During the Victorian era (1830 - 1910), many important advances were made in medical science. Three main theories were developed at this time which improved sanitation, and thereby improved the quality of life in England.

The first was the Miasma Theory which held that sickness was caused by bad odors in the air. Therefore, when someone took ill, doctors would often recommend a trip to the country or the seaside to get away from the "bad air". Although the Miasma Theory was flawed, efforts to erradicate bad odors in the cities led to the construction of sewers, and the removal of garbage from the streets which in turn lessened the amount of bacteria - the true cause of sickness. However, at that time, sewage was not treated. It was flushed directly into the water which only increased the spread of bacteria in the water.

It wasn't until 1849 that William Budd and John Snow introduced the Bacteria Theory which stated that sickness was caused not by "miasmas" or bad odors, but by bacteria, tiny organisms too small to be seen by the naked eye, which multiplied within the body. The theory was rejected. Louis Pasteur's Germ Theory, developed in 1861, was also rejected at first. Both of these theories had to compete against the popular Miasma Theory which, due to the good results brought about by the sanitization projects of its supportors, seemed much more credible.

However, not everyone discounted the Germ Theory. In the 1860s it led to the development of antiseptic surgery by John Lister. Dr. Lister instituted the practice of boiling and scrubbing all instruments before and after surgery, and thoroughly washing the hands. He also proposed the use of the first antiseptic - carbonic acid - as he had noticed that it inhibited the growth of bacteria on tissue during surgery if applied directly to the wound. Lister proved that the use of antiseptic during surgery reduced the mortality rate by as much as fifty percent, and by 1877, the need for antiseptic was widely recognized. With scientific evidence of the existence of bacteria which had been identified by microscopes, the Miasma Theory began to lose popularity, and by 1890, it was considered obsolete.

The Victorian era also saw the development of the important small pox vaccine. It was Dr. Edward Jenner who proposed the injection of cow pox as a vaccine against small pox which was a considerably less risky procedure than the existing method which involved injecting a weakened strain of the small pox wirus itself. The British government has since imposed manditory innoculation with Jenner's vaccine, and small pox has disappeared in the British Isles.

Like everything in the Victorian age, the medical profession was divided by social class. At the top was the physician. The physician was an educated man. He studied Greek and Latin theory, but was not required or expected to have any practical experience. Unlike other medical professionals, the physician did not apprentice himself in hospital wards. For this reason, and because his profession did not include manual labour, the physician was considered a gentleman. Unlike the doctors of today, Victorian physicians did not examine patients, treat external injuries, perform surgery, or set bones. The physician administered "physic" or drugs based on the case history of another practitioner.

Most physicians maintained a "surgery" - a room within their houses were patients could come for treatment without appointment between certain hours. Physicians also customarily made home visits. The normal price for a home visit was five shillings, but often if a patient were unable to pay, the physician would accept less. Many physicians also set aside one morning a week for charity cases. Nevertheless, a successful physician could make upwards of 700 pounds a year.

Second to the physician was the surgeon. Unlike the physician, the surgeon did not attend medical school. The surgeon was usually apprenticed to another surgeon in his teens, and would pay for the priviledge of watching the surgeon at work, and reading his books, and then would act as the surgeon's assistant. The surgeon, not the physician, treated wounds, pulled teeth, stitched wounds, and set bones.

Many surgeons were also qualified as apothecaries. It was the apothecary's duty to examine patients and to perform the miriad minor medical tasks. He also sold drugs, and would offer medical advice. In 1815, all that was required for an apothecary's licence was a six month apprenticeship in a hospital ward, but later, the two professions - apothecary and surgeon - became less distinct, and eventually merged into one - the general practitioner.

At the lowest level was the nurse. The first nursing school was founded by Florence Nightengale, and nursing was practiced primarily by women. In order to qualify as a nurse, one year of service as a probationer - somewhere between a maid and a nurse - was required. It was the nurse's duty to clean the hospital and to cook meals for the patients. Typically, they worked from 7:00am until 9:00pm with only two hours' break for mealtime. The nurse earned one shilling a day, and qualified nurses were able to earn up to 50 pounds a year with free room and board.