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24 - Evolution of Modern Medicine by Sir William Osler · Evolution of Modern Medicine

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  Speaker 1: Section twenty three of the Evolution of Modern Medicine. This
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  Speaker 1: is a LibriVox recording. All LibriVox recordings are in the
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  Speaker 1: public domain. For more information or to volunteer, please visit
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  Speaker 1: LibriVox dot org. The Evolution of Modern Medicine by Sir
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  Speaker 1: William Osler, Section twenty three, Chapter five, The Rise and
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  Speaker 1: Development of modern Medicine, Part two. The early years of
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  Speaker 1: the century saw the rise of modern clinical medicine in Paris.
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  Speaker 1: In the art of observation, men had come to a standstille.
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  Speaker 1: I doubt very much whether Corvassans in eighteen hundred was
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  Speaker 1: any more skillful in recognizing a case of pneumonia than
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  Speaker 1: was Auretius in the second century AD. But disease had
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  Speaker 1: come to be more systematically studied. Special clinics were organized,
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  Speaker 1: and teaching became much more au thorough. Anyone who wishes
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  Speaker 1: to have a picture of the medical schools in Europe
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  Speaker 1: in the first few years of the century should read
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  Speaker 1: the account of the travels of Joseph Frank of Vienna.
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  Speaker 1: The description of Corvassas is of a pioneer in clinical
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  Speaker 1: teaching whose method remains invoked today in France. The Ward visit,
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  Speaker 1: followed by a systematic lecturer in the amphitheater. There were
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  Speaker 1: still lectures on Hippocrates three times a week, and bleeding
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  Speaker 1: was the principal plan of treatment. One morning, Frank saw
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  Speaker 1: thirty patients out of one hundred and twelve bled. Corvaissaw
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  Speaker 1: was the strong clinician of his generation, and his accurate
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  Speaker 1: studies on the heart were among the first that had
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  Speaker 1: concentrated attention upon a special organ. To him, too, is
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  Speaker 1: due the reintroduction of the art of percussion in internal disease,
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  Speaker 1: discovered by Allenberger in seventeen sixty one. The man who
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  Speaker 1: gave the grit greatest impetus to the study of scientific
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  Speaker 1: medicine at this time was Bishah, who pointed out that
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  Speaker 1: the pathological changes in disease were not so much in
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  Speaker 1: organs as in tissues. His studies laid the foundation of
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  Speaker 1: modern histology. He separated the chief constituent elements of the
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  Speaker 1: body into various tissues possessing definite physical and vital qualities.
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  Speaker 1: Sensibility and contractability are the fundamental qualities of living matter
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  Speaker 1: and of the life of our tissues. Thus, Bishas substituted
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  Speaker 1: for vital forces vital properties, that is to say, a
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  Speaker 1: series of vital forces inherent in the different tissues. His
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  Speaker 1: Anatomic General, published in eighteen oh two, gave an extraordinary
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  Speaker 1: stimulus to the study of the finer processes of disease,
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  Speaker 1: and his famous Usersche surla viet sur lemore eighteen hundred
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  Speaker 1: felt the death blow to old iatro mechanical and iiotrochemical views.
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  Speaker 1: This celebrated definition may be quoted le viet lossomblas de
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  Speaker 1: propriative vitala quiries his tall proprietive physique boubien la villete
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  Speaker 1: lossmbles de funcion qui resistant alamo. Life is the sum
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  Speaker 1: of the vital properties that withstand the physical properties, or
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  Speaker 1: life is the sum of the functions that withstand death.
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  Speaker 1: Bishah is another pathetic figure in medical history. His meteoric
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  Speaker 1: career ended in his thirty first year. He died, a
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  Speaker 1: victim of post mortem wound infection. At his death, Corvassar wrote,
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  Speaker 1: Napoleon Bishah has just died at the age of thirty.
