James Johnston

Dr. Eghigian
History 124M
11 April 2014
Progress in Public Health and Research Medicine
In the 19
th
and early 20
th
centuries, a seismic shift occurred in the field of
medicine. As industrialization and war gripped the western world, an increased focus on
public health and research emerged. Populations were packed into cities that were not
growing rapidly enough to accommodate industrialization. The urban poor often went
untreated due to both lack of money and lack of treatment facilities. War veterans
returned from battle bearing psychological scars on a scale never before seen. With them,
they brought the epidemic, the Spanish Influenza - among the most deadly ever to sweep
the earth. These issues all posed serious threats to the general welfare of society and
opinions on how to deal with the threats differed., Significant progress was made during
this era in dealing with medical issues that posed a threat to society, both through medical
research and public works projects.
Sanitation and over population were major problems in the cities of the 19
th
and
20
th
centuries and were significant problems for hospitals as well. The Industrial
Revolution brought more people to live in cities and consequently close proximity. As
cities grew, more and more hospitals were built and existing hospitals were expanded
upon. Though the number of hospitals grew to accommodate the expanding population,
the quality of care provided by those hospitals was inconsistent. Providing evidence of
this inconsistency was Florence Nightingale, a powerful advocate for both the
improvement of both hospital care but more importantly hospital administration. In
Nightingales Notes on Hospitals, she raises important issues with the hospital system
issues that plagued many major cities. The first and possibly most important of
Nightingales observations was the overcrowding of many hospitals. People in hospitals
tended to catch the diseases of others because of the close proximity of patients. Another
issue with the hospitals was over lack of proper techniques to sterilize equipment and
facilities. This further promoted the spread of disease within the facilities. Nightingale
states in her article, No stronger condemnation of any hospital or ward could be
pronounced than the simple fact that any zygotic disease has originated in it, or that such
diseases have attacked other patients than those brought in with them (Medicine and
Western Civilization, page 363). Nightingale believed that no disease should spread more
in a hospital than in the general population: no matter how infectious the disease was,
hospitals were supposed to be places of healing. Ms. Nightingale realized the problems
caused by over-crowding and sanitation issues and proposed more hospitals and better
sanitation in those hospitals as possible solutions.
Hospitals were not the only place where sanitation and over-crowding posed
serious public health issues. The British government recognized a tendency for the
poorest to suffer more illnesses; so, they commissioned a member of the government to
look into potential causes of poor health amongst this population. Edwin Chadwick was
assigned to this task. In an attempt to find the sources of prevailing illnesses amongst the
poor, Chadwick interviewed a wide variety of town and city officials. The chief cause
found for the illnesses was poor sanitation. Most municipal officials who observed
sicknesses noted poor sanitary conditions. For instance, the medical officer of the
Woburn union states said, in regards to the town of Toddington, In this town fever
prevailed during the last yearVery few of the cottages were furnished with privies that
could be used, and contiguous to almost every door a dung heap was raised on which
every species of filth was raised. (MWC, pg 220). While the lack of a sewage system in
rural areas also led to poor sanitation and poor health, these issues were magnified in
urban environments due to over-population. A medical officer from a region of
Liverpool told Chadwick, There is commonly only one receptacle for refuse in a court
of eight, ten or twelve densely crowded houses (MWC, pg 223). The lack of a sanitary
system for disposing filth was partially credited with the rapid spread of diseases amongst
the poor and their close proximity to the filth exacerbated the problem. In response to the
Chadwick report, the British government placed an increased emphasis on sanitation
standards in an effort to reduce disease.
The increased efforts by the British government were primarily focused on
building public drainage systems as well modifying building codes in order to implement
a minimum standard of living. The importance of proper drainage was especially
important according to the Chadwick report. One exert, provided by a doctor to
Chadwick, Mr. Crowfoot, compares the health of two towns, Bungay and Beccles.
Beccles implemented a public drainage system thirty years prior to Mr. Crowfoots letter,
while Bungay did not have one. Mr. Crowfoot explains, The result you will see is, that
Bungay, with a smaller proportion of town inhabitants, has become of late years less
healthy than Beccles (MWC, pg 225). This passage clearly demonstrates the need for
public sewage systems and would have helped persuade the British government to
sponsor the building of more sewers. Chadwick argues in his conclusions that not only
would public sewers be effective in limiting the spread of disease, but they would also
save the government money by reducing the need to cart off waste. That this expense
may be reduced to one-twentieth or to one-thirtieth, or rendered inconsiderable, by the
use of water and self-acting means of removal by improved and cheaper sewers and
drains (MWC, pg 238). Chadwick shows that there are no potential drawbacks to
implementing public sewage throughout England; money and lives would be saved. The
effects of overpopulation and poor living standards amongst the poor could be aided by
the building of public sewers.
