VII. THE EIGHTEENTH CENTURY
The Sciences accessory to Medicine.—The great Schools of Medical Theory.—Boerhaave and his System.—Stahl.—Hoffman.—Cullen.—Brown.—Hospitals.—Bichat and the New Era of Anatomy.—Mesmer and Mesmerism.—Surgery.—The Anatomists, Physiologists, and Scientists of the Period.—Inoculation and Vaccination.
The medical history of the eighteenth century affords but a meagre result, notwithstanding the brilliant talents and indefatigable industry of the famous men who devoted their energies to the healing art. Their great aim was to create systems of medicine which should be philosophical and complete.
It is not only in what is strictly the art of healing that the members of the medical profession have ever been amongst the greatest benefactors of the world, but in what are known as the accessory sciences many of the most distinguished, enlightened, and self-sacrificing of the heroes of science have been affiliated to the profession of medicine. Not only the heroes, but the martyrs of medicine, crowd the scientific calendar. The seventeenth and eighteenth centuries were fertile in the efforts to apply the results of discoveries in the physical sciences to the relief of human suffering. If these efforts were but partially successful, so far as medicine—considered apart from surgery—was concerned, it was not in consequence of less industry in that department, but because speculation and theorising about the causes of disease monopolised the attention which, if devoted to observation of facts, would have been fertile in result. Schools, Systems, and Sects were the chief product of the medical activity of the eighteenth century. Although not perhaps of much direct benefit to medicine, indirectly the study of the sciences accessory to it must have been of considerable benefit as an educational factor in the training of the intellect of physicians.
THE GREAT SCHOOLS OF MEDICAL THEORY.
Whewell, in his History of Scientific Ideas,[990] classifies the successive biological hypotheses under the heads: (1) THE MYSTICAL SCHOOL; (2) THE IATRO-CHEMICAL SCHOOL; (3) THE IATRO-MATHEMATICAL SCHOOL; (4) THE VITAL-FLUID SCHOOL; (5) THE PSYCHICAL SCHOOL.
THE MYSTICAL SCHOOL found its most distinguished representative in Paracelsus; it derived its doctrine of the Macrocosm and the Microcosm from the Neoplatonists, and was largely imbued with alchemy and magic, the doctrines of the Cabala and the fanciful interpretations of the Bible. Later Paracelsists, Rosicrucians, and other speculators of the same character, such as Sir Kenelm Digby, brought the Mystical School of Medicine down to the seventeenth century. Our modern Theosophists are striving to restore much of the mystical teaching of Paracelsus and his followers. Again we meet the “astral bodies,” “the elementary spirits,” the cabalistic interpretations of the Bible, and the astrological absurdities of a pre-scientific period.
THE IATRO-CHEMICAL SCHOOL really arose from PARACELSUS, who amongst many absurdities held much important truth. SPRENGEL indicates LIBAVIUS of Saxony as the person who first cultivated chemistry apart from theosophy, and he names ANGELUS SALA as his successor. LEMERY, in the middle of the seventeenth century, began to reform pharmaceutical chemistry. After PARACELSUS chemistry became an indispensable study to every physician. Our word tartar, the scale which forms on the teeth, is of Paracelsian origin. He taught that the basis of all diseases was a thickening of the juices and the formation of earthy matter, which he called Tartarus, because it burns like the fire of hell. After PARACELSUS we have VAN HELMONT, a true chemical discoverer who sought in chemistry a theory of disease of which his doctrine of fermentation in the body holds an important place. Next we have SYLVIUS, with his doctrine of the opposition of acid and alkali. Digestion he considered a process of fermentation or effervescence of the acid of the saliva and pancreatic juice with the alkali of the gall. When either the acid or the alkali predominated, disease was supposed to follow. The human body was regarded as a laboratory, the stomach as a sort of test tube. BOYLE made objections to the doctrines of this school, and HERMAN CONRING taught that the proper place of chemistry was not in physiology and pathology, but in pharmacy.
VIRIDET of Geneva endeavoured to prove that the fluids of the body are either acid or alkaline by experiment. RAIMOND VIEUSSENS declared that he had discovered an acid in the blood and a ferment in the stomach. HECQUET opposed him, and said that digestion was not a process of fermentation, but of trituration. PITCAIRN in England, BOHN and HOFFMAN in Germany, and BOERHAAVE in Holland opposed the iatro-chemists, and proved by observation that digestion is not fermentation, and that the acid and alkali theories of disease supported by SYLVIUS were false. By the influence and authority of these eminent physicians, the reign of the chemical school of physiology was overturned. The great fault of the iatro-chemists was their neglect of the effect of the solids of the animal body; they assimilated the work of the physician, as Whewell says, to that of the vintner or the brewer.
THE IATRO-MATHEMATICAL or MECHANICAL SCHOOL attacked, defeated, and superseded the iatro-chemists. According to this sect, the human body is a mere machine. Whewell explains that the Mechanical Physiologists came into existence in consequence of the splendid results obtained by the schools of Galileo and Newton. It was not so much the exposure of the weaknesses of the chemical physiology as the effects produced upon the world by the explanation of so many of the phenomena of the external universe by the men who had revolutionized astronomy by their discoveries; it was naturally hoped that that which served to explain the great world of matter might also elucidate the little world of man. Whewell divides the school into two parts—the Italian and the Cartesio-Newtonian sect. The Italian calculated and analysed the properties of the animal body which are undoubtedly purely mechanical, the Cartesio-Newtonians went much further than this and introduced many baseless hypotheses. The Italians occupied themselves with such calculations as the force of muscles and the hydraulics of the animal fluid. BORELLI was the first great investigator on these lines; his work De Motu Animalium (Rome, 1680), treats of the forces and action of the bones and muscles. JOHN and DANIEL BERNOUELLI and HENRY PEMBERTON pursued the same line of research. The principles of hydrostatics were brought to bear on the questions of the blood pressure and the breath. KEILL endeavoured to estimate the velocity of the blood. The other school occupied itself with the corpuscular hypothesis in physiology. The organs were considered as a species of sieves. Both NEWTON and DESCARTES sought to explain physiology on a theory of round particles passing through cylindrical tubes, pyramidal ones through pores of a triangular shape, cubical through square openings. The diameter and curves of the different vessels formed subjects of calculations, and BELLINI, DONZELLINI, and GUGLIELMINI in Italy, PERRAULT and DODART in France, COLE, KEILL, and JURIN in England, devoted themselves to their study.[991]
The investigation of the size and shape of the particles of the fluids, and the diameter and form of the invisible vessels, formed a large part of the physiology of the beginning of the eighteenth century. CHEYNE thought that fevers of the acute sort arise from glandular obstruction; and MEAD, the royal physician and friend of Newton, explained the action of poisons on mechanical principles. The error of this school, as Whewell explains, lay in considering the animal frame as a lifeless compound of canals, cords and levers; the physicians, to its adherents, were merely hydraulic engineers. Some iatro-mathematicians were, in fact, at the same time teachers both of engineering and medicine.[992]
THE VITAL-FLUID SCHOOL. The mechanical explanation of the motions of the animal body may satisfy some observers up to a certain point; there, however, they must confess their theory fails them. How does motion originate in the living frame? FRIEDRICH HOFFMAN, of Halle (b. 1660), assumed a principle, material, yet of a higher kind than the adherents of the mechanical sect were inclined to recognise. This principle is exceedingly subtle, and is endued with great energy. It is the ether diffused through all nature, and which has its seat in the brain of animals and acts upon the body through the nerves. This vital fluid operates by laws which at one time were explained on the principles of a higher mechanics, of which we know little, and at another on metaphysical grounds, of which we know less. Naturally the discoveries connected with electricity imported a new element into these speculations. The vital principle was then held to be a modification of the electric fluid. JOHN HUNTER discerned it in the blood. CUVIER believed the vital fluid to be nervous. The objections to the doctrine of a vital fluid “as one uniform material agent pervading the organic frame,” are many. If the vital principle be the same in every part of the body, how does it happen that the secretions are all so different? How does the blood under the same influence furnish all the different fluids produced by the glands? How is it the liver secretes bile, the kidneys their peculiar fluid, the lachrymal gland the tears? The hypothesis of a vital fluid really explains nothing.
THE PSYCHICAL SCHOOL held the doctrine of an immaterial vital principle. This is at least as old as ARISTOTLE,[993] who attributes the cause of motion to the soul. According to that philosopher the soul has different parts: the nutritive or vegetative, the sensitive, and the rational. STAHL, the great discoverer in chemistry, opposed the physiological theories of HOFFMAN, and declared that there is something in living bodies which cannot be accounted for by mechanics or chemistry. “All motion,” according to him, “is a spiritual act.” Nutrition and secretion belong to the operations of the soul; but he overlooked the fact that these are not peculiar to animals, but are characteristics of vegetables, which have no soul. CHEYNE and MEAD, PATERFIELD and WHYTT in England inclined to Stahl’s views. BOISSIER DE SAUVAGES defended them in France. HOFFMAN and afterwards HALLER opposed them, the latter inventing the theory of Irritability.
BOERHAAVE (1668-1738), professor of medicine at Leyden, was a man of varied and profound erudition, conversant with the teaching of the ancient philosophers and the Greek and Arabian physicians; he was in addition fully conversant with all the discoveries connected with the healing art down to his own time. Beyond this he was a natural philosopher, chemist, botanist, and anatomist, and an indefatigable experimentalist. In teaching medicine he simplified its study as much as possible by rejecting the absurd and useless speculations which encumbered it, and putting in their place the facts which he believed his own experience and observation had enabled him to ascertain. He published his system of medicine in two volumes, one entitled the Instructions or Theory and the other the Aphorisms or Practice of Medicine. “These short treatises,” says Dr. Thomson,[994] “which gave to medicine a more systematic form than it had previously exhibited, are remarkable for brevity, perspicuity, and elegance of style, for great condensation of ideas, and for the number of important facts which they contain relative to the healthy and diseased states of the human economy.” The genius of Boerhaave raised the medical school of Leyden to the highest distinction. Princes in all countries sent him pupils; Peter the Great took lessons in medicine from him, and so great was his reputation that when a Chinese mandarin directed a letter to him, “To the illustrious Boerhaave, physician in Europe,” it was duly delivered. He held the study of Mind to form an important part of physiology. He taught that the change produced upon the extremity of the sentient nerve must be transmitted by the nerve to the brain before sensation can be produced. He considered the nerves to be hollow undulatory canals. He also held that each of the senses has its distinct seat in the common sensory or brain. His lectures on the mental faculties are full of varied and curious information. Considering the human body as a combination of various machines arranged in one harmonious whole, he endeavoured to explain its phenomena in health and disease on the principles of natural philosophy and chemistry to the almost entire exclusion of vital forces, which, however, he did not reject. He denied that all medical phenomena are to be explained upon mechanical principles. He lamented that “physiological subjects are usually handled either by mathematicians unskilful in anatomy, or by anatomists who are not versed in mathematics.” Yet his system of physiology embraced but a poor conception of the mystery of life. He says, “Let anatomy faithfully describe the parts and structure of the body; let the mechanician apply his particular science to the solids; let hydrostatics explain the laws of fluids in general, and hydraulics their actions, as they move through given canals; and lastly, let the chemist add to all these whatever his art, when fairly and carefully applied, has been able to discover; and then, if I am not mistaken, we shall have a complete account of medical physiology.”
It is to BOERHAAVE that we owe the peculiar chemical idea of affinity, that mutual virtue by which one chemical substance loves, unites with, and holds the other (amat, unit, retinet). He called it love. “We are here to imagine, not mechanical action, not violent impulse, not antipathy, but love, at least if love be the desire of uniting.” It is to BOERHAAVE, therefore, we are indebted for a view of chemical affinity which enables us to comprehend all chemical changes.[995]
The idea of affinity as marriage naturally leads to analysis as divorce. Thus affinity, imperfectly understood before the time of Boerhaave, made analysis possible. One of the first to express this conviction was DR. MAYOW, who published his Medico-Physical Tracts in 1674. He shows how an acid and an alkali lose their properties by combination, a new substance being formed not at all resembling either of the ingredients. He explains that, “although these salts thus mixed appear to be destroyed, it is still possible for them to be separated from each other, with their power still entire.”[996]
GEORGE ERNEST STAHL (1660-1734), chemist, was professor of medicine at Halle (1694) and physician to the King of Prussia (1716). He opposed materialism, and substituted “animism,” explaining the symptoms of disease as efforts of the soul to get rid of morbid influences. Stahl’s “anima” corresponds to Sydenham’s “nature” in a measure, and has some relationship to the Archeus of Paracelsus and Van Helmont. STAHL was the author of the “phlogiston” theory in chemistry, which in its time has had important influence on medicine. Phlogiston was a substance which he supposed to exist in all combustible matters, and the escape of this principle from any compound was held to account for the phenomenon of fire. According to STAHL, diseases arise from the direct action of noxious powers upon the body; and from the reaction of the system itself endeavouring to oppose and counteract the effects of the noxious powers, and so preserve and repair itself.[997] He did not consider diseases, therefore, pernicious in themselves, though he admitted that they might become so from mistakes made by the soul in the choice, or proportion of the motions excited to remove them, or the time when these efforts are made. Death, according to this theory, is due to the indolence of the soul, leading it to desist from its vital motions, and refusing to continue longer the struggle against the derangements of the body.[998] Here we have the “expectant treatment” so much in vogue with many medical men. “Trusting to the constant attention and wisdom of nature,” they administered inert medicines as placebos, while they left to nature the cure of the disease. But they neglected the use of invaluable remedies such as opium and Peruvian bark, for which error it must be admitted they atoned by discountenancing bleeding, vomiting, etc.[999] Stahl’s remedies were chiefly of the class known as “Antiphlogistic,” or antefebrile.
DE SAUVAGES (1706-1767), the French physicist, was a disciple of Stahl, and adopted his theory of soul as the cause of the mechanical action of the body. He invented a system of classifying diseases under the title of Nosologia Methodica, founded on the principles of natural history.
FRIEDRICH HOFFMAN (1660-1742) was a fellow-student with Stahl at Jena. He was the author of a system of medicine in some respects original. He distinguished in the human economy three principal agents: Nature, or the Organic Body; the Sentient Soul; and the Rational Soul; corresponding to the classification of the Scripture of body, soul, and spirit—a classification which originated doubtless in Indian philosophy. Hoffman did not admit with Stahl that the organic functions of the human body depend on the agency of an intelligent soul or any immaterial agent whatsoever, but are merely mechanical and chemical properties of the elements which compose our bodies. The functions most essential to life he considered to be the circulatory, secretory, and excretory motions, and these seemed to him to depend upon the dilating and contracting powers of the muscular fibres of the vascular system. These powers then he held to be the cause of the organic functions which depend on the animal spirits, an ethereal fluid contained in the nerves and the blood.[1000]
Hoffman first made known the virtues of the Seidlitz waters; he also invented a nostrum which was popular for a long time, and called “Hoffman’s Anodyne Liquor.”
PHYSICIANS.
ARCHIBALD PITCAIRN, M.D. (1652-1713), was a famous physician of Edinburgh. In 1692 he occupied a professor’s chair at Leyden with great distinction. Among his pupils were MEAD and BOERHAAVE, who both attributed much of their skill to his tuition. On his return to Edinburgh he greatly interested himself in improving the teaching of anatomy. He begged the Town Council to permit the dissection of the bodies of paupers; and though the chief surgeons of the place did all they could to oppose his efforts, they were successful, and Pitcairn had the credit of laying the foundation of the great Edinburgh school of medicine. He insisted on the strict adherence to Bacon’s method of attending to facts of experience and observation. “Nothing,” he said, “more hinders physic from being improved than the curiosity of searching into the natural causes of the effects of medicines. The business of men is to know the virtues of medicines; but to inquire whence they have that power is a superfluous amusement, since nature lies concealed. A physician ought therefore to apply himself to discover by experience the effects of medicines and diseases, and reduce his observations into maxims, and not needlessly fatigue himself by inquiring into their causes, which are neither possible nor necessary to be known. If all physicians would act thus, we should not see physic divided into so many sects.” In his DISSERTATIONS (1701) he discusses the application of geometry to physic, the circulation of the blood, the cure of fevers by purgation, and the effects of acids and alkalis in medicine. A learned and skilful physician, an accomplished mathematician, and a thorough classical scholar, he was not discreet in his political utterances. His library was purchased by Peter the Great of Russia.
JOHN RADCLIFFE, M.D. (1650-1714), was famous for “his magnificent regard for the advancement of learning and science.” The Radcliffe infirmary and observatory at Oxford were built from funds bequeathed by him.
SIR HANS SLOANE, M.D. (1660-1753), was a physician whose noble museum and library were the foundation of the British Museum.
SIR RICHARD BLACKMORE, M.D. (1650-1729), wrote on inoculation for small-pox, on consumption, gout, rheumatism, scrofula, diabetes, jaundice, etc.
