1. MEDICINE IN THE 19 TH CENTURY Lecture 6

2. Lecture Plan 1.Development of Physiology. 2.Verification of the germ theory. 3.Discoveries in clinical medicine and anaesthesia. 4.Advances at the end of the century.

3. DEVELOPMENT OF PHYSIOLOGY

4. By the beginning of the 19th century, the structure of the human body was almost fully known, due to new methods of microscopy and of injections. Even the body's microscopic structure was understood. But as important as anatomical knowledge was an understanding of physiological processes, which were rapidly being elucidated. By the beginning of the 19th century, the structure of the human body was almost fully known, due to new methods of microscopy and of injections. Even the body's microscopic structure was understood. But as important as anatomical knowledge was an understanding of physiological processes, which were rapidly being elucidated. MEDICINE IN THE 19TH CENTURY

5. In Germany physiology became established as a distinct science under the guidance of Johannes Müller, who was a professor at Bonn and then at the University of Berlin. An energetic worker and an inspiring teacher, he described his discoveries in a famous textbook, Handbuch der Physiologie des Menschen (“Manual of Human Physiology”), published in the 1830s. In Germany physiology became established as a distinct science under the guidance of Johannes Müller, who was a professor at Bonn and then at the University of Berlin. An energetic worker and an inspiring teacher, he described his discoveries in a famous textbook, Handbuch der Physiologie des Menschen (“Manual of Human Physiology”), published in the 1830s. MEDICINE IN THE 19TH CENTURY

6. Hermann von Helmholtz German scientist, made groundbreaking contributions to physiology and physics in the 19th century.

7. Among Müller's illustrious pupils were Hermann von Helmholtz, who made significant discoveries relating to sight and hearing and who invented the ophthalmoscope; and Rudolf Virchow, one of the century's great medical scientists, whose outstanding achievement was his conception of the cell as the centre of all pathological changes. Among Müller's illustrious pupils were Hermann von Helmholtz, who made significant discoveries relating to sight and hearing and who invented the ophthalmoscope; and Rudolf Virchow, one of the century's great medical scientists, whose outstanding achievement was his conception of the cell as the centre of all pathological changes. MEDICINE IN THE 19TH CENTURY

8. In France the most brilliant physiologist of the time was Claude Bernard, whose many important discoveries were the outcome of carefully planned experiments. His researches clarified the role of the pancreas in digestion, revealed the presence of glycogen in the liver, and explained how the contraction and expansion of the blood vessels are controlled by vasomotor nerves. He proposed the concept of the internal environment—the chemical balance in and around the cells—and the importance of its stability. In France the most brilliant physiologist of the time was Claude Bernard, whose many important discoveries were the outcome of carefully planned experiments. His researches clarified the role of the pancreas in digestion, revealed the presence of glycogen in the liver, and explained how the contraction and expansion of the blood vessels are controlled by vasomotor nerves. He proposed the concept of the internal environment—the chemical balance in and around the cells—and the importance of its stability. MEDICINE IN THE 19TH CENTURY

9. VERIFICATION OF THE GERM THEORY

10. Perhaps the overarching medical advance of the 19th century, certainly the most spectacular, was the conclusive demonstration that certain diseases, as well as the infection of surgical wounds, were directly caused by minute living organisms. This discovery changed the whole face of pathology and effected a complete revolution in the practice of surgery. Perhaps the overarching medical advance of the 19th century, certainly the most spectacular, was the conclusive demonstration that certain diseases, as well as the infection of surgical wounds, were directly caused by minute living organisms. This discovery changed the whole face of pathology and effected a complete revolution in the practice of surgery. MEDICINE IN THE 19TH CENTURY

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

12. The main credit for establishing the science of bacteriology must be accorded to the French chemist Louis Pasteur. It was Pasteur who, by a brilliant series of experiments, proved that the fermentation of wine and the souring of milk are caused by living microorganisms. His work led to the pasteurization of milk and solved problems of agriculture and industry as well as those of animal and human diseases. He successfully employed inoculations to prevent anthrax in sheep and cattle, chicken cholera in fowl, and finally rabies in humans and dogs. The main credit for establishing the science of bacteriology must be accorded to the French chemist Louis Pasteur. It was Pasteur who, by a brilliant series of experiments, proved that the fermentation of wine and the souring of milk are caused by living microorganisms. His work led to the pasteurization of milk and solved problems of agriculture and industry as well as those of animal and human diseases. He successfully employed inoculations to prevent anthrax in sheep and cattle, chicken cholera in fowl, and finally rabies in humans and dogs. MEDICINE IN THE 19TH CENTURY

