THE DOCTOR'S BAG
- the blog about 19th century medicine and surgery
by Keith Souter aka Clay More
The 19th century saw some of the greatest changes in both medicine and surgery, thanks to the germ theory and the introduction of aseptic surgery.
Yet it is wrong to think that there was complete ignorance about infections before this time. Indeed, if we look back through the centuries we can see that there was a slowly developing and evolving concept about the way infections were transmitted.
The Roman scholar and writer Marcus Terentius Varro (116 BC - 27 BC) contributed to many fields of knowledge and wrote over 600 books. Sadly, only one has survived to this day, but he was influential and his writings are referred to by others, including Cicero, Pliny the Elder (who died trying to save friends from the volcanic eruption that destroyed Pompei).
He wrote that swampy lands were dangerous and should be avoided because: 'certain minute animals, invisible to the eye, breed there, and borne of the air reach the inside of the body by way of the mouth and cause disease.'
The Middle Ages
Ever since biblical times people suffering from leprosy were cast out of communities. Over time the condition came to be thought of as a punishment for sins, yet it was also realised that the condition could be transmitted somehow. Accordingly, lepers were made to carry a leper bell, warning people of their presence.
Medieval leper bell at the museum Ribes Vikinger, Ribe, Denmark
During the Middle Ages throughout Europe leper colonies or leper houses started to be used, where people with leprosy were effectively quarantined. They were often run by Roman Catholic monks. These places were often referred to as Lazar houses, named after Lazarus, the patron saint of lepers. We shall be looking at leprosy in a later post.
This segregation of the ill, especially during epidemics was extended to all sorts of illnesses, including the Black Death or 1346-1353 which ravaged Europe.
Ackworth Plague Stone at the top of Castle Syke Hill leading from Ackworth to Pontefract
A small town called Ackworth, a few miles from the author's home, was struck by the Plague in 1645. The town was quarantined, during which time 153 people died. In keeping with the rule of quarantine no-one from the town was permitted to wander beyond the parish boundary. Merchants would leave goods at the boundary beside a plague stone. This was a stone trough filled with vinegar into which money was left to pay for the goods, since it was found that this seemed to protect against the transmission of the disease.
The Elf-shot belief
During the so-called Dark Ages people widely believed that illnesses in people and cattle were caused by elves or fairies who shot with invisible arrows, which they called elf shot. All sorts of talismans were used to try to stave off elf shot and deflect the arrows of malevolent elves.
A commonly used charm was a flint arrowhead. Although in those times people were not aware of it, many of these arrowheads were neolithic and had been used by people who had lived and hunted in the area thousands of years before.
'Elfshot' flint arrowhead
Carrying an elf shot arrowhead was thought to be a powerful health talisman, which had to be kept safely. As with most superstitions, however, it came with a stipulation. That was that once it had been found and picked up t should never be allowed to fall to the ground again, or else it would lose its magic. They were therefore usually tied and worn around the neck. It was also thought that if someone else did succumb to an infection, that they could be helped by immersing the elf-shot in water and giving the liquid to the sufferer.
In later centuries in Scotland elf-shot would be considered tangible evidence of witchcraft and swede often cited during the witch trials that took place between 1563 and 1736. Woe that any local wise woman should be found with one in her possession.
Bad air and bad water
Hippocrates, the father of medicine (circa 460- 375 BC) had taught that many illnesses were caused by drinking tainted water and breathing bad air. This was of course based on observation, for people who drank stagnant water often fell ill. So too did people who lived near swamps and marshes where the air was bad. Indeed, this is how the disease malaria obtained its name from the medieval Italian 'mala aria', which literally means 'bad air.'
Once again, these astute observations became distorted as religion became involved in folk medicine. Flies became associated with bad air. Also, since disease was thought to be bad and caused by evil or malevolent spirits, the old name for Satan - Beelzebub - was considered evidence of his influence, for it literally means 'Lord of the Flies.'
This idea of bad air inevitably led to the idea that good air could counteract it and be sued to combat illness. Accordingly, breathing in sweet smelling herbs like rue and wormwood, coupled with prayers, of course, was thought to be a treatment for all types of contagion.
THE EVOLUTION OF THE GERM THEORYIn 1546 Giralamo Fracastoro, known by his latinised name of Hieronymous Fracastorius, a Veronese scholar, poet and physician wrote a book entitled De Contagione, in which he postulated that infection was spread by tiny living particles that he called seminaria, 'which multiply rapidly and propagate their like.'
Giralamo Fracastoro by Titian
Unfortunately, the majority of doctors of his day did not accept Fracastro's ideas. They still subscribed to the Doctrine of Spontaneous Generation, which had been propounded by Aristotle back in the days of Classical Greece.
