MEDICINE  IN  XIX.  CENTURY

 

Preceding the 19^th century, medicine had advanced at a slowly increasing rate; the scientific basis of practice, however, aside from anatomy, was created during the 19^th century. The basic medical sciences were founded, opening the way for immense strides in clinical practice during the 20^th century.

 

Advances in Medical Science

During the 19^th century Jakob Henle showed that the kidney contained tiny tubules responsible for the urine-forming function of that organ. His descriptions of the microscopic structure of the eye and brain also led to consideration of the relationship of structure (anatomy) to function (physiology). Rudolf Virchow, the founder of cellular pathology, was responsible for promoting the use of the microscope. He demonstrated that all body tissues and organs are made of cells and their products that all cells are produced from other cells, which many diseases are the result of changes in cells, and that one could identify a disease by the appearance of the cells. His work became the basis for modern-day understanding of disease.

 

Rudolf Virchow 1821 – 1902

German pathologist, archaeologist, anthropologist and the founder of cellular pathology. Virchow was born in Schivelbein, Pomerania (now Swidwin, Poland), and educated at the University of Berlin. In 1843 he became prosector (dissector of bodies) at the Charité Hospital in Berlin, and in 1847 a university lecturer. In 1849 he was invited to the medical school of Würzburg as Professor of Pathological Anatomy, having been dismissed from his Berlin posts because of revolutionary activities. In 1856 he returned to Berlin as professor and director of the university's pathological institute.

Virchow was the first to demonstrate that the cell theory applies to diseased tissue as well as to healthy tissue—that is, that diseased cells derive from the healthy cells of normal tissue. He did not, however, accept Louis Pasteur's germ theory of disease. He is best known for his text Cellular Pathology as Based on Histology. He also engaged in extensive research in the fields of archaeology and anthropology, producing numerous writings, among them Crania Ethnica Americana (1892). Other publications include discussions of topical political and social questions. Virchow was influential in German politics, and from 1880 to 1893 served as a Liberal in the German Reichstag, where he opposed the policies of the German chancellor, Prince Otto von Bismarck. He was instrumental in the establishment of the Pathological Institute and Museum in Berlin.

The science of microbiology was founded by Louis Pasteur, who trained as a chemist and became interest in the chemical basis for fermentation. In his chemical work, Pasteur showed that certain pure chemical crystals could exist in two forms, differing from each other as an object differs from its mirror image. The importance to medicine of this work is that the building blocks of the body, such as amino acids and sugars, are usable in one form only and not in mirror-image form. Pasteur conducted a series of complex experiments proving that many plant and animal diseases are due to yeasts and bacteria. He discovered methods of immunization, a process that has saved more lives than all advances in all of previous medicine. Further, his work, developed by others after him, has resulted in safe milk (through pasteurization) and food, better methods of producing chemicals and drugs, and increased agricultural production.

 

The science of bacteriology developed rapidly in the last quarter of the 19^th century, when the bacterial causes of many important diseases were identified. The greatest of the numerous scientists working in this field was Robert Koch, who along with Pasteur is considered the founder of scientific bacteriology. Koch isolated the organisms that produce anthrax, tuberculosis, and cholera, and invented the gel-like medium used for many years on plates in bacteriology laboratories (a substance now replaced by agar). He also developed a set of rules (Koch's postulates) that, if followed, can prove that an organism is truly the cause of a disease rather than simply having been found in a sick person.

 

Claude bernard 1813 – 1878

French physiologist, regarded as the founder of experimental medicine. Born in St-Julien, Bernard received a humanistic education during his youth; he did not take any classes exploring the physical or natural sciences. After leaving school at 18, he wrote two plays, but the eminent French critic Saint-Marc Girardin, upon reading the second one, suggested to Bernard that he find a different career. In 1834 Bernard enrolled in the Paris School of Medicine, and after a few years he obtained a position at a laboratory at the Collège de France, where he worked under the French physiologist François Magendie.

Bernard received his medical degree in 1843 and went on to make a series of important discoveries in physiology. In 1846, by means of experiments on rabbits and other animals, Bernard discovered the role of the pancreas in digestion. He showed that the pancreas secretes a fluid that allows fat to be digested. Later, he discovered the role of the liver in the transformation, storage, and use of sugar in the body. He also explored functions of the autonomic nervous system— in particular; he discovered the function of the vasomotor nerves, which are responsible for regulating blood supply by constricting or dilating blood vessels.

