19th C Modern Day /Quacks and Bonesetters
Anaesthetics, Jenner, Lister, Pasteur,
Koch, Public Health and Antibiotics ?Index
This package covers a lot of work. However by the end you will have a good knowledge about how medicine changes dramatically over the past 100 years to where we are today. An awful lot occurred over a short period of time. The discovery of anaesthesia and the cause of sepsis were made at similar times to public health measures. Alternative medicine also sprang up at this time. Lastly the Medical act of 1858 united doctors under a common banner for the first time in history. This legalising process gave patients the ability to seek out qualified practitioners for the first time. Very much like the GOSc. in 2001.
Page 1-4 Introduction and Public
Health
Page 5-7 Anaesthesia, Bacteria, Lister
and Koch
Page 8-9 Useful Dates / Time line
Page 10-15 Quacks and Bonesetters
Page 16-17 History of Infection
Page 18-19 History of Penicillin
Page 20-21 History of Anaesthesia
Page 22-end The Anatomy Act?DEVELOPMENT OF OSTEOPATHY
Lecture VII
Evolution Of Current Medicine 19th, 20th C
And lets not forget the mis-term Quack
Aims of Lecture VII
· Remember when the Industrial revolution was and its effect.
Have a view on Public health and how it changed mortality
Be able to write a short paragraph on Pasteur, Lister, Koch.
Give a brief account of the History of the Smallpox vaccine
Give a brief account of the History of anaesthesia and its significance
Name three alternative medicines of the 19th C and their inventors / discoverers.
The thought of another history lesson eventually got to the
First Years
Keep going this is your last package before A. T Still
Throughout the last three thousand years we have covered an awful lot of history and potential medical changes but little seemed to effect mortality rates or even treatment.
Why?
All this changed in the last 100 years.
One reason is the Industrial revolution. An increase influx of people led to social change, complex machinery, dangerous housing and work and the need for revolution in thought.
Public Health 1800 –1900
For a full account see Web page. http://65.107.211.206/health/healthov.html
Think about the advantages in Public health and compare them to the advances in science. Both have major merit.
By 1850, many advances had been made. Tables created from the 17th C showed average life expectancy was 40 if born before the middle of the 19th century.
In 1842 Average age of death for a professional in a town was 38 and 52 in the country.
Tradesman or farmers in a town was and in the country
Labourers in a town lived until and in the country
Major diseases were Cholera, which killed 72000 in 1848-9,
T.B killed 50 - 60000 a year. Small pox measles and diphtheria were prolific.
200 people may share one toilet at the end of a street.
By 1848 The first public Health act demanded any town should have a Public Health Board if the death rate was 23 in 1000 or at least 1/10 of the rate payers demanded it. The board could set rates for proper drainage and sewage disposal and clean the streets.
1854 Chadwick and the Public Health Board set up 182 local Boards. Chadwick believed sewers and drainage would resolve all public Health issues. He used to be in charge of a workhouse where the poor would receive treatment for sickness. His ideas were taken into account for the first Health act. He convinced M.P`s he was right. John Simon continued Chadwicks work.
1875 was the New Health Act.
1854 Chadwicks board was closed down.
1855 Board of Health re set up with John Simon as its head.
1864 Factory act to guard against unhealthy conditions and ventilation
1866 Sanitary Act to stop landlords overcrowding and to remove health hazards.
1875 Public Health Act II allowed councils to pull down slums. Inspect food, Towns had to have Health and Sanitary Officers.
Note that in 1903 the average life expectancy had risen to 74 in the UK.
In 1973 this had only risen by four years to 77.
In America today 1998 the average life expectancy in 73 (MNH USA 2000)
Surgery did not fair much better.
In Glasgow in 1860 1/3 of all operative patients died from blood poisoning spread from their wounds. Despite Pasteur, most Doctors felt a poisonous mist in the air caused disease and patients thought the more dirty a surgeons coat was the more operations he had performed and the greater he would be.
The New Renaissance.
In 1858 the first government health reform and list of Doctors was created. Before this time anyone with a slip of paper from any university could practice a form of medicine. Quacks and physicians were almost indistinguishable. The Act of 1858 bought all doctors under one board and regulated the profession. Much opposition occurred but the act was passed. Since that time medicine became regulated, promoted and safer. In May 2001, the same thing occurred with the same opposition to Osteopaths. The GOSc.
