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Understanding disease etiology around 1800

Medical theory and practice in the 1800s

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In the late 1800s the quality of medical treatments improved on an unprecedented scale. Giant leaps took place: in scientific method, in the most fundamental understanding of what a disease is, and in the arsenal of cures available to the patients. This article presents medical theories and practices in use until the mid-1800s, with a special emphasis on the period 1840-1860, as they were taught at leading universities or discussed in the highest learned circles at the time.

science of medicine underwent an unprecedented development took a quantum leap

Understanding disease etiology around 1800
What is a disease? Perhaps the most commonsense and natural way of defining a disease (relative to other diseases) is to associate it with a a set of specific signs and symptoms. The next logical step would then be to examine the history of patients with the same disease in order to identify and classify common patterns or triggers, which would then be interpreted as causes for the disease. From the privileged view of present medical knowledge, this approach in many cases would be confusing misleading and entirely useless. For instance, physicians in the early 1800s thought that hydrophobia - "the complete horror of fluids" - could be caused by certain fevers, disorders in the throat, emotional factors including fear, and by the bite of a rabid dog.

A prominent medical text from 1825 gave this description of the causes of phthisis (most cases of phthisis would now be identified as tubercolosis):

"The causes which predispose to this disease are very numerous; the following are, however, the most general: hereditary disposition; particular formation of the body, obvious by a long neck, prominent shoulders, and narrow chest; scrofulous diathesis, indicated by a fine clear skin, fair hair, delicate rosy complexion, large veins, thick upper lip, a weak voice, and great sensibility; certain diseases, such as catarrh, pneumonic inflammation, hæmoptoë syphilis, scrofula, small pox, and measles; particular employments exposing artificers to dust, such as needle pointers, stone cutters, millers &c; or to the fumes of metals or minerals under a confined and unwholesome air; violent passions, exertions, or affections of the mind, as grief, disappointment, anxiety, or close application to study, without using proper exercise; playing much on wind instruments; frequent and excessive debaucheries; late watching, and drinking freely of strong liquors; great evacuations, as diarrhæa, diabetes, excessive venery, fluor albus, immoderate discharge of the menstrual flux, and the continuing to suckle too long under a debilitated state; and lastly, the application of cold, either by too quick a change of apparel, keeping on wet clothes, lying in damp beds, or exposing the body too suddenly to cool air when heated by exercise; in short, by any thing that gives a considerable check to the perspiration."

filthy hospital carter 1983:138brit hosp

Medieval medicine

Early treatments of childbed fever
In England, at the time of the reign of Henry VIII (1491–1547), women with puerperal fever were managed this way according to a text from 1535:

Likewise do if the woman have the ague after her labour for that cometh of like cause by retention of the floweres; and in the fever let her use to drinke water in the whiche is decocte barley beaten, or cider and barley together, or water in which is sodden TAMARINDS, or whay of mylke, and let her eate a cullis made of a cocke and sweete pomegranates, for these things do provoke the flowres and mittigateth the immoderate heate, refreshing greatly the body, loossyng and opening suche thinges the whiche before were constricte and cluddered together. If the body after labour do swell and inflate, then let her drinke water in which is sodden cicer and cummin, beaten together.

In France, at the time of the reign of Louis XIV (1638–1715), the following prophylactic procedure was applied to Mary Anne of Bavaria at the birth of Louis Duke of Burgundy in 1682 to avoid childbed fever, as documented in this 1724 text:

There are certain teachers who insist that as soon as a woman is delivered, the skin of a black sheep, just torn from the body of the animal must be laid over the patient's abdomen, under the idea that the warmth of such a skin restores and comforts the parts that have suffered. M. Clement applied one of them to Madame la Dauphine at her first confinement, but it was not repeated in her others on account of the inconveniences attending it. In fact, the precautions required are very troublesome, for a butcher must be had in readiness to skin the animal in an adjoining chamber, so that the skin can be had quite warm. The butcher who skinned the sheep for Madame la Dauphine's case, having taken it off and wrapped it in his apron, and having brought it close to the bedside, the sheep all bloody and naked, followed him to the bedside, which frightened all the ladies who were present at this spectacle.

In 1854, the celebrated American obstetrician Charles Delucena Meigs (then aged 62) reported to have witnessed nearly such an application some fifty years earlier. The practice was "still held by some in our most polished society as a most excellent cure" and Meigs had recently declined a proposal to apply this procedure that came from a high social quarter, which merely "shows us how slowly we advance" [in knowledge].

Treatment of syphilis with iron compounds
In article decribing several cases of successful treatment of primary syphilis sore with potassio tartrate of iron In was publiched in the 1856 issue of The Lancet.

In March 1854, an experienced doctor was called upon by 27 year old man, of sanguine temperament, florid complexion, no heriditary cachexia, and accostumed to live well. A minor pimple on the penis had developed into a small, deep, and very painful sore, discharging thick, dark-coloured secretions. The doctor administered lunar caustic, zinc lotion and warm water dressings. The sore developed further however, to the size of a shilling, but in reality larger, as a probe easily could be passed underneath the edges for a considerable distance.

The patient was now confined to the bed. The doctor ordered mercury iodide pills; he also suggested iron potassio tartrate pills but this was overruled by the local doctor. A variety of local applications were ordered: plaisters, ointments, oak-bark decoctions; silver nitrate and strong nitric acid were frequently used. Opium was given in vain to produce sleep. The patient was allowed a generous diet, and a bottle of claret (red wine, usually a Bordeaux blend) a day. Under this treatment the discharge improved in appearance, but the sore continued its gradual increase.

In late June 1854 the patient was transferred to the sea-side. He was in depressed spirits, pain and lack of sleep had taken a visible toll. The sore was now the size of a florin, it extended to the scrotum, margins were rough and elevated, the discharge healthy. He was now ordered to take iron potassium tartrate three times a day, and twice a day local application of aromatic wine. The doctor ordered a generous diet, a bottle of champagne a day, plenty of fruit, no patry or cheese. An improvement became at once manifest.

In late July the patient ceased all treatment, the sore now reduced to pinhead and rapidly improving.

The article continues with several other successful treatments of of chancres (sores) with potassio tartrate of iron.

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