In 1860, the American doctor and poet Oliver Wendell Holmes remarked, “If all our medical drugs could be sunk to the bottom of the sea, it would be all the better for humanity and all the worse for the fishes.” And yet this was the century that laid the foundations of modern medicine. Indeed, greater advances were made in the 19th-century than all the previous centuries combined.
Just as we should not overestimate modern medicine (which even today cannot cure a long list of illnesses) so we ought not to underestimate efforts of the past. When people think of an 18th-century doctor, they picture someone brutal and ignorant. In many cases that was no doubt true. And yet even before the 19th-century, advances had been made. As early as the 17th, for example, it was known that living things were built from cells, and by 1800 the structure of the human body was largely understood. Physiology, on the other hand, meaning the processes of life, remained mysterious.
Germany was to make the greatest progress. And this was thanks in part to the efforts of a University professor, Johannes Muller. In the 1830s, Muller published The Manual of Human Physiology, in which he ordered and clarified what was known at the time. He also made use of new tools like the microscope. And Muller suggested ways in which physics and chemistry could be applied to physiology.
In particular, Muller’s book advanced our understanding of the senses and nervous system. More generally, he approached the deepest mystery of all: the relationship between living and non-living matter. Though Muller believed in scientific rigour, he was also convinced that some kind of force or “life energy” was at work. This, he argued, lies beyond the grasp of science.
Muller was also an influential teacher. Indeed, one of his pupils, Hermann von Helmholtz, made significant discoveries of his own, especially regarding sight and hearing. He also invented the ophthalmoscope. Another, Rudolf Virchow, established the cell as the center of pathological change.
Another leading physiologist of the 19th-century was the Frenchman Claude Bernard. Bernard made several breakthroughs, from the role played by the pancreas in digestion to the way the contraction of blood vessels is controlled by vasomotor nerves. He also suggested that the body’s internal world comprises a delicate balance, and that when this is upset, disease arises. Even today, his Introduction to the Study of Experimental Medicine, though published in 1865, is a respected piece of work.
The Germ Theory of Disease
Throughout human history, tribes, villages, and even whole civilizations, were ravaged by infectious diseases. So dreadful could these be that they sometimes threatened the very fabric of civilized life. And yet people had no understanding of either their origin or cause. As Yuval Harari remarks in Homo Deus, “until the modern era, humans blamed disease on bad air, malicious demons and angry gods.” In the 19th-century, it was finally established that disease is caused by microscopic organisms.
Of course, not everyone blamed disease on demons or gods. As far back as 100BC, the Roman writer Varro suggested that it began when invisible particles entered the body. But it was not until the 19th-century that this was fully explained. And the result was a revolution in medicine, one that continues to this day.
What people vaguely refer to as “germs” are in fact tiny organisms that invade humans, animals and even plants. The four major types are viruses, bacteria, fungi and protozoa. A virus cannot exist apart from a living thing (referred to as the viruses’ “host”), but once inside will grow and reproduce. Flu and measles are both caused by viruses. Bacteria, on the other hand, are one-celled creatures that can survive and reproduce outside an animal or plant. These cause things like sore throats and pneumonia. Fungi are multi-celled and cause problems like athlete’s foot, while protozoa spread disease through water.
It was the French chemist Louis Pasteur who did most to establish the science of bacteriology. He demonstrated that a process like the fermentation of wine is caused by these living organisms. In Germany, the physician Robert Koch found ways to cultivate, isolate, and then study bacteria in a laboratory. In 1882, he discovered the organisms responsible for TB, and in 1883 those involved in cholera. At the start of the 19th-century, very little was known about these micro-organisms. By the end of the century, not only had they been labelled and classified, many had been linked to specific diseases.
In his History of the World, J.M. Roberts writes, “doctors only came to grips with the great killing diseases from 1870 onwards.” Once they did, astonishing progress was made. First, the big child killers like diphtheria and scarlet fever were brought under control. By the end of the century, cholera had been eliminated from the developed nations and plague outbreaks ended.
