Victorian medicine: why the 19th century was a time of seismic medical change

• Read more | 14 surprising facts about the history of medicine

One of the most important medical breakthroughs of the 19th century was French chemist Louis Pasteur’s discovery that germs cause disease, following on from Italian bacteriologist Agostino Bassi’s work on silkworm infections. Pasteur’s work with pasteurisation and his subsequent breakthroughs with inoculations against anthrax and rabies in turn inspired men like Robert Koch, who, in the early 1880s, identified the microorganisms that cause tuberculosis and cholera and created standards for researching the links between germs and disease.

“Having the ability to separate different bacteria and identify them for the first time was a huge medical breakthrough,” says Professor Mary Fissell. “Being able to associate a specific germ with a specific disease and form a clear relationship between the two ushered in a completely new way of thinking about the body and ill health. There wasn’t an immediate therapeutic payoff to the discovery, but it wasn’t long before scientists started to figure out that antitoxins could be created to cure specific diseases.

“The first antitoxin, for diphtheria, was developed in the early 1890s and its impact was incredibly dramatic. I’ve always loved the fact that, in Britain, the diphtheria antitoxin was held in police stations because they could be accessed all night.”

Internal operations

Prior to the 19th century, surgery had largely been performed outside the body – the only real operative surgery undertaken was the removal of bladder stones, a procedure performed without anaesthetic and usually completed in under two minutes to avoid the patient dying of shock and pain. In 1658, prolific diarist Samuel Pepys had a bladder stone allegedly the size of a tennis ball removed without pain relief – historians have suggested Pepys may have survived the procedure because he had been first on the surgeon’s list that morning and had therefore been operated on with clean tools and hands!

“The advent of anaesthesia and antiseptic surgery was a real game changer, and surgery as we know it today was really invented in the late 19th century”, comments Fissell. “As germ theory developed, people began to conceptualise what that might mean in terms of surgery. Initially, antiseptic surgery saw mists of carbolic acid continually sprayed in operating rooms during medical procedures in order to kill bacteria in the air, and wounds were packed and covered with lint and gauze soaked in carbolic acid. But by the 1880s, aseptic practices were being developed, eventually including steam sterilisation of instruments, rubber gloves, and the wearing of surgical gowns.”

9 medical breakthroughs in the 19th century

From X-rays to new wonder drugs, the 19th century saw seismic change…

In 1816, French physician René Laënnec observed two children signalling to each other via a piece of wood and a pin – one child had their ear to the wood and was receiving the amplified sound of a pin being scratched at the opposite end. Laënnec was inspired by this acoustic phenomenon to invent the stethoscope, with which the sounds made by the heart and lungs could be heard more clearly.

In 1820, French scientists Pierre Pelletier and Joseph-Bienaimé Caventou discovered the process to extract and isolate quinine from the bark of the Cinchona tree, which had been used in powdered form to treat malaria since the 17th century.

In 1897, German chemist Felix Hoffman successfully combined acetylating salicylic acid with acetic anhydride, creating acetylsalicylic acid, a substance that could relieve fever, pain, and inflammation without upsetting a patient’s stomach.

In 1847, James Young Simpson, professor of midwifery at the University of Edinburgh (below), became the first physician to demonstrate the anaesthetic properties of chloroform on humans. He went on to pioneer its application in surgery and obstetrics.

Using the work of men like Louis Pasteur and Ignaz Semmelweis (the latter who proved that doctors were responsible for transmitting childbed fevers in hospitals), Joseph Lister developed a carbolic acid spray for use during surgery. The death rate from infection after surgery decreased significantly as a result, although it was later realised that carbolic acid damaged tissues in the body.

In 1895, German physicist Wilhelm Röntgen accidentally discovered X-rays while testing whether cathode rays could pass through glass. Soon, doctors in Europe and the US were using X-rays to locate gun shots, bone fractures, swallowed items and kidney stones.

The first portable electric hearing aid was patented in 1895 by electrical engineer Miller Reese Hutchison (below). Known as the Akouphone, it used a carbon transmitter and electrical current to amplify weak audio signals.

In 1893, African-American general surgeon Daniel Hale Williams performed the first successful documented heart surgery on a young black man, James Cornish, who had been stabbed in his chest. Cornish survived and was discharged 51 days later.

The German physiologist Hermann von Helmholtz is generally considered to have invented the ophthalmoscope, in 1851, although English mathematician and inventor Charles Babbage is also a contender. The device revolutionised ophthalmology, allowing physicians to examine the inside of the human eye.

This article first appeared in the February 2021 issue of BBC History Revealed