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  Speaker 1: That battlefield on which he fell is one which demands
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  Speaker 1: courage and claims many victims. He has advanced the science
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  Speaker 1: of medicine. No one at his age has done so much.
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  Speaker 1: So it was a pupil of Corvassar renee thialfil Layonek,
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  Speaker 1: who laid the foundation of modern clinical medicine. Story of
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  Speaker 1: his life is well known. A Breton by birth, he
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  Speaker 1: had a hard, uphill struggle as a young man, a
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  Speaker 1: struggle of which we have only recently been made aware
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  Speaker 1: by the publication of a charming book by Professor Russeau
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  Speaker 1: of Nantes laonik Avant eighteen o six. Influenced by Corvassar,
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  Speaker 1: he began to combine the accurate study of cases in
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  Speaker 1: the wards with anatomical investigations in the dead house. Before layonec,
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  Speaker 1: the examination of a patient had been largely by a
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  Speaker 1: sense of sight supplemented by that of touch, as in
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  Speaker 1: estimating the degree of fever for the character of the pulse.
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  Speaker 1: Allen Berger's inventim novum of percussion, recognized by Corvassar, extended
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  Speaker 1: the field, but the dis discovery of occultation by Layanek
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  Speaker 1: and the publication of his work De le Osco Tession
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  Speaker 1: Medieight in eighteen nineteen marked an era in the study
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  Speaker 1: of medicine. The clinical recognition of individual diseases had made
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  Speaker 1: really very little progress with the stethoscope begins the day
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  Speaker 1: of physical diagnosis. The clinical pathology of the heart, lungs,
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  Speaker 1: and abdomen was revolutionized. Lenik's book is in the category
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  Speaker 1: of the eight or ten greatest contributions to the science
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  Speaker 1: of medicine. His description of tuberculosis is perhaps the most
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  Speaker 1: masterly chapter in clinical medicine. This revolution was effected by
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  Speaker 1: a simple extension of the Hippocratic method from the bed
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  Speaker 1: to the dead house, and by correlating the science and
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  Speaker 1: symptoms of a disease with its anatomical appearances. The pupils
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  Speaker 1: and successors of Corvus, bail andral Boulau, Chomel, Fiori, Pretuneau, Reyer,
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  Speaker 1: Crivilihre and Trousseau brought a new spirit into the profession. Everywhere.
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  Speaker 1: The investigation of disease by clinical pathological methods widened enormously
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  Speaker 1: the diagnostic powers of the physician by this method, Richard
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  Speaker 1: Bright in eighteen thirty six opened a new chapter on
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  Speaker 1: the relation of disease of the kidney to dropsy and
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  Speaker 1: to albuminous urine. It had already been shown by Blackwell
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  Speaker 1: and by Wells. The celebrated Charleston's South Carolina physician in
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  Speaker 1: eighteen eleven that the urine contained albumin in many cases
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  Speaker 1: of dropsy. But it was not until Bright began a
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  Speaker 1: careful investigation of the bodies of patients who had presented
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  Speaker 1: these symptoms that he discovered the association of various forms
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  Speaker 1: of disease of the kidney with anasarca and almamus urine.
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  Speaker 1: In no direction. Was the harvest of this combined study
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  Speaker 1: more abundant than in the complicated and confused subject of fever.
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  Speaker 1: The work of Lewis and of his pupils W. W.
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  Speaker 1: Gerhardt and others revealed the distinction between typhus and typhoid
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  Speaker 1: fever and so cleared up one of the most obscure
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  Speaker 1: problems in pathology. By Morgani's method of anatomical thinking Scota
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  Speaker 1: and Vienna Schanline in Berlin, Graves and Stokes in Dublin, Marshall, Hall, C. J. B.
