CHAPTER XV

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.