1849: Great inventors at the dawn of modern medicine

The man who would become the father of modern medicine was born in Canada on July 12, 1849.  His parents would name him William Henry Osler. He was born into an era where medicine was changing for the better, and he would grow to become a significant part of it.

Yet a post about the life and times of the infamous Dr. Osler won't come on this blog for another few months.  First we must consider medical significance of the era to which he was born into.

It was an era, they say, where physicians were just starting to adapt to new equipment, such as the stethoscope, laryngoscope, thermometer and microscope.  Students were just starting to learn about them, and physicians just starting to adapt them into their daily practice.

The incorporation and use of these devices would allow physicians to learn what went on inside the body that affected what went on outside the body.  It was by knowledge obtained by their investigations with these tools that antiquated medical theories about medicine were being reviewed.  Those proven true were further substantiated, and those proven false were cast away.  

The following are some of the significant contributions that affected the medical community at this time:

Oliver Wendell Holmes (1809-1894)
was among the first to realize
fevers may spread by unclean hands.
 (4, page 457)

1843:  Oliver Wendell Holmes announced to the medical community that women in child bed should not be attended by physicians who had been studying the victims of perpetual fever. He was concerned the causative agent might be spread to the mothers and their babies. He recommended that physicians and medical caregivers wash their hands and change their clothing after leaving patients infected with perpetual fever. He received harsh criticism from his fellow physicians who were in harsh opposition to change. (4, page 457)

Ignaz Semmelweis (1818-1865)
proved hand washing between patients
 reduced the spread of sickness.
He was mocked and ignored.
(4, page 458)

1846:    Ignaz Philipp Semmelweis became an assistant in an obstetric ward in Vienna where there was such a high death rate from child bed fever that women feared to go there. Semmelweis observed the death rate was higher in the 1st ward where he and his fellow male physicians worked compared to the 2nd ward where female mid wives worked. Upon investigation he learned the women were much cleaner in appearance than the physicians, who often walked proudly around with blood stained hands and aprons. The physicians also were more likely to perform postmortem investigations just prior to checking the vagina. The women, on the other hand, did not have blood stained clothes and washed their hands in calcium chloride solution between patients. When he insisted his physicians likewise wash their hands and put on clean clothes prior to checking women in child bed, the death rate fell from 9.92% to 3.8%. The following year it was down to 1.27%. The proud physicians were unhappy, and eventually rejected Semmelweis. After they went back to their old poor habits, the death rare once again duly rose. (4, pages 457-8)

Charles Darwin (1809-1882)
His theory of evolution
may have been controversial,
yet it helped transform medicine.

1859:  Charles Darwin, the grandson of Erasmus Darwin, published his "Origin of Species" in which he introduced his theory of evolution. Surely it resulted in much scrutiny and controversy, but this may have been one of the key publications that helped to spark the scientific revolution, of which the medical profession was one of the main beneficiaries. However, and to be expected, many proud and stubborn medical professors and physicians refused to let go of old theories. Yet the few who did continued investigating, and scientific evidence would ultimately force change, and change for the better.

Louis Pasteur (1882-1895)
His Germ theory of Medicine
Revolutionized medicine 

1865:  Louis Pasteur discovered that microbes were the cause of diseases. He invented vaccinations for anthrax, cholera, consumption and smallpox." (3)

Joseph Lister (1827-1912)
invented a rinse to disinfect wounds.
It was also useful for cleaning mouths.

1870s:  Joseph Lister discovered that antiseptic use reduced post surgical infections.  He was a British scientist and physician who observed that about 50 percent of amputation patients survived the surgery but died later of septic fevers, or what was known as "ward fevers."   With knowledge of the works of men like Pasteur and Semmelweiz, Lister surmised microbes in the air were infecting wounds, and so he used phenol as an antimicrobial to reduce the death rate by 15 percent. (4)  He recommended the antimicrobial carbolic acid to be placed on bandages to keep the wounds clean, and he invented a machine to pump carbolic acid into the air in the rooms where surgeries were being performed.  Post operative mortality rates plummeted. (5)

Listerine bottle from the 1920s

1879:  While working with Jordan Wheat Lambert (1851-1889), Lister invented an antiseptic to use during surgeries.  In honor of Lister's discovery, Lambert insisted the product be named "Listerine," introducing it to surgeons in 1879.  The product was so successful that it was ultimately marketed to dentists as an oral rinse in 1895, and to the public as a mouthwash in 1914.  The product is still available on the market to this day (although the taste has been improved).

A young William Osler must have been inspired by all this wisdom, becoming so rapt that he cast aside his father's dream that he go into the ministry, and instead studied medicine.

