Chapter IV: , VII (172)

"One of the most notable events of the 18th century, or for
that matter, in the history of medicine, was the introduction
of the systematic practice of preventive inoculation against
small-pox. We are so generally taught that this is entirely
due to the efforts of Jenner, or rather we are so often
allowed to think it without being necessarily taught
otherwise, that the measure deserves a historical sketch. The
communication of the natural disease to the healthy in order
to protect them from the same natural disease, in other words,
the communication of small-pox to prevent the same, reaches
back into antiquity. It is mentioned in the Sanskrit Vedas as
then performed, always by Brahmins, who employed pus procured
from small-pox vesicles a year before. They rubbed the place
selected for operation until the skin was red, then scratched
with a sharp instrument, and laid upon the place cotton soaked
in the variolous pus, moistened with water from the sacred
Ganges. Along with this measure they insisted upon most
hygienic regulations, to which in a large measure their good
results were due. Among the Chinese was practised what was
known as 'Pock-sowing,' and as long ago as 1000 years before
Christ they introduced into the nasal cavities of young
children pledgets of cotton saturated with variolous pus. The
Arabians inoculated the same disease with needles, and so did
the Circassians, while in the states of north Africa incisions
were made between the fingers, and among some of the negroes
inoculation was performed in or upon the nose. In
Constantinople, under the Greeks, the custom had long been
naturalized and was practised by old women instructed in the
art, who regarded it as a revelation of St. Mary. The first
accounts of this practice were given to the Royal Society by
Timoni, a physician of Constantinople, in 1714. The actual
introduction of the practice into the West, however, was due
to Lady Mary Wortley Montagu, who died in 1762, and who was
wife of the English ambassador to the Porte in 1717. She had
her son inoculated in Constantinople by her surgeon Maitland,
and after her return to London, in 1721, it was also performed
upon her daughter. During the same years experiments were
undertaken by Maitland upon criminals; and as these turned out
favorably, the Prince of Wales and his sisters were inoculated
by Mead. The practice was then more or less speedily adopted
on this side of the ocean as well as on that, but suffered
occasional severe blows because of unfortunate cases here and
there, such as never can be avoided. The clergy, especially,
using the Bible, as designing men always can use it, to back
up any view or practice, became warm opponents of vaccination,
and stigmatized it as a very atrocious invasion of the Divine
prerogative of punishment. But in 1746 the Bishop of Worcester
recommended it from the pulpit, and established houses for
inoculation, and thus made it again popular. In Germany the
operation was generally favored, and in France and Italy a
little later came into vogue."

_Roswell Park,
Lectures on the History of Medicine (in MS.)._

MEDICAL SCIENCE: 18th Century.
Jenner and the discovery of Vaccination.