WALTER NEEDHAM, M.D. (died 1691), made important investigations in the anatomy of the fœtus, and the changes of the pregnant uterus.
CLOPTON HAVERS, M.D. (died 1702), was the author of a standard work on the bones, certain canals of which were called after him Haversian canals.
JAMES DOUGLAS, M.D. (1675-1742), was an excellent anatomist, who was one of the first to demonstrate from anatomy that the high operation for stone might be safely performed. He was a skilful accoucheur, an accomplished botanist, and a man of letters. Pope mentions him in the Dunciad, and in a note describes him as a physician of great learning and no less taste. He wrote several works, the most famous of which is Myographiæ Comparatæ Specimen; or a comparative description of all the muscles in a man and in a quadruped; added is an account of the muscles peculiar to a woman. London, 1707.
WILLIAM CULLEN, M.D. (1710-1790), was the first professor in Great Britain to deliver his lectures in the English language.[1001] He was appointed lecturer on chemistry at Glasgow University in 1746, and in 1751 was chosen regius professor of medicine. In 1756 he became professor of chemistry in the University of Edinburgh; in 1760 he was made lecturer on materia medica. Dr. Cullen earned great distinction as a lecturer on medicine; he opposed the teaching of Boerhaave and the principles of the humoral pathology, founding his own teaching on that of Hoffman. His system was to a great extent based on the new physiological doctrine of irritability as taught by Haller.
He attached great importance to nervous action in the induction of disease, considering even gout as a neurosis.
His First Lines of the Practice of Physic was long exceedingly popular, but his fame as a medical writer rests on his Nosology, or Classification of Diseases. In all his labours Dr. Cullen aimed at the practical rather than the theoretical. “My business is not,” he remarks,[1002] “so much to explain how this and that happens, as to examine what is truly matter of fact.” “My anxiety is not so much to find out how it happens as to find out what happens.” Cullen invented no ingenious hypothesis, rather he new-modelled the whole practice of medicine; “he defined and arranged diseases with an unrivalled accuracy, and reduced their treatment to a simplicity formerly unknown.”[1003]
JAMES GREGORY, M.D. (1758-1822), exercised the greatest influence on the progress of medicine in England. As the successor of Cullen, and as the author of the famous Conspectus Medicinæ Theoreticæ, the name of Gregory, borne by many ornaments of British science, became still more distinguished.
SIR GILBERT BLANE, M.D. (born 1747), rendered important medical services to the State by his researches on the diseases incident to seamen. He banished scurvy from the fleet by his arrangements for provisioning ships on foreign stations, particularly by making lemon juice a regular ingredient of diet.
SIR WILLIAM WATSON, M.D. (1715-1787), was a devoted botanist and student of electricity. His electrical researches raised him to a position of European fame. He was the first in England who succeeded in igniting spirit of wine by electricity; he was the first to note the different colour of the spark, as drawn from different bodies; and his researches in the power and accumulation of electricity, the nature of its conductors, etc., qualified him to take part in the experiments carried out in 1747 and 1748, by which the “electric current was extended to four miles in order to prove the velocity of its transmission.”[1004] The doctor’s house in Aldersgate Street was long the resort of the most distinguished men of science in Europe. He was not less the benign and generous friend to the poor and suffering, than the ardent investigator of the secrets of Nature. His work Experiments and Observations on Electricity is quite a remarkable production considering the age in which it was published (1768).
ROBERT WILLAN, M.D. (1757-1812), was the founder of the science of skin diseases in England. His attention was directed in 1784 to the elementary forms of eruption, and on this basis he erected his magnum opus, The Description and Treatment of Cutaneous Diseases (1798).
JOHN BROWN (1735-1788), was a systematizer of medicine, whose popularity was even continental. He endeavoured to explain the processes of life and disease and the principles of cure upon one simple idea, the property of “excitability.” The “exciting powers” are the external forces, and the functions of the body are stimulants, so that “the whole phenomena of life, health as well as disease, consist in stimulus and nothing else.” Diseases he divided as sthenic, attended with preternatural excitement, and asthenic, characterized by debility.
Ninety-seven per cent. of all diseases, he declared, require a “stimulating treatment.” One good result of this theory was that it introduced a milder treatment of disease than the bleeding and purging doctors of his time advocated. The theory was called the Brunonian, and received greater attention in Italy than in England.
JOHN MORGAN, M.D. (1736-1789), was born in Philadelphia. He wrote an essay on his graduation at Edinburgh (1763), wherein “he maintained that pus is a secretion from the vessels, and in this view anticipated John Hunter.”[1005]
ROBERT JAMES, M.D. (1703-1776), was the inventor of the celebrated fever-powder which bears his name.
FRANCIS DE VALINGEN, M.D. (1725-1805), was a Swiss who practised in London. He was the first to suggest the employment of chloride of arsenic in practice. His preparation was admitted into the London Pharmacopœia.
ERASMUS DARWIN (1701-1802), a physician of Lichfield, was a true poet of science. His fame rests on the Botanic Garden, in which he describes the Loves of the Plants according to the Linnæan system. His most important scientific work is his Zoonomia, a pathological work, and a treatise on generation, in which he anticipated the views of Lamarck. He asks: “Would it be too bold to imagine that in the great length of time since the earth began to exist, perhaps millions of ages before the commencement of the history of mankind, would it be too bold to imagine that all warm-blooded animals have arisen from one living filament, which the Great First Cause endued with animality, with the power of acquiring new parts, attended with new propensities, directed by irritations, sensations, volitions, and associations, and thus possessing the faculty of continuing to improve by its own inherent activity, and of delivering down these improvements by generation to its posterity, world without end!” He believed that plants possess sensation and volition.
EDWARD SPRY, M.D. (lived in 1756). At the fire of Eddystone lighthouse an old man was injured by the fall of a quantity of molten lead upon him. Dying of his injuries in twelve days, he was examined by Dr. Spry, who stated that he found in the stomach a lump of lead three and three-quarter inches long by one and a half in breadth. As no surgeon would believe this story, Dr. Spry performed a number of experiments upon animals by pouring molten lead down their throats, with the result that at the Royal Society, Dr. Huxham, in his letter to Sir William Watson, “testified to his own belief in Mr. Spry’s veracity.”[1006]
JOHN COAKLEY LETTSOM, M.D. (1744-1815), was a learned and amiable philanthropist, who published several important medical and scientific works. His Reflections on the Treatment and Cure of Fevers and The Natural History of the Tea Tree appeared in 1772. He wrote the following lines:—
“When patients sick to me apply, I physics, bleeds, and sweats ’em. Sometimes they live, sometimes they die: What’s that to me? I. Lettsom.”
He gave away immense sums in charity, he was not so unfeeling as his verse would make him appear.
WILLIAM STARK (1742-1770) was the earliest writer who distinguished between tuberculosis and scrofula.
JEAN ASTRUC (1684-1766), professor at Montpellier, the oldest of the celebrated French obstetricians, was the author of a work on the diseases of women from the pathological point of view.
JOHANN E. WICHMANN (1740-1802), a scientific physician of Hanover, in 1786 explained the cause of itch as due to the itch-mite passing from one individual to another. He experimented upon himself. BONOMO had, however, discovered the insect in the itch pustules in 1687.
Wichmann suggested the contagiousness of consumption, whooping cough, diarrhœa, and several other complaints.
J. P. FRANK (1745-1821) was “the founder of medical police as a distinct department of science.”[1007]
HOSPITALS.
The condition of the hospitals for the sick in the eighteenth century was scandalous almost beyond belief. Thus, in the Hôtel Dieu of Paris, the mortality at one time was 220 per 1,000; a state of affairs which, however, we surpassed in the present century, when in the British hospitals at Scutari the mortality reached between 400 and 500 per 1,000. In both cases this was due to overcrowding. At the Hôtel Dieu two or three small-pox cases, or several surgical cases, or sometimes even four lying-in women would be packed into one bed. A large proportion of the beds were purposely made for four patients, and six were frequently crowded in.
JOHN HOWARD (1726-1790), the philanthropist, by his splendid and devoted labours in connection with the reform of prisons, hospitals, and lazarettos, drew attention to the means of preventing the communication of the plague and other infectious fevers. In the words of Burke “his philanthropic spirit led him to dive into the depths of dungeons; to plunge into the infection of hospitals; to survey the mansions of sorrow and pain; to take the gauge and dimensions of misery, depression, and contempt; to remember the forgotten; to attend to the neglected; to visit the forsaken, and to compare and collate the distresses of all men in all countries.” Not the least of his services were those he rendered to the cause of sanitary science and public health.
THÉOPHILE DE BORDEU (1722-1776) was a professor of anatomy and midwifery at Montpellier. By his great work, Recherches sur le Pouls, he so enraged his professional brethren (who, like the Jews, always either maim or kill the prophets sent unto them), that he was attacked in his personal character with disgraceful malignity for several years. He rendered very great services to the progress of medical science. His physiology was far in advance of his age, and many men have found in his researches on the functions of the glands a mine of wealth for the establishment of their own reputation.
M. F. X. DE BICHAT (1771-1802) was a celebrated French anatomist and physiologist, whose great work, Anatomie Générale, was the foundation of the reform of French medicine at the intellectual awakening after the great revolution. Pathology, the science of disease, would have been impossible without such researches as those of Bichat. He first took a “commanding view,” not merely of the organs of the body, but of the tissues of which they are built up. He resolved the complex into its elements, and investigated the structure of each. He completed the overthrow of the iatro-mathematical school, regarding the properties of the living tissues as vital actions. He classified the functions as organic and animal, and greatly aided in systematising the phenomena of life.
MESMERISM.
FREDERICK ANTON MESMER (1733-1815) studied medicine at Vienna. He embraced astrology, and believed in the influence of the stars on living beings. He came to think that cures might be effected by stroking with magnets; afterwards he discarded the magnets, and convinced himself that he could influence others by stroking them with his hands alone. In 1778 Paris was greatly excited over the miraculous cures of mesmerism. The medical faculty denounced him as a charlatan, though a Government Commission in its report admitted many of the facts, while tracing them to physiological causes. The Marquis de Puysegur revolutionised the art of mesmerism by producing all the phenomena without the mummeries and violent means resorted to by Mesmer. Dr. John Elliotson in England in 1830 successfully practised the art.
In 1845 BARON VON REICHENBACH declared he had discovered a new force which he called odyl, and in 1850 his Researches on Magnetism were translated into English by Dr. Gregory, professor of chemistry in the University of Edinburgh.
G. VAN SWIETEN (1700-1772) was a pupil of Boerhaave, and famous in the history of medicine as the founder of the Old Vienna School. He brought about the clinical teaching for which that school has since been so famous. Following the instructions of Paracelsus, he introduced into his practice the use of mercuric perchloride internally in the treatment of syphilis. His commentaries on Boerhaave were considered to be more valuable than the text itself.
DE HAEN (1704-1776), of the Hague, studied under Boerhaave, and having been recommended by Van Swieten, was invited to Vienna as president of the clinical school in the hospital of that city. Observation, and the simplest treatment in disease, especially in fevers, made up the chief part of his medical system. Purgatives and emetics and powerful medicines he would use only on the most urgent necessity. Hygiene, both for the patient and the state, he considered of the highest importance in medical education. Clinical thermometry received great attention from De Haen, who demonstrated that in what is considered by the patient the cold stage of fevers there is really a notable increase in the temperature.
JAMES YONGE (1646-1721), physician and F.R.S., wrote an important treatise on the use of turpentine as a means of arresting hæmorrhage, entitled Currus Triumphalis de Terebintho. He described the flap operation in amputations, and was acquainted with the principle of the tourniquet for the arrest of bleeding during operations.
JOHN ADDENBROOKE, M.D., died 1719, leaving by his will four thousand pounds to found a hospital at Cambridge, which now bears his name.
JAMES DRAKE, M.D. (1667-1707), wrote a work, once deservedly popular, entitled Anthropologia Nova; or, a New System of Anatomy.
JOHN ARBUTHNOT, M.D. (1658-1735), physician to Queen Anne, was a man of extensive learning and of great scientific abilities, characterized by Thackeray as “one of the wisest, wittiest, most accomplished, gentlest of mankind.”
DANIEL TURNER, M.D. (1667-1741), achieved a certain fame as the inventor of an excellent ointment, still known as “Turner’s Cerate,” composed of oil, wax, and calamine.
RICHARD MEAD, M.D. (1673-1754), was the author of the Mechanical Account of Poisons, a work which at once established his reputation. He was elected a Fellow of the Royal Society in 1703. On the accession of George II. he was appointed physician-in-ordinary to the King. He was the friend of Radcliffe, and like him a generous promoter of science and learning and of unbounded charity to those in misery. It was Mead who persuaded Guy to bequeath his fortune to found the noble hospital which bears his name. Mead was a political physician, and it is said by Miss Strickland that his prompt boldness occasioned the peaceable proclamation of George I. Mead’s work on the diseases of the Bible, entitled Medica Sacra, is a curious and interesting treatise. Excellent physician as he was, he recommended pepper and lichen as a specific against the bite of a mad dog.
JOHN FREIND, M.D. (1675-1728), a learned and accomplished physician, is famous as the author of an elaborate work, The History of Physick from the Time of Galen to the Beginning of the Sixteenth Century. He laid the plan of this important work whilst a prisoner in the Tower, to which he was committed on suspicion of participation in the so-called “Bishop’s plot.” He was liberated after about three months’ confinement by the firmness of Dr. Mead, who refused to prescribe for Sir Robert Walpole till he consented to admit him to bail.[1008] During his imprisonment Freind wrote a Latin letter On certain Kinds of Small Pox.
How near the physicians of Mead’s time came towards the discovery of the germ theory of infectious disorders may be seen from his account of the leprosy.[1009] In this treatise he says it has been found by experiments that in the plague and other malignant eruptive fevers the infection once received into articles of clothing remains in them for a long time, and thence passes into human bodies, and “like seeds sown produces the disease peculiar to them.” With reference to the retention of the infection by dry walls, he says, “I thought it probable that they may, by a kind of fermentation, produce these hollow, greenish, or reddish strokes,” etc.
SURGEONS.
DOMINIQUE ANEL (1679-1730) was the famous French surgeon who invented the operation for aneurism, which Hunter afterwards modified and called by his own name.
He successfully treated lachrymal fistula, and invented several surgical instruments which are named after him.
J. L. PETIT (1674-1750) in 1718 invented the screw tourniquet for compressing bleeding arteries. He was one of the most famous surgeons in the brightest period of the art in France, and was besides an excellent ophthalmologist.
LE CAT (1700-1768) was the famous lithotomist, and opponent of the doctrines of Haller.
LE DRAN (1685-1770) performed the first disarticulation of the thigh.
MORAND (1697-1773) performed disarticulation of the upper arm.
PIERRE JOSEPH DESAULT (1744-1795) was a great French anatomist and surgeon, who instituted a clinical school of surgery at the Hôtel Dieu in Paris. He frequently had an audience of six hundred.
He introduced many improvements in surgical practice and in the construction of surgical instruments.
G. DE LA FAYE (d. 1781), a great surgeon and oculist, also disarticulated the shoulder joint.
A. LOUIS (1723-1792) was a distinguished military surgeon.
R. B. SABATIER (1723-1811) was a distinguished surgeon, anatomist, and ophthalmologist, and a man of great and all-round information on medical subjects in general.
P. F. PERCY (1754-1825) was a military surgeon who introduced cold-water dressings into French surgery.
ANTONIO SCARPA (1748-1832), the famous Italian anatomist, held the chair of anatomy at Modena, was distinguished in every branch of anatomical research, and investigated the minute anatomy of the nerves and bones. He decided the long-debated question whether the heart is supplied with nerves in the affirmative. He wrote on diseases of the eye, on aneurism, and on hernia. He was an elegant scholar, “equally at home in the criticism of the fine arts and in the details of scientific agriculture.”
Amongst the principal Italian surgeons of the century were BERTRANDI (1723-1797), TROJA (1747-1827), and PALLETTA (1747-1823).
Of the Germans the great names are, SCHMUCKER (1712-1786), RICHTER (1742-1812), and SIEBOLD (1736-1807), who first taught surgery clinically in Germany.
CALLISEN (1740-1824), the great Danish surgeon, and ANEL (1741-1801), the founder of the Swedish School of Surgery, are two famous names which must be remembered in the surgical history of the period.
WILLIAM CHESELDEN (1688-1752) was famous as a lithotomist and oculist. His dexterity in the performance of lithotomy caused marvellous legends to be told of him, it was even said that he had operated in fifty-four seconds. He published his Anatomy of the Human Body in 1713.
SAMUEL SHARP (1700-1778) excelled in nearly every branch of surgery, and was a skilful operator, who by his efforts to stimulate English surgeons to emulate the French did much to advance British surgery.
BENJAMIN GOOCH of Norwich, HEY of Leeds, and PARK of Liverpool, were also famous in this period.
