When the nineteenth century opened, medical men were unaware of the value of auscultation and percussion. They were familiar with the symptoms of fevers and with diseases of the heart and chest, but they had no means of determining differences between them. Textbooks of that time show that the now common forms of heart disease were known only from post-mortem inspections. But they distinctly state that physicians were unable to determine, in case of changes in stricture of the heart's valves, what part was affected. The seat of disease in heart and chest troubles could not be located.
Parasitology was no better advanced. Books published as late as 1810 indicated that parasites, like hydatids, threadworms, etc., were very puzzling phenomena to the physician.
The status of surgery throughout the eighteenth century was very low. The best work was done in France and Holland, until Cheselden, the Hunters, the Monros, and Abernethy established their schools in England and Scotland. German medical practitioners were barbers until after the army authorities formed the Medico-Chirurgical Pépinière in Berlin in 1785. There were several good medical schools in the United States in 1800 including those of the King's College, New York, and of the Harvard, Dartmouth, and Philadelphia Colleges, and the University of Pennsylvania. There were also numerous medical societies. European medical and surgical textbooks were used like those of Cheselden, Monro, Haller, Boerhaave and Sydenham. Medical practice was on the same plane in America as in Europe. There were many patent remedies used, but the authorities recognized the importance of regulating the practice of medicine. Regulation acts were passed in New York City in 1760, New Jersey in 1772, and a general quarantine act was enacted by Congress in 1799.
The modernization of medicine was brought about to a large extent by the publication of the "Conservation of Energy" by Helmholtz, in 1847, and Darwin's "Origin of Species," in 1859. These books cleared away completely the myths and legends which had surrounded medicine at earlier periods, and taught medical students the strict need of proceeding entirely upon scientific grounds precisely as chemists, physicists, engineers, and others were already doing with wonderful success. Darwin's biological teachings appealed very strongly to medical men and influenced all their activities.
Virchow's "Cellular Pathology," published in 1858, Huxley's textbooks on "Physiology" (1866) and on "Vertebrate and Invertebrate Anatomy" (1871-77) Haeckel's "General Morphology" (1866), and numerous medical encyclopedias and textbooks on practice and special diseases were the result of the new scientific spirit. New medical associations were formed and these promoted discussions, the reporting of observations, and the publication of innumerable monographs. Medical journals and magazines of a high character did fine educational work.
The investigations on fermentation and putrefaction made in France by Pasteur caused Joseph Lister, professor of surgery at Glasgow University, to reflect upon the great mortality witnessed daily in the hospitals from pyæmia, erysipelas, tetanus, septicemia, gangrene, and other similar diseases. He observed that in spite of his great care to maintain scrupulous cleanliness in treating wounds, 45 per cent of his surgical cases were mortal. Pasteur's dictum that putrefaction is a micro-organic phenomenon, caused Lister to experiment with the view of preventing the development of microorganisms in wounds. Beginning with weak solutions of zinc chloride and zinc sulphite, he accidentally tried carbolic acid, securing surprising results, and two years later, in 1867, he published his monograph on antiseptic surgery which instantly became world-famous. Lister, instead of being carried away by the celebrity he attained, turned his attention to the scientific development of his important discovery. He investigated lactic-acid fermentation, the relation of bacteria to flesh inflammations and to the best methods of treating wounds antiseptically.
Lister, however, was not the first to employ antiseptics in the treatment of wounds, and his great contribution to medical practice was due to the systematic manner in which he experimented. He was not a brilliant surgeon, but a deliberate and careful one whose chief desire was to have the patient recover. His whole surgical career was guided by this principle which proved so successful that before his death the whole medical profession saluted him as master, and when he died, rejoiced that his remains were entombed in Westminster Abbey.
Theodor Billroth was one of Lister's greatest disciples. He introduced Lister's methods into continental surgery and through their use improved the treatment of wounds and opened up new fields in the surgery of the alimentary tract. He was the first to make a resection of the esophagus and pylorus and to excise the larynx.
Mikulicz-Rodecki, a Pole, was Billroth's chief assistant. He was also a pioneer in Lister's practice. Specializing on the surgery of the alimentary organs, he promoted antiseptic methods and introduced the modern modes of exploring the esophagus and stomach. He was also a master in the treatment of diseases of the mouth.