Ancient discovery concerning smallpox—Inoculation experiment in London upon six criminals—Jenner's discovery—His ambition—First experiments in vaccination—Discovery of anaesthetics—Davy and laughing-gas—Faraday and ether—Simpson and chloroform—Spinal anaesthesia—Lister's great discovery—Hospital wards before his discovery—Lister and Pasteur—What suggested carbolic acid—Lister's highest reward—Pasteur and hydrophobia—Malaria—Plague—Sleeping-sickness—How does the white man escape generally?
More than a thousand years ago the Arabs, the Chinese, and the Brahmins of India observed that if a person had smallpox once, he seemed to be protected against a second attack. In those early days it was discovered that the disease could be produced artificially by giving a person an injection of some of the poisonous matter produced by smallpox. In such cases the disease was very much milder, and yet it protected the inoculated person against the ravages of smallpox when an epidemic occurred.
This practice of inoculating with smallpox was not approved by the physicians, but many women practised it, often combining it with a sort of witchcraft. The Turkish women also practised this art, and about two hundred years ago the wife of the English Ambassador in Constantinople happened to see such an operation performed by an old woman, who claimed to have inoculated no less than forty thousand persons. The English lady had so much confidence in the art that she had her little son inoculated, and on her return to England she made known the success of the operation.
That the English authorities did not place implicit confidence in this practice of inoculation is apparent from the fact that when an experiment was proposed, they asked the permission of King George I to allow inoculation to be carried out on six condemned criminals in Newgate Prison. These operations were performed by the physician who had been attached to the English Embassy at Constantinople. However, when it was found that these cases were successful, a few hundred people offered themselves for inoculation, and even some of the children of the Royal Family underwent the operation. But the clergy objected to the practice as being opposed to the divine rights, and as a few deaths resulted from the treatment, it began to meet with general opposition in this country, although the practice was continued on the Continent.
Then came the famous discovery of Edward Jenner, which has done so much to protect against smallpox. While this discovery was the result of long and patient observation and experiment, the idea seems to have been suggested to Jenner in the following manner. When still a youth, and pursuing his studies in the house of his master, there came a young country-woman seeking medical advice. During her visit she happened to remark that she had no fear of taking smallpox as she had already had cow-pox. This idea so impressed itself upon the mind of young Jenner that he determined to make a very careful study of cow-pox in the hope that it might act as a protection against the ravages of smallpox.
It is difficult for us to realise what smallpox meant to our forefathers; they counted it the worst scourge of the human race. Epidemics were disastrous, even although most adult persons were protected by a previous attack of the disease; it cut off many thousands of young persons every year. The most striking demonstration of the fatality of this disease is in cases where an epidemic has broken out among people, none of whom have been protected by a previous attack. For instance, the first epidemic in Greenland killed two-thirds of the total inhabitants.
Jenner's ambition was to banish smallpox from the face of the Earth, but he required many years of careful study before he could proceed to put his idea into practice. Twenty-six years elapsed between the conversation with the country-woman about cow-pox and Jenner's first experiment upon a patient. His experiment was to take the fluid or "lymph" from cases of cow-pox, and inoculate the patient with this. But that could not be a conclusive experiment; it might so happen that this patient might have chanced to escape smallpox in any case. So Jenner attempted to give the vaccinated patient smallpox by inoculating that disease.
He found it impossible to produce smallpox in any one of a number of persons whom he had treated previously with lymph from a cow suffering with cow-pox. One name for cow-pox is "vaccinia," and so the new method of inoculating with calf-lymph was called "vaccination."
It should be understood clearly that there was a very great difference between Jenner's vaccination with lymph and the early inoculation with smallpox. Smallpox inoculation brought about a real attack of the disease, though in a mild form. Still the inoculated person became ill and was placed in an Inoculation Hospital till the fever had run its course, while three in every thousand inoculations proved fatal. How very different is the method of vaccination discovered by Jenner! In most cases the adult person may be vaccinated, and continue to go about his daily business, with little discomfort. Another serious disadvantage in the old method of inoculation was that the inoculated person, although suffering only a mild form of the disease, could spread the disease of smallpox in the ordinary way, whereas there is no such possibility in Jenner's method.