PERCIVAL POTT (1713-1788) was a surgeon to St. Bartholomew’s Hospital, London, whose life formed a sort of epoch in the history of surgery in England. Samuel Cooper says of him[1010] that he was in his time the best practical surgeon, the best lecturer, the best writer on surgery, the best operator of which the metropolis could boast.
JOHN HUNTER (1728-1793) was a physiologist and surgeon combined, unrivalled in the annals of medicine. He raised surgery, which before his time was little more than a mechanical art, to the rank of a scientific profession. As a pathologist and comparative anatomist, he rendered the greatest services to medicine and surgery. He dissected 500 different species of animals. One of the most brilliant surgical discoveries of the century was Hunter’s operation for the cure of popliteal aneurism, by tying the femoral artery above the tumour and without interfering with it. He improved the treatment of rupture of the tendo achillis, and invented a method of curing lachrymal fistula, and of curing hydrocele radically by injection.
He was the first to describe phlebitis (inflammation of the veins), and he made the discovery that the white blood corpuscles are antecedent to the red. He investigated the subject of inflammation, the results of which he published in his Treatise on the Blood, Inflammation and Gun-shot Wounds. Other works of Hunter’s are his Treatise on the Natural History of the Human Teeth, A Treatise on the Venereal Disease, and Observations on Certain Points of the Animal Economy. “His greatest monument is the splendid museum which he formed by his sole efforts, which he made too when labouring under every disadvantage of deficient education and limited means.” His brother-in-law, Sir Everard Home, prepared the catalogue of the museum and then burned Hunter’s manuscripts, probably that he might conceal the plagiarisms of which he had been guilty in writing his book on Comparative Anatomy. The Government purchased Hunter’s museum from his widow for £15,000, upon condition that twenty-four lectures should be delivered every year to members of the college, and that the museum should be open to the public.
CHARLES WHITE, a Manchester surgeon (circ. 1768), was the first to introduce what is known as conservative surgery. He first resected[1011] the humerus, and taught the reduction of shoulder dislocations with the heel in the arm-pit.
The German surgeons in the seventeenth century held simply the position of barbers; they began life by cutting hair, shaving, cupping and bleeding, and then rose to be dressers of wounds and ulcers, and to treat fractures and dislocations.[1012] In 1713, Berlin acquired its first anatomical theatre for the instruction of military doctors and “medico-surgeons.” Dresden and Hanover began to improve the education of clever barbers about the middle of the eighteenth century. The Military Medical School of Vienna was opened in 1781. Barbers and bathmen in the eighteenth century were trained into district medical officers and surgeons by a course of instruction lasting from two to three years. In Holland students were privileged to assist in operations at the hospitals. The first surgical clinic in Germany was established at Würzburg, in 1769. The Vienna surgical clinic arose in 1774. The greatest teacher of surgery in Germany, A. G. Richter, gave clinical instruction at Göttingen, in 1781.[1013]
G. M. THILENIUS in 1784 performed the first division of the tendo achillis for the cure of club-foot.
JUSTUS ARNEMAN (1763-1807) was a surgical professor at Göttingen, who wrote a system of surgery and advanced the study of diseases of the ear.
CAMPER (1722-1789), a Dutch surgeon of a mechanical turn of mind, made improvements in trusses. LEGUIN, a Frenchman, was the first to employ steel springs in trusses (1663). TIPHARIE in 1761 introduced the double truss.[1014]
OBSTETRICIANS.
JOHANN PALFYN (1649-1730), a celebrated obstetric physician, in 1721 invented, or rather re-introduced, a species of forceps in difficult labour.
HUGH CHAMBERLEN, M.D. (1664-1728), was the most famous man-midwife of his day. His name is for ever associated with the invention of the obstetric forceps—a noble instrument, which has saved more lives than any mechanical invention ever associated with the healing art. A monument was erected to his memory in Westminster Abbey, with a long Latin epitaph by Bishop Atterbury.
WILLIAM SMELLIE (1680-1763), a distinguished English obstetric physician, improved the midwifery forceps and suggested and performed various operations in obstetric practice.
* * * * *
WILLIAM BROMFIELD (1712-1792) founded the Lock Hospital, London. He invented a tenaculum (a fine sharp hook by which the mouths of bleeding arteries are drawn out). He was a celebrated operator, and wrote a work on surgery.
* * * * *
The Medical College of Philadelphia was the first institution established in North America to give medical instruction. It was organized in May, 1765, by Drs. Shippen and Morgan. The University of Pennsylvania developed its medical department from this humble beginning.
ANATOMISTS, PHYSIOLOGISTS, BOTANISTS, ETC.
ALEXANDER MONRO (1697-1767) was a very eminent surgeon and anatomist of Edinburgh, whose Medical School owes more to him probably than to any other individual. He wrote on the Anatomy of the Bones, and an Essay on Comparative Anatomy.
FRANK NICHOLLS, M.D. (1699-1778), was a famous anatomist and physiologist at Oxford. “He was the inventor of corroded anatomical preparations, and one of the first to study and teach the minute anatomy of tissues, in other words, general, as distinguished from regional and descriptive anatomy.”[1015] He was one of the first to describe correctly the mode of the production of aneurism, and he distinctly recognised the existence and function of the vaso-motor nerves.[1016]
BROWNE LANGRISH, M.D., was elected a Fellow of the Royal Society in 1734. He was the author of several medical treatises, one of which was entitled Physical Experiments upon Brutes to discover a Method of dissolving Stone in the Bladder by Injections; to which is added a course of Experiments with the Lauro-Cerasus; on Fumes of Sulphur, etc. 8vo. Lond., 1746. His researches on the action of cherry laurel water are said to have suggested the use of prussic acid in medicine.[1017]
JOHN FOTHERGILL, M.D. (1712-1780), was a distinguished botanist, who collected a great number of rare plants from all parts of the world.
WILLIAM CRUIKSHANK (1745-1800) was an anatomist who discovered urea.
STEPHEN HALES (1677-1761), an experimental physiologist and pathologist, produced dropsy by injecting water into the veins of animals, and investigated by experiments on animals the relative movements of the blood.
ANTONIO VALSALVA (1666-1723), a great Italian anatomist, held the professor’s chair at Bologna and wrote a valuable treatise upon the ear and its anatomy.
GIOVANNI SANTORINI (1681-1737) was a Venetian anatomist whose investigations in the anatomy of the larynx, nose, face, etc., have immortalised his name in connection with several structures of those parts.
GIOVANNI B. MORGAGNI (1682-1772) was the great founder of pathological anatomy. He was a pupil of Valsalva. His famous book on pathological anatomy was not published until he was in his 79th year. He was the author of the maxim that “observations should be weighed, not counted.” The researches in morbid anatomy carried out by Morgagni formed an epoch in the history of modern medicine, which may indeed be said to rest on the two methods of Sydenham and Morgagni. The work of the Italian anatomist was complementary to that of the English Hippocrates, who neglected anatomy. Morgagni and the “Encyclopædic Haller,” whom we are next to consider, were two of the brightest medical lights of the century.
ALBERT VON HALLER (1708-1777), surnamed “the Great,” was a Swiss physician of Berne, who was not only a distinguished scientist, but a man of letters and a famous poet. He studied comparative anatomy at Tübingen; in 1725 he removed to Leyden, which at that time was the first medical school in Europe. He visited England in 1727, and made the acquaintance of Sir Hans Sloane, Cheselden, Dr. James Douglas, and other eminent persons. Leaving London, he went to Paris, but having been detected by the police in dissecting in his lodgings, he had to leave France, and he went to Basle to continue his investigations in anatomy; there he studied mathematics under John Bernoulli, and, having imbibed a taste for botany, studied the flora of Switzerland, on which he afterwards published a work. In 1729 he returned to Berne and lectured on anatomy; invited in 1726 to accept the professorship of anatomy, surgery, and botany in the newly founded University of Göttingen, he removed to that city, and by his influence a botanical garden, an anatomical theatre, a school of surgery and midwifery were established there. In 1747 he published his most valuable work, the Primæ Lineæ Physiologiæ which was used as a text-book in medical schools.
VAN SWIETEN (1700-1772), the pupil of Boerhaave, established the first clinical institution in Germany. He was with Sanchez the first to use corrosive sublimate in medicine. To his exertions it was due that the teaching of medicine was greatly improved in Austria.
J. F. MECKEL (1724-1774) was an anatomist whose researches on the nerves, blood-vessels, glands, etc., have greatly contributed to our knowledge of their physiological functions.
J. C. PEYER (1653-1712) and J. C. BRUNER (1653-1727) discovered the glands in the intestines which are known to this day by their names.
A. PACCHIONI (1665-1726) described the glands we call in his honour “Pacchionian.” W. COWPER (1666-1709) discovered those which bear his name. M. NABOTH (1675-1721) described the structures we call ovula Nabothi. H. MEIBOM (1638-1700) discovered the glands of the eyelids named after him.
WALTER CHARLTON, M.D. (1619-1707), anatomist, a voluminous writer, was to some extent a follower of Van Helmont.
THOMAS FULLER, M.D. (died 1734), published several pharmacopœias and an account of eruptive fevers, with several other works.
NEHEMIAH GREW, M.D. (born about 1641), wrote The Anatomy of Plants, with an Idea of a Philosophical History of Plants, which Sprengel calls opus absolutum et immortale. Hallam says,[1018] “no man, perhaps, who created a science has carried it further than Grew; few discoveries of great importance have been made in the mere anatomy of plants since his time.” His great discovery was the sexual system of plants; “that the sexual system is universal in the vegetable kingdom, and that the dust of the antheræ is endowed with an impregnating power.”[1019]
He was the first to obtain sulphate of magnesia from the Epsom waters, and to investigate its properties. His treatise on Epsom salts was published in 1697.
WILLIAM BRIGGS, M.D. (died 1704), was famous for his “skill in difficult cases of the eye.”
EDWARD TYSON, M.D. (died 1708), wrote on anatomy; he was the Carus of Garth’s Dispensary, and the discoverer of “Tyson’s Glands.”
WILLIAM PITCAIRN, M.D. (1711-1791), was an accomplished botanist. He lived in the Upper Street, Islington, where he had a botanical garden five acres in extent, stocked with the scarcest and most valuable plants. He introduced into St. Bartholomew’s Hospital a much freer use of opium in the treatment of disease, and especially of fevers, than had hitherto been customary, and that with the greatest benefit to the patients.
PETER SHAW, M.D. (1694-1763), greatly facilitated the study of chemistry in England by his translations of the chemical works of Stahl and Boerhaave, as well as by his own works. He edited the works of Bacon and Boyle, and published a number of books on medicine and chemistry.
WILLIAM HUNTER, M.D. (1718-1783), was an earnest and devoted anatomist and obstetrician. He was a pupil of Cullen, and was so successful a practitioner that he expended £100,000 upon his house and anatomical collection, etc. The Hunterian Museum of the University of Glasgow was formed from this collection. The famous John Hunter was his younger brother.
THOMAS DIMSDALE, M.D. (1711-1800), a celebrated promoter of inoculation for small-pox, acquired a great reputation and immense wealth by the process. Catherine II. of Russia paid him enormous sums for successful inoculations, and gave him a barony.
WILLIAM HEBERDEN, M.D. (1710-1801), lectured on Materia Medica at Cambridge. Dr. Munk[1020] gives an interesting extract from one of Heberden’s lectures on Mithridatum and Theriaca, the famous classic medicines; he proves that the only poisons known to the ancients were hemlock, monk’s-hood, and those of venomous beasts, and that they had no antidotes for these. He says that the first accounts of powerful poisons concealed in seals or rings, poisonous vapours in gloves and letters, etc., are idle inventions of ignorant and superstitious persons.
BUFFON (1707-1788) was the celebrated French naturalist to whom “we owe our first clear and practical connection of the distribution of animals with the geography of the globe.”
GEORGE ARMSTRONG in 1769 opened the first children’s hospital in Europe; he was the physician who first devoted special attention to the diseases of children. Armstrong was a London man, and died 1781.
JOH. E. GREDRING (1718-1775) was a German physician who was the first to investigate “the seat, cause, and diagnosis of insanity.”[1021]
JAMES CURRIE (1756-1805) advocated the cold-water treatment of typhus fever patients, and thus introduced a method of treatment which in one form or another is used at the present time for reducing the temperature of the body in such cases. Currie determined the temperature by the thermometer.
LADY WORTLEY MONTAGU (1690-1762) is famous in the annals of medicine for her courageous adoption of the Turkish practice of inoculation for small-pox in the case of her own son. By her zealous advocacy she was instrumental in causing the practice to be introduced into England in 1721. Dr. Keith having subjected his son to the operation, experiments were conducted upon criminals by Maitland, and these having been successful, the Prince of Wales and the royal princesses were inoculated by Mead. On behalf of the Almighty, whose province was supposed to be trespassed upon by these and similar proceedings, the practice was violently opposed by the clergy and others.
EDWARD JENNER (1749-1823) introduced the practice of vaccination as a preventive of small-pox. He commenced his investigations concerning cow-pox about the year 1776. The practice of inoculation with the virus of small-pox, which had been introduced into England through the suggestion of Lady Wortley Montagu, indirectly led Jenner to his grand discovery. His attention was excited by finding that certain persons to whom he attempted to communicate small-pox by inoculation were not susceptible to the disease; on pursuing his inquiries he found that these persons had undergone cow-pox—a complaint common among the dairy-servants and farmers in Gloucestershire, and that these people were aware that cow-pox in some way was a preventive against the small-pox. Local medical men had long been acquainted with this idea, but had paid no attention to it, considering it merely a popular and groundless belief. Jenner’s genius, however, led him to divine the truth of the matter and turn it to practical advantage. The disease which affects the udder of the cow was found to be inoculable in the human subject, and could be propagated from one person to another, rendering those who had passed through the complaint secure from an attack of small-pox. Having confided the fact of this discovery to some medical friends, it was taken up in 1796 by Mr. Clive, of St. Thomas’s Hospital, who introduced vaccination into London. Vaccination was adopted in the army and navy, and Jenner was honoured by professional distinctions and a parliamentary grant of £20,000. He was made a Fellow of the Royal Society, and his fame and the benefits of his discovery were rapidly extended to continental nations.
Book VI
THE AGE OF SCIENCE.
I. THE NINTEENTH CENTURY.—PHYSICAL SCIENCE ALLIED TO MEDICINE
Exit the Disease-Demon.—Medical Systems again.—Homœopathy.—The Natural Sciences.—Chemistry, Electricity, Physiology, Anatomy, Medicine and Pathology.—Psychiatry.—Surgery.—Ophthalmology.
With the dawn of modern science was sounded the death-knell of the disease-demon and its twin brother “Visitation.” When the French Revolution, having at first intoxicated men, had had time to effect its really beneficent aims, the age of modern science was fairly inaugurated, and daily conferred some fresh blessing on the race. The beginning of the nineteenth century saw the steam engine rapidly approaching perfection. In 1801 took place the first experiment with steam navigation on the Thames. In 1814 steam was first applied to printing in the Times office. In 1829 locomotive steam-carriages were employed on railways at Liverpool. In the early years of the century the electric telegraph was being developed. Machinery began to take the place of hand labour in numberless branches of trade and industry. Nobler than these material blessings, however, was the awakening of the English people to a new and higher humanity. It seemed that as Science began to shower her gifts on our nation, it yearned to become the almoner of mankind, and in its turn to bless the world with the precious gifts of freedom, education, improved sanitation, and the means of developing the dormant higher powers of the species. The slave trade of England was abolished by Parliament in 1807. In 1834 the English government began to make annual grants in aid of education. Sanitary commissions were appointed in 1838 and 1844, which were of incalculable benefit, not only to our own national health, but in suggesting to other countries the means of improving the health and combating the ravages of preventable diseases. In the early years of the century Dr. Birkbeck founded Mechanics’ Institutions, thus commencing the era of enlightenment for the working classes, which has resulted in raising the mental condition of our labouring and lower middle classes to a higher level than that of any other nation of the old world. Everywhere schools sprung up, books and newspapers were multiplied, until everybody who could read had mental provender provided at a merely nominal rate.
In relation to the history of medicine, the science of the century has perhaps on the whole done greater service to the healing art by that which it has taught doctors to leave undone than by what it has taught them to do. It has arrested the murderous lancet of the blood-letter; it has stayed the hand of the purger, who merely bled in another manner; it has rescued the unhappy victims of mental disorders from their dungeons, their beds of straw, and the cruel lash of their keepers; it has liberated the invalid from the tyranny of the medicine-monger; it is no longer possible to force down any patient’s throat such a mass of filthy concoctions as the following items of medicine enumerated in an apothecary’s bill for attending one Mr. Dalby, of Ludgate Hill, which in five days amounted to £17 2_s._ 10_d._
The items for one day (August 12) are:—
s. d. An emulsion 4 6 A mucilage 3 4 Jelly of hawthorn 4 0 Plaster to dress blister 1 0 A clyster 2 6 An ivory pipe 1 0 A cordial bolus 2 6 The same again 2 6 A cordial draught 2 4 The same again 2 4 Another bolus 2 6 Another draught 2 4 A glass of cordial spirits 3 6 Blister to the arm 5 0 The same to the wrists 5 0 Two boluses again 5 0 Two draughts again 4 8 Another emulsion 4 6 Another pearl julep 4 6
This is quoted in the Historical Sketch of the Progress of Pharmacy in Great Britain,[1022] p. 17, not as an isolated case, but as an illustration of the practice of apothecaries when attending patients of the higher classes.
