Prominent among the therapeutic advances of the century is the direct reduction of the high temperature of sunstroke and certain fevers by the use of cold. Although foreshadowed by Currie early in the century by his use of cold affusion in the treatment of scarlet fever, it did not come into general use until the closing decades. It is employed principally in typhoid fever, on the theory that a condition of high fever is in itself a source of danger quite distinct from the other injurious effects of a febrile disease. On the other hand, the employment of high degrees of heat has of late been shown to be a potent agency in the treatment of certain forms of disease, notably in various affections classed as rheumatic. Applications of very hot air, provided it is thoroughly dry, are borne without serious discomfort, and their employment promises to be of greater service in the conditions in which it is resorted to than that of any other agent.
A revelation in the treatment of heart disease has been effected by the Bad Nauheim system of effervescent baths and resisted exercises. It is not only functional disorders of the heart that are relieved, but grave organic diseases also. Somewhat elaborate explanations of the way in which the treatment proves beneficial have been given, but they are not altogether satisfactory.
Thus far we have dealt chiefly with those developments of medicine that seem to have been the outgrowth of much thought and experiment, but there was one that can hardly be viewed as other than a happy discovery, yet it was one that was fraught with unspeakable mitigation of human suffering, and that wrought a boundless extension of the field of surgery. It was that of anaesthesia. The first to discover an efficient surgical anaesthetic was Crawford W. Long, of Georgia. It has been established that he performed several minor operations with the patient anaesthetized with sulphuric ether, but he did not proclaim his discovery, and so it was reserved for William T. G. Morton, of Boston (then a dentist, but subsequently a physician), to make the first public demonstration of the efficiency of ether as an anaesthetic, which he did in the operating theatre of the Massachusetts General Hospital, in Boston, in the year 1846. The news of Morton's achievement spread broadcast, and it was at once realized that it was destined to revolutionize surgery. It certainly has done that, and in no less degree than was afterward accomplished by Listerism. Ether did not long remain the only anaesthetic known; Simpson, of Edinburgh, soon discovered that chloroform was possessed of even more decided anaesthetic properties. The inhalation of ether is disagreeable, and it is slow in producing the desired effect, whereas that of chloroform is not unpleasant, and it acts more rapidly. Consequently chloroform soon came to be generally preferred; but abundant experience has finally shown that ether is much the safer agent of the two, and improved methods of administration have almost entirely done away with the objections to its use, so that now it is looked upon as the preferable general anaesthetic. But general anaesthesia–meaning the suspension of sensibility in the whole organism, including unconsciousness–is not always necessary, and sometimes it is undesirable. We have now trustworthy local anaesthetics, the chief of which is cocaine, wherewith we are able to anaesthetize the part to be operated on without rendering the patient unconscious, and the co-operation that a conscious patient may be able to render is sometimes valuable. It was not alone in the direct saving of human suffering that anaesthetics proved a boon to the world; they have made possible an amount of experimental work on animals in the way of vivisection that humane investigators would otherwise have shrunk from, necessary as it has been and still is for the advancement of the healing art.
The operation of ovariotomy, first performed by Ephraim McDowell, of Kentucky, can hardly be classed with the happy accidents; but so little had been said about it or thought concerning it that when the news of it reached Europe "from the wilds of America" the editor of a ponderous English quarterly journal of medicine recorded his incredulity in the words "Credat Judoeus, non ego" An ovarian tumor inevitably proves fatal in the long run if it is not removed. In a certain percentage of cases it is malignant and will kill whether it is removed or not, but the general result of ovariotomy has been the saving of thousands of women from untimely death. Bell, of Edinburgh, had imagined the operation and had mentioned it in his lectures, but none the less to McDowell is due the credit of demonstrating its feasibility.
Medicine bore quite its full share in the mitigation of the horrors and hardships of war that marked the Nineteenth Century. Its work was shown in the great reduction of pestilential disease incident to camp life, in prompt aid to the wounded, in the establishment of salubrious field and general hospitals, and in improved methods of transportation of the sick and wounded. Certainly the soldier on the sick list never before had such a fair prospect of rejoining his comrades safe and sound as he has now.
In the care of the insane, too–care not only in the sense of humane treatment, but in the systematic employment of measures for their restoration to mental soundness–the century has been marked by notable progress. This has been chiefly in the direction of preventing insanity, and although mental disease is said to be on the increase, it may undoubtedly be said with entire truth that its growing prevalence is not in proportion to the heightened frequency of "the strenuous life." We may confidently expect that a more pronounced mastery over diseases of the mind will come when physicians in general are taught psychiatry clinically, so that the beginnings of mental alienation may be intelligently met by the family practitioner.
The supreme achievement of the medicine of the Nineteenth Century undoubtedly has been the development of its preventive feature. When we recall the fact that but a few years ago an attack of infectious disease was interpreted as a visitation of Providence, by a perversity that even the triumphs of vaccination did not serve to do away with; when we contemplate the well-ordered and well-understood measures that are now resorted to in an ever-increasing number of communities (and resorted to not solely on the outbreak of an epidemic, but at all times), to purify the air we breathe, the food we eat, and the water we drink; and when we reflect upon the greatly reduced morbidity as well as mortality of most infectious diseases–we must realize the immense service that has been rendered by preventive medicine. No doubt we must all die some time, and the day is yet far remote when the only causes of death will be old age and injury; but a decided prolongation of the average lifetime, such as the life-insurance companies recognize, is an unquestionable gain to the human race.
