CHAPTER I.
THE NINTEENTH CENTURY.—PHYSICAL SCIENCE ALLIED TO MEDICINE.

Exit the Disease-Demon.—Medical Systems again.—Homoeopathy.—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 2s. 10d.

The items for one day (August 12) are:—

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.

Homoeopathy 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:—

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 diarrhoea, and 60 to 90 grammes of saltpetre a day1023—doses which would be large for a horse.

The wonder is that anybody survived the treatment.

Homoeopathy, 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 Homoeopathy, 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 homoeopathic 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 homoeopathist; 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 says1029 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.

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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

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 myxoedema 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.

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CHAPTER 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 thinks1037 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 Homoeopathy.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 says1042 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 Proetus’ 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.

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CHAPTER 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 said1046 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.”

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