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Hello, everyone, welcome to Dan Snow's history hit in the 19th century, the world was in the grip of the industrial revolution. There was a fire power revolution on the battlefield and at sea. There was a communications revolution going on as railways and telegraph banned the world.


But there was another revolution as well for the more I'm not thinking of. But there was not a particular revolution. There was a medical revolution, the medical revolution that saw giant strides made in the fields of public health, but also things like surgery and pharmaceuticals as well.


This is a very, very popular subject for UK students take at school. And so, as we've been doing every Friday for the last few weeks, we're doing a lock down learning episode.


We want to support students, teachers and parents as we all navigate our way through these crazy times. I've got the wonderful Monica Walker on the podcast now. She works at one of the best museums in London, the old operating theatre. It's one of the hidden gems of London. When you're next in London, folks go to the all operating theatre when it opens. And she talks to me in this episode about just what happened during the 19th century that took medicine into a completely different realm.


This episode has been recorded in response to many of you requesting it. We hope it's useful. Don't forget the wonderful Simon Beale, history teacher in the UK, has produced a worksheet to go along with this episode, Absolute Hero. Well done, Samuel. That Workshy is available in the description for this podcast. Just click on that link and go to Google. Doc, if you listen to the other lockdown landing episodes, please check Thede wherever you get your pods.


If you want some history documentaries, head over to history hit TV. We've actually got the most watched documentary of all time. I mean, we do have a lot more subscribers now than we did a year ago. So I suppose it's inevitable. At the top of the charts will be dominated by the more recent releases that we've got an episode about the Bronze Age, the first Britons that is actually our most popular ever documentary that we have made and posted on the history hit TV.


So please go and check that out. And if you want to come and watch a live tour, you have announced dates for the autumn in all of Britain's biggest cities. You can love it. Come and watch an episode of the podcast being recorded and come and listen to a wonderful historian tell you all about the history of the city in which we're recording. Go to history at dot com slash talk. But in the meantime, everybody here is the very brilliant Monica Walker talking about 19th century medicine.


Enjoy. Thank you so much, Monica, for coming on this special lookdown learning version of the podcast. Perfect. Thank you so much for inviting me. Pre modern medicine has got a pretty bad reputation, hasn't it? Before we talk about the kind of 19th century we were focused on today, where are we at the end of the 18th century, the Georgian period, we think about the madness, Georgian thermal treatment he received. What is the state of medicine?


And if you're sick, can doctors actually do anything to help you in this period?


Well, the sort of medicine before the advent of change that happened in the 19th century was definitely kind of grim. We are talking about a time period where people are still looking into their old traditions of Glienicke medicine. So basically, physicians created a type of diagnosis based on the humeral theory. You pretty much mentioned that the body is divided between four humerus. You have like biology Lowville, you have Flem and you have blood and that all diseases can be explained because there is an imbalance of the humerus.


And of course, what the physicians will do at that point when somebody came to them will be to make kind of like a holistic assessment. OK, so let's see. Do you have a cold? Do you have a fever? Your sweaty, your moist, your hot. That pretty much means that you probably have some sort of excess of blood. So how do we cure an excess of blood, Will? We'll just either apply leeches to you or we'll do some bloodletting just to make sure that you take all of that excess blood out.


And of course, that was probably the preferred method of treatment for something like a fever. It was just going to make you a little bit more uncomfortable, probably making things a little bit more difficult for your body to recover. So the good thing about the humeral theory and the way that physicians apply it is that it also looked at things like diet and you also look at things that lifestyle. And sometimes even though that some of the treatments obviously did not work that well, on the other hand, some of them could have like a beneficial effect, especially because they will basically suggest what you should eat, these kind of foods that is going to help you.


So that's more or less how medicine was at the turn of the 18th century, especially with physicians.


But some of that foodstuffs probably quite useful. Were they recommending the wrong food, irrelevant food?