13. Louis Pasteur and his device for germ experiment. MEDICINE IN THE 19TH CENTURY

14. Pasteur studied alcoholic fermentation and lactic fermentation in sour milk; he found that both fermentations were caused by minute organisms, and were hastened by exposure to the air. He proved that the microscopic organisms were not spontaneously generated but were introduced by air. Pasteur studied alcoholic fermentation and lactic fermentation in sour milk; he found that both fermentations were caused by minute organisms, and were hastened by exposure to the air. He proved that the microscopic organisms were not spontaneously generated but were introduced by air. MEDICINE IN THE 19TH CENTURY

15. Joseph Lister MEDICINE IN THE 19TH CENTURY

16. From Pasteur, Joseph Lister derived the concepts that enabled him to introduce the antiseptic principle into surgery. In 1865 Lister, a professor of surgery at Glasgow University, began placing an antiseptic barrier of carbolic acid between the wound and the germ- containing atmosphere. Infections and deaths fell dramatically, and his pioneering work led to more refined techniques of sterilizing the surgical environment. From Pasteur, Joseph Lister derived the concepts that enabled him to introduce the antiseptic principle into surgery. In 1865 Lister, a professor of surgery at Glasgow University, began placing an antiseptic barrier of carbolic acid between the wound and the germ- containing atmosphere. Infections and deaths fell dramatically, and his pioneering work led to more refined techniques of sterilizing the surgical environment. MEDICINE IN THE 19TH CENTURY

17. Lister saw that sepsis was the principal obstacle to any great advantage in surgery. Finally, noting that closed wounds did not suppurate while open ones ex­posed to the air did, he concluded that suppuration was in some manner due to contact with the air but that the air alone did not cause suppuration. Lister saw that sepsis was the principal obstacle to any great advantage in surgery. Finally, noting that closed wounds did not suppurate while open ones ex­posed to the air did, he concluded that suppuration was in some manner due to contact with the air but that the air alone did not cause suppuration. MEDICINE IN THE 19TH CENTURY

18. He found the solution of his problem in the work of Louis Pasteur on fermen­tation and putrefaction; it was not the air but the germs in the air that produced sup­puration. He saw at once that putrefaction could only be avoided by preventing germs from gaining access to wounds. He looked around for a suitable antiseptic, and chose carbolic acid. With it Lister made his first antiseptic dressing in March, 1865. He found the solution of his problem in the work of Louis Pasteur on fermen­tation and putrefaction; it was not the air but the germs in the air that produced sup­puration. He saw at once that putrefaction could only be avoided by preventing germs from gaining access to wounds. He looked around for a suitable antiseptic, and chose carbolic acid. With it Lister made his first antiseptic dressing in March, 1865. MEDICINE IN THE 19TH CENTURY

19. The antiseptic doctrine did not have a sympathetic reception in England: it was attacked by some medical men. Lister nevertheless went ahead with his experiments to improve his method. After a while he stopped using undiluted carbolic acid to purify recent wounds because he found that it caused superficial sloughing. A five per cent watery solution proved to be strong enough for his purposes. The antiseptic doctrine did not have a sympathetic reception in England: it was attacked by some medical men. Lister nevertheless went ahead with his experiments to improve his method. After a while he stopped using undiluted carbolic acid to purify recent wounds because he found that it caused superficial sloughing. A five per cent watery solution proved to be strong enough for his purposes. MEDICINE IN THE 19TH CENTURY

20. Obstetrics had already been robbed of some of its terrors by Alexander Gordon at Aberdeen, Scotland, Oliver Wendell Holmes at Boston, and Ignaz Semmelweis at Vienna and Pest (Budapest), who advocated disinfection of the hands and clothing of midwives and medical students who attended confinements. These measures produced a marked reduction in cases of puerperal fever, the bacterial scourge of women following childbirth. Obstetrics had already been robbed of some of its terrors by Alexander Gordon at Aberdeen, Scotland, Oliver Wendell Holmes at Boston, and Ignaz Semmelweis at Vienna and Pest (Budapest), who advocated disinfection of the hands and clothing of midwives and medical students who attended confinements. These measures produced a marked reduction in cases of puerperal fever, the bacterial scourge of women following childbirth. MEDICINE IN THE 19TH CENTURY

21. Another pioneer in bacteriology was the German physician Robert Koch, who showed how bacteria could be cultivated, isolated, and examined in the laboratory. A meticulous investigator, Koch discovered the organisms of tuberculosis, in 1882, and cholera, in 1883. By the end of the century many other disease- producing microorganisms had been identified. Another pioneer in bacteriology was the German physician Robert Koch, who showed how bacteria could be cultivated, isolated, and examined in the laboratory. A meticulous investigator, Koch discovered the organisms of tuberculosis, in 1882, and cholera, in 1883. By the end of the century many other disease- producing microorganisms had been identified. MEDICINE IN THE 19TH CENTURY