Although the great value of Jenner's discovery was not recognised for some years, its great importance was acknowledged ultimately by nearly every learned Society in Europe, while the British Government voted him a grant of ten thousand pounds, and, later, a second grant of double that amount.
Another humane discovery was the introduction of anaesthetics, enabling operations to be carried out by the surgeon while the patient remained unconscious. The Ancients used several drugs which when inhaled produced insensibility to pain. In the Middle Ages we find a "quintessence" used for a similar purpose, and of which it was said: "It is applied to the nostrils of the sleeper, who draws in the most subtile power of the vapour by smelling, and so blocks up the fortress of the senses, that he is plunged into the most profound sleep, and cannot be roused without the greatest effort. . . . These things are plain to the skilful physician, but unintelligible to the wicked." These drugs, however, fell into disuse.
In the beginning of the nineteenth century the famous chemist, Sir Humphry Davy, was an assistant in a hospital for treating patients with different gases in the hope of curing their diseases. When trying the effects of nitrous oxide gas, which had been discovered a generation earlier, Davy found that it had a peculiar intoxicating effect when inhaled. Further experiments proved that it rendered a person insensible. Davy had a tooth extracted painlessly under the influence of this "laughing-gas," and he even suggested that it might be used to advantage in surgical operations, but the idea lay dormant for half a century.
In the meantime Davy's successor as Professor in the Royal Institution in London, the renowned Michael Faraday, discovered that sulphuric ether had the same effects as laughing-gas. The demonstration of the properties of these two gases became a favourite lecture experiment. Many years later a dentist happened to be present at a lecture in America when a student inhaled laughing-gas. The student, when going under the influence of the gas, fell and cut his hand, but he was not aware of it till some time later when he saw the blood. The dentist was impressed with this fact, and as he was about to have one of his own teeth extracted, he asked the lecturer to give him an inhalation of the gas before the operation. He felt no pain whatever, and he was so pleased that he began to give it to any patient who desired painless extraction. This dentist saw that it would be very useful in surgery, but he could not get any surgeon to take the matter up.
One of the pupils of the dentist, referred to in the fore-going paragraph, tried sulphuric ether on one occasion when he could not obtain laughing-gas. This proved so successful that he patented the method, pretending that the substance used was some secret concoction which he called "letheon." However, the substance soon declared itself by its odour.
The foregoing experiments were made in the United States, but when news of them reached Great Britain, ether was tried by both dentists and surgeons. Among the Scotch doctors who adopted this "anesthetic "(which name was suggested by Oliver Wendell Holmes) was James Y. Simpson, of Edinburgh. He did not find it entirely satisfactory, and he sought to get some better substitute, which would act equally well and not have the disadvantages attached to the use of sulphuric ether, which, by the way, was not the same as the ether treatment now in use.
One of Simpson's colleagues gives us a full description of the discovery of chloroform. Simpson and two of his friends acting as his assistants spent a great deal of their spare time testing all sorts of liquids in the hope of discovering a suitable anesthetic. Among many suggestions offered to them was chloroform, a substance scarcely known at that time, but Simpson and his friends, upon receiving a sample of it, thought it much too heavy a liquid, and it was put aside. Late on the evening of 4th November, 1847, Simpson and his friends sat down to test a number of other liquids. Each held glasses of liquids to his nose, but one after another the prepared liquids proved of no avail. Then Simpson made a search for the sample bottle of chloroform, which had been mislaid among some waste paper. All three commenced inhaling this chloroform as they had done with the other liquids. "Suddenly an unwonted hilarity seized the party, they became bright-eyed, very happy, and very loquacious, expatiating on the delicious aroma of the new fluid," Without any warning the three doctors were soon prostrate on the floor, to the alarm of the others who were present. As soon as they had recovered their senses they all expressed their delight at the results, and they repeated the experiment many times that night. A niece of Mrs. Simpson, who happened to be one of the party, offered to try the effects. She folded her arms across her breast as she inhaled the vapour and fell asleep, crying, "I'm an angel! Oh, I'm an angel!"