1847 James Simpson uses Chloroform as an anaesthetic.
1848 First public Health Act
1859 First Official list of Doctors.
1864 Pasteur proves disease ass. with bacteria.
1875 Councils have to provide provisions for water, sewage and disposal.
1882 Koch finds T.B vaccine and Cholera.
1895 Aspirin replaces opium as main pain killer.
1902 Midwives registered to receive special training.
Anaesthetics
The discovery of Anaesthetics (See history of Anaesthetics at end) which were discovered by the quite unscientific medicine of sniff it and see, evolved from Humprey Davis in 1799 using Nitrous oxide (laughing Gas eased pain but the patient was conscience). Ether used by most people up to James Simpson Young who used Chloroform. Some doctors thought painless operations were staged or fixed. Some opposed on religious grounds that God meant us to suffer. But in 1853 the Queen had chloroform administered in her confinement (the birth of Leopold). If it was all right by the Queen it was all right for everyone. This led to longer operations being performed and hence more chance of infection.
Understanding Bacteria. (See History of Infection at end)
Louis Pasteur
http://www.accessexcellence.org/AB/BC/Louis_Pasteur.html
1822-95 was employed by the French Wine making industry to find out why there wine kept going bad. With the aid of a microscope he saw tiny microbes in the wine and discovered these germs disappeared when they were boiled. Hence “pasteurised”. Mostly Doctors thought germs grew from wounds "spontaneous generation" Pasteur showed they were around us at all times. This was vital to the development of antiseptic surgery. He also isolated many bacteria, which caused particular diseases, and as a result later science got "serums". Used to vaccinate. In 1881 developed a serum to prevent Rabies. In 1888 the Pasture Institute was built.
In 1865 Joseph Lister
http://www.fordham.edu/halsall/mod/1867lister.html
(professor of Surgery at Glasgow University) read Pasteur’s theories and decided to do something about it. He tried many experiments and failed but eventually found if he wrapped bandages in Carbonic acid and wrapped the wound it would often not become infected.
1864-1866 treated 34 fractures 19 recovered and 15 died
1867-70 treated 40 fractures 34 recovered and 6 died.
By 1865 he insisted that bandages were only used once and doctors and surgeons washed their hands regularly. He also insisted silk threads used for sewing were washed in carbonic acid. He fought sepsis and hence was known as antiseptic surgery.
Lister was mocked as he constantly changed his ideas to improve but others thought he changed them because he was wrong. People often complained he took to long to wash all bandages, hands etc.
Hospitals
A lot of Hospitals were opening in the 18th century
1740 London Hospital
1745 Middx Hospital
1814 London Chest Hospital
1828 Royal Free founded by William Marsden
1851 Royal Marsden Cancer Hospital
1852 Children`s Hospital in Great Ormand Street.
People were afraid to go into Hospital due to use of anaesthetic and hygiene. People had to pay to go to Hospital so poor went to work houses or Charity ones. As population grew so did need for doctors and rules occurred.
First Women doctor was from New York called Elizabeth Blackwell. In Britain she obtained a licence to practise from the society of Apothecaries in 1865.
She later founded the St. Marys dispensary. The next female doctor was not until 1892. She became dean of the London school of Medicine for women for twenty years.
Penicillin
The first of the Wonder Drugs so called because it killed of so many kinds of Bacteria. Alexandra Flemming discovered the drug by accident. He was growing some bacteria when he noticed some mould on his plate and that all around the mould the bacteria didn`t grow..
In 1942 penicillin was mass-produced. The Second World War in 1939 undoubtedly speeded this process up.
Chemotherapy is treatment of a disease using chemical substances. Ehrichs started this in 1910 with Salvarson 606 which could kill many bacteria at the same time, including syphilis.
Ivan Pavov did his experiments on dogs at this time. 1849 -1936
New Drugs and Pills
1819 Iodine first used.
1820 Quinine used against Malaria
1885 Amyl Nitrate used for heart disease - angina
1898 Barbitine used as sedative - the first barbiturate
1899 Aspirin used in shops.
1910 Ehrlich discovers Salvarsen
1911 Vitimins proved to be in food.
1911-12 Banting and Best discover Insulin
1928 Flemming and Penicillin
1938 M&B 69s (May and Baker the British firm that produced it). It helps combat pneumonia, boils, meningitis scarlet fever and leprosy.
1942 U.S.A mass produce Penicillin
Useful Dates
1740 London Hospital
1745 Middx Hospital
1814 London Chest Hospital
1819 Iodine first used.
1820 Quinine used against Malaria1847 James Simpson uses Chloroform as an anaesthetic.
1828 Royal Free founded by William Marsden
1848 First public Health Act
1851 Royal Marsden Cancer Hospital
1852 Children`s Hospital in Great Ormand Street.
1854 Chadwicks board was closed down.
1855 Board of Health re set up with John Simon as its head
1859 First Official list of Doctors.
1864 Pasteur proves disease ass. with bacteria.
1864 Factory act to guard against unhealthy conditions and ventilation
1866 Sanitary Act to stop landlords overcrowding and to remove health hazards.
1874 A.T. Still discovered Osteopathy
1875 Councils have to provide provisions for water, sewage and disposal.
1875 Public Health Act II allowed councils to pull down slums. Inspect food, Towns had to have Health and Sanitary Officers.