Oh, no. They would work on that sympathetic magic. So basically, the idea that, for example, is something is red and you're suffering from loss, that eating something that is red is going to help. So maybe someone that has suffered this loss can actually be recommended to eat red meat, which of course, he has IRA. And so in a way it could actually work. But in other ways, some of the other treatments that they had were horrendous.


Where, for example, if you were suffering from something like syphilis, this comes a little bit later. But the treatment with mercury became quite extended afterwards. So they're trying to sweat it out by rubbing your entire body with mercury, which, of course, is also poisoning you. So it's just not the best answer to disease.


OK, so in eighteen hundreds, if you get a disease going to a really expensive doctor, it may even do more harm than good in some cases, quite possibly, because as with every other profession, you do have good doctors and you do have bad doctors in the sense that they were trying to help. I mean, herbal medicine has come a long way. We're talking about herbal remedies being used by the apothecaries at a time period which had been more professionalized and understanding what type of plants could have some sort of beneficial effects in the human body.


I mean, I don't know about a lot of people, but I still swear by Camomile when I have an upset stomach. So, I mean, a lot of these things have had a really long standing tradition of certain types of herbs that are actually quite good for the human body. So it was kind of like a 50 50 in a way. This it's a lot of trial and error. Sometimes things worked, sometimes to just didn't. Sometimes it was just a bunch of quacks trying to extort money from the poor people that could not afford a physician or even an apothecary.


And sometimes you actually did get the occasional kind of like healer that was capable of actually helping out a little bit.


Let's talk about the 19 Centrino, which I know is on lots of people's syllabus. What happens in that vital hundred years? That means that by the end of it, doctors are pretty much for real. You can go and get yourself sorted out. Absolutely.


Well, the 19th century saw an incredible amount of change taking place at various levels. Obviously, physicians are starting to work more and more and more on an observational basis. So the birth of clinical trials start to take shape. So it's not just that they're Langlands following Galani medicine from the past, although the humeral medicine still is quite important throughout the period. I mean, Centavos, this hospital spent I think was about five thousand pounds or in purchasing over one hundred thousand leeches for treatment.


So we still see that leeching or letting still kind of like a fairly popular remedy to. With some of the issues, but at the same time, we see more and more that physicians are trying to use more observations and they're trying to take more time recording those observations. And so instead of just blindly following what others have said in the past, they're taking the time to continue to do this clinical test, this trial and error. And this doesn't happen overnight.


This is a process that gets its roots already in the 18th century, towards the end of the 18th century, and then it just moves all the way into the 19th century, working its way quite successfully towards modern medicine. But the changes are incredible. So you have these trial and error is being done by physicians trying to figure out the causes of disease, trying to figure out how to best treat their patients that you have on the one hand. Then on the other hand, you also have new advances made in surgery where originally surgery was done to cases that have absolutely no other way of getting fixed.


So let's just say that someone has to get into an accident. And of course, they have gotten a compound fracture. That pretty much means that the bones have splintered and they have opened and gone through the skin. I, I should have said Akhaten warning there. But there is no way of setting those bones back. And of course, because in the early 19th century, there is no understanding of germ theory, it pretty much means that a lot of these cases got infected, got gangrene and died quite a slow and painful death.


Now, when the surgeon saw this, they couldn't make the decision of actually doing a surgical procedure, which involves amputating the leg in the case of an accident where the leg has been fracture and of course, surgery had to do quite fast. You had under two minutes to complete the procedure because you had to take into consideration the blood loss and the pain, as in the first half of the 19th century, patients will undergo these kind of surgical procedures without any sort of anesthesia.


So there will be completely awake. There will be seeing what is happening to them. And of course, there will be very little as in terms of pain management at that point. So in order to avoid shock or an excessive blood loss, for example, the one thing that the surgeons had going on for them was to be very speedy and therefore most operations had to happen under two minutes, which was quite fast. If you think about trying to amputate a leg or something like that, but they were absolutely capable of doing this and some of them were really good at it.


