Part 185

"About the time when we seniors commenced the study of medicine, it was still under the influence of the important discoveries which Albrecht von Haller [1708-1777] had made on the excitability of nerves; and which he had placed in connection with the vitalistic theory of the nature of life. Haller had observed the excitability in the nerves and muscles of amputated members. The most surprising thing to him was, that the most varied external actions, mechanical, chemical, thermal, to which electrical ones were subsequently added, had always the same result; namely, that they produced muscular contraction. They were only quantitatively distinguished as regards their action on the organism, that is, only by the strength of the excitation; he designated them by the common name of stimulus; he called the altered condition of the nerve the excitation, and its capacity of responding to a stimulus the excitability, which was lost at death. {2142} This entire condition of things, which physically speaking asserts no more than the nerves, as concerns the changes which take place in them after excitation, are in an exceedingly unstable state of equilibrium; this was looked upon as the fundamental property of animal life, and was unhesitatingly transferred to the other organs and tissues of the body, for which there was no similar justification. It was believed that none of them were active of themselves, but must receive an impulse by a stimulus from without; air and nourishment were considered to be the normal stimuli. The kind of activity seemed, on the contrary, to be conditioned by the specific energy of the organ, under the influence of the vital force. Increase or diminution of the excitability was the category under which the whole of the acute diseases were referred, and from which indications were taken as to whether the treatment should be lowering or stimulating. The rigid one-sidedness and the unrelenting logic with which … [John] Brown had once worked out the system was broken, but it always furnished the leading points of view."

_H. Helmholtz, On Thought in Medicine (Popular Lectures, series 2, lecture 5)._

MEDICAL SCIENCE: 18th. Century. Physiological Views of Bichat.

Marie Francis Xavier Bichat, was born in 1771 and died in 1802, accomplishing his extraordinary work as an anatomist and physician within a lifetime of thirty-one years. "The peculiar physiological views of Bichat are to be found stated more or less distinctly in all his works; and it is a merit of his that he has always kept in sight the necessary connexion of this part of the science of medicine with every other, and, so far as he has developed his ideas upon the subjects of pathology, materia medica, and therapeutics, they seem all to have been founded upon and connected with the principles of physiology, which he had adopted. … Everything around living bodies, according to Bichat, tends constantly to their destruction. And to this influence they would necessarily yield, were they not gifted with some permanent principle of reaction. This principle is their life, and a living system is therefore necessarily always engaged in the performance of functions, whose object is to resist death. Life, however, does not consist in a single principle, as has been taught by some celebrated writers, by Stahl, Van Helmont, and Barthez, &c. We are to study the phenomena of life, as we do those of other matter, and refer the operations performed in living systems to such ultimate principles as we can trace them to, in the same way that we do the operations taking place among inorganic substances. … His essential doctrine … is that there is no one single, individual, presiding principle of vitality, which animates the body, but that it is a collection of matter gifted for a time with certain powers of action, combined into organs which are thus enabled to act, and that the result is a series of functions, the connected performance of which constitutes it a living thing. This is his view of life, considered in the most general and simple way. But in carrying the examination farther, he points out two remarkable modifications of life, as considered in different relations, one common both to vegetables and animals, the other peculiar to animals. … Those which we have in common with the vegetable, which are necessary merely to our individual, bodily existence, are called the functions of organic life, because they are common to all organized matter. Those, on the other hand, which are peculiar to animals, which in them are superadded to the possession of the organic functions, are called the functions of animal life. Physiologically speaking, then, we have two lives, the concurrence of which enables us to live and move and have our being; both equally necessary to the relations we maintain as human beings, but not equally necessary to the simple existence of a living thing. … The two lives differ, in some important respects, as to the organs by which their functions are performed. Those of the animal life present a symmetry of external form, strongly contrasted with the irregularity, which is a prominent characteristic of those of organic life. In the animal life, every function IS either performed by a pair of organs, perfectly similar in structure and size, situated one upon each side of the median dividing line of the body, or else by a single organ divided into two similar and perfectly symmetrical halves by that line. … The organs of the organic life, on the contrary, present a picture totally different; they are irregularly formed, and irregularly arranged. … This symmetry of the form is accompanied by a corresponding harmony in the functions of the organs of the animal life. … The functions of the organic life are constantly going on; they admit of no interruption, no repose. … In those of the animal life, the case is widely different. They have intervals of entire repose. The organs of this life are incapable of constant activity, they become fatigued by exercise and require rest. This rest, with regard to any particular organ, is the sleep of that organ. … Upon this principle, Bichat founds his theory of sleep. General sleep is the combination of the sleep of particular organs. Sleep then is not any definite state, but is more or less complete rest of the whole system in proportion to the number of organs which require repose. … The two lives differ also in regard to habit; the animal being much under its control, the organic but slightly. … But the principal and most important feature in the physiological system of Bichat, is the complete, and entire, and exclusive explanation of all the phenomena of the living system upon the principles of vitality alone. Former physiologists have not always kept this distinctly in view. … The human body has been regarded, too often, as a mass of matter, organized to be sure, but yet under the direction of physical laws, and the performance of its functions has been ascribed to the powers of inorganic matter. Hence, physiology has generally been somewhat tinctured by the favorite science of the age, with some of its notions. … With Bichat the properties of life were all in all. The phenomena of the system, whether in health or disease, were all ascribed to their influence and operation."

