Medical Advances in Nineteenth-Century America
by Bert Hansen - Professor of History, Baruch College
Photograph of wounded soldier with diagram of path of the bullet, c. 1861, GLC 05111.02.1293
We live in an age when there seems to be a medical breakthrough in the headlines every few days, when new discoveries are immediately -- and sometimes prematurely -- put into practice. It is easy for us, therefore, to assume that this same enthusiasm for novelty characterized medicine in the past as well. But that is not what history shows.
Medicine became recognizably �modern� in the nineteenth century, producing new inventions, new theories, new curative powers, and a rebirth of professionalism (for both doctors and nurses). Scientific developments played a role in all these changes, gradually replacing the trial-and-error inventiveness that had long characterized medical practice.
By a quirk of history, we can even pick a symbolic birthday for modern medicine, October 16, 1846 -- the date of the first publicly reported use of ether for surgical anesthesia. This particular discovery was also America's first major contribution to international medical practice. The path-breaking operation took place in Boston�s Massachusetts General Hospital (MGH). Following the custom of the time, surgical suites and surgical amphitheaters for student observation were located on a hospital's uppermost floor to maximize natural illumination.
At MGH, that attic room is still called The Ether Dome. On this red-letter day, Harvard Professor of Surgery John Collins Warren removed a tumor on the jaw for a patient named Gilbert Abbot as the first test of a new inhaled anesthetic invented and administered by a dentist named William Thomas Green Morton. Many of those watching the operation were skeptical since earlier experiments at MGH had faltered and because no solution had been found in thousands of years. When Dr. Warren finished his work without any screaming or thrashing from his patient, he is said to have announced to those in attendance, "Gentlemen, this is no humbug." (Fenster 2001; Wolfe 1993).
Before this date, physicians had repeatedly tried and failed to find an adequate means to instill a temporary suspension of pain. Without any way to control pain, most surgery simply could not be undertaken. Even if physicians proved willing to inflict horrible pain, a patient writhing from it could not be held still enough for the surgeon's scalpel to do its delicate work. Surgery had thus been limited to a few types of procedures: cataract removal, extirpation of superficial growths on the skin, and amputation of a badly damaged limb (such as a foot crushed by a wagon wheel or an arm blasted apart by a bullet).
Amputation, often on the battlefield, did save lives, since a crushed foot or arm would almost always lead to a fatal systemic infection. Working very quickly, a skillful surgeon could cut through the flesh, saw completely through the bone, and apply a red hot iron to cauterize the stump's raw surface and stop the bleeding -- sometimes performing the entire operation in less than two minutes. The amputation of a limb carried a mortality risk of about fifty percent -- a depressing figure, to be sure. But even a fifty-fifty chance of survival was a fair gain over an almost certain death without such treatment.
The ability to banish pain during surgery (though not during the recovery period) was a medical breakthrough of the highest order and a landmark eminently visible in retrospect. But to gain a more complete picture of the historical significance of a medical innovation, we must understand not only who discovered it and how it worked, but also, and perhaps more importantly, who used it, how quickly and how widely it became known, and what further changes it made possible.
For example, the world barely took notice of ether surgery in 1846. There was no medical revolution. There were no headlines. Even over several years, only a handful of newspaper reports appeared. The public image of the doctor did not change. There was no wholesale adoption of this technique by the medical profession despite reports published in medical journals and the occasional use of ether by other surgeons. Surgeons used it or avoided it in individuals cases for a variety of reasons, including notions of which patients (by ethnicity or gender or social class) would be more sensitive to pain and thus more in need of the anodyne (Pernick, 1985). Although the use of ether ultimately triumphed, its acceptance was slow and uneven for several decades.
For us today, a large oil painting of the first American operation using ether and a few daguerreotype photographs of early operations are fascinating historical images. (Wolfe 1993; Lowry and Lowry 2005). But the impression they create � that is, that the public immediately recognized ether surgery as a momentous breakthrough�is false. All the early photographs were posed re-enactments taken after the fact; and none of them was published at the time.