Simpson commenced the use of chloroform in his own practice, and its great advantages appealed to physicians, so that it came into general use very quickly. Simpson was appointed one of the physicians to Queen Victoria, who created him a baronet in 1866. Sir James Young Simpson was an eminent physician quite apart from his great discovery of chloroform as an anesthetic.
The only discovery of importance in connection with anaesthetics made in recent years is that method which is described as "spinal anesthesia." By injecting cocaine or other allied substance, not into the tissues to be cut but into the spinal canal, a temporary paralysis of that part of the spinal cord is brought about, and all sensation from the part of the body to be operated upon is completely cut off from reaching the brain. In this case the patient retains consciousness although feeling no pain whatever. This method, however, does not appear to be making much headway.
It is not easy for us to realise the difficulties of operations before the days of anaesthetics. Very occasionally an operation has still to be carried out without an anaesthetic, because of the condition of the patient's heart. A famous surgeon, who had to do so recently, remarked on coming out of the operating theatre that if surgery meant operating without chloroform, he for one could not continue his work, and it was quite apparent what a strain it had been upon his nervous system.
One great advantage of anaesthetics is that the operation can be performed with every care upon a person offering no resistance, instead of having to hurry through as quickly as possible while the patient was often held down by strong arms.
Another very humane discovery is what is known as the "antiseptic treatment." It is difficult for the younger generation to realise the tremendous importance of the discovery of antiseptics by Joseph Lister (afterwards Lord Lister). To attempt to realise this importance we must picture the condition of things when Lister was a professor in the University of Glasgow, and acting as a, surgeon in the Royal Infirmary in that city.
The number of operations had greatly increased with the introduction of chloroform, but the result of an operation was most uncertain. It was said by some that Simpson's discovery would die of its own success. No matter how cleverly the surgeon performed an operation, its result was too often fatal, because of troubles such as gangrene, erysipelas, and blood-poisoning occurring in the wound. Indeed, so frequent was the result fatal that some people declared that the surgeons operated merely "to satisfy a scientific curiosity" and not with any real hope of saving life. It is true that more than one half of those patients who had to lose an arm or a leg lost their lives also. Indeed, the death-rate in all operations in Lister's own infirmary ward was very nearly one half of the total cases, being forty-five per cent.
Lister was a man with a big heart, and he worried very much over this high death-rate. The inflammation or suppuration of wounds was considered to be necessary to the healing of the wound; it was only when inflammation became excessive that it was thought wise to try and relieve it. It had been observed, however, that operations performed in a private house gave a better chance of recovery than' those 'performed in a hospital ward, where the inflammation of wounds was much greater. It was observed also that operations on the battlefield were practically free of this trouble of inflammation.
In a very interesting address delivered by Sir William McEwan, f.r.s. , at the Royal Institution, London, in 1912, he gave a vivid description of the hospital ward before Lister's discovery: "The handling of highly inflamed wounds was a source of pain, and the dressing (sometimes done several times a day) was anticipated by the patients with an apprehension akin to terror, especially as the exhausting process, with its accompanying high fever, reduced the resisting powers of the individual to a low ebb. The effect was soon shown in the high temperature, the violent rigors, the final delirium which all too frequently ended in death. Sometimes every patient in a ward who had a serious operation performed upon him would be swept away. The wards would then be emptied, lime-washed, well ventilated, and reopened, soon to be the scene of further pyaemic ravages. All this was most depressing for the attendants, and many of the young student dressers had at times to retire to the restoring influence of the open air, and there debate within themselves whether it were physically possible for them to continue their work in the midst of such scenes of suffering. Surgeons and patients alike dreaded operations, owing to their terrible results, and only operations of dire necessity were permitted to be performed. Severe compound fractures were treated by amputation of the limbs, as to attempt to save them was to court disaster. Consequently amputations in those days were common. It is impossible for students of the present day adequately to realise the conditions which previously existed."