In addition to his work in experimental physiology, Bernard made contributions to other fields in the natural and experimental sciences. Most notably, his insistence that an experiment should be designed to either prove or disprove a guiding hypothesis is an integral part of the modern scientific method. Also, in trying to understand how the systems of an organism maintain a state of balance, he was the first to propose the concept that later became known as homeostasis.

Because of his many important discoveries, Bernard became a prominent scientist during his lifetime. In 1854 he accepted the newly created chair of physiology at the Sorbonne. When Magendie died in 1855, Bernard took over his post at the Collège de France; he held the positions at the Sorbonne and the Collège de France concurrently until 1868. In 1855 Bernard also became a member of the French Academy of Sciences. Upon his death in 1878, Bernard received a public funeral—the first time a scientist had received such an honor in France.

 

 

Louis Pasteur 1822 – 1895

French chemist and biologist, who founded the science of microbiology, proved the germ theory of disease, invented the process of pasteurization, and developed vaccines for several diseases, including rabies.

                    

Pasteur was born in Dôle on 7.12.1822, the son of a tanner, and grew up in the small town of Arbois. In 1847 he earned a doctorate at the École Normale in Paris, with a focus on both physics and chemistry. Becoming an assistant to one of his teachers, he began research that led to a significant discovery. He found that a beam of polarized light was rotated to either the right or the left as it passed through a pure solution of naturally produced organic nutrients, whereas when such a beam was passed through a solution of artificially synthesized organic nutrients, no rotation took place. If, however, bacteria or other micro-organisms were placed in the latter solution, after a while it would also rotate light to the right or left.

Pasteur concluded that organic molecules can exist in one of two forms, called isomers (that is, having the same structure and differing only in being mirror images of each other), which he referred to as “left-handed” and “right-handed” forms. When chemists synthesize an organic compound, these forms are produced in equal proportions, canceling each other's optical effects. Living systems, however, which have a high degree of chemical specificity, can discriminate between the two forms, metabolizing one and leaving the other untouched and free to rotate light.

Work on Fermentation       

After spending several years of research and teaching at Dijon and Strasbourg, Pasteur moved in 1854 to the University of Lille, where he was named Professor of Chemistry and dean of the faculty of sciences. This faculty had been set up partly to serve as a means of applying science to the practical problems of the industries of the region, especially the manufacture of alcoholic drinks. Pasteur immediately devoted himself to research on the process of fermentation. Although his belief that yeast plays some kind of role in this process was not original, he was able to demonstrate, from his earlier work on chemical specificity, that the desired production of alcohol in fermentation is indeed due to yeast and that the undesired production of substances (such as lactic acid or acetic acid) that make wine sour is due to the presence of additional organisms, such as bacteria. The souring of wine and beer had been a major economic problem in France; Pasteur contributed to solving the problem by showing that bacteria can be eliminated by heating the initial sugar solutions to a high temperature.

Pasteur extended these studies to such other problems as the souring of milk, and he proposed a similar solution: heating the milk to a high temperature and pressure before bottling. This process is now called pasteurization.

Disproof of Spontaneous Generation

Fully aware of the presence of micro-organisms in nature, Pasteur undertook several experiments designed to address the question of where these “germs” came from. Were they spontaneously produced in substances themselves, or were they introduced into substances from the environment? Pasteur concluded that the latter was always the case. His findings resulted in a fierce debate with the French biologist Félix Pouchet—and later with the noted English bacteriologist Henry Bastion—who maintained that under appropriate conditions instances of spontaneous generation could be found. These debates, which lasted well into the 1870s, although a commission of the Academy of Sciences officially accepted Pasteur's results in 1864, gave great impetus to improving experimental techniques in microbiology.

Silkworm Studies

In 1865 Pasteur was summoned from Paris, where he had become administrator and director of scientific studies at the École Normale, to come to the aid of the silk industry in southern France. The country's enormous production of silk had suddenly been curtailed because a disease of silkworms, known as pébrine, had reached epidemic proportions. Suspecting that certain microscopic objects found in the diseased silkworms (and in the moths and their eggs) were disease-producing organisms; Pasteur experimented with controlled breeding and proved that pébrine was not only contagious but also hereditary. He concluded that only in diseased and living eggs was the cause of the disease maintained; therefore, selection of disease-free eggs was the solution. By adopting this method of selection, the silk industry was saved from disaster.