You have the example of Robert Liston, who is supposed to be the fastest knife in England, who was able to amputate a leg in almost under 30 seconds. I mean, this is like incredible feats that they managed to do. But the risk to the patient was quite high. Regardless if they didn't die of shock in the operating table, they could die of a loss or later on they could die of the infection. So at the beginning of the 19th century, we still have a lot of challenges that are present to the physicians and of course, also to the surgeons.


What are the developments through the 19th century that are transformative and what are the most important developments, do you think?


There's two extremely important developments that take place in the 19th century, and these two are the two that really change and reshape the entire history of medicine in a way. On the one hand, I would say the introduction of anesthetics into surgical procedures, because these definitely revolutionized in many ways how surgeons approach surgery. So before the introduction of anesthetics, like I mentioned, the surgeons didn't have the chance to take their time. Everything has to be fast. They had to be quick.


Only three different Draycott procedures were allowed to me, the removal of bladder stones, the amputations, and, of course, anything that's external to the body as well as trepanation. Somebody hits you in the head and you can actually open up the cranium and allow the excess fluid to come out. So these are the only options that they will did. And they were considered to be the last ditch effort to save someone's life. If you had to be an operating table, you were already dead, so to speak.


So this was your last chance to survive. Then, of course, in the middle of the 19th century, you actually have the development of anesthesia first tested in the United States by a dentist, by the name of Morton. He basically used substantial ether in the removal of a tooth were it basically lessen the pain of the patient.


This was done in September 1846. And very quickly, that use of this new agent, Ether, reached the UK quite quickly. Actually, by December, the first attempt had been done as well by a dentist. And then Robert Liston, who I already mentioned, also introduced it as a way to see how it will work also in surgery.


So if you anesthetize somebody, yeah, you can put them under and then you can get to work on them. So you can chop someone's arm off. You can drill through the head. Thank you, troponin. But now that you got anesthetics, what you can open someone's torso up and able to root around, get their appendix out, have a little check what's going on elsewhere. Exactly.


It actually gave surgeons the ability. First of all, the patients, the. We have to move, so originally what the surgeons will have are what we call Dresser's, which are basically his apprentices holding the patient down while the procedures are being taken care of. And if it's a very strong patient, it's like it doesn't matter how composed and how mentally prepared you are to undergo an operation without anesthetics, it is going to hurt and your body's going to tense and you're going to try to move because it's the normal human reaction when we are faced with pain.


Right. So having all these people around as well, holding you down, it does impede in a way, the actual process of surgery from the actual surgeon. Now that the patient has gone under and it's not moving, it pretty much means that they have a better chance of starting to do more internal medicine, because up until now, most of the surgeries have been more external, like with the limbs and very little things that they could do. But now, because they're not moving, they're also not feeling pain while this is happening to them because they are under, then it pretty much means that they could take longer.


And of course, this is when internal medicine starts being a thing. But we still have at least three really big problems. One of them, of course, is they still don't understand how to replenish blood at this point. So there are no blood transfusions. So the loss of blood is still a really high risk when you actually start doing these internal surgical procedures in the early stages of the introduction of anesthetics. So blood loss is still a thing, as well as the fact that because they are opening deeper into the human body, but we still talking about a time period where antiseptics had not been introduced.


It pretty much means that you are allowing for germs to actually get further into the human body and attacking more delicate parts of the human anatomy. And, of course, infection increase exponentially after the advent of anaesthesia because it's not aseptic. So all the germs are still all around. Surgeons were wearing coats filled with blood and pus from previous operations. The instruments were clean after the operation. But if you were the first one, yeah, fine. You may have a clean blade, but if you won the second one or the third one, you will be cut with the same blade that is already bloody from the previous operation.


So is quite a circumstance where you think about the fact that, yeah, the patient may have gone under. Yes, you can actually stay longer and check for more internal medicine, but at the same time, the chances of infection increase exponentially, the chances of blood loss increase exponentially, not to mention the fact that there is a very big possibility that your anaesthetist, although they were not called anaesthetists, but the person that was giving you the anaesthetic substance, which at the beginning was ether by later on to chloroform, could give you an overdose and killed you even before you had a chance to go through the surgical procedure.