_J. Ware, Life and Writings of Bichat (North American Review, July, 1822)._

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MEDICAL SCIENCE: 18-19th Centuries. Pinel and the Reform in treatment of the Insane.

Philippe Pinel, "who had attained some distinction as an alienist, was appointed, 1792, to fill the post of superintendent of the Bicêtre, which then contained upwards of 200 male patients, believed not only to be incurable, but entirely uncontrollable. The previous experience of the physician, here stood him in good stead. He had been a diligent student of the authorities of his own and foreign countries on diseases of the mind, and in his earlier years had been appointed by the French government to report on the condition of the asylums at Paris and Charenton. On assuming the oversight of the Bicêtre, he found 53 men languishing in chains, some of whom had been bound for a great number of years. These were regarded by the authorities as dangerous and even desperate characters; but the sight of men grown gray and decrepit as the result of prolonged torture, made a very different impression on the mind of Pinel. He addressed appeal after appeal to the Commune, craving power to release, without delay, the unhappy beings under his charge. The authorities tardily and unwillingly yielded to the importunity of the physician. An official, who was deputed by the Commune to accompany the superintendent and watch his experiment, no sooner caught sight of the chained maniacs than he excitedly exclaimed: 'Ah, ça! citoyen, es-tu fou toi-même de vouloir déchaîner de pareils animaux?' The physician was not to be deterred, however, from carrying out his benevolent project, and did not rest satisfied until all of the 53 men had been gradually liberated from their chains. Singular as it may appear, the man who had been regarded as the most dangerous, and who had survived forty years of this severe treatment, was afterwards known as the faithful and devoted servant of Pinel. The reforms of Pinel were not confined to the Bicêtre, an establishment exclusively for men, but extended to the Salpêtrière, an institution for women. There is, perhaps, no more touching event in history than that of this kind-hearted and wise physician removing the bands and chains from the ill-fated inmates of this place of horrors. The monstrous fallacy of cruel treatment once fully exposed, the insane came to be looked upon as unfortunate human beings, stricken with a terrible disease, and, like other sick persons, requiring every aid which science and benevolent sympathy could provide with a view to cure. Governmental inquiries were instituted with a view to the attainment of better treatment, and in different countries, almost simultaneously, the provision of suitable and adequate accommodation for the insane was declared to be a State necessity."

_W. P. Letchworth, The Insane in Foreign Countries, chapter 1._

MEDICAL SCIENCE: 19th Century. The Discovery of Anæsthetics.

