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News, Notes and Next from Arizona Theatre Company
Winter 2007
Volume XXI - No. 2
DR. JEKYLL AND MR. HYDE
Victorian Medicine – Medieval to Modern
By David Morden
The 19th-century was a time of monumental progress in science and medicine. Advancing from what has been described as a “medieval” system of care to fact-based practices based on a blossoming knowledge of life on a molecular level, medicine was – to say the least – far more effective and humane by the dawning of the 20th century.
The 19th-century was, of course, the era of the Industrial Revolution and cities at that time were growing at exponential rates. Many health issues of the day were related to a larger number of people living in smaller areas. The accompanying dilemmas of poverty and sanitation offered the medical world many new challenges not faced before. Smallpox, typhus and tuberculosis were endemic; London endured three cholera epidemics in the course of the century (1832, 1848 and 1954).
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| Among the most popular treatments that doctors might recommend in the early 1800s were a “change of air,” vomiting, laxatives, bleeding or leeches. It was commonly thought that illness was brought on by noxious odors, or miasmas. While this seems unsophisticated today, methods of treatment for sewage and garbage were still fairly rudimentary at the time and disease was, indeed, spread through the bacteria that thrived in the water and air. Though a physician of that era may not have realized that a “change of air” moved a patient further from a potential source of contamination and infection, the practice did sometimes affect a cure. Other popular methods of diagnosis and treatment included phrenology (study of the bumps of the skull), hypnosis and spiritualism. |
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In general, there were three tiers of medical practitioners in London. Doctors and physicians were on the highest rung of the social ladder. These highly educated gentlemen consulted patients and offered diagnoses, but did not perform any sort of manual labor, such as setting bones or surgery. They often attained their degrees at England’s most prestigious universities and were not required to apprentice in the profession. They maintained a room in their residence for treatment, called the surgery (even though they were not, in fact, surgeons).
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Surgeons were a step down from doctors and were required to undertake a more extensive practical training – usually being apprenticed in their middle teens. They observed established surgeons, read extensively from his library and acted as his assistant. Surgeons dealt with some of the more immediate medical needs of patients, including stitching wounds and pulling teeth. Surgeons often acted as apothecaries, as well, selling drugs and advice. In 1815, the Apothecaries Act provided licenses for practitioners who “walked the wards” of a medical establishment for six months. As time passed, the line between surgeon and apothecary blurred and the two professions merged into one: general practitioner.
Nurses, while not unknown during the18th-century, did not find their rightful place in patient care until Florence Nightingale led ten women nurses into the Crimean War. Afterwards, she was given funding to start a nursing school, and the role of the nurse as a medical professional was firmly established. It also gave women of the time one more viable option for career choices. |
In 1854, when London was in the throes of yet another cholera epidemic, John Snow began to map the progress of the disease in Soho. He found that the affected cases were clustering around a specific point – a single, contaminated well. This led to the affirmation of a theory by John Snow and William Budd, that illness was caused by living organisms in the water (i.e., bacteria). The well’s water-pump handle was removed and, indeed, the epidemic subsided. The discovery and identification of microorganisms, however, was initially rejected by the scientific community – though it did lead to the practice of boiling water before use.
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In 1861, Louis Pasteur published his Germ Theory. This was a radical departure from the accepted ideas of the day and people found it hard to grasp the notion of organisms which they could not see being present in everyday life. Improved, more effective microscopes that were capable of identifying microorganisms were being developed throughout the century, allowing scientists to identify the bacteria responsible for the most aggressive diseases of the era. This led to the concept of sterilization and antiseptic surgery. Louis Pasteur began to boil and scrub his surgical instruments before and after operations; the practice became widespread when it was seen to reduce the rate of infection.
Other breakthroughs in the medical world included the invention of anaesthesia in the late 1840s. Ether was used initially, with chloroform soon becoming the anaesthetic of choice. This allowed surgeons to operate more slowly and carefully on patients.
19th-century London also saw the beginning of regulation of the medical world. This began with the establishment of the British Medical Association in 1856 and the General Medical Council in 1858. Medical training became more formalized as medical schools came into existence and the number of doctors increased markedly in the last half of the century.
The last part of the century witnessed a revolution in the development of vaccines, allowing prevention to become a major part of the medical culture and ushering in the modern medical breakthroughs of the 20th-century.
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