A History of Science Volume IV Part 10

At the time that his theory of potentialities was promulgated, the medical world had gone mad in its administration of huge doses of compound mixtures of drugs, and any reaction against this was surely an improvement. In short, no medicine at all was much better than the heaping doses used in common practice; and hence one advantage, at least, of Hahnemann's methods. Stated briefly, his theory was that if a tincture be reduced to one-fiftieth in strength, and this again reduced to one-fiftieth, and this process repeated up to thirty such dilutions, the potency of such a medicine will be increased by each dilution, Hahnemann himself preferring the weakest, or, as he would call it, the strongest dilution. The absurdity of such a theory is apparent when it is understood that long before any drug has been raised to its thirtieth dilution it has been so reduced in quant.i.ty that it cannot be weighed, measured, or recognized as being present in the solution at all by any means known to chemists. It is but just to modern followers of h.o.m.oeopathy to say that while most of them advocate small dosage, they do not necessarily follow the teachings of Hahnemann in this respect, believing that the theory of the dose "has nothing more to do with the original law of cure than the psora (itch) theory has; and that it was one of the later creations of Hahnemann's mind."

Hahnemann's theory that all chronic diseases are derived from either itch, syphilis, or fig-wart disease is no longer advocated by his followers, because it is so easily disproved, particularly in the case of itch. Hahnemann taught that fully three-quarters of all diseases were caused by "itch struck in," and yet it had been demonstrated long before his day, and can be demonstrated any time, that itch is simply a local skin disease caused by a small parasite.

JENNER AND VACCINATION

All advances in science have a bearing, near or remote, on the welfare of our race; but it remains to credit to the closing decade of the eighteenth century a discovery which, in its power of direct and immediate benefit to humanity, surpa.s.ses any other discovery of this or any previous epoch. Needless to say, I refer to Jenner's discovery of the method of preventing smallpox by inoculation with the virus of cow-pox. It detracts nothing from the merit of this discovery to say that the preventive power of accidental inoculation had long been rumored among the peasantry of England. Such vague, unavailing half-knowledge is often the forerunner of fruitful discovery.

To all intents and purposes Jenner's discovery was original and unique.

Nor, considered as a perfect method, was it in any sense an accident. It was a triumph of experimental science. The discoverer was no novice in scientific investigation, but a trained observer, who had served a long apprenticeship in scientific observation under no less a scientist than the celebrated John Hunter. At the age of twenty-one Jenner had gone to London to pursue his medical studies, and soon after he proved himself so worthy a pupil that for two years he remained a member of Hunter's household as his favorite pupil. His taste for science and natural history soon attracted the attention of Sir Joseph Banks, who intrusted him with the preparation of the zoological specimens brought back by Captain Cook's expedition in 1771. He performed this task so well that he was offered the position of naturalist to the second expedition, but declined it, preferring to take up the practice of his profession in his native town of Berkeley.

His many accomplishments and genial personality soon made him a favorite both as a physician and in society. He was a good singer, a fair violinist and flute-player, and a very successful writer of prose and verse. But with all his professional and social duties he still kept up his scientific investigations, among other things making some careful observations on the hibernation of hedgehogs at the instigation of Hunter, the results of which were laid before the Royal Society. He also made quite extensive investigations as to the geological formations and fossils found in his neighborhood.

Even during his student days with Hunter he had been much interested in the belief, current in the rural districts of Gloucestershire, of the antagonism between cow-pox and small-pox, a person having suffered from cow-pox being immuned to small-pox. At various times Jenner had mentioned the subject to Hunter, and he was constantly making inquiries of his fellow-pract.i.tioners as to their observations and opinions on the subject. Hunter was too fully engrossed in other pursuits to give the matter much serious attention, however, and Jenner's brothers of the profession gave scant credence to the rumors, although such rumors were common enough.

At this time the practice of inoculation for preventing small-pox, or rather averting the severer forms of the disease, was widely practised.

