Medicine in the 19th century

Surgery

A man lies on the floor after being anesthetised with chloroform by James Simpson.
James Simpson experiments with chloroform

For the first time in history, a patient had the prospect of going into hospital, undergoing an operation without pain or infection, and surviving! The problems for patients were pain, infection and bleeding.

  • The development of anaesthetics such as chloroform, which was discovered by James Simpson in 1847, greatly improved the success rate of surgery. Anaesthetics weren’t always popular though as they were uncomfortable for patients. Some doctors believed that pain was good for healing, people didn’t understand how they worked and the side effects on the body were not properly recognised. The final breakthrough came when Queen Victoria accepted the use of chloroform as an anaesthetic during the delivery of her eighth child.
  • Until Louis Pasteur’s pioneering work on germ theory in the 1850s, surgeons left wounds unprotected. They reused bandages and rarely washed their hands or surgical equipment before operations. In 1864, Joseph Lister introduced an antiseptic spray that by 1866, reduced the death rate in patients by 45.7 per cent. His spray was not used for long though, because carbolic acid actually damages the tissues and breathing it in causes many problems for doctor as well as patient. More successful was the special dressings he developed which contained carbolic acid to keep the wound clean.
  • After 1860, the work of Florence Nightingale began to improve standards of nursing in Britain, and to improve cleanliness in hospitals. She increased respect and reputation for nurses and established training schools. During her time there the death rate in Scutari fell from 43 per cent to 2 per cent. She believed in prioritising cleanliness and fresh air, work which was reported in British newspapers. By 1900 there were 64,000 trained nurses.
  • By the late 1890s Lister’s antiseptic methods led to aseptic surgery and the introduction of sterile instruments in operating theatres. By 1898 rubber gloves were used and surgeon’s hands were scrubbed clean beforehand.
  • By the end of the century, surgeons were regularly doing successful internal operations, eg appendectomies. X-rays (which were discovered in 1895) allowed doctors to see inside the body helping in the diagnosis and treatment of patients.
A hospital ward with nursing staff and patients.
A hospital ward in 1888

Blood

In 1628, William Harvey published his theories on blood circulation and this later allowed the problem of bleeding to be dealt with and the first attempts at blood transfusions.

  • Early blood transfusions often ended disastrously because blood groups had not been discovered, clotting could not yet be prevented and infection was rife. It was not until 1813 that transfusion was reintroduced into medical practice by James Blundell at Guy’s Hospital and by 1873 Sir Thomas Smith’s pioneering work on clotting made survival in surgery more likely.
  • In 1901, Karl Landsteiner discovered blood groups that made transfusion even safer for the patient.