medicine in the 19 th century lecture 6. lecture plan 1.development of physiology. 2.verification of...

MEDICINE IN MEDICINE IN THE 19THE 19THTH CENTURYCENTURY

Lecture 6Lecture 6

Lecture PlanLecture Plan

1.Development of Physiology.

2.Verification of the germ theory.

3.Discoveries in clinical medicine and anaesthesia.

4.Advances at the end of the century.

DEVELOPMENT DEVELOPMENT

OF PHYSIOLOGYOF PHYSIOLOGY

By the beginning of the 19th century, the By the beginning of the 19th century, the structure of the human body was structure of the human body was almost fully knownalmost fully known, due to new methods , due to new methods of microscopy and of injections. Even the of microscopy and of injections. Even the body's body's microscopic structure was microscopic structure was understoodunderstood. But as important as . But as important as anatomical knowledge was an anatomical knowledge was an understanding of understanding of physiological processesphysiological processes, , which which were rapidly being elucidatedwere rapidly being elucidated..

MEDICINE IN THE 19TH MEDICINE IN THE 19TH CENTURYCENTURY

In Germany physiology became established In Germany physiology became established as a distinct science under the guidance of as a distinct science under the guidance of Johannes MüllerJohannes Müller, who was a professor at , who was a professor at Bonn and then at the University of Berlin. Bonn and then at the University of Berlin. An energetic worker and an inspiring An energetic worker and an inspiring teacher, he described his discoveries in a teacher, he described his discoveries in a famous textbook, famous textbook, Handbuch der Physiologie Handbuch der Physiologie des Menschen (“Manual of Human des Menschen (“Manual of Human Physiology”)Physiology”), published in the 1830s., published in the 1830s.



Hermann von HelmholtzGerman scientist, made

groundbreaking contributions to physiology and physics in the

19th century.

Among Müller's illustrious pupils were Among Müller's illustrious pupils were Hermann von HelmholtzHermann von Helmholtz, who made , who made significant discoveries relating to sight significant discoveries relating to sight and hearing and who invented the and hearing and who invented the ophthalmoscope; and ophthalmoscope; and Rudolf VirchowRudolf Virchow, , one of the century's great medical one of the century's great medical scientists, whose outstanding achievement scientists, whose outstanding achievement was his conception of the cell as the was his conception of the cell as the centre of all pathological changes. centre of all pathological changes.


In France the most brilliant physiologist of the In France the most brilliant physiologist of the time was time was Claude BernardClaude Bernard, whose many , whose many important discoveries were the outcome of important discoveries were the outcome of carefully planned experiments. His researches carefully planned experiments. His researches clarified the role of the pancreas in digestion, clarified the role of the pancreas in digestion, revealed the presence of glycogen in the liver, revealed the presence of glycogen in the liver, and explained how the contraction and and explained how the contraction and expansion of the blood vessels are controlled expansion of the blood vessels are controlled by vasomotor nerves. He proposed the concept by vasomotor nerves. He proposed the concept of the internal environment—the chemical of the internal environment—the chemical balance in and around the cells—and the balance in and around the cells—and the importance of its stability.importance of its stability.


VERIFICATION OF THE VERIFICATION OF THE GERM THEORYGERM THEORY

Perhaps the overarching medical advance of Perhaps the overarching medical advance of the 19th century, certainly the most the 19th century, certainly the most spectacular, was the conclusive spectacular, was the conclusive demonstration that certain demonstration that certain diseasesdiseases, as well , as well as the as the infectioninfection of surgical wounds, were of surgical wounds, were directly caused by directly caused by minute living minute living organismsorganisms. This discovery changed the . This discovery changed the whole face of pathology and effected a whole face of pathology and effected a complete complete revolution in the practice of revolution in the practice of surgerysurgery..


A 19th-century pioneer in this field, A 19th-century pioneer in this field, regarded by some as founder of the regarded by some as founder of the parasitic theory of infectionparasitic theory of infection, was , was Agostino BassiAgostino Bassi of Italy, who of Italy, who showed that a disease of silkworms showed that a disease of silkworms was caused by a fungus that could was caused by a fungus that could be destroyed by chemical agents.be destroyed by chemical agents.


The main credit for establishing the science of The main credit for establishing the science of bacteriologybacteriology must be accorded to the French must be accorded to the French chemist chemist Louis PasteurLouis Pasteur. It was Pasteur who, . It was Pasteur who, by a brilliant series of experiments, proved by a brilliant series of experiments, proved that the fermentation of wine and the souring that the fermentation of wine and the souring of milk are caused by living microorganisms. of milk are caused by living microorganisms. His work led to the pasteurization of milk and His work led to the pasteurization of milk and solved problems of agriculture and industry as solved problems of agriculture and industry as well as those of animal and human diseases. well as those of animal and human diseases. He successfully employed inoculations to He successfully employed inoculations to prevent anthrax in sheep and cattle, chicken prevent anthrax in sheep and cattle, chicken cholera in fowl, and finally rabies in humans cholera in fowl, and finally rabies in humans and dogs.and dogs.