Abiogenesis - The Doctrine of Spontaneous Generation
This doctrine was based on empirical observation. It was the belief that creatures could be generated from non-living matter in certain circumstances. Thus the name, a-bio, meaning without life and genesis meaning origin of.
For example, if bread or cheese was wrapped in rags and left in a dark corner, after a few weeks mice would grow spontaneously from them.
The ancient belief that dental caries occurred because of a toothworm was another example. Indeed, this idea persisted right up until the development of then germ theory.
Yet it was the phenomenon of maggots appearing in rotting flesh or on festering wounds that most convinced people that creatures generated spontaneously, since no way that such creatures could suddenly appear.
There was a subtler reason why people accepted spontaneous generation, perhaps. It all may have reinforce the belief that life could be created, just as the bible said that God had created Adam from the dust of the ground.
The invention of the microscope
Science does not advance in a linear fashion. Some of the greatest advances have been the result of chance discovery rather than logical progression. The germ theory was still some way off and some means of seeing beyond the capability of the human eye was needed.
The first compound microscope was invented by Hans and Zacharias Janssen, two Dutch lens grinders in 1590. Their device was a simple arrangement of two lenses mounted in a tube.
The next advance was made by Galileo Galilei (1564-1642), perhaps the greatest scientist of the Renaissance when he invented a really effective compound microscope in 1609, using a convex and concave lens. He called his instrument 'the occhiolino,' or 'the little eye.
Portrait of Galileo by Justus Sustermans 1636
Anton van Leewenhoek (1632-1723) was a Dutch draper living in Delft, who was fascinated by microscopes. He made over four hundred instruments of varying complexity throughout his life, of which nine have survived.
Anton van Leewenhoek subjected everything he could think of, including his own body fluids to microscopic examination. Indeed, one day he used a piece of wire to scrape some matter from between his own two from teeth which he then examined in a drop of water under his microscope. There he saw what he described as animalcules. He said that he saw: 'little animals more numerous than all the people in the Netherlands and moving about in a most delightful manner.'
Grenada stamp to commemorate Anton van Leewenhoek and the microscope that he used to see animalcules
He sent all his findings to the Royal Society in London. Among the 'animalcules' he described as being present in the teeth scrapings, he observed and sent illustrations of other organisms in his body fluids, including protozoa, yeast cells, blood cells, bacteria and spermatozoa. He had literally opened up the microscopic world to scientific interest.
Anton van Leewenhoeck's own drawings of bacteria
The above plate is extracted from Leewenhoeck's letter to the Royal Society. It shows his drawings of bacteria that he found in the scarping from between his teeth. Figures A and B represent rod bacteria and C and D indicate the pathway of their motion in the water. Figure E shows a spherical form, while figure F shows longer types. Figure G is a spiral organism.
A contemporary of his, the English architect, physicist and curator of experiments at the Royal Society, Robert Hooke (1643-1703) also made extensive investigations into the miniature world with his microscope. In his book Micrographia published in 1665 he included a series of beautifully illustrated pictures of the things he saw through the microscope lenses. Among these were pictures of the compound eye of a fly and the first depiction of a plant cell. Indeed, he was the first person to use the word 'cell' in a biological sense, since he likened its appearance to that of a monk's cell, from the Latin cella meaning 'small room.
The illustration of his microscope in Micrographia, 1665
Hooke's contributions to science were phenomenal, yet his place in the history of science was largely suppressed by Sir Isaac Newton, because they had fallen out. Newton removed all references to Hooke in his subsequent books. Interestingly, there are no surviving portraits of this great scientist!
In 1688 the Italian physician Francesco Redi (1626-1678) blew a hole in the Doctrine of Spontaneous Generation by demonstrating that rotting meat or fish do not produce maggots if they are kept away from flies.
He concluded in a series of experiments that flies laid their eggs in the decaying meat or fish and that larvae (maggots) hatched from them and ultimately, turned into adult flies. He did it by using jars into which he put identical quantities of meat or fish. In one they were In one group the jars were covered with gauze which let air in, but excluded entry to flies. The others were left open and exposed to flies. No larvae developed from the fly-excluded jars, but the others produced larvae and then a cocoon stage adult flies.
Front cover of Experiments on the Generation of Insects by Francesco Redi, 1688
Illustration illustrating the life cycle of flies, which disproved the Doctrine of Spontaneous Generation
His book entitled Esperienze Intorno alla Generazione degl'Insetti (Experiments on the Generation of Insects) was published in 1688 and is regarded as one of the classics of science. As you can see from the illustration he included, he accurately described the life cycle of the fly, which undergoes a complete metamorphosis as it develops from egg to larva to pupa to imago or adult fly.