Many before the English physician, Dr. Jenner, "had witnessed
the cow-pox, and had heard of the report current among the
milkmaids in Gloucestershire, that whoever had taken that
disease was secure against smallpox. It was a trifling, vulgar
rumor, supposed to have no significance whatever; and no one
had thought it worthy of investigation, until it was
accidentally brought under the notice of Jenner. He was a
youth, pursuing his studies at Sodbury, when his attention was
arrested by the casual observation made by a country girl who
came to his master's shop for advice. The smallpox was
mentioned, when the girl said, 'I can't take that disease, for
I have had cow-pox.' The observation immediately riveted
Jenner's attention, and he forthwith set about inquiring and
making observations on the subject. His professional friends,
to whom he mentioned his views as to the prophylactic virtues
of cow-pox, laughed at him, and even threatened to expel him
from their society, if he persisted in harassing them with the
subject. In London he was so fortunate as to study under John
Hunter [1770-1773] to whom he communicated his views. The
advice of the great anatomist was thoroughly characteristic:
'Don't think, but try; be patient, be accurate.' Jenner's
courage was greatly supported by the advice, which conveyed to
him the true art of philosophical investigation. He went back
to the country to practise his profession, and carefully to
make observations and experiments, which he continued to
pursue for a period of twenty years. His faith in his
discovery was so implicit that he vaccinated his own son on
three several occasions. At length he published his views in a
quarto of about seventy pages, in which he gave the details of
twenty-three cases of successful vaccination of individuals,
to whom it was found afterwards impossible to communicate the
smallpox either by contagion or inoculation. It was in 1798
that this treatise was published; though he had been working
out his ideas as long before as 1775, when they began to
assume a definite form. How was the discovery received? First
with indifference, then with active hostility. He proceeded to
London to exhibit to the profession the process of vaccination
and its successful results; but not a single doctor could be
got to make a trial of it, and after fruitlessly waiting for
nearly three months, Jenner returned to his native village.
{2141}
He was even caricatured and abused for his attempt to
'bestialize' his species by the introduction into their
systems of diseased matter from the cow's udder. Cobbett was
one of his most furious assailants. Vaccination was denounced
from the pulpit as 'diabolical.' It was averred that
vaccinated children became 'ox-faced,' that abscesses broke
out to 'indicate sprouting horns,' and that the countenance
was gradually 'transmuted into the visage of a cow, the voice
into the bellowing of bulls.' Vaccination, however, was a
truth, and notwithstanding the violence of the opposition
belief in it spread slowly. In one village where a gentleman
tried to introduce the practice, the first persons who
permitted themselves to be vaccinated were absolutely pelted,
and were driven into their houses if they appeared out of
doors. Two ladies of title,—Lady Ducie and the Countess of
Berkeley,—to their honor be it remembered,—had the courage
to vaccinate their own children; and the prejudices of the day
were at once broken through. The medical profession gradually
came round, and there were several who even sought to rob Dr.
Jenner of the merit of the discovery, when its vast importance
came to be recognized. Jenner's cause at last triumphed, and
he was publicly honored and rewarded. In his prosperity he was
as modest as he had been in his obscurity. He was invited to
settle in London, and told that he might command a practice of
£10,000 a year. But his answer was, 'No! In the morning of my
days I have sought the sequestered and lowly paths of
life,—the valley, and not the mountain,—and now, in the
evening of my days, it is not meet for me to hold myself up as
an object for fortune and for fame.' In Jenner's own lifetime
the practice of vaccination had been adopted all over the
civilized world; and when he died, his title as Benefactor of
his kind was recognized far and wide. Cuvier has said, 'If
vaccine were the only discovery of the epoch, it would serve
to render it illustrious forever."

_S. Smiles,
Self-help,
chapter 4._

ALSO IN:
_J. Barron,
Life of Edward Jenner._

MEDICAL SCIENCE: 18th Century.
The Brunonian System of Stimulation.

"John Brown, born of obscure parents in a village of Berwick,
in Scotland, was remarkable, from his early youth, for an
extraordinary aptitude for acquiring languages, a decided
inclination for scholastic dispute, a pedantic tone and
manner, and somewhat irregular conduct. Having abandoned
theology for medicine, he fixed his residence in Edinburgh.
… He was particularly entertained and countenanced by
Cullen, who even took him into his family in the character of
preceptor of his children. This agreeable relation subsisted
during twelve consecutive years between these two men, whose
characters and minds were so different. … But some trifling
matters of mutual discontent grew at length into coldness, and
changed the old friendship which had united them into an
irreconcilable hatred. Their rupture broke out about the year
1778, and in a short time after, Brown published his Elements
of Medicine. … Brown employed some of the ideas of his
master to develop a doctrine much more simple in appearance,
but founded entirely on abstract considerations; a doctrine in
which every provision seems to be made for discussion, but
none for practice. Cullen had said that the nervous system
receives the first impression of excitants, and transmits it
afterwards to the other organs endowed with motion and
vitality. Brown explains thus, the same thought: 'Life is only
sustained by incitation. It is only the result of the action
of incitants on the incitability of organs.' Cullen regarded
the atony of the small vessels as the proximate cause of
fever. Brown, improving on this hypothesis, admits, with
hardly any exceptions, only hyposthenic diseases. … The
Scotch physiologist distinguished only two pathological
states—one consisting in an excess of incitability, which he
names the sthenic diathesis; the other, constituted by a want,
more or less notable, of the same faculty, which he designates
as the asthenic diathesis. Besides, Brown considers these two
states as affecting the entire economy, rather than any organ
in particular. … After having reduced all diseases to two
genera, and withdrawn from pathology the study of local
lesions, Brown arrives, by a subtile argumentation, to
consider the affections of the sthenic order as prevailing in
a very small number of instances, so that the diseases of the
asthenic type comprehend nearly the totality of affections.
According to this theory, a physician is rarely ever mistaken
if he orders in all his cases, remedies of an exciting nature.
… Never since the days of Thessalus (of charlatan memory)
had anyone simplified to such a point the study and practice
of medicine. We may even say that in this respect the Scotch
pathologist left far in the rear the physician of Nero. To
this attraction, well calculated to tempt students and
practitioners, the doctrine of Brown joined the advantage of
being presented in an energetic and captivating style, full of
imagery, which suffices to explain its rapid progress. But
this doctrine, so seductive in its exposition, so easy in its
application, is one of the most disastrous that man has been
able to imagine, for it tends to propagate the abuse of
diffusible stimulants, of which spirituous liquors make a
part, an abuse excessively injurious to health in general, and
the intellectual faculties in particular—an abuse to which
man is too much inclined, naturally, and which the sophisms of
Brown may have contributed to spread in all classes of English
society. … Notwithstanding its defects, the system of Brown
made rapid progress, principally in Germany and Italy."