1882 Koch finds T.B vaccine and Cholera.
1885 Amyl Nitrate used for heart disease - angina
1895 Aspirin replaces opium as main pain killer.
1898 Barbitine used as sedative - the first barbiturate
1899 Aspirin used in shops.
1902 Midwives registered to receive special training.
1910 Ehrlich discovers Salvarsen
1911 Vitamins proved to be in food.
1911-12 Banting and Best discover Insulin
1928 Flemming and Penicillin
1938 M&B 69s (May and Baker the British firm that produced it). It helps combat pneumonia, boils, meningitis scarlet fever and leprosy.
1942 U.S.A mass produce Penicillin
1948 Cortisone / Compound E discovery
1949 Streptomycin tests
1955 Open heart surgery
1961 Replacement Hips
1963 Transplant Kidneys
1978 First test tube baby
1984 Discover Helicobacter
Quacks
Predominately 17th and 18th century
A huge term with no specific definition, it could be associated with lawyers, or any profession. It is usually regarded as an insult and Ned Ward defined it by poem, as you can red they were not well thought of amongst the elite.
“ A shame to Art, to learning, and to sense,
A Foe to virtue, friend or impudence
Wanting in Nature’s gift and Heavens grace,
An object scandalous to the Human race;
A Spurious breed by some Jack Adams got,
Born of some common monstrous god knows what;
Into the World no women sure could bring
So Vile a birth, such an un-man like thing.”
They were scoffed at, ridiculed and impostors. But Above all they were “someone else”. Hence no one liked being a quack and so accused others of it. Used mostly by ‘regular’ doctors against those without formal raining. But Doctors would accuse each other of quackery, especially if there patient list was being poached or helped away. Even doctors who introduced new equipment were often accused of quackery by the old guard.
The way they would work was hand out paper handbills, offering free advise or cheap consultations and on the paper it was full of royal or important testimonies etc. Of course many doctors did the same.
At this time one could legitimately purchase a medical degree from any university.
Quacks were thought to be Rash, inconsiderate, heady, ignorant, promise infallible success from the nicest, most uncertain and most desperate remedies. Often daring and the regulars put it down to ignorance.
Quacks were responsible for improvements in inoculation, use of mercury, opium and the bark, and like all bold innovations were laughed at the time. Even Dr. Adair grudgingly accepted Swainson’s notion that quackery was the engine of invaluable innovation.
The press exposed’ quackery of the medical profession’ with certain high ranking physicians cashing in by patenting medicines. Leading physicians attached there name to cures. Medicinal chocolate (Dr. Hans Sloane) or rabies powder (Dr. R. Mead). Dr. Edward Jenner sold his own stomach medicine, indigestion lozenges etc and thus the antivaccination campaigners branded him a man consumed by greed and it was thought vaccination itself was quackery.
Some 19th C Alternatives
http://www.gober.net/victorian/reports/mesmersm.html
Mesmerism
Mesmer, Franz Friedrich Anton (1734-1815), Austrian physician, known for inducing a trancelike state, called mesmerism, as a curative agent. Mesmer was born near Constance, Germany, and educated at the University of Vienna. About 1772 he asserted the existence of a power, similar to magnetism, that exercises an extraordinary influence on the human body. This power he called animal magnetism, and in 1775 he published an account of his discovery, claiming that it had medicinal value. Mesmer successfully used his new system, which was a type of hypnotism, to cure patients. His technique received some support among members of the medical profession. His institute in Paris attracted 100’s of patients and helped many. In 1785 the French government was induced to appoint an investigative commission composed of physicians and scientists, but the committee`s report was unfavourable to Mesmer`s theory. He went to Switzerland where many of his followers and patient’s followed him. Mesmer subsequently fell into disrepute and spent the rest of his life in obscurity.. It was his use of hypnotic suggestion that led Bernheim to use it for pain killing, and in India James Esdaile was stimulated by his work and carried out 73 operations painlessly. Since Mesmer`s day the subject has been elevated from the domain of charlatanism to that of scientific research
The mesmeric trance is today identified as hypnosis, and its value in the management of certain medical conditions has been widely recognised. From this Psychoanalysis occurred.
Homeopathy
Samual Hahemann 1755-1843 like cures like and in small doses. Very popular in the USA and its true form is very spiritual in nature.
Cranioscopy / Phrenology
Another German physician Franz Joseph Gall , Taught the shape and irregularities in the skull were projections of the underlying brain and consequently a persons characteristics. People would get there bumps felt. However the principle that the brain was composed of many separate areas became the basics of Brain Physiology.
Phineus P Quimby 1802-1866 a mesmerist attributed his cures to the faith of his patient. A patient of his was Mary Baker eddy who later founded the Christian Science movement which says health and recovery from disease is completely dependent in Gods divine Laws. Thus opposes surgery and drugs.
