Achievements Of The 19th Century:
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Medical Science, Hygiene, And Surgery
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Medical Science, Hygiene, And Surgery
( Originally Published Early 1900's )
To the sick and suffering science has proved, in the Nineteenth Century, an angel with healing in its wings. The healing art, in all its branches, has made more progress during the last hundred years than it had made in all the history of the world.
The Egyptians were possessed of many of the secrets of medicine as long ago, or longer, than 4000 B.C. From them the Israelites learned the principles of their medical practice and with the Israelites, as with the Egyptians, the priesthood prescribed for the sick. In India, in the Eleventh Century B.C., the healing art appears to have been better understood than it was by either the Egyptians or the Israelites, but it was still empirical. Greece was the birth-place of rational medicine, which traveled, by way of Alexandria, to Rome. After the fall of Rome, the Arabians, those true disciples of science, kept alive the torch of medicine. Expert chemists, they made an especial study of pharmacy and of drugs, founding apothecaries' shops and the pharmacopoeia. During the dark ages the Jews and the Mohammedans were the skillful physicians. The Jews retained many of the sanitary and hygienic ideas of the Pentateuch at a time when such ideas were sorely needed. Latin translations of Arabian renderings of Greek works on medicine helped Europe to recover its knowledge of the medical lore of antiquity. The study of anatomy, of physiology, and of medical botany began and very gradually the foundations of true medical science were laid. Ambrose Paré, who died in 1590, is called the father of modern surgery. In 1628 William Harvey explained the circulation of the blood, with the effect of setting many ingenious minds to work at trying to place medicine on a physiological basis. The Eighteenth Century was mainly spent in efforts to construct a theoretical system of medicine, but the acquisition of positive knowledge did not stop.
Yet at the beginning of the Nineteenth Century medical science and its practice were in a state difficult to realize in this day of education and enlightenment. The most learned physician was a babe in knowledge compared with his brethren of today. In England medical practitioners were divided into three classes, physicians, surgeons, and apothecaries, most of whom had some knowledge of their profession, although libraries were few and medicine generally in its infancy. Still they had received a technical education and had been examined before admission to practice. But beneath these was a host of empirics who practiced without diplomas surgeons, apothecaries, cuppers, leechers, herb-doctors, who were most harmless of all, men-midwives, and dispensers of drugs. It was because of these charlatans that the first advance toward improvement was made. It came from the doctors who were actuated by motives both selfish and altruistic. Some earnestly desired to benefit mankind, others objected to their un-diplomaed competitors only because they interfered with their practice. Both classes of reformers, how-ever, worked to the same good end. The Society of Apothecaries took precedence of both the College of Physicians and the University of Surgeons, in the good work, and it was through its efforts that the Apothecaries' Act was passed in Parliament January 15, 1 8 1 5 . This declared it necessary that every medical man should give evidence that he possessed some knowledge of his profession before he began to practice, and that all apothecaries should be licensed. The act was enforced with much wisdom, and so began a revolution in medicine.
Anatomy soon showed the effect of the new state 0f affairs, for a thorough knowledge of the human body was insisted upon as a qualification for the practice of medicine. But the obtaining of subjects for dissection was attended with great difficulties. Bodies had to be imported from abroad and body-snatching, dangerous as it was, was often the only means by which subjects could be procured. In the United States, where only skeletons could be brought from abroad, this was still more the case, and when the medical school was opened at Harvard College a single body did duty for a year's lectures in anatomical demonstration. Students were forced to learn from books without the aid of practical demonstration and doctors gained knowledge through mistakes, killing not a few patients in the course of their experiments. People were bled for fevers and for fainting fits ; ten grains of calomel was a usual dose for an adult, and cases of salivation, with the loss of teeth were of common occurrence. Still the old country doctor, whose saddle-bags were the only drug store within twenty miles, who was every one's friend and who, for a radius of ten miles or more, ushered all the babies into the world and closed the eyes of the dead, was a power in the land, who ranked next to the justice of the peace, if he was not himself one, and to the minister. He did his best for all his patients, and thought far more of their good than of his fee, often riding ten miles for less than the physician of to-day asks to step next door. With tears in his eyes, he refused cold water to his fevered patients, and denied fresh air to weak lungs, from the kindest of mistaken motives.
