MEDICINE AND PHARMACY
Medicine was in a state of transition at the beginning of the
nineteenth century. The great scientific discoveries of the eighteenth
century had carried people away to such an extent that they showed a
tendency to exaggerate their bearings upon medicine. The result was a
wild diffusion of extravagant speculation and unsubstantial hypotheses.
One of the leading physicians of the eighteenth century, who wielded
broad influence throughout Europe, was Herman Boerhaave (1668-1738).
His work, entitled "Aphorismi," published in Leyden, 1709, was
immensely popular. It was translated into all the European and several
Asiatic languages. His reputation now depends upon his chemical
discoveries and his medical teachings.
One of the most brilliant students of Boerhaave's medical school was
Albrecht von Haller (1708-77). Haller published many medical works and
monographs. His "Elements of Human Physiology," (1759-66) is the best
known. The function of bile in the digestion of fats, the demonstration
of Glisson's hypothesis that irritability in an excised muscle is
a specific property of all living tissues, and several theories
explaining the heart's activities, were among his best contributions to
medical science.
The discovery of the existence of lacteal and lymphatic vessels in
birds, reptiles, and fish brought William Hewson into prominence and
secured him membership in the Royal Society. He published his monograph
on the coagulation of the blood in 1771.
William Cumberland Cruikshank (1745-1800) investigated the surgery of
the nerves, the functioning of the Fallopian tubes, the physiology of
absorption.
The electrical discoveries of Galvani, Volta, Benjamin Franklin, Henly
and others caused much experimenting with the electric current in the
treatment of muscular diseases.
The Monros, father, son and grandson, by their wonderful teaching
abilities, caused the medical teaching center of Europe to be
transferred from Leyden to Edinburgh in 1720. These men, and many of
their students, did brilliant work in all branches of medicine.
The medical school which they so established in Edinburgh University
still maintains its great reputation.
The best anatomists of the eighteenth century were Cheselden, Pott,
the Monros, the Hunters, Desault, and Scarpa. Their work was largely
topographical. Surgical anatomy started with the writings of Joseph
Lieutaud (1703-1780), Albinus, Eisenmann, Soemmering, Mascagni,
Sandifort, and Caldani.
The anatomical textbooks in use in the year 1800 gave general accounts
of the body's structure and included current theories of the functions
of organs and their relationships to injuries and disease. More than
half of the chapters were occupied with morbid anatomy and the recital
of cases. The anatomy of the tissues and finer structures was neglected
because the microscopes of the period were little better than simple
lenses.
Physiology was studied by all medical students, but the science was so
badly developed that it never stood alone. For many years it formed a
part of studies in anatomy. Early in the nineteenth century it began
to expand, and in 1846 physiology was taught as a separate subject for
the first time at Guy's hospital, London, by Sir William Gull. Before
that it was taught by the professors of midwifery. It was the great
developments made in chemistry and physics, referred to in previous
chapters, that pushed physiology to the front as an important branch of
medical science.
Denman's "Introduction to the Practice of Midwifery," the work of the
greatest living authority at the time of its publication in 1805, shows
that gynecology hardly existed at that time.
Anesthetics and antiseptics, together with the systematic employment of
abdominal and bimanual palpation, all were revolutionary discoveries of
the nineteenth century, unknown when Denman presided over the obstetric
department of the Middlesex Hospital.
When the nineteenth century opened, medical men were unaware of the
value of auscultation and percussion. They were familiar with the
symptoms of fevers and with diseases of the heart and chest, but they
had no means of determining differences between them. Textbooks of that
time show that the now common forms of heart disease were known only
from post-mortem inspections. But they distinctly state that physicians
were unable to determine, in case of changes in stricture of the
heart's valves, what part was affected. The seat of disease in heart
and chest troubles could not be located.
Parasitology was no better advanced. Books published as late as 1810
indicated that parasites, like hydatids, threadworms, etc., were very
puzzling phenomena to the physician.
The status of surgery throughout the eighteenth century was very low.
