Romance Of Medicine


Serious anatomy of the human brain only began about a hundred years ago. It was not until 1832 that the Anatomy Act was passed in England, putting an end to the anomaly that young doctors were let loose upon living man but not upon the dead. In view of this undoubted fact, ridicule of homeopathic doses may well be reconsidered.


Serious anatomy of the human brain only began about a hundred years ago. It was not until 1832 that the Anatomy Act was passed in England, putting an end to the anomaly that young doctors were let loose upon living man but not upon the dead. Until then, the most that ever happened was that a barber might do a dissection while a professor stood beside him with a pointer and lectured. There was, of course, the greatest difficulty in obtaining bodies for dissection; and even the famous anatomist John Hunter was obliged to avail himself of the services of the so-called “resurrection men”. These were persons who broke open graves and vaults after dark in order to steal corpses for anatomical students. It was not until this branch of business passed all bounds that science was finally delivered from her discreditable allies.

Who knows when the release would have come had not a great scandal finally brought the traffic to an end. The origin of the scandal was in a lodging-house in Edinburgh. The keeper of this, one Hare, had begun in a small way by taking to an anatomy laboratory by night, the body of a guest who died without paying his reckoning; insisting like Shylock upon his pound of flesh, he exchanged the body for good English gold. At Surgeons Square he asked a student for Professor Munroe.

This student happened to be the pupil of another anatomist, the great Knox, so he took the man to his own professor, who paid him and expressed a wish to enter into further and permanent business relations with him. The landlord, as a good business man, could not simply trust to luck and hope that another traveller would die at his establishment; he gave a little assistance to fortune, and in the course of time he and his friend Burke slew some thirty persons, whose bodies they delivered to Professor Knox. Everything proceeded on a sound business footing – in the summer he got eight pounds and in the winter ten pounds apiece.

The undertaking grew, a branch concern was opened in Dublin, and great care was taken that the bodies should be in good condition and that there should be no external signs of violence. It is, however, a well-known fact that people in a large organization are apt in time to grow careless, and so this purveyor of anatomical specimens failed in circumspection, and one day a neighbours wife saw something of what was going on and lodged an accusation against him. Legal proceedings were instituted, and Knox, the accessory as is generally the case, got off scot free, Hare turned Kings evidence and so saved his neck, while Burke paid the penalty.

DIABETES

If the normal course of events is interrupted at any point, if the sugar is not deposited in the store-rooms of the liver to be ready for use when required, but if instead it gets into the blood, it will be eliminated through the urine and thus be lost to the economy of the body. The patient will vainly try to make good the loss by excessive eating and drinking; raging hunger and perpetual thirst are the most noticeable symptoms of the disease; and, moreover, sugar will be lacking where it is needed – to provide muscular activity.

This is the reason why the diabetic is always so tired. The organism tries to make shift by using up the reserve of fat for combustion, but the only result is that despite a remarkably hearty appetite, the patient gets more and more emaciated. On the other hand, sugar is found in all sorts of places where it is not required, it becomes troublesome, causes all kinds of unpleasantnesses, such as fatigue, headaches, stomach and intestinal troubles, almost unbearable irritation of the skin, as well as inflammation of the nerves; sciatica, especially when it appears on both sides, always arouses suspicion of diabetes.

For a long time medical science was very helpless in face of these symptoms. At first, since the patient was obviously losing sugar, it seemed reasonable to try to make up for this by feeding him on sugar. This proved only to aggravate matters. Hence the opposite was tried, and until a very few years ago the treatment consisted almost entirely in giving a sugarless diet. At the same time, the error in the calculation, the factor causing the disturbance, was continually sought. Which organ could it be that controlled the assimilation of sugar?.

An Englishman, Thomas Cawley, was the first to give an indication, when in 1788 he described a case of diabetes in which a morbid condition of the pancreatic gland was found. Nevertheless, Cawley was nowhere near realizing a causal connection, and another hundred years were to pass before the German scientists, von Mehring and Minkowski, discovered it.