22. Robert Koch MEDICINE IN THE 19TH CENTURY

23. In 1882 Koch discovered tuberculosis bacilli. Due to his discovery Koch became known all over the world. In 1884 Koch published his book on cholera. This book included the investigations of his research work carried out during the cholera epidemic in Egypt and India. From the intestines of the men with cholera Koch isolated a small comma-shaped bacterium. He determined that these bacteria spread through drinking water. In 1882 Koch discovered tuberculosis bacilli. Due to his discovery Koch became known all over the world. In 1884 Koch published his book on cholera. This book included the investigations of his research work carried out during the cholera epidemic in Egypt and India. From the intestines of the men with cholera Koch isolated a small comma-shaped bacterium. He determined that these bacteria spread through drinking water. MEDICINE IN THE 19TH CENTURY

24. DISCOVERIES IN CLINICAL MEDICINE AND ANAESTHESIA

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

26. In Dublin Robert Graves and William Stokes introduced new methods in clinical diagnosis and medical training; while in Paris a leading clinician, Pierre-Charles-Alexandre Louis, was attracting many students from America by the excellence of his teaching. In Dublin Robert Graves and William Stokes introduced new methods in clinical diagnosis and medical training; while in Paris a leading clinician, Pierre-Charles-Alexandre Louis, was attracting many students from America by the excellence of his teaching. MEDICINE IN THE 19TH CENTURY

27. The most famous contribution by the United States to medical progress at this period was undoubtedly the introduction of general anaesthesia, a procedure that not only liberated the patient from the fearful pain of surgery but also enabled the surgeon to perform more extensive operations. The discovery was marred by controversy. Crawford Long, Gardner Colton, and Horace Wells are all claimants for priority. The most famous contribution by the United States to medical progress at this period was undoubtedly the introduction of general anaesthesia, a procedure that not only liberated the patient from the fearful pain of surgery but also enabled the surgeon to perform more extensive operations. The discovery was marred by controversy. Crawford Long, Gardner Colton, and Horace Wells are all claimants for priority. MEDICINE IN THE 19TH CENTURY

28. Crawford Long, American physician, is traditionally considered the first to have used ether as an anesthetic in surgery. He observed that persons injured in “ether frolics” (social gatherings of people who were in a playful state of ether-induced intoxication) seemed to suffer no pain, and in 1842 he painlessly removed a tumour from the neck of a patient to whom he had administered ether. Crawford Long, American physician, is traditionally considered the first to have used ether as an anesthetic in surgery. He observed that persons injured in “ether frolics” (social gatherings of people who were in a playful state of ether-induced intoxication) seemed to suffer no pain, and in 1842 he painlessly removed a tumour from the neck of a patient to whom he had administered ether. MEDICINE IN THE 19TH CENTURY

29. Gardner Colton, American anesthetist and inventor, was among the first to utilize the anesthetic properties of nitrous oxide in medical practice. After a dentist suggested the use of the gas as an anesthetic, Colton safely used it in extracting thousands of teeth. As he was studying medicine in New York (without taking a degree), Colton learned that the inhalation of nitrous oxide, or laughing gas, produced exhilaration. After a public demonstration of its effects in New York City proved to be a financial success, he began a lecture tour of other cities. Gardner Colton, American anesthetist and inventor, was among the first to utilize the anesthetic properties of nitrous oxide in medical practice. After a dentist suggested the use of the gas as an anesthetic, Colton safely used it in extracting thousands of teeth. As he was studying medicine in New York (without taking a degree), Colton learned that the inhalation of nitrous oxide, or laughing gas, produced exhilaration. After a public demonstration of its effects in New York City proved to be a financial success, he began a lecture tour of other cities. MEDICINE IN THE 19TH CENTURY

30. Horace Wells, American dentist, was a pioneer in the use of surgical anesthesia. While practicing in Hartford, Connecticut, in 1844, Wells noted the pain-killing properties of nitrous oxide (“laughing gas”) during a laughing-gas road show and thereafter used it in performing painless dental operations. He was allowed to demonstrate the method at the Massachusetts General Hospital in January 1845, but when the patient proved unresponsive to the gas, Wells was exposed to ridicule. Horace Wells, American dentist, was a pioneer in the use of surgical anesthesia. While practicing in Hartford, Connecticut, in 1844, Wells noted the pain-killing properties of nitrous oxide (“laughing gas”) during a laughing-gas road show and thereafter used it in performing painless dental operations. He was allowed to demonstrate the method at the Massachusetts General Hospital in January 1845, but when the patient proved unresponsive to the gas, Wells was exposed to ridicule. MEDICINE IN THE 19TH CENTURY