It was customary, when there was a mild case of the disease, to take some of the virus from the patient and inoculate persons who had never had the disease, producing a similar attack in them. Unfortunately there were many objections to this practice. The inoculated patient frequently developed a virulent form of the disease and died; or if he recovered, even after a mild attack, he was likely to be "pitted" and disfigured.

But, perhaps worst of all, a patient so inoculated became the source of infection to others, and it sometimes happened that disastrous epidemics were thus brought about. The case was a most perplexing one, for the awful scourge of small-pox hung perpetually over the head of every person who had not already suffered and recovered from it. The practice of inoculation was introduced into England by Lady Mary Wortley Montague (1690-1762), who had seen it practised in the East, and who announced her intention of "introducing it into England in spite of the doctors."

From the fact that certain persons, usually milkmaids, who had suffered from cow-pox seemed to be immuned to small-pox, it would seem a very simple process of deduction to discover that cow-pox inoculation was the solution of the problem of preventing the disease. But there was another form of disease which, while closely resembling cow-pox and quite generally confounded with it, did not produce immunity. The confusion of these two forms of the disease had constantly misled investigations as to the possibility of either of them immunizing against smallpox, and the confusion of these two diseases for a time led Jenner to question the possibility of doing so. After careful investigations, however, he reached the conclusion that there was a difference in the effects of the two diseases, only one of which produced immunity from small-pox.

"There is a disease to which the horse, from his state of domestication, is frequently subject," wrote Jenner, in his famous paper on vaccination. "The farriers call it the grease. It is an inflammation and swelling in the heel, accompanied at its commencement with small cracks or fissures, from which issues a limpid fluid possessing properties of a very peculiar kind. This fluid seems capable of generating a disease in the human body (after it has undergone the modification I shall presently speak of) which bears so strong a resemblance to small-pox that I think it highly probable it may be the source of that disease.

"In this dairy country a great number of cows are kept, and the office of milking is performed indiscriminately by men and maid servants. One of the former having been appointed to apply dressings to the heels of a horse affected with the malady I have mentioned, and not paying due attention to cleanliness, incautiously bears his part in milking the cows with some particles of the infectious matter adhering to his fingers. When this is the case it frequently happens that a disease is communicated to the cows, and from the cows to the dairy-maids, which spreads through the farm until most of the cattle and domestics feel its unpleasant consequences. This disease has obtained the name of Cow-Pox.

It appears on the nipples of the cows in the form of irregular pustules.

At their first appearance they are commonly of a palish blue, or rather of a color somewhat approaching to livid, and are surrounded by an inflammation. These pustules, unless a timely remedy be applied, frequently degenerate into phagedenic ulcers, which prove extremely troublesome. The animals become indisposed, and the secretion of milk is much lessened. Inflamed spots now begin to appear on different parts of the hands of the domestics employed in milking, and sometimes on the wrists, which run on to suppuration, first a.s.suming the appearance of the small vesications produced by a burn. Most commonly they appear about the joints of the fingers and at their extremities; but whatever parts are affected, if the situation will admit the superficial suppurations put on a circular form with their edges more elevated than their centre and of a color distinctly approaching to blue. Absorption takes place, and tumors appear in each axilla. The system becomes affected, the pulse is quickened; shiverings, succeeded by heat, general la.s.situde, and pains about the loins and limbs, with vomiting, come on.

The head is painful, and the patient is now and then even affected with delirium. These symptoms, varying in their degrees of violence, generally continue from one day to three or four, leaving ulcerated sores about the hands which, from the sensibility of the parts, are very troublesome and commonly heal slowly, frequently becoming phagedenic, like those from which they sprang. During the progress of the disease the lips, nostrils, eyelids, and other parts of the body are sometimes affected with sores; but these evidently arise from their being heedlessly rubbed or scratched by the patient's infected fingers. No eruptions on the skin have followed the decline of the feverish symptoms in any instance that has come under my inspection, one only excepted, and in this case a very few appeared on the arms: they were very minute, of a vivid red color, and soon died away without advancing to maturation, so that I cannot determine whether they had any connection with the preceding symptoms.