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  Speaker 1: Williams and many others introduced the new and exact methods
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  Speaker 1: of the French and created a new clinical medicine. A
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  Speaker 1: very strong impetus was given by the researches of Eschau
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  Speaker 1: on cellular pathology, which removed the seats of disease from
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  Speaker 1: the tissues as taught by Bishah, to the individual elements
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  Speaker 1: the cells. The introduction of the use of the microscope
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  Speaker 1: and clinical work widened greatly our powers of diagnosis, and
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  Speaker 1: we obtained thereby a very much clearer conception of the
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  Speaker 1: actual process of a disease. In another way, too, medicine
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  Speaker 1: was greatly helped by the rise of experimental pathology, which
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  Speaker 1: had been introduced by John Hunter, was carried along by
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  Speaker 1: Magendi and others, and reached its culmination in the epic
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  Speaker 1: making researches of Claude Bernard. Not only were valuable studies
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  Speaker 1: made on the action of drugs, but also our knowledge
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  Speaker 1: of cardiac pathology was revolutionized by the work of Traubach,
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  Speaker 1: Conheim and others. In no direction did the experimental method
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  Speaker 1: effect such a revolution as in our knowledge of the
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  Speaker 1: functions of the brain. Clinical neurology, which had received a
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  Speaker 1: great impetus by the studies of Todd, Romberg, Lockhart, Clark,
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  Speaker 1: Dushane and Dwyer Mitchell, was completely revolutionized by the experimental
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  Speaker 1: work of Hitzig, Fritch, and Ferrier on the localistation and
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  Speaker 1: functions in the brain. Under Charceaux, the school of French
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  Speaker 1: neurologists give great accuracy to the diagnosis of obscure affections
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  Speaker 1: on the brain and spinal cord, and the combined results
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  Speaker 1: of the new anatomical, physiological and experimental work have rendered
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  Speaker 1: clear and definite what was formerly the most obscure and
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  Speaker 1: complicated section of internal medicine. The end of the fifth
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  Speaker 1: decade of the century is marked by a discovery of
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  Speaker 1: supreme importance. Humphrey Davy had noted the effects of nitrous oxide,
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  Speaker 1: the exhilarating influence of sulphuric ether had been casually studied,
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  Speaker 1: and Long of Georgia had made patients inhale the vapor
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  Speaker 1: until anesthetic, and had performed operations upon them when in
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  Speaker 1: this state. But it was not until October sixteenth, eighteen
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  Speaker 1: forty six, in the Massachusetts General Hospital, that Morton, in
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  Speaker 1: a public operating room, rendered a patient insensible with ether
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  Speaker 1: and demonstrated the utility of surgical anesthesia. The rival claims
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  Speaker 1: of priority no longer interest us, but the occasion is
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  Speaker 1: one of the most memorable in the history of the race.
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  Speaker 1: It is well that our colleagues celebrate Ether Day in Boston.
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  Speaker 1: No more precious boon has ever been granted to suffering humanity.
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  Speaker 1: In eighteen fifty seven, a young man, Louis Pastor, sent
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  Speaker 1: to the Lilo Scientific Society a paper on lactic acid fermentation,
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  Speaker 1: and in December of the same year presented to the
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  Speaker 1: Academy of Sciences in Paris a paper on alcoholic fermentation,
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  Speaker 1: in which he concluded that the deep duplication of sugar
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  Speaker 1: into alcohol and carbonic acid is correlative to a phenomenon
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  Speaker 1: of life. A new era in medicine dates from those
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  Speaker 1: to publications. The story of Pastor's life should be read
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  Speaker 1: by every student. It is one of the glories of
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  Speaker 1: human literature, and as a record of achievement and of
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  Speaker 1: nobility of character, is almost without an equal. At the
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  Speaker 1: middle of the last century we did not know much
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  Speaker 1: more of the actual causes of the great scourges of
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  Speaker 1: the race, the plagues, the fevers, and the pestilences, than
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  Speaker 1: did the Greeks. Here comes Pastor's great work before him
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  Speaker 1: Egyptian darkness, with his advent, a light that brightens more
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  Speaker 1: and more as the years give us ever fuller knowledge.
