NORTH AMERICAN

JOURNAL OF HOMEOPATHY

Original Articles in Medicine.

OUR MEDICAL PROGRESS DURING THE PAST QUARTER CENTURY.*

BY CHARLES L. NICHOLS, M. D.

Boston, Mass.

N 1875 three men were at work whose labors have been the

IN 1975 of our recent medical progress:

In Berlin a man, whose principle enunciated in 1858 was not then universally accepted-Rudolph Virchow; in Paris, Claude Bernard, whose book "An Introduction to the Study of Experimental Medicine" appeared in 1865; and in England Joseph Lister, who was still experimenting on antiseptics, the results of which appeared in 1878 in an article entitled "The Germ Theory of Fermentation and Its Bearing on Pathology."

Cellular Pathology, the Germ Theory and the method of Scientific Research are the tripod upon which modern medicine stands.

Of these three no one can estimate which will prove more valuable in the end, although the method of research must at least have a lasting value from its tendency to educate the mind to habits of close observation and careful inference.

Had not Bichat studied tissues and Muller investigated the structure of tumors, and Schwann discovered vegetable cells, Virchow's Cellular Pathology might not have been promulgated at that time, but it would have come soon, for all great discoveries originate from a demand of the times, though the honor belongs to him who presents it to the world in a form of practical value.

Harvey's investigations upon the Circulation were models of care and logical deduction, and the experiments of Galileo, Newton and Galvani perfected the instruments of precision used in research, but to Claude Bernard belongs the credit of formulating

*Read before the Hughes Medical Club.

the lines upon which research should proceed. In the case of the Germ Theory, it is perhaps more difficult to decide to whom most honor is due. Pasteur in 1857 settled the dispute between Latour and Schwann whether micro-organisms were causes of animal as well as vegetable fermentation; Davaine later proved micro-organisms the cause of the disease he was studying-anthrax; Koch formulated rules which have made Bacteriology a science; but to Lister, it seems to me, belongs the honor, because of his applying this to practical medicine and surgery.

Let us note briefly what effect the labors of these men-forwarded by hundreds of others, good men and true-have had upon medical education, literature and practice.

In an introductory address at Jefferson Medical College, in 1867, Dr. S. D. Gross said: "Medical colleges have multiplied in a ratio altogether disproportionate to the wants and requirements of the country. Many of these institutions are, from their unfavorable location, destitute of anatomical and clinical facilities upon which so much stress is justly placed in a course of medical education. Even the best and most favored schools are far from what they ought to be as great seminaries of medical science. Hardly any change in the curriculum of instruction has occurred in any of them since my entrance into the profession. The number and character of the chairs, the length of the session, the period of study and the preliminary education of the student are in most of the colleges the same as formerly. The principal improvement has been in the addition of clinical teaching, rendered indispensably necessary by the demands of the age."

In 1832, at the time of Dr. Gross' entrance into medicine, Jefferson Medical College required two courses of four months each, giving as an option, but not requirement, spring terms in addition. The course consisted of lectures on Anatomy, Surgery, Theory and Practice, Materia Medica, Chemistry and Midwifery. Dissection, a little clinical instruction in the Hospital, and a probable case of confinement were added. In 1890 the same school had ten large laboratories and seventeen private rooms for research, and the required courses in special laboratory work covered nine subjects. Turning to Harvard Medical School in 1875, the year of my graduation—and I speak of myself as an average student, although some few may have had better opportunities—in addition to the regular chairs, there were courses in eight specialties, e. g., skin, eye, ear, &c., without required examination. Careful attention was given to diagnosis, and the clinical opportunities of that

day were very carefully used. A good course was given in microscopical manipulation, and each student was allowed to make one or two experiments in laboratory technique in connection with the course on experimental physiology.

Research proper, however, was little known, and the study of Bacteriology in its infancy. Indeed, not until the oil immersion lens and the generalization in 1897 regarding coal tar stains by Ehrlich were applied to bacteriological study have the labors of Kech had their full fruition.

Turning to the catalogue of Harvard Medical School in 1902, with its four years' course (to which we as pioneers may point with pride), with its extended courses in pathology, bacteriology, research and technical training; reading the discussions which are going on within its borders as to the best methods of instruction, didatic or clinical, practical or investigating, we are struck most forcibly with the fact of the enormous advance in opportunities, as well as the great responsibility of the student in making use of them. The question is also forced upon us, Does it make a better trained physician in the end?

The answer to this must be that while some men can never be made good physicians, and many of this class drop out before graduation, it must be surely true that the standard of the majority at least is raised by the training now furnished.

The most important question, and one impossible yet to answer, is whether the present training, with so much time given up to research work, is not better for the exceptional scientific worker rather than the average man who needs some training in these methods but requires a larger share of practical diagnosis, pathology and clinical work.

Turning to the medical literature of to-day we find the Journal of Medical Research, of Experimental Medicine, of Physiology, and a long list of records of careful, painstaking investigations on special subjects. Many of the more essentially practical medical journals also contain treatises upon various diseases, with careful collations of similar cases, and in most instances a brief and valuable compendium with bibliography at the end.

These are far in advance of the articles of thirty years ago, which, clinical though they were, had in a large majority of cases too little careful scientific treatment to be of great value, either in practice or for a comparison in similar cases.

In the field of applied medicine the change is equally noticeable. In the 1867 address before quoted, Dr. Gross says: "Among the