The interesting thing about the story thus far is that although bacteria and other organisms had been described by Anton van Leewenhoeck back in the 17th century, yet no connection was made between them and illness. This was despite the fact that Giralamo Fracastoro had postulated 'seminaria' or seeds of some sort whole century before that in 1564.
In 1835 Agostino Bassi de Lodi (1773-1856) was an Italian entomologist who demonstrated that muscardine, a disease of silkworms (silk production was an important and lucrative industry) was cause by a fungus. This was the first micro-organism to be proven as a causative factor in a disease. This
Agostino Bassi de Lodi
After a decade of research on other diseases he proposed that other diseases like measles, cholera, typhoid, smallpox and syphilis could be caused by micro-organisms. Agostino Bassi de Lodi had effectively proposed a germ theory of disease. Yet it is a French scientist, Louis Pasteur whose name has gone down in history as the originator of the germ theory.
Before that, however, we have to consider the work of Ignatz Semmelweiss (1818-1865) a Hungarian physician who was working as the director of the maternity clinic at the Vienna General Hospital in Austria. The death rate from puerperal fever, otherwise known as childbed fever, was extremely high. He deduced after performing various statistical analyses that women attended in their labour by doctors or medical students had a far higher risk than women delivered by midwives.
Ignatz Semmelweiss in 1860
The reason, he concluded, was that the doctors and medical students did not change clothes or wash their hands between performing operations or autopsies and going to the maternity wards to deliver babies. Something was being transmitted by the unwashed hands. Accordingly, he instituted a rule that hands had to be washed before entering the delivery rooms and the wards. The rate of puerperal fever plummeted.
For his work Semmelweiss became known as the 'saviour of mothers.' Sadly, however, he developed what we now suspect to be early onset Alzheimer's disease (which was not described until the early 20th century). He was admitted to an insane asylum where he was beaten by the staff. Tragically, he died from his injuries.
Louis Pasteur (1822-1895) was a French chemist who was one of the true giants of modern science. He discovered that microbes were responsible for making wine turn sour and that they did this by turning alcohol into vinegar. This led him to develop the process of pasteurisation (named after him) in which bacteria are destroyed by heating beverages and then allowing them to cool. In 1860 the Academy of Science gave him an award for this very important discovery.
Louis Pasteur working on experiments in his laboratory
Pasteur then turned his attention to the study of disease. His researches led him to conclude that micro-organisms were the cause of various infectious diseases. He proposed the germ theory and such was his standing in science that within a short period of time it was widely accepted.
In 1865 building on the work of Agostino Bassi de Lodi he saved the silk industry by showing that if the fungi that caused muscardine in the silkworms could be eliminated then the disease would disappear.
He went on to develop vaccine therapy, producing a vaccine against chicken cholera in 1879. He went on to develop vaccines against anthrax, smallpox, TB, cholera and rabies.
We conclude this overview of the fight against infection with Robert Koch (1843-1910). He was a German physician who is regarded by many as the father of microbiology. He had an advantage over Pasteur in that he was a qualified doctor with a good knowledge of anatomy and physiology.
He also did work on anthrax, but is famous for having devised the four principles of microbiology, known as Koch's postulates.
These are 4 criteria that must be met to demonstrate a cause and effect between an organism and a disease:
1. The organism must always be present, in every case of the disease.
2. The organism must be isolated from a host containing the disease and grown in pure culture.
3. Samples of the organism taken from pure culture must cause the same disease when inoculated into a healthy, susceptible animal in the laboratory.
4. The organism must be isolated from the inoculated animal and must be identified as the same original organism first isolated from the originally diseased host
In Egypt he worked on the devastatingly dangerous disease of cholera and demonstrated that it was caused by Vibrio cholera.
In the 1880s he did ground-breaking work on tuberculosis, applying good laboratory techniques and using his flu Koch postulates, he demonstrated that TB was caused by a bacterium called Mycobacterium tuberculosis. His work won him the 1905 Nobel Prize for Physiology and Medicine.
Next time we will look at Lord Lister and Aseptic Surgery, one of the most important discoveries of medicine and surgery.
Some of Clay More's latest releases:
- a novelette- novella
Sam Gibson used to be a lawman, until the day he made a terrible mistake that could never be taken back. Since then, he has alternated between wishing there were a way he could redeem himself and believing he deserved punishment.
He’s about to get both…
And his collection of short stories about Doc Marcus Quigley is published by High Noon Press
Available at Amazon.com:
And his latest western novel Dry Gulch Revenge was published by Hale on 29th August.