_P. V. Renouard,
History of Medicine,
pages 555-560._

MEDICAL SCIENCE: 18th Century.
The System of Haller.

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

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

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

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

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

{2143}

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

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

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

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

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

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

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

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

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

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The question of fermentation "had come to present an entirely
new aspect through the discovery of Cagniard de la Tour that
yeast is really a plant belonging to one of the lowest types
of fungi, which grows and reproduces itself in the fermentable
fluid, and whose vegetative action is presumably the cause of
that fermentation, just as the development of mould in a
jam-pot occasions a like change in the upper stratum of the
jam, on whose surface, and at whose expense, it lives and
reproduces itself. Chemists generally—especially Liebig, who
had a fermentation theory of his own—pooh-poohed this idea
altogether; maintaining the presence of the yeast-plant to be
a mere concomitant, and refusing to believe that it had any
real share in the process. But in 1843, Professor Helmholtz,
then a young undistinguished man, devised a method of stopping
the passage of organic germs from a fermenting into a
fermentable liquid, without checking the passage of fluids;
and as no fermentation was then set up, he drew the inference
that the 'particulate' organic germs, not the soluble material
of the yeast, furnish the primum mobile of this change,—a
doctrine which, though now universally accepted, had to fight
its way for some time against the whole force of chemical
authority. A little before Cagniard de la Tour's discovery, a
set of investigations had been made by Schulze and Schwann, to
determine whether the exclusion of air was absolutely
necessary to prevent the appearance of living organisms in
decomposing fluids, or whether these fluids might be kept free
from animal or vegetable life, by such means as would
presumably destroy any germs which the air admitted to them
might bring in from without, such as passing it through a
red-hot tube or strong sulphuric acid. These experiments, it
should be said, had reference rather to the question of
'spontaneous generation,' or 'abiogenesis,' than to the cause
of fermentation and decomposition; its object being to
determine whether the living things found by the microscope in
a decomposing liquid exposed to the air, spring from germs
brought by the atmosphere, or are generated 'de novo' in the
act of decay—the latter doctrine having then many upholders.
But the discovery of the real nature of yeast, and the
recognition of the part it plays in alcoholic fermentation,
gave an entirely new value to Schulze's and Schwann's results;
suggesting that putrefactive and other kinds of decomposition
may be really due, not (as formerly supposed) to the action of
atmospheric oxygen upon unstable organic compounds, but to a
new arrangement of elements brought about by the development
of germinal particles deposited from the atmosphere. It was at
this point that Pasteur took up the inquiry; and for its
subsequent complete working-out, science is mainly indebted to
him: for although other investigators—notably Professor
Tyndall—have confirmed and extended his conclusions by
ingenious variations on his mode of research, they would be
the first to acknowledge that all those main positions which
have now gained universal acceptance—save on the part of a
few obstinate 'irreconcilables'—have been established by
Pasteur's own labours. … The first application of these
doctrines to the study of disease in the living animal was
made in a very important investigation, committed to Pasteur
by his old master in chemistry (the eminent and eloquent
Dumas), into the nature of the 'pébrine,' which was
threatening to extinguish the whole silk culture of France and
Italy. … Though it concerned only a humble worm, it laid the
foundation of an entirely new system and method of research
into the nature and causes of a large class of diseases in man
and the higher animals, of which we are now only beginning to
see the important issues. Among the most immediately
productive of its results, may be accounted the 'antiseptic
surgery' of Professor Lister; of which the principle is the
careful exclusion of living bacteria and other germs, alike
from the natural internal cavities of the body, and from such
as are formed by disease, whenever these may be laid open by
accident, or may have to be opened surgically. This exclusion
is effected by the judicious use of carbolic acid, which kills
the germs without doing any mischief to the patient; and the
saving of lives, of limbs, and of severe suffering, already
brought about by this method, constitutes in itself a glorious
triumph alike to the scientific elaborator of the
germ-doctrine, and to the scientific surgeon by whom it has
been thus applied. A far wider range of study, however, soon
opened itself. The revival by Dr. Farr of the doctrine of
'zymosis' (fermentation),—long ago suggested by the sagacity
of Robert Boyle, and practically taken up in the middle of the
last century by Sir John Pringle (the most scientific
physician of his time),—as the expression of the effect
produced in the blood by the introduction of a specific poison
(such as that of small-pox, measles, scarlatina, cholera,
typhus, &c.), had naturally directed the attention of
thoughtful men to the question (often previously raised
speculatively), whether these specific poisons are not really
organic germs, each kind of which, a real 'contagium vivum,'
when sown in the circulating fluid, produces a definite
'zymosis' of its own, in the course of which the poison is
reproduced with large increase, exactly after the manner of
yeast in a fermenting wort. Pasteur's success brought this
question to the front, as one not to talk about, but to work at."