"Thus the disease makes its progress from the horse (as I conceive) to the nipple of the cow, and from the cow to the human subject.

"Morbid matter of various kinds, when absorbed into the system, may produce effects in some degree similar; but what renders the cow-pox virus so extremely singular is that the person that has been thus affected is forever after secure from the infection of small-pox, neither exposure to the variolous effluvia nor the insertion of the matter into the skin producing this distemper."(2)

In 1796 Jenner made his first inoculation with cowpox matter, and two months later the same subject was inoculated with small-pox matter. But, as Jenner had predicted, no attack of small-pox followed. Although fully convinced by this experiment that the case was conclusively proven, he continued his investigations, waiting two years before publishing his discovery. Then, fortified by indisputable proofs, he gave it to the world. The immediate effects of his announcement have probably never been equalled in the history of scientific discovery, unless, perhaps, in the single instance of the discovery of anaesthesia. In Geneva and Holland clergymen advocated the practice of vaccination from their pulpits; in some of the Latin countries religious processions were formed for receiving vaccination; Jenner's birthday was celebrated as a feast in Germany; and the first child vaccinated in Russia was named "Vaccinov" and educated at public expense. In six years the discovery had penetrated to the most remote corners of civilization; it had even reached some savage nations. And in a few years small-pox had fallen from the position of the most dreaded of all diseases to that of being practically the only disease for which a sure and easy preventive was known.

Honors were showered upon Jenner from the Old and the New World, and even Napoleon, the bitter hater of the English, was among the others who honored his name. On one occasion Jenner applied to the Emperor for the release of certain Englishmen detained in France. The pet.i.tion was about to be rejected when the name of the pet.i.tioner was mentioned. "Ah," said Napoleon, "we can refuse nothing to that name!"

It is difficult for us of to-day clearly to conceive the greatness of Jenner's triumph, for we can only vaguely realize what a ruthless and ever-present scourge smallpox had been to all previous generations of men since history began. Despite all efforts to check it by medication and by direct inoculation, it swept now and then over the earth as an all-devastating pestilence, and year by year it claimed one-tenth of all the beings in Christendom by death as its average quota of victims.

"From small-pox and love but few remain free," ran the old saw. A pitted face was almost as much a matter of course a hundred years ago as a smooth one is to-day.

Little wonder, then, that the world gave eager acceptance to Jenner's discovery. No urging was needed to induce the majority to give it trial; pa.s.sengers on a burning ship do not hold aloof from the life-boats. Rich and poor, high and low, sought succor in vaccination and blessed the name of their deliverer. Of all the great names that were before the world in the closing days of the century, there was perhaps no other one at once so widely known and so uniformly reverenced as that of the great English physician Edward Jenner. Surely there was no other one that should be recalled with greater grat.i.tude by posterity.

VIII. NINETEENTH-CENTURY MEDICINE

PHYSICAL DIAGNOSIS

Although Napoleon Bonaparte, First Consul, was not lacking in self-appreciation, he probably did not realize that in selecting a physician for his own needs he was markedly influencing the progress of medical science as a whole. Yet so strangely are cause and effect adjusted in human affairs that this simple act of the First Consul had that very unexpected effect. For the man chosen was the envoy of a new method in medical practice, and the fame which came to him through being physician to the First Consul, and subsequently to the Emperor, enabled him to promulgate the method in a way otherwise impracticable. Hence the indirect but telling value to medical science of Napoleon's selection.

The physician in question was Jean Nicolas de Corvisart. His novel method was nothing more startling than the now-familiar procedure of tapping the chest of a patient to elicit sounds indicative of diseased tissues within. Every one has seen this done commonly enough in our day, but at the beginning of the century Corvisart, and perhaps some of his pupils, were probably the only physicians in the world who resorted to this simple and useful procedure. Hence Napoleon's surprise when, on calling in Corvisart, after becoming somewhat dissatisfied with his other physicians Pinel and Portal, his physical condition was interrogated in this strange manner. With characteristic shrewdness Bonaparte saw the utility of the method, and the physician who thus attempted to subst.i.tute scientific method for guess-work in the diagnosis of disease at once found favor in his eyes and was installed as his regular medical adviser.