Homœopathy did much to remedy this state of affairs, and by deluding people into believing that the billionth of a grain of a certain drug skilfully manipulated was more effectual than the bolus and decoction of the medicine-monger, tended gradually to destroy the popular faith in the dosing system.
The student of medical history is often reminded forcibly of Tennyson’s lines:—
“Our little systems have their day; They have their day, and cease to be.”
As he reflects on the many schools, sects, and systems which have dominated the practice of physic, he will often, as he passes them in review one by one, ask mournfully with Hans Breitmann:—
“Vhere ish dot barty now?”
Where now is the Iatro-mathematical School, the party of the Iatro-chemists, the Brunonian sect? One and all vanished into the Ewigkeit!
To have maintained, in the zenith of their fame, that either of the great medical schools could ever have so completely perished would have been the rankest heresy; to believe now that the germ theory of disease can ever be superseded is to be subjected to the charge, not of medical heresy alone, but of the completest ignorance of science. Yet there are some bold spirits who have dared even this. The history of the past forbids the cautious historian of medicine to make too sure of the permanence of any theory of disease or system of cure, but the germ theory has claims to our acceptance which far outweigh those of any other theories which we have reviewed. From the length of time it has been under construction, from the marvellous care and minute caution exercised by the profound scientists who have devoted their lives and utmost energies to the innumerable experiments which their researches have embraced, from the fact that not medical theorists merely, but sober-minded scientists as well as practical surgeons and physicians, have everywhere given their adherence to the germ theory of disease, we have good reason to believe that it will hold its ground as a theory of the cause—if not of much value as a system of cure—of a great number of the most serious maladies which afflict the races of men and animals.
MEDICAL SYSTEMS.
GIOVANNI RASORI (1762-1837), of Milan, introduced a theory which was a revival of Methodism combined with that of Brunonianism. The Methodists held a status strictus and a status laxus, Brown a sthenic diathesis and an asthenic diathesis.
Rasori taught a combination of these theories modified by his own. His doctrines were accepted by a multitude of learned and eminent medical men, yet his teaching was simply atrocious, and a study of it almost makes one despair of any real advance for the healing art. His system of therapeutics consisted in the endeavour to make a diagnosis of the disease by watching the effects of the remedies which make it better or worse! Bleeding was held to be the best diagnostic means: if it did the patient good, the sthenic diathesis was assumed; if it made him worse, the asthenic was demonstrated.
He administered enormous doses of powerful drugs, such as would be considered nothing less than simply poisonous now. Baas says he gave 1 to 4 grammes of gamboge for diarrhœa, and 60 to 90 grammes of saltpetre a day[1023]—doses which would be large for a horse.
The wonder is that anybody survived the treatment.
Homœopathy, faith-healing, peculiar-people treatment, anything, however heterodox, is better than this licensed system of murder, which actually received the adhesion of famous professors at Italian universities, where the art of medicine was supposed to be taught sixty years ago.
JOHANN A. ROESCHLAUB (1768-1835), a highly cultivated German physician, was the founder of a medical system on the “Theory of Excitement.” Life depends upon irritability which belongs to the natural disposition. To be healthy, the body must be in a state of moderate irritation and moderate excitability. Disease disturbs the happy medium upwards as hypersthenia, or downwards as asthenia; in other words, by inducing too much strength or actual debility.
JOHANN STIEGLITZ (1767-1840) was an eminent physician who opposed the theory of excitement, saying, “There is no such thing as one only saving system.” He was the founder of Etiological diagnosis (or diagnosis dependent on a knowledge of the causes of disease).
C. W. VON HUFELAND (1762-1836), professor at Jena, and afterwards in Berlin, opposed the theory of excitement. He used to say, “Successful treatment requires only one-third science and two-thirds savoir faire,” and, “To him who fails to make a religion of the healing art, it is the most cheerless, wearisome, and thankless art upon earth; indeed, in him it must become the greatest frivolity and a sin.”
F. J. W. BROUSSAIS (1772-1838), a physician of the vitalist school, was a devoted follower of Bichat, who made it his chief aim to find an anatomical basis for all diseases. He is particularly known for his theory that all fevers arise from irritation or inflammation of the intestinal canal. His long-exploded theory led to an enormous misuse of bleeding. He christened his system “Physiological Medicine,” which by directing attention to the morbid changes in the organs, led to the rise of the pathological school of Corvisart, Laënnec, and Bayle. The systems of Brown and Broussais must have destroyed, says Dr. De Noé Walker, more human beings than the whole revolutionary wars from 1793 to 1815.
SAMUEL C. F. HAHNEMANN (1755-1843), the founder of Homœopathy, was born at Meissen, near Dresden. He studied medicine at Leipsic, and afterwards at Vienna, graduating at Erlangen in 1779. In his first medical treatise he takes a despondent view of medical practice in general, and of his own in particular, as he is candid enough to own that most of his patients would have done better had they been let alone.
In a letter to Hufeland upon the necessity of a regeneration in medicine (1808), he declares that after eight years’ practice he had so learned the delusive nature of the ordinary methods of treatment as to be compelled to relinquish practice. He devoted much attention to the science of chemistry.
Berzelius said of him, “That man would have been a great chemist had he not been a great quack.” He translated Cullen’s Materia Medica in 1790, and the necessary study of medicinal agents which this involved set him thinking of a new theory of disease and cure which should replace that which he had found so unsatisfactory; he came to the conclusion, as the result of his researches, that “medicines must only have the power of curing diseases similar to those which they produce in the healthy body, and only manifest such morbid actions as they are capable of curing in diseases.”[1024]
He thus proceeded to lay down the homœopathic law that the power of medicines to alter the health must be proved on the healthy body. He endeavoured to discover a rule by which the effect of remedies might be ascertained, and which should supersede the old method of working in the dark.
Considering the endless powers which medicines possess, and feeling sure that the Creator intended them to have some purpose, and that to lighten the afflictions of the race, he felt that there must be a better way of employing them than that which he considered had so grievously failed in the past. He was therefore henceforth the enemy of all empiricism. Antipathy, or the method by which contraries are cured by contraries, so that the diseased part is acted upon by something that opposes it, he considered a fatal error in medical practice. Contrary medicine he held could at best be palliative and temporary, not curative. He designated as Allopathy the method by which it is attempted to remove natural disease from one part by exciting artificial disease in another, or the principle of counter irritation.
The sciences of anatomy and physiology are quite superfluous to the homœopathist; the remedies being merely addressed to symptoms, the knowledge of their causes can have little or no concern to those who follow Hahnemann’s doctrines. The application of a remedy for facial neuralgia, as Dr. Mapother points out,[1025] has been applied over the motor nerve of the face, the inventor being ignorant that it has no connection with sensibility.
Hahnemann taught that all chronic maladies proceed from the itch.
Amongst other remedies for the itch, or psora, the swallowing of lice or a decoction of them was seriously recommended, because these parasites tickle the skin, and on the like-cures-like principle, would be beneficial for itch![1026]
THE NATURAL SCIENCES.
The Natural Sciences in the closing years of the eighteenth century began to render the most important services to the art of medicine, and from that time onwards it has marked its progress step by step with the advances of botany, chemistry, and physics. Linnæus invented a system of the classification of plants which Adanson, Jussieu, De Candolle, and others did much to improve; the anatomy and physiology, and even the pathology of plants were closely studied, with results of the greatest value to scientific medicine. Buffon excited the interest of men of science by his declaration that there is no essential difference between animals and plants, and that all organic life follows the same plan. He explained the geographical distribution of the animal kingdom. Hunter, Blumenbach, St. Hilaire, Cuvier, and others advanced the sciences of comparative anatomy and physiology, and Lamarck divided bony animals into vertebrata and invertebrata. Cuvier, by founding the doctrine of types, explained the general plan on which animals are modelled. Pander and Baer rendered the greatest services to the study of development—the former by his researches on the development of the chick, the latter by his observations on the cleavage in the ovum. To Hunter, Kielmeyer, and Owen in a later period we owe the most important discovery—that the higher animals, even man himself, in the embryo pass through the stages of development of the lower animals.
CHEMISTS.
JOSEPH PRIESTLY discovered oxygen in 1772, and thus introduced a new chemical era. LAVOISIER, however, was the first to observe the vast importance of the discovery, and CAVENDISH established his theories by his researches on the composition of the air, water, and acids. It is to Lavoisier’s discoveries in relation to oxygen that physiology is indebted for the knowledge of the influence of that element on respiration and the blood. Doctors looked upon it as the “air of life,” and in its excess or deficiency saw the causes of certain diseases. FOURCROY applied himself to the study of medical chemistry.
BERTHOLLET discovered the composition of ammonia, and the bleaching properties of chlorine. He discovered chlorate of potash, and founded the doctrine of chemical affinity.
DALTON (1776-1844) by his atomic theory and his discovery of the law of multiple proportions still further advanced the science; in 1794 he first described colour-blindness.
BERZELIUS (1779-1848) developed the atomic theory and improved our knowledge of animal chemistry.
GAY-LUSSAC in 1805, with ALEXANDER VON HUMBOLDT, discovered that water is composed of one volume of oxygen and two volumes of hydrogen.
SIR HUMPHRY DAVY (1788-1829) discovered the anæsthetic effect of nitrous oxide gas, invented the safety-lamp for miners, and greatly advanced the study of agricultural chemistry.
DUMAS (1800-1884) investigated the alkaloids.
PELLETIER in 1820 discovered quinine.
ORFILA (1787-1853), one of the most eminent men of the French school of medicine, founded modern toxicology, the science of poisons. His fame chiefly rests on his Treatise of General Toxicology (1814), which is a vast mine of experimental research on the symptoms of every kind of poisoning.
SIR WILLIAM HYDE WOOLASTON, M.D. (1766-1828), was a distinguished philosopher and chemist. One of his great discoveries was the malleability of platinum, which is said to have produced him no less than thirty thousand pounds. He was even more famous as a student of ophthalmology than as a chemist.
MICHAEL FARADAY (1791-1867) was the great chemist, whose glory in chemical science was overshadowed by his electrical discoveries.
JUSTUS VON LIEBIG (1803-1873) influenced the history of chemistry by his successful efforts to spread the knowledge of the science by improving the methods of investigation, and above all by the application of chemistry to physiology, agriculture, and the arts.
ELECTRICIANS.
The history of electricity has an important bearing on that of medicine. It will be necessary at least to indicate the chief points in its progress. GILBERT published a treatise on the magnet in 1600. He speaks of magnetic phenomena, and the extravagant stories circulated about the attraction of magnets and amber by persons who gave no reason from experiment. He distinguished magnetic from electric forces,[1027] and it is to him that we owe the term “electric” itself.[1028]
Boyle repeated the experiments of GILBERT, but seems to have made no discoveries. OTTO GUERICKE, of Magdeburg, next discovered that there is electric force of repulsion as well as of attraction. HAWKSBEE, in his Physico-Mechanical Experiments, 1709, observed the effects of attraction and repulsion on threads hanging loosely. DUFAY, in 1733, 1734, and 1737, observed that electric bodies attract all those that are not so, and repel them as soon as they are become electric by the vicinity or contact of the electric body. In 1729, GREY discovered the properties of conductors.
FRANKLIN distinguished between positive and negative electricity in 1747, and demonstrated the identity of the electric spark and lightning in 1752. GALVANI in 1791 laid the foundation of the Galvanic Battery. VOLTA discovered the “Voltaic pile” in 1800. Henceforward year by year the science progressed by leaps and bounds. The use of the magnet in medicine was known to Aetius, who lived A.D. 500. He says: “We are assured that those who are troubled with the gout in their hands or their feet, or with convulsions, find relief when they hold a magnet in their hand.” Beckmann says[1029] this is the oldest account of this virtue of the magnet. The more ancient writers refer only to its internal uses. Lessing ascribes the external use of the magnet as a cure for toothache and other disorders to Paracelsus. Marcellus in the fifteenth century assures us that the magnet cures toothache, as also does Leonard Camillus in the sixteenth century. Wecker about the same period says it cures headache. Porta (1591) confirms this, and Kircher (1643) states that it was worn about the neck to prevent convulsions and nervous disorders. Magnetic toothpicks and ear-pickers were extolled as cures for disorders of the teeth, ears, and eyes about the end of the seventeenth century.[1030]
ANTHROPOLOGY.
JOH. F. BLUMENBACH (1752-1840), professor in Göttingen, was the founder of Anthropology. He collected a great museum of skulls, and was famous as a comparative anatomist. He wrote on physiology, anatomy, and natural history.
PHILOSOPHERS.
VON SCHELLING (1775-1854) taught that “God is the indifference of the ideal and real, soul and body, and the identity of subjectivity and objectivity. In a word, the All.” He held that health is the harmony of reproduction, irritability, and sensibility; disease, the alteration of dimensions of the organism, by which it ceases to be a pure, untroubled reflex of the All.
G. W. F. HEGEL (1770-1831) was the philosopher whose supreme principle was absolute reason, and to whom in a great measure is due what is known as Modern Materialism. He was opposed by R. H. LOTZE (1817-1884), a medical philosopher of Göttingen, the author of the Mikrokosmos and works on pathology, physiology, and psychology. He laid it down that the significance of the phenomena of life and mind would only unfold itself when by an exhausted survey of the entire life of man, individually, socially, and historically, we gain the necessary data for explaining the microcosm by the macrocosm of the universe. The world of facts and the laws of nature are only to be understood by the idea of a personal deity.
* * * * *
CHARLES DARWIN (1809-1882), grandson of Erasmus Darwin, startled and shocked the whole Christian world by his theory that man has possibly descended at a highly remote period from “a group of marine animals resembling the larvæ of existing Ascidians.” He traced our ancestry through the fish, amphibian, marsupial, and ape species; a theory which, despite the original opposition it excited, is now generally accepted. He is best known in connection with medical science by his famous work, On the Origin of Species by means of Natural Selection, 1859, his Descent of Man and Selection in Relation to Sex, 1871, and The Expression of the Emotions in Man and Animals, 1872. At first his theory of the Descent of Man was held to teach that
“A very tall pig with a very long nose Puts forth a proboscis quite down to his toes, And then by the name of an elephant goes.”
Darwin recognised not merely a God but a Creator.
ANATOMISTS AND BIOLOGISTS.
SIR RICHARD OWEN, M.D., F.R.S., etc. (1804-1892), the celebrated comparative anatomist and palæontologist, made it possible for us to see what the extinct monsters were when he enabled us to construct scientifically the models of the megatherium, plesiosaurus, and other animals of remote ages. It has been well said of him that “the most characteristic of his faculties was a powerful scientific imagination. Fragments of bone which might be meaningless to less alert observers enabled him to divine the structure and to present the images of whole groups of extinct animal forms.”
At the suggestion of Dr. Abernethy (whose pupil he had been) he was invited in 1828 to prepare the catalogue of the Hunterian collection in the museum of the Royal College of Surgeons, of which Mr. Clift (whom he eventually succeeded and whose daughter he married) was conservator. This great work largely occupied some of the best years of Owen’s life, the three quarto volumes on the Fossil Vertebrates and Cephalopods of the collection not appearing till 1855. Meanwhile he had given to the world his Odontography, his Lectures on Comparative Anatomy and Physiology (which won a continental reputation), and his famous work on the Archetype and Homologies of the Vertebrate Skeleton. In 1849 he issued an important memoir On Parthenogenesis.
In 1856 Owen was appointed Superintendent of the Department of Natural History in the British Museum, which, through his untiring exertions, was at last to be suitably housed at South Kensington. In 1861 he published his manual of Paleontology; from 1865 to 1877 a succession of works on British Fossil Reptiles and the Fossil Reptiles of South Africa.
F. G. HENLE (1809-1885) so early as 1840 advocated the germ theory of disease. It was first suggested, however, by Latour’s discovery of the yeast plant in 1836.
ST. GEORGE MIVART, M.D., F.R.S. (born 1827), the distinguished anatomist and zoologist, is to a certain extent the opponent of Darwin, as he denies that the doctrine of Evolution is applicable to the human intellect. He is the author of many works on anatomy, biology, and zoology.
THOMAS HUXLEY, F.R.S., M.D. (born 1825), the famous physiologist and comparative anatomist and biologist, is a well-known writer on natural science, and the most prominent of the scientific opponents of revealed religion.
DR. ALFRED RUSSEL WALLACE (born 1822), the eminent naturalist, published his Contributions to the Theory of Natural Selection in 1870, and in 1878, in his volume Tropical Nature, still further contributes to our knowledge of sexual selection, etc.
