Harvard Classics, Volume 38: Historical Medicine

I admittedly plowed through this volume, and didn’t take time to savor it the way I do with many of the literary ones. This is mainly because the prime interest in these works isn’t their depth of insight, or teaching me new things about medicine I didn’t know before, it is in figuring out how things came to be.

One of the problems with the Harvard Classics, especially the scientific sections, is that it is very out of date and what they saw as new, groundbreaking findings, we think of as common sense. Vaccines, the contagiousness of disease, the importance of anti-septics, and germ theory are all relatively recent developments whose implications have become a matter of habit to modern man.

The volume starts with the Hippocratic Oath which is interesting mainly because of its fairly modern understanding of what a doctor should be as well as specific calls against assisted suicide and abortion.

The best part of this volume is Ambroise Paré’s Journeys in Diverse Places. Written as a way for Paré to defend himself against accusations of incompetence, this collection of stories is a first hand account of battlefield surgery from the Renaissance. The depictions of war, of medical care, and they types of injuries sustained, and the way people died are deeply moving, and do not paint a romantic image of conflict the way many contemporary sources do.

Next up was William Harvey’s papers describing the circulatory system. What he went through to understand that blood circulated through the body is quite extraordinary, and required the use of living (animal) subjects to figure out.

The common presumption was that blood stayed in one place and the pulse pushed air throughout the body. It is easy to see why people thought that when you consider anatomists were working on cadavers. They intuited that there was some connection between the heart and air because the heart is right between the lungs and the lungs are so dense with blood vessels.

Edward Jenner’s publications on the vaccination for smallpox were an edifying look into rural life in the 18th century as well as a demonstration of how one actually went about testing your medical theories in those days.

It had been known for centuries that once you had smallpox once, you’d never get it again. To that end, sometimes healthy people who were at low risk from dying of smallpox would purposefully infect themselves to gain immunity to protect them later in life. This was still sometimes fatal and could lead to permanent scarring.

Jenner’s discovery was that people who contracted cowpox were immune to smallpox. Cowpox isn’t pleasant, but it generally isn’t deadly, and done in a purposeful way, might just consist of a single pustule on the upper arm.

Jenner experimented with his technique, trying it on people of various ages, and waited until the next smallpox outbreak to see if anyone got it. He had inculcated over one thousand people, and none of them had gotten smallpox by the time he was writing.

Other people, wanting to test the idea, corroborated Jenner’s results on a large scale and began the modern era of vaccination.

Shifting over to the United States is a paper on The Contagiousness of Puerperal Fever by Oliver Wendell Holmes Sr. This would be the father of the Supreme Court justice you probably associate with the name. The elder Holmes is probably best known today for his poem: Old Ironsides, about the USS Constitution.

The main point of the paper is an important, but today obvious, insight. Puerperal fever, which is caused by uterine infection in the post-partum period, was killing huge numbers of women. Holmes figured out that the disease was contagious and carried from patient to patient by the doctor. They didn’t have enough medical knowledge at the time for Holmes to recommend that the doctor shut down his practice for a month if one of his patients got puerperal fever, but it turns out the solution is to sterilize your tools and wash your hands in-between patients.

The Antispetic Principle of the Practice of Surgery by Joseph Lister laid out findings and recommendations for surgeons to use various acids to clean out incisions and wounds in order to prevent infection. Seems like an obvious point today, but it was a big deal at the time.

The papers of Louis Pasteur covered two different topics. The first was his work on understanding fermentation. This is much closer to what we think of as a modern scientific work, so it is filled with hypotheses, tests, results, measurements, and discussions of criticisms. It is pretty dry but nevertheless important research, especially if you enjoy alcoholic beverages.

The second topic is germ theory, that idea that disease was caused by microscopic organisms. His examples are pretty gross. For instance, he took pus from different boils on the same person, cultured them separately and showed they had identical bacteria in them. Doing observations and experiments like this showed how diseases worked and helped bring about modern medicine.

The final work isn’t actually about medicine at all, but about geology and paleontology. Sir Charles Lyell wrote about the contemporary findings in geology, and how the big important conclusion you could draw from studying places all over the world was that geology is always in a state of flux. What is covered by water and what is land changes with time. Different epochs shape lands in different ways, but the constant thing is change. We’ve come a long way in our understanding since then, but we know on that count, Lyell was correct.

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