Minkowski tells how his chief, Von Mehring, was studying the absorption of fats, and in the course of experiment told him to cut the pancreatic gland out of a dog; the only question he had in mind was whether or not the animal would survive the operation. But a few days later it was running about the laboratory quite happily. The one curious thing was that it seemed to have forgotten its manners, for the lavatory attendant was always having to go round and clean up after it – the dog seemed to have an inexhaustible flow.

Now came the moment of inspiration that proceeds every great discovery. The idea shot through the scientists mind: might not the frequent and increased passing of water indicate diabetes? Minkowski picked up a few drops of the urine in a pipette. The liquid was found to contain sugar. The pancreatic gland was recognized as the organ whose inadequate functioning caused diabetes.

The further development of this important discovery was carried out by Minkowski alone. It was this which made it certain that a dog only became diabetic when the whole of his pancreatic gland was removed. If only a fragment of it remained, and even if this fragment was only inserted under the skin, he remained healthy.

By means of this now famous experiment, it was shown that the pancreatic gland is not only, as had until then been thought, an ordinary gland secreting externally a digestive juice, but that it must also be a ductless gland which sends out a particular fluid directly into the blood.

This fluid comes from particular insular cell groups that are embedded in the remaining tissues of the organ named after their discoverer, Paul Langerhans, which are the actual regulators of the assimilation of the sugar. In most cases of diabetes, the Langerhans islands, the source of Insulin, are in some way out of order.

Thus diabetics seemed also to have turned out to be the result of a deficiency in an organ – a decreased productivity on the part of the pancreatic gland. But at the same moment that on riddle seemed to be solved, another made its appearance. For sugar may be found when the insulin mechanism is perfectly sound, if other organs such as the suprarenal glands, the thyroid gland or the central nervous system and the pituitary gland are damaged.

An experiment carried out by Claude Bernard has become famous: he made a puncture in the brain at a particular point and found that it at once caused the precipitation of sugar. This experiment also shows the influence of the brain – which had already been observed in other experiments – upon the assimilation of sugar, which is evidently not controlled by one organ alone, but by the mutual work of several, which act in part as deterrents and in part as promoters of the formation of sugar.

HOSPITAL FEVER AND CHILDBIRTH FEVER.

A Viennese surgeon, Professor Frankel, in an excellent commemorative speech upon Lister, described how as late as the middle of the nineteenth century the so-called hospital gangrene presented an insoluble mystery. Surgical patients were attacked by it, so that for certain hospitals, and in certain wards of these, a particular “hygienic condition” was thought to exist.

Instead of realizing that the infection was carried from bed to bed by using the same sponge to wash out one suppurating wound after another, a particular local demon was surmized, and St. Georges Hospital in London was pulled down in order to exercise such a one. The same plague, of course, raged in the new building erected on the old site. But this only served as confirmation of the theory that it was due to the genius loci, who-as his name implied – was attached to the locality.

However, not all surgeons were satisfied with this explanation. The number grew of those who suspected some external infectious matter, some virus, some miasma, and the problems of decay and fermentation began to be studied. As early as 1840 the German anatomist Jakob Henle tried to explain infection, and, as it happened, in exactly the way that proved afterwards to be correct, that is by the presence of minute living beings. But he had no facts to support him; his views remained hypotheses without any proof and hence without any weight.

These hypotheses passed across surgery leaving no trace on its evolution; but they did play a part in one branch of science which, indeed, is closely related – obstetrics. Unfortunately, they played an episodic part and a particularly tragic one. For surely it is tragic to the last degree that truth was so nearly approached without being recognized: surely it is terrible that the moment that might have seen the beginning of a decisive change in surgery and obstetrics was missed and progress therefore deferred for many years, with the sacrifice of innumerable lives.

Joesef Loebel