So it's an important step within the 19th century, the introduction of anesthetics. But with that alone, it was not going to get ahead as much.


You're listening to dance news history here and got Monica Walker on talking about 19th century medicine, though it's useful for all the students out there.


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Don't miss this out people this is special offer. Get involved. Hello Fresh America's number one meal kit. But what about antiseptics, when does that start to come and when do we start to learn about cleanliness? This is really good because this happened simultaneously. This is a really strange thing. So I'm just going to see if I can explain it in a way that sees how great this was in the second half of the 19th century, because the introduction, of course, of anesthetics happens in eighteen forty six forty seven Christmas around Christmas time between forty six and forty seven.


Right. We'll give you that. That's OK. Yeah. And then of course we are going to see that we Sebesta is already studying the development of germ theory in France and he's actually discovering that these microorganisms are the ones that are actually causing the infection, not what they used to think, which was the idea of miasma theory. A lot of surgeons and physicians thought that my asthma theory was the primary cause of disease and also of infection. And my asthma theory pretty much says that diseases were transmitted through foul odors.


So something that was really, really, really smelly could actually be the carrier of the diseases. So if you put in those two things together, something that smells really bad, then you have this idea of my asthma theory and you must believe that that's how infection was transmitted and how it got started. Well, Pasteur discover it wasn't spontaneous, that they thought that it was going to be basically just look into it and discovered there were microorganisms that were actually producing these infections.


And then here in the UK, we actually have Joseph Lister, who is very concerned with this idea that trauma alone could not be the reason why restrung men keep dying in the operating table, took many years of research and study trying to figure it out. What was it that in the end took away the lives of so many strong men that had gone through surgical procedures? And, of course, it was infection, but at that time it wasn't well understood.


So he basically started reading Pesters theories and he said, well, if he's right, then he pretty much means that this infection is actually taking place while I'm operating. So he came up with the idea of introducing carbonic acid into his operations. What he used to do is that he created a machine that will spray carbonic acid in the space where he was. So the idea was that carbonic acid is capable of killing germs. Then he also kind of like dip his hands and his instruments in carbonic acid as he was doing the whole operation.


And then he made his rest, the bandages that they were going to use in carbonic acid as well, which pretty much means that throughout history of procedure, the amount of germs that surrounded him and his patients had minimised. Because suddenly you have the introduction of these antiseptic that, as a matter of fact, increase in many ways the survival rates of his patients. But again, this is one of those things that the introduction of antiseptically by themselves, we're not going to be enough.


At the same time, you actually have a movement in the rest of England about how hospitals should be designed and how this idea of my asthma theory makes someone like Florence Nightingale think that, well, hospitals needed to be clean, they had to have open windows. So there is this idea that if there is no bad odors, there is no way to transmit diseases. And therefore, cleanliness becomes a really important aspect also within the hospitals. And this is a parallel development.


You actually having these ideas at the same time that we see the introduction of antiseptics, at the same time that we see these introduction of cleanliness in the spaces inside of the hospital that need to be increased. And then suddenly, instead of having great spikes of infection rates, they start to drop. And of course, suddenly we are going to see that towards the end of the 19th century, the beginning of the 20th century, instead of just doing antiseptic surgery, they actually understood that what they needed was to have aseptic surgery.


So literally nothing could enter into the operating theatre, the operating table. So the surgeons had to have their head covers. They had to wash their hands before they did that, have all of the instruments wash before the operation. And then with the introduction of anesthetics and antiseptics, that's when everything is revolutionised in a way, at least in the surgical department throughout the 19th century. Plus, these new kind of ideas surrounding cleanliness inside of hospitals just all comes together to make the perfect storm for the development of the type of modern medicine that we have come to know.


Well, that's fantastic. And now let's move on to when you talk about cleanliness and cleaning up the environment. That brings me what kind of public health. So surgery that's dealing with your appendicitis or something wrong with your body. What about looking more generally in society, these terrible waves of pandemic disease or in the military sphere? Armies would get incredibly sick when they gathered together with gastrointestinal diarrhoea, dysentery. How do they get a handle on that in the 19th century?


