The Progress of the Century

by Unknown

In all these laboratories, instead of simply hearing about the experiments and observations, each student is required to handle the drugs, the chemicals, the apparatus, to do all the operations, to look through the microscope, etc.; in other words, to do all that which is necessary for the proper understanding of the case in hand. In fact, it may be said that in view of the opportunities and the requirements of modern hospitals, it is undoubtedly true that a hospital patient, the poorest of the poor, often has his case more thoroughly studied and more accurately observed than the wealthy patient who is attended at his home. On the other hand, however, so many laboratories with their expensive apparatus and a large staff of assistants mean an enormous increase in the expense of a medical education, for which the student does not pay anything like an equivalent. Hence the need in all of our best modern medical schools for endowments, in order that such work may be carried on properly, and yet the student not be charged such fees as to be practically prohibitory, excepting for the rich, or at the least the well-to-do. I do not hesitate to say that at the end of the second year many a diligent student of to-day is better fitted to practise medicine than was the graduate of half a century ago.

ANATOMICAL MATERIAL

One of the most important means of the study of medicine, and especially of surgery, is a thorough acquaintance with the anatomy of the human body. No one would think of placing an engineer in charge of a complicated piece of machinery, who had never become intimately acquainted with all the parts of such a machine, so that he could take it to pieces and put it together again with ease and intelligence. Yet, until comparatively recently, this knowledge of anatomy was both required of, and yet at the same time the means of obtaining it was forbidden to, the medical student. If he performed an operation and was guilty of negligence or error, due to his want of anatomical knowledge, he was liable to a suit for malpractice. Yet his only means of becoming acquainted with the anatomy of the human body was by stealing the bodies of the dead. In England, up to 1832, this was equally true. A regular traffic in human bodies existed there as well as here, and, by reason of its perils, the cost of bodies for dissection was very great; but it was only a question of money. In his testimony before the Parliamentary Committee, Sir Astley Cooper made a shiver run down the backs of the noble lords who listened to him when he said that in order to dissect the body of any of them it was only necessary for him to pay enough. The large pecuniary profits of such business, when the supply was very small, led to the horrible atrocities of Burke and Hare in Edinburgh in 1832. They deliberately murdered a considerable number of persons, and sold the bodies to the dissecting rooms in that city. The discovery of their crimes finally led to the passage of the Anatomy Act, which has been in force in Great Britain ever since. Similar violations of graveyards in this country have led to the passage in various States of somewhat similar laws, usually giving for dissection the bodies of those who were so poor in friendship that no one would spend the money necessary for their burial. Even to-day, in a large number of our States, the former anomalous condition of affairs exists. The increase of anatomical material which has resulted from the enactment of wise and salutary laws for this purpose has given a great impetus to the study of anatomy, and has produced a far better educated class of physicians in most parts of the United States within the last few years. The enlightened sense of the community has perceived that to deny the medical schools the means of properly teaching anatomy was a fatal mistake, and resulted in an ignorance of which the community were the victims. As a result, it is possible now, by law, in most States to obtain a reasonable number of cadavers, not only for the study of anatomy, but for the performance of all the usual operations.

MEDICAL LIBRARIES

Along with this there has been throughout this country a marked movement in favor of medical libraries. It is to the credit of the government of the United States that the whole world is debtor to us, not only for the foremost medical library in the world, that of the surgeon-general of the army in Washington, but also for the magnificent index-catalogue, not only of the books, but all the journal articles in every language in the world. No better investment of money was ever made than the establishment of this library, and its allied museum, and the publication of the index-catalogue.

EMBRYOLOGY

As a result of all these means and methods of study, and as a part of the great educational and scientific movement of the century, medical men now take a wholly different view of the normal and abnormal structures of the human body. The study of embryology has shown us that many of the deviations from the normal development of the human body are easily explained by embryology. One of the most important changes in our idea, for example, of tumors is due to the fact that the study of embryology and of the tissues of the embryo have shown us that diseased structures, which lack explanation entirely, when compared with the adult human tissues, readily find their explanation and fall into an unexpected order when compared with the tissues of the embryo. Not only, however, has the study of embryological tissues thrown a flood of light on diseased structures, but we have obtained new views of the relation of man to all creatures, lower in the scale of life. Largely owing to the doctrine of evolution, we now recognize the fact that, so far as his body is concerned, man is kindred to the brutes; that his diseases, within certain limitations, are identical with similar diseases of the lower animals; that his anatomy and physiology are, in essence, the same as the anatomy and physiology of the lower animals, even the very lowest, and that many of his diseases can be best studied in the lower animals, because upon them we can make exact experiments which would be impossible in man. While it is true that each animal has disorders which are peculiar to itself, and that it is not subject to some of the disorders to which man is a victim, and, per contra, that man is a victim to some disorders from which animals do not suffer, yet, taking them as a whole, the diseases of man and of animals, and the action of remedies on both, are practically identical. To this I shall have occasion to refer again.

PATHOLOGY

Among the laboratories which I mentioned, one of the most important is that of pathology and morbid anatomy, or the study of diseased tissues and organs. The first work on pathology written in this country was by one of our best-known surgeons, the late Samuel D. Gross, and one of his most important contributions to surgical progress consisted in his persistent advocacy of the need for the study of pathology as a basis for all our means of cure. This is evident, if we consider the illustration I used a moment ago of a steam-engine. Unless he knows precisely the defects of such a machine, the influence of fresh or salt water on a boiler, the influence of rust, the effect of oils, entirely apart from the mere mechanism of the engine, an engineer might make the most serious mistake, resulting in fatal damage, both to the machine and probably to life. So, surgical pathology is the study of the processes of disease, the alterations in the minute structure of tissues and organs, without which no surgeon can be fitted for his task, much less can he be called an accomplished surgeon. All of these laboratories mark the difference between the scientific and the empirical method. The old student of medicine went from case to case, heard many a good maxim, and learned many a useful trick; but, after all, it was only an empirical knowledge which he obtained. It did not go to the foundation of things, it was not scientific, as is the collegiate instruction of to-day.

Having now glanced rapidly at the improvement in medical instruction, let me turn next to a few of the principal discoveries which have made the surgery of to-day so much superior to the surgery of a hundred years ago.