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November 23 - November 26, 2021
When a distinguished but elderly scientist states that something is possible, he is almost certainly right. When he states that something is impossible, he is almost certainly wrong.
“What a terrible sight an anatomy theatre is! Stinking corpses, livid running flesh, blood, repellent intestines, horrible skeletons, pestilential vapors! Believe me, this is not the place where [I] will go looking for amusement.”
the 1840s, operative surgery was a filthy business fraught with hidden dangers. It was to be avoided at all costs. Due to the risks, many surgeons refused to operate altogether, choosing instead to limit their scope to the treatment of external ailments like skin conditions and superficial wounds.
The physician Thomas Percival advised surgeons to change their aprons and to clean the table and instruments between procedures, not for hygienic purposes, but to avoid “every thing that may incite terror.” Few heeded his advice. The surgeon, wearing a blood-encrusted apron, rarely washed his hands or his instruments and carried with him into the theater the unmistakable smell of rotting flesh, which those in the profession cheerfully referred to as “good old hospital stink.”
At a time when surgeons believed pus was a natural part of the healing process rather than a sinister sign of sepsis, most deaths were due to postoperative infections. Operating theaters were gateways to death. It was safer to have an operation at home than in a hospital, where mortality rates were three to five times higher than they were in domestic settings.
1863, Florence Nightingale declared, “The actual mortality in hospitals, especially in those of large crowded cities, is very much higher than any calculation founded on the mortality of the same class of diseases amongst patients treated out of the hospital wo...
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Paracelsus experimented with ether on chickens, noting that when the birds drank the liquid, they would undergo prolonged sleep and awake unharmed. He concluded that the substance “quiets all suffering without any harm and relieves all pain, and quenches all fevers, and prevents complications in all disease.” Yet it would be several hundred years before it was tested on humans.
This was a gas named after the river Lethe in classical mythology, which made the souls of the dead forget their lives on earth.
“gentleman physicians” held considerable power and influence over the medical community. They were part of the ruling elite, forming the top of a medical pyramid.
In contrast, surgeons came from a long tradition of being trained through apprenticeships, the value of which depended heavily on the master’s capabilities. Theirs was a practical trade, one to be taught by precept and example. Many surgeons in the first decades of the nineteenth century didn’t attend university. Some were even illiterate.
Liston could remove a leg in less than thirty seconds, and in order to keep both hands free, he often clasped the bloody knife between his teeth while working.
Liston’s speed was both a gift and a curse. Once, he accidentally sliced off a patient’s testicle along with the leg he was amputating. His most famous (and possibly apocryphal) mishap involved an operation during which he worked so rapidly that he took off three of his assistant’s fingers and, while switching blades, slashed a spectator’s coat. Both the assistant and the patient died later of gangrene, and the unfortunate bystander expired on the spot from fright. It is the only surgery in history said to have had a 300 percent fatality rate.
two decades immediately following the popularization of anesthesia saw surgical outcomes worsen.
Operating theaters became filthier than ever as the number of surgeries increased.
The surgeon was very much viewed as a manual laborer who used his hands to make his living, much like a key cutter or plumber today. Nothing better demonstrated the inferiority of surgeons than their relative poverty. Before 1848, no major hospital had a salaried surgeon on its staff, and most surgeons (with the exception of a notable few) made very little money from their private practices.
for Jack the Ripper, the “Liston knife” was the weapon of choice for the gutting of victims during his killing spree in 1888.
Bichat’s research led him to conclude that the seat of disease was inside the body and that tissues were distinct entities that could be compromised. This was a departure from prevailing beliefs that disease attacked whole organs or the entire body.
Theirs was a centuries-old battle between reason and superstition: a chance to shed light where there was still scientific darkness.
The best that can be said about Victorian hospitals is that they were a slight improvement over their Georgian predecessors. That’s hardly a ringing endorsement when one considers that a hospital’s “Chief Bug-Catcher”—whose job it was to rid the mattresses of lice—was paid more than its surgeons.
“soldier has more chance of survival on the field of Waterloo than a man who goes into hospital.”
Pregnant women who suffered vaginal tears during delivery were especially at risk in these dangerous environments because these wounds provided welcome openings for the bacteria that doctors and surgeons carried on them wherever they went. In England and Wales in the 1840s, approximately 3,000 mothers died each year from bacterial infections such as puerperal fever (also known as childbed fever).
He also led a scathing attack on homeopathic medicine, which he argued was “perfectly untenable scientifically.”
Contagionists maintained that the only way to prevent and control epidemic diseases was through the use of quarantines and trade restrictions.
In 1844, the physician Neil Arnott summarized anti-contagionism when he argued that the immediate and chief cause of disease in metropolitan areas was “the poison of atmospheric impurity arising from the accumulation in and around [people’s] dwellings of the decomposing remnants of the substances used for food and from the impurities given out from their own bodies.”