That one is a really amazing question because we also see the. Century becoming the time period where we actually have the introduction of the actual public health that is literally in the hands of the government as opposed to localized associations that were trying to relieve the poor and things like that, we actually see that at least in the United Kingdom, they actually try to come up with a public health body that was an official government public health body to deal with issues like controlling of disease and, of course, to alleviate these areas of transmission.


And we know, for example, that the 19th century is quite famous for having constant cholera outbreaks that were brought in from the east. And of course, a lot of this cholera outbreaks seem to be very much connected where the poor lived. And, of course, we know for a fact that England was extremely industrialized. And, of course, cities through London was huge. It attracted a really large amount of people. But of course, those that couldn't work ended up living in slums with overcrowding.


Places that didn't have a proper sewage system, places that the moment that you have someone being sick because of the conditions in which they were living, that it spread quite quickly. And therefore, a lot of people saw that it was the fault of the poor that I love. This is this is where taking place. But a lot of men actually decided, no, we have to find out real reasons. How can we stop the spread of these different pandemics?


How can we make things better for the poor that we have in our country? And so, again, this idea of miasma theory also helped in the introduction of going into the slums and actually cleaning them up, creating sewage systems, having running water and just trying in general to ameliorate the lives of the people that were living in those areas. Because, of course, if it's because of foul odors that diseases are transmitting, then it comes to show that if you actually have clean roads, clean environment, and you change the way that they live, then there's a big chance that poverty and disease and illness could actually be separated because one does not need to be the reflection of the other.


So, yeah, in the 19th century, we actually see for the first time that the government creates a new body that is going to study the causes of illnesses and trying to prevent them by establishing a number of things like Switches and Clearwater's and of course, ensuring that there are enough doctors in an area that people can actually go to in order for them to feel better.


So diseases like typhus and dysentery can be hugely improved by Clearwater. Getting rid of all the excrement. Yeah, the poo in the way off the streets, get rid of it all on personal cleanliness, uncleanness of your situation. OK, so we've done surgery. We've done some public health drugs. What about medicine? It's kind of a 20th century thing, that stuff in the 19th. It depends on what we're talking about.


The 19th century actually saw a great number of new plants being introduced into Europe. We are talking about plants that since the rediscovery of America, people that are troubling are bringing plants with different properties into the UK, which they start to experiment and start to develop. We have more morphine. We have the introduction of more opium. We have the introduction of cocaine. And even though today we actually know that these kind of drugs breed dependency in that time period, a lot of medicines actually contain some of these properties.


As a matter of fact, there was an ad to give opium to fussy babies. Oh, do you want your baby to come down here, give them some opium? So, yeah, they are starting to establish some of that chemistry, but it's going to take a little while longer before we actually have a really good handle on what all of these different plans can do. There's a lot of trial and error, obviously, with absolutely everything. Some things work and they continue to use them.


Some things don't work or they give you more symptoms, so they start getting rid of them. So again, we actually see there is a lot more science going into how people actually deal with things, not just repeating things from the past, but actually putting together all of these different elements into like a scientific method and started developing these kinds of drugs. But definitely the twentieth century, it's much more connected with the development of more effective drugs to alleviate the symptoms and in some cases of diseases.


OK, well, let's finish up now with vaccines. We're all talking about vaccines at the moment. Everywhere in the world. We're vaccinating ourself very successfully, we think, against covid. Tell me about vaccines in the 19th century and perhaps just right at the end of the 18th century. How important were they? What were the diseases they start to take on?


The most important diseases that started having vaccine quite early on is going to be smallpox. Edward Jenner was the one that basically in his studies, like he was practicing medicine, kind of discovered that the milkmaids that used to have this disease called cowpox did not get smallpox. So he started experimenting and he actually inoculated one of the neighbor's kids with a small pox. So he basically introduced cowpox into his bloodstream and then exposed him to smallpox and he didn't get smallpox.


