CHAPTER V HISTORY OF MODERN MEDICINE' (During the Nineteenth and Twentieth Centuries) BY MAX KAHN, M.A., PH.D., M.D. The world was in the midst of upheaval at the beginning of the nineteenth century. The rat-a-tat of the military drums was heard all over Europe. The time was out of joint, and hordes of men stood up in arms to struggle for liberty. It had taken centuries of oppression to make the yoke so heavy for the downtrodden, that they overthrew, with volcanic violence, thrones and principles, royalty and clergyparasites that had thriven on the sweat and toil of the masses. The conflagration begun by the fall of the Bastille spread to other countries, and with the succeeding eruptions of 1831, 1848 and 1871, western Europe became more and more democratized, and an epoch of rationalism was established which resulted in glorious achievements not encountered in any other century of history. The masses may mock God, but they always fear the Devil. It takes longer to eradicate superstition than to implant science. Men overthrow governments, demolish churches, declare that the Age of Reason prevails, but in the limited mind of the "great majority" there yet linger that fol-de-rol of the clergy and the fi-fo-fum of the quack, which are supposed to have such magical properties and which yield such golden returns to the coffers of that great army of charlatans. It has always been the principle and practice of the "respectable" established religion or profession to oppress and persecute all men who would reason and question their theories, who feared not to speak the truth as they knew it, or who discovered newer facts which controverted their false doctrines. All so-called established opinions are alike in this. The old refuse to change. Witness the condemnation of Socrates by the Greeks, the martyrdom of Jesus by the Jews, the persecution of Galileo by the Catholic Church, the burning of Servetus by Calvin, and the oppression of Paré by the Parisian Faculty. To speak of the history of medical practice previous to the nineteenth century is really to speak of the history of quackery, or rather of the history of men who in their hearts knew that they were thriving *It is not proposed in the limited space allotted to this Chapter to discuss in detail "dates and battles" in the history of Medicine during the last one hundred and twenty years. An attempt will be made to describe currents in medical thought, and personal mention will be made of those men only who lit new torches to guide the way for those that follow, and who stand, rock-fast, against the eroding influence of time and human forgetfulness. on the ignorance of the public. Mature consideration makes one justify Molière's description of a physician of his time: "Longue peruque, habit grotesque, And when one reads the medical therapy advised by the physicians of that period, one assumes that the physician may have thought that his remedy will prove effectual due to the gruesomeness and incongruity of the concoction, or, perhaps, to the prayers that were advised to be chanted simultaneously. It is, perchance, the prayers that may have helped his patients; it is certain that his medicaments did not aid, if they did not harm, the sick. After that great period of mental darkness which pervaded Europe, when the Church of Rome reigned supreme, there was inaugurated another epoch characterized by the historic fact that tyranny changed hands, and though the so-called strivings for religious liberty resulted in the establishment of newer churches, it meant only the foundation of new theories of fanaticism; for, while until the sixteenth century only Rome murdered thousands at the auto-da-fés and at St. Bartholomew's nights in the name of religion, the "liberty" attained after the sixteenth century was that in certain countries the Protestants gained the power to burn and hang heretics, Catholics and all other non-conforming Protestants. It was not that Justice or Enlightenment had triumphed. It was only that the power to do wrong was wrested from a certain group of hands and wielded by another. The Church could not stop all progress. There was Bacon pleading for experimentation and urging that "To know truly is to know the cause"; there was the great school of anatomists who began to describe the body structure; there was Harvey, who noted the circulation of the blood. However, in the eighteenth century there prevailed the system of theorization and classification which infested the work of every great man of that time. Volumes were written to prove or disprove fantastical theories, not after due experimentation in a laboratory, but after ponderous thought in the library. There was the "phlogiston" school, the school of "vitalism," the iatro-mechanical and the iatro-chemical schools, the Brunonian theory, and others. Scientists of that day seemed not to desire to delve in the unknown, but to classify and ratiocinate on the things that were known, or rather were thought