For fifteen years before this Corvisart had practised percussion, as the chest-tapping method is called, without succeeding in convincing the profession of its value. The method itself, it should be added, had not originated with Corvisart, nor did the French physician for a moment claim it as his own. The true originator of the practice was the German physician Avenbrugger, who published a book about it as early as 1761.

This book had even been translated into French, then the language of international communication everywhere, by Roziere de la Cha.s.sagne, of Montpellier, in 1770; but no one other than Corvisart appears to have paid any attention to either original or translation. It was far otherwise, however, when Corvisart translated Avenbrugger's work anew, with important additions of his own, in 1808.

"I know very well how little reputation is allotted to translator and commentators," writes Corvisart, "and I might easily have elevated myself to the rank of an author if I had elaborated anew the doctrine of Avenbrugger and published an independent work on percussion. In this way, however, I should have sacrificed the name of Avenbrugger to my own vanity, a thing which I am unwilling to do. It is he, and the beautiful invention which of right belongs to him, that I desire to recall to life."(1)

By this time a reaction had set in against the metaphysical methods in medicine that had previously been so alluring; the scientific spirit of the time was making itself felt in medical practice; and this, combined with Corvisart's fame, brought the method of percussion into immediate and well-deserved popularity. Thus was laid the foundation for the method of so-called physical diagnosis, which is one of the corner-stones of modern medicine.

The method of physical diagnosis as practised in our day was by no means completed, however, with the work of Corvisart. Percussion alone tells much less than half the story that may be elicited from the organs of the chest by proper interrogation. The remainder of the story can only be learned by applying the ear itself to the chest, directly or indirectly. Simple as this seems, no one thought of practising it for some years after Corvisart had shown the value of percussion.

Then, in 1815, another Paris physician, Rene Theophile Hyacinthe Laennec, discovered, almost by accident, that the sound of the heart-beat could be heard surprisingly through a cylinder of paper held to the ear and against the patient's chest. Acting on the hint thus received, Laennec subst.i.tuted a hollow cylinder of wood for the paper, and found himself provided with an instrument through which not merely heart sounds but murmurs of the lungs in respiration could be heard with almost startling distinctness.

The possibility of a.s.sociating the varying chest sounds with diseased conditions of the organs within appealed to the fertile mind of Laennec as opening new vistas in therapeutics, which he determined to enter to the fullest extent practicable. His connection with the hospitals of Paris gave him full opportunity in this direction, and his labors of the next few years served not merely to establish the value of the new method as an aid to diagnosis, but laid the foundation also for the science of morbid anatomy. In 1819 Laennec published the results of his labors in a work called Traite d'Auscultation Mediate,(2) a work which forms one of the landmarks of scientific medicine. By mediate auscultation is meant, of course, the interrogation of the chest with the aid of the little instrument already referred to, an instrument which its originator thought hardly worth naming until various barbarous appellations were applied to it by others, after which Laennec decided to call it the stethoscope, a name which it has ever since retained.

In subsequent years the form of the stethoscope, as usually employed, was modified and its value augmented by a binauricular attachment, and in very recent years a further improvement has been made through application of the principle of the telephone; but the essentials of auscultation with the stethoscope were established in much detail by Laennec, and the honor must always be his of thus taking one of the longest single steps by which practical medicine has in our century acquired the right to be considered a rational science. Laennec's efforts cost him his life, for he died in 1826 of a lung disease acquired in the course of his hospital practice; but even before this his fame was universal, and the value of his method had been recognized all over the world. Not long after, in 1828, yet another French physician, Piorry, perfected the method of percussion by introducing the custom of tapping, not the chest directly, but the finger or a small metal or hard-rubber plate held against the chest-mediate percussion, in short. This perfected the methods of physical diagnosis of diseases of the chest in all essentials; and from that day till this percussion and auscultation have held an unquestioned place in the regular armamentarium of the physician.