_W. B. Carpenter,
Disease-Germs
(Nineteenth Century, October, 1881)._

ALSO IN:
_L. Pasteur,
Studies in Fermentation._

_Dr. Duclaux,
Fermentation._

MEDICAL SCIENCE: 19th Century.
Virchow and Cellular Pathology.

"That really gifted scholar and paragon of industry and
attainment, Rudolph Virchow, announced in 1858 a theory known
as Modern Vitalism which was borrowed from natural scientific
medicine and is distinguished from the vitalism of the
previous century in this, that it breaks up the old vital
force, which was supposed to be either distributed throughout
the entire body, or located in a few organs, into an
indefinite number of associate vital forces working
harmoniously, and assigns to them all the final elementary
principles without microscopic seat. 'Every animal principle
has a sum of vital unities, each of which bears all the
characteristics of life.
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The characteristics and unity of life cannot be found in any
determinate point of a higher organism, e. g., in the brain,
but only in the definite, ever recurring arrangements of each
element present. Hence it results that the composition of a
large body amounts to a kind of social arrangement, in which
each one of the movements of individual existence is dependent
upon the others, but in such a way that each element has a
special activity of its own, and that each, although it
receives the impulse to its own activity from other parts,
still itself performs its own functions.' This it will be seen
is nothing but another way of expressing the cell doctrine to
which most medical men are now committed, which means that our
bodies are built up with cells, and that each cell has a unity
and a purpose of its own. Sir Robert Hooke in 1677 discovered
plant cells. Schwann discovered animal cells, and Robert Brown
discovered cell nuclei, but it remained for Virchow, using the
microscope, to supply the gap which had risen between
anatomical knowledge and medical theory, that is, to supply a
'cellular pathology,' since which time the cell has assumed
the role which the fibre occupied in the theories of the 17th
and 18th centuries. Time alone can decide as to the ultimate
validity of these views. This theory was from its announcement
most enthusiastically received, and so far has responded to
nearly all the requirements which have been made of it. Even
its author was almost startled with its success. … As a
result of Virchow's labors there has arisen in Germany what
has been called the medical school of natural sciences of
which Virchow is the intellectual father. This school seeks
mainly by means of pathological anatomy and microscopy,
experimental physiology and pathology, and the other applied
sciences, or rather by their methods, to make medicine also an
exact science."