known. But, towards the end of the eighteenth century, the old order of things began to shake and topple over, and scientific reform, like political reform, made great progress. Great times produce great men, and we find in the beginning of the eighteenth century thinkers in Western Europe, who after speculations and investigations, laid the foundations of the newer science of the modern period. Of the absurd theories current at the beginning of the nineteenth century, the one of the vitalistic production of organic substances was the most pernicious. It was assumed that no organic chemical substance could be prepared in the laboratory; that only the living body can do it, and therefrom the learned professors drew the moral that some unknown "vital" force was present in the living organism which it was useless to investigate, and which alone is able to produce all organic compounds from those of simpler to those of higher composition. In 1828, Friedrich Wöhler (1800-1882) demonstrated that such an essentially organic compound as Urea could be prepared by heating ammonium cyanate, a substance easily prepared from its constituent elements. This simple experiment revolutionized the conception of the chemistry of life processes, and inaugurated an era of organic chemical research which ultimately resulted in the synthesis of such highly complex compounds as the polypeptids and the carbohydrates by Emil Fischer. This discovery of Wöhler, and his other discovery of the synthesis of hippuric acid by the body after the ingestion of benzoic acid, was the beginning of the study of the chemistry of the life processes going on in the animal economy. To these body chemical changes Liebig gave the name of "Metabolism" (Stoffwechsel), (1842). The two greatest names in biological science during the nineteenth century are those of Darwin and of Pasteur. To appreciate truly the great advances of Medicine requires but to know the lives of those two eminent men, both of them pure in thought, honest in their actions and truly saints in their relations with their fellowmen. There are no greater men than these two. The great question of the origin of man was always considered settled by the theologian and ever pondered upon by the scientist. All species were created by the special design of a divinity, said the theologians, and the individual male and the female of the species were saved in the Ark, when it pleased Providence to destroy all the world's occupants. Thoughtful men doubted this church doctrine, but could come to no other conclusion. Robinson writes, "To Buffon belongs the high honor of first scientifically discussing the origin of species by development. But Buffon lived in the priest-pested age of Louis XV, when the Bastille cast its shadow on the brain of every thinker. And Buffon thought of the chains that eat out the flesh, and the dungeons which the sun cannot find, and then he ended his arguments thus: 'But to us, it is certain from revelation that every species was directly created by a separate fiat.'" The Theory of Evolution, advanced by Darwin in 1859 in his great book "On the Origin of Species by Means of Natural Selection," was propounded so clearly, and the evidence arrayed so masterfully, that the scientific world was almost immediately converted. Only priest and minister dared raise the cry of Atheist against Darwin, but truth conquered these also. And great men such as Spencer and Huxley, and Haeckel and Weissmann arose in England and in Germany and spread the teachings of Darwin, so that the whole science of Biology was revolutionized. One of Darwin's disciples, Thomas Henry Huxley, declared he was more solicitous for the principle of freedom of thought than for the mere advancement of science, and this is the great good that Darwin and his followers have accomplished, for with Huxley they believed that "there is no alleviation for the sufferings of mankind except veracity of thought and action and the resolute facing of the world as it is, when the garment of make-believe by which pious hands have hidden its uglier features is stripped off." The influence of Darwin, Wallace and their disciples was mainly on Biology and, therefore, only indirectly on Medicine which is founded on the biological sciences. Their philosophic conceptions permeated all the then known branches of knowledge, and inspired men to reinvestigate older conceptions, and to seek new explanations for the causes of phenomena in Nature. But while Darwin's influence on Medicine was indirect, the epoch making investigations of Pasteur are of such fundamental importance that many of the very conceptions of modern medicine have their birth in his experimental discoveries. For his influence was far-reaching. He not only investigated the older sciences, but he established new schools of learning, and to him is due our basic facts in bacteriology, immunology, and serology, and our principles of asepsis and antisepsis upon which modern surgery is based, and our