Bone setting a brief History
Please see: for the origin and chiropractor and osteopathy / bonesetting: http://www.mediprint.net/oxfordspine/index20.htm
The Greek physician Periarthron which means "about joints" gave treatment for L.sp. Kyphosis ie. by lying the patient on his front after a steam bath with a board his back, two assistants gave traction and adjustments were made. Galen also used them and reference was also made in the Arabic writing of the 11th century.
James Cook in 1777 describes he developed Rheumatic joints and the natives squeezed him until he cracked.
Bone setting as it was called was very popular in Germany and Sweden.
In England it all started in the 17th century while Harvey was playing around with veins etc a certain Friar Moultan published "The complete bone-setter" and in the year of 1665 an edition of it called English and enlarged was written by Robert Turner.
Bone setters received there training mostly through the hands of their predecessors, daughters as well as sons. The best were almost magical ie Seventh sons of seventh sons.
Hence family names were famous and information was passed down.. One famous family were the Huttons of Watford. In 1871 Dr. Wharton Hood published some work in the Lancet. Whartons father was a doctor who treated a bone setter Hutton of Watford. There was no fee charged if Hutton would teach his son Mr. Wharton Hood. So bone setting became accepted in the Lancet. There were many famous families especially Thomas`s from Liverpool. Later Hugh Owen Thomas who was the founder of Modern Orthopaedic surgery in 1912`s. So some orthopaedic techniques are bone setting techniques.
In 1882 Marcus Ward one of Stills patients donated a lot of Money to the A.S.O. He later set up a school opposite the A.S.O and claimed Still learnt Bone setting from Wharton Hood as he had read his work. These were early days for the ASO and potential dangerous. Even Littlejohn had not arrived yet as he was at school at Glasgow University in 1882.
Herbert Baker was another famous setter in London. He learnt from John Atkinson who learnt from Robert Hutton, nephew of Richard Hutton. He treated H.G Wells etc and other famous people. He offered to demo to the medical establishment. He employed an anaesthetist who was struck off the register for helping him.
In 1922 he received a knighthood, which really annoyed the medical fraternity. He also received a honouree diploma from Kirksville in 1927. There is a picture of him and Wilfred Streater who tried to get acceptance of Osteopaths at the A.S.O graduation.
It was he and the other bonesetters who really laid the way for Osteopathy to be accepted in the U.K.
In 1886 Sir James Paget gave a lecture at Barts Hospital on Bone setting. Published in the B.M.A 1867. Although Barts had used bone setters since the 17th century.
He said " few of you are likely to practise without having a bone setter for your enemy - it sometimes does good - so learn how to imitate what is good and avoid what is bad."
Between 1871 -88 there are numerous mentions of the setters and was the principle subject of the Annual General Meeting of the B.M.A in 1882.
In 1884 Bennett a bone setter publicly criticised Paget saying they wanted to learn there skills so they could charge more.
Mr Charles Waterton the naturalist points out there was in every country in Europe a bonesetter.
The most famous of Bone setters
One famous one was a lady called Mrs.Sarah Mapp (cross eyed Sally) of Epsom who was the daughter of a setter named Wallin. In London Magazine 1736 reported she received about 10 guineas a day and had strength enough to put in a mans shoulder with no help. A man came to her one day supposedly sent by some surgeons with his hand bound up and pretended to have a wrist problem., she examined and found him to be fake. However to give him note she gave it a wrench to really put it out and bade him go to the fools that sent you and get it set again, or come back in a month and she would put it right herself. She was reported to go to town once a week and return home with sets of crutches as trophies of honour. She successfully helped the niece of Sir Han`s Slone and that increased her reputation. A play was written about her with a song in her praise it went: She moved to Pall Mall London.
you surgeons of London who puzzle your pates
to ride in your coaches and purchase estates
Give over, for shame, for your pride has a fall,
and the Doctress of Epsom has outdone you all
Dame Nature has given her a Doctors Degree,
She gets all the patients and pockets the Fee
so if you don`t instantly prove it a cheat,
She will loll in a chariot while you walk the street.
She was once reported in her coach stopped by a mob of angry people thinking she was the Kings German mistress. She popped her head out the window ands shouted 2 Damm you Fools, don`t you know me I am Mrs Mapp" The crowd cheered and she drove off.
Sir Percival Pott wrote and criticised her calling her immoral drunken female savage. Her fate was sealed.
In 1736 she was at the height of her career but by 1737 the London Daily Post Dec. 22 she died in miserable circumstances in poverty.
In the 19th C people were fed up with medicine that just did not seem to be working. Although the knowledge base was expanding, the death rates and physicians tools had not really changed since the 16th C. In A. T Stills notes next chapter, we will see how he to was disgusted with allopathic medicine and like many others sort alternative ways to heal.