ERNST HAECKEL (born 1834), a celebrated German naturalist and writer on science, is the chief supporter in Germany of Darwin’s theories. It may be remembered in this connection that these were anticipated to some extent by Lamarck (1744-1829) and Goethe (1749-1832).
HERBERT SPENCER (born 1820) has devoted his life mainly to the working out of his “System of Synthetic Philosophy,” which proposed “to carry out in its application to all orders of phenomena the general law of evolution.”
GEORGE J. ROMANES, F.R.S. (born 1848), an ardent member of the Darwinian school, is a distinguished physiologist and biologist.
PHYSICIANS AND PATHOLOGISTS.
LEOPOLD AUENBRUGGER (1722-1809), a physician of Vienna, was the inventor of the method of detecting diseases of the chest by percussion. By striking the chest directly with the tips of the fingers (not as we do now by interposing a finger of our left hand while we percuss the chest mediately with the fingers of the other hand) he diagnosed by the sound evoked the condition of the organs of the thorax. His system was at first received with contempt and ridicule by his profession; but in 1808, Corvisart translated Auenbrugger’s great work, the Inventum Novum, into French, and the method quickly achieved an European reputation.
RENÉ T. H. LAËNNEC (1781-1826), the celebrated French pathologist, was the inventor of the stethoscope. His great discovery was purely accidental—a fact which he declares in his famous work.
“In 1816 I was consulted by a young woman labouring under general symptoms of diseased heart, and in whose case percussion and the application of the hand were of little avail on account of the great degree of fatness. I happened to recollect a simple and well-known fact in acoustics, and fancied it might be turned to some use on the present occasion. The fact I allude to is the great distinctness with which we hear the scratch of a pin at one end of a piece of wood, on applying our ear to the other. Immediately, on this suggestion, I rolled a quire of paper into a kind of cylinder, and applied one end of it to the region of the heart and the other to my ear, and was not a little surprised and pleased to find that I could thereby perceive the action of the heart in a manner much more clear and distinct than I had ever been able to do by the immediate application of the ear.”[1031]
JEAN N. CORVISART (1755-1821) introduced into France Auenbrugger’s method of percussion, one of the most important aids to physical diagnosis.
GASPARD L. BAYLE (1774-1816) made those important researches on tubercle and the changes in the lungs and other organs in consumption which form the basis of our present knowledge of the subject. From this time French physicians introduced great precision in their study of symptoms, so as to invest them with a really scientific character. Combined with the perfected methods of anatomical observation, a new era in clinical medicine dates from this period.
LOUIS (1787-1872) made important researches on pulmonary consumption and typhoid fever, and introduced the numerical or statistical method in medical science, which was an important step towards making it an exact science.
SIR ROBERT CHRISTISON (1797-1882) discovered the effects and properties of Calabar bean, and was the most famous of all English investigators of poisons and poisoning.
JOHN CHEYNE (1777-1836), in conjunction with WILLIAM STOKES (1804-1878), a great clinical teacher and author of works on diseases of the chest and heart, discovered the form of breathing in certain disordered conditions which is called “Cheyne-Stokes’ respiration.”
ROBERT J. GRAVES (1797-1853), a great observer and clinical teacher, gave his name to a disease.
SIR WILLIAM JENNER, M.D. (born 1815), was the first to establish beyond dispute the difference between typhus and typhoid fevers.
JOHN HUGHES BENNETT, M.D. (1812-1875), was the first to introduce the use of cod-liver oil in consumption into English practice (1841). He claimed also to have discovered leucocythemia before Virchow.
ALFRED SWAYNE TAYLOR, M.D. (1806-1880), was the founder of forensic medicine in England, and his great work on Medical Jurisprudence (published 1836) has long been the standard authority in medico-legal cases.
THOMAS HODGKIN (1797-1866) discovered the disease which goes by his name.
CHARLES MURCHISON, M.D. (1830-1879), is celebrated for his researches in epidemic diseases.
SIR THOMAS WATSON (1792-1882) was the author of the ever-popular lectures, The Practice of Physic, a work whose graces of style and elegance of phraseology entitle it to be considered a medical classic.
MATTHEW BAILLIE (1761-1823) was a famous pathologist. He devoted special attention to the pathology of the brain, heart, lungs, stomach, and intestines. It was he who first described the grey miliary tubercle of consumption. In all his profound researches he never failed to remember their practical end in the cure of disease.
JOHN ABERCROMBIE (1780-1844) is celebrated for his researches on diseases of the brain and spinal cord.
RICHARD BRIGHT (1789-1858), the reformer of renal pathology, was the discoverer of the disease which bears his name.
THOMAS ADDISON (1793-1860) discovered the disease of the suprarenal bodies which is called after him.
KARL V. ROKITANSKY (1804-1878), one of the most famous of the founders of the New Vienna School, was so indefatigable a pathologist that he is said to have celebrated his thirty-thousandth post-mortem in 1866. His great work, The Handbook of Pathological Anatomy, was published in 1841.
JOSEPH SKODA (1805-1881), a physician of the New Vienna School, improved physical diagnosis by his application of the laws of sound. He rendered percussion more perfect by correctly explaining the import of the various sounds heard on striking the chest. He threw great light upon our knowledge of the phenomena of heart diseases.
HEBRA (1816-1880) created a revolution in the science of skin diseases by basing it upon pathological anatomy.
WUNDERLICH (1815-1877) introduced the use of the clinical thermometer as an important aid to diagnosis, and claimed that “pathology is the physiology of sick men.”
RUDOLPH VIRCHOW (born 1821), the constructor of the cellular pathology, is a celebrated German pathologist and anthropologist. On the basis of the cellular theory, which teaches that the cells live their own independent life, have their own active properties, proliferations and degenerations, Virchow built up his cellular pathology into a comprehensive system, attaching greater importance to the cell changes than to an altered condition of the circulation or quality of the blood, as was previously held to account for pathological changes. The theory explains many facts which were previously obscure, but is not wholly satisfactory. Virchow’s system led to the foundation of pathological histology.
SIR ANDREW CLARK, M.D., F.R.S., President of the College of Physicians, London (born 1826), is a physician distinguished alike for his profound scientific knowledge and his admirable skill in its application to the relief and cure of disease. As a physiologist, anatomist, and pathologist, especially in connection with the organs of respiration, the kidneys, and digestive functions, Sir Andrew Clark occupies the foremost place in English medical practice of the time. He has written extensively on diseases of the chest, is one of the most brilliant clinical lecturers of the day, and for many years has been a chief attraction in the teaching power of the London Hospital.
SIR EDWARD H. SIEVEKING, M.D., etc. (born 1816), was with Dr. H. Jones joint-author of the well-known Manual of Pathological Anatomy (1854).
SAMUEL WILKS, M.D., F.R.S., etc. (born 1824), is an eminent pathologist and neurologist. He published his excellent Lectures on Pathological Anatomy in 1859.[1032]
BRAIN AND NERVE SPECIALISTS.
PHILIPPE PINEL (1745-1826), a French physician, published a translation of Cullen’s Nosology (1785) in the language of his country. His claim to our gratitude rests on the fact that he was among the first to introduce the humane treatment of the insane. With his own hands he, when physician to the Bicêtre and Salpêtrière, removed the bonds of insane patients who had been chained to the wall for years.
SIR CHARLES BELL (1774-1842) made the greatest discoveries in physiology since those of Harvey. We owe to him the knowledge that in the nervous trunks are special sensory filaments whose office is to convey impressions from the periphery to the sensorium, and special motor filaments which convey motor impressions from the brain or other nerve centre to the muscles. This great discovery of the functions of the nerves, concerning which there previously existed much confusion amongst physiologists, was published in 1807, and entitles England to claim that in Bell and Harvey she has given to science the two most distinguished physiologists of the world.
FRANZ J. GALL (1757-1828) was a skilful Viennese anatomist, who, by his researches upon the anatomy of the brain, came to the conclusion that the talents and dispositions of men may be inferred with exactitude from the external appearance of the skull, and thus founded phrenology.
CASPAR SPURZHEIM (1776-1832), an anatomist, was a pupil of Gall, and assisted in the development of phrenology.
JEAN M. CHARCOT (born 1825) is a Paris physician greatly distinguished by his important investigations in diseases of the nervous system, upon which he has written many works.
PIERRE FLOURENS (1794-1867), a distinguished French physiologist, sought to assign their special functions to the brain, corpora quadrigemina, and lesser brain by experiments. In 1847 he directed the attention of the Academy of Sciences to the anæsthetic effect of chloroform upon animals. Chloric ether in the same year was used at St. Bartholomew’s Hospital as an anæsthetic in operations by Dr. Furnell.
ARMAND TROUSSEAU (1801-1866) was an eloquent and popular clinical lecturer on medicine. He introduced tracheotomy in croup, and largely contributed to our knowledge of laryngeal phthisis, etc.
CLAUDE BERNARD (1813-1878), the celebrated experimental physiologist and pathologist, made numerous researches on the digestion of fat by the pancreatic juice, the formation of sugar in the liver, and the artificial production of diabetes by puncturing the fourth ventricle of the brain, etc. He wrote Physiologie et Pathologie du Systeme nerveux, 1858.
BROWN-SEQUARD (born 1817), the experimental physiologist, discovered the vaso-motor nerves. He has investigated the functions of the spinal cord, its normal and pathological states, the brain and sympathetic nerves and ganglions, the inhibitory and other nerves.
PAUL BERT (1833-1886) was a physiologist and neuro-pathologist.
G. B. DUCHENNE (1806-1875) introduced electro-therapeutics by means of the induced current in diseases of the nervous system.
ROBERT REMAK (1815-1865) still further pursued the treatment of nervous diseases by means of the constant current. He investigated the subject of the parasitic origin of certain diseases of the skin, and produced favus experimentally.
ELIE VON CYON (born 1843) continued the investigation of electro-therapeutics.
MARSHALL HALL (1790-1857) discovered reflex action, which fact he communicated to the Royal Society in 1833.
JAMES BRAID, a Manchester surgeon, in 1841 investigated mesmerism, and discovered what is now called hypnotism. He found that he could artificially produce “a peculiar condition of the nervous system, induced by a fixed and abstracted attention of the mental and visual eye on one object, not of an exciting nature.” Thus Braid was the first to investigate the subject scientifically, and to trace the phenomena of mesmerism to their true physiological cause. Dr. Rudolf Heidenhain, of Breslau, has recently traced these phenomena to inhibitory nervous action.[1033]
HENRY MAUDSLEY, M.D. (born 1835), is the author of several important works on mental diseases: The Physiology of Mind, The Pathology of Mind, Body and Mind, and Responsibility in Mental Disease.
JOHN CONOLLY (1796-1866) was physician to Hanwell Asylum. To him is due the honour of having first in England pressed upon the notice of his profession the advantages of the “No Restraint” system in mental diseases.
DR. FORBES WINSLOW was a popular and humane “mad doctor.”
JOHN C. BUCKNILL, M.D., F.R.S., etc. (born 1817), is a distinguished student of mental diseases, and the author of several treatises on Unsoundness of Mind in relation to Crime and Drunkenness. He is one of the original editors of Brain, and for nine years he has edited the Journal of Mental Science.
DAVID FERRIER, M.D., F.R.S., etc. (born 1843), a specialist in brain surgery, is well known for his researches in cerebral physiology and pathology, and has acquired great celebrity throughout the English-speaking world for his investigations connected with the localisation of the functions of the brain.
PAUL BROCA (1824-1880), the surgeon and anatomist, discovered that the faculty of speech lies in the third left frontal convolution of the brain, which in his honour is called Broca’s convolution.
JULES BECLARD (1818-1887) was a distinguished French physiologist.
HENRY C. BASTIAN, M.D., F.R.S. (b. 1837), is a pathological anatomist and cerebral physiologist. His Brain as an Organ of Mind, 1880, is one of his best known works, and his articles in Quain’s Dictionary of Medicine, on Diseases of the Spinal Cord and Nervous System generally, are equally valuable contributions to this department of medical science.
JOHN HUGHLINGS JACKSON, M.D., F.R.S., although distinguished as an ophthalmologist, is more famous for his researches and discoveries in connection with the nervous system and the localisation of cerebral functions.
DR. JULIUS ALTHAUS has made many valuable contributions to our knowledge of the nervous system.
VICTOR A. H. HORSLEY, F.R.S., etc., pathologist and brain surgeon, is the author of many papers on the functions of the brain and spinal cord, and has made important contributions to our knowledge of the functions of the thyroid gland, hitherto little understood, by which the treatment of myxœdema will, it is hoped, be greatly improved.
SURGEONS.
The founding of museums of anatomy and surgical pathology by the HUNTERS, DUPUYTREN, CLOQUET, BLUMENBACH, BARCLAY, and a great number of other anatomists and surgeons, has greatly assisted to advance the practical surgery of this century. Some of the more important improvements in the art as practised at the present time are the following, which are given in the article on Surgery in the Encyclopædia Britannica:—The thin thread ligature for arteries, introduced by JONES, of Jersey (1805); the revival of the twisting of arteries to arrest bleeding by AMUSSAT (1829); the practice of drainage in large wounds and after operations by CHASSAIGNAC (1859); aspiration or the application of the principle of the air-pump for removing pus and fluid from tumours, etc., by PELLETAN and others; the plaster-of-Paris bandage and other similar immovable applications for fractures, etc. (an old Eastern practice recommended in Europe about 1814 by the English consul at Bassorah); the re-breaking of badly set fractures; galvanocaustics and écraseurs; the general introduction of resection of joints (FERGUSSON, SYME, and others); tenotomy by DELPECH and STROMEYER (1831); operation for squint by DIEFFENBACH (1842); successful ligature of great arteries by ABERNETHY and ASTLEY COOPER (1806); crushing of stone in the bladder by GRUITHUISEN of Munich (1819), and CIVIALE of Paris (1826); cure of ovarian dropsy by the removal of the cyst, discovery of the ophthalmoscope, and great improvements in ophthalmic surgery by VON GRÄFE and others; application of the laryngoscope in operations on the larynx by CZERMAK (1860) and others, together with additions to the resources of aural surgery and dentistry.
In the treatment of fractures English surgery was inferior to that of continental practice, especially French, in the early part of the present century. M. ROUX in 1814 pointed out our shortcomings in this respect, contrasting English with French methods much to our disadvantage.[1034]
SIR WM. BLIZZARD (1743-1835) was the first surgeon who tied the superior thyroid artery for goitre. He founded in conjunction with Maclaurin the medical school of the London Hospital.
BENJAMIN BELL (1763-1820), of Edinburgh, was the elder brother of Sir Charles Bell. He was professor of anatomy, surgery, and obstetrics, a man of letters and a famous operator. He published a System of the Anatomy of the Human Body and The Principles of Surgery.
JOHN ABERNETHY (1764-1831), the celebrated surgeon and lecturer on anatomy, became the founder of the distinguished school of surgery and anatomy at St. Bartholomew’s Hospital, London.
SIR ASTLEY COOPER (1768-1841) was the first surgeon to tie the abdominal aorta.
SIR BENJAMIN BRODIE (1783-1862) was an anatomist and physiologist, as well as a distinguished surgeon.
ABRAHAM COLLES, M.D. (1773-1843), was an eminent Dublin surgeon, the author of a work on Surgical Anatomy, who has given his name to the fracture of the radius at the wrist.
JOHN BURNS, M.D. (1775-1850), was a teacher of surgery and midwifery at Glasgow. His world-wide reputation was gained for him by his Principles of Midwifery.
JAMES WARDROP (1782-1869) was the author of a well-known treatise on the pathology of the human eye.
BENJAMIN TRAVERS (1783-1858) was celebrated for his theory of “Constitutional Irritation.”
LISTON (1794-1847) was famous for his resections of the elbow and other joints.
SIR WM. LAURENCE (1783-1867) was one of the greatest clinical teachers the British school of surgery has produced.
GEORGE GUTHRIE (1785-1856) accompanied Wellington in his campaigns, and was in his time the great English authority on military surgery.
JAMES SYME (1799-1870) was a distinguished teacher of clinical surgery. He improved the operation of exarticulation at the knee-joint, and recommended the operation for amputating at the ankle which goes by his name.
SIR JAMES PAGET, F.R.S. (born 1814), the distinguished surgeon, is the author of the Pathological Catalogue of the Museum of the College of Surgeons, Lectures on Surgical Pathology, etc.
JOHN ERIC ERICHSEN, F.R.S. (born 1818), is the author of The Science and Art of Surgery, which has not only gone through nine large editions in this country, but has passed through many editions in America, and has been translated into German, Spanish, Italian, and Chinese (partly). Probably no treatise on English surgery has exercised so much influence on the progress of this branch of the healing art as Mr. Erichsen’s noble work.
JONATHAN HUTCHINSON, F.R.S. (born 1828), one of the most distinguished surgeons of the Victorian age, is famous throughout the empire as a clinical teacher, especially in connection with specific and skin diseases.