Southworth & Hawes, "Early Operation Using Ether for Anesthesia," Late Spring 1847, Daguerreotype
Consider, for example, Harvard Medical School�s impressive painting, First Operation Under Ether by William Hinckley (http://www.anesthesiadoc.net/History%20Section.htm). This painting has also been widely reproduced in more recent times. Because of its naturalistic style and its methodical attention to detail, the canvas is easily taken for a contemporary recording of the event. Yet Hinckley only began the painting in 1882 while in Paris. His research efforts to get the scene right were prodigious, and he continued work on the painting until 1893�some 47 years after Dr. Warren�s path-breaking surgery. (Wolfe 1993).
Popular recognition of the value of ether anesthesia for surgery did not come until the 1890s. And Ether Day did not come to be celebrated in Boston on an annual basis until about 1903. That recognition owed much to a profound revolution in thinking among doctors and laypeople alike about the importance of novelties in medicine.
What happened in the mid-1880s to cause such a change? It was rabies shots, invented by the great chemist Louis Pasteur in France. But it was in America, rather than in Europe, that this innovation had its greatest impact and garnered its greatest enthusiasm and publicity. It was the first medical advance accorded "breakthrough" status, and the ensuing cultural excitement helped to create starkly new expectations of medical progress (Hansen, 1998).
Prior to this breakthrough, few people thought the medical care they received should be different from what their grandparents had received. In fact, those with wealth did not choose young doctors with the latest training; they chose older doctors educated decades earlier, doctors who had never been in a laboratory, but who knew their Galen and Hippocrates, often in Greek and Latin versions.
The general public's low regard for medicine at that time may be illustrated by a delightfully bitter cartoon on the cover of Puck magazine in 1884. William Vanderbilt had just proposed a gift of $500,000 to Columbia's College of Physicians and Surgeons. Puck, a popular American magazine of political and social satire, mocked this kind of medical philanthropy, suggesting that it was simply producing more young doctors likely to kill more patients and generate more work for the happy undertakers.
"Our Merciless Millionaire. Vanderbilt: The Public Be -- Doctored!" cover of Puck, October 29, 1884
Puck was not opposed to medical charity; it campaigned annually to raise donations for the hospital care of indigent patients. But none of this money went for research and education. And yet the following year, the low expectations about medical care were overturned�and even Puck would publicize the change.
Rabies was not a common disease in humans. Tuberculosis, typhoid and diphtheria cases numbered in the thousands, but rabies victims numbered only in the dozens. Yet it was among the most feared of diseases since it was uniformly fatal, and everyone knew that. After a child was bitten, its parents could do nothing but worry and wait as the wound healed and the weeks went by. Most victims would have no further problems. But, in roughly six weeks, a small number of those victims would develop symptoms of nerve and muscle problems, swallowing difficulties (and thus the hesitation to drink that provided the name hydrophobia), and paroxysms of agitation and wild behavior that required their being tied to their beds. Patients became exhausted and died of asphyxiation and nervous collapse.
This discouraging course of symptoms was not an esoteric medical fact, but a familiar reality in the popular consciousness. Rabies deaths were regularly reported in the daily press with articles detailing all these symptoms. Any new treatment that would successfully pull victims of dog bites back from death's door was an invention that ordinary people could enthusiastically endorse. But how did a small-scale experimental treatment in Paris become America's first medical breakthrough?
In October 1885, newspaper articles on Pasteur's feat were scientific reports, respectful if not large or prominent. Then in early December a mad dog ran furiously through the streets of Newark, New Jersey, biting several other dogs and six young children. In an era when hundreds of thousands of stray dogs lived in large cities, such events were commonplace. But this was the first such calamity since Pasteur's announcement. Within hours, a local doctor told the newspapers that the children's parents should take them to Paris immediately. If the families could not afford the trip, he said, there should be a public campaign to raise the necessary funds. Within a few hours the doctor received a collection from the employees of a local manufacturing plant.