A great blessing that has been brought about in great measure by medical men has been the establishment of the profession of nursing. The work of caring for the sick between the physician's visits is no longer, at least in large communities and in cases of severe illness, left to over-sympathetic and uninstructed relatives or to outsiders who traded on mystery. An intelligent and intelligible record is now kept of all important happenings in the sick room, remedies are administered as they were ordered, needless alarm at something deemed by the patient to be of ill omen is quelled, and in case of real emergency, overlooked as it might otherwise have been, the physician is summoned to meet it. The advent of the trained nurse marked an era in medicine.
The literature of medicine has fully kept pace in volume with the progress of the art itself, and its quality has steadily improved. To this the great tomes of that gigantic work, the "Index-Catalogue of the Library of the Surgeon-General's Office, United States Army," bear solid testimony. It is a consolidated catalogue, by subjects and by authors' names, of practically every medical book published throughout the world and of every article in the periodical literature of medicine. For its existence the world is indebted to Dr. John S. Billings, formerly a surgeon of high rank in the army and now the director of the New York Public Library, and for its continued existence to the United States Government, and it is to be hoped that Congress will never cease to provide adequately for its continued publication. Its completeness and its accuracy long ago led to its being prized everywhere.
There are some problems of which medicine has hardly yet entered upon the solution. Prominent among them is that of cancer. Little as we now know of the real nature of that disease, we know quite as much of it as we knew but a few years ago concerning other diseases equally destructive and far more prevalent, which, however, we have now practically mastered. Who can say that we shall not triumph over cancer while the Twentieth Century is still young? Our final triumph is indubitable.
The strongest individuality in the medicine of the Nineteenth Century was without doubt that of Rudolf Ludwig Karl Virchow (commonly written by him simply Rudolf Virchow). Although he took no direct part in any of the striking advances in practice that appeal to the laity, yet he was recognized the world over, among all classes of educated and well-informed persons, as the one beacon light of Nineteenth-Century medicine whose glow had been the steadiest and the most enduring. This is because of the wide range of his learning in matters not pertaining closely to his profession. His professional brethren hold the same view, and this is because he so well controlled himself–checked himself at every turn by the severest application of system–that he continued for more than half a century an anchor to hold medical thought strictly down to fact. This was from no natural lack of volatility, for he was an Acht-und-vierziger (Forty-eighter). In 1846, as a prosector in the University of Berlin, Virchow entered with Reinhardt upon a series of pathological investigations which at once received wide attention. In conjunction with Reinhardt, he founded the Archiv für pathologische Anatomie und Physiologie und für klinische Medicin6 (a periodical familiarly called "Virchow's Archiv"), the publication of which was begun in the year 1847. Reinhardt died in 1852, leaving the editorship in the hands of Virchow alone, and he was still its editor up to the time of his death, on September 5, 1902.
In consequence of his having openly proclaimed himself a Democrat in 1848, Virchow was forced to retire from the University of Berlin in the following year. He was at once made a professor in the University of Würzburg, whence seven years later, in 1856, as the result of the strenuous interposition of various medical organizations, he was recalled to Berlin, where he was made a professor and director of the Pathological Institute. He was appointed medical privy councillor in 1874, having several years before that entered upon an active political career and been one of the founders of the Progressive party, which he ably represented in the Landtag and the Reichstag. In 1869 he took part in founding the German and the Berlin Anthropological Societies, of each of which he was several times president.
Virchow investigated the most diverse subjects, as his profound studies of Schliemann's discoveries, as well as his other archaeological researches, show, and he was a rather prolific writer. The most important of his early works was Die Cellularpathologie, the first edition of which was published in 1858. Chance's English translation appeared in 1860, and Picard's French version came out in 1861. It is safe to say that no book of the century exerted a profounder influence on medical thought than Virchow's exposition of the cellular pathology. His next notable publication was a collection of thirty lectures on Tumors (Die krankhaften Geschwülste,7 Berlin, 1863-67). That he was not too absorbed in these lectures to bring his great powers to bear upon topics of the day is shown by the fact that before their publication was completed he brought out his work on Trichinae (Darstellung der Lehre von den Trichinen, 1864). Old age found him with industry and versatility unabated, for it was in 1892 that his Crania ethnica americana appeared, and after that time he wrote a vigorous protest against the new-fangled spelling of the German language which he accused the schoolmasters of trying to foist on the people. This was published in his Archiv. It may well be that his arguments have not been unavailing, since it is observable that several German publications that had adopted the new spelling have now dropped it.
It must not be supposed that it was by his literary work alone, founded though it was manifestly on his profound study, that Virchow impressed his personality upon medicine; it was in his lectures and in his laboratory teaching, too, that he made himself felt. In all civilized countries there are many devoted workers in medical science who caught their first real inspiration from Virchow.
The writer once saw Virchow–only once, but it was a sight never to be forgotten. It was at a banquet given as one of the festivities incident to the annual meeting of the British Medical Association in London in 1873. The company was not a large one, but it included such celebrities as Professor J. Burdon Sanderson, Sir William Jenner, Professor Chauveau, and Professor Marey. Virchow was conspicuously the man toward whom the eyes of all others were oftenest directed. Virchow met with the love as well as the admiration of his contemporaries, and both sentiments will descend to their successors, for his impress on the records of medicine is indelible, both as an instructor and as a friend of all real truth-seekers.
AUTHORITIES
There is no full and connected account of the progress of medicine during the Nineteenth Century, but the reader may consult with profit the various medical biographies, also the following works: Silliman's "A Century of Medicine and Chemistry;" Jenner's "The Practical Medicine of To-day;" Buck's "Reference Handbook of the Medical Sciences;" Eulenburg's "Real-Encyclopädie der gesammten Heilkunde;" the "Annus Medicus," published in the Lancet at the close of each year; and Tinker's "America's Contributions to Surgery" (Bulletin of the Johns Hopkins Hospital, Aug.-Sept., 1902).