_Roswell Park,
Lectures on the History of Medicine (in MS.)._

MEDICAL SCIENCE: 19th Century.
The development of Bacteriology.

"The traditional expression contagium vivum received a more
precise meaning in 1840 from Henle, who in his 'Pathologischen
Untersuchungen,' showed clearly and distinctly that the
contagia till then invisible must be regarded as living
organisms, and gave his reasons for this view. … If we are
forced to recognise the characteristic qualities of living
beings in these contagia, there is no good reason why we
should not regard them as real living beings, parasites. For
the only general distinction between their mode of appearance
and operation and that of parasites is, that the parasites
with which we are acquainted have been seen and the contagia
have not. That this may be due to imperfect observation is
shown by the experiments on the itch in 1840, in which the
contagium, the itch-mite, though almost visible without
magnifying power, was long at least misunderstood. It was only
a short time before that the microscopic Fungus, Achorion,
which causes favus, was unexpectedly discovered, as well as
the Fungus which gives rise to the infectious disease in the
caterpillar of the silkworm known as muscardine. Other and
similar cases occurred at a later time, and among them that of
the discovery of the Trichinae between 1850 and 1860, a very
remarkable instance of a contagious parasite long overlooked.
Henle repeated his statements in 1853 in his 'Rationelle
Pathologie,' but for reasons which it is not our business to
examine, his views on animal pathology met with little
attention or approval. It was in connection with
plant-pathology that Henle's views were first destined to
further development, and obtained a firmer footing. It is true
that the botanists who occupied themselves with the diseases
of plants knew nothing of Henle's pathological writings, but
made independent efforts to carry on some first attempts which
had been made with distinguished success in the beginning of
the century. But they did in fact strike upon the path
indicated by Henle, and the constant advance made after, about
the year 1850, resulted not only in the tracing back of all
infectious diseases in plants to parasites as their exciting
cause, but in proving that most of the diseases of plants are
due to parasitic infection. It may now certainly be admitted
that the task was comparatively easy in the vegetable kingdom,
partly because the structure of plants makes them more
accessible to research, partly because most of the parasites
which infect them are true Fungi, and considerably larger than
most of the contagia of animal bodies. From this time
observers in the domain of animal pathology, partly
influenced, more or less, by these discoveries in botany, and
partly in consequence of the revival of the vitalistic theory
of fermentation by Pasteur about the year 1860, returned to
Henle's vitalistic theory of contagion. Henle himself, in the
exposition of his views, had already indicated the points of
comparison between his own theory and the theory of
fermentation founded at that time by Cagniard-Latour and
Schwann. Under the influence, as he expressly says, of
Pasteur's writings, Davaine recalled to mind the little rods
first seen by his teacher, Rayer, in the blood of an animal
suffering from anthrax, and actually discovered in them the
exciting cause of the disease, which may be taken as a type of
an infectious disease both contagious and miasmatic also, in
so far as it originates, as has been said, in
anthrax-districts. This was, in 1863, a very important
confirmation of Henle's theory, inasmuch as a very small
parasite, not very easy of observation at that time, was
recognised as a contagium. It was some time before much
further advance was made. … The latest advance to be
recorded begins with the participation of Robert Koch in the
work of research since 1876."