So he started understanding how vaccines starting to work in that way. And so very early on, he tried to show his results to the Royal Academy. First, they did not pay much attention to him, thought that it was a fluke. But again, he did try very hard and in the end, the idea of vaccination became quite important because for those who have not seen people suffering from smallpox, it is quite a horrendous disease in every possible way.


And by the middle of the 19th century, the government actually created the Vaccination Act, where every parent was required by law to vaccinate their child in the first three months of life. And if they fail to do so, they will be fined. So smallpox is one of those diseases that has been eradicated because everybody follow the instructions. In some cases, yes, of course, it was always even that time period movement against vaccination. But the truth of the matter is that it was something that was quite demonstrable, that it worked and therefore, like everybody should be doing it.


And I think that that was one of those time periods when that was proven to be the case.


Okay, Monica, this is a question of left field to end up on here. We'll say, oh, the modern times, everything changes so fast. It's unprecedented. If you were born in 1881 and you died when you were a hundred and nineteen in that extraordinary lifetime. What do you see? More medical transformation revolution than someone who's 100 right now going back 100 years to 1920?


That's really difficult because in the past 100 years, Medicare has Abad's at giant steps. We're talking about people that can actually be in Australia doing an operation in London. It is incredible what people can do today, even though we don't see it as much, because, I mean, we see it on the news all the time. But sometimes the general public doesn't see all of the advances that are taking place in medicine unless they actually need some surgical advancements.


Meanwhile, in the 19th century, people were very much aware of all of these new developments because they saw them as the sign of progress, a sign of modernity. So the news we're always talking about this new developments in medicine, this new the in public health. So it would have been something that people would have really paid attention throughout the 100 years that we were talking about. Once things started moving, they really started moving fast. Although I would say that I think that person that has lived for 100 years now, we have seen a lot more changes, much more rapidly than someone that has been living in the 19th century up until the early 20th century.


But still quite impressive because we're talking about two hundred years of history, of medicine and in a way, how fast things have changed in those 200 years. It's not that long ago, just a couple of lifespans, really, two or three lifespan. Exactly. We have transformed life on this planet. We have no idea with this crazy journey. Exactly. Thank you so much, Monica, for coming on this podcast that was of interest to students, teachers and parents helping students in this tricky times of the moment.


Tell everyone about the old operating theatre museum is one of the best kept secrets in London.


It certainly is. I think that there's one thing to be telling you about history, but another thing is actually to be in a space where you can actually see it because it happened there. So London Bridge has in the church of what used to be also Thomas's hospital and the Church of St Thomas's in the attic there is the oldest operating theatre is still in existence, which predates anaesthesia and antiseptics and is a treat to actually be able to go there because you actually feel that you step back in time.


We have a whole section dedicated to the history of pharmacy, obviously, because it used to be a herb garret. So the apothecaries would drink your herbs there as well and use it for medicine making. And then he became an operating theatre for the women's wards in twenty two. So it's still there. And it's a fascinating space to experience history because there's no other place in Europe where you can actually go and experience this before the advent of anaesthesia and antiseptics.


So when we reopen, hopefully after the May deadline, I hope that people can actually come and join us there to really understand how dire things were, but also how incredible the flavour of all of the medical practitioners that there was and how important that was.


I've been to thousands of historical spaces all over the world and very few of them are better than the old operating theatre in London. So.


Oh, thank you.


Thank you very much for coming on the podcast. Thank you.


And allow us to create a strong bond in the history of our country. Of. Prime Minister, quick message at the end of this podcast, I'm currently sheltering in a small, windswept building on a piece of rock in the Bristol Channel called Lundie. I'm here to make a podcast. I'm here in enduring weather that frankly is apocalyptic because I want to get some great podcast material. You guys, in return, a little tiny favor to ask if you could go to get your podcasts, if you could give it a five star rating, if you could share it, if you could give it a review.


I really appreciate that. From the comfort of your own homes, you'll be doing me a massive favour. Then more people listen to the podcast. We can do more and more ambitious things and I can spend more of my time getting pummeled. Thank you.