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  Speaker 1: The facts that fevers were catching, that epidemics spread, that
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  Speaker 1: infection could remain attached to articles of clothing, etc. All
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  Speaker 1: gave support to the view that the actual cause was
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  Speaker 1: something alive. A contagium vivim was really a very old view,
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  Speaker 1: the germs of which may be found in the fathers,
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  Speaker 1: but which was first clearly expressed, so far as I know,
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  Speaker 1: by Fracastorius, the Viennese physician in the sixteenth century, who
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  Speaker 1: spoke of the seeds of contagion passing from one person
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  Speaker 1: to another, and he first drew a parallel between the
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  Speaker 1: processes of contagion and the fermentation of wine. There was
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  Speaker 1: more than one hundred years before Kircher, Luvenhak and others
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  Speaker 1: began to use the microscope and to see anomalcula et
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  Speaker 1: cetera in water, and so give a basis for the
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  Speaker 1: infinitely little view of the nature of disease germs. And
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  Speaker 1: it was a study of the processes of fermentation that
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  Speaker 1: led Pastor to the shore ground on which we now stand.
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  Speaker 1: Out of these researches arose a famous battle which kept
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  Speaker 1: Pastor hard at work for four or five years, the
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  Speaker 1: struggle over spontaneous generation. It was an old warfare, but
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  Speaker 1: the microscope had revealed a new world, and the experiments
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  Speaker 1: on fermentation had lent great weight to the omni vivum
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  Speaker 1: ex ovo doctrine. The famous Italians Reddy and Spallanzani had
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  Speaker 1: led the way in their experiments, and the latter had
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  Speaker 1: reached the conclusion that there is no vegetable and no
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  Speaker 1: animal that has not its own germ. But heterogenesis became
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  Speaker 1: the burning question, and Pouchet in France and Bastion in
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  Speaker 1: England led the opposition to Pastor. The many famous experiments
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  Speaker 1: carried conviction to the minds of scientific men and destroyed
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  Speaker 1: forever the old belief and spontaneous generation. All along, the
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  Speaker 1: analogy between disease and fermentation must have been in Pastor's mind,
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  Speaker 1: And then came the suggestion, what would be most desirable
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  Speaker 1: is to push those studies far enough to prepare the
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  Speaker 1: road for a serious research into the origin of various diseases.
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  Speaker 1: If the changes in lactic alcohol and bututeric fermentations are
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  Speaker 1: due to minute living organisms, why should not the same
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  Speaker 1: tiny creatures make the changes which occur in the body
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  Speaker 1: in the putrid and supporative diseases. With an accurate training
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  Speaker 1: as a chemist, Having been diverted in his studies upon
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  Speaker 1: fermentation into the realm of biology and nourishing a strong
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  Speaker 1: conviction of the identity between future factive changes of the
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  Speaker 1: body and fermentation, Pastor was well prepared to undertake investigations
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  Speaker 1: which had hitherto been confined to physicians alone. So impressed
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  Speaker 1: was he with the analogy between fermentation and the infectious
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  Speaker 1: diseases that in eighteen sixty three he assured the French
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  Speaker 1: Emperor of his ambition to arrive at the knowledge of
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  Speaker 1: the causes of putrid and contagious disease. After a study
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  Speaker 1: upon the diseases of wines, which has had most important
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  Speaker 1: practical bearings, an opportunity arose which changed the whole course
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  Speaker 1: of his career and profoundly influenced the development of medical science.
