Changes in medicine, c1848–c1948 — timeline

Key topic 1 · Progress in the mid-19th century; Nightingale, Chadwick, Snow and Simpson

Barriers to progress: miasma and the absence of a theory of cause

1846

The Nuisances Removal Act, one of several piecemeal measures before 1848. Why this date: Public health legislation did not begin in 1848, and knowing that prevents an over-simple story.

to about 1861

Miasma remains the mainstream explanation of epidemic disease. Why this date: Everything in key topic 1 happens before a theory of cause exists, which is what makes the progress patchy.

1867

The Second Reform Act enfranchises urban working men. Why this date: The political barrier falls, and the compulsory Act follows eight years later.

Nightingale, Scutari, and changes in nursing and hospitals

November 1854

Nightingale arrives at Scutari with thirty-eight nurses. Why this date: The death rate rose after her arrival, which is the fact the legend omits.

March 1855

The Sanitary Commission flushes the sewers and cleans the water supply. Why this date: The intervention that immediately precedes the fall in mortality.

1859

Notes on Nursing published. Why this date: Nursing acquires a body of stated principle and a mass readership.

1860

The Nightingale School opens at St Thomas's. Why this date: The mechanism by which the model spread — trained nurses who founded further schools.

Pain, infection and bleeding; Simpson and chloroform

December 1846

Liston performs the first British operation under ether. Why this date: Anaesthesia arrives in Britain before chloroform, and the sequence matters.

November 1847

Simpson tests chloroform on himself and uses it in obstetrics within days. Why this date: The date and the method — self-experiment in a dining room — are both quotable.

1848

Hannah Greener dies under chloroform. Why this date: The first recorded death, and the beginning of the serious dosage problem.

April 1853

Snow administers chloroform to Queen Victoria for Prince Leopold's birth. Why this date: Royal endorsement rather than evidence is what settled the argument, which is itself an examinable point.

Chadwick, the 1848 Public Health Act, cholera and Snow

1842

Chadwick's Sanitary Report. Why this date: The evidence base and the engineering remedy, from a man who believed the wrong theory of cause.

1848

The Public Health Act: permissive, with a General Board abolished in 1854. Why this date: Permissive is the word that does the work; nothing had to be done.

September 1854

Snow maps the Broad Street outbreak and removes the pump handle. Why this date: Proof, and it changed no policy for over a decade.

Summer 1858

The Great Stink; Parliament funds Bazalgette's scheme within about eighteen days. Why this date: The contrast with 1854 is the strand's central argument about what actually causes change.

1866

Cholera returns to London only in the district not yet connected to the new sewers. Why this date: The nearest thing to a controlled test that the option contains.

Key topic 2 · Discovery and development, 1860–75; Lister and Pasteur

Pasteur and the germ theory of disease

1850s

Pasteur's work for brewers and vintners; pasteurisation. Why this date: Germ theory arrives from industry, not from medicine, which is a useful correction to the story.

1861

The germ theory published after the swan-neck flask experiments. Why this date: The date to quote, and the point at which nothing yet changes clinically.

1881

The public anthrax vaccine demonstration at Pouilly-le-Fort. Why this date: Germ theory becomes a source of treatments, twenty years after publication.

1885

Rabies treatment of Joseph Meister. Why this date: The first vaccine against a virus, and it made Pasteur internationally famous.

Lister and antiseptic surgery

1847

Semmelweis cuts puerperal fever mortality by hand-washing in Vienna and is rejected. Why this date: The same demand made eighteen years earlier with the same result — the pattern, not the coincidence.

August 1865

Lister uses carbolic on James Greenlees's compound fracture. Why this date: The first case, and it is a fracture rather than an operation.

1867

Publication in The Lancet; ward mortality reported down from about 46 to about 15 per cent. Why this date: The figures a candidate should be able to produce.

1880s

General acceptance follows German adoption and Koch's bacteriology. Why this date: The mechanism arrives and the resistance dissolves, which shows what the resistance had been about.

The 1875 Public Health Act

1866

The last British cholera epidemic. Why this date: The evidence available to legislators in 1875 that sanitary engineering worked.

1867

The Second Reform Act enfranchises urban working men. Why this date: The single most useful date in the public health theme, and it is not a medical date.

1874

Disraeli's government adopts social reform as a programme. Why this date: Party competition for the new electorate turns the franchise into legislation.

1875

The Public Health Act imposes compulsory duties and consolidates the law. Why this date: Compulsion is the change, and it lasted as the framework until 1936.

Elizabeth Garrett and the progress of women in medicine

1858

The Medical Act creates the register; the licensing bodies do not admit women. Why this date: Exclusion by institutional composition rather than by explicit rule — which is why a loophole existed.

1865

Garrett qualifies through the Society of Apothecaries, which then changes its rules. Why this date: The exception and its immediate closure in the same year is the strand's central fact.

1869–70

The Edinburgh Seven matriculate; the Surgeons' Hall riot; the university refuses to graduate them. Why this date: The confrontation route fails at first and produces the campaign that succeeds.

1874–77

The London School of Medicine for Women founded; the 1876 Enabling Act; clinical teaching at the Royal Free. Why this date: The institutional machinery through which numbers could actually grow.

Key topic 3 · Accelerating change, 1875–1905; Ehrlich, Koch and chemistry

Koch and bacteriology

1876

Koch identifies the anthrax bacillus and completes its life cycle. Why this date: The first demonstration that a named organism causes a named disease.