Most of the remedies in his saddle-bags are unknown to the present generation, and he had few or none of the weapons with which the medical men of today fight disease and death. Laudanum was the best sedative in his pharmacopoeia, while prior to 1820, he knew quinine only in its original form as Jesuit's or chinchona bark, which, administered in powder, called for such large doses, and was so costly as to be practically useless to the masses. Anaesthetics were unknown until 1846, when sulphuric ether first was used, and there were no antiseptic bandages and no surgical cotton. Well people took huge doses of sulphur and molasses and of jalap, in the spring, to clear their blood. As a rule, it was believed that the efficacy of a drug was in exact proportion to its nauseousness, and no one had faith in small doses.
A college course in the early part of the Nineteenth Century was expensive and not obligatory. To have "read with a doctor" was all that the law required for the granting of a license to practice medicine. In a doctor's office there were usually one or more students whom he taught what he knew, to the best of his ability ; what they learned depended on their own. There were comparatively good medical colleges in Paris and in Vienna in which clinical surgery and medicine were taught. The intellectual awakening resulting from the French Revolution gave an impetus to reform in France, in which medicine participated. Marie Francois Xavier Bichat, who died in 1802 when only thirty-three years of age, in his short life-time, through his "Anatomie generale," supplied a new basis for the science of disease. He was followed by Broussais and Bouillard, who tried to find an anatomical basis for all disease. Broussais is noted for his ex-planation and treatment of fevers, which led to a great misuse of bleeding. It is recorded that he used 100,000 leeches in his own hospital wards in one year.
Avenbrugger, of Vienna, invented direct percussion in the Eighteenth Century. Mediate percussion was introduced by Piorry in 1828. Supplemented by auscultation, it revolutionized the methods of medicine, making possible exact diagnosis. . Auscultation is accomplished by means of the stethoscope. By its use it is practicable to deter-mine the condition of heart and lungs by listening to the sounds produced by their movements. This valuable instrument was in general use abroad long before the average English or American practitioner availed himself of it.
The discovery of anaesthesia conveyed a priceless boon to mankind. Chloroform was discovered in the early thirties by Gruthrie in America, Liebig in Germany, and Soubeiran in France, but not until 1847 was it used as an anaesthetic. In 1839 the surgeon Velpeau wrote :
"The escape from pain in surgical operations is a chimera which it is idle to follow up to-day. 'Knife' and 'pain' in surgery are two words which are always inseparable in the minds of patients, and this necessary association must be conceded."
Yet, during the next few years, various discoveries revolutionized the practice of surgery and banished the intense agony caused by the knife. In 1844 Horace Wells, a Massachusetts dentist, inhaled nitrous oxide and, while he was under its effects, a brother dentist painlessly extracted a tooth. In 1846 William Thomas Green Morton, another dentist, made use of ether as an anaesthetic. It has been claimed that he was not the discoverer of the anaesthetic properties of sulphuric ether, and that Dr. Charles Thomas Jackson revealed to him the secret. However this may be, William T. G. Morton obtained per-mission from Dr. John Collins Warren to etherize a patient on whom the physician was going to operate. This was done in 1846 at the Massachusetts General Hospital. From Boston the use of ether in connection with surgery spread to all parts of the world. In 1847 Dr. James Young Simpson, of Edinburgh, inaugurated the use of chloroform as an anaesthetic. We are told that, while yet a boy studying medicine, Simpson was so overcome by the sight of the sufferings of a woman undergoing a surgical operation, that he resolved to abandon the profession, feeling that he could never learn to endure such sights. But, happily, he altered his decision, determining rather to devote himself to finding something to alleviate or banish the pain of those under the knife.