It seems bone setting opened the doors to the spark of osteopathy, but remember it is in context of the general beliefs of the day.
Look up and write notes on the history of
Reiki
Reflexology
Aromatherapy
Shiatsu
Zone therapy
Bowen
Dry needling
Auric Healing
Colonic irrigation
Are these treatments of value? What justification is there?
Infection
Back in the 1st C Ad Marcus Varro had warned people about invisible creatures that were not conducive to their health. In the middle ages lepers were shunned and people fled from areas of pestilence. It was Leewenhoek who saw through the microscope and described animalcules in the 17th C.
In the 16th C, Moffet described mites, and scabies; he advised sulphur treatment, which has remained popular for centuries. Moffett also described the animalcule responsible for silkworm disease but his notes and comments went unnoticed. Bassi followed this and even suggested other diseases were associated with other diseases but again was ignored.
The first bacteria study was undertaken in the 19th C by Davaine and Rayner who studied the rod shaped bacteria of anthrax and injected it into live sheep and killed them. They found the bacteria in the blood and when used again it reproduced in other to kill them.
The main stream of thought was spontaneous generation, ie life could occur from fermentation and putrefaction, a chemical process. Spallanzani in 18th C had showed animalcules could occur in flasks unless they were sealed and heated, the general belief remained strong.
Louis Pasteur and Robert Koch
The nineteenth century saw the origin of bacteriology. There was some previous work from Leeuwenhoek to show animalcules (1675), evidence that pox, syphilis and puerperal fever was contagious but no one thought it was the tiny animalcules that transmitted them. Fractorious had hinted at seeds transmission (1546) or fromites, Spallanzani showed hermitical sealed broth would not produce maggots but always counter arguments and no real shift of thinking. Bassi (1846) showed silkworm disease caused by a particular microbe.
Born in 1822 and was the son of a tanner. French and with a real hate of the Prussians. He was labelled mediocre at school (like Jenner), and went on to study chemistry where he made his first discovery. It was known that tartaric acid could polarize light, in two ways. He separated the two forms and showed they were two different types of crystal. Thus showing that there was a previously unknown form of tartaric acid that contained two types of crystal that neutralized each other’s polarizing effects. He acclaimed much fame through this finding. He went to investigate spontaneous generation, which although Leewenhoek, Spallanzani had written on was in debate. He showed that boiled tubes with air unable to enter showed no animalcules. Later employed to the French wine making industry to show yeasts were necessary for fermentation, to grow uniformly and without stray infections. Later employed by the silkworm industry to save infections there, he received high acclaim by isolating and preventing further spread. After that he moved his study to Leeuwenhoeks animalcules. He noticed puerperal fever swabs from the uterus all contained beaded animalcules. Semmelweis had already showed they were contagious.
1878 he stood and claimed that germs were responsible for infections.
Luck bestowed him again and when he experimented on cholera and chickens. Just before a holiday instead of injecting them with new germ, he used an old version. Later on re injection after the break they did not get cholera. He realized that this old culture could stop future cultures developing. He than read Koch’s discovery of the anthrax bacillus causing anthrax. He put two and two together and proclaimed in 1880 he could save cattle from anthrax. Premature and ridiculed he set up experiment. Koch openly mocked him. The German, French divide opened. Despite a stroke and age, he went on to work on the rabies vaccine. He died in 1885.
Robert Koch 1843 –1910
He was the first to show that germs were responsible for disease transmission. In 1882 he formed what is known Koch’s postulates that had to be demonstrated to show that a particular organism was responsible for a particular disease.
Koch was a slow methodical worker who for three years worked with a microscope and a few simple tools in a curtained off part of his consultation room. He isolated spores of anthrax, heated them etc and showed they could survive and later re generate.
Most microbes were cultured in liquid until Koch needed a solid medium. First he used a potato slice but later he used Alga.
In 1882 he showed the bacillus that caused Tuberculosis. The onset of a cholera epidemic saw him head to head with Pasteur team to isolate the microbe in which Koch won. He showed it communicated in water and vindicated Jon Snow. Later toxins such as diphtheria (introduced by Joseph Lister to England) were founded at the Koch Institute. Virchow worked with this and on the panacea goal of TB. In 1890 Koch found a substance that he called tuberculin, which could halt TB spread in a test tube. Before any tests could be done the government and other states all rallied him as a national hero. In one year thousands had received treatment but quickly it showed it did not work,. Koch left Germany with a new bride and fled to Egypt.
Paul Ehrlich joined Koch research team in Berlin in 1890. He dyed bacteria and saw what would seek them out. His research led him to believe in the antibodies that can kill bacteria. He called them Magic Bullets.
