19th Century Advances in Medicine – Increasing Hygiene, Reducing Suffering

Louis Pasteur experimenting in his laboratory

In the 19th century, it was possible for whole families to die from diseases such as cholera, typhoid and smallpox and giving birth was a risk for both mother and child.

Surgery was an agonizing process. Patients had to be strapped or held down on the operating tables because there were no anaesthetics to put them to sleep or adequate drugs to ease their pain. Some patients died of shock after operations, others because their operation wounds became infected.

A Poor Standard of Hygiene

In these fearful circumstances, people were lucky if they lived for more than thirty-five or forty years, and many died at much younger ages. So many children died that parents actually expected to lose four, five or more of their sons and daughters. All too often they did not even survive infancy.

One of the causes of this high death rate was the generally poor standard of hygiene. The larger cities of Europe and North America had reasonable supplies of fresh water for drinking, but not to every house. The bigger houses had piped water supplied to their basements and servants were expected to carry it upstairs as required. Away from the large towns, people generally relied on wells, which sometimes became polluted.

Problems in the Towns

Cleanliness in towns presented a different set of problems: the removal of rubbish, the disposal of rainwater and the clearing away of human waste and dirty household water. Water-closets started to come into use at the start of the 18th century, but progress was very slow.

An outside privy was still the general rule for smaller houses. There were very few private baths. Privies and water-closets alike were emptied about once a year. Not surprisingly,these poor standards of hygiene helped to spread disease.

The Work of Pasteur and Koch

Fortunately, the situation began to improve in the middle of the 19th century. The great breakthrough came when the French chemist Louis Pasteur discovered in 1854 that diseases were caused by germs. He also proved that when dead or weakened germs were introduced into the body, this developed immunity to a particular disease.

Pasteur was confirming an important discovery made many years earlier, in England. In 1796, a doctor called Edward Jenner vaccinated a boy with a substance derived from cowpox, a mild disease that affected cattle. He found that the boy developed an immunity to the much more serious illness, smallpox.

In 1882, a German physician, Robert Koch, identified the germ which caused tuberculosis As a result of Koch’s and Pasteur’s discoveries, doctors became able to immunize people against specific diseases. This included cholera, diphtheria and tropical diseases like sleeping sickness and yellow fever.

Advances in Surgery and Sewers

Great advances were made in surgery with the introduction of anaesthetics – first, ether vapour used in 1842 and chloroform in 1847. Surgeons could now work more slowly and carefully and patients did not suffer so much. Even so, many still died because their operation wounds became infected, but after 1865 this problem, too, was solved.

In that year, an English surgeon, Joseph Lister, first experimented with antiseptics. In time, Lister found that germs were carried on a surgeon’s hands, his clothes and the instruments he used. By insisting on the greater use of antiseptics, Lister reduced the death rate from operation from fifty in every hundred patients to only two or three.

At about the same time, the supply of pure water to towns and small places improved. Just as important was the improvement in the drains. Hamburg and Paris were two of the cities which pioneered the installation of good sewers, while London soon followed suit after two disastrous epidemics of cholera killed twenty thousand people.


  1. Bynum, W.F. Science and the Practice of Medicine in the Nineteenth Century (Cambridge Studies in the History of Science) New York, NY Cambridge University Press 1994) ISBN-10: 052127205X/ISBN-13: 978-0521272056
  2. Brock, Thomas D. Robert Koch: A Life in Medicine and Bacteriology (Washington DC ASM Press, 1999) ISBN-10: 1555811434/ ISBN-13: 978-1555811433