While Lister and others were struggling on under these depressing conditions, Pasteur was throwing a clear light upon the true nature of putrefaction; that it was due to the presence of living organisms, as explained in the preceding chapter. Some writers have said that Lister's discovery was quite independent of this knowledge, and that his treatment would have been originated even had the nature of putrefaction not been discovered previously. But there seems to be no room for doubt upon this matter, for Lister refers to Pasteur's work in the first paper describing his antiseptic treatment. Again, on the occasion of a banquet given in his honour in Paris, Lister said, "What could I have done, if it had not been for your Pasteur?"
Lister set himself to find out in what manner these organisms producing suppuration or inflammation might be fought. He was impressed with a published statement that a substance known as "carbolic acid" had been applied to the sewage of Carlisle with the result that there had been a great diminution in the amount of putrefaction. Lister sent for a sample of this carbolic acid, which was at that time quite a chemical curiosity. He tried washing the wounds with this, and while it seemed to have very beneficial results it had a rather serious burning effect. Further experiment showed that a very little of the acid in water was equally good.
As there were several means by which the microbes could enter a wound, Lister had to fight in each possible direction. He saw that the germs might float in the air and drop into the wound, so he kept a carbolic spray playing upon the part of the body upon which the operation was being performed. He washed his own hands very thoroughly in a carbolic solution, and steeped all his instruments in a strong solution, allowing them to remain there for some time before the operation. The results were truly marvellous. He was able to declare very soon that his hospital wards were the happiest in the world, while similar wards separated from his only by a passage a few feet broad, where former modes of treatment were for a while continued, retained their previous fearful death-rate. In less than two years the death-rate in Lister's wards was reduced from forty-five per cent to fifteen per cent.
Later he discovered that it was unnecessary to use the carbolic spray, as the air was not the chief, nor even an important, factor in the trouble. He found that the disease germs were chiefly upon the skin of the patient, the hands of the surgeon, and upon the instruments, and so he treated all those with his antiseptic solution. Further experience showed that it was unnecessary to treat the wound itself unless it was inflamed already; the one essential was to try and prevent microbes reaching the wound. With this alteration the treatment became known as "aseptic," which term must not be mistaken for something in opposition to "antiseptic"; it is merely a modification of Lister's original treatment.
At first Lister had to fight on single-handed, with the assistance of a few admiring students. Not only was the new treatment looked upon with scepticism and coldness, but even with open hostility. We must remember that disease germs had not been actually found at that time, although Pasteur had proved that all fermentation was due to their presence. In the address already referred to, Sir William McEwan says: "The usual fate meted out to innovators or disturbers of settled doctrines was shared by Lister. He and his theory were virulently assailed both from within the hospital and from without. Some colleagues, some governors, and a host of free lances all joined in the fray, the most ignorant being ever the loudest. He was despitefully used, and had to bear the derision and cackle of fools."
It soon became apparent, however, that Lister was meeting with success, such as the most skilful surgeons in the world could not claim, and gradually his discovery came to be recognised as of very great importance. Foreign surgeons became enthusiastic, even before those at home. Operations on the internal organs, and even on the brain, became commonplace now that the former risks were abolished.
It is a pleasing fact that this great discoverer was honoured, by his own people also, during his lifetime. He was the first surgeon to be created a peer, and honours were showered upon him by all countries. It has been said truly that he has saved millions of lives.
Over the door of the chief hospital in Rome there is a bas-relief representing the great English surgeon dressing a wound.
Lister's own words, when receiving the freedom of the City of Edinburgh, were these: "I regard this and all worldly distinctions as nothing in comparison with the hope that I have been the means of reducing in some degree the sum of human misery."
It has been remarked in the preceding chapter that in the mind of the general public it is in connection with hydrophobia that the name of Pasteur is best known. The year before Pasteur's discovery there were sixty-seven deaths from hydrophobia in Great Britain alone. In France there were no less than three hundred deaths in one year, while the death-rate in Prussia and Austria was even more serious.
