The awakening came in France. In 1801 Bichat, a young man, published a work on general anatomy, in which he placed the seat of disease, not in the organs, but in the tissues or fabrics of which they were composed, which gave an extraordinary impetus to the investigation of pathological changes. Meanwhile, the study of the appearances of organs and bodies when diseased (morbid anatomy), which had been prosecuted with vigor by Morgagni in the eighteenth century, had been carried on actively in Great Britain and on the Continent, and the work of Broussais stimulated a more accurate investigation of local disorders. The discovery by Laennec of the art of auscultation, by which, through changes in the normal sounds within the chest, various diseases of the heart and lungs could be recognized, gave an immense impetus to clinical research. The art of percussion, discovered by Avenbrugger in the eighteenth century, and reintroduced by Corvisart, contributed not a little to the same. Laennec’s contributions to the study of diseases of the lungs, of the heart, and of the abdominal organs really laid the foundation of modern clinical medicine. A little later Bright published his researches on diseases of the kidneys, from which we date our knowledge of this important subject. One of the most complicated problems of the first half of the century related to the differentiation of the fevers. The eruptive fevers, measles, scarlet fever, and small-pox, were easily recognized, and the great group of malarial fevers was well known; but there remained the large class of continued fevers, which had been a source of worry and dispute for many generations. Louis clearly differentiated typhoid fever, and by the work of his American pupils, W. W. Gerhard and Alfred Stillé, of Philadelphia, and George B. Shattuck, of Boston, typhus and typhoid fevers were defined as separate and independent affections. Relapsing fever, yellow fever, dengue, etc., were also distinguished. The work of Graves and Stokes, of Dublin, of Jenner and Budd, in England, of Drake, Dickson, and Flint, in America, supplemented the labors of the French physicians, and by the year 1860 the profession had reached a sure and safe position on the question of the clinical aspects of fevers.
The most distinguishing feature of the scientific medicine of the century has been the phenomenal results which have followed experimental investigations. While this method of research is not new, since it was introduced by Galen, perfected by Harvey, and carried on by Hunter, it was not until well into the middle of the century that, by the growth of research laboratories, the method exercised a deep influence on progress. The lines of experimental research have sought to determine the functions of the organs in health, the conditions under which perversion of these functions occur in diseases, and the possibility of exercising protective and curative influences on the processes of disease.
The researches of the physiological laboratories have enlarged in every direction our knowledge of the great functions of life—digestion, assimilation, circulation, respiration, and excretion. Perhaps in no department have the results been more surprising than in the growth of our knowledge of the functions of the brain and nerves. Not only has experimental science given us clear and accurate data upon the localization of certain functions of the brain and of the paths of sensatory and of motor impulses, but it has opened an entirely new field in the diagnosis and treatment of the diseases of these organs, in certain directions of a most practical nature, enabling us to resort to measures of relief undreamed of even thirty years ago.
The study of physiology and pathology within the past half-century has done more to emancipate medicine from routine and the thraldom of authority than all the work of all the physicians from the days of Hippocrates to Jenner, and we are as yet but on the threshold.
THE GROWTH OF SPECIALISM
The restriction of the energies of trained students to narrow fields in science, while not without its faults, has been the most important single factor in the remarkable expansion of our knowledge. Against the disadvantages in a loss of breadth and harmony there is the compensatory benefit of a greater accuracy in the application of knowledge in specialism, as is well illustrated in the cultivation of special branches of practice. Diseases of the skin, of the eye, of the ear, of the throat, of the teeth, diseases of women and of children, are now studied and practised by men who devote all their time to one limited field of work. While not without minor evils, this custom has yielded some of the great triumphs of the profession. Dentistry, ophthalmology, and gynæcology are branches which have been brought to a state of comparative perfection, and very largely by the labors of American physicians. In the last-named branch the blessings which have been brought to suffering women are incalculable, not only as regards the minor ailments of life, but in the graver and more critical accidents to which the sex is liable.
One of the most remarkable and beneficial reforms of the century has been in the attitude of the profession and the public to the subject of insanity, and the gradual formation of a body of men in the profession who labor to find out the cause and means of relief of this most distressing of all human maladies. The reform movement inaugurated by Tuke in England, by Rush in the United States, by Pinel and Esquirol in France, and by Jacobi and Hasse in Germany, has spread to all civilized countries, and has led not only to an amelioration and improvement in the care of the insane, but to a scientific study of the subject which has already been productive of much good. In this country, while the treatment of the insane is careful and humanitarian, the unfortunate affiliation of insanity with politics is still in many States a serious hinderance to progress.
It may be interesting to take a glance at the state of medicine in this country at the opening of the nineteenth century. There were only three schools of medicine, the most important of which were the University of Pennsylvania and the Harvard. There were only two general hospitals. The medical education was chiefly in the hands of the practitioners, who took students as apprentices for a certain number of years. The well-to-do students and those wishing a better class of education went to Edinburgh or London. There were only two or three medical journals, and very few books had been published in the country, and the profession was dependent entirely upon translations from the French and upon English works. The only medical libraries were in connection with the Pennsylvania Hospital and the New York Hospital. The leading practitioners in the early years were Rush and Physick, in Philadelphia; Hossack and Mitchill, in New York; and James Jackson and John Collins Warren, in Boston. There were throughout the country, in smaller places, men of great capabilities and energy, such as Nathan Smith, the founder of the Medical Schools of Dartmouth and of Yale, and Daniel Drake in Cincinnati. After 1830 a remarkable change took place in the profession, owing to the leaven of French science brought back from Paris by American students. Between 1840 and 1870 there was a great increase in the number of medical schools, but the general standard of education was low—lower, indeed, than had ever before been reached in the medical profession. The private schools multiplied rapidly, diplomas were given on short two-year sessions, and nothing contributed more to the degeneration of the profession than this competition and rivalry between ill-equipped medical schools. The reformation, which started at Harvard shortly after 1870, spread over the entire country, and the rapid evolution of the medical school has been one of the most striking phenomena in the history of medicine in the century. University authorities began to appreciate the fact that medicine was a great department of knowledge, to be cultivated as a science and promoted as an art. Wealthy men felt that in no better way could they contribute to the progress of the race than by the establishment of laboratories for the study of disease and hospitals for the care of the sick poor. The benefactions of Johns Hopkins, of Sims, of Vanderbilt, of Pierpont Morgan, of Strathcona, of Mount-Stephen, of Payne, and of Levi C. Lane and others have placed scientific medicine on a firm basis.
THE GROWTH OF PREVENTIVE MEDICINE
Sanitary science, hygiene, or preventive medicine may claim to be one of the brightest spots in the history of the nineteenth century. Public hygiene was cultivated among the Egyptians, and in the Mosaic law it reached a remarkable organization. The personal hygiene of the Greeks was embraced in the saying, “The fair mind in the fair body,” and the value of exercise and training was fully recognized. The Romans, too, in public and private hygiene, were our superiors in the matter of water supply and baths. But modern sanitary science has a much wider scope and is concerned with the causes of disease quite as much as with the conditions under which these diseases prevail. The foundations of the science were laid in the last century with Jenner’s discovery of vaccination. Howard, too, had grasped the association of fever with overcrowding in the jails, while the possibility of the prevention of scurvy had been shown by Captain Cook and by Sir Gilbert Blaine.