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  Speaker 1: A disease of the silkworm had for some years ruined
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  Speaker 1: one of the most important industries in France, and in
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  Speaker 1: eighteen sixty five the government asked Pastor to give up
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  Speaker 1: his laboratory work in teaching and to devote his whole
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  Speaker 1: energies to the task of investigating it. The story of
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  Speaker 1: the brilliant success which followed years of application to the
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  Speaker 1: problem will be read with deep interest by every student
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  Speaker 1: of science. It was the first of his victories in
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  Speaker 1: the application of the experimental methods of a trained chemist
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  Speaker 1: to the problems of biology, and it placed his name
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  Speaker 1: high in the group of the most eluss sstrious benefactors
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  Speaker 1: of practical industries. In a series of studies on the
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  Speaker 1: diseases of beer and on the mode of production of vinegar,
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  Speaker 1: he became more and more convinced that these studies on
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  Speaker 1: fermentation had given him the key to the nature of
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  Speaker 1: the infectious diseases. It is a remarkable fact that the
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  Speaker 1: distinguished English professor of the seventeenth century, the man who
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  Speaker 1: more than anyone else of his century appreciated the importance
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  Speaker 1: of the experimental method, Robert Boyle, had said that he
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  Speaker 1: who could discover the nature of ferments and fermentation, would
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  Speaker 1: be more capable than anyone else of explaining the nature
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  Speaker 1: of certain diseases. In eighteen seventy six, there appeared in
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  Speaker 1: Cones by Tragatsur Morphology Defanzen, Volume two, pages two seventy
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  Speaker 1: seven through three ten, a paper on the ideology of
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  Speaker 1: anthrax by a German district physician in Wolstein, Robert Koch,
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  Speaker 1: which is memorable in our literature as the starting point
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  Speaker 1: of a new method of research. Into the causation of
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  Speaker 1: infectious diseases. Kok demonstrated the constant presence of germs in
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  Speaker 1: the blood of animals dying from the disease. Years before
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  Speaker 1: those organisms had been seen by Pollander and Duvane. But
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  Speaker 1: the epic making advance of Kok was to grow those
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  Speaker 1: organisms in a pure culture outside the body, and to
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  Speaker 1: produce the disease artificially by inoculating animals with the cultures.
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  Speaker 1: Kok is really our medical galilea who, by means of
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  Speaker 1: a new technique, pure cultures and isolated staining, introduced us
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  Speaker 1: to a new world. In eighteen seventy eight followed his
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  Speaker 1: study on the ideology of wound infections, in which he
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  Speaker 1: was able to demonstrate conclusively the association of micro organisms
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  Speaker 1: with the disease. The next great advance was the discovery
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  Speaker 1: by Pastor of the possibility of so attenuating or weakening
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  Speaker 1: the poison that an animal inoculated had a slight attack, recovered,
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  Speaker 1: and was then protected against the disease. More than eighty
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  Speaker 1: years had passed since. On May fourteen, seventeen ninety six,
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  Speaker 1: Jenner had vaccinated a child with cowpox and proved that
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  Speaker 1: a slight attack of one disease protected the body from
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  Speaker 1: a disease of an allied nature. An occasion equally famous
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  Speaker 1: in the history of medicine was a day in eighteen
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  Speaker 1: eighty one when Pasteur determined that a flock of sheep
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  Speaker 1: vaccinated with the attenuated virus of anthrax remained well when
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  Speaker 1: every one of the unvaccinated infected from the same material
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  Speaker 1: had died. Meanwhile, from Pastor's researches on fermentation and spontaneous generation,
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  Speaker 1: a transformation had been initiated in the practice of surgery, which,
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  Speaker 1: it is not too much to say, has proven one
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  Speaker 1: of the greatest boons ever conferred upon humanity. It had
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  Speaker 1: long been recognized that now and again a wound healed
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  Speaker 1: without the formation of pus, that is, without supperation, but
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  Speaker 1: both spontaneous and operative wounds were almost invariably associated with
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  Speaker 1: that process, and moreover, they frequently became futrid, as it
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  Speaker 1: was then called infected, as we should say, the general
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  Speaker 1: system became involved and the patient died of blood poisoning.