Germ Theory of Disease

Pasteur's work on fermentation and spontaneous generation had considerable implications for medicine, because he believed that the origin and development of disease are analogous to the origin and process of fermentation. That is, disease arises from germs attacking the body from outside, just as unwanted micro-organisms invade milk and cause fermentation. This concept, called the germ theory of disease, was strongly debated by doctors and scientists around the world. One of the main arguments against it was the contention that the role germs played during the course of disease was secondary and unimportant; the notion that tiny organisms could kill vastly larger ones seemed ridiculous to many people. Pasteur's studies convinced him that he was right, however, and in the course of his career he extended the germ theory to explain the causes of many diseases.

Anthrax Research

Pasteur also determined the natural history of anthrax, a fatal disease of cattle. He proved that anthrax is caused by a particular bacillus and suggested that animals could be given anthrax in a mild form by vaccinating them with attenuated (weakened) bacilli, thus providing immunity from potentially fatal attacks. In order to prove his theory, Pasteur began by inoculating 25 sheep; a few days later he inoculated these and 25 more sheep with an especially strong inoculant, and he left 10 sheep untreated. He predicted that the second 25 sheep would all perish and concluded the experiment dramatically by showing, to a skeptical crowd, the carcasses of the 25 sheep lying side by side.

Rabies Vaccine

Pasteur spent the rest of his life working on the causes of various diseases—including septicemia, cholera, diphtheria, fowl cholera, tuberculosis, and smallpox—and their prevention by means of vaccination. He is best known for his investigations concerning the prevention of rabies, otherwise known in humans as hydrophobia. After experimenting with the saliva of animals suffering from this disease, Pasteur concluded that the disease rests in the nerve centers of the body; when an extract from the spinal column of a rabid dog was injected into the bodies of healthy animals, symptoms of rabies were produced. By studying the tissues of infected animals, particularly rabbits, Pasteur was able to develop an attenuated form of the virus that could be used for inoculation.

In 1885 a young boy and his mother arrived at Pasteur's laboratory; the boy had been bitten badly by a rabid dog, and Pasteur was urged to treat him with his new method. At the end of the treatment, which lasted ten days, the boy was being inoculated with the most potent rabies virus known; he recovered and remained healthy. Since that time, thousands of people have been saved from rabies by this treatment.

Pasteur's research on rabies resulted, in 1888, in the founding of a special institute in Paris for the treatment of the disease. This became known as the Institute Pasteur, and it was directed by Pasteur himself until he died. (The institute still flourishes and is one of the most important centers in the world for the study of infectious diseases and other subjects related to micro-organisms, including molecular genetics.) By the time of his death in St-Cloud on September 28, 1895, Pasteur had long been a national hero and had been honored in many ways. He was given a state funeral at the cathedral of Notre Dame, and his body was placed in a permanent crypt in his institute.

 

Robert koch 1843 – 1910

German scientist and Nobel laureate, who founded modern medical bacteriology, isolated several disease-causing bacteria, including those of tuberculosis, and discovered the animal vectors of a number of major diseases.

Born in Klausthal-Zellerfeld on December 11, 1843, Koch enrolled at the University of Göttingen in 1862, where he studied botany, physics, and mathematics and began his lifelong medical career. After a brief tenure at the Hamburg General Hospital and at an institute for retarded children, he started private practice. His professional activities did not deter him from developing outside interests in archaeology, anthropology, occupational diseases such as lead poisoning, and the newly emerging field of bacteriology.

Koch's first major breakthrough in bacteriology occurred in the 1870s, when he demonstrated that the infectious disease anthrax developed in mice only when the disease-bearing material injected into a mouse's bloodstream contained viable rods or spores of Bacillus anthracis. Koch's isolation of the anthrax bacillus was of momentous import, because this was the first time that the causative agent of an infectious disease had been demonstrated beyond a reasonable doubt. It now became clear that infectious diseases were not caused by mysterious substances but instead by specific micro-organisms—in this case, bacteria. Koch also showed how the investigator must work with such micro-organisms, how to obtain them from infected animals, how to cultivate them artificially, and how to destroy them. He revealed these observations to the great German pathologist Julius Friedrich Cohnheim and his associates, one of whom was the bacteriologist Paul Ehrlich, the founder of modern immunology.