References:

1. "Sir William Osler At Seventy -- A Retrospect," The Journal of the American medical Association," 1919, Saturday, July 12, pages 106-108
2. Osler, William, "The Principles and Practice of Medicine," 1892, New York, pages 497-501
3. Bliss, Micheal, "William Osler:  A Life in Medicine," 1999, New York
4. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1921, London and Philadelphia, 

Further readings:

1. Jackson, Mark, "Asthma: The Biography," 2009, New York, pages 211-12
2. Brenner, Barry E, ed., "Emergency Asthma," 1998, New York, pages 212-14

RT Cave Facebook Page
RT Cave on Twitter

1800-1900: The scientific revolution and the age of progress

Charles Darwin's "Origin of Species" may have helped
to spark the scientific revolution 

Perhaps among the most important centuries in the evolution of medicine wisdom was the 19th century. The great historian Fielding Hudson Garrison explained that this was the century that put an end to old dogmatic theories, thus opening the door for medicine and science to move forward. (1, page 424)

Respiratory diseases, particularly those looped under the umbrella term asthma, benefited greatly as pathology (the study of disease) and internal medicine (diagnosis and treatment of disease) were advanced during the course of the 18th century.  This brought us a greater understanding of the physiology of respiration,  setting the stage for what would transpire in the 19th century.

For instance, Mark Jackson, in his book "Asthma: A Biography, explained the following:

Eager to reject older irrational, mystical models of health and sickness, prominent Enlightenment physicians, such as Thomas Sydenham 1624-1689), George Stahl (1660-1734), Friedrish Hoffmann (1660-1742), and Herman Boerhaave (1668-1738), not only increasingly emphasized the importance of careful observation of the patterns and presentations of disease, but also strove to develop 'a simple and logical synthesis of medical knowledge designed to replace increasingly obsolete humoral conceptions inherited from antiquity' and to alleviate and conquer ill health.  (2, page 70)

Investigations of the human body, and new ideas such as "careful observation of patters and presentations of disease" brought about a better understanding not just regarding diseases, but the treatments to remedy them.  However, old theories persisted, thus acting as fetters to the furthering of wisdom.

Such theoretic fetters holding back great minds did not exist in the 19th century, wrote Fielding Hudson Garrison in his book "An Introduction to the history of medicine,"  mainly due to such works as: (1, page 424, 426)

• Friedrich Schelling's "Natural Philosophy" in 1797, "which aimed at establishing a subjective and objective identity of all things." (1, page 425)
• Hermann von Hemholtz,'s "Conservation of Energy" in 1847, which established the idea that no energy was lost in muscle movement, and that there was no vital force that causes muscle movement (wikepedia)
• Charles Darwin's "Origin of Species" in 1859, which established the idea that living creatures, including humans, evolve over time as changes in their environments occur. 

These works were met with much reservation and controversy by a dogmatic society, although they had a significant impact on both science and medicine, helping to open up the doors for scientific progress. As the ideas put forth by these works were accepted, great minds were no longer limited by theories made by famous men of the past, thus opening up a whole new world for them. (1, page 424)

Hermann Hemholtz shot down the age old theory that
'there was a vital force responsible for muscle movement.
His scientifically proven idea helped spark a revolution.

As noted by Garrison:

"It took a long time to demonstrate that the advancement of internal medicine as a science can never be accomplished by hugging some pet theory out of a regard for it's author's personality, but only through the performance of a vast amount of chemical, physical, and biological research by thousands of willing workers." (1, page 426)

Yet even though medical theories were no longer existent, "the modern scientific movement did not attain its full stride until well after the middle of the century. The medicine of the early half was, with a few noble exceptions, only part and parcel of the stationary theorizing of the preceding age," wrote Garrison.  (1, page 425)

A good example of this we can find in our own asthma history.  Dr. Robert Bree, who was the preeminent asthma expert in the first half of the 19th century, continued to believe in old humoral theories.  On the other hand, Dr. Henry Hyde Salter, who was the preeminent asthma expert in the second half of the 19th century, devised modern conclusions regarding asthma based on scientific investigations. 

Friedrish Schelling encouraged the subjective and the objective
review of patients. His ideas helped spark the scientific revolution.

We have to under stand, however, that the fact Bree did not use science and Salter did does not mean that Salter's conclusions were flawless, because they weren't.  The fact that pure asthma left behind no scarring in the lungs caused him to deduce, as experts before him had, that asthma must be nervous in origin.  Surely he was wrong, but he also didn't know about the immune system. 

The term asthma went through an amazing transformation during the course of the 19th century, with many physicians hunting for answers, and each coming to his own conclusion.  Some were right, thus leading investigators in the right direction.  Some were wrong, thus leading investigators in the wrong direction.  Regardless, all such investigations benefited our disease, thus setting the stage for what would transpire in the 20th century. 

References:

1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1913, 1st edition, Philadelphia and London, W.B. Saunders and Company
2. Jackson, Mark, "Asthma: A biography," 2009, New York, Oxford University Press; reference quoted by Jackson: Guenter B. Risse, "Medicine in the age of Enlightenment," in Andrew Wear, editor, Medicine in Society: Historical Essays, (Cambridge, 1992), pages 149-95

RT Cave Facebook Page
RT Cave on Twitter