Department of english language and literature

MasAryk university Brno
Faculty of Education

DEPARTMENT OF ENGLISH LANGUAGE

AND LITERATURE

The Development of Medical Care in Great Britain since the 17^th Century

Diploma Thesis

Brno 2007

Supervisor: Written by:

Andrew Philip Oakland, M.A. Zuzana Teplíková

TEPLÍKOVÁ, Zuzana. The Development of Medical Care in Great Britain since the 17^th Century: diplomová práce. Brno : Masarykova univerzita, Fakulta pedagogická, Katedra anglického jazyka a literatury, 2007. 72 s. Vedoucí diplomové práce Andrew Philip Oakland.

Declaration:

I hereby declare that this diploma thesis is my own work and that I used only the sources listed in the bibliography and websites.

Zuzana Teplíková

Acknowledgements:

I would like to thank my supervisor, Andrew Philip Oakland, M.A. for his kind help, comments, and valuable advice.

Content

1. Introduction 6

2. Medical Care in Britain before 1946 7

2.1. The Seventeenth and Eighteenth Centuries 7

2.1.1. William Harvey (1578 – 1657) 9

2.1.2. Thomas Sydenham (1624 – 1689) 10

2.1.3. Edward Jenner (1749 - 1823) 14

2.1.4. Hospitals 15

2.2. The Nineteenth Century 16

2.2.1. Cholera and Precautions against the Disease 16

2.2.1.1. John Snow (1813 – 1858) 18

2.2.2. James Parkinson (1755 - 1824) 19

2.2.3. Hospitals 20

2.3. The Twentieth Century 22

2.3.1. Alexander Fleming (1881 - 1955) 23

2.3.2. Sir Ronald Ross (1857 – 1932) 24

Notes 1 25

3. The National Health Service (NHS) 27

3.1. History of the National Health Service 27

3.1.1. Aneurin Bevan (1897 – 1960) 28

3.2. How the NHS Works 30

3.2.1. Primary Care 31

3.2.2. Secondary Care 33

3.3. Contemporary NHS 35

3.3.1. The Structure of the NHS in England 39

3.3.1.1. The Department of Health 40

3.3.1.2. Strategic Health Authorities 41

3.3.1.3. Primary Care Trusts 41

3.3.1.4. GPs 42

3.3.1.5. Dentists 43

3.3.1.6. Hospitals 43

Notes 2 45

4. The Medical Profession 46

4.1. Doctors and the Past 46

4.2. Nurses 47

4.2.1. Nurses in the Past 47

4.2.1.1. Florence Nightingale (1820 - 1910) 50

4.2.1.2. Mary Jane Seacole (1805 - 1881) 51

4.2.2. Nurses and the Present 53

Notes 3 54

5. Conclusion 55

6. Summary 56

7. Resumé 57

9. Bibliography and Internet Sources 68

1. Introduction

I became interested in healthcare while I was studying nursing at secondary school, during the course of my studies I started to be more interested in the subject of healthcare, especially in England. I had heard about certain well-known Britons in the medical field, such as Nightingale, Harvey and Fleming, so I decided to gain more information, not only about those people but also about the whole system of medical care in Britain in the past as well as the present.

My thesis is a theoretical work focused on the overall state of medical care in Great Britain from the historic point of view until the present. The intent of my work is to make an outline of the development of British medical care from the seventeenth century until the present, concerning the dubious remedies used in the seventeenth and eighteenth centuries. I also cover the creation of the National Health Service, including hospital care and medical staff. Moreover, my work contains short concise sub-chapters about several famous Britons who have contributed to medical advances in British history and therefore even today have benefited many people’s lives. It is not my intention to tell their life stories. I focus only on the areas of their lives which somehow relate to medicine or are necessary to mention because of their significant influence upon the person and his or her professional life.

At the end of my work there is an Appendix with additional materials which extend the thesis and can help with understanding or explaining the matters which are mentioned only marginally in the body of the work

2. Medical Care in Britain before 1946

2.1. The Seventeenth and Eighteenth Centuries

The seventeenth and eighteenth centuries were periods of time when the people lacked knowledge about their bodies and how to treat illnesses effectively. During this time developments in medicine were made little by little. This work is concerned with some of the major developments which occurred in Great Britain. Many diseases existed then which do not exist nowadays, because there has been much progress made, not only in medicine but also in the way of life of people living in the 21^st century. For instance, proper drainage allows people nowadays to stay healthy whereas people in the 17^th century could not perhaps imagine such a luxury. Nowadays there are many books about medicine, and even without being a doctor, one can know quite a lot about medicine and how to treat a fever or simple diseases such as influenza or tonsillitis, for example. In that time such minor illnesses might have caused death because of the lack of proper treatment which is available nowadays.