In 1880, after completing important work on the bacteriology of wound infections, Koch was appointed government adviser with the Imperial Department of Health in Berlin, where he carried out most of his research for the rest of his career. In 1881 he launched his studies of tuberculosis, and in the following year he announced that he had isolated a bacillus that was the causative agent of the dreaded disease. Koch's findings were confirmed by investigators around the world. The discovery led to an improvement in diagnosis by means of finding evidence of the bacilli in bodily excretions, especially sputum.

Koch now focused his attention on cholera, which had reached epidemic levels in India by 1883. Traveling there, he identified the bacillus that causes the disease and found that the bacillus was transmitted to human beings primarily through water. Koch later traveled in Africa, where he studied the causes of insect-borne diseases.

In 1891 Koch became director of the Institute for Infectious Disorders in Berlin (the institute now bears his name), which had been organized for specialized medical research; he remained there until he retired in 1904. In 1905 he won the Nobel Prize for Physiology or Medicine. On May 27, 1910, Koch died at the German health resort of Baden-Baden.

 

Emil Adolph von behring 1854 – 1917

German bacteriologist and Nobel laureate. He was born in Deutsch-Eylau, Prussia (now Ilawa, Poland), and educated at the University of Berlin. In 1880 he became an army surgeon. He was appointed professor at the University of Halle in 1894 and the following year became director of the Hygienic Institute at Marburg, a post he held until his death. In 1890, while working in the laboratory of the German bacteriologist Robert Koch in Berlin, Behring and the Japanese bacteriologist Kitasato Shibasaburo discovered that injecting the blood serum of an animal that has tetanus into another animal produces an immunity against the disease in the second animal. Serum from the immunized animal can then be injected into another individual in whom it will produce immunity to the same disease. On Behring's suggestion and through the work of the German bacteriologist Paul Ehrlich, this principle was applied the following year to fight diphtheria in children, with dramatically successful results. In 1901 Behring was awarded the first Nobel Prize for Physiology or Medicine.

 

Paul ehrlich 1854 – 1915

German bacteriologist and Nobel laureate, noted for studies of the immune system and for his method of treating syphilis.

Ehrlich was born in Strehlen, Silesia (now Strzelin, Poland), on March 14, 1854. He received a somewhat varied formal education in medicine, studying first at the University of Breslau (now Wroclaw, Poland), then the University of Strasbourg, returning to Breslau, and spending a final term at Leipzig, where his doctoral dissertation on the theory and practice of histological staining was approved in 1878. As head doctor at the renowned Charité Hospital in Berlin, he advanced the field of hematology by developing methods of detecting and differentiating between various blood diseases. Most significant among his innovations was the use of different dyes, for example methylene blue and indophenol blue, as selective vital stains for different types of cells.

Ehrlich's chief contribution to medicine was his side-chain theory of immunity, which established the chemical basis for the specificity of the immune response. The side-chain theory was an attempt to account for the ability of certain toxins both to produce a toxic effect and to elicit a specific immune response in mammals. Ehrlich postulated that cells have specific receptor molecules, or side chains, on their surfaces that bind only to certain chemical groups in toxin molecules; if the cells survive this binding they produce side chains in excess, some of them being released as circulating antitoxins, or what today would be called antibodies, in the blood. This theory laid the foundation for modern theories of immunity. Ehrlich also made great contributions in the field of chemotherapy, including using “606”, the so-called magic bullet known as Salvarsan, or organic arsenic, to treat syphilis.

Ehrlich shared the 1908 Nobel Prize for Physiology or Medicine with the Russian bacteriologist Élie Metchnikoff in recognition of their work on the chemistry of immunity. He also received the Prussian Great Gold Medal of Science (1903) and the Liebig Medal (1911), held honorary and foreign memberships in more than 80 scientific and medical societies, and received several honorary degrees. Ehrlich died in Hamburg on August 20, 1915.

 

Élie Metchnikoff 1845 – 1916

Russian biologist and Nobel laureate, a founder of the science of immunity. His name in Russian is Ilya Ilich Mechnikov.