The ever-increasing knowledge of these deadly organisms also had a profound effect on surgery. A British Professor of Surgery, Joseph Lister, was aware of Pasteur’s work and began to apply it in the operating theatre. In the 1860s, he used carbolic acid as an antiseptic barrier to protect the patient’s wound. It worked. Deaths fell dramatically, prompting others to find new ways of sterilizing the surgical environment.
General anesthesia marked another great advance. Before this, operations were horrific. The English poet John Keats trained as a medical doctor in 1814 and, as part of his training, had to literally hold down screaming, writhing patients while the surgeon cut into them. Charles Darwin, who trained as a medical doctor in the 1820s, was so revolted by an amputation that he quit medicine and decided to be a clergyman.
Most agree that it was William Morton who first performed an operation on an anesthetised patient. On the 16th of October 1846, he used ether as a general anesthetic at the Massachusetts General Hospital in Boston. A year later, chloroform was tried instead and soon became the anesthetic of choice.
In his essay How the Poor Die, George Orwell remarks that until the middle of the 19th-century surgery was regarded as a kind of torture. People were terrified of hospitals and did all they could to avoid them. And since surgery was largely useless (those who didn’t die of shock usually died of infection), it was used more as an opportunity to learn than as a way of healing. As Orwell adds, the violence and brutality involved no doubt attracted sadists. Even the doctors to King George III (who died in 1820) could think of nothing better than to “bleed him ’til he faints.”
By the end of the 19th-century, however, surgery was a respectable profession. Once again it was to be in Germany that the major advances were made. The German surgeon Theodor Billroth performed the first total removal of a larynx. He also pioneered surgery methods for a whole range of cancers, especially of the breast, and demonstrated that abdominal surgery could be both safe and effective. By the final decade of the century, appendectomies were common. In 1882, a gall bladder was successfully removed and operations on the prostate improved. Surgery was given a final boost in 1896 with the introduction of X-rays.
In spite of these advances, some criticise the path medicine took in the 19th-century. Though it seems the most objective of human endeavours, medicine is still the work of human beings, and human beings have their limitations. Even the most brilliant individual lives and works in a specific time and place, one with its own strengths and weaknesses. Nineteenth century medicine was largely the product of Europeans and Americans – men who approached the body as if it were a machine. Some argue that medicine is still dominated by this thinking. Their point is not that 19th-century medicine got everything wrong, simply that it was limited.
The Austrian physicist Fritjof Capra writes at length about this in his book The Turning Point. Capra argues that discoveries in 20th-century physics have initiated a fundamental shift in our view of the world. The idea that matter consists of hard “stuff,” and that everything can be reduced to separate bits that click together, is outdated. During the 19th-century, the doctor came to be seen as a mechanic; a part of the human machine malfunctions, or is damaged from the outside, and the doctor intervenes to correct it.
Again, Capra is not saying that the 19th-century “biomedical model,” as he puts it, is wrong but that it is too reductive; it fails to grasp the psychological, social and environmental dimension. Instead, he argues for a holistic approach, one that makes use of 19th-century advances but moves beyond the limited outlook. For example, when someone becomes physically ill, we must see this in context. Are they lonely? What sort of environment do they live in? What messages are they receiving from the wider society? As Capra writes, “there can be no absolute level of health independent of environment.”
Nineteenth-century doctors were still under the influence of Descartes, a 17th-century philosopher who argued that mind and body were separate entities. This led them to neglect ways in which the mind affects the body. Physical illness can be an outlet for extreme mental or emotional disturbance, writes Capra. To quote Capra again, “virtually all disorders are psychosomatic in the sense that they all involve the continual interplay of mind and body in their origin, development and cure.” We know from Psychoanalysis, for example, that physical symptoms such as paralysis can even be symbolic.
In spite of such criticisms, the 19th-century remains a time of great advance. And whatever its faults or limitations, by the end of the century medicine was more effective than it had ever been.
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