SIR HENRY THOMPSON (born 1820), the distinguished surgeon and pathologist, is famous for his researches in the pathology of the urethra and prostate gland, and for his clinical teaching in lithotomy and lithotrity. He has taken an active part in the cremation propaganda.
SIR W. J. ERASMUS WILSON (1809-1884) was the famous specialist in skin diseases, whose munificent benefactions to the Royal College of Surgeons have enormously extended the resources of its museum and library.
GYNÆCOLOGISTS.
SIR T. SPENCER WELLS, M.D. (born 1818), the celebrated ovariotomist, and MR. LAWSON TAIT, well described by Dr. Baas as “the magical operator and despiser of antiseptics,” in abdominal diseases, especially those of women, are without rivals in the world as benefactors to humanity by their life-saving discoveries.
ANATOMY IN ENGLAND.
Until 1832 the bodies of executed murderers were ordered for dissection, by 32 Hen. VIII. c. 42, 1540. Surgeons were granted four bodies of executed malefactors for “anathomyes” which privilege was extended in the following reigns; but in consequence of the crimes committed by “resurrection men” in order to supply the medical schools, a new statute was passed in 1832, which prohibited the dissection of murderers, and provided for the necessities of the dissecting room by permitting, under certain regulations, the dissection of the bodies of unclaimed persons dying in workhouses, etc.
Inspectors of anatomy were appointed, and various regulations were made for the decent and reverent disposal of the remains. The Anatomy Act was passed in consequence of the scandals connected with the great Anatomy School at Edinburgh, at which Dr. Knox was a celebrated teacher. It was discovered that a murderer named Burke provided bodies for surgeons by killing his victims by suffocation, leaving no marks of violence. The crime was known as Burking, and to remove the temptation to such scandals as the robbery of graveyards, and the murder of persons for the sake of the prices paid for their bodies, the wants of the surgeons were provided for in a legal manner.
FRENCH SURGEONS.
ALEXIS BOYER (1757-1833), one of the most eminent French teachers of surgery, wrote a great work on surgical diseases and operations, in eleven volumes.
JEAN D. LARRY (1766-1842) was a famous military surgeon under Napoleon. His opportunities for studying his profession must have been unique, as he participated in sixty great battles and four hundred engagements. He wrote several treatises on military medicine and invented field ambulances.
PHILIBERT J. ROUX (1780-1854), surgeon to the Hôtel Dieu at Paris, practised resections of joints, by which the articular diseased extremity of the bone is removed and a false joint formed.
JACQUES LISFRANC (1790-1847) was a famous amputator, whose operation for the partial removal of the foot is known by his name.
ARMAND VELPEAU (1795-1867) was a celebrated teacher of clinical surgery.
JOSEPH MALGAIGNE (1806-1865) was a very distinguished writer on surgical anatomy and operative surgery.
AUGUSTE NELATON (1807-1874) was called “the Napoleon of Surgery.” He invented the probe by which he detected the bullet in the wound of Garibaldi.
GERMAN SURGEONS.
Plastic operations were revived by C. F. VON GRAEFE, of Warsaw (1787-1840), DELPECH, DIEFFENBACH, B. LANGENBECK, and others. After severe burns there is frequently great loss of skin; it was found that this could be repaired by the transplantation of very minute portions of skin from healthy surfaces; periosteum and bones were also successfully transplanted.
VON KERN (1769-1829), the great Viennese surgeon, emphatically insisted that surgery could not be divorced from medicine. He adopted the very opposite treatment of wounds to that followed now by Lister; instead of excluding the air for fear of the germs contained in it, he insisted that operative wounds should be freely exposed to the atmosphere. He applied the simplest dressings of wet lint.
F. SCHUH (1804-1865) greatly advanced scientific surgery by advocating the use of the microscope in pathological anatomy.
VON WALTHER (1782-1849) was a great and scrupulously careful surgical operator, who, like Kern, declared that surgery and medicine are indivisible.
VON CHELIUS (1794-1876), a famous teacher of clinical surgery at Heidelberg, was a well-known writer on surgery.
CONRAD J. M. LANGENBECK (1776-1851) and BERNHARD LANGENBECK (1810-1887) greatly contributed to found military surgery in Germany.
G. F. L. STROMEYER (1804-1876), a famous military surgeon of Germany, obtained great success in that department of operative surgery known as subcutaneous division of tendons for the relief and cure of deformities such as club foot.
FRIEDRICH ESMARCH (born 1823) is famous for his invention of the method of bloodless amputations of limbs by the use of the bandage of india-rubber which goes by his name.
AMERICAN SURGEONS.
VALENTINE MOTT (1785-1865), the celebrated New York surgeon, is said to have tied more arteries for the relief or cure of surgical diseases than any other surgeon.
SAMUEL GROSS (1805-1884), a great American teacher of surgery, was the author of the well-known System of Surgery.
OPHTHALMIC SURGEONS.
J. A. H. REIMARUS (1729-1814), of Hamburg, first employed belladonna in ophthalmic surgery.
JOSEPH BARTH (1745-1818), of Malta, founded an ophthalmic hospital, and first lectured on eye diseases and their treatment.
JUNG-STILLING (1740-1817) was a celebrated coucher of cataracts.
DR. THOMAS YOUNG (1773-1829) rendered great services to optical science, and was the first to describe astigmatism, or the want of symmetry in the anterior refracting surfaces of the eyeball—a disorder of vision which has considerable influence in causing headache.
J. A. SCHMIDT (1759-1809) first described syphilitic iritis; he called eye disease with great justice “the elegant diminishing mirror of diseases of the body.”
C. HIMLY (1772-1837) used mydriatics (dilators of the pupil, such as hyoscyamus and belladonna) in operations on the eye. Atropine afterwards superseded these.
G. J. BEER (1763-1821), a professor of Vienna, founded the famous teaching of the Vienna school of ophthalmology, and greatly improved the practice of the art and the instruments employed in it.
H. L. HELMHOLTZ (born 1821) invented that powerful aid to the ophthalmic surgeon—the ophthalmoscope—in 1851. It is said that the observation of the reddening of the pupil in a drowning cat first suggested the invention to Méry in 1704. Helmholtz’s invention made scientific ophthalmology possible. This branch of surgery may be said to date from this great discovery.
HERMANN SNELLEN (born 1834), an oculist of Utrecht, introduced test types for ascertaining the distinctness of vision.
R. BRUDENELL CARTER, the eminent ophthalmologist, is a well-known and graceful writer on medical and scientific subjects.
II. MEDICAL REFORMS
Discovery of Anæsthetics.—Medical Literature.—Nursing Reform.—History of the Treatment of the Insane.
CONSERVATIVE SURGERY.
What is known as “conservative surgery” is the distinguishing feature of the art as practised at the present day. Whatever Lord Tennyson may have had in his mind in his lines on the children’s hospital, the highest surgical practice now is to save diseased and injured parts as much as possible, instead of removing them. Antiseptic surgery and the discovery of anæsthetics have alone made this possible.
DISCOVERY OF ANÆSTHETICS.
The Chinese have a drug named Mago, by which they have been able, so they maintain, to destroy pain for thousands of years past. The vapour of hemp seed and the drug mandragora have for ages been employed for anæsthetic purposes previous to surgical operations. In Homer’s time the properties of opium were well understood, and other narcotic drugs were used for the same purpose. Patients were also sometimes stupefied by strong drink, and among some savage tribes banana wine was copiously administered so as to intoxicate the patient. It was not, however, until the discovery of the true anæsthesia produced by sulphuric ether and chloroform that grave surgical operations could be performed without causing pain to the patient. Nitrous oxide gas, discovered by Priestley in 1776, was recommended as an anæsthetic by Davy in 1800, and its use was begun in America by Wells, the dentist, in 1844. The discovery that by inhaling ether the patient is rendered unconscious of pain is due to Dr. C. T. Jackson, of Boston, U.S. Mr. T. Morton, of the same city, first introduced it into surgical practice in 1846. Chloroform was discovered by Souberain in 1831, and independently by Liebig in 1832. Dumas determined its composition in 1834. JACOB BELL in London, and Dr. SIMPSON in Edinburgh, first applied chloroform experimentally. The late Professor James Miller thus describes the discovery of the anæsthetic effects of chloroform:[1035] “The trial proceeded, and the safety as well as suitableness of anæsthesia, by ether, became more and more established. But a new phase was at hand. My friend, Dr. Simpson, had long felt convinced that some anæsthetic agent existed superior to ether, and, in the end of October, 1847, being then engaged in writing a paper on ‘Etherization in Surgery,’ he began to make experiments on himself and friends in regard to the effects of other respirable matters—other ethers, essential oils, and various gases; chloride of hydrocarbon, acetone, nitrate of oxide of ethyl, benzine, the vapour of iodoform, etc. The ordinary method of experimenting was as follows: Each ‘operator’ having been provided with a tumbler, finger glass, saucer, or some such vessel, about a teaspoonful of the respirable substance was put in the bottom of it, and this again was placed in hot water, if the substance happened to be not very volatile. Holding the mouth and nostrils over the vessel’s orifice, inhalation was proceeded with, slowly and deliberately, all inhaling at the same time, and each noting the effects as they advanced. Late one evening—it was the 4th November, 1847—Dr. Simpson, with his two friends and assistants, Drs. Keith and Matthews Duncan, sat down to their somewhat hazardous work in Dr. Simpson’s dining-room. Having inhaled several substances, but without much effect, it occurred to Dr. Simpson to try a ponderous material, which he had formerly set aside on a lumber-table, and which, on account of its great weight, he had hitherto regarded as of no likelihood whatever. That happened to be a small bottle of chloroform. It was searched for, and recovered from beneath a heap of waste paper. And, with each tumbler newly charged, the inhalers resumed their vocation. Immediately an unwonted hilarity seized the party; they became bright-eyed, very happy, and very loquacious—expatiating on the delicious aroma of the new fluid. The conversation was of unusual intelligence, and quite charmed the listeners—some ladies of the family, and a naval officer, brother-in-law of Dr. Simpson. But suddenly there was a talk of sounds being heard like those of a cotton-mill, louder and louder; a moment more, then all was quiet, and then a crash. On awaking, Dr. Simpson’s first perception was mental. ‘This is far stronger and better than ether,’ said he to himself. His second was to note that he was prostrate on the floor, and that among the friends about him there was both confusion and alarm.” Each of the investigators related his experience of the new drug, and the experiments were repeated, always, however, on this first occasion, stopping short of unconsciousness. They were all convinced that the new agent had full anæsthetic power when pushed. Thus was it satisfactorily proved that chloroform was something much better than ether. Dr. Simpson continued to pursue his experiments upon himself until he had perfected the method he had so happily discovered.
A curious incident connected with anæsthesia is mentioned by Dr. Paris in his well-known work Pharmacologia.[1036] He relates an anecdote which he heard from the poet Coleridge, which illustrates the curative influence of the imagination.
“As soon as the powers of nitrous oxide were discovered, Dr. Beddoes at once concluded that it must necessarily be a specific for paralysis; a patient was selected for the trial, and the management of it was intrusted to Sir Humphry Davy. Previous to the administration of the gas, he inserted a small pocket thermometer under the tongue of the patient, as he was accustomed to do upon such occasions, to ascertain the degree of animal temperature, with a view to future comparison. The paralytic man, wholly ignorant of the nature of the process to which he was to submit, but deeply impressed, from the representation of Dr. Beddoes, with the certainty of its success, no sooner felt the thermometer under his tongue than he concluded the talisman was in full operation, and in a burst of enthusiasm declared that he already experienced the effect of its benign influence throughout his whole body. The opportunity was too tempting to be lost; Davy cast an intelligent glance at Coleridge, and desired his patient to renew his visit on the following day, when the same ceremony was performed, and repeated every succeeding day for a fortnight, the patient gradually improving during that period, when he was dismissed as cured, no other application having been used.”
MEDICAL LITERATURE.
The greatest historians of medicine are the Germans. Especially valuable are the works of—
KURT P. J. SPRENGEL (1766-1833), of Pomerania, professor of medicine at Halle. He was a great botanist, but his immortal work on the History of Medicine eclipsed all his other labours for medical science.
HEINRICH HAESER (1811-1885), the author of the learned Lehrbuch der Geschichte der Medicin und der Epidemischen Krankheiten, which is one of the most popular works of this class.
DR. JOH. HERMANN BAAS, who is the author of the valuable and encyclopædic Grundriss der Geschichte der Medicin, excellently translated into English by Dr. H. E. Handerson, of Cleveland, Ohio (1889).
DR. THEO. PUSCHMANN’S History of Medical Education has recently been translated into English by Mr. E. H. Hare (1891).
Amongst those of our own countrymen who have rendered great services to medical literature are—
SIR CHARLES HASTINGS (1794-1866), the founder of the British Medical Association.
SIR CHARLES SCUDAMORE (1779-1849), one of the greatest authorities on gout, who popularised Hydro-therapeutics by his writings.
SIR JOHN FORBES (1787-1861), founder of the Sydenham Society.
SIR RICHARD QUAIN, M.D., editor of the Dictionary of Medicine which bears his name.
MR. ERNEST HART (born 1836), editor (since 1866) of the British Medical Journal, which, by his great literary ability and scientific knowledge, has become the chief agent in the advancement of the British Medical Association to its present proud position amongst the scientific societies of the empire. Mr. Hart has rendered great public services in improving the condition of the sick poor in workhouses, and the creation of the metropolitan asylums. Mr. Hart’s labours in connection with many questions of social and sanitary progress have been pre-eminently crowned with success.
NURSING REFORM.
When the nineteenth century had run half its course, FLORENCE NIGHTINGALE (born 1820) was providentially raised up to reform the working of hospitals, schools, and reformatory institutions, after the mismanagement of our military hospitals in the Crimea had led to terrible suffering amongst our wounded soldiers. Her noble devotion and self-sacrifice amongst the troops earned her the blessing of the nation, and her name will for ever be gratefully remembered in all questions connected with hospital reform and the improvement of nursing.
MRS. WARDROPER (died 1892), the exterminator of Mrs. Gamp and her sisterhood, made her mark in the Crimean War, and put her finger on some of the most flagrant abuses of the nursing system of the day. She was the first superintendent of the Nightingale School of Nursing, and the original trainer of technically educated nurses for hospitals and infirmaries.
THE TREATMENT OF INSANITY.
It is customary to divide the treatment of the insane into three periods—the barbaric, humane, and remedial. We must not, however, suppose that in ancient times the treatment was everywhere barbaric, and that only in recent times has it become humane and remedial; nothing could be further from the truth. The treatment of persons mentally afflicted in ancient Egypt and in Greece was not only humane, but was probably remedial. In the temples of Saturn in Egypt, and in the Asclepia of Greece, which were resorted to by lunatics, Dr. J. B. Tuke thinks[1037] the treatment was identical in principle with that of the present day. He praises the sound principles on which Hippocrates and Galen treated insane patients, and there is no doubt that it was directed towards a cure. With these exceptions little is known as to the treatment of the insane before the advent of Christianity. The earliest recorded case of the administration of medicine to an insane patient is that in which Melampus was the physician, and the neglect of the worship of Bacchus the cause of the malady. As Mr. Burdett well remarks,[1038] nowadays the worship of Bacchus is responsible for much of the insanity which exists. From several accounts in the Greek poets we may assume that insanity prevailed in classic times in the forms with which we are now familiar. Hippocrates adopted a peculiar treatment in cases of suicidal mania. “Give the patient a draught made from the root of mandrake, in a smaller dose than will induce mania.” He remarks that although the general rule of treatment be “contraria contrariis curantur,” the opposite rule also holds good in some cases, namely, “similia similibus curantur.” It is evident therefore that in some degree the Father of Medicine was in accord with Homœopathy.[1039]
Whatever may have been the practice of the ancients, it is certain that in the Middle Ages the treatment of lunatics, up to the middle of the last century, was simply disgraceful. Little or no effort was made to cure or even to take proper care of the mentally afflicted. Some few were lodged in monastic houses, many in the common jails. In 1537 a house in Bishopsgate Street came into the possession of the Corporation of London, and was used to confine fifty lunatics. This was the first Bethlehem Hospital; it was removed in 1675 to Moorfields, and in 1814 the present hospital was built in St. George’s Fields. St. Luke’s was instituted in 1751.[1040] Many lunatics were executed as criminals or witches. It was not till the efforts of Pinel, Tuke, and Conolly were directed to the proper care and treatment of the insane that the barbarous period of European practice in regard to lunacy was happily ended.