In those days it was a matter of pride with the surgeon to use the knife quickly and dexterously, so as to perform an operation with the infliction of as little pain as possible. Sir Robert Liston won a brilliant reputation throughout Europe for the extraordinary rapidity with which he could perform the most difficult surgical feats of the day. It is said that he could amputate a thigh in less than a minute. Liston died at the height of his fame in the year that Simpson introduced chloroform as an anaesthetic. It is pleasing to know that he had the extreme pleasure of using anaesthesia before he died. Operations in the days before patients could be "put to sleep" were torture to the surgeon as well as to the patient. In December, 1846, the great surgeon administered ether for the first time in the theater of the University College Hospital. When the operation was finished, according to an eye-witness of the scene, "everybody seemed pale and silent except Liston, who was flushed and so breathless that when he broke the silence with the word, 'Gentlemen,' he almost choked."
Simpson did not consider ether an ideal anaesthetic and continued his experiments after the use of it. He finally found what he wished in chloroform, which he held was particularly adapted to his own department of practice, midwifery. A relative of Simpson's family, Miss Grindlay, tells a dramatic story of his announcement of his discovery. She says that one day he came quickly into the dining-room and, taking a glass from the sideboard and a tiny phial from his pocket, poured a few drops from the phial into the glass, saying, "See, this will turn the world upside down." Then, inhaling the liquid, he fell down unconscious, greatly frightening the family.
Many objections were opposed to the use of anaesthetics. Among others it was seriously argued that as pain was part of the curse of Adam and Eve it was wicked to abolish it. Simpson was ready with an answer to this extraordinary objection. He showed how God himself, when he performed the first surgical operation that of taking a rib from Adam's side, in order to make woman caused the man to fall into a deep sleep.
Ether is preferred as an anaesthetic in America, and chloroform is the favorite in Europe. Through their use wonders have been wrought. Not only are the pain of patients minimized and the evil effects of its dread banished, but the operator is no longer obliged to hasten his work unduly. He is enabled, unhindered by the sufferings and struggles of those under the knife, to proceed slowly and cautiously, with minute attention to detail. All this renders possible operations which could not have been performed in the old days and in the old ways.
Just here antiseptics step in and immeasurably increase the scope and lessen the danger of surgery. Blood-poisoning and other terrible results used to follow almost unfailingly certain sorts of wounds. Simple fractures in which the skin was unbroken used to heal easily and well, but, if there were even a slight break of the skin, the wound would fester and cause great trouble. Amputations were considered necessary in numerous cases which the surgeon 0f to-day finds simple. Such amputations were followed apallingly often by gangrene or other putrefactive processes. Louis Pasteur led the way in discovering that germs or microbes from the air caused the festering and poisoning of wounds. In 1867 Joseph Lister first published his experiments on the antiseptic treatment of wounds. He thoroughly appreciated the work of Pasteur and, applying his theory to the process of healing, recognized that living organisms must be excluded from wounds. On this basis he founded a system of antiseptic surgery which has almost done away with pyaemia, septicaemia, gangrene, and erysipelas, and greatly reduced the mortality in hospitals. Statistics show that in 1861 in the hospitals of Paris, there were three deaths resulting from each five cases of amputation, and the state of affairs in Great Britain, Germany, and Austria was almost as bad. After Lister's introduction of his methods into his hospital wards in Glasgow, the death rate after major amputations fell from 45 to 15 per cent in two years. Later it fell lower still.
In 1881 Professor Koch, of Berlin, announced to the scientific world that perchloride of mercury or corrosive sublimate was a more powerful antiseptic than thymol, eucalyptus oil, iodoform, and boric, salicylic and carbolic acids, which were all in use. This and carbolic acid are now the usual antiseptics. The hands, the clothing, instruments of the operator and his assistants are carefully sterilized before an operation is performed, and the atmosphere is impregnated with an antiseptic. Such treatment is called aseptic and does away with the necessity for disinfecting the wound with chemicals. Armed with antiseptics or the precautions of the newer aseptic methods the surgeon can perform feats which were scarcely imagined half a Century ago.
Diseases of the bones and joints are wonderfully surgeon Reverdin is especially celebrated in connection with skin-grafting on ulcerated surfaces.