The best work was done in France and Holland, until Cheselden, the
Hunters, the Monros, and Abernethy established their schools in England
and Scotland. German medical practitioners were barbers until after
the army authorities formed the Medico-Chirurgical Pépinière in Berlin
in 1785. There were several good medical schools in the United States
in 1800 including those of the King's College, New York, and of the
Harvard, Dartmouth, and Philadelphia Colleges, and the University of
Pennsylvania. There were also numerous medical societies. European
medical and surgical textbooks were used like those of Cheselden,
Monro, Haller, Boerhaave and Sydenham. Medical practice was on the
same plane in America as in Europe. There were many patent remedies
used, but the authorities recognized the importance of regulating the
practice of medicine. Regulation acts were passed in New York City in
1760, New Jersey in 1772, and a general quarantine act was enacted by
Congress in 1799.
The modernization of medicine was brought about to a large extent
by the publication of the "Conservation of Energy" by Helmholtz, in
1847, and Darwin's "Origin of Species," in 1859. These books cleared
away completely the myths and legends which had surrounded medicine
at earlier periods, and taught medical students the strict need of
proceeding entirely upon scientific grounds precisely as chemists,
physicists, engineers, and others were already doing with wonderful
success. Darwin's biological teachings appealed very strongly to
medical men and influenced all their activities.
Virchow's "Cellular Pathology," published in 1858, Huxley's textbooks
on "Physiology" (1866) and on "Vertebrate and Invertebrate Anatomy"
(1871-77) Haeckel's "General Morphology" (1866), and numerous medical
encyclopedias and textbooks on practice and special diseases were the
result of the new scientific spirit. New medical associations were
formed and these promoted discussions, the reporting of observations,
and the publication of innumerable monographs. Medical journals and
magazines of a high character did fine educational work.
The investigations on fermentation and putrefaction made in France
by Pasteur caused Joseph Lister, professor of surgery at Glasgow
University, to reflect upon the great mortality witnessed daily in the
hospitals from pyæmia, erysipelas, tetanus, septicemia, gangrene, and
other similar diseases. He observed that in spite of his great care
to maintain scrupulous cleanliness in treating wounds, 45 per cent of
his surgical cases were mortal. Pasteur's dictum that putrefaction is
a micro-organic phenomenon, caused Lister to experiment with the view
of preventing the development of microorganisms in wounds. Beginning
with weak solutions of zinc chloride and zinc sulphite, he accidentally
tried carbolic acid, securing surprising results, and two years
later, in 1867, he published his monograph on antiseptic surgery which
instantly became world-famous. Lister, instead of being carried away
by the celebrity he attained, turned his attention to the scientific
development of his important discovery. He investigated lactic-acid
fermentation, the relation of bacteria to flesh inflammations and to
the best methods of treating wounds antiseptically.
Lister, however, was not the first to employ antiseptics in the
treatment of wounds, and his great contribution to medical practice was
due to the systematic manner in which he experimented. He was not a
brilliant surgeon, but a deliberate and careful one whose chief desire
was to have the patient recover. His whole surgical career was guided
by this principle which proved so successful that before his death
the whole medical profession saluted him as master, and when he died,
rejoiced that his remains were entombed in Westminster Abbey.
Theodor Billroth was one of Lister's greatest disciples. He introduced
Lister's methods into continental surgery and through their use
improved the treatment of wounds and opened up new fields in the
surgery of the alimentary tract. He was the first to make a resection
of the esophagus and pylorus and to excise the larynx.
Mikulicz-Rodecki, a Pole, was Billroth's chief assistant. He was also
a pioneer in Lister's practice. Specializing on the surgery of the
alimentary organs, he promoted antiseptic methods and introduced the
modern modes of exploring the esophagus and stomach. He was also a
master in the treatment of diseases of the mouth.
Felix Guyon applied Lister's system to surgical treatment of the
genitourinary ailments, and became a leader in this class of surgery.