Mr. Bennett says:[1041] “The Germans seem to have excelled all other nations in the ingenuity of the torture which they sought to inflict upon their patients. Some of them advocated the use of machinery, by which a patient, on first entering an asylum, was to be first drawn with frightful clangour over a metal bridge across a moat, and then to be suddenly raised to the top of a tower, and as suddenly lowered into a dark and subterraneous cavern. These practitioners avowed, according to Conolly, that if a patient could be lowered so as to alight among snakes and serpents, it would be better still.” “One humane doctor invented an excruciating form of torture in the shape of a pump, worked by four men, which projected a stream of water with great force down the spine of the patient, who was firmly fixed in a bath made for this apparatus.” Patients were taken to a bath in the ordinary way and allowed to bathe, but the bath had a bottom which gave way under their weight and plunged them into “the bath of surprise” underneath. Dr. Darwin is credited with having invented “the circulating swing” for lunatics; it was worked by a windlass, and was capable of being revolved a hundred times a minute. Esquirol approves this horrible instrument of torture, and speaks of it as having passed from the arts into medicine. Terror, cold water, shower baths, horrible noises, smells, darkness, were employed by the faculty in the treatment of insanity up to the beginning of the nineteenth century. The leaders of the French Revolution added starvation to the treatment. In England, in 1846, the diet in some of the licensed houses was starvation fare. Cruelty was identical in form in all the countries of Europe. Esquirol, in 1818, said the insane were either naked or in rags, no bedding was allowed but a little straw, the stone cells were dark and damp, and the wretched patients were chained in caves not good enough for wild beasts. They wore iron collars and belts, and had no medical treatment but baths of surprise and occasional floggings. Even up to 1850 this state of things still existed in England.
In England, in 1820, one of the great sights of London was Bedlam. The keepers were allowed to add to their income by exhibiting the patients at one penny or twopence per head.
Doubtless the chief reason of the neglect and cruelty to which lunatics were thus subjected in Christian Europe, so long fruitful in all other works of mercy, was the theory of possession by an evil spirit; conjurations and exorcisms were considered the only safe and efficacious methods of expelling the demons. This grievous blunder is one of many illustrations which might be given of the necessity of making an accurate diagnosis before attempting to treat disease. Dr. Baas says[1042] that lunatic asylums were established first at Feltre in Italy. The next were those of Seville, established in 1409; Padua, 1410; Saragossa, 1425; Toledo, 1483; Fez, 1492.
Burton, in his Anatomy of Melancholy, thus describes Lycanthropy, “which Avicenna calls cucubuth, others lupinam insaniam, or wolf-madness, when men run howling about graves and fields in the night, and will not be persuaded but that they are wolves or some such beasts. Ætius (lib. 6, cap. 11) and Paulus (lib. 3, cap. 16) call it a kind of melancholy; but I should rather refer it to madness, as most do. Some make a doubt of it, whether there be any such disease. Donat. ab Altomari (cap. 9, Art. Med.) saith, that he saw two of them in his time. Wierus (De Præstiv. Demonum, l. 3, cap. 21) tells a story of such a one at Padua, 1541, that would not believe to the contrary but that he was a wolf. He hath another instance of a Spaniard who thought himself a bear. Forestus (Observat. lib. 10, de Morbis Cerebri, c. 15) confirms as much by many examples; one among the rest, of which he was an eye-witness, at Alcmaer, in Holland. A poor husbandman that still hunted about graves, and kept in churchyards, of a pale, black, ugly, and fearful look. Such belike, or little better, were King Prœtus’ daughters (Hippocrates, lib. de insaniâ), that thought themselves kine; and Nebuchadnezzar, in Daniel, as some interpreters hold, was only troubled with this kind of madness. This disease, perhaps, gave occasion to that bold assertion of Pliny (lib. 8, cap. 22, homines interdum lupos fieri; et contra), some men were turned into wolves in his time, and from wolves to men again: and to that fable of Pausanias, of a man that was ten years a wolf, and afterwards turned to his former shape; to Ovid’s (Met. lib. 1) tale of Lycaon, etc. He that is desirous to hear of this disease, or more examples, let him read Austin in his eighteenth book, de Civitate Dei, cap. 5,” etc., etc.
III. THE GERM THEORY OF DISEASE
The Disease-Demon reappears as a Germ.—Phagocytes.—Ptomaines.—Lister’s Antiseptic Surgery.—Sanitary Science or Hygiene.—Bacteriologists.—Faith Cures.—Experimental Physiology and the Latest System of Medicine.
Soon after the discovery of the microscope, men began to seek for the causes of diseases in the infinitely little. ATHANASIUS KIRCHER (1598-1680), a Jesuit priest of Fulda, seems to have been gifted with the ability to foresee three of our greatest modern scientific discoveries. He anticipated Darwin’s dictum that life is maintained by struggle and counter-struggle. He described hypnotism in certain animals, and detected, as he thought, micro-organisms with the microscope, then in its infancy, in the blood and pus of patients suffering with the plague and other infectious diseases, which “worms,” as he termed the corpuscles, he considered to be the cause of the disease. His instrument had enabled him to discover that all decomposing substances swarmed with low forms of life. His theory, however, gained little credence at the time.[1043] Next ANTONY VAN LEEUWENHOEK, “the father of microscopy,” in 1675 published his researches in a series of letters to the Royal Society, in which he described minute organisms in waters, vegetable infusions, saliva, and in scrapings from the teeth, and he was able to differentiate these special forms of life. Some of his descriptions are so graphic that microscopists can almost recognise these forms as bacteria with which we are now familiar. Physicians still designating these as “worms” began to attribute to their influence various diseases.
In 1701 NICHOLAS ANDRY wrote on this subject a treatise entitled De la Génération des Vers dans le Corps de l’Homme. The germ theory of putrefaction and fermentation originated with Andry; he maintained that air, water, vinegar, fermenting wine, old beer, and sour milk contained myriads of germs; he detected these in the blood and pustules of small-pox, and believed that they could be found in other maladies. His views met with general acceptance, and curiously enough it was believed—and has since been verified by our own observation—that mercurial preparations were fatal to such disease germs.[1044] LANCISI in 1718 attributed the unhealthy effects of malarial air to animalcules, and “inconceivable worms” met with as much ridicule in Paris in 1726 as the “microbe” has been received with to-day. Linnæus out of all this chaos thought order might possibly be evolved; he believed that the actual contagion of certain eruptive diseases might be discovered in these small living beings.
MARCUS ANTONIUS PLENCIZ in 1762 discussed the relation of animalcules to putrefaction and disease in his works.[1045]
Notwithstanding all these clear indications, which, if followed up, would have been fertile in result, the germ theory of disease fell almost into oblivion. OTTO MÜLLER in 1786 began a more systematic study of the life history of various micro-organisms, and thus advanced the science of minute forms of life. The question arose, How do these forms originate? Dr. Needham was the first to suggest the theory of their spontaneous generation. Bonnet, of Geneva, disputed the results of Dr. Needham’s experiments, and Spallanzani demonstrated by experiment the correctness of Bonnet’s criticism.
FRANCIS SCHULZE in 1836, by a carefully devised experiment, struck another blow at Needham’s theory of spontaneous generation. In 1837 SCHWANN convinced himself that the cause of decomposition must exist in the air. SCHROEDER and VAN DUSCH in 1854 proved that filtration of the air through cotton-wool was effectual in excluding germs. Then HOFFMAN in 1860, and CHEVREUIL and PASTEUR working independently in 1861, showed that a sterile solution could be kept sterile if the neck of the vessel were bent in the form of an S, so that the micro-organisms in the air entering the neck of the flask, would be deposited by gravitation in the curve.
But the advocates of the theory of spontaneous generation were not yet satisfied. They objected that by the boiling of the infusions, etc., under examination they lost the ability to become decomposed; but it was shown that the admission of unfiltered air set up decomposition. PASTEUR, BURDON SANDERSON, and LISTER next showed that blood, urine, and milk would not decompose if proper precautions were taken to avoid contamination. In 1872 CHARLTON BASTIAN endeavoured to rehabilitate the spontaneous generation theory, but TYNDALL effectually disposed of his contentions. It is settled that bacteria, or microbes, as these germs are now called, when once destroyed by heat and by certain chemical agents in any medium, cannot be resuscitated, and that Harvey’s axiom, omne vivum ex ovo, applies to all forms of organisms. As DR. SIMS WOODHEAD has said[1046] concerning the battle between the advocates and opponents of the spontaneous generation theory:—
“The triumphs of surgery, of preventive inoculation of hygiene in relation to specific infective diseases, of preservation of food, have had their origin in the knowledge gained during the battle which waged round the question of spontaneous generation or generatio æquivoca; and to the disciples of that school every acknowledgment must be made and due credit assigned for the attitude of scepticism, and free, ingenious, and honest criticism which they passed concerning half-formed and inadequately-supported theories and imperfectly-conducted experiments, for to their efforts is certainly due the fact that the experiments of their opponents became more and more perfect, and if to-day we have perfect methods of sterilization and of making pure cultivations, it is because nothing was taken for granted, and because able men on both sides of the controversy were ranged against one another to fight the matter to the death.”
Another question which had to be determined was whether these organisms were of the animal or vegetable kingdom. EHRENBERG came to the conclusion that in consequence of snake-like and rotary movements of certain micro-organisms they were animals; and this opinion held its ground till DAVAINE decided that bacteria must be considered as belonging to the vegetable kingdom. Up to 1852 the animal theory was unshaken; in 1854 COHN demonstrated the plant nature of bacteria.
In 1857 NAEGELI made a group of all the forms of lesser minute organisms, and termed it Schizomycetes, or fission fungi. The connection between micro-organisms and disease was the subject of research also in another direction. The discovery by LATUM and SCHWANN in 1837, that the yeast plant is a living organism, and the true cause of fermentation, threw great light on the whole inquiry. Many observers had long recognised the likeness of certain diseases to fermentation processes, and it gradually became the opinion that such diseases were similarly produced. In 1837 BASSI discovered that the silk-worm disease was due to microscopic spores on the bodies of sick worms, and that healthy worms became diseased when these spores were conveyed to them. HENLE in 1840 declared that all contagious diseases must be caused by the growth of something of a living nature, although he had searched in vain for the living contagion of small-pox and scarlet fever. When fungi were found to be the cause of favus, herpes tonsurans, and pityriasis versicolor, the theory received a still greater impetus. SWAINE, BRITTAN, and BUDD found micro-organisms in connection with cholera. In 1857 PASTEUR demonstrated that lactic, acetic, and butyric fermentations were produced by micro-organisms.[1047] In 1863 DAVAINE came to the conclusion that the disease known as splenic fever is caused by an organised being which kills the animal by multiplying in its blood, and so changing its nature, after the manner of a fermentation process. PASTEUR next took up the investigation of silk-worm disease, and was ultimately able to confirm the opinion that the disease was due to micro-organisms, and to devise a remedy for it.
ROBERT KOCH in 1877 described the life-history of the bacillus of anthrax or splenic fever. PASTEUR also devoted much attention to the same subject, and confirmed the observations of Koch. PAUL BERT, on the other hand, argued that the bacilli were of no importance. Ultimately he was convinced of his error by Pasteur; it was, however, says PROFESSOR CRUIKSHANK,[1048] “principally the researches of Koch which placed the doctrine of contagium vivum on a scientific basis. Koch elevated the theory of contagium vivum to a demonstrated and established fact.”
The whole matter is beset with fallacies. Because certain bacteria have been discovered in the blood of animals suffering from a particular disease, it must not be rashly concluded that these bacteria are always its cause, they may be in some cases only its effects. At the present time the nature of the contagion in many diseases, such as hydrophobia, variola, vaccinia, scarlet fever, and measles, has not been discovered. The comma-bacillus is associated with cholera in some mysterious manner, yet experimenters have swallowed myriads of comma-bacilli, and have remained never the worse. Although Pasteur’s prophylactic treatment against hydrophobia is based upon the theory that a micro-organism is the cause of the disease, Pasteur has never yet discovered the bacterium of hydrophobia, yet there would seem to be one. DR. SIMS WOODHEAD says:[1049] “It is a most remarkable fact that although no micro-organisms can be found in the virus, filtration through the Pasteur filter keeps back the effective part of the virus, whilst heating to 100°C. destroys the activity of the virus.”
The disease-demon has now reappeared in the form of a germ.
THE PHAGOCYTE THEORY.
Some thirty-six diseases, many of which are amongst the most terrible which afflict men and animals, are attributed by bacteriologists to micro-organisms.[1050] It is sufficiently alarming to reflect that enemies which can only be detected by a specialist armed with a powerful microscope are everywhere around us, waiting to attack us in a favourable spot, and slay us without hope of escape.
Yet the germ-theorists have not left us entirely without hope. One of Pasteur’s most distinguished pupils, M. METSCHNIKOFF, offers us salvation through faith in his phagocytes. The white blood corpuscles are for ever on the watch for the incursions of disease germs. These they instantly arrest and imprison by taking them into their own substance, digesting and converting them to their own uses. Whenever there is an extra demand for the services of these admirable blood-police, a large number are attracted to the point where the burglarious and murderous enemy has entrenched himself; and if the system is in a position to maintain a sufficient force of these guardians of health, the enemy is rapidly digested, and the effete products are expelled by the regular physiological channels.
It has been found that men and animals may be insusceptible to an infective disease by natural immunity. Not all persons subjected to exposure to epidemic diseases contract them. Ordinary sheep readily succumb to anthrax, but Algerian sheep resist any but large doses of the virus.[1051] Acquired immunity is that by which one attack, say of measles or of small-pox, protects against a second. Acclimatization also affords immunity. Pasteur, in his researches on fowl cholera, noticed that in non-fatal cases the disease did not recur. This set him to work out a theory of attenuated inoculations which should afford protection by giving the disease in a mild form in cultivations of the micro-organism. Pasteur next endeavoured to protect animals against anthrax by inoculating them with a mitigated virus. His results were criticised and his researches opposed by Koch, who came to the conclusion that the process did not admit of practical application, chiefly because the immunity would only last a year, and on account of the danger of disseminating a vaccine of the necessary strength.[1052] The theory of protective inoculation in hydrophobia has been much discussed. Pasteur’s explanation does not entirely satisfy some experts. Dr. Sims Woodhead gives the following: “I am inclined to think that the explanation advanced by Wood and myself, that the treatment consists essentially in causing the tissues to acquire a tolerance before the microbe has had time to develop, is more in accordance with the facts. The tissue cells are acted upon by increasingly active virus, each step of which acclimatizes the cells for the next stronger virus, until at length, when the virus formed by the micro-organisms introduced at the time of the bite comes to exert its action, the tissues have been so far altered or acclimatized that they can continue their work undisturbed in its presence; and treating the micro-organisms themselves as foreign bodies, destroy them. When the cells are suddenly attacked by a strong dose of the poison of this virus, they are so paralysed that the micro-organisms can continue to carry on their poison-manufacturing process without let or hindrance; but when the cells are gradually, though rapidly, accustomed to the presence of the poison by the exhibition of constantly increasing doses, they can carry on their scavenging work even in its presence, and the micro-organisms are destroyed, possibly even before they can exert their full poison-manufacturing powers.”[1053]
PTOMAINES.
The germ theory has thrown great light upon the subject of certain mysterious organic poisoning processes, which long puzzled analysts and physicians. Diseased meat, fish, cheese, and other articles of food frequently cause symptoms of poisoning in those who have partaken of them. The analyst failed to detect the precise agent which caused the mischief, and it was not till the bacteriologists investigated the subject that it was satisfactorily explained. In 1814, BURROWS described a poisonous substance in decaying fish. In 1820, KERNER described a poisonous alkaloid which he discovered in sausages. In 1856, PANUM isolated a poison from some decomposing animal matter. ZUELZA and SONNENSCHEIN from the same substance obtained a poison which closely resembled atropine in its physiological action. SELMI between 1871 and 1880 described substances which he called cadaveric alkaloids or ptomaines. Pasteur and others, working in the same direction, have greatly advanced our knowledge of these deadly agents. Bacteria are now known to have the power to build up deadly substances as they grow in dead or living animal tissues, just as plants build up poisons in their own tissues; these substances exert a deadly influence on the nerve centres, and hence a cheese bacillus may be as dangerous to human life as a dose of aconite.
LISTER’S ANTISEPTIC SURGERY.
What is commonly known as “Listerism” is a development of the germ theory of disease, which has revolutionised the art of surgery by its direct and indirect influence. Pus formation, the result of destructive processes which prevent the healing of wounds, was discovered to be due to the action of germs falling from the atmosphere on the injured flesh. LISTER sought to destroy these germs by powerful disinfectants. This was the first step in the antiseptic treatment. When carbolic-acid lotions were applied for this purpose, LISTER discovered that the wound healed rapidly. He believed that he had destroyed the micro-organisms by the carbolic-acid lotions. But LISTER improved on this process, and seeing how difficult it is to destroy the germs when they have once entered the tissues, he invented a method whereby they were prevented from gaining admission at all. He fought the micro-organisms in the atmosphere of the operating room, in the dressings, instruments, and hands of the operator, and thus gradually built up his system of absolute surgical cleanliness called antiseptic surgery. Even those surgeons who rejected his method in its entirety, and declined to adopt his complicated system of dressings, devoted so much attention to the minutest cleanliness, that they achieved results not less successful than those of the inventor of the antiseptic system itself.