Metchnikoff was born near Kharkov on May 15, 1845, and educated at the University of Kharkov and, in Germany, at the Universities of Giessen, Göttingen, and Munich. He lectured in zoology and comparative anatomy at the University of Odessa from 1870 to 1882. In 1904 he became a subdirector of the Pasteur Institute in Paris. His early studies were devoted to the process of intracellular digestion in invertebrates. He later established the destructive effect of certain white blood cells, which he called phagocytes, on harmful materials in the bloodstream, and in 1884 he announced his theory of phagocytosis, which formed a basis for the theory of immunity. Metchnikoff also advocated consumption of lactic acid bacteria for the prevention and remedy of intestinal putrefaction. For his research on immunity he shared the 1908 Nobel Prize for Physiology or Medicine with the German bacteriologist Paul Ehrlich.

 

The Rise of Modern Surgery

The 19^th century made modern surgery possible by means of two great discoveries: safe anesthesia, and control of wound infection. A Boston dentist, William Morton, discovered that inhalation of diethyl ether would render a person unconscious and incapable of perceiving pain. He demonstrated his discovery at the Massachusetts General Hospital in 1846 by making it possible for a leading Boston surgeon, John C. Warren, to operate on an unconscious patient. As surgeons began using anesthesia to perform longer, more intricate operations, however, the benefits of Morton's discovery began to be diminished by wound infections, or sepsis, caused by the entrance of bacteria into the bloodstream. In Vienna, Hungarian physician Ignaz Semmelweis had been insisting that puerperal sepsis, a usually fatal infection experienced by some women after childbirth, was due to infection of the birth canal by the hands of hospital attendants. This theory was ridiculed, because at the time no scientific reason was known that supported it. When Pasteur showed that microorganisms in the air and on hands could produce disease, however, the British surgeon Joseph Lister began his epochal work on infection. Published in 1867, this work showed that surgery was made safer by using antiseptics such as phenol to sterilize equipment and the surrounding environment. The antiseptic process was thereafter gradually extended to make the operating room germ free by sterilizing all equipment and supplies, covering surgeons and attendants with sterile gowns, and draping the patient so that only the site of actual operation is exposed. The consequences for surgery were enormous.

 

Ignaz Philipp Semmelweis 1818 – 1865

Hungarian obstetrician, who discovered how to prevent puerperal fever from being transmitted to mothers, thus introducing antiseptic prophylaxis into medicine. Born in Buda and educated at the Universities of Pest and Vienna, Semmelweis became Assistant Professor in the maternity ward of the Vienna General Hospital. In the 1840’s puerperal, or childbed, fever, a bacterial infection of the female genital tract after childbirth, was taking the lives of up to 30% of the women giving birth in lying-in wards, whereas most women who gave birth at home remained relatively unaffected. Semmelweis noticed that women who were examined by student doctors who had not washed their hands after leaving the autopsy room had much higher mortality rates. When a colleague who had received a scalpel cut died from infection, Semmelweis concluded that the puerperal fever was septic and contagious. By ordering students to wash their hands with chlorinated lime before examining patients, he reduced the maternal mortality rate from 12.24% to 1.27% in two years.

Semmelweis nevertheless encountered strong opposition from hospital officials, and because of his political activity as well, he left Vienna in 1850 for the University of Pest, where he became Professor of Obstetrics at the university hospital. In spite of his enforcing antiseptic practices and reducing the mortality rate from puerperal fever to 0.85%, Semmelweis's findings and publications were resisted by hospital and medical authorities in Hungary and abroad. After suffering a breakdown, he went to a mental hospital in Vienna, where he died from an infection contracted during an operation he had performed earlier.

 

Joseph Lister 1827 – 1912

British surgeon, whose discovery of antiseptics in 1865 greatly reduced the number of deaths due to operating-room infections. Born in Upton, Essex, and educated at the Universities of London and Edinburgh, Lister began to study the coagulation of blood and the inflammation that followed injuries and surgical wounds. In 1861 he was appointed surgeon of the Glasgow Royal Infirmary in a new surgery unit designed to reduce gangrene and other infections, then thought to be caused by bad air. Despite his efforts to keep surgical instruments and rooms clean, the mortality rate remained close to 50%.

Believing infection to be caused by airborne dust particles, Lister sprayed the air with carbolic acid (now called phenol), a chemical that was then being used to treat foul-smelling sewers. In 1865 he came upon the germ theory of the French bacteriologist Louis Pasteur, whose experiments revealed that fermentation and putrefaction were caused by micro-organisms brought in contact with organic material. By applying carbolic acid to instruments and directly to wounds and dressings, Lister reduced surgical mortality to 15% by 1869.