_A. De Bary,
Lectures on Bacteria,
pages 145-148._

"M. Pasteur is no ordinary man; he is one of the rare
individuals who must be described by the term 'genius.' Having
commenced his scientific career and attained great distinction
as a chemist, M. Pasteur was led by his study of the chemical
process of fermentations to give his attention to the
phenomena of disease in living bodies resembling
fermentations. Owing to a singular and fortunate mental
characteristic, he has been able, not simply to pursue a rigid
path of investigation dictated by the logical or natural
connection of the phenomena investigated, but deliberately to
select for inquiry matters of the most profound importance to
the community, and to bring his inquiries to a successful
practical issue in a large number of instances.
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Thus he has saved the silkworm industry of France and Italy
from destruction, he has taught the French wine-makers to
quickly mature their wine, he has effected an enormous
improvement and economy in the manufacture of beer, he has
rescued the sheep and cattle of Europe from the fatal disease
'anthrax,' and it is probable—he would not himself assert
that it is at present more than probable—that he has rendered
hydrophobia a thing of the past. The discoveries made by this
remarkable man would have rendered him, had he patented their
application and disposed of them according to commercial
principles, the richest man in the world. They represent a
gain of some millions sterling annually to the community. …
M. Pasteur's first experiment in relation to hydrophobia was
made in December 1880, when he inoculated two rabbits with the
mucus from the mouth of a child which had died of that
disease. As his inquiries extended he found that it was
necessary to establish by means of experiment even the most
elementary facts with regard to the disease, for the existing
knowledge on the subject was extremely small, and much of what
passed for knowledge was only ill-founded tradition."

_E. R. Lankester,
The Advancement of Science,
pages 121-123._

"The development of our knowledge relating to the bacteria,
stimulated by the controversy relating to spontaneous
generation and by the demonstration that various processes of
fermentation and putrefaction are due to microörganisms of
this class, has depended largely upon improvements in methods
of research. Among the most important points in the
development of bacteriological technique we may mention first,
the use of a cotton air filter (Schröder and Von Dusch, 1854);
second, the sterilization of culture fluids by heat (methods
perfected by Pasteur, Koch, and others); third, the use of the
aniline dyes as staining agents (first recommended by Weigert
in 1877); fourth, the introduction of solid culture media and
the 'plate method' for obtaining pure cultures, by Koch in
1881. The various improvements in methods of research, and
especially the introduction of solid culture media and Koch's
'plate method' for isolating bacteria from mixed 'cultures,
have placed bacteriology upon a scientific basis. … It was a
distinguished French physician, Davaine, who first
demonstrated the etiological relation of a microörganism of
this class to a specific infectious disease. The anthrax
bacillus had been seen in the blood of animals dying from this
disease by Pollender in 1849, and by Davaine in 1850, but it
was several years later (1863) before the last-named observer
claimed to have demonstrated by inoculation experiments the
causal relation of the bacillus to the disease in question.
The experiments of Davaine were not generally accepted as
conclusive, because in inoculating an animal with blood
containing the bacillus, from an infected animal which had
succumbed to the disease, the living microörganism was
associated with material from the body of the diseased animal.
This objection was subsequently removed by the experiments of
Pasteur, Koch, and many others, with pure cultures of the
bacillus, which were shown to have the same pathogenic effects
as had been obtained in inoculation experiments with the blood
of an infected animal."

_G. M. Sternberg,
Manual of Bacteriology,
page 6._

"In 1876 the eminent microscopist, Professor Cohn, of Breslau,
was in London, and he then handed me a number of his
'Beiträge,' containing a memoir by Dr. Koch on Splenic Fever
(Milzbrand, Charbon, Malignant Pustule), which seemed to me to
mark an epoch in the history of this formidable disease. With
admirable patience, skill, and penetration Koch followed up
the life-history of bacillus anthracis, the contagium of this
fever. At the time here referred to he was a young physician
holding a small appointment in the neighbourhood of Breslau,
and it was easy to predict, and indeed I predicted at the
time, that he would soon find himself in a higher position.
When I next heard of him he was head of the Imperial Sanitary
Institute of Berlin. … Koch was not the discoverer of the
parasite of splenic fever. Davaine and Rayer, in 1850, had
observed the little microscopic rods in the blood of animals
which had died of splenic fever. But they were quite
unconscious of the significance of their observation, and for
thirteen years, as M. Radot informs us, strangely let the
matter drop. In 1863 Davaine's attention was again directed to
the subject by the researches of Pasteur, and he then
pronounced the parasite to be the cause of the fever. He was
opposed by some of his fellow-countrymen; long discussions
followed, and a second period of thirteen years, ending with
the publication of Koch's paper, elapsed before M. Pasteur
took up the question. I always, indeed, assumed that from the
paper of the learned German came the impulse towards a line of
inquiry in which M. Pasteur has achieved such splendid
results."

_J. Tyndall,
New Fragments,
pages 190-191._