Within 24 hours, sufficient funds arrived as nickels, dimes, and dollars from ordinary folks. The penny press loved the story and all the newspapers of New York competed for special angles on it. Their articles were reprinted in out-of-town papers all across the US. The trip to Paris by four working class boys was an enormous media sensation. For example, on some days a full ten percent of the New York Herald was given over to one rabies story or another.
The pictorial press grabbed the story too. News drawings and humorous cartoons appeared in Harper's Weekly, Frank Leslie's Weekly, The New York Daily Graphic, and the National Police Gazette.
"M. Pasteur. An Inoculation for Hydrophobia," Harper's Weekly, December 19, 1885
Puck quickly ran jokes about the excitement of going to Paris for the latest cure, of rich folks taking their pet dogs to Paris for treatment to prevent their getting or giving rabies, about doctors putting the skeleton aside in medical education and studying virus and inoculation instead, along with laboratory experiments on rabbits.
"The Pasteur Boom -- High Time for Hydrophobists," back cover of Puck, December 23, 1885
When the boys returned hale and hearty from Paris a few weeks later, they became the toast of the town -- and the country! The new celebrities were exhibited in theaters and dime museums not only in New York City, but as far west as Chicago and St. Louis. Crowds paid ten cent just to hear the boys tell of their Atlantic voyages and how Pasteur had saved their lives. (for more information, visit
http://www.pasteurfoundation.org/index.html and click on "Pasteur and the United States a History.")
The media bonanza lasted for months and took many forms. New York's famous wax museum, the Eden Mus�e, created a Pasteur Group, showing the great chemist supervising a physician injecting rabies virus into a child. Judge magazine ran a political cartoon in which reforming President Grover Cleveland was portrayed in the guise of Louis Pasteur, vaccinating the Democratic Party to protect it from the spoils system.
"Pasteur Cleveland Vaccinating Democracy," detail from "Judge's Wax-Works -- The Political Eden Mus�e," centerfold in Judge, February 20, 1886
Such human interest stories gave the main momentum to the media bonanza that continued for several months. But thousands of words and quite a few pictures were devoted to explaining this new kind of laboratory-based scientific research. And less than a month after the dog bites on the streets of Newark, groups of physicians in three different cities (New York, Newark, and St. Louis) began efforts to establish American Pasteur institutes in which the immunizing material for the rabies shots could be produced. Such a supply would save the lives of the countless victims who could not afford to go to Paris, or would not get there in time for the treatment to work.
All this publicity and the public conversations that ensued had a profound effect on people's thinking. It reversed the assumption that older doctors and older medicines were better than new ones. It created a new expectation that medicine can and should change, that progress is to be expected, that the new advances would come from laboratory experiments on animals, and that specific injections would be a major tool of the new medicine.
The rabies breakthrough set this paradigm in place, and new medical discoveries soon followed it: tuberculin treatment for consumption, diphtheria antitoxin, and the X-ray. The press and the public saw these innovations as part of the new model of constantly improving medicine. (Hansen 1999, Howell 1995). After the turn of the century, injections for typhoid and meningitis were added to the list of innovations. Vitamins then emerged as another powerful product of laboratory research. In the 1920s injectable insulin saved emaciated patients and restored them to blooming health.
Living as we do after the introduction of penicillin in the 1940s, followed by polio vaccines in the 1950s, and then organ transplants and artificial organs, the medical inventions of the nineteenth century cannot easily compete for our attention or that of our students. But the stories of ether surgery and of rabies shots -- and especially of public reactions to them at the time -- offer intellectual tools for understanding the present as well as the past. These inventions make clear that a full appreciation of a medical invention (then or now) requires that we attend carefully to social and cultural meanings of the device, to the rate of implementation by specialists, and to the feedback the specialists get from the wider community. Sometimes the biggest inventions had only limited effects at the time. And at least once, a modest discovery caused enormous transformations in ideas and institutions far beyond the disease it aimed to cure.
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