History 104: Western Civilization since 1648
Lecture: 19th Century Society

Medicine click here for audio

The 19th century experienced a revolution in medicine.

18th century battlefieldsAmputation Case

The foundation of this revolution was the gentlemanly wars of the 18th century. Surgeons reigned supreme on the battlefield. They were not physicians: physicians did house calls, gave potions, and demonstrated a proper bedside manner. They tended to be aristocrats. But surgeons were craftsmen, and the battlefield was an excellent workshop. Necessity was the mother of invention. Surgeons learned that irrigated wounds healed faster when they ran out of the usual ointments. They discovered that liberal use of alcohol and tobacco made setting fractures easier, and that operations should wait until shock was treated (though amputations had to be done within 24 hours). When no needle or thread was available, they developed skin grafting, which also helped with burns. All these techniques, and more, were used routinely in hospitals by 1800. doctor examining boy with tube-type stethoscope

examination techniques

Prior to the 19th century, examinations of the patient were based to a large extent on the patient's own view of his/her illness. If a patient refused treatment, the doctor's reputation would be in jeopardy, so trust was very important.

But by the 19th century, exams were based on new ideas, developed due to new technologies. Philippe Pinel developed the idea of separate tissue types, popularizing the notion that disease could be traced to certain organs. He used observation and statistics, and his ideas led to improvements in post-mortem analysis of diseases. But the stethoscope was clearly the most important device. Developed by Dr. Laennec, it was at first just a cylinder of cardboard for hearing internal sounds of the body. A doctor with training and experience could identify emphysema, pneumonia, or tuberculosis just by listening.

Examinations of women were hampered by Victorian modesty: image of doctor putting hands under skirt of fully-dressed patient

What this meant was that the doctor knew more than the patient about the patient's condition. As further devices were developed, the patient's interpretation became less important. Thus the doctor's relationship with the patient became less critical, and the doctor's relationship with other doctors (the "medical community") became more important.

anesthesia: nitrous -> ether -> chloroform

The development of anesthesia was the result of investigation into air and gasses. Nitrous oxide was isolated by a medical assistant in Bristol who breathed some in 1798. This "laughing gas" was good for light anesthesia (as it is used today at dentists' offices), but it was most popular as a party drug.

For extensive surgeries, the first major development was ether, the gas of which was breathed to create the first deep anesthesia. It was first used in the removal of a neck tumor in the 1840s. For the first time, surgeons had time to work on deep cases inside cavities of the body, without relying on pain-induced unconsciousness or unreliable methods like drunkenness. Inhaler apparatusEther drops could be administered on a mask over the patient's nose and mouth until the patient was deeply asleep, and the dosage was somewhat forgiving. The problem with ether was that it smelled horrible, sometimes causing the patient to vomit and choke. It was also highly explosive.

Chloroform was the answer to these difficulties. It was not as flammable, and more pleasant to breathe than ether. It was, however, more dangerous in that exact dosage was required (thus leading to the specialty of anesthesiology). Queen Victoria, with her physician John Snow (who also had helped clean up the water system in London), popularized the use of chloroform for childbirth. The delivery of her seventh child convinced her to try light anesthesia for her eighth, ninth and tenth deliveries. She was so happy with it that anesthesia became the norm among the elite, and eventually acceptable to all.


Various theories of the spread of infection were popular in the 19th century. Among them was the idea that putrid gas (miasma) spread disease from filth. In 1831, the first cholera epidemic in Lister's Carbolic Spray deviceLondon provided an opportunity for study. Cholera causes diarrheah, vomiting, loss of fluid, limb and abdominal pain, greying skin, and ultimately death. Data was kept about where the most deaths occurred, enabling John Snow and others to trace a connection to the water and sewage systems in 1853. Sand filters installed on the drinking water lines stopped the epidemic. Cholera poster warning not to drink water that hasn't been boiledBy 1850, Pasteur's germ theory was dominating thought, and disinfectants (such as alcohol and vinegar) were in use. One of the most persistent killers was post-operative infection or sepsis (also the major cause of death in childbirth). In 1865, Joseph Lister (Listerine?) developed the use of carbolic acid (phenol) as an antiseptic. Carbolic was sprayed over the open cavity of a person being operated on, which helped kill germs on instruments within the body cavity. At the time, surgeons wore street clothes to operate, usually with an apron. In 1878, Robert Koch used hot steam to sterilize instruments and other tools in the operating room, creating the "aseptic surgery" that is standard today. Perhaps it's a good time to point out that as early as the first cholera outbreak (1831), Samuel Hahnemann (below) was already using sterilization.

homeopathy Statue of Hahnemann

The physician's highest calling, his only calling, is to make sick people healthy --- to heal --- as it is termed. The highest ideal of therapy is to restore health rapidly, gently, permanently; to remove and destroy the whole disease in the shortest, surest, least harmful way, according to clearly comprehensible principles.
Samuel Hahnemann,
Organon of Medicine, 1810

Homeopathy is a system of medicine with which most Americans are not familiar. It is based on the principles of Samuel Hahnemann, a German doctor.

Hahnemann, discouraged with the failure of early 19th century medicine to cure as much as it harmed, became a medical translator. In translating a work on cinchona bark, he read that it was a treatment for malaria due to its particular action on the organs. Knowing that other substances had similar actions but did not work against malaria, he began dosing himself with cinchona (the active ingredient is quinine) and found it created malaria symptoms. He went on to experiment with other substances, and disovered curative properties in small amounts of substances which in larger quantities caused harmful symptoms. He discovered that extreme (sub-molecular) dilution and impaction (shaking the dilution) could lead to cures that began with a toxic base, such as arsenic or mercury. Homeopathy is based on the principle of "like cures like".

Hahnemann had much success when he resumed his practice using these remedies, and they are still widely used today to cure illnesses. Homeopathy was introduced around the world, as it Oscillococcinum, a popular flu remedyproved itself curing illnesses safely and cheaply (for example, treating eye diseases in the Russian army in the 1820s). Homeopathy today is the preferred medicine of both Britain's royal family and the poor in India, where over 100 homeopathic medical schools exist, and is used as normal medicine throughout Europe. It is unpopular in the U.S. as a result of the American Medical Association, a group of allopathic ("opposite" cures disease) doctors formed in 1847 to counter the popularity of homeopathy. At the turn of the 20th century, the U.S. had 15,000 physicians practicing homeopathy and 22 homeopathic medical schools. By 1938, the AMA had pushed for the closing of all the schools and succeeded in having the subject excluded from standard medical texts.


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