The terrible disease in the seventeenth century was the plague which was sometimes called “Black Death.” It had already appeared in Britain in the Middle Ages and there were also many outbreaks in the 17^th century; in 1603, 1625, 1640 and 1665. In the last mentioned year was the worst outbreak, also known as Great Plague of London.

Plague was a viral disease transmitted to people from rats through plague-carrying fleas. People did not know its cause and therefore, precautions against plague were not effective enough. If a member of a family died of plague, the rest of the family was locked up in the house for forty days, although the corpse was removed from the house by the “Searchers of the Dead”.¹ It frequently meant death for the family members too, especially due to the infected rats which lived in their dwellings. Such houses were marked with a red cross on the door and the words “Lord have mercy on us”. Plague progressed very rapidly with the following symptoms:

The first the man knew of this was a cold shivering, followed by terrible vomiting, so severe that it sometimes killed. Then came a high fever, which made the patient delirious. There followed the growth of the buboes, black swellings under armpits and in the groin, which caused great pain. Sometimes these would burst and the fever might then go down, but more often the unfortunate man would be dead before they could do so, killed by the poisoning of his whole body by the germs of plague.²
There were many other illogical precautions taken by the authorities as soon as new cases of plague emerged. They ordered the killing of all dogs; this meant that there were no predators to kill the rats, therefore the number of these pests greatly increased. Nobody was allowed to hold public meetings and some houses were torched because authorities believed that the cause of plague was in the air, so this way the air needed to be purified. It is estimated that more than 100,000 people died of plague in 1665.³
In the seventeenth and eighteenth centuries English doctors, although they were not properly qualified and had little or no medical knowledge, had very high social status, power and influence. They had to obtain a license in order to practice. To obtain the license at the Royal College of Physicians, which was set up in 1518, applicants needed only a slight knowledge of ancient Greek theories about medicine. However, this knowledge was sufficient only for practicing in the provinces. Doctors in London needed to be better educated. They were expected to have a better knowledge of the nature of illness. They did know that being ill meant that something had happened to upset the normal working of a patient’s body, but they did not have a clue as to what had caused this upset, or how to cure it.

If a person became ill, a doctor would come to try to find out what was wrong with the patient. In that time, doctors did not have any special devices which helped them to make the diagnosis. There were no thermometers so the doctor simply put his hand on the patient’s forehead to discover if the patient was feverish. Moreover, doctors would ask questions and possibly squeeze and poke several tender areas of the body in the belief that they could find something evidently wrong. Doctors learnt from this examination practically nothing and some of them even prescribed medicine without seeing the patient at all. They would prescribe some poultices which used to be placed on painful places, a sip of medicine to drink or a pill to swallow. Another remedy which was widespread at that time was blood-letting. It could be performed in several ways. The best was probably by cutting a vein with a lancet but doctors would also use certain blood-sucking parasites such as leeches, which are black slug-like creatures. There used to be other appalling methods of treatment, especially in the seventeenth century. For instance, doctors used to put pans of hot coal on a patient’s body to bring the patient around, they would give laxatives and medicine which made a patient vomit, burn plaster on a patient’s body to cause the formation of blisters or make minute cuts on various parts of the patient’s body. Only the rich or royalty could afford many of these various treatments.

In that time, there were several people who wanted to and tried to find out more about the human body rather than to merely rely upon questionable practices. One of these was William Harvey who is known among doctors and medical staff all over the world as the man who discovered the circulation of the blood. His discovery was really vital because it brought a completely different view of the human body and its function, even though this did not happen immediately after the discovery. Another man, Thomas Sydenham, was likewise pre-eminent in the medical field at that time. In the seventeenth century not much information about diseases and their treatments was known, however these two men made great strides in medicine during that period.