The Greatest Discovery of the 20th C
ANTIBIOTICS
The antibiotic changed people’s lives. It changes doctor’s lives and at last allowed medicine to flourish. From septicaemia to chronic sinusitis, antibiotics transformed our ways to allow us to concentrate on other aspects of distress and disease.
Following Leeuwenhoek and his discovery of animalcules in rainwater in 1675, Marc Von Plenciz statement that all diseases were due to them in 1762, and Bassi confirmation that silkworm disease was associated with animalcules in 1832 it did not take long for Koch in 1882 to determined that one could isolate and show a bacteria was responsible for disease. The most important step taken after that was Alexander Fleming’s discovery of Penicillin. Although it had been written about before in various forms it was not well known that Penicillin could prevent bacteria formation. Mostly as it was not known until Koch that bacteria was responsible for disease. In times past it was noted but not looked for and of course unless you look for something you often never see it.
Fleming was born in 1881 in Scotland. His love was swimming and rifle shooting. Graduated at St. Mary’s London in 1906. He was employed as an assistant in the inoculation department. Sir Almouth Allwright was the director of the department. Fleming was a quiet and soft man while working at St. Mary’s. His outside life was as socialite in Chelsea. While at St Mary’s he researched lysozme, an enzyme found in tears that inhibits certain types of bacteria. He bought art and artists gave it to him for treatment off their syphilis. He became quite rich this way.
One day Fleming opened his petri dish rubbed some straphycocci on it and closed it. It happened that his window was open and an expert on moulds working on penicillin was working downstairs. The tiny mould had floated up and landed in his dish. Fleming went on holiday for two weeks and left the dish on his workstation. The staphylococci usually would have multiplied a billion fold in the incubator but as he left them out they grew only slowly. On return in 1924 two weeks later Fleming noted although a huge ring of staphylococci had formed, a circle of emptiness surrounded where the penicillin had flown in. Fleming was lucky that he left the dish out, he was lucky that the spores flew in while he was scrapping staphylococci and it was staphylococci and not influenza or another germ untouched by penicillin. He was also lucky a heat wave heat London and broke the day he opened his dish to allow the spores to fall in. The cool air that followed the wave allowed the penicillin to flourish and inhibited the staphylococcus.
Fleming asked the question could it inhibit other bacteria growth and investigated. He noticed that the mould grew on broth and extracted the juice from it. By trail he found it most effective at eight days. He tested it against a string of bacteria and found it effective against some of the most deadly germs known to humans. He also found it incapable of inhibition with influenza TB and typhoid. He never tested it on Syphilis even though that was the area he was expert in. He published in 1929 and a small paper in 1932. Than he seemed to give up on the report. There was a view that chemicals would be too harsh to use in the body.
After that the discovery had to be started all over again by Howard Florey and Ernest Chain in Oxford ten years later. Florey and Chain, a Jewish refugee, investigated Fleming’s work on why lysozme could destroy bacteria. The Rockerfeller foundation took up their endeavours and helped fund them
They than went onto penicillin and injected mice with the drug. In 1940 they published their results in the Lancet. They found the urine of the mice had turned brown and when tested they found that the penicillin had seeped through the kidneys unchanged. It was concluded that this substance could thus be used on humans and be safe. However mid war and just post D-Day, no pharmaceutical company would produce it. Florey decided to make it in the laboratory in Oxford. He committed the staff and lab to it and by 1941 had enough penicillin to use. Later when they thought that Britain may be invaded they spread some on their jackets in the hope that one of them may get away to America and carry on the research there.
On December 1941 Albert Alexander became to first person to be treated with penicillin. He was a police officer who had scratched himself on a rose. The wound turned septic and it looked as if he could die. His eye had to be removed; he coughed up phlegm and pus and was in great pain. Charles Fletcher administered penicillin every three hours. Mr Alexander urine was collected and the penicillin removed to be used again. By day four he was strikingly better, but by day 5 penicillin had run out and he deterated and died. Over the next few years this chamber of horrors associated with infection began to ebb away as greater amounts of penicillin became available.
Throughout the war the penicillin girls rolled the bottles and as the bombs dropped the factory was luckily never hit.
Fleming was one of the few scientists ever to be buried in the crypt of St. Paul’s in 1955 when he died.
Eventually Florey went to the USA where four chemical companies took him up on mass production.
The unanswered question lies on why these micro organisms exist. As yet no on can answer that.
History Of Surgical Anaesthesia
Since ancient times, medical men and women had sought to reduce pain, by substances like alcohol and opium. The trepanned skulls with evidence of bony re-growth shows that some form of anaesthesia must have been present as operations like this would be excruciating. Splints in Thebes in ancient Egypt have been found packed in herbs. Perhaps these were pain relieving. The Chinese tell of their Generals distracting themselves as a show of power while operations occurred. The Greeks and Romans were thought to supply herbs to relief pain, or put a patient to sleep. The Greek army surgeon, Dioscorides was the first to use the term Anaesthesia.