The large cavities of the body are all reached by the surgeon's knife. He excels in abdominal operations. He cuts into a kidney or the liver and sews them up again with ease. He can remove one of the kidneys from the body, if necessary, leaving the other to do its work. Or if one of these organs becomes dislocated the surgeon sews it into place. The gall-bladder, the spleen, and the pancreas can each be excised and many inches of the intestine can be cut away. Indeed, in some cases several feet of the intestine have been removed with the successful re-establishment of the alimentary canal. It was William T. Bull who first showed that intestinal wounds can be mended with needle and silk. It is a difficult piece of work and must be accomplished quickly enough to prevent leak-age of the contents. Surgical needle-work is so deftly per-formed that even the suturing of longitudinal wounds of blood-vessels is done. Professor Horoch, of Berlin, has accomplished wonderful feats in the suturing of veins and even arteries. Tumors are removed from the brain, the skull being opened for the purpose, as well as for the stop-page of intracranial bleeding and for the treatment of intracranial abscesses. Lately, surgeons have been trying to cure epilepsy by trephining operations to remove the pressure on the brain, which is thought to be the cause of that disease. The thorax is penetrated for various reasons; sometimes for banishing empymea, and sometimes for operations on the lungs. A wound in the heart has been considered, throughout the ages, absolutely fatal. But Dr. Rehn, of Frankfort-on-the-Main, successfully demonstrated that such is not necessarily the case. He sewed up a cut in the heart occasioned by a knife thrust, and his patient recovered. Thus the very "tripod of life," as Bichat called the brain, the heart and the lungs, are the subjects of the surgeon, who over and over saves a life by his daring and skill where death were else the only chance.
The modern surgeon has a valuable ally in electricity, not only in the treatment of disease, but as an aid to diagnosis. The French scientist Trouve was experimenting with fish when he discovered a way of illuminating the interior of their bodies so that their entire internal anatomy was visible. A fish was tempted to swallow a small electric light bulb which could be withdrawn from its stomach at the will of the scientist, who had attached to it a wire. Trouve was delighted with his invention, which enabled him to study the interior organism of his fish, but the glass bulb was put to another use by a physician who saw it applied to the fish. He persuaded a dyspeptic patient to swallow such a lighted bulb, and found that he could, in a darkened room, see what was the matter with his stomach. The cancer in the stomach of the Count of Paris was discovered in this way. The physicians talked of supplying the count with the stomach of a lamb instead of his own diseased organ, but the risk was so great that the idea was abandoned. It is a common thing nowadays to examine the interior of the bladder with an electric light. The throat is inspected, a search-light being thrown into the wind-pipe to find out if there is anything the matter with that organ. Instruments of the greatest delicacy have been made for removing abnormal growths from the throat when they have been revealed by the electric light. To the layman, however, the most striking use of electric light in surgery is the illumination of the body to discover if anything is wrong with the pharnyx or other cavities behind the face. The whole mask of the face is iliuminated by an electric bulb, and the result is ghastly to the observer.
More wonderful in its results has been the application of the Röentgen Ray to surgical operations. Frederick Strange Kolle, one of the most prominent of the newly arisen specialists in radiography, gives eight uses to which the X-rays can be applied in medicine and surgery. These are : To study normal anatomy; to preserve the relations of fragments in fractures of bones; to study and diagnose its locations; to study and diagnose diseased bone; to diagnose anchylosis of joints; to locate foreign bodies, i. e., bullets, needles, glass, wood, etc., in flesh or bone; it is of diagnostic value in cases of tumors or enlargements of inner organs, such as the spleen, liver, kidney, heart, etc.; in obsetrics radiograms may be used to show the exact relations between the bony pelvis and the foetus in utero.