Between 1800 and 1850, there were more than two hundred recorded cases of wife sales in England. Undoubtedly, there were more that went unreported.
opium, a drug that had become more popular than alcohol in the nineteenth century due to the ever-expanding British Empire. Before the Pharmacy Act of 1868 limited the sale of dangerous substances to qualified druggists, a person could buy opium from just about anyone, from barbers and confectioners to ironmongers, tobacconists, and wine merchants.
As John Thomas Arlidge—a Victorian doctor who took a keen interest in occupational medicine—observed, “Dust does not kill suddenly, but settles, year after year, a little more firmly into the lungs, until at length a case of plaster is formed. Breathing becomes more and more difficult and depressed, and finally ceases.”
(Syphilis was so common that “no nose clubs” sprang up all over London. One newspaper reported that “an eccentric gentleman, having taken a fancy to see a large party of noseless persons, invited every one thus afflicted, whom he met in the streets, to dine on a certain day at a tavern, where he formed them into a brotherhood.” The man, who assumed the alias of Mr. Crampton for these clandestine parties, entertained his noseless friends every month for a year until his death, at which time the group “unhappily dissolved.”)
In 1884, the American physician William Pancoast injected sperm from his “best-looking” student into an anesthetized woman—without her knowledge—whose husband had been deemed infertile. Nine months later, she gave birth to a healthy baby. Pancoast eventually told her husband what he had done, but the two men decided to spare the woman
the truth. Pancoast’s experiment remained a secret for twenty-five years. After his death in 1909, the donor—a man ironically named Dr. Addison Davis Hard—confessed to the underhanded deed in a letter to Medical World.)
During the two-and-a-half-year conflict, more than eighteen thousand soldiers would die from the disease, which claimed more lives than any other that plagued the British army during the Crimean War.
“Every patient, even the most degraded, should be treated with the same care and regard as though he were the Prince of Wales himself.”
contact of which for a very brief period effects a change in the blood, inducing a mutual reaction between its solid and fluid constituents, in which the corpuscles impart to the liquor sanguinis a disposition to coagulate.”
And so he began subscribing to what was known in the 1860s as the “cleanliness and cold water” school of thought, which drew analogies between the tarnishing of silver and the infections caused by bad air. Advocates of this philosophy knew that if a person dipped a spoon in cold water, it would delay the formation of a sulfide coating. Using that same logic, they thought that by boiling water and letting it cool before washing both the instruments and the wound site, a surgeon could prevent postoperative infections from developing. Their emphasis on cold water specifically was meant to
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Between 1795 and 1860, three doctors put forward the idea that puerperal (or childbed) fever—which, like sepsis, was accompanied by both localized and systemic inflammation—was caused not by miasma but by materies morbi (morbid substances) transmitted from doctor to patient.
Scotsman named Alexander Gordon,
He claimed he could “foretell what women would be affected with the disease, upon hearing by what midwife they were to be delivered, or by what nurse they were to be attended during their lying-in.”
Oliver Wendell Holmes, who was also a physician and later professor of anatomy at Harvard University.
Holmes failed to make an impression on his contemporaries and in the 1850s was attacked for his beliefs by two prominent obstetricians, who thought it was a personal insult to be accused of being the carrier of the very disease they were trying to combat.
Ignaz Semmelweis, who solved the problem of how to prevent childbed fever in Vienna
In 1847, one of his colleagues died after cutting his hand during a postmortem examination. To his surprise, the Hungarian physician realized that the disease that had killed his friend was identical to puerperal fever.
many of these young men went directly from an autopsy to attend to the pregnant women at the hospital.
Semmelweis set up a basin filled with chlorinated water in the hospital. Those passing from the dissection room to the wards were required to wash their hands before attending to living patients. Mortality rates on the medical students’ ward plummeted. In April 1847, the rate was 18.3 percent. After hand-washing was instituted the following month, rates in June were 2.2 percent, followed by 1.2 percent in July and 1.9 percent in August.
His behavior became so erratic and embarrassing to his colleagues that he was eventually confined to a mental institute, where he spent his final days raging about childbed fever and the doctors who refused to wash their hands.
No Scientific subject can be so important to Man as that of his own life. No knowledge can be so incessantly appealed to by the incidents of every day, as the knowledge of the processes by which he lives and acts.
Back in the late 1840s, a physician from Bristol named William Budd argued that the disease was spread by contaminated sewage carrying “a living organism of a distinct species, which was taken by the act of swallowing it, which multiplied in the intestine by self propagation.”
“All discharges from the sick men to be received, on their issue from the body, if possible, into vessels containing a solution of chloride of zinc.”
“The Great Stink” arose from human excrement piled along the riverbanks—a problem that had been growing worse as London became more and more populated. As the scientist Michael Faraday, famed for his work on electromagnetism, observed, “The feculence rolled up in clouds so dense that they were visible at the surface.” As he sailed down the river one afternoon, he noted that the water was an “opaque pale brown fluid.”
fermentation was thought to be a chemical process rather than a biological one.
For some time, he had been interested in the nature of amyl alcohol, which he discovered was a “complex milieu composed of two isomers;