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  Speaker 1: So common was this, particularly in old ill equip hospitals,
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  Speaker 1: that many surgeons feared to operate, and the general mortality
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  Speaker 1: in all surgical cases was very high. Believing that it
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  Speaker 1: was from outside that the germs came which caused the
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  Speaker 1: decomposition of wounds. Justice from the atmosphere, the sugar solution
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  Speaker 1: got the germs which caused the fermentation. A young surgeon
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  Speaker 1: in Glascow, Joseph Lister, applied the principles of Pastor's experiments
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  Speaker 1: to their treatment. From Lister's original paper, I quote the following.
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  Speaker 1: Turning now to the question how the atmosphere produces decomposition
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  Speaker 1: of organic substances, we find that a flood of light
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  Speaker 1: has been thrown upon this most important subject by the
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  Speaker 1: philosophic researches of Majeur Pasteur, who has demonstrated by thoroughly
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  Speaker 1: convincing evidence, that it is not to its oxygen or
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  Speaker 1: to any of its gaseous constituents, that the air owes
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  Speaker 1: this property, but to minute particles suspended in it, which
• 20:50
  Speaker 1: are the germs of various low forms of life, long
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  Speaker 1: since revealed by the microscope and regarded as merely accidental
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  Speaker 1: concomon tants of putrescence, but now shown by Pasture to
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  Speaker 1: be its essential cause, resolving the complex organic compounds into
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  Speaker 1: substances of similar chemical constitution, just as the yeast plant
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  Speaker 1: converts sugar into alcohol and carbonic acid. From these beginnings,
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  Speaker 1: modern surgery took its rise, and the whole subject of
• 21:25
  Speaker 1: wound infection, not only in relation to surgical diseases, but
• 21:29
  Speaker 1: to child bed fever forms now one of the most
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  Speaker 1: brilliant chapters in the history of preventative medicine. With the
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  Speaker 1: new technique and experimental methods, the discovery of the specific
• 21:42
  Speaker 1: germs of many of the more important acute infections followed
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  Speaker 1: each other with bewildering rapidity, typhoid fever, diphtheria, cholera, tetanus, plague, pneumonia, gonnorrhea,
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  Speaker 1: and most important of all, tuberculosis. It is not too
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  Speaker 1: much disas say that the demonstration by cock of the
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  Speaker 1: basilis tuberculosis in eighteen eighty two is in its far
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  Speaker 1: reaching results. One of the most momentous discoveries ever made.
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  Speaker 1: Of almost equal value have been the researches upon the
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  Speaker 1: protozoan forms of animal life as causes of disease. As
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  Speaker 1: early as eighteen seventy three, Spirella were demonstrated in relapsing fever.
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  Speaker 1: Laveran proved the association of hematozoa with malaria in eighteen eighty.
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  Speaker 1: In the same year, Griffith Evans discovered tripanosomes in a
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  Speaker 1: disease of horses and cattle in India, and the same
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  Speaker 1: type of parasite was found in the sleeping sickness. Amiba
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  Speaker 1: were demonstrated in one form of dysentery, and in other
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  Speaker 1: tropical diseases. Protozoa were discovered, so that we were really
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  Speaker 1: prepared for the announcement in nineteen oh five by Shao
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  Speaker 1: of the discovery of reprotozoan parasite in syphilis. Just fifty
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  Speaker 1: years had passed since Pastor had sent in his paper
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  Speaker 1: on lactic acid fermentation to the Lila Scientific Society, half
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  Speaker 1: a century in which more had been done to determine
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  Speaker 1: the true nature of disease than in all the time
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  Speaker 1: that had passed since Hippocrates Celsus makes the oft quoted
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  Speaker 1: remark that to determine the cause of a disease often
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  Speaker 1: leads to the remedy, and it is the possibility of
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  Speaker 1: removing the cause that gives such importance to the new
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  Speaker 1: researches on disease. End of Part two, end of Section
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  Speaker 1: twenty three