The fact that certain forms of disease are caused by low organisms was suspected long ago, and expressions of the theory are found in ancient writings. Nevertheless, the establishment of the germ theory of disease and the science of bacteria is recent. Bacteria were described, in the Seventeenth Century, by Leeuwenhoek, who discovered some forms of them, notwithstanding the imperfection of his microscope; but the study of bacteria made little progress until nearly the middle of the Nineteenth Century. The phenomena of fermentation had attracted the attention of scientists, and there was much discussion of the process and its cause. In 1836 Cagniard-Latour detected and described an organism, the yeast plant, on which depends the process of fermentation. The same discovery was made by Schwann, in 1837, and was confirmed in 1843 by Helmholtz. Louis Pasteur elaborated the doctrine through a long course of painstaking experiments, and many other scientists, notably Schultz, Schroeder, Dusch, Lister and Tyndall, added their quota to its establishment. It was shown that fermentation is caused by the presence of such organisms, which grow and multiply in the fermenting fluid. Through the valuable aid of the microscope, other low organisms were also discovered and examined, and it was found that many diseases of plants and animals are caused through such agency. In 1848 Fuchs discovered bacteria in animals which had died of septicaemia, and in 1849 Pollender observed rodlets in the blood of animals sick with anthrax or splenic fever. Soon after, Davaine identified those rodlets as the specific virus of the disease. They are called bacillus anthracis. This was substantial proof of the germ theory. Mainly through the researches of Koch, the life history of various bacteria has been made known. In 1882 the bacillus tuberculosis was discovered by Koch, and asserted to be responsible for consumption. The bacillus of cholera was discovered also by Koch in 1883.
Bacteria pervade the world, and are to be found in all three kingdoms, animal, vegetable and mineral, and wherever the conditions are favorable, they develop and multiply. They are breathed in the human body with the air or are swallowed with every mouthful of food that is taken. If they meet with the proper conditions for their growth and reproduction they may do vast harm. Once in circulation they may be carried to every part of the body and injure its organs. It has recently been discovered that the white corpuscles of the blood are living organ-isms, which are ever on guard to overcome harmful bacteria. The leucocytes, as these white corpuscles are called, are generated by the spleen. They do their work well as long as the bacteria are not too numerous or malignant for them, which is seldom the case when food is good, air and water are pure, and proper sanitary rules are observed.
Bacteria are sedulously studied by scientists who hope to discover the proper means of preventing disease by germ destruction or by inoculation. Thus in 1894 was discovered the antitoxin cure for diphtheria. In order that such profitable investigation may be carried on, much ingenuity is devoted to the cultivation of bacteria, and many ways of securing complete isolation of each kind of bacterium have been introduced. Not only is it necessary to carefully examine each specimen, which is cleverly accomplished by methods of staining, but the life history of each micro-organism must be carefully watched throughout its stages. The micrococci or sphaerobacteria are the kind of bacteria found most often in connection with disease. The bacterium usually is distinguished by the name of the disease of which it is the exciting cause.
Among the remarkable results of Louis Pasteur's re-searches is the method of preventing hydrophobia by inoculation. His first experiment was the inoculation of two rabbits with mucus from the mouth of a child who had died of hydrophobia. This was in December, 1880. Nearly five years after, in July, 1885, the first human being was inoculated for the prevention of the dread disease. This was Joseph Meister, an Alsatian child, who had been severely bitten in fourteen places by a mad dog. Eminent Parisian physicians pronounced the boy almost certain to 'die of hydrophobia. Pasteur treated Joseph with daily injections of a series of spinal cords of rabbits who had been inoculated, beginning with one kept so long that it was too weak to harm even a rabbit, and ending with one virulent enough to give a large dog the rabies in eight days. The successive inoculation lasted thirteen days and prevented the boy's having hydrophobia.
A special feature of the medical science of the present era is its tendency towards specialization. This has given rise to physicians who devote their entire energies to a chosen branch of their profession. Ophthalmology, or the science of the eye, has been carried to a remarkable state of development. Von Helmholtz, the famous German scientist, has been called the "father of the modern school of ophthalmology." He revolutionized the science by the invention of the ophthalmoscope. This is a disk-shaped mirror with a small hole through the center, and is used for examining the interior of the eyes. The physician seats the patient beneath a lighted lamp, and throws a reflected ray of light into the patient's eye, and perceives the interior of the eye illuminated by the ray of light. He can then see how things are, both inside and outside of the organ, and prescribe accordingly. The eye is more thoroughly understood than any other organ of the body, which is well, for, owing to its complicated structure and extreme delicacy, it is peculiarly liable to disease and in-jury. Many diseases which were thought incurable until within the last fifty years, are now constantly remedied. Errors of refraction, such as myopia or short-sightedness, and hypermetropia or far-sightedness, were not well understood until Franz Cornelius Donders, professor of physiology at Utrecht, published his work on "Anomalies of Accommodation and Refraction of the Eye." Long before the Christian Era artificial eyes were made of gold, silver, copper and ivory. Today they are made so ingeniously that it is difficult to detect their presence. The finest ones are made in France, of a superior kind of porcelain, by a secret process. Others are manufactured of glass and come from Germany.
