Medicine, Disease and Society in Britain, 1750 - 1950
Medical Science in the
Nineteenth Century
Lecture 13
Lecture themes/outline
• New ‘developments’
– The rise of surgery and medical science (new
ideas about disease and the body)
– The rise of the modern hospital
– 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
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?
• How 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?
Definition of Science
from the Latin scientia, meaning
"knowledge"
An enterprise that builds and organizes
knowledge in the form of testable
explanations and predictions about
the world
Theophile Hyacinthe Laennec
(1781-1826)
Christopher Lawrence:
• Even the simplest surgical practices
employ a theory of the body and of
disease.
• Extracting a tooth ‘implies a theory of
the local origin of pain and the relative
harmlessness of removing a body
part’.
Christopher Lawrence (ed.), Medical Theory, Surgical
Practice: Studies in the History of Surgery (London:
Routledge, 1992).
Thomas Schlich:
• Resective surgery demonstrates how surgery and
medicine interacted.
• Medicine adopted a localistic approach from
surgery and developed a new understanding of
disease as pathological change of tissues and cells.
• By including the surgical point of view in medical
education, physicians gained a new and
productive approach to disease.
• Learning medicine helped surgeons to see the
body in a way that made surgery on the body’s
interior possible.
Thomas Schlich, ‘The Emergence of Modern Surgery’ in Deborah Brunton
(ed.), Medicine Transformed: Health, Disease and Society in Europe
1800-1930 (Manchester: Manchester University Press, 2004).
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
microorganisms to prevent infection.
• Asepsis:
Prevention of contamination with
infectious agents.
Igniz Semmelweis, (18181865)
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 - significant that it was
adopted by the Germans.
• Threatened old surgery- would open up new
procedures- threatened status and incomes of
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.
Photograph of operating theatre, 1904.
Abdominal surgery to remove diseased ovarian tissue (ovariotomy). Surgeon
and anesthesiologist in street clothes. From Thomas Spencer Wells, Diseases of
the Ovaries, 1872.
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
Claude Bernard, An Introduction to the
Study of Experimental Medicine (trans. H.C.
Greene) (New Work: Dover publications,
1957; first edn 1865), pp. 145-9:
‘The laboratory is the real nursery of true experimental
scientists, i.e., those who create the science that others
afterward popularize…[I]t is to-day everywhere
recognized that pure science germinates and develops
in laboratories, to spread out later and cover the world
with useful applications. We must, therefore, first of all
attend to the scientific source, since applied science
necessarily proceeds from pure science…Only
laboratories can teach the difficulties of science to those
who frequent them; they show that pure science has
always been the source of all the riches acquired by
man and of all his real conquests over the phenomena
of nature.’
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.
Ronald Ross, Charles Sherrington and Robert Boyce in a laboratory at the
Liverpool School of Tropical Medicine, 1899.
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.
Dr Robert Knox (1791-1862)
Broadside regarding the Burke and Hare trials (1829).
Michel Foucault (1926-1984).
Foucault:
• The Paris hospitals saw the emergence of the ‘clinician’s gaze’
– a way of looking at the patient and ‘seeing’ disease which
no longer dealt with environment or lifestyle, but focused on
the organic changes occurring in the spaces within the body.
• This new way of seeing and thinking turned the body into an
object that could be understood by scientific knowledge, and
the foundation for the emergence of the human sciences.
• As practitioners developed a new discourse of disease, they
acquired a new power within the clinical relationship. The
patient became teaching material to be probed and
examined during life and a ‘commodity’ to be dissected after
death.
• In return for free medical assistance, the poor made their
bodies available to the medical gaze.
Mary Fissell, ‘The disappearance of
the patient’s narrative’
‘The third Day after the Wether happened to be very warm he
changed his Thick waistcot for a Linning one and being
careless sat a quarter day in a Room that was wett the same
evening he found himself not well and a little Feverish & thirsty
for which he Went to Bed and Drank Plentifull of Sack Whey.
The Next Morning he was very horse and out of order’ (1744)
‘His appearance was florid, his complexion clear. He complained
of a light headache and a sore throat. His pulse was full and
rather frequent, the tongue white, the tonsils slightly inflamed,
the parotid glands were very much enlarged, the bowels were
confined, and there was a little oppression about the chest’.
(1816)
Nicholas Jewson:
• Jewson concerned with what he calls ‘the
disappearance of the sick-man’ from
medical cosmology in the period 1770-1870.
• Shift from ‘bedside medicine’ to ‘hospital
medicine’ to ‘laboratory medicine’.
• Bedside Medicine- marketplace
• Hospital Medicine- Paris
• ‘Laboratory medicine’- Germany
• By ‘medical cosmology’ Jewson means
knowledge, practice, practitioners and
patients.
Nicholas Jewson, ‘The disappearance of the sick-man from
medical cosmology, 1770-1870’, Sociology, (1976) 10; 225-44.
Nicholas Jewson, ‘The disappearance of the sick-man from
medical cosmology, 1770-1870’, Sociology, (1976) 10; 225-44.
Bedside Medicine:
Early modern marketplace- competition
Paying patient had a voice in the medical encounter
Common language and concepts of health and illness
Patient an individual
Holistic approach- disease affected the whole organism
Hospital Medicine:
Post Revolution French hospitals- Paris
Development of the construct of ‘the patient’ – ‘the clinical gaze’
Clinicians hold the power
The patient became an object
Disease located in specific organs
Laboratory medicine: Late C19 German universities and research institutes
Scientists hold the power
Disease is located in cells
Conclusion
• Slow uptake of theories and associated practices
– Germ theory
– Antisepsis and Asepsis – Semmelweis and Lister
• Why? Numerous factors including: moral grounds
(anaesthetics in childbirth, vivisection), challenge to
existing medical authority, ‘the way things are
done’
• For more on this see, A. J. Young, The Scientific
Revolution in Victorian Medicine, and John
Pickstone, Medical Innovation in Historical
Perspective - diffusion, fitting in with social and
cultural context
• Nonetheless, bedside medicine had become more
‘scientific’ – measurement devices