2.1.1. William Harvey (1578 – 1657)

William Harvey was quite important person in the British history of medicine. He was an English physician and a surgeon, who is credited with the discovery of the circulation of the blood. He worked as the king James’s I personal physician and in 1625 to 1647 he was also Charles’s I personal doctor.

In the Harvey’s time surgeons were not so important. Many of them were merely barbers who from time to time did blood- letting. Surgeons in England did not have propitious conditions. The dissection was banned in England. The only exception was permitted by the king, Henry VIII, who allowed dissecting four criminals every year (the number of the bodies was increased to six by Charles II, in 1663⁴). The dissections took place in the Barber Surgeons Hall⁵ in London. Henry VIII decreed that the Company of the Barber-Surgeons (1540-1745) would give the corpses of for criminals to help surgeons study the anatomy of the human bodies. Till that time, surgeons could only rely on books and theoretical diagrams. The dissections were accessible only to barbers, surgeons, physicians and apprentices. They had to follow some rules; the surgeon who performed the dissection had to wear clothing which was ordered to him and he had to use special tools designed for dissections.

Unfortunately, four dead bodies were not enough for the surgeons’ purposes. Therefore, surgeons often left England for other country where they could study and train because there dissections were legal. The same case was Harvey; he left England for Italy where he studied at University of Padua. There, in 1616 he announced his great discovery. The discovery was not his only contribution to medicine. He dealt with the function of the valves and clarified the purpose of the valves in veins and heart valves likewise. He proved many other things about human body. Firstly, the blood did not go through the heart septum. Secondly, in addition to the systematic circulation he proved there was the pulmonary circulation in human body. Thirdly, the blood was pumped from the heart (exactly from the atria into the ventricle) into the arteries of the whole body. Moreover, he explained that the pulse is the reflection of the heart contractions. What, however, he did not know was how the blood transferred from the arteries to the veins; he did not distinguish capillary network so he could only speculate about that transfer.

The other finding which Harvey did, however, it is not as well-know as his discovery of the blood circulation was that the reproduction of mammals and humans happened when the ovum was fertilized by sperm.

Harvey’s advice addressed to doctors was “Don’t think, try.” He wrote a book about his discovery and published it in 1628. Regardless these discoveries and explanations, Harvey was not appreciated by the people when he came back from Italy to London. They believed that a person became ill because of the excessive amount of blood in a human body. Therefore, people accepted practice of blood letting. Harvey’s discovery, however, contradicted such an idea. Despite the fact that his ideas about the blood circulation were finally accepted during his lifetime, it did not stop other doctors to continue in blood-letting. Nevertheless, his discovery of the circulation of the blood was an important step to the other, no less important advances in the knowledge of anatomy and physiology in the seventeenth century.

2.1.2. Thomas Sydenham (1624 – 1689)

Sydenham was the Puritan Physician, sometimes called the English Hippocrates or the father of English medicine. He is considered to be one of the principal founders of epidemiology but he was not widely appreciated in his time. He was a Puritan and this was unfashionable for many people. Sydenham was even derided by his colleagues. Nevertheless, his knowledge was recognized later.

He specifically employed two methods, which came from Hippocrates, observation and experience. Sydenham believed that there was only one way to learn more about diseases – sitting at the patient’s bedside, watching him carefully and trying to notice all the symptoms. Then he compared one case with another. Due to the comparisons he noted that some illnesses showed exactly the same pattern of events as they progressed. This discovery helped him greatly. As soon as he observed the same pattern again, he knew what to do. He had his clinical experience and knew what to expect and therefore what remedy had worked, which allowed him to help the patient more effectively.

Although he practised blood letting (which he pursued less frequently than his colleagues) his treatment was not so fanciful and he appeared to practise mainly medicine based on observation as was already mentioned. He used cinchona as a treatment of smallpox⁶ and he even invented liquid laudanum. What is more, he started using opium in medical practice and he was the first to administer iron for the treatment of iron-deficiency anaemia. Moreover, he encouraged the use of quinine for treating malaria, which even nowadays is the ingredient of some anti-malarial drugs. Sydenham believed was that Nature would heal most diseases on her own, it was only necessary to give her a chance. Furthermore, he assumed that fresh air could also help in the treatment of disease and illness.