Dentistry is almost entirely a growth of the Nineteenth Century, and a marvelous growth it is. It is claimed that the ancient Egyptians were familiar with some of the methods of modern dentists, but the fact has never been adequately proved. The Greeks and the Romans under-stood a few principles of dental science, and were able to relieve pain and to make false teeth. During the Middle Ages and for long afterward, dentistry shared the fate of medicine and surgery, and made almost no advance; in fact, for centuries its estate was far lower than it had been in ancient times. The barber was the dentist as well as the surgeon, after the Church of Rome forbade priests and monks to perform bloody operations. But surgery rose to the dignity of a profession long before dentistry was regarded as a calling which a gentleman could properly follow. Nor is this to be wondered at when the state of its practice is considered. Pulling teeth and plugging them, as the rude filling of the time was fitly called, were its principal operations.
The American dentist has led the way in the perfection of his art, and he is justly celebrated all over the world. The first native dentist in the United States is supposed to have been John Greenwood, who began to practice in 1788. Thirty-two years after there were one hundred followers of his calling in the United States; in 1892 there were 18,000. So important has the science of the teeth grown that from 1800 to 1892 there were published two hundred volumes devoted to that subject alone. The first dental school in the United States was chartered by the Maryland Legislature in 1839. Since then colleges and schools of dentistry have sprung up all over the land. If there are as good dentists in other countries as there are in this it is largely due to the fact that they have been trained in American schools. Men come from all over the civilized world to the United States for higher education in dentistry. American ingenuity has invented numerous mechanical aids to the practice of the art. From 1880 to 1890 over 500 dental instruments were patented at Washington. In his methods the dentist is well abreast of the times, so that what were considered wonderful labor-saving inventions only a few years ago are being rapidly succeeded by others still more useful and remarkable. The dental engine is now run by electricity instead of by the operator's foot, and the same force has been applied in other ways to assist the practitioner. There is an electric mallet for use in filling excavated cavities, which is both ingenious and useful; there is -an electric syringe for drying out cavities, and small electric lamps are used in connection with reflectors for exploring the mouth. Nor is this all; the new power, compressed air, is used to keep the saliva away from the part of the mouth under treatment.
Before the rise of the American dentist, the most advanced practitioners were to be found in France. The first dentist to set foot in this country was Dr. Joseph Lemaire, who landed in July, 1778. One of the triumphs of American dental science is the implanting of human teeth in artificially formed sockets of the jaw. In 1881 Dr. Younger, of San Francisco, made the first artificial socket for a tooth. He discovered that a tooth that has been extracted, even a long time before, may, after being thoroughly prepared and sterilized, be implanted in such a socket and left with confidence that the bony tissues will harden around it, holding it firmly in place. The operation has been repeated successfully many times since it was first performed by Dr. Younger, although the announcement that it could be done was met with ridicule and incredulity.
In connection with the advancement of medical science must be mentioned the fact, already alluded to, that anaesthesia was a discovery of American dentists, notably of Horace Wells, who made the first use of "laughing gas."
It has been estimated that fully one-third of the teeth extracted in civilized countries are removed while the patients are under the influence of anaesthesia.