knowledge of vaccination in certain diseases. The life of Pasteur is full of inspiration to him who would make Science his religion. He was born in the small town of Dole, in 1822. His father, a veteran of the Napoleonic Wars, was a tanner, who, though poor, insisted that his son receive a good education. Accordingly, after preliminary studies, Louis Pasteur arrived in Paris, and studied the Natural Sciences, particularizing in Physics and Chemistry. We shall follow his discoveries in chronological order. His first great contribution was in 1848, when he was twenty-six years old. Of this discovery, Professor Cohen writes: "Pasteur did not range far into the field of chemistry, but during the few years that he labored at the subject he struck so rich a vein of scientific wealth that, after the lapse of half a century, it still remains unexhausted.” The investigation in question concerns the Nature of the two isomeric compounds, tartaric and racemic (paratartaric) acids. Pasteur found that on crystallization of the tartrates, the crystals formed, while similar in general appearance, had the facets differently situated in the different crystals, so that their resemblance and their distinction were analogous to the similarity and difference which exist between the right one and the left of a pair of gloves. The forms were enantiomorphous. Pasteur separated the crystals in the presence of Biot, the great French chemist, and demonstrated to him that one form of the crystal turned the ray of polarized light to the right, and the other form to the left, while the mixture of the two in equal quantities produced a solution which was inactive. Biot, who had doubted Pas * A very sympathetic life of Pasteur has been written by René Vallery-Radot in French, and has been translated into English by Mrs. R. L. Devonshire. teur's ability before, embraced him at the successful completion of the demonstration, and said to him: "My dear boy, I have loved Science so much during my life, that this touches my very heart." His next great work was on fermentation and spontaneous generation. Do living bodies arise from parent living bodies, or are they under certain circumstances generated spontaneously? Is it a fact, as one man wrote, that given an old boot with soiled rags and pieces of cheese in it, young mice will spontaneously develop there? Since the days of Aristotle the theory of spontaneous generation was generally accepted. It was thought that frogs and toads and other animals arose from the mud of the brooks and ponds due to the life-giving influence of the sun's rays. In the seventeenth century, Alexander Ross, commenting on Sir Thomas Brown's doubt as to whether mice may be bred by putrefaction, flays his antagonist in the following words: "So may we doubt whether in cheese and timber, worms are generated, or if beetles and wasps in cow dung, or if butterflies, locusts, shell-fish, snails, eels, and such life be procreated of putrefied matter, which is to receive the form of that creature to which it is by formative power disposed. To question this is to question reason, sense and experience. If he doubts this let him go to Egypt, and there he will find the fields swarming with mice begot of the mud of the Nylus, to the great calamity of the inhabitants!" The work of Redi (1626-1697), an Italian scientist, confirmed by the experiments of Swammerdam (1637-1681) and of Vallisnieri (1661-1730), with putrefying meat served to prove that all visible life came from ova deposited by insects in matter allowed to putrefy. But with the study of microscopic life by Leeuwenhoek, the question assumed a new form. A certain English Jesuit, Needham (1713-1784), and his contemporary, Lazarus Spallanzani (1729-1799), then took up the question, the former seeming to demonstrate that there is such a thing as spontaneous generation and the latter absolutely denying it. Their experiments made on vegetable and meat extracts subjected to heat in glass vessels seemed to yield different results in the hands of Needham and of Spallanzani. The question of spontaneous generation was seemingly settled by the experiments of Franz Schulze and of Theodore Schwann, whose work convinced the scientists of those days that there is no basis for belief in the spontaneous origin of life. But the whole question was reopened by the Frenchman, Pouchet, who made the following experiment: He filled a flask with water and sealed it with great care. This flask he inverted over a mercury bath, and opened the neck of the bottle while under the mercury. The water he partially drove out by passing into the flask oxygen generated from salts. He now introduced with a sterile forceps a few granules of hay heated in an oven to a high temperature. After a few days he found that the hay was swarming with microscopic life. "Where," exclaimed he, "does this life come from? It cannot come from the water, which had been boiled, destroying all living germs that may have existed in it. It cannot come |