Lister's discoveries in antisepsis met initial resistance, but by the 1880’s they had become widely accepted. In 1897 he was made a baron by Queen Victoria, who had been his patient.

Friedrich Esmarch 1833 – 1908

German famous surgeon, founder of Red Cross in Schleswig-Holstein in Germany

 

 

Physical Diagnosis

The process of diagnosis, which involves taking a patient's medical history and then conducting a careful examination, was perfected in the 19^th century. Most notable in this development was the Viennese school of so-called nihilists, who felt that what was then known of therapy was so poor that the brightest physicians should devote themselves to diagnosis rather than employ invalid therapy. Whatever the merits of this stance, its leading exponent, the Czech physician Joseph Skoda 1805 – 1881, laid the groundwork for the diagnostic process as it is known today.

 

 

J.Skoda

 

 

Psychiatry

The roots of modern psychiatry extend to the very last years of the 18^th century, when French physician Philippe Pinel 1745 – 1826,  was beginning to alter the treatment of persons suffering from psychoses. Such patients had been incarcerated in institutions and chained to walls until, in 1798; Pinel removed chains from patients at the Bicetre Hospital in Paris and began to popularize the concept of psychotics as patients and psychiatry as a field of medicine rather than a branch of penology. These enlightened attitudes developed until, by the last quarter of the 19^th century, psychiatry was dominated by two figures: Emil Kraepelin in Germany and Sigmund Freud in Vienna. Kraepelin's work was important in demonstrating that the discipline of psychiatry could be subjected to the same rigorous standards of investigation as other medical disciplines, while Freud revolutionized understanding of the unconscious mind and the treatment of sufferers from neuroses and anxiety. Freud's concept of the role of the unconscious and the significance of dreams affected not only psychiatry and the rest of medicine thereafter but also anthropology, sociology, and the arts.

 

Sigmund freud 1856 – 1939

Austrian doctor, neurologist, and founder of psychoanalysis. Freud's main contribution was to create an entirely new approach to the understanding of human personality by his demonstration of the existence and force of the unconscious. In addition, he founded a new medical discipline and formulated basic therapeutic procedures that in modified form are applied widely in the present-day treatment of neuroses and psychoses through psychotherapy. Although never accorded full recognition during his lifetime and often questioned by others in the field since then, Freud is generally acknowledged as one of the great creative minds of modern times.

Early Background and Studies

Freud was born in Freiberg (now Príbor, Czech Republic), on May 6, 1856, and educated at the University of Vienna. When he was three years old his family, fleeing from the anti-Semitic riots then raging in Freiberg, moved to Leipzig. Shortly thereafter, the family settled in Vienna, where Freud remained for most of his life.

Although his ambition from childhood had been a career in law, Freud decided to become a medical student shortly before he entered the University of Vienna in 1873. Inspired by the scientific investigations of Johann Wolfgang von Goethe, he was driven by an intense desire to study natural science and to solve some of the challenging problems confronting contemporary scientists.

In his third year at the University of Vienna Freud began research work on the central nervous system. This was conducted in the physiology laboratory under the direction of the German doctor Ernst Wilhelm von Brücke. Freud found neurological research so engrossing that he neglected the prescribed courses and as a result remained in medical school three years longer than was normally required to qualify as a doctor.

In 1881, after completing a year of compulsory military service, he received his medical degree. Unwilling to give up his experimental work, however, he remained at the university as a demonstrator in the physiology laboratory. In 1883, at von Brücke's urging, he reluctantly abandoned theoretical research to gain practical experience.

 

The Influence of Charcot

Jean Martin Charcot 1825 – 1893

French neurologist, considered the father of clinical neurology. Born in Paris and educated at the University of Paris, in 1856 he was appointed doctor to the Central Bureau of Hospitals. In 1860 he became Professor of Pathological Anatomy in the faculty of medicine at the University of Paris. Two years later he joined the staff of the Salpêtrière Hospital, and he opened the most highly regarded neurological clinic of his day. He specialized in the study of hysteria, locomotor ataxia, hypnosis, and aphasia. Cerebrospinal sclerosis was named Charcot's disease after him. Achieving international fame, Charcot became an honorary member of the American Neurological Association in 1881. He attracted pupils and scientists from all over the world. His most celebrated pupil was Sigmund Freud.