Hygiene scarcely existed during the Middle Ages. The ancients had regarded simple laws of health and the prevention of disease, but these were neglected or forgotten, together with many other things, for centuries. The Mohammedans and Jews alone practiced sanitary science. The rest of Europe did not realize that the public health might be preserved and disease prevented by cleanliness and the observation of simple rules of health. The cities of Europe were filthy; there was practically no drainage and people herded together so closely that no one can wonder at the frequent occurrence of terrible epidemics. Such visitations were received as inevitable, and they were allowed to run their death-dealing courses, unchecked. Often the bodies of those who had died with the Black Plague were allowed to lie unburied for days. The one measure for warding off infection was the burning of pitch in the open streets "to purify the air." In the Twelfth Century fifteen epidemics are said to have occurred; in the Thirteenth Century there were at least twenty. The condition of the people can scarcely be conceived. In England, even in the time of Elizabeth, many still lived in clay-plastered hovels. The fireplace was often a place hollowed out in the clay floor and there was no chimney, the smoke escaping through a hole in the roof. The floor was strewn with rushes, "under which," to quote Erasmus, "lies unmolested an ancient collection of beer, grease, fragments, bones, and everything nasty." The use of rushes for a floor covering was by no means confined to the occupants of hovels. We are told that the floor of the presence chamber in Greenwich palace was, at this time, covered with hay. Personal cleanliness was as little understood as the care of the house. Clothing was often worn until ready to drop off with rottenness. The Black Death or Great Pestilence came to Europe from the East. It is estimated that its victims numbered 25,000,000. In 1348 this terrible epidemic visited England, where it raged frightfully, fed by the squalor and filth which it found. Again and again it broke out, until it reached its climax ' in the Great Plague of London in 1665. Another awful epidemic in London was the "sweating sickness," which usually killed its victim in twenty-four hours or less. Erasmus did not hesitate to attribute this dread disease to the filthy habits and neglected surroundings of the people. The Great Fire was a blessing in disguise. It removed many of the impurities and disease centers of the city, and prepared the way for wider streets, better houses and improved paving.
Street paving was one of the things most neglected in the dark ages. In the Moorish cities of Spain fine pavements still remain, testifying to their high civilization, but until the Twelfth Century, the streets of Paris were unpaved. They were then so filthy that it became absolutely necessary to improve them. Paving was followed by a dim perception of the need of some system of drainage, but its evolution was slow indeed. Jail fever was one of the diseases resulting from ignorance of the laws of sanitation. The prisons in England, where the fever was frequent, were vile in the extreme. There was no fit drain-age, or ventilation; and disinfection was poorly practiced, if ever. From the towns in which the prisons were, the fever would often be carried to other places. A Scotch regiment, having become infected through some prisoners, lost two hundred men. In 1750, while attending the assizes at the Old Bailey, the lord mayor, an alderman, two judges, most of the jury and many spectators caught the disease and died of it. Jail fever has been identified as a severe form of typhus fever which, as is well known now, is caused by over-crowding and improper air, the cure being isolation, fresh air and light. The great prison reformer, John Howard, recognized the fact that the ravages of jail fever could be prevented, and he worked until he forced the world to realize it, also, and the prisons were improved. Howard was a martyr to the cause, for, after he had accomplished a vast amount of good in England, he visited other countries, bent on the same good errand and, at last, died of a disease contracted in the course of his humane work. Out of humble beginnings have grown mighty results. The perfect sanitation practiced by many governments render their prisons to-day among the most healthful abodes.
Other steps towards disease prevention were made in the Eighteenth Century. Captain Cook discovered that the scourge of the sailor, scurvy, could be kept away by a proper diet. The value of Captain Cook's methods is realized when the mortality among his crew, during a long voyage, is contrasted with that among Lord Anson's men. Out of 900 men, during a single long voyage, Anson lost 600 from scurvy. Starting out with 118 men, Cook came home, after a three years' voyage, with 114. Of the four who died, not one perished from scurvy. The early years of the Nineteenth Century saw this disease almost stamped out. In 1780 there were 1,457 cases of it received into one naval hospital in England; in 1807 there was but one case. So uncommon has scurvy become, that comparatively few surgeons in the navy, at the present time, have ever seen a case of it, while the whaling crews, which it formerly desolated, are, thanks to the superior food which they now receive, almost exempt from it.