Bernard Naunyn, a well-known German writer on surgery, became a leading
authority on diabetes and diseases of the liver and pancreas. Jean
Martin Charcot made the Salpêtrière Hospital, Paris, the greatest
of the world's neurological clinics. He was also a great authority
on diseases of the biliary passages and kidneys. Sir James Paget,
Sir Jonathan Hutchinson, Sir William Gull, Jenner, Wilks, Spencer
Wells, and Clifford Allbutt, besides doing much by their writings
to advance the practice of medicine, all closely allied themselves
with large hospitals, giving as much attention to the hospitals as to
the treatment of disease. Modern hospitals are largely due to their
pioneering work.
Louis Pasteur's studies in fermentation led to the discovery of
lactic-acid bacteria and this was the starting point for a number of
revolutionary discoveries in bacterial diseases. Infectious diseases
were placed in new categories by his work.
The etiology of traumatic infectious diseases was advanced by the
researches of Robert Koch (1843-1910). His work in discovering the
cholera vibrio, the microorganisms of Oriental ophthalmia and his
researches on the nature and treatment of tuberculosis, made his name
known everywhere. His isolation of the tuberculosis germ in 1882,
and that of Asiatic cholera in 1884, were leading steps toward the
discovery of a great number of disease germs.
Fevers, like typhus, typhoid, yellow fever, and malaria, a few
generations ago, took a great annual toll of lives. The work of
the men mentioned above, Lister, Pasteur, Koch, and the French
physiologist, Claude Bernard, gave medical men the means of curbing the
ravages of these diseases so that to-day they are incidental annoyances
rather than human scourges.
The germ of typhoid fever was discovered in 1880 by Eberth. The cocci
of pneumonia were isolated by Frankel in 1886.
Modern surgery has been greatly facilitated by the employment of
numerous anesthetics, chemicals which possess the power of inducing
local or general insensibility. Soporific drugs have been used in
surgical operations since the remotest antiquity, but modern practices
in the employment of anesthetics followed the discoveries of Faraday in
1818. He described the properties of nitrous oxide, or ether and other
gases in that year and suggested their use in medicine.
John Godman (1822), James Jackson (1833), and Drs. Wood and Bache
(1834) were among American medical men who made use of Faraday's
suggestions. Dr. Horace Wells, a dentist at Hartford, Connecticut,
used ether in 1844. Two years later W. T. Morton, a dentist in Boston,
employed it successfully. Chloroform was described as a useful
anesthetic by Dr. Flourens, of Paris, in 1847, the year in which Sir
James Simpson introduced ether as an anesthetic in obstetric practice.
Mesmer introduced hypnosis into medical practice about 1777, and in
1784 Benjamin Franklin reported favorably on the medical value of what
he called magnetic sleep. Alexandre Bertrand, about 1831, described the
nature of hypnosis and in 1841 James Braid employed it in his English
medical practice. The employment of hypnosis has not become general,
although it is recognized that in certain nervous troubles there is a
field for it.
Among other American medical men who advanced their science in the past
were James Marion Sims (1813-1883) and Thomas Emmet, who acquired wide
fame for successful methods of operating in obstetric diseases. William
Beaumont (1785-1853) investigated the offices of the gastric juice and
devised treatment for digestive troubles. John Shaw Billings served his
profession by compiling, with the assistance of Robert Fletcher, an
Index Catalogue of the Surgeon General's library, Washington.
Pharmacology is as old as medicine. The medicinal qualities of herbs,
roots, and gums were known to primitive man. There have been herbalists
and druggists in all important communities at all times. Scientific
pharmacology, however, is just as new as modern medicine. Cordus
published a pharmacopœia, which listed drugs in use in 1535. Since
that time many such works have appeared. The second of the Monros of
Edinburgh University Medical School, Magendie, and Claude Bernard
placed pharmacy upon a scientific basis. They followed scientific
methods used by Fontana in Florence in 1765 in studying the effects
of snake poisons. Pareira's "Elements of Materia Medica" was the
leading textbook in 1842. This work gave very brief accounts of the
physiological effects of drugs. The physiological values were not
properly appreciated until about twenty years later.
Drugs are now scientifically classified and prepared, the full
resources of science being used in their manufacture. American
chemists have invented machinery and methods of preparing new drugs.
Citrate of magnesia was invented by Henry Blair, of Philadelphia. Many
other valuable remedies came from his laboratory, including sirup of
phosphates.