He also deserves credit for discovering and naming scarlet fever. Also Sydenham noticed the tie between fleas and typhus fever. Although he described a number of other diseases aptly for the first time such as gout, malarial fever, scarlatina, measles, dysentery or hysteria, the only eponymous use of his name that is commonly known is “Sydenham’s chorea”. It is a streptococcal disease of the central nervous system accompanied by rheumatic fever and characterized by uncontrolled and purposeless contractions of the trunk and limb muscles. Ironically, the description refers to approximately two paragraphs remarked on in one of his papers, more or less of an aside. As he himself, suffered from gout and renal stones, he managed to describe the disease precisely and in great detail. He also wrote several books about medicine which seem nowadays more reasonable than many other works written at that time.

The seventeenth and eighteenth centuries were difficult time periods to live in. Streets in the larger towns and cities were extremely filthy so it was no wonder that diseases could spread very quickly and that so many people became ill. In the eighteenth century there were Commissioners appointed for the larger cities and they arranged for the clean up of some of the main streets. Unfortunately, they were not able to take care of the side streets where the majority of people lived. Refuse was thrown into the streets; there was no water or drainage system. People used communal wells frequently contaminated by cesspits which were often placed near a well. Unfortunately, many people, especially paupers, regularly died because of the lack of medical care. They simply could not afford a doctor. Nonetheless, they could rely on the apothecary if they had at least a little money. The apothecary has disappeared from our modern society, but the job might be compared to that of the chemist, who prepares the medicine prescribed by a doctor, by mixing various ingredients. Unlike the modern chemist, the apothecary acted as a doctor for poor people. He not only sold all sorts of drugs but he also treated people much cheaper than would a physician at that time. He had no qualifications for doing this. His only training was by working as an apprentice so gaining experience at another apothecary. On account of having almost no qualifications yet earning quite a lot of money, he was sometimes regarded as an artful seller by more respectable people.

An apothecary even had advertisements for his wares, and the advertised medicine sold very well regardless of whether it was effective or not. If it appeared to be effective, people who had tried it recommended the remedy to their friends. Spending money on such a remedy was still cheaper than the fees charged by any physician. Yet for the poorest, even a shilling spent on pills was too much so they had no choice but to take either nothing or rely on the odd traditional remedies which were handed down from their ancestors. For example, here are some traditional remedies which were present in Hertfordshire in the eighteenth century:

To cure jaundice, it was recommended to take nine lice in a little ale every morning for a week. Shingles could be cured by using ointment made up of blood from a black cat’s tail, mixed with juice from a house-leek and cream. Ague was relieved either by taking strong beer and honey, or by dumping the sufferer into a tub of cold water. Hedgehog drippings dropped into the ear was a certain cure for deafness, while consumption could be banished by drinking ‘the very disagreeable liquor’ produced by boiling turnips with a piece of rusty bacon. Swallowing young frogs was good for asthma and hog’s dung would stop bleeding. Oddest of all, rashes and skins diseases could be put right by carrying a dried toad in a silk bag around one’s neck.⁷

Besides apothecaries, there were also surgeons who treated people by operating on them. It was not easy for surgeons to work in that time period because they were regarded as somewhat less respectable than physicians and moreover, they had little chance to learn any useful details about human anatomy. Dissections were banned, so they learnt anatomy from their own patients. Unfortunately, it was often too late. The other possibility, although an illegal one, was to purchase bodies from so called ‘resurrection men’⁸ to practise dissections.

Due to the knowledge gained from making dissections, surgeons were able to perform a number of operations even though the results of these operations were not always successful. Failure was attributed to many causes. First, the operations were limited because of shortness of duration. A patient was not able to bear the pain caused by cutting for long without any anaesthetic. Second, the operation often ended with the death of a patient which was brought about by dirty instruments which caused successive blood poisoning. Despite such complications and life threatening situations, surgeons continued to pursue various kinds of operations; they ordinarily amputated damaged limbs, let blood or removed stones from the bladder or kidneys. The last mentioned operation was the only one which included cutting open the patient. The operation was very risky as were other operations at that time, the pain caused by the bladder or kidney stone was so great and unbearable that patients were often willing to undergo the dubious operation.