1882

The tuberculosis bacillus identified. Why this date: The greatest killer of the century acquires a cause, which is why the announcement was a scientific sensation.

1883

The cholera bacillus identified in Egypt and India. Why this date: Snow's 1854 argument confirmed, twenty-nine years later and by a different route.

1884

Koch's postulates stated. Why this date: A test anyone can apply, which is what makes the method transferable.

From antiseptic to aseptic surgery

1881

Koch demonstrates steam sterilisation. Why this date: The technical basis for exclusion rather than destruction.

1880s

Bergmann and Neuber build practice around sterilisation; the carbolic spray is abandoned. Why this date: German surgery leads the change, and Lister himself gave up the spray.

1889–90

Rubber gloves introduced at Johns Hopkins. Why this date: Adopted for a nurse's dermatitis and retained as an infection barrier — a good example of unintended consequence.

1901

Landsteiner identifies blood groups. Why this date: The third of surgery's three problems is addressed, and storage still has to wait for the war.

Magic bullets, blood transfusion and Marie Curie

1895 and 1898

Röntgen discovers X-rays; the Curies isolate radium. Why this date: Physics enters medicine, and X-rays were in clinical use within a year of discovery.

1901

Landsteiner identifies blood groups. Why this date: Explains why transfusion had been killing people and makes matching possible.

1909–10

Salvarsan, compound 606, developed and marketed. Why this date: The first chemical cure for a specific disease, and the number is the argument about method.

1917

Sodium citrate and refrigeration allow blood storage; the first depot on the Western Front. Why this date: Transfusion becomes practical, sixteen years after the science and only under wartime pressure.

1932

Prontosil, the first sulphonamide. Why this date: Common bacterial infections become treatable a decade before penicillin was available.

Key topic 4 · Government action and war, 1905–20

The Liberal reforms, 1906–11

1899–1902

Boer War recruitment reveals widespread unfitness; the 1904 report follows. Why this date: The documented motive, and it is national efficiency rather than compassion.

1901

Rowntree's study of York; around 30 per cent below a subsistence line. Why this date: Poverty acquires a measurement and a set of causes thrift could not address.

1908

Old Age Pensions, paid at the post office to avoid the Poor Law's stigma. Why this date: The delivery mechanism is the policy; around 650,000 claimed in the first year.

1911

National Insurance: free treatment for insured workers, not their families. Why this date: The gap that defines the reform's limit and explains the shape of 1948.

The First World War: surgery, x-rays, blood and women

1914

Tetanus antitoxin issued routinely. Why this date: An existing product applied systematically because an army can standardise.

1915

The Thomas splint applied systematically; femoral fracture mortality falls from about 80 to about 20 per cent. Why this date: The clearest single case of organisation rather than invention producing an advance.

1915–16 and early 1920s

Medical schools open to women, and several close again. Why this date: The opening and the reversal are the theme's central evidence.

1917

The first blood depot with citrated, refrigerated blood; Gillies opens Sidcup. Why this date: Storage and reconstructive surgery, both driven by casualty numbers.

Key topic 5 · Advances in medicine, surgery and public health 1920–48; the NHS

Penicillin: Fleming, Florey and Chain

September 1928

Fleming observes the mould; publishes in 1929 and moves on. Why this date: The observation, and the twelve-year gap that follows it.

May 1940

The Oxford mouse experiment: four treated survive, four untreated die. Why this date: The first demonstration that penicillin works systemically.

February 1941

Albert Alexander improves and dies when supplies run out. Why this date: The constraint is manufacturing, and the case states it in one sentence.

July 1941

Florey and Heatley go to the United States. Why this date: The decision that produced mass production, taken because British industry could not.

1944

Enough penicillin for the D-Day casualties. Why this date: Sixteen years after the observation, and it took a war and an industry.

The Second World War: skin grafts, blood and women in medicine

1938

The national blood transfusion service established in anticipation of bombing. Why this date: A state-run national medical service, free at the point of use, nine years before the NHS.

1941

The Guinea Pig Club formed at East Grinstead. Why this date: Rehabilitation treated as part of surgery, which is a change in what treatment includes.

1943

Penicillin reaches Allied casualties; DDT controls typhus. Why this date: Infection ceases to be the main killer of the wounded for the first time in the history of war.

1948

The NHS creates a permanent employer for medical staff. Why this date: Why the wartime gains for women were not reversed as they had been after 1918.

Beveridge and the NHS

December 1942

The Beveridge Report names the five giants and sells over 600,000 copies. Why this date: Public appetite measured in sales, and Beveridge's own scheme was contributory rather than free.

1946

The National Health Service Act; hospitals nationalised. Why this date: Nationalisation of the hospitals is the most radical element and the one the BMA fought hardest.

February 1948

A BMA plebiscite returns around 90 per cent against entering the service. Why this date: Five months before it opened, the profession was overwhelmingly opposed.

Spring 1948

Bevan concedes private practice, pay beds and independent contractor status. Why this date: The compromise that produced participation, and the tension built into the service from day one.

5 July 1948

The NHS opens, free at the point of use. Why this date: The end point of the option and the answer to the question it opened with.

1951

Charges for spectacles and dentures; Bevan resigns. Why this date: The finite-budget problem appears within three years, which is part of the assessment of the service.