Louis Pasteur and his device for germ experiment.Louis Pasteur and his device for germ experiment.


Pasteur studied alcoholic fermentation Pasteur studied alcoholic fermentation and lactic fermentation in sour milk; and lactic fermentation in sour milk; he found that both fermentations were he found that both fermentations were caused by minute organisms, and caused by minute organisms, and were hastened by exposure to the air. were hastened by exposure to the air. He proved that the microscopic He proved that the microscopic organisms were not spontaneously organisms were not spontaneously generated but were introduced by air.generated but were introduced by air.


Joseph ListerJoseph Lister


From Pasteur, From Pasteur, Joseph ListerJoseph Lister derived the derived the concepts that enabled him to introduce the concepts that enabled him to introduce the antiseptic principle into surgery. In 1865 antiseptic principle into surgery. In 1865 Lister, a professor of surgery at Glasgow Lister, a professor of surgery at Glasgow University, began placing an antiseptic barrier University, began placing an antiseptic barrier of carbolic acid between the wound and the of carbolic acid between the wound and the germ-containing atmosphere. Infections and germ-containing atmosphere. Infections and deaths fell dramatically, and his pioneering deaths fell dramatically, and his pioneering work led to more refined techniques of work led to more refined techniques of sterilizing the surgical environment.sterilizing the surgical environment.


Lister saw that sepsis was the principal Lister saw that sepsis was the principal obstacle to any great advantage in obstacle to any great advantage in surgery. Finally, noting that closed surgery. Finally, noting that closed wounds did not suppurate while open wounds did not suppurate while open ones ex posed to the air did, he ones ex posed to the air did, he concluded that suppuration was in some concluded that suppuration was in some manner due to contact with the air but manner due to contact with the air but that the air alone did not cause that the air alone did not cause suppuration.suppuration.


He found the solution of his problem in the He found the solution of his problem in the work of Louis Pasteur on fermen tation and work of Louis Pasteur on fermen tation and putrefaction; it was not the air but the putrefaction; it was not the air but the germs in the air that produced sup germs in the air that produced sup puration. He saw at once that putrefaction puration. He saw at once that putrefaction could only be avoided by preventing germs could only be avoided by preventing germs from gaining access to wounds. He looked from gaining access to wounds. He looked around for a suitable antiseptic, and chose around for a suitable antiseptic, and chose carbolic acid. With it Lister made his first carbolic acid. With it Lister made his first antiseptic dressing in March, 1865.antiseptic dressing in March, 1865.


The antiseptic doctrine did not have a The antiseptic doctrine did not have a sympathetic reception in England: it was sympathetic reception in England: it was attacked by some medical men. Lister attacked by some medical men. Lister nevertheless went ahead with his nevertheless went ahead with his experiments to improve his method. After a experiments to improve his method. After a while he stopped using undiluted carbolic while he stopped using undiluted carbolic acid to purify recent wounds because he acid to purify recent wounds because he found that it caused superficial sloughing. A found that it caused superficial sloughing. A five per cent watery solution proved to be five per cent watery solution proved to be strong enough for his purposes.strong enough for his purposes.


ObstetricsObstetrics had already been robbed of some of had already been robbed of some of its terrors by its terrors by Alexander GordonAlexander Gordon at Aberdeen, at Aberdeen, Scotland, Scotland, Oliver Wendell HolmesOliver Wendell Holmes at Boston, at Boston, and and Ignaz SemmelweisIgnaz Semmelweis at Vienna and Pest at Vienna and Pest (Budapest), who advocated disinfection of the (Budapest), who advocated disinfection of the hands and clothing of midwives and medical hands and clothing of midwives and medical students who attended confinements. These students who attended confinements. These measures produced a marked reduction in cases measures produced a marked reduction in cases of puerperal fever, the bacterial scourge of of puerperal fever, the bacterial scourge of women following childbirth.women following childbirth.


Another pioneer in bacteriology was the Another pioneer in bacteriology was the German physician German physician Robert KochRobert Koch, who , who showed how bacteria could be cultivated, showed how bacteria could be cultivated, isolated, and examined in the laboratory. A isolated, and examined in the laboratory. A meticulous investigator, Koch discovered meticulous investigator, Koch discovered the the organisms oforganisms of tuberculosistuberculosis, in 1882, , in 1882, and and choleracholera, in 1883. By the end of the , in 1883. By the end of the century many other disease-producing century many other disease-producing microorganisms had been identified.microorganisms had been identified.


Robert KochRobert Koch


In 1882 Koch discovered tuberculosis bacilli. In 1882 Koch discovered tuberculosis bacilli. Due to his discovery Koch became known all Due to his discovery Koch became known all over the world. In 1884 Koch published his over the world. In 1884 Koch published his book on cholera. This book included the book on cholera. This book included the investigations of his research work carried investigations of his research work carried out during the cholera epidemic in Egypt and out during the cholera epidemic in Egypt and India. From the intestines of the men with India. From the intestines of the men with cholera Koch isolated a small comma-shaped cholera Koch isolated a small comma-shaped bacterium. He determined that these bacteria bacterium. He determined that these bacteria spread through drinking water.spread through drinking water.


DISCOVERIES IN DISCOVERIES IN

CLINICAL MEDICINE CLINICAL MEDICINE

AND ANAESTHESIAAND ANAESTHESIA

There was perhaps some danger that in the There was perhaps some danger that in the search for bacteria other causes of disease search for bacteria other causes of disease would escape detection. Many physicians, would escape detection. Many physicians, however, were working along different lines in however, were working along different lines in the 19th century. Among them were a group the 19th century. Among them were a group attached to Guy's Hospital, in London: attached to Guy's Hospital, in London: Richard Richard Bright, Thomas Addison, Bright, Thomas Addison, andand Sir William Sir William GullGull. Bright contributed significantly to the . Bright contributed significantly to the knowledge of kidney diseases, including Bright's knowledge of kidney diseases, including Bright's disease, and Addison gave his name to disorders disease, and Addison gave his name to disorders of the adrenal glands and the blood. of the adrenal glands and the blood. GullGull, a , a famous clinical teacher, left a legacy of pithy famous clinical teacher, left a legacy of pithy aphorisms that might well rank with those of aphorisms that might well rank with those of Hippocrates.Hippocrates.


In Dublin In Dublin Robert GravesRobert Graves and and William StokesWilliam Stokes introduced new introduced new methods in clinical diagnosis and methods in clinical diagnosis and medical training; while in Paris a medical training; while in Paris a leading clinician, leading clinician, Pierre-Charles-Pierre-Charles-Alexandre LouisAlexandre Louis, was attracting , was attracting many students from America by the many students from America by the excellence of his teaching. excellence of his teaching.


The most famous contribution by the United The most famous contribution by the United States to medical progress at this period was States to medical progress at this period was undoubtedly the undoubtedly the introduction of general introduction of general anaesthesiaanaesthesia, a procedure that not only , a procedure that not only liberated the patient from the fearful pain of liberated the patient from the fearful pain of surgery but also enabled the surgeon to surgery but also enabled the surgeon to perform more extensive operations. The perform more extensive operations. The discovery was marred by controversy. discovery was marred by controversy. Crawford Long, Gardner Colton, and Horace Crawford Long, Gardner Colton, and Horace Wells are all claimants for priority. Wells are all claimants for priority.


Crawford LongCrawford Long, American physician, is , American physician, is traditionally considered the first to have traditionally considered the first to have used ether as an anesthetic in surgery. He used ether as an anesthetic in surgery. He observed that persons injured in “ether observed that persons injured in “ether frolics” (social gatherings of people who frolics” (social gatherings of people who were in a playful state of ether-induced were in a playful state of ether-induced intoxication) seemed to suffer no pain, intoxication) seemed to suffer no pain, and in 1842 he painlessly removed a and in 1842 he painlessly removed a tumour from the neck of a patient to tumour from the neck of a patient to whom he had administered ether. whom he had administered ether.


Gardner ColtonGardner Colton, American anesthetist and , American anesthetist and inventor, was among the first to utilize the inventor, was among the first to utilize the anesthetic properties of nitrous oxide in anesthetic properties of nitrous oxide in medical practice. After a dentist suggested medical practice. After a dentist suggested the use of the gas as an anesthetic, Colton the use of the gas as an anesthetic, Colton safely used it in extracting thousands of teeth. safely used it in extracting thousands of teeth. As he was studying medicine in New York As he was studying medicine in New York (without taking a degree), Colton learned that (without taking a degree), Colton learned that the inhalation of nitrous oxide, or laughing the inhalation of nitrous oxide, or laughing gas, produced exhilaration. After a public gas, produced exhilaration. After a public demonstration of its effects in New York City demonstration of its effects in New York City proved to be a financial success, he began a proved to be a financial success, he began a lecture tour of other cities. lecture tour of other cities.


Horace WellsHorace Wells, American dentist, was a , American dentist, was a pioneer in the use of surgical anesthesia. While pioneer in the use of surgical anesthesia. While practicing in Hartford, Connecticut, in 1844, practicing in Hartford, Connecticut, in 1844, Wells noted the pain-killing properties of Wells noted the pain-killing properties of nitrous oxide (“laughing gas”) during a nitrous oxide (“laughing gas”) during a laughing-gas road show and thereafter used it laughing-gas road show and thereafter used it in performing painless dental operations. He in performing painless dental operations. He was allowed to demonstrate the method at the was allowed to demonstrate the method at the Massachusetts General Hospital in January Massachusetts General Hospital in January 1845, but when the patient proved 1845, but when the patient proved unresponsive to the gas, Wells was exposed to unresponsive to the gas, Wells was exposed to ridicule.ridicule.


It was It was William Thomas MortonWilliam Thomas Morton who, who, on Oct. 16, 1846, at Massachusetts on Oct. 16, 1846, at Massachusetts General Hospital, in Boston, first General Hospital, in Boston, first demonstrated before a gathering of demonstrated before a gathering of physicians the use of ether as a general physicians the use of ether as a general anaesthetic. He is credited with gaining anaesthetic. He is credited with gaining the medical world's acceptance of the medical world's acceptance of surgical anesthesia. The news quickly surgical anesthesia. The news quickly reached Europe, and general anaesthesia reached Europe, and general anaesthesia soon became prevalent in surgery. soon became prevalent in surgery.


At Edinburgh, the professor of midwifery, At Edinburgh, the professor of midwifery, James Young SimpsonJames Young Simpson, had been , had been experimenting upon himself and his assistants, experimenting upon himself and his assistants, inhaling various vapours with the object of inhaling various vapours with the object of discovering an effective anaesthetic. He was discovering an effective anaesthetic. He was the first to use chloroform in obstetrics and the first to use chloroform in obstetrics and the first in Britain to use ether. In November the first in Britain to use ether. In November 1847 1847 chloroformchloroform was tried with complete was tried with complete success, and soon it was preferred to ether success, and soon it was preferred to ether and became the anaesthetic of choice.and became the anaesthetic of choice.


ADVANCES AT THE END ADVANCES AT THE END OF THE CENTURYOF THE CENTURY

Patrick MansonPatrick Manson, a British pioneer in , a British pioneer in tropical medicine, showed in China, in tropical medicine, showed in China, in 1877, how insects can carry disease and 1877, how insects can carry disease and how the embryos of the Filaria worm, which how the embryos of the Filaria worm, which can cause elephantiasis, are transmitted by can cause elephantiasis, are transmitted by the mosquito. Manson explained his views the mosquito. Manson explained his views to a British army surgeon, Ronald Ross, to a British army surgeon, Ronald Ross, then working on the problem of malaria, then working on the problem of malaria, and Ross discovered the malarial parasite and Ross discovered the malarial parasite in the stomach of the Anopheles mosquito in the stomach of the Anopheles mosquito in 1897.in 1897.


In Cuba, In Cuba, Carlos FinlayCarlos Finlay expressed the expressed the view, in 1881, that yellow fever is view, in 1881, that yellow fever is carried by the Stegomyia mosquito. carried by the Stegomyia mosquito. Following his lead, the Americans Walter Following his lead, the Americans Walter Reed, William Gorgas, and others were Reed, William Gorgas, and others were able to conquer the scourge of yellow able to conquer the scourge of yellow fever in Panama and made possible the fever in Panama and made possible the completion of the Panama Canal by completion of the Panama Canal by reducing the death rate there from 176 reducing the death rate there from 176 per 1,000 to 6 per 1,000.per 1,000 to 6 per 1,000.


Other victories in Other victories in preventive preventive medicinemedicine ensued, because the ensued, because the maintenance of health was now maintenance of health was now becoming as important a concern as becoming as important a concern as the cure of disease; and the 20th the cure of disease; and the 20th century was to witness the evolution century was to witness the evolution and progress of national health and progress of national health services in a number of countries. services in a number of countries.


In addition, spectacular advances in In addition, spectacular advances in diagnosis and treatment followed the diagnosis and treatment followed the discovery of X rays by Wilhelm Conrad discovery of X rays by Wilhelm Conrad Röntgen, in 1895, and of radium by Röntgen, in 1895, and of radium by Pierre and Marie Curie in 1898. Before Pierre and Marie Curie in 1898. Before the turn of the century, too, the vast the turn of the century, too, the vast new field of new field of psychiatrypsychiatry had been had been opened up by opened up by Sigmund FreudSigmund Freud. .


The tremendous increase in scientific The tremendous increase in scientific knowledge during the 19th century knowledge during the 19th century radically altered and expanded the radically altered and expanded the practice of medicine. Concern for practice of medicine. Concern for upholding the quality of services led to upholding the quality of services led to the establishment of the establishment of public and public and professional bodies to govern the professional bodies to govern the standards for medical training and standards for medical training and practicepractice..


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medicine in the 19 th century lecture 6. lecture plan 1.development of physiology. 2.verification of...

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