When a person was bitten by a mad dog, or more correctly a dog suffering from rabies, there was grave danger of hydrophobia setting in. The trouble did not appear immediately; the wound healed, and in about a month or sometimes longer there appeared very distressing symptoms. Not every person bitten by a mad dog died, but if hydrophobia did set in there was practically no chance of recovery. The writer of the article on Hydrophobia in Chambers's Encyelopaedia (1876) says: "Little need be said of the treatment of hydrophobia, for there is no well-authenticated case of recovery on record."
The malady showed itself in a feeling of unrest, and the patient's face became terror-stricken, giving suspicious side-long glances as though constantly looking for hidden dangers. Then followed a great difficulty in swallowing, especially any fluid; even the sight or sound of water brought on paroxysms. The spasms were not unlike those accompanying lock-jaw (tetanus); the patient became delirious and ultimately died of suffocation.
Pasteur's discovery was that by inoculating a person with matter taken from the spinal cord of an animal which had died as a result of modified hydrophobia, he could bring about protection against the fearful malady. It was not a cure, indeed hydrophobia is still incurable, but it was a protection. A very weakened injection is given at first, then a stronger one, and so on over a period of some days. Fortunately it is not necessary for every person to be inoculated against the small chance of being bitten by a mad dog. It is time enough to think of the treatment after one has been bitten, for the disease is slow in developing, taking at least a month to appear. Before this time of incubation has elapsed the treatment brings about a condition of things that protects the patient against the germs.
Of course Pasteur did not commence with experiments upon human beings. It meant the death of many dogs and rabbits before he gained sufficient knowledge of the different injections. Surely the results which followed justified the death of these dumb creatures! It is well to emphasise one point which the anti-vivisectionists omit to mention that none of these operations are carried on except with the aid of an anaesthetic. For a single injection it was sufficient to give a local anaesthetic. One of our professors who visited the Pasteur Institute says that the animal "does not suffer even discomfort, and I have seen a rabbit going on eating while the operation was being performed." When it was necessary to carry out any surgical operation the animal was chloroformed in the usual way.
After Pasteur had satisfied himself that he could protect animals against the occurrence of hydrophobia, his next step was to try the treatment upon a human being. The first case was that of a little fellow of nine years of age, who had been very severely bitten by a rabid dog. There were no less than fourteen different wounds upon the boy, and when Pasteur consulted two of the most eminent physicians, they said that they were perfectly willing to accept responsibility for the experiment, as it was certain that the boy would develop hydrophobia, and there was, of course, no possible chance of recovery. Pasteur commenced his treatment of inoculation, and when the time of incubation expired, there were no signs of hydrophobia, and the boy made an excellent recovery.
One eminent British physician who visited the Pasteur Institute has given us the following description: "He [the assistant] handed the syringe to the operating doctor, who, taking a fold of the skin (which had been previously washed and purified with carbolic acid), inserted the point of the needle, injected about half a syringeful, withdrew the needle, and the patient passed on. The syringe was handed back to the assistant, who carefully sterilized it. The whole operation seemed to take only a few seconds. A continual stream kept passing from one room to another, each patient, as he went through, undergoing the same process of inoculation. Everything was done in the most orderly fashion, and one could not but feel that Pasteur, who was standing in the room whilst this was going on, had every right to feel proud."
People who had been bitten by rabid animals flocked to Paris from other countries, and during the first year about fifteen hundred patients were treated. Of course, the whole of these cases would not have developed hydrophobia. In some cases the teeth of the animal might have been cleaned in passing through the clothing of the person, and in other cases the dog or other animal might not have been really rabid. But according to the ordinary death-rate among people who are bitten, at least one hundred and eighteen of these cases should have proved fatal. Even had Pasteur reduced the death-rate by one half he would have been a great benefactor, but as a matter of fact he reduced it to four deaths out of the one hundred and eighteen cases destined to be fatal.
The most outstanding discovery in the medical world towards the close of the nineteenth century was that connected with malarial fever. At first it was believed that this distressing malady was due to the conditions of the atmosphere; hence its name from the Italian mala (bad) aria (air). Then some authorities supposed that it was due to marshy ground, others said that it came from stagnant water, and yet others said the trouble arose from the soil. But all these were far from the truth.