Coupled with the new method of physical diagnosis in the effort to subst.i.tute knowledge for guess-work came the studies of the experimental physiologists--in particular, Marshall Hall in England and Francois Magendie in France; and the joint efforts of these various workers led presently to the abandonment of those severe and often irrational depletive methods--blood-letting and the like--that had previously dominated medical practice. To this end also the "statistical method,"

introduced by Louis and his followers, largely contributed; and by the close of the first third of our century the idea was gaining ground that the province of therapeutics is to aid nature in combating disease, and that this may often be accomplished better by simple means than by the heroic measures. .h.i.therto thought necessary. In a word, scientific empiricism was beginning to gain a hearing in medicine as against the metaphysical preconceptions of the earlier generations.

PARASITIC DISEASES

I have just adverted to the fact that Napoleon Bonaparte, as First Consul and as Emperor, was the victim of a malady which caused him to seek the advice of the most distinguished physicians of Paris. It is a little shocking to modern sensibilities to read that these physicians, except Corvisart, diagnosed the distinguished patient's malady as "gale repercutee"--that is to say, in idiomatic English, the itch "struck in."

It is hardly necessary to say that no physician of today would make so inconsiderate a diagnosis in the case of a royal patient. If by any chance a distinguished patient were afflicted with the itch, the sagacious physician would carefully hide the fact behind circ.u.mlocutions and proceed to eradicate the disease with all despatch. That the physicians of Napoleon did otherwise is evidence that at the beginning of the century the disease in question enjoyed a very different status.

At that time itch, instead of being a most plebeian malady, was, so to say, a court disease. It enjoyed a circulation, in high circles and in low, that modern therapeutics has quite denied it; and the physicians of the time gave it a fict.i.tious added importance by ascribing to its influence the existence of almost any obscure malady that came under their observation. Long after Napoleon's time gale continued to hold this proud distinction. For example, the imaginative Dr. Hahnemann did not hesitate to affirm, as a positive maxim, that three-fourths of all the ills that flesh is heir to were in reality nothing but various forms of "gale repercutee."

All of which goes to show how easy it may be for a masked pretender to impose on credulous humanity, for nothing is more clearly established in modern knowledge than the fact that "gale repercutee" was simply a name to hide a profound ignorance; no such disease exists or ever did exist.

Gale itself is a sufficiently tangible reality, to be sure, but it is a purely local disease of the skin, due to a perfectly definite cause, and the dire internal conditions formerly ascribed to it have really no causal connection with it whatever. This definite cause, as every one nowadays knows, is nothing more or less than a microscopic insect which has found lodgment on the skin, and has burrowed and made itself at home there. Kill that insect and the disease is no more; hence it has come to be an axiom with the modern physician that the itch is one of the three or four diseases that he positively is able to cure, and that very speedily. But it was far otherwise with the physicians of the first third of our century, because to them the cause of the disease was an absolute mystery.

It is true that here and there a physician had claimed to find an insect lodged in the skin of a sufferer from itch, and two or three times the claim had been made that this was the cause of the malady, but such views were quite ignored by the general profession, and in 1833 it was stated in an authoritative medical treatise that the "cause of gale is absolutely unknown." But even at this time, as it curiously happened, there were certain ignorant laymen who had attained to a bit of medical knowledge that was withheld from the inner circles of the profession. As the peasantry of England before Jenner had known of the curative value of cow-pox over small-pox, so the peasant women of Poland had learned that the annoying skin disease from which they suffered was caused by an almost invisible insect, and, furthermore, had acquired the trick of dislodging the pestiferous little creature with the point of a needle.

From them a youth of the country, F. Renucci by name, learned the open secret. He conveyed it to Paris when he went there to study medicine, and in 1834 demonstrated it to his master Alibert. This physician, at first sceptical, soon was convinced, and gave out the discovery to the medical world with an authority that led to early acceptance.