In the eighteenth century there was quite a lot of progress made concerning surgery. In 1727 surgeons became a little more respectable after an Englishman, William Cheseldon, performed a successful operation, extracting a kidney stone. He used a French method which he modified slightly to make it safer. He usually charged 500 guineas for an operation, but he proved himself willing to carry out operations on the poor for free The other surgeon who played an important role in the development of surgery was a Scottish surgeon, John Hunter. He maintained that not only were speed and accuracy important in surgery but that precise knowledge of the human body was indeed indispensable. He was interested in every organ in the human body, in its shape, function and its specific location in the human body. To gain the knowledge he needed, Hunter pursued thousands of dissections, not only on human bodies but also on various kinds of animals as well. John Hunter was not the only doctor in his family, his elder brother, William Hunter, was a successful anatomist at that time as well. William was, however more interested in obstetrics.

The eighteenth century, moreover, brought some discoveries which resulted in it being possible to treat people using more scientific methods. In some cases observations sufficed.

The disease which was most easy observable was scurvy. It was caused by lack of vitamin C and usually afflicted sailors who did not have enough fresh fruit and vegetables to eat. Ship’s captains did not know the cause of the illness but they did know that if sailors ate fresh fruit and vegetables the disease would not appear. Therefore they took on board a fresh supply of fruit and vegetables at every port. After having found the fact that fruit and vegetables kept them healthy, every ship Of the Royal Navy was obliged to have limejuice onboard their ships. Actually, scurvy was already known by Hippocrates but the proof that it could be cured by eating citrus fruit came from a Scottish captain James Lind who lived in the eighteenth century. Lind wrote a book in 1753 about his experiments called A Treatise of the Scurvy.

Another great discovery made in the eighteenth century was Dr Jenner’s smallpox vaccine.

2.1.3. Edward Jenner (1749 - 1823)

Edward Jenner was an English physician who is well-known, mainly for his discovery of a vaccination against smallpox. Jenner studied nature and practised medicine in Gloucestershire in England. He went to London and studied under, besides others, the famous surgeon John Hunter at St George’s, University of London.

Jenner made a great discovery when he noticed that smallpox never afflicted milkmaids. He observed that they often had small pocks on their hands. They had been infected by cowpox, (which was a disease very similar to smallpox, but no so virulent) which they got from milking the cows. This finding led Jenner to the idea that cowpox would prevent people from being infected from smallpox. In 1796, he tried to vaccinate an eight-year-old boy by using the cowpox serum from the cowpox blister on a milkmaid’s hand and injected the boy. The vaccination caused a fever but no serious disease. Jenner repeated the vaccination of the boy but no disease followed and no signs of infection were observed. Jenner continued with his research and finally, he wrote a report about what he had discovered. It took a while but over time, Jenner’s effort proved to be very useful and successful. In 1840 the British government accepted vaccination and it was even provided to people free of charge.

2.1.4. Hospitals

In the eighteenth century there was quite substantial progress made in the development of hospitals. Hospitals had existed in the previous century also but they used to serve as a place where people were only taken care of rather than treated. These kinds of hospitals were established as a part of convents these institutions were simultaneously being cancelled in the 18^th century and only a small number of them remained. Nevertheless, other new hospitals were being founded and became centres of training for physicians, surgeons and nurses.

At the end of the eighteenth century and at the very beginning of the nineteenth century, in other words, around 1800 it was possible to find two kinds of hospitals. There were the workhouses and the voluntary ones. The former hospitals were mainly for sick paupers. There were no nurses until the second half of the nineteenth century. Therefore, the sick paupers were taken care of by other poor people who could at least walk but were frequently insane. The latter hospitals were voluntary hospitals that carried over into the following century. They were founded by charitable people and designated especially for use by the poor.

In the eighteenth century there were also hospitals for people who were popularly considered to be 'lunatics'. The most famous one was the hospital of St Mary of Bethlehem in London founded already in the Middle Ages. It was commonly known as ‘Bedlam’. Treatment in this hospital from the perspective of today would be considered inhuman and the mentally ill were rarely cured.

‘…patients [were] kept permanently in chains, and others had their blood let, were given vomits and laxatives, were kept drugged with opium, or were dumped into baths of cold water.’⁹

What is more, Bedlam was also something like a museum. For their amusements, visitors could go round the hospital for a mere penny. They watched, teased and provoked patients. Fortunately, in 1770 these undignified visits were stopped. Public could visit Bedlam but only under an attendant’s supervision.