While public health advocates focused on limiting disease transmission by
improving sanitation and other issues of over-crowding, others focused on a more narrow
approach improving the treatment of patients. A physician by trade, Claude Bernard
saw first hand the affects of disease. However, his answer as to how to more affectively
deal with disease did not lie in public works projects such as improved hospitals or
sewage systems. Bernard, often known as the father of experimental medicine, believed
that developing new treatments for disease and gaining a greater understanding of the
workings of the human body were key to dealing with the health problems that plagued
the general public. In particular, Bernard believed that many scientists during his time
were unwilling to question previous findings and existing orthodoxies. As Bernard said in
his piece, An Introduction to the Study of Experimental Medicine, The first condition
to be fulfilled by men of science, applying themselves to the investigation of natural
phenomena, is to maintain absolute freedom of the mind, based on philosophic doubt
(MWC, pg 315). This general acceptance of prior theories led to less than expeditious
medical progress. Unfortunately, many disagreed with Bernard over the importance of
medical research and he struggled for much of his early life to find funding for a
laboratory. If fact, when he became the chair of physiology at the College of Paris,
Bernard was not given a lab. Instead, he was expected to conduct his experiments in a
cellar - funding his work with the money from his wifes dowry. As his profile rose, so
did the profile of experimental medicine. More people began to see the field as a potential
solution to many of the diseases associated with the era. Experimental medicine provided
an equally valuable alternative to public works such as better sewage systems as a
possible solution for diseases that plagued the 19
th
and 20
th
century world.
Louis Pasteur built off of many of the ideas of Claude Bernard. His work in
inventing Pasteurization was in response to the public issue of spoiling wine. It would
later be adapted to help cleanse many other beverages and foods proving, eventually,
to be of great importance to public health. Pasteurs contributions, however, were not
limited to food. In his paper, The Germ Theory, Pasteur describes how he put
experimental medicine to practical use. In particular, he writes about the Puerperal
Fever, a fever that infects women immediately after birth. Pasteur was invited by another
doctor to observe a woman who had fallen victim to the illness. He applied the
experimental method of medicine in order to find the cause of the disease as well as a
treatment. Pasteur was able to locate where the infection resided in the body and through
his cultures, he was able to determine that the disease is deadly when, After
confinement, the pus that always naturally forms in the injured parts of the uterus instead
of remaining pure becomes contaminated with microscopic organisms from the outside
(MWC, pg 256). Essentially, the pathogen is often present but cannot act without a
laceration. This understanding allowed Pasteur to suggest a potential treatment, an
antiseptic technique applied immediately upon confinement in a hospital in order to kill
the offending bacteria before a laceration can occur. Pasteur noticed a problem that
plagued many women who had just given birth and used experimental to find the cause as
well as an effective treatment for the infection.
Another public health issue during the late 19
th
century and early 20
th
century was
the result of wars that were being fought a phenomenon known as shell shock. It was a
clear threat to the health of the general public because many young men fighting in the
First World War were incapacitated by this infliction. Initially misunderstood, soldiers
exhibiting signs of shell shock were often tried for cowardice. As the numbers of men
suffering increased, the treatment of soldiers on the front line was changed. It was
decidedly unsafe to leave disturbed troops on the front line; they could neither care for
their peers or themselves. Afflicted soldiers were quickly removed from the front lines
and, if their disposition did not improve, they were sent to neurological centers for
treatment. The prevalence of shell shock was significant; in one battle, the Battle of the
Somme, an estimated forty percent of the casualties were victims of shell shock.
Shell shock became a public health crisis because it not only threatened domestic
life but also resulted in loss of human capital - hundreds of thousands of young men were
crippled by the disease. In response to the threat, scientists around the world attempted to
find cures and treatments for shell shock. For instance, Fritz Kauffman, a German
physician, used a form of shock therapy in order to treat his patients. His shock therapy
was developed as a fast way to cure shell shock. Kauffman contended that though there
were other, moderately effective treatments available for shell shock, many of them,
specifically hypnosis, lead, to unhappy consequences for the families; it also leads to
loss of human labor power for the state; another, not insignificant, consequence is the
considerable burden on the military budget (War and Neurosis, pg 235). Kauffman is
referring to those who the general hypnotic treatment failed to fully cure and how they
can no longer contribute to the war effort or society. Practitioners of medicine saw the
crippling effects of shell shock on both the victim and society. As a result, they studied
those afflicted and many attempted to find a cure for the disease.
The 19
th
century and the early 20
th
century served as a period of significant
advances in medicine particularly in the field of public health. The growth of cities and
over-crowding provided the need to address medical issues on a community wide basis. .
In their pursuit of protecting the general public from diseases, officials shifted their focus
towards ideas such as the importance of sanitation and improved living conditions of the
poor. Both Florence Nightingale and Edwin Chadwick were two leaders in this effort.
Progress was also made on understanding the nature of diseases. While many
practitioners continued to explore where illness originates and how to control disease,
some began to expand the field of knowledge by a more experimental approach to
medicine as preached by Claude Bernard. These ideas continue to remain cornerstones of
medicine since their inception. Great advances still visible today in public health and
experimental medicine were catalyzed by worries about diseases and their direct threat to
the population.
Works Cited
MacCurdy, John T. War Neuroses. N.p.: n.p., n.d. Print.
Rothman, David J., Steven Marcus, and Stephanie A. Kiceluk. Medicine and Western
Civilization. New Brunswick, NJ: Rutgers UP, 1995. Print.
"Shell Shock." Wikipedia. Wikimedia Foundation, 04 Nov. 2014. Web. 11 Apr. 2014.