Freud spent three years at the General Hospital of Vienna, devoting himself successively to psychiatry, dermatology, and nervous diseases. In 1885, following his appointment as a lecturer in neuropathology at the University of Vienna, he left his post at the hospital. Later the same year he was awarded a government grant enabling him to spend 19 weeks in Paris as a student of the French neurologist Jean Charcot. As the director of the clinic at the Salpêtrière mental hospital, Charcot was then treating nervous disorders by the use of hypnotic suggestion. Freud's studies under Charcot, which centered largely on hysteria, influenced him greatly in channeling his interests to psychopathology—the scientific study of mental disorders.

In 1886 Freud established a private practice in Vienna specializing in nervous diseases. He met with violent opposition from the Viennese medical profession because of his strong support of Charcot's unorthodox views on hysteria and hypnotherapy. The resentment he incurred was to delay any acceptance of his subsequent findings on the origins of neurosis.

The Beginnings of Psychoanalysis

Freud's first published work, On Aphasia, appeared in 1891; it was a study of the neurological disorder in which the ability to pronounce words or to name common objects is lost as a result of organic brain disease. His final work in neurology was an article, “Infantile Cerebral Paralysis”; this was written for an encyclopedia in 1897 only at the insistence of the editor, since by this time Freud was occupied largely with psychological rather than physiological explanations for mental disorders. His subsequent writings were devoted entirely to that field, which he had named psychoanalysis in 1896.

Hysteria

Freud's new orientation was heralded by his collaborative work on hysteria with the Viennese doctor Josef Breuer. The work was presented in 1893 in a preliminary paper and two years later in an expanded form under the title Studies on Hysteria. In this work the symptoms of hysteria were ascribed to manifestations of discharged emotional energy associated with forgotten psychic traumas. The therapeutic procedure involved the use of a hypnotic state in which the patient was led to recall and re-enact the traumatic experience, thus discharging by catharsis the emotions causing the symptoms. The publication of this work marked the beginning of psychoanalytic theory formulated on the basis of clinical observations.

The Unconscious

During the period from 1895 to 1900 Freud developed many of the concepts that were later incorporated into psychoanalytic practice and doctrine. Soon after publishing the studies on hysteria he abandoned the use of hypnosis as a cathartic procedure and replaced it by the investigation of the patient's spontaneous flow of thoughts—called free association—to reveal the unconscious mental processes at the root of the neurotic disturbance.

In his clinical observations Freud found evidence for the mental mechanisms of repression and resistance. He described repression as a device operating unconsciously to make the memory of painful or threatening events inaccessible to the conscious mind. Resistance is defined as the unconscious defense against awareness of repressed experiences in order to avoid the resulting anxiety. He traced the operation of unconscious processes, using the free associations of the patient to guide him in the interpretation of dreams and slips of speech (“Freudian slips”—which Freud claimed were revelations of unconscious wishes).

Controversial Contributions

Analysis of dreaming led to his theories of infantile sexuality and of the so-called Oedipus complex, which constitutes a purported erotic attachment of the child for the parent of the opposite sex, together with hostile feelings towards the other parent. This aligned to the emphasis on the biological bases for human behavior—particularly sex and aggression—were among Freud's most controversial theories. The term “Freudian” is often used in connection with these theories, many of which were to become major concepts in psychiatry. They were infused with rich symbolism, and were in the main preoccupied with reconciling the conflict between biological factors of human existence and what Freud believed were the civilizing aspects of human behavior: aesthetics, intellectual capacity, and religion. Terms often thought of as Freudian, such as id and ego, are now no longer regarded as exclusive to Freudian theory.

In these years he also developed the theory of transference—the process by which emotional attitudes, established originally towards parental figures in childhood, are transferred in later life to others. The end of this period was marked by the appearance of Freud's most important work, The Interpretation of Dreams (1900). Here Freud analyzed many of his own dreams recorded in a three-year period of self-analysis which began in 1897. This work expounds all the fundamental concepts underlying psychoanalytic technique and doctrine.

In 1902 Freud was appointed a full professor at the University of Vienna. This honor was granted not in recognition of his contributions but as a result of the efforts of a highly influential patient. The medical world still regarded his work with hostility, and his next writings, The Psychopathology of Everyday Life (1901) and Three Contributions to the Theory of Sexuality (1905), only increased this antagonism. As a result, Freud continued to work virtually alone in what he termed “splendid isolation”.

