During the century there have appeared in civilized countries two strange and unfamiliar forms of epidemic disease, namely, Asiatic cholera and the plague, the first coming from the valley of the Ganges, the second from the valley of the Euphrates, and each having a long history. A really new disease was the outbreak in Paris in 1892 of a specific contagious disease transmitted from sick parrots, and known as psittacosis. This little epidemic affected forty-nine persons, and caused sixteen deaths. Typhus fever has almost disappeared, while some diseases have increased in relative frequency, in part, at least, because of medical progress. The children who would have died of small-pox in the eighteenth century now live to be affected with diphtheria or scarlet fever, and the increase in the number of deaths reported as due to cancer is partly due to the fact that a greater proportion of people live to the age most subject to this disease.
A large part of modern progress in medicine is due to improved methods of diagnosis, and to the use of instruments of precision for recording the results of examinations. The use of the clinical thermometer has effected a revolution in medical practice. Our knowledge of diseases of the heart and lungs has been greatly expanded during the century by auscultation [trained listening to sounds] and percussion, and especially by the use of the stethoscope. The test-tube and the microscope warn us of kidney troubles which formerly would not have been suspected, and the mysterious Röntgen rays are called in to aid the surgeon in locating foreign bodies and in determining the precise nature of certain injuries of the bones. Bacteriological examination has become a necessary part of the examination in cases of suspected diphtheria, tuberculosis, or typhoid, and a minute drop of blood under the microscope may furnish data which will enable the skilled physician to predict the result in certain cases of anæmia [bloodlessness], or to make a positive diagnosis as between malaria and other obscure forms of periodic fever.
The means at the command of the physician for the relief of pain now include, not only the general anæsthetics,—chloroform, ether, and nitrous oxide,—but also the hypodermic use of the concentrated alkaloids of opium, belladonna, and other narcotics, and the local use of cocaine; and restful sleep for the weary brain may be obtained by sulphonal, chloral, etc. Some agonizing forms of neuralgic pain are now promptly relieved by the section or excision of a portion of the affected nerve; or it may be forcibly stretched into a condition of innocuous desuetude. Relief to the sufferings of thousands of neurotic women, and of their families and friends, has been produced by the systematic scientific application of the rest cure of Dr. Weir Mitchell.
A hundred years ago the medical advertisement which was most prominent in New York and Philadelphia newspapers was one of a remedy for worms. Many symptoms of nervous and digestive troubles in children were in those days wrongly attributed to worms. Nevertheless, there is good reason to believe that parasitic diseases derived from animals were in those days much more prevalent in this country than they are to-day. Our knowledge of the mode of origin and development of the tapeworm, the trichina spiralis, the liver fluke, and the itch insect has been gained during the nineteenth century. Much the same may be said with regard to the peculiar worm known as anchylostum, the cause of Egyptian chlorosis, and of the St. Gothard tunnel disease, although prescriptions for this parasite are found in the Papyrus Ebers, written before the time of Pharaoh.
The limits of this article permit of but a brief reference to the progress in preventive medicine during the century. The studies made in England of the results of the cholera epidemic of 1849, and the experience gained in the English army during the Crimean war, led to some of the most important advances in sanitary science, more especially to the demonstration of the importance of pure water supplies, and of proper drainage and sewerage. During our Revolutionary War, and the Napoleonic wars, the losses to the armies from disease greatly exceeded those from wounds; and hospital fever—in other words, typhus—was dreaded by a general almost more than the opposing forces. During the wars of the last twenty-five years, typhus and hospital gangrene have been unknown, but some extensive outbreaks of typhoid fever have occurred, showing that our knowledge of the causes and mode of transmission of this disease has not been practically applied to the extent to which it should have been; this remark applies also to some of the most fatal diseases in civil life. In the United States diphtheria and typhoid fever each causes from twenty to thirty thousand deaths a year, while more than one hundred thousand deaths are annually due to consumption. Yet for each of these diseases we know the specific germ, the channels through which it is usually conveyed, and the means by which this conveyance can be to a great extent prevented. The ravages of these diseases are, therefore, largely due to the fact that the great mass of the people are still ignorant of these subjects. Antitoxin is not yet used for either prevention or treatment in diphtheria to anything like the extent which our knowledge of its powers demands.
Our better knowledge of the causes of certain infectious and contagious diseases, and of the mode of their spread, has been of great importance to the world from a purely commercial point of view, since it has led to the doing away with many unnecessary obstructions to traffic and travel which were connected with the old systems of quarantine, while the security which has been gained from the modern method of cleansing and disinfection is decidedly greater than that secured by the old methods. A striking illustration of the effect of these improvements is seen in the manner in which the news of the recent outbreak of plague in Glasgow was received in England and throughout Europe. One hundred years ago the city would have been almost deserted, and terror would have reigned in all England. To-day it is well understood that the disease spreads by a bacillus which is not conveyed through the air. No one fears a repetition of the ghastly scenes of the Black Death in the fourteenth century. In like manner, and for the same reasons, Asiatic cholera has lost most of its terrors.
The benefits to the public of modern progress in medicine have been greatly enlarged by the establishment of many small hospitals, and by the steady increase in the employment of specially trained nurses in private practice, even in rural districts. The results of a case of typhoid or of pneumonia often depend as much upon the nurse as upon the doctor; and affection cannot take the place of skill in either. For the great mass of the people, cases of severe illness or injury, or those requiring major surgical operations, can be treated more successfully in well-appointed hospitals than in private houses, and as this is becoming generally understood the old feeling against entering a hospital for treatment is rapidly disappearing. Improvement in hospital construction and management has kept pace with progress in medical knowledge; and in future such institutions seem destined to play an increasingly important part in municipal and village life.
All progress in civilization is attended with injury to some individuals. Trained nurses have deprived some unskilled labour of employment; hospitals have injured the business of some physicians; pure-water supplies, good sewers, food inspection, vaccination,—in short, all effective measures in public hygiene,—interfere with the trade side of medical practice; but upon the whole the public at large benefits by all these things. In one sense they seem opposed to the general law of evolution, in that they prolong the life of the unfit; but in a broader sense they work in accordance with this law by increasing the power of the strong to protect and care for the weak.
All told, the most important feature in the progress of medicine during the century has been the discovery of new methods of scientific investigation, more especially in the fields of bacteriology and pathology. These methods have been as yet only partially applied, and great results are to be hoped from their extension in the near future. They will not lead to the discovery of an elixir of life, and the increasing feebleness of old age will continue to be the certain result of living a long time, for the tissues and organs of each man have a definitely limited term of duration peculiar to himself; but many of the disorders which make life a burden in advancing years can now be palliated, or so dealt with as to secure comparative comfort to the patient, so that “if by reason of strength” life can be prolonged beyond threescore years and ten it no longer necessarily involves labour and sorrow.
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