Treatment - inoculation, magic bullets

The search for new ways to cure disease also gained momentum in the 19th century, and included the discovery of how inoculation could prevent disease.

Charles Chamberland (France: 1880) discovered by chance (when he left bacteria exposed to air) that injecting chickens with an attenuated (weakened) form of chicken cholera gave them immunity to the disease (ie he discovered the principle of inoculation).

That realisation was the start of an important chain of events.

·Louis Pasteur developed an effective inoculation against anthrax (1881), and rabies (1885).

·Albert Calmette and Camille Guérin (France: 1906) developed the BCG injection against TB.

·Emil von Behring (Germany: 1913) developed an anti-toxin against diphtheria.

Magic bullets

·Paul Ehrlich (Germany: 1890s) reasoned that, if certain dyes could stain bacteria, perhaps certain chemicals could kill them. He set up a private laboratory and a team of scientists. By 1914 they had discovered several 'magic bullets' - compounds that would have a specific attraction to disease-causing microorganisms in the body, and that would target and kill them. These were methylene blue (for malaria), trypan red (for sleeping sickness) and Salvarsan (for syphilis) - although Salvarsan was more effective than the other two.

Most vaccines, however (eg one developed by Robert Koch against TB in 1891), were not successful. And against acute infectious disease, doctors were largely powerless. They carried, as one medical historian wrote, 'a box of blanks'. So people looked elsewhere for their cures - sometimes in strange places.

Outlandish or alternative cures

·A home medicine encyclopaedia of 1910 recommended cures that included electrical shocks, injection with animal hormones, and a range of harmful substances including cocaine, mercury, creosote and strychnine.

·Other alternative medical treatments included mesmerism (hypnotism), homeopathy (taking tiny doses of poisons), 'health reform' (a religious movement which recommended a healthy lifestyle - it was run by John Kellogg whose brother invented cornflakes) and Christian Science (which taught that disease only existed in the mind).

·Travelling 'quacks' sold patent medicines (such as Lily the Pink's medicinal compound).

Public health

Public health provision was completely transformed as the 19th century progressed. Overcrowding, dirt, poverty and disease went hand in hand at the century's start, but by the 1900s energetic social reformers had comprehensively turned things round.

Summary

In the early 19th century, the growing towns of Britain were characterised by overcrowding, poor housing, bad water and disease.

In 1842, Edwin Chadwick argued that disease was the main reason for poverty, and that preventing disease would reduce the poor rates.

In 1848, a cholera epidemic terrified the government into doing something about prevention of disease - through both public and individual health measures.

Public measures

At first the government tried - as the Romans had done - to prevent illness among the population by public sanitation measures.

The first public health measures were based upon the idea that miasmas (bad smells) caused disease. Although the idea was wrong, the measures against the miasmas involved a greater focus on cleanliness, and this improved public health.

Further measures included:

·In 1848 the first Public Health Act caused the setting up of a Board of Health, and gave towns the right to appoint a Medical Officer of Health.

·In 1853 vaccination against smallpox was made compulsory.

·In 1854 improvements in hospital hygiene were introduced (thanks in large part to Florence Nightingale).

·In 1875 a Public Health Act enforced laws about slum clearance, provision of sewers and clean water, and the removal of nuisances.

The benefits of these measures soon became clear, and by the late 19th century local councils were competing with each other:/strong> to provide the best public health.

Individual measures

When the Boer War revealed that half the population were unfit for military service, the government accepted that it had to pass laws to improve the situation of the individual poor:

·In 1906 local councils were told to provide free school meals for poor children.

·In 1907 school medical examinations were ordered for all children (among these examinations were those of the 'nitty nurse').

·In 1908 Old-age pensions were introduced.

·In 1911 National Insurance (free medical treatment for workers who fell ill) was introduced.

The 19th century was a time of great change for doctors. They started the century able to do very little for their patients, and ended it with a far greater understanding of disease, how to prevent it, and how to help patients through it.

The 19th century saw great advances in the practice of medicine.

In 1800, the doctor may have been a friend of the rich, but many doctors themselves were poor. They could do little to heal disease, and their main role was to provide comfort and reassurance. As the century progressed, however, so did the role of doctors.

·1803 Thomas Percival wrote the first book on medical behaviour.

·1823 The first issue of the the medical journal the 'Lancet' was published.

·1832 The British Medical Association was formed.

By 1900, doctors and surgeons occupied a highly respected place in society. They provided treatment increasingly through hospital provision, and in certain situations were able to heal their patients with surgery.