Romance Of Medicine



Terrible tragic, like the fate of the doctor who had a hold upon the cloak of truth, and saved the lives of millions of mothers by his discovery of the cause of puerperal fever. That Semmelweis was the man who introduced a new era into obstetrics, may perhaps have been simply due to his being a man. Until just before his time, it was considered impossible and abdominable for anyone of the male sex to be admitted to a room where a confinement was in progress.

In the sixteenth century a Doctor Wirth was burnt at the stake in Hamburg for having disguised himself as a midwife and attended a confinement – solely from scientific interest since, though a doctor, he had no idea how a birth took place. But even as late as the nineteenth century, after a certain Royal Princess had had an unfortunate experience with her first confinement, at which two doctors had attended her, a midwife was sent from Germany when the second baby was expected, and she brought the future Queen Victoria into the world. What was considered right by the enlightened great ones of the earth was felt to be good enough for the ordinary citizens, and the preference for female midwives persisted for a long time.

It is perhaps one of the strongest arguments against the emancipation of women that though women carried on midwifery for thousands of years, the profession never developed into science until men took a hand in it, and that no woman has ever made a single discovery in this sphere. At the same time it cannot be denied that in those days women were much more successful than the male doctors – far fewer of their patients died than those of their scientifically better instructed male colleagues.

What was the reason for this? It is well known how Semmelweis, deeply affected by a fatal infection that a friend of his, also a doctor, had contracted while dissecting a body, had lighted on the idea that it might be the hands of the examining doctors that conveyed puerperal fever. He gave orders that every medical student must wash his hands in chlorine before touching a woman in child birth; and within two years the number of those who died in childbirth in one ward of the Vienna General Hospital had gone down from 459 to forty-five.

In August of the revolutionary year 1848, when the students were more often to be found on the barricades than in the hospital wards, there was not a single case of the fever. This should have proved the correctness of the Semmelweis views, and he should have been hailed by his fellow-practitioners and the world in general as a life saver on a large scale.

“Dogs bark at everyone whom they do not know,” said Heraclitus. “I prefer,” wrote gynaecologist sarcastically, “to ascribe death in childbed to providence, which I know about, than to an infection of which I know nothing”; and even fifteen years later, the result of Semmelweis efforts was that during three years in the University Hospital at Jena every single woman who was having a baby there died; not one escaped with her life.

This great doctor, who was the first to recognize that the toxin passed from the wound into the blood, was born before this time. He went mad and died in a lunatic asylum, after, as Goethe said, “having worked indefatigably without recognition and without disciples”.

Nevertheless, Semmelweis had launched an idea into the world. If it were true that in the case of a woman in childbirth, whose organs form a single great wound during the process, this wound was the place where infection occurred, then attention had at least been directed to the idea that possibly the wound was the porta malorum – the door at which the evil entered – in all cases of blood poisoning.

No longer was it regarded as the fault of the hospital demon or the bad air. It certainly was a little while, but at all events not so very long, before Hillroth produced proof that “accidental vulnerary disease”, as he called them, were due to secretions in the wound.

SOME WONDERS OF THE BODY

The constitution of the Cell State is not monarchical; the brain, much as it would no doubt like to think otherwise, is not an autocrat. It cannot even be regarded as a premier; at most it may be looked upon as a (certainly extraordinarily competent) foreign secretary. it supervises the exports and the imports, decides for peace or war; whether a danger is to be met by militarist measures or more pacifically by flight, lies in its discretion.

The preparation of the means, however, that is, of the forces required either for flight or for battle, do not come within its jurisdiction. Without awaiting the instruction of the brain, another organ in moments of danger sends the order to the heart to pump more quickly, or to the liver to supply more sugar to the blood, so that the body shall be provided with sufficient reserves in either case.

This organ bears the misleading name of the adrenal gland. It has nothing at all to do with the kidneys; but when it was discovered by Eustachius in the middle of the sixteenth century, so little was known of its purpose that it was labelled simply according to its geographical position “next to the kidneys”. Its purpose did not indeed become much clearer in the succeeding centuries, for the usual means of determining the function of an organ does not act in the case of the adrenal gland.

The ordinary method of discovering the use of an organ is to cut it out and see what functions do not take place when it is no longer there. If the adrenal gland is removed, however, the animal upon which the experiment is made dies so quickly that there is no time to determine why it does so. Here the knife does not suffice the biologist; he must turn for help to the histologist, the specialist on the interior of the body, and take the counsel of embryology and comparative anatomy.

Histologists put the organ under the microscope and found that it consists of two layers – a covering and an inner substance, exactly like the brain. And as in the brain, the two are divided by an undulating boundary line; like the brain, the covering of the adrenal gland is rich in cells and fatty substances, while the centre is predominantly fibrous.

Over and above these external similarities, however, there seems to be some mysterious inner connection. For example, if a monstrosity is born without a brain, the covering of the adrenal is also invariably missing. And there must be other intimate connections between the brain that is in the head and this brain in the abdomen.

Hence research is being carried on with the most eager interest. After the microscope, comparative anatomy has played a part in the endeavour to fathom the mystery surrounding this organ. Investigation of the animal kingdom showed that in fish the part that is called the covering of the human adrenal gland is an independent formation; it lies in the body apart from the central substance.

Here at length was a case where something could be done with the knife. It was found that the central substance may be removed, but not the covering. Hence this is obviously the part that is essential to life. If this is removed the animal dies.

If the covering determines death, the inner substance determines life and the course it shall take. This has been known since it was discovered how, by treating it with water and glycerine, to extract a part of the inner substance – which, by the way, can now be produced synthetically in the laboratory – that is called adrenalin. Adrenalin is the inner secretion of the adrenal, the fluid that is passed straight into the blood, circulates with it, and exercises a considerable influence upon the most remote organs.

How was this discovered? It only had to be shown that the blood that enters the adrenal contains less adrenalin that that which passes out of it; if the veins are richer in adrenalin than the arteries, this must be produced in the adrenal and pass from it straight into the blood.

That should be very simple if it were not that the quantities are so incredibly minute that they defy attempts to demonstrate the fact chemically. Complicated methods have to be adopted, physiological instead of chemical. The greater or less proportion of adrenalin in the blood is measured by the greater or less effect that this exercises upon some organ, say the bladder.

The bladder is so extraordinarily sensitive to this substance that it is actually contained in the blood that leaves the adrenal than in that which enters it; which proves that the adrenal really does produce adrenalin.

The “abdominal brain” has, moreover, its own particular serum and uses it as a chemical messenger. It uses it to tell the heart to bear more strongly; to order the blood vessels to contract; to cause the intestines and bladder to relax. It is true that the adrenal also has other functions the reason for which has not yet been discovered. It causes a discolouration of the skin in the disorder known as Addisons disease; it removes toxins from the blood, and animals that are inoculated with blood taken from another animal shortly after the removal of the adrenal, are poisoned with it.

Joesef Loebel