"In 1798, Mr. Humphry Davy, an apprentice to Mr. Borlase a surgeon at Bodmin, had so distinguished himself by zeal and power in the study of chemistry and natural philosophy, that he was invited by Dr. Beddoes of Bristol, to become the 'superintendent of the Pneumatic Institution which had been established at Clifton for the purpose of trying the medicinal effects of different gases.' He obtained release from his apprenticeship, accepted the appointment, and devoted himself to the study of gases, not only in their medicinal effects, but much more in all their chemical and physical relations. After two years' work he published his 'Researches, Chemical and Philosophical, chiefly concerning Nitrous Oxide.' … He wrote, near the end of his essay: 'As nitrous oxide in its extensive operation appears capable of destroying physical pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place.' It seems strange that no one caught at a suggestion such as this. … The nitrous oxide might have been of as little general interest as the carbonic or any other, had it not been for the strange and various excitements produced by its inhalation. These made it a favourite subject with chemical lecturers, and year after year, in nearly every chemical theatre, it was fun to inhale it after the lecture on the gaseous compounds of nitrogen; and among those who inhaled it there must have been many who, in their intoxication, received sharp and heavy blows, but, at the time, felt no pain. And this went on for more than forty years, exciting nothing worthy to be called thought or observation, till, in December 1844, Mr. Colton, a popular itinerant lecturer on chemistry, delivered a lecture on 'laughing gas' in Hartford, Connecticut. Among his auditors was Mr. Horace Wells, an enterprising dentist in that town, a man of some power in mechanical invention. After the lecture came the usual amusement of inhaling the gas, and Wells, in whom long wishing had bred a kind of belief that something might be found to make tooth-drawing painless, observed that one of the men excited by the gas was not conscious of hurting himself when he fell on the benches and bruised and cut his knees. Even when he became calm and clear-headed the man was sure that he did not feel pain at the time of his fall. Wells was at once convinced—more easily convinced than a man of more scientific mind would have been—that, during similar insensibility, in a state of intense nervous excitement, teeth might be drawn without pain, and he determined that himself and one of his own largest teeth should be the first for trial. Next morning Colton gave him the gas, and his friend Dr. Riggs extracted his tooth. He remained unconscious for a few moments, and then exclaimed, 'A new era in tooth-pulling! It did not hurt me more than the prick of a pin. It is the greatest discovery ever made.' In the next three weeks Wells extracted teeth from some twelve or fifteen persons under the influence of the nitrous oxide, and gave pain to only two or three. Dr. Riggs, also, used it with the same success, and the practice was well known and talked of in Hartford. Encouraged by his success Wells went to Boston, wishing to enlarge the reputation of his discovery and to have an opportunity of giving the gas to some one undergoing a surgical operation. Dr. J. C. Warren, the senior Surgeon of the Massachusetts General Hospital, to whom he applied for this purpose, asked him to show first its effects on some one from whom he would draw a tooth. He undertook to do this in the theatre of the medical college before a large class of students, to whom he had, on a previous day, explained his plan. Unluckily, the bag of gas from which the patient was inhaling was taken a way too soon; he cried out when his tooth was drawn; the students hissed and hooted; and the discovery was denounced as an imposture. Wells left Boston disappointed and disheartened; he fell ill, and was for many months unable to practise his profession. Soon afterwards he gave up dentistry, and neglected the use and study of the nitrous oxide, till he was recalled to it by a discovery even more important than his own. The thread of the history of nitrous oxide may be broken here. {2144} The inhalation of sulphuric ether was often, even in the last century, used for the relief of spasmodic asthma, phthisis, and some other diseases of the chest. … As the sulphuric ether would 'produce effects very similar to those occasioned by nitrous oxide,' and was much the more easy to procure, it came to be often inhaled, for amusement, by chemist's lads and by pupils in the dispensaries of surgeons. It was often thus used by young people in many places in the United States. They had what they called 'ether frolics.' … Among those who had joined in these ether-frolics was Dr. Wilhite of Anderson, South Carolina. In one of them, in 1839," a negro boy was unconscious so long that he was supposed for some time to be dead. "The fright at having, it was supposed, so nearly killed the boy, put an end to the ether-frolics in that neighbourhood; but in 1842, Wilhite had become a pupil of Dr. Crauford Long, practising at that time at Jefferson (Jackson County, Georgia). Here he and Dr. Long and three fellow-pupils often amused themselves with the ether-inhalation, and Dr. Long observed that when he became furiously excited, as he often did, he was unconscious of the blows which he, by chance, received as he rushed or tumbled about. He observed the same in his pupils; and thinking over this, and emboldened by what Mr. Wilhite told him of the negro-boy recovering after an hour's insensibility, he determined to try whether the ether-inhalation would make any one insensible of the pain of an operation. So, in March, 1842, nearly three years before