried out about them at this time. The link between microorganisms and disease hadn’t been established yet, so theories that are now seen as nonsensical were developed, such as spontaneous generation. This is the theory that rotting material (food remains, dead animals, rotting plants etc.), was responsible for disease. Miasma was another theory, as mentioned earlier.
What made these theories so persuasive?
Doctors were occasionally able to observe a few dissections during their training, but because of the widespread belief of a life after death, the majority of people wanted to be buried and were unwilling to donate their bodies to research. Doctors usually only got to operate on criminals who had been executed, but this became even harder when in 1823, the number of crimes punishable by death reduced. This left fewer bodies to dissect, and medical schools went so far as to pay body snatchers—people who would dig up and steal bodies from graves—for corpses, especially if they were fairly fresh.
Furthermore, they were also faced with funding issues, as the government didn’t feel as if they were at all responsible for research and the development of new ideas. As a result, hospitals were forced to rely on charity money. This meant they had little to no money left for research.
On top of this, many doctors weren’t open to new ideas, and resisted learning new ways of treatment. At the time, there was no proof that their methods were faulty, so they thought there was no reason to change them.
Surgery in the 19th century
Drawing of surgery in the 19th century (istock)
Because of the lack of anaesthesia, surgery was extremely painful and dangerous during the 19th century. Nitrous oxide (laughing gas) was used from 1772, but rarely, because the results produced were unreliable. Patients would have to be restrained because of the overwhelming paint. Surgeons would usually try to complete procedures as quickly as possible so the patients wouldn’t have to deal with the pain for extended periods of time. Often, patients were given a piece of wood to bite on or alcohol to drink to numb the pain. Surgeries were usually only performed because they were worried about infection; for example, amputation was a common procedure due to concerns about gangrene.
Hygiene in surgery
Even though infection was a huge risk in surgery, when they got advice from people like Thomas Percival who would advise surgeons to change aprons and clean equipment, only few listened. His original reasoning for this wasn’t actually hygiene related, but because he wanted to “avoid anything that might entice error”. Hospitals were so unhygienic, that it was actually safer to operate at home. This was because in the operating theatres, nothing was cleaned, whereas at home it was a lot more hygienic. Operating at home had mortality rates that were 3-5 times higher.
The invention of anaesthesia
Painkillers, chloroform and ether (www.history.com)
Nitrous oxide (laughing gas) made patients unaware of pain, but it was used mainly in dentistry and was unsuitable for surgical operations. William Morton, a dentist from the US, started experimenting with the gas ether in the year 1846 and discovered that it actually had a stronger effect on patients.
Robert Liston heard about this. He wanted to try it out, so he used ether when amputating a patient's leg. It was astonishing that the patient didn’t need to be held down, and when the patient finally woke up, he was unaware that the operation had even happened. This was a breakthrough in science.
Even though ether was a good pain reliever, it had its downsides. It caused vomiting, lung irritation, and it also occasionally left the patients asleep for days.
Chloroform
Picture of James Simpson (wikipedia)
James Simpson was a brave and resilient man who was determined to find a better anaesthetic, and so he inhaled different gases to see which ones worked. He tested various gases on rabbits, and when he saw it worked, he wanted to test it on himself. The rabbits died the next night, so his assistant tried to persuade him to wait. Simpson was determined and didn’t seem to mind, so when he and his friends tried chloroform and woke up the next day slumped around the table, he was elated that it was an effective anaesthetic. Not only this, but chloroform didn’t have the same side effects as ether. Simpson started using chloroform for childbirth in 1847, and even Queen Victoria requested chloroform for her 8th childbirth in 1853. Chloroform usage started spreading like wildfire, partly because of publicity in the newspaper, but also because of the approval from the Queen.
Objections to the use of chloroform
Of course, there are always going to be people that don’t agree. They had many concerns about chloroform that now would probably go unnoticed. It was known to be an aphrodisiac, and it was said to go against God. It also caused foul language, and people didn’t want women to use it during childbirth as they said pain was ‘natural’. Not only was it taboo for women to use, but many said that painkillers ‘weren’t manly’.
Evolution in medicine and surgery
The amount of progress we have made since then is extremely impressive. We now have the right technology to learn more about disease and microorganisms, and it's amazing how we can comfortably and safely conduct surgeries. It's so interesting to see how they dealt with problems back then compared to how we do now, and it's exciting to see how much more medical practice changes in the future.
Info from:
Pearson Edexcel International GCSE (9–1) History textbook
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