In England a Saxon book in the 11th century relates packing a finger etc. in snow to null the pain. In middle ages they drank “dwale” (opium and other herbs) to null it. It should be of note that the book describes the collection of this plant. In it states that the spirit of the plant would shriek as you pulled it and any in earshot would die. Thus dogs were used to collect it. The concept of pain as a God blessing date as far back to early Christian teachings so often it was looked at as a good thing. Suppressing pain by herbal practise did not seem to spread and although the herbs were supposed to have used herbs to relief pain in the form of sponges called soporific sponge, evidence shows they were not effective. The Christian monks introduced them in Europe about 13 –17th century. As recently as 1591 Eufane MacAyne was buried alive for asking for pain relief during birth. Angus Simpson a Scottish doctor was burned at the stake for trying to relive the pain of childbirth.
As surgery advanced it was not halted by pain, but it must have made it unbearable for the receiver.
The first recorded advance must be Raymundus Lucius a Spanish alchemist in 1275, who mixed sulphuric acid and alcohol to produce ether. It was Paracelsus who used ether to relieve pain in 1600’s, he used it medically not surgically and it was forgotten about for another three hundred years.
By 1660, Wren and Boyle describe using intravenous opium to stupefy a dog. Stephan Hales had described blood pressure in horses and other physiological experiments were on the move. None had been transferred to humans yet.
1772 Joseph Priestly invented nitrous oxide or laughing gas. He managed to upset the state by implying in his religious beliefs that Jesus was a man and not god all-powerful. The Christian church revolted and he fled to the USA. He helped found Pneumatic medicine or medicine from the inhalation of gases and when of its lead exponents was Thomas Beddoes (a neighbour of Jenners). Beddoes, a liberal like Priestly was forced to leave Oxford as reader in Chemistry and travelled to Bristol to open the Pneumatic Institute which Humphrey Davies was superintendent. In 1799 Humphrey tried inhaling NO and found its anaesthetic properties.
In 1800, Davy published a book on the chemical, physical etc effects of what he called laughing gas. He never pursued the idea and concentrated on more chemistry and poetry. He invented the Davy lamp, was awarded fellowship of the Royal Society and approved Jenner’s work on bird migration, just after Jenner had died.
By the 19th century tours of laughing gas and party’s were occurring.
There seems debate unto who used ether as an anaesthetic first. In 1840 in America a dentist called William Clarke used it. Miss Hovey became the first person in history to have a tooth extract using anaesthetic in 1842. Crawford Long in 1842 (two months later) used it as a general anaesthetic to extract a neck cyst on James Venable. He continued to practise surgical anaesthesia until 1878 when he died.
In December 1844 Horace Wells went to a fair and saw the effects of NO. He volunteered himself and had a tooth extracted. He demonstrated this at Massachusetts General Hospital in January 1845 but his subject woke up and screamed. Wells was ridiculed. He ended up addicted to chloroform and was jailed for hurling sulphuric acid at prostitutes. He committed suicide in jail.
His former college William Morton discovered with Charles Jackson that ether worked better. He successfully demonstrated ethers use in dental anaesthetic in 1845.
By 1846 ether usage spread to Europe and on Decembers 15th 1846 was used in Paris, London four days later. Anaesthesia became accepted but ether that irritated the lungs was replaced with chloroform. It was not felt universally accepted. In the Crimean war in 1856 the surgeon general felt the shock of the knife was better.
John Snow in England advanced on the administration of chloroform and published its physiological effects. Sir James Simpson started to use it for obstetrics. The Calvinist Church opposed him on the grounds that the bible was relief enough and said women should bear forth in pain.
1853 Simpson administered chloroform to Queen Victoria under John Snow. The Calvinists remained silent from than on. Chloroform however had side effects and it was found to increase liver problems. Coca leaves were tried and their active ingredient cocaine extracted. It was patented and marketed by Merck in 1885.
Other advances included placing a tube down the lungs, entering the trachea so chest surgery could be done and the lungs ventilated. Various side effects did occur so new drugs were sought.
By 1917 Trilene was used, by 1931 divinyl ether. Cyclopropane was used in the 30’s and 40’s. Halothane is mixed with No and oxygen to be administered to patients. Now pentothal is used to put a patient to sleep before general anaesthetic so to be distress free.
Acupuncture is also being investigated.
The Anatomy Act
1832
By the 18th C barbers would be involved with minor surgery, burns, fractures etc. Bladder stones the size of golf balls would be removed. These were so painful that patients knowing death may result still tried surgery. Willaim Cheseldon (1688-1752) a English surgeon perfected bladder stone cutting, lithotomy. He would insert a metal tube in the penis and slide a cutting blade next to it. Cutting the perineum revealed the bladder and the stone removed. It is said it took him under two minutes. Other operations were done such as mastectomies and amputations.