The practice of vaccination began about 1796. It was received, for the most part, with as intense prejudice as inoculation had been before it. Yet, during the first part of the Century, it won its way by the enormous amount of good it accomplished. The decrease in the number of deaths from smallpox was marvelous. In England, prior to 1800, the average annual number of deaths from small-pox per 100,000 of the population was over 700. After 1800 the average was about twenty-five or thirty per 100,-000. Not only did smallpox kill so large a proportion of the population of England, but it disfigured or injured permanently many others. In the years before i800, when the disease was very prevalent, most of the inmates of the blind asylums had lost their sight through its ravages. At the same time, it was calculated that fully thirty per cent of all children born died of smallpox before the end of their first year. In New York between 1785 and 1800 there were 5,756 burials in Trinity and St. Paul's church-yards; of these 610, or a little more than one-ninth, were deaths from smallpox. During the years 1805 and 1806, the population of the city having grown, there were 4,595 burials in the same two cemeteries; 110, or about one-fortieth of the entire number were deaths from smallpox. At the present time, although smallpox has not been universally banished, vaccination has reduced it to a mini-mum.
The progress of medical science and the enlightenment of the people at large, during the Nineteenth Century, have brought about an entirely new attitude in regard to the preservation of individual and, public health. The maintaining of proper sanitary conditions and the pre-venting of the spread of disease are accomplished in in-numerable ways. Municipal government watches over the health of the public. Boards of Health enforce regulations which have been found by experience to be necessary.
Thus in most cities it is required by law that householders and physicians notify the proper authorities of the occurrence of contagious and infectious diseases as soon as their presence is detected, and on the receipt of such notification, proper precautions are taken to prevent their spread. By prompt isolation of the patient thousands of lives may be saved. Health officers inspect the drainage systems, the water supply and general sanitary conditions of the districts under their supervision. Food and drugs are examined, and laws against adulteration are enforced. Instructions on health and science are issued to the people, and there are free dispensaries. In some parts of the world the establishment of free baths and wash-houses has had a noticeable effect on the public health, causing an actual reduction of the number of applications for admission to the hospitals.
Quarantine is the rule at seaports. All incoming vessels are inspected carefully, and no suspicious cases of disease are passed by. Thus, of late years, cholera and other dreaded epidemics have been kept out of the United States and England when they were raging elsewhere. But it is not quarantine alone, efficient though it be, which is restricting the ravages of frightful epidemics. Yellow fever is kept under by proper methods of sanitation. Even in the Southern cities of the Union changed conditions have lessened its terrors. Typhus and typhoid fever, two very different diseases, which, one hundred years ago, were not distinguished between, have each been traced to its true cause and are dealt with accordingly. So it is with many other ailments. Especial progress has been made in the discovery of the nature of zymotic diseases.
Hospitals are, by no means, an innovation of the Nineteenth Century, but until within the last fifty years hospital methods stood in great need of improvement. With the introduction of antiseptic surgery and with the attention to nursing which is characteristic of the age, marvels have been accomplished in the way of life-saving. Improved methods of sanitation and construction are also a product of the thought and ingenuity which have been bestowed on the lodging and caring for the sick and the hurt by the leading physicians and surgeons of the day. With the specialization of the study and practice of the healing art has come a tendency to maintain hospitals for a restricted class of patients. There are lying-in hospitals, hospitals for contagious diseases, children's hospitals, hospitals for the diseases of women, consumptives' hospitals, eye and ear hospitals, hospitals for the insane, and others, each intended for the accommodation of a special kind of the ailing in mind or body. In the treatment of those unfortunate beings who have the misfortune to suffer from mental disease, the Nineteenth Century has made a great advance over previous ages. Lunatics, idiots and all of the insane or unsound in mind used to be considered possessed of devils, and, therefore, were treated harshly, often brutally. Straight-jackets, irons, coercion, chains, and other instruments of torture were the usual apparatus for the treatment of the insane, one hundred years ago. Flogging, starving, solitary confinement in dungeon or cell were all approved methods of dealing with the unhappy inmates of lunatic asylums or hospitals. These methods have been succeeded by reforms so great that the mere mention of the former state of affairs arouses indignation.