Wells's observations with the nitrous oxide, he induced a Mr. Venable, who had been very fond of inhaling ether, to inhale it till he was quite insensible. Then he dissected a tumour from his neck; no pain was felt, and no harm followed. Three months later, he similarly removed another tumour from him; and again, in 1842 and in 1845, he operated on other three patients, and none felt pain. His operations were known and talked of in his neighbourhood; but the neighbourhood was only that of an obscure little town; and he did not publish any of his observations. … He waited to test the ether more thoroughly in some greater operation than those in which he had yet tried it; and then he would have published his account of it. While he was waiting, others began to stir more actively in busier places, where his work was quite unknown, not even heard of. Among those with whom, in his unlucky visit to Boston, Wells talked of his use of the nitrous oxide, and of the great discovery which he believed that he had made, were Dr. Morton and Dr. Charles Jackson. … Morton was a restless energetic dentist, a rough man, resolute to get practice and make his fortune. Jackson was a quiet scientific gentleman, unpractical and unselfish, in good repute as a chemist, geologist, and mineralogist. At the time of Wells's visit, Morton, who had been his pupil in 1842, and for a short time, in 1843, his partner, was studying medicine and anatomy at the Massachusetts Medical College, and was living in Jackson's house. Neither Morton nor Jackson put much if any faith in Wells's story, and Morton witnessed his failure in the medical theatre. Still, Morton had it in his head that tooth-drawing might somehow be made painless. … Jackson had long known, as many others did, of sulphuric ether being inhaled for amusement and of its producing effects like those of nitrous oxide; he knew also of its employment as a remedy for the irritation caused by inhaling chlorine. He had himself used it for this purpose, and once, in 1842, while using it, he became completely insensible. He had thus been led to think that the pure ether might be used for the prevention of pain in surgical operations; he spoke of it with some scientific friends, and sometimes advised a trial of it; but he did not urge it or take any active steps to promote even the trial. One evening, Morton, who was now in practice as a dentist, called on him, full of some scheme which he did not divulge, and urgent for success in painless tooth-drawing. Jackson advised him to use the ether, and taught him how to use it. On that same evening, the 30th of September, 1846, Morton inhaled the ether, put himself to sleep, and, when he awoke, found that he had been asleep for eight minutes. Instantly, as he tells, he looked for an opportunity of giving it to a patient; and one just then coming in, a stout healthy man, he induced him to inhale, made him quite insensible, and drew his tooth without his having the least consciousness of what was done. But the great step had yet to be made. … Could it be right to incur the risk of insensibility long enough and deep enough for a large surgical operation? It was generally believed that in such insensibility there was serious danger to life. Was it really so? Jackson advised Morton to ask Dr. J. C. Warren to let him try, and Warren dared to let him. It is hard, now, to think how bold the enterprise must have seemed to those who were capable of thinking accurately on the facts then known. The first trial was made on the 16th of October, 1846. Morton gave the ether to a patient in the Massachusetts General Hospital, and Dr. Warren removed a tumour from his neck. The result was not complete success; the patient hardly felt the pain of the cutting, but he was aware that the operation was being performed. On the next day, in a severer operation by Dr. Hayward, the success was perfect; the patient felt nothing, and in long insensibility there was no appearance of danger to life. The discovery might already be deemed complete; for the trials of the next following days had the same success, and thence onwards the use of the ether extended over constantly widening fields. … It might almost be said that in every place, at least in Europe, where the discovery was promoted more quickly than in America, the month might be named before which all operative surgery was agonising, and after which it was painless."

_Sir J. Paget, Escape from Pain (Nineteenth Century, December 1879)._

MEDICAL SCIENCE: 19th Century. The Study of Fermentation and its results.

"It was some time ago the current belief that epidemic diseases generally were propagated by a kind of malaria, which consisted of organic matter in a state of motor-decay; that when such matter was taken into the body through the lungs, skin, or stomach, it had the power of spreading there the destroying process by which itself had been assailed. Such a power was visibly exerted in the case of yeast. A little leaven was seen to leaven the whole lump—a mere speck of matter, in this supposed state of decomposition, being apparently competent to propagate indefinitely its own decay. Why should not a bit of rotten malaria act in a similar manner within the human frame? In 1836 a very wonderful reply was given to this question. In that year Cagniard de la Tour discovered the yeast-plant—a living organism, which when placed in a proper medium feeds, grows, and reproduces itself, and in this way carries on the process which we name fermentation. By this striking discovery fermentation was connected with organic growth. Schwann, of Berlin, discovered the yeast-plant independently about the same time."

_J. Tyndall, Fragments of Science, volume 1, chapter 5._

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