In 1735 he opened an anatomy school for training surgeons and cut all ties with barbers. Within five years many more opened. However the only place to obtain bodies legally was from the hangman’s noose. (this was at Tiban near marble arch).
In 1815 the Apothecaries act determined all apothecaries (G.P’s) should be licensed. Not only did they need to attend lectures in Anatomy, medical theory and practice but they were to undertake six months bedside watch. By 1830, 400 people a year were taking the LSA (Licence of Society of Apothecaries).
One of the problems with the rapidly growing field of anatomy was the lack of bodies. It was said that if you were dismembered you would have eternal damnation. Even criminal families cowered against the dissector. Art also called for bodies, as they wanted more realistic pictures. Bodies would be cut boiled and flayed to allow a in depth study of them. As only six bodies a year could be taken from the hangman, and with tens of new schools, bodies became in shorter and shorter supply. Grave robbers begun to appear. They were paid up to £7 an adult and per inch for children. The poor who were buried in just a foot of earth protected their graves and organised watch towers and vigilant.
The Hunter brothers were from Scotland, John and William. William Hunter opened the Windmill School of anatomy and was the foremost obstetrician of his day. He learnt and eventually out fashioned his master, Willaim Smellie (inventor of the English lock). The windmill school was the first medical school in London. John learnt his anatomy at his brothers school. William Hunter and John Hunter were two brother who were vicars. Later they became surgeons. William Hunter built a huge collection of anatomical bits and displayed them to the public. He injected specimens with bright liquid which was mercury and found a new form of transport which was the lymph system. John Hunter studied the deformed and abnormal. He toured freak shows and asked one giant called Burns for his body. Although it was denied, he later bribed the undertaker and displayed it for all to see. After this he had a short spell in the army where he introduced the ideas that arteries should be tied up before the aneurysm. He studied under Sir Percivel Pott and Willaim Cheseldon. John kept menageries in Earls Court for his animal experiments and gathered a huge collection of specimens for show. John Hunter also inoculated himself with pus from vaginal disease. He had both syphilis and gonorrhoea from his efforts and slowed them down with mercury. Thus he managed an account of the slow progression of the disease. He is called the founder of experimental surgery.
It should be remembered that signs and symptoms were indistinguishable at this time. Diagnosis could be done by phone and post. Therefore the symptoms described were deemed very important in diagnosis.
Edingborough was by then the top university for surgeon. They would earn the equivalent of £500, 000 today. But even famous anatomists such as Robert Knox fell foul of the body snatchers who would resurrect bodies for a price.
The most famous were a pair of flat mates called William Burke and William Hare. When an old man died in their house, they thought of bypassing the grave and selling directly to the anatomists. Later they turned to murder and suffocated their victims to conceal foul play. The price was £7 each. They were bought to justice, Hare, turned kings evidence, Burke was striped flayed and his skin was sold by the strip. Of the bodies they murdered the police found the final body in Knox’s dissecting room. The public burned his house and forced him to flee.
The fight for the dead bodies of the diseased were fought for from about 1829. A bill passed the House of Commons but was stopped in the Lords as it was unfair on the poor.
The anatomy act in 1832 gave the anatomists the right to claim unclaimed bodies. But it did more than that. It was a landmark in the acceptance of doctors need to knowledge of the make up of the human body. It nearly stopped the illegal trade of bodies. Regional inspectors kept the law and dissection was only permissible with the acceptance of the next of kin and must be greater than 48 hours after death. However murderer’s were used previously for dissection so for the poor the stigma of being used medically was an extra insult. In workhouses inmates could sign and write a declaration in front of two wittiness to prevent they body being used but as many were illiterate this proved worthless.
Had the act allowed for an opting ‘in’ instead of by default the act would have failed. (Richardson 1991). What’s more the consequences were a stigma for punishment and poor once more paying for there wealth. Secondly more dissection was done, outstripping the number of bodies and which lead to body snatching again and the fight between hospital school and private teaching clinic in which the hospital school won. It lead to trying to preserve bodies for longer and utilisation of formaldehydes to do so.
The apothecaries also lost out as it was the physicians surgeons who were allowed to claim bodies not them. It placed one more wedge between them.
Finally the act caused public riots, burning of anatomists houses and their schools.
The tradition of anatomy lived on and Henry Grey who later died of smallpox produced his works in 1858.
Overall the public has changed with time to give there body up to dissection.
The body snatching profession still goes on. In 2001 Liverpool hospital were accused of taking parts of babies without consent on over 800 families.
There are no questions over this section for you to hand in. Providing you have read and digested a little of what is in the hand out it is enough. My hope is you will use this as a resource guide in the future.
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