SANITARY SCIENCE.
Hygiene, the art of preserving health, has always been recognised as a branch of medical science, not less important than that which concerns itself with the cure of disease. MOSES (B.C. 1490) enjoined the strictest cleanliness, and anticipated our modern sanitary laws. HIPPOCRATES embodied in his works treatises on hygiene, which existed in Greece probably long anterior to his time. The value of attention to rules of diet and exercise was recognised by HERODICUS, one of his preceptors, who introduced a system of medicinal gymnastics for the improvement of the health and the cure of disease. Such rules must to a greater or less extent have always been in force in any well-constituted army. Gymnasts, athletes, and others must have been fully aware of the necessity for attending to such rules. Hippocrates, in his treatise Airs, Waters, and Places, has insisted on the duty of the physician to study the effects of the seasons, the winds, the position of cities, and the diseases which are endemic and epidemic in them, the qualities of waters, and their effects on public health, and so forth. Had men taken up the study of Hygiene where Hippocrates left off, we should not have heard of the plagues, pestilences, and epidemics which up to modern times periodically devastated the civilized world.
HYGIENE.
Mr. PARKES, in the introduction to his Manual of Practical Hygiene, defines hygiene in its largest sense to signify “rules for perfect culture of mind and body.” The two are not to be dissociated. Every mental and moral action influences the body; the physical conditions equally re-act upon the mind. He admirably says: “For a perfect system of hygiene we must combine the knowledge of the physician, the schoolmaster, and the priest, and must train the body, the intellect, and the moral soul in a perfect and balanced order. Then, if our knowledge were exact, and our means of application adequate, we should see the human being in his perfect beauty, as Providence, perhaps, intended him to be; in the harmonious proportion and complete balance of all parts in which he came out of his Maker’s hands, in whose divine image, we are told, he was in the beginning made.” Mr. Parkes asks if such a system is possible? He replies that we can even now literally choose between health and disease. There are certain hereditary conditions which we may not be able to avoid, and men may hinder our acquisition of the boon; but as a race man holds his own destiny in his hands, and can choose the good and reject the evil. Exit the disease-demon! Fevers and other epidemic diseases are no longer attributed to the anger of the Supreme Being; they may be prevented. If we use the words scourge, plague, visitation, and the like, it is merely because we recognise that Nature can take offence at our violation of her laws, and visit us with the penalty.
One of the most important events of our time was the establishment of the Registrar-General’s office in 1838. To DR. WILLIAM FARR we owe a nation’s gratitude for the admirable manner in which he performed the duties of his office. The Government Inquiry into the Health of Towns and of the Country generally, undertaken by EDWIN CHADWICK, SOUTHWOOD SMITH, NEIL ARNOTT, SUTHERLAND, GUY, TOYNBEE, and others, was of immense importance to the national health. The medical officer to the Privy Council, SIMON, carried on the work thus ably commenced with the greatest vigour; and the consequence of the important departure was that medical officers of health were appointed to the different towns and parishes.
Various public health acts have followed from time to time, and it has been found, in the words of Mr. Parkes, that “nothing is so costly in all ways as disease, and that nothing is so remunerative as the outlay which augments health, and in doing so, augments the amount and value of the work done.”
It is a reproach frequently brought against medicine that it makes little advance. Some have even said that in some respects we are no better off than if we lived in the days of Hippocrates. However this may be, we may be justly proud of the splendid work which hygienic medicine has performed, and we have every reason to look hopefully forward to the benefits this branch of medical science will confer upon us in the near future. Hygiene is the outcome of physiology. Until we knew the laws of life, it was impossible that hygiene should have a scientific basis; and henceforth physiology and hygiene will go hand in hand.[1054]
JOHN SIMON, C.B., F.R.S. (born 1816), the eminent physiologist, pathologist, and surgeon, became the first appointed officer of health to the City of London. He was for some time medical adviser to the Privy Council. He rendered the greatest services to the health of the nation by his reports and official papers on sanitary matters.
EDMUND A. PARKES (1819-1876) was the great sanitary reformer whose name is gratefully enshrined in the “Parkes Museum of Hygiene,” instituted in 1876, of University College, London.
LUDWIG J. P. SEMMELWEIS (1818-1865), “the Father of Antiseptic Midwifery,” was professor in Pesth, and has earned the gratitude of his profession and of the whole world by demonstrating that puerperal fever was due to inoculation, that the poison which caused it was introduced by organic matter below the nails and epidermis of the students and doctors who had been engaged in anatomical or pathological work and had not taken sufficient pains to disinfect and purify their hands. He recommended careful washing with chlorine water before each examination; the consequence of which was, that the mortality among lying-in women fell in two months from twelve to three per cent. He anticipated the methods of Lister, and died in a lunatic asylum, galled by the attacks which his doctrines experienced.[1055] Sir Andrew Clark said:[1056] “There are few such parallels in the history of science, in regard to his tremendous moral heroism; in spite of every conceivable difficulty, in positions of misrepresentation, in spite of persecution, he continued his labours, until crowned with a full clearing up of the difficulties. As to his martyrdom, there is not such a history. The persecution to which he was exposed in the later years of his stay in Vienna, his being hounded out of Vienna and settling in Budapest, and his premature end in loss of reason, form indeed a sad story, and one of the highest examples that can be presented.”
BACTERIOLOGISTS AND OTHER SCIENTISTS.
BENJAMIN W. RICHARDSON, M.D., F.R.S., etc. (born 1828). In 1865 he made important researches on the nature of the poisons of contagious diseases and discovered septine. In 1866 he discovered the use of the ether spray for locally abolishing pain in surgical operations. He introduced bichloride of methylene as an anæsthetic, and discovered the influence of nitrite of amyl over tetanus, angina pectoris, etc. He invented the lethal chamber for killing animals without pain, and has made many most important researches on the action of alcohol on man. In 1875 he gave a sketch of a “Model City of Health,” to be called Hygeia, which awakened much interest and discussion.
JOHN BURDON SANDERSON, M.D. (born 1828), Professor of Physiology at Oxford, made investigations respecting the cattle plague, 1865-66. In 1883 he sat on the Royal Commission on Hospitals for infectious diseases, and has made elaborate researches on animal and plant electricity, and on the nature of contagion.
ROBERT KOCH (born 1843), the eminent bacteriologist, the discoverer of the “comma” bacillus, and the tubercle bacillus, is Professor of the Institute of Hygiene in Berlin.
JOHN TYNDALL, F.R.S. (born 1820), is one of the foremost of the scientific explorers of the century. Besides his researches in relation to magnetism, radiant heat, heat as a mode of motion, light, etc., Professor Tyndall has rendered very important services to medicine by his studies on The Floating Matter of the Air in Relation to Putrification and Infection, 1881.
LOUIS PASTEUR (born 1822), chemist, is celebrated for his researches relative to the polarization of light, and for his investigations on fermentation, the preservation of wines, and the propagation of zymotic diseases in silkworms and domestic animals. Pasteur’s most important work for medicine was the demonstration of the existence of the germs which cause putrefaction.
The Minister of Public Instruction, addressing M. Pasteur on the occasion of his seventieth birthday, summed up what is known as Pasteurism in the following words: “Henceforward the formula is definitive and complete. Your disciples give it in two words—ferments and virus are living beings; vaccine is an attenuated virus, the basis of medicine is the artificial attenuation of virus, and thus the microbic treatment is founded.”
Pasteur’s later work has been chiefly in connection with the attempt to discover a prophylactic for hydrophobia.
LIONEL S. BEALE, F.R.S. (born 1828), physiologist and pathological anatomist, is a celebrated microscopist, author of The Microscope in its Application to Practical Medicine; Disease Germs, their Supposed and Real Nature, and on the Treatment of Diseases caused by their Presence; and many other works of equal importance to medical science.
WILLIAM B. CARPENTER (1812-1885) was a celebrated physiologist, whose great work has done more to popularise the study of physiology amongst non-professional, as well as medical readers, than any other, except that of Professor Huxley, which followed it.
Amongst other scientific workers of the century may be mentioned PURKINJE, who rediscovered and described the bone corpuscles, contributed greatly to the study of microscopical anatomy and ophthalmology by his experiments with the ophthalmoscope.
R. WAGNER (1805-1864) in 1861 called an anthropological congress, which was attended by several distinguished anatomists, and thus originated the “Anthropological Congress.”
PANDER (1794-1865) and BAER (1792-1876) made important researches in the history of development. To Baer is due the splendid discovery of the mammalian ovum.
FRANÇOIS MAGENDIE (1782-1855) was the first to introduce the experimental method into pathology and pharmacology. His investigations in what are called pharmaco-dynamics, chiefly connected with the alkaloids, introduced many of these powerful remedies into medical practice. He admitted a vital principle in nervous activity, but for the rest endeavoured to reduce medicine to mere physiological and chemical laws.
MIRACLES OF HEALING, FAITH CURES, MIND CURES, CHRISTIAN SCIENCE HEALING, ETC., ETC.
There are many things connected with the healing art on which the public mind is better informed than the recognised authorities on medicine. Mesmerism is now accepted by the faculty under the name of hypnotism, and the miracles of healing wrought at the shrines of saints, long the objects of scorn and contempt at the hands of the medical profession, are now declared to be well within the domain of scientific fact. The miracles of Lourdes, the faith cures at Bethshan, and similar phenomena, having been subjected to the strictest investigation by the most competent medical authorities, are proved to be not impostures and delusions, but simple matters of fact. Science having reluctantly accepted the faith-cure, now declares it to be “an ideal method, since it often attains its end when all other means have failed.”[1057]
Professor Charcot, while declaring that the faith-cure is entirely of a scientific order, insists that its domain is limited; “to produce its effects it must be applied to those cases which demand for their cure no intervention beyond the power which the mind has over the body.” That is to say, faith will cure paralysis and other disorders of motion and sensation dependent on idea, but does not avail to restore a lost organ or an amputated limb.
Professor Charcot believes also that the faith-cure may cause ulcers and tumours to disappear, if such lesions be of the same nature as the paralysis cured by the same means. In all this there is no miracle. The diseases are all of hysterical origin, according to this eminent authority, and being purely dynamic, and not organic, the mind has power to influence and cure them. The mind of the invalid becomes possessed of the overpowering idea that a cure is to be effected, and it is so.
M. Littré has explained for us how this happens.[1058] The mind, which is most eminently receptive of suggestion, will be the most likely to be influential in curing the body in which it is enshrined, by the powerful force of auto-suggestion.[1059]
In expressing this opinion, no question need arise of the efficacy of prayer or of the intervention of the Divine power. The aim of the physician is to understand the medical side of the subject, and science is daily becoming more capable of offering an explanation of such phenomena from a purely medical point of view. A curious instance of faith-cure was recently given in a Catholic magazine.
The Month for June, 1892, published an account, by the late Earl of Denbigh, of a cure worked by a member of a family named Cancelli on Lady Denbigh in 1850. She was suffering severely from rheumatism, and the Pope (Pius IX.) mentioned to the Earl that near Foligno there was a family of peasants who were credited with a miraculous power of curing rheumatic disorders. Lord Denbigh succeeded in getting one of the family, an old man, to come, and learned from him the legend of the cure. The belief was that in the reign of Nero, the Apostles Peter and Paul took refuge in the hut of an old couple named Cancelli, near Foligno, and as a proof of gratitude, gave to the male descendants of the family living near the spot the power of curing rheumatic disorders to the end of time. Lord Denbigh described how the old man made a solemn invocation, using the sign of the cross, and, in fact, Lady Denbigh did recover at once. In a few days the pains returned, but she made an act of resignation, and they then left her, and never returned with any acuteness.
EXPERIMENTAL PHYSIOLOGY.
The question of vivisection, or experimental physiology, pathology, and pharmacology, has become a burning one in England and America of recent years. In a history of medicine so prominent a question cannot be entirely ignored, although it would be out of place to discuss it here at length. It has been claimed that almost all our real knowledge of the healing art, and the most important steps of medical progress, have been gained by experiments upon living animals. On the other hand, it has been maintained by practical physicians and surgeons that the method in question is not less misleading than cruel; that “the only correct path is that of thoughtful experience.”[1060] On behalf of the advocates of the experimental method, PROFESSOR MICHAEL FOSTER shall state the case; that of the other side shall be given in the words of SIR ANDREW CLARK, “the prince of physicians, and one of the noblest of men,” under whom it was my happiness and privilege to study medicine in the wards of the London Hospital.
PROFESSOR MICHAEL FOSTER says: “It would not be a hard task to give chapter and verse for the assertion that the experimental method has, especially in these later times, supplied the chief means of progress in physiology; but it would be a long task, and we may content ourselves with calling attention to what is in many respects a typical case. We referred a short time back to the phenomena of ‘inhibition.’ It is not too much to say that the discovery of the inhibitory function of certain nerves marks one of the most important steps in the progress of physiology during the past half-century. The mere attainment of the fact that the stimulation of a nerve might stop action instead of inducing action constituted in itself almost a revolution; and the value of that fact in helping us on the one hand to unravel the tangled puzzles of physiological action and reaction, and on the other hand to push our inquiries into the still more difficult problems of molecular changes, has proved immense. One cannot at the present time take up a physiological memoir covering any large extent of ground without finding some use made of inhibitory processes for the purpose of explaining physiological phenomena. Now, however skilfully we may read older statements between the lines, no scientific—that is, no exact—knowledge of inhibition was possessed by any physiologist, until Weber, by a direct experiment on a living animal, discovered the inhibitory influence of the pneumogastric nerve over the beating of the heart. It was, of course, previously known that under certain circumstances the beating of the heart might be stopped; but all ideas as to how the stoppage was, or might be, brought about, were vague and uncertain before Weber made his experiment. That experiment gave the clue to an exact knowledge, and it is difficult, if not impossible, to see how the clue could have been gained otherwise than by experiment; other experiments have enabled us to follow up the clue, so that it may with justice be said that all that part of the recent progress of physiology which is due to the introduction of a knowledge of inhibitory processes is the direct result of the experimental method. But the story of our knowledge of inhibition is only one of the innumerable instances of the value of this method. In almost every department of physiology, an experiment, or a series of experiments, has proved a turning-point at which vague, nebulous fancies were exchanged for clear, decided knowledge, or a starting-point for the introduction of wholly new and startling ideas.
“And we may venture to repeat, that not only must the experimental method be continued, but the progress of physiology will chiefly depend on the increased application of that method. The more involved and abstruse the problems become, the more necessary does it also become that the inquirer should be able to choose his own conditions for the observations he desires to make. Happily, the experimental method itself brings with it in the course of its own development the power of removing the only valid objection to physiological experiments, viz., that in certain cases they involve pain and suffering. For in nearly all experiments pain and suffering are disturbing elements. These disturbing elements the present imperfect methods are often unable to overcome; but their removal will become a more and more pressing necessity in the interests of the experiments themselves, as the science becomes more exact and exacting, and will also become a more and more easy task as the progress of the science makes the investigator more and more master of the organism. In the physiology of the future, pain and suffering will be admissible in an experiment only when pain and suffering are themselves the object of inquiry. And such an inquiry will of necessity take a subjective rather than an objective form.”[1061]
Let the President of the Royal College of Physicians give his views of the utility of vivisection from the point of view of a practical physician:—
SIR ANDREW CLARK before the “Clinical Society of London” (British Medical Journal, Feb. 3, 1883) said: “For whatever purpose they may be employed; however carefully they may be designed and executed; however successful may be the precautions taken to exclude error, experiments have their subtle difficulties and dangers which are perilous to truth, and cannot be wholly averted. By the prestige of precision, which often undeservedly they profess, undue weight is attached to their results; and by the assumption that in like conditions the results would be the same in man as in the lower animals, flagrant errors are committed, and currency is given to false or inadequate generalisations. The experimenter interprets the results of his experiments by the light of their structural results; he forgets or he ignores the life-history of the processes by which they have been evolved, and he takes no account of the fact, beyond controversy, that different clinical states find occasionally the same structural expression. In such circumstances doubt is inevitable, and it is only to clinical medicine that any just appeal for its solution can be made. To her, at last, all such experiments must be brought for trial; she must be their examiner, critic, interpreter, user, and judge. And no results of experiments can be made of any avail to medicine, or be used with safety in her service, until they have been filtered through the checks and counter-checks of clinical experience, and have responded to the tests and counter-tests of clinical trial. Had these principles exerted their just influence in the recent debates concerning questions of this kind, we should not have had a seton in the neck of a man taken as the parallel of a seton in the neck of a guinea-pig; we should not have had the artificial tuberculosis of the rodent pronounced to be identical with the natural tuberculosis of the child; we should not have had grey tubercles and caseous pneumonias pronounced on the grounds of mere likeness of structure to be of one and the same nature; and we should have been spared the sight of science, drunken with success and drivelling with prophecies, soliciting the public on the common highway.”