About thirty-five years ago a French army doctor discovered a microbe present in the blood of a malaria patient, but it could not be discovered how this parasite got entry to the blood. Nearly twenty years elapsed before it was discovered by a band of students that malaria was introduced into the human being by mosquitoes. It was proved beyond a doubt that these insects were carrying the disease from man to man. Then it was discovered that only one particular class of mosquito was taking part in this unfortunate business, and further that only the female of that class was the guilty party. Different classes of mosquitoes were allowed to suck blood from malaria patients, and the insects' stomachs were then examined for the malaria parasite, and in this way it was found who was the active party.
In order to prove the truth of this discovery, one of the doctors produced malaria in his own son by allowing some of these malaria mosquitoes to bite the boy. To prove that if one kept free from the mosquitoes one could not take malaria, two experimenters spent a summer in one of the places where malaria was at its worst. The only precaution they took was to close all entries to their houses, during the night, by means of screens of very fine wire-netting, through which mosquitoes could not pass. The experiment was entirely successful; the inmates escaped the fever. Then the experiment was tried on a much larger scale. They protected from mosquitoes all the inhabitants of a given zone, while those of the neighbouring localities were not protected. The result was remarkable; not a single case of malaria appeared in the protected area, which included one hundred and thirteen persons, while only two persons in a hundred escaped in the surrounding localities.
It was Major Sir Ronald Ross, of the British Army, who discovered the complete life-history of this parasite which produces malaria fever. The importance of this discovery is not confined to malaria alone; it opened up the way to a very wide field of research.
Among other diseases which are carried by different insects are yellow fever, bubonic plague, and sleeping-sickness. Probably every one of us has recollections of our first hearing of the Great Plague, which played such havoc in London in 1665, cutting off no less than sixty thousand persons in the one autumn. Some three centuries earlier, one quarter of the whole population of Europe perished at the hands of this "Black Death." It was not till 1894 that the plague germ was discovered by a Japanese doctor, Professor Kitasato, who had studied under Koch in Germany, and then undertaken researches on his own account. The insect guilty of spreading plague was discovered, by Major Liston of the Indian Army, to be a flea which infested rats, and when these rats died of plague, and no other rats were conveniently at hand, the insects often made their way to human beings, and thus introduced the disease to men.
Another interesting discovery was that of the parasite which produces sleeping-sickness. This microbe was discovered by Sir David Bruce, the celebrated Scottish physician, a few years ago. This mysterious disease had proved very fatal among the natives of West Africa, from whence it spread to other districts of that continent. When Bruce had discovered the parasite in the blood of patients suffering from sleeping-sickness, he sought to find out what insect was guilty in this case. He employed a large number of natives to collect flies throughout a belt of about thirty miles in the country. A vast collection of thousands of flies was made, it being noted very carefully from what district they had been brought. When this collection of flies was examined by experts at the Natural History Museum, in London, one particular kind of fly was selected as the probable culprit. It resembled the tsetse fly, although it differed from this insect which spreads the tsetse fly disease among cattle in other parts of Africa.
Bruce found that this suspected insect had been brought in by the natives from all districts in which sleeping-sickness was prevalent, and it was absent from districts that were free of the malady. Then experiments were made upon monkeys, by which it was discovered that this fly could carry the parasite of sleeping-sickness from an infected negro to a monkey. White men may fall victims to sleeping-sickness, but fortunately the cases are not common. It has been suggested that the reason for the white man's escape is that he has a natural dislike to the mere touch of a fly alighting upon him, and that he drives off the invader before any injection has been made.
Although no antidote has been found with which to fight these insect-borne parasites in the blood, yet the discovery of the means of infection is of very great importance, and has enabled the diseases to be fought in a practical manner. Prevention is better than cure.
Each of the discoveries dealt with in this chapter forms a romance, but it will be understood that these are only a small part of the sum-total; they are merely examples of some humane discoveries.