31. It was William Thomas Morton who, on Oct. 16, 1846, at Massachusetts General Hospital, in Boston, first demonstrated before a gathering of physicians the use of ether as a general anaesthetic. He is credited with gaining the medical world's acceptance of surgical anesthesia. The news quickly reached Europe, and general anaesthesia soon became prevalent in surgery. It was William Thomas Morton who, on Oct. 16, 1846, at Massachusetts General Hospital, in Boston, first demonstrated before a gathering of physicians the use of ether as a general anaesthetic. He is credited with gaining the medical world's acceptance of surgical anesthesia. The news quickly reached Europe, and general anaesthesia soon became prevalent in surgery. MEDICINE IN THE 19TH CENTURY

32. At Edinburgh, the professor of midwifery, James Young Simpson, had been experimenting upon himself and his assistants, inhaling various vapours with the object of discovering an effective anaesthetic. He was the first to use chloroform in obstetrics and the first in Britain to use ether. In November 1847 chloroform was tried with complete success, and soon it was preferred to ether and became the anaesthetic of choice. At Edinburgh, the professor of midwifery, James Young Simpson, had been experimenting upon himself and his assistants, inhaling various vapours with the object of discovering an effective anaesthetic. He was the first to use chloroform in obstetrics and the first in Britain to use ether. In November 1847 chloroform was tried with complete success, and soon it was preferred to ether and became the anaesthetic of choice. MEDICINE IN THE 19TH CENTURY

33. ADVANCES AT THE END OF THE CENTURY

34. Patrick Manson, a British pioneer in tropical medicine, showed in China, in 1877, how insects can carry disease and how the embryos of the Filaria worm, which can cause elephantiasis, are transmitted by the mosquito. Manson explained his views to a British army surgeon, Ronald Ross, then working on the problem of malaria, and Ross discovered the malarial parasite in the stomach of the Anopheles mosquito in 1897. Patrick Manson, a British pioneer in tropical medicine, showed in China, in 1877, how insects can carry disease and how the embryos of the Filaria worm, which can cause elephantiasis, are transmitted by the mosquito. Manson explained his views to a British army surgeon, Ronald Ross, then working on the problem of malaria, and Ross discovered the malarial parasite in the stomach of the Anopheles mosquito in 1897. MEDICINE IN THE 19TH CENTURY

35. In Cuba, Carlos Finlay expressed the view, in 1881, that yellow fever is carried by the Stegomyia mosquito. Following his lead, the Americans Walter Reed, William Gorgas, and others were able to conquer the scourge of yellow fever in Panama and made possible the completion of the Panama Canal by reducing the death rate there from 176 per 1,000 to 6 per 1,000. In Cuba, Carlos Finlay expressed the view, in 1881, that yellow fever is carried by the Stegomyia mosquito. Following his lead, the Americans Walter Reed, William Gorgas, and others were able to conquer the scourge of yellow fever in Panama and made possible the completion of the Panama Canal by reducing the death rate there from 176 per 1,000 to 6 per 1,000. MEDICINE IN THE 19TH CENTURY

36. Other victories in preventive medicine ensued, because the maintenance of health was now becoming as important a concern as the cure of disease; and the 20th century was to witness the evolution and progress of national health services in a number of countries. Other victories in preventive medicine ensued, because the maintenance of health was now becoming as important a concern as the cure of disease; and the 20th century was to witness the evolution and progress of national health services in a number of countries. MEDICINE IN THE 19TH CENTURY

37. In addition, spectacular advances in diagnosis and treatment followed the discovery of X rays by Wilhelm Conrad Röntgen, in 1895, and of radium by Pierre and Marie Curie in 1898. Before the turn of the century, too, the vast new field of psychiatry had been opened up by Sigmund Freud. In addition, spectacular advances in diagnosis and treatment followed the discovery of X rays by Wilhelm Conrad Röntgen, in 1895, and of radium by Pierre and Marie Curie in 1898. Before the turn of the century, too, the vast new field of psychiatry had been opened up by Sigmund Freud. MEDICINE IN THE 19TH CENTURY

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

39. Дякую за увагу! Thank you for your attention! Merci de votre attention! Dziękuję za uwagę! Danke für Ihre Aufmerksamkeit! Grazie dell'attenzione!