By 1906, however, Freud had a small number of pupils and followers—including the Austrian psychiatrists William Stekel and Alfred Adler, the Austrian psychologist Otto Rank, the American psychiatrist Abraham Brill, and the Swiss psychiatrists Eugen Bleuler and Carl Gustav Jung. Other notable associates, who joined the circle in 1908, were the Hungarian psychiatrist Sándor Ferenczi and the British psychiatrist Ernest Jones.

International Acceptance

Increasing recognition of the psychoanalytic movement made possible the formation in 1910 of a worldwide organization called the International Psychoanalytic Association. As the movement spread, gaining new adherents throughout Europe and the United States, Freud was troubled by the dissension that arose among members of his original circle. Most disturbing were the defections from the group of Adler and Jung, each of whom developed a different theoretical basis for disagreement with Freud's emphasis on the sexual origin of neurosis. Freud met these setbacks by developing further his basic concepts and by elaborating his own views in many publications and lectures.

After the onset of World War I Freud devoted little time to clinical observation and concentrated on the application of his theories to the interpretation of religion, mythology, art, and literature. In 1923 he was stricken with cancer of the jaw, which necessitated constant, painful treatment in addition to many surgical operations. Despite his physical suffering he continued his literary activity for the next 16 years, writing mostly on cultural and philosophical problems. Among his other works are Totem and Taboo (1913), The Ego and the Id (1923), New Introductory Lectures on Psychoanalysis (1933), and Moses and Monotheism (1939).

When the Germans occupied Austria in 1938, Freud was persuaded by friends to escape with his family to England. He died in London on September 23, 1939.

 

Ivan Petrovich Pavlov 1849 – 1936

Russian physiologist and Nobel laureate, best known for his studies of reflex behavior. He was born in Ryazan and educated at the University of St Petersburg and at the Military Medical Academy, St Petersburg; from 1884 to 1886 he studied in Breslau (now Wroclaw, Poland) and Leipzig, Germany. Before the Russian Revolution he served as director of the department of physiology at the Institute of Experimental Medicine (part of the present Academy of Medical Sciences), St Petersburg, and was Professor of Medicine at the Military Medical Academy. In spite of his opposition to Communism, Pavlov was allowed to continue his research in a laboratory built by the Soviet government in 1935. Pavlov is noted for his pioneer work in the physiology of the heart, nervous system, and digestive system. His most famous experiments, begun in 1889, demonstrated the conditioned and unconditioned reflexes in dogs, and they had an influence on the development of physiologically orientated behaviorist theories of psychology during the early years of the 20^th century. His work on the physiology of the digestive glands won him the 1904 Nobel Prize for Physiology or Medicine. His major work is Conditioned Reflexes

 

 

By the end of the 19^th Century, the development of the American surgeon as a medical specialist had evolved. Medical education was shifting from proprietary schools to university-based schools. William Halsted 1852 – 1922 of Johns Hopkins Hospital and School of Medicine formalized what is known today as the "sine qua non of modern surgical residencies."

William Morton 1819 – 1869, a dentist, successfully used sulfuric ether as a general anesthetic agent for surgical procedures in 1846. The following year, Marie Floureus 1794 – 1867 of Paris authored a paper announcing that chloroform had an effect analogous to ether. As the use of ether and chloroform became more commonplace, speed during surgery was less important and the surgeon gained greater skill and developed more scientific approaches to surgical procedures.

"Contagion" or "hospital gangrene" took the lives of many patients and thus inhibited the evolution of surgery. As early as 1775, a French surgeon, Claude Pouteau 1724 – 1775 advocated clean hands in dealing with patients' wounds to prevent "putrescence". In 1843, Oliver Wendall Holmes 1808 – 1910 suggested hand washing in calcium chloride before attending women in childbirth to prevent the spread of Puerperal Fever. The individual works of the Frenchman, Louis Pasteur 1809 – 1894 and the German, Robert Koch 1843 – 1910 advanced the knowledge that "germs and microbes" caused infectious diseases. Not until the 1867 published works of the English Quaker, Joseph Lister 1827 – 1912, on systematic antisepsis and the use of carbolic acid in surgery was the evolution complete.

 

Burril Bernhard Crohn 1884 – 1983

specialized in gastroenterology, Morbus crohn

special cancellation from DCCV = German Crohn – Colitis – Ulcerosa – Association 

 

Antonio Soler Roig 1889 – 1970

Spanish physician in urology. He was famous by philately. He worked only a short time as physician.