Now the importance of all this, in the present connection, is not at all that it gave the clew to the method of cure of a single disease. What makes the discovery epochal is the fact that it dropped a brand-new idea into the medical ranks--an idea destined, in the long-run, to prove itself a veritable bomb--the idea, namely, that a minute and quite unsuspected animal parasite may be the cause of a well-known, widely prevalent, and important human disease. Of course the full force of this idea could only be appreciated in the light of later knowledge; but even at the time of its coming it sufficed to give a great impetus to that new medical knowledge, based on microscopical studies, which had but recently been made accessible by the inventions of the lens-makers. The new knowledge clarified one very turbid medical pool and pointed the way to the clarification of many others.

Almost at the same time that the Polish medical student was demonstrating the itch mite in Paris, it chanced, curiously enough, that another medical student, this time an Englishman, made an a.n.a.logous discovery of perhaps even greater importance. Indeed, this English discovery in its initial stages slightly antedated the other, for it was in 1833 that the student in question, James Paget, interne in St.

Bartholomew's Hospital, London, while dissecting the muscular tissues of a human subject, found little specks of extraneous matter, which, when taken to the professor of comparative anatomy, Richard Owen, were ascertained, with the aid of the microscope, to be the coc.o.o.n of a minute and hitherto unknown insect. Owen named the insect Trichina spiralis. After the discovery was published it transpired that similar specks had been observed by several earlier investigators, but no one had previously suspected or, at any rate, demonstrated their nature. Nor was the full story of the trichina made out for a long time after Owen's discovery. It was not till 1847 that the American anatomist Dr. Joseph Leidy found the cysts of trichina in the tissues of pork; and another decade or so elapsed after that before German workers, chief among whom were Leuckart, Virchow, and Zenker, proved that the parasite gets into the human system through ingestion of infected pork, and that it causes a definite set of symptoms of disease which hitherto had been mistaken for rheumatism, typhoid fever, and other maladies. Then the medical world was agog for a time over the subject of trichinosis; government inspection of pork was established in some parts of Germany; American pork was excluded altogether from France; and the whole subject thus came prominently to public attention. But important as the trichina parasite proved on its own account in the end, its greatest importance, after all, was in the share it played in directing attention at the time of its discovery in 1833 to the subject of microscopic parasites in general.

The decade that followed that discovery was a time of great activity in the study of microscopic organisms and microscopic tissues, and such men as Ehrenberg and Henle and Bory Saint-Vincent and Kolliker and Rokitansky and Remak and Dujardin were widening the bounds of knowledge of this new subject with details that cannot be more than referred to here. But the crowning achievement of the period in this direction was the discovery made by the German, J. L. Schoenlein, in 1839, that a very common and most distressing disease of the scalp, known as favus, is really due to the presence and growth on the scalp of a vegetable organism of microscopic size. Thus it was made clear that not merely animal but also vegetable organisms of obscure, microscopic species have causal relations to the diseases with which mankind is afflicted. This knowledge of the parasites was another long step in the direction of scientific medical knowledge; but the heights to which this knowledge led were not to be scaled, or even recognized, until another generation of workers had entered the field.

PAINLESS SURGERY

Meantime, in quite another field of medicine, events were developing which led presently to a revelation of greater immediate importance to humanity than any other discovery that had come in the century, perhaps in any field of science whatever. This was the discovery of the pain-dispelling power of the vapor of sulphuric ether inhaled by a patient undergoing a surgical operation. This discovery came solely out of America, and it stands curiously isolated, since apparently no minds in any other country were trending towards it even vaguely. Davy, in England, had indeed originated the method of medication by inhalation, and earned out some most interesting experiments fifty years earlier, and it was doubtless his experiments with nitrous oxide gas that gave the clew to one of the American investigators; but this was the sole contribution of preceding generations to the subject, and since the beginning of the century, when Davy turned his attention to other matters, no one had made the slightest advance along the same line until an American dentist renewed the investigation.

In view of the sequel, Davy's experiments merit full attention. Here is his own account of them, as written in 1799: