Medical Science in the Nineteenth Century

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Medical Science in the Nineteenth Century
Medicine, Disease and Society in Britain, 1750 -
1950

• Lecture 13

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Lecture themes/outline

• New developments
• The rise of surgery and medical science (new
  ideas about disease and the body)
• The rise of the modern hospital
• Increase in status of modern medicine
• Social and Cultural History of Medicine
• The importance of social and cultural context in
  the reception and adoption of innovation
• The complex relationship between new theories of
  disease and the development of effective
  therapies.
• Effect on the patient/ practitioner relationship

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Important Questions

• What impact does science have on medicine?
• How swiftly and to what extent is change
  accepted?
• Does science change medical practice in general?
• How does it change the image of the medical
  profession?
• How does it influence the public understanding of
  medicine? i.e. How does science filter down?
• Did it impact on the general practitioner or was
  it restricted to hospital medicine?
• Did it lead to a separation of ideas between lay
  people and medical men on illness?

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Definition of Science

• from the Latin scientia, meaning "knowledge"
• An enterprise that builds and organizes knowledge
  in the form of testable explanations and
  predictions about the world

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Theophile Hyacinthe Laennec (1781-1826)
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Christopher Lawrence

• Even the simplest surgical practices employ a
  theory of the body and of disease.
• Extracting a tooth implies a theory of the local
  origin of pain and the relative harmlessness of
  removing a body part.

Christopher Lawrence (ed.), Medical Theory,
Surgical Practice Studies in the History of
Surgery (London Routledge, 1992).
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Thomas Schlich

• Resective surgery demonstrates how surgery and
  medicine interacted.
• Medicine adopted a localistic approach from
  surgery and developed a new understanding of
  disease as pathological change of tissues and
  cells.
• By including the surgical point of view in
  medical education, physicians gained a new and
  productive approach to disease.
• Learning medicine helped surgeons to see the body
  in a way that made surgery on the bodys interior
  possible.

Thomas Schlich, The Emergence of Modern Surgery
in Deborah Brunton (ed.), Medicine Transformed
Health, Disease and Society in Europe 1800-1930
(Manchester Manchester University Press, 2004).
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An early operation under anaesthesia, c. 1847.
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Martin Pernick

• Sudden increase in the number of operations at
  the Massachusetts General Hospital.
• The growth in the number of operations was
  greatest among those groups who were most likely
  to receive anaesthetics.
• Anaesthesia thus brought about a sort of
  levelling up, where the groups of patients
  previously thought too weak or too sensitive to
  stand surgery could be operated on.
• Anaesthesia allowed surgeons to perform different
  types of operation.
• Mortality rates from surgery did not increase
  with the arrival of anaesthetics. The greater
  numbers of victims of serious accidents
  receiving surgery as a last resort helped to
  push up the number of deaths.

Martin Pernick, A Calculus of Suffering Pain,
Professionalism and Anaesthesia in
Nineteenth-Century America (New York Columbia
University Press, 2004).
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• Antisepsis
• Destruction of disease-causing microorganisms to
  prevent infection.
• Asepsis
• Prevention of contamination with infectious
  agents.

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Igniz Semmelweis, (1818-1865)
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The use of the Lister carbolic acid spray
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Opposition to Carbolic Spray

• Difficult to carry out procedure - complicated
• Relied on germ theory that many still resisted-
  based on too much science - significant that it
  was adopted by the Germans.
• Threatened old surgery- would open up new
  procedures- threatened status and incomes of
  guard.
• More immediately, the spray smelt vile and could
  irritate skin
• Hospital politics- where medical men made the
  decisions and this would bring surgeons greater
  autonomy.
• Some management committees got cold feet due to
  deaths.

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Photograph of operating theatre, 1904.
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Abdominal surgery to remove diseased ovarian
tissue (ovariotomy). Surgeon and anesthesiologist
in street clothes. From Thomas Spencer Wells,
Diseases of the Ovaries, 1872.
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The Germ Theory of Disease

• Louis Pasteur
• Micro organisms enter the body in a number of
  ways.
• Specific diseases are caused by specific
  micro-organisms.
• Natural immunity is an inherited resistance to
  infection.
• Justus von Liebig
• The body as a chemical system, measure what comes
  in and goes out
• Rudolph Virchow
• Disease arises due to abnormal changes in cells

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Claude Bernard, An Introduction to the Study of
Experimental Medicine (trans. H.C. Greene) (New
Work Dover publications, 1957 first edn 1865),
pp. 145-9

• The laboratory is the real nursery of true
  experimental scientists, i.e., those who create
  the science that others afterward popularizeIt
  is to-day everywhere recognized that pure science
  germinates and develops in laboratories, to
  spread out later and cover the world with useful
  applications. We must, therefore, first of all
  attend to the scientific source, since applied
  science necessarily proceeds from pure
  scienceOnly laboratories can teach the
  difficulties of science to those who frequent
  them they show that pure science has always been
  the source of all the riches acquired by man and
  of all his real conquests over the phenomena of
  nature.

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Kochs postulates

• The organism suspected of causing a particular
  disease could be discovered in every instance of
  the disease.
• When extracted from the body, the germ could be
  grown in the laboratory and maintained for
  several generations.
• When this culture was injected into animals, it
  should induce the same disease observed in the
  original source.
• The organism could then be retrieved from the
  experimental animal and cultured again.

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Chemistry laboratory, Glasgow University, 1864.
A very early photograph of a chemistry
laboratory.
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Ronald Ross, Charles Sherrington and Robert Boyce
in a laboratory at the Liverpool School of
Tropical Medicine, 1899.
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The Pasteur Institute, Paris, 1888. The
institute was built in Paris in 1888 both to
honour the work of Louis Pasteur and to provide a
base for his further research.
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Research in Britain

• The Lister Institute of Preventive Medicine was
  an independent, non-profit-making organisation
  established in 1893.
• 1893-1914 the only institute of its kind in
  Britain, ranking internationally with the Pasteur
  Institute in Paris and the Rockefeller Institute
  in New York. Focus on microbiology (bacteriology
  and virology).
• Worldwide renown working on smallpox, typhoid and
  diphtheria in the 19th century cancer,
  rheumatism and nutritional disorders in the 20th
  century. Invaluable work was done on viruses and
  genes, on blood and disinfection, vitamins and
  nutrition.
• 1914 National Institute for Medical Research Set
  up
• Almroth Wright at St Marys London- work on
  vaccines

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The Anti-Vivisection and Humanitarian Review vol
9 (1930) no 1.
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Dr Robert Knox (1791-1862)
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Broadside regarding the Burke and Hare trials
(1829).
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Michel Foucault (1926-1984).
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Foucault

• The Paris hospitals saw the emergence of the
  clinicians gaze a way of looking at the
  patient and seeing disease which no longer
  dealt with environment or lifestyle, but focused
  on the organic changes occurring in the spaces
  within the body.
• This new way of seeing and thinking turned the
  body into an object that could be understood by
  scientific knowledge, and the foundation for the
  emergence of the human sciences.
• As practitioners developed a new discourse of
  disease, they acquired a new power within the
  clinical relationship. The patient became
  teaching material to be probed and examined
  during life and a commodity to be dissected
  after death.
• In return for free medical assistance, the poor
  made their bodies available to the medical gaze.

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Mary Fissell, The disappearance of the patients
narrative

• The third Day after the Wether happened to be
  very warm he changed his Thick waistcot for a
  Linning one and being careless sat a quarter day
  in a Room that was wett the same evening he found
  himself not well and a little Feverish thirsty
  for which he Went to Bed and Drank Plentifull of
  Sack Whey. The Next Morning he was very horse and
  out of order (1744)
• His appearance was florid, his complexion clear.
  He complained of a light headache and a sore
  throat. His pulse was full and rather frequent,
  the tongue white, the tonsils slightly inflamed,
  the parotid glands were very much enlarged, the
  bowels were confined, and there was a little
  oppression about the chest. (1816)

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Nicholas Jewson

• Jewson concerned with what he calls the
  disappearance of the sick-man from medical
  cosmology in the period 1770-1870.
• Shift from bedside medicine to hospital
  medicine to laboratory medicine.
• Bedside Medicine- marketplace
• Hospital Medicine- Paris
• Laboratory medicine- Germany
• By medical cosmology Jewson means knowledge,
  practice, practitioners and patients.

Nicholas Jewson, The disappearance of the
sick-man from medical cosmology, 1770-1870,
Sociology, (1976) 10 225-44.
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Nicholas Jewson, The disappearance of the
sick-man from medical cosmology, 1770-1870,
Sociology, (1976) 10 225-44.

• Bedside Medicine Early modern marketplace-
  competition
• Paying patient had a voice in the medical
  encounter
• Common language and concepts of health and
  illness
• Patient an individual
• Holistic approach- disease affected the whole
  organism
• Hospital Medicine Post Revolution French
  hospitals- Paris
• Development of the construct of the patient
  the clinical gaze
• Clinicians hold the power
• The patient became an object
• Disease located in specific organs
• Laboratory medicine Late C19 German universities
  and research institutes
• Scientists hold the power
• Disease is located in cells

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Conclusion

• Slow uptake of theories and associated practices
• Germ theory
• Antisepsis and Asepsis Semmelweis and Lister
• Why? Numerous factors including moral grounds
  (anaesthetics in childbirth, vivisection),
  challenge to existing medical authority, the way
  things are done
• For more on this see, A. J. Young, The Scientific
  Revolution in Victorian Medicine, and John
  Pickstone, Medical Innovation in Historical
  Perspective - diffusion, fitting in with social
  and cultural context
• Nonetheless, bedside medicine had become more
  scientific measurement devices