Between 1850 and 1870, two major intellectual developments are evident: the growth of scientific knowledge, with its rapidly increasing impact on the Western worldview, and the shift from Romanticism and its focus on the inner world of reality to Realism and its turning toward the outer, material world.
By the mid-nineteenth century, science was having an ever-greater impact on European life. The Scientific Revolution of the sixteenth and seventeenth centuries had fundamentally transformed the Western worldview and led to a modern, rational approach to the study of the natural world. Even in the eighteenth century, however, these intellectual developments had remained the preserve of an educated elite and resulted in few practical benefits. Moreover, the technical advances of the early Industrial Revolution had depended little on pure science and much more on the practical experiments of technologically-oriented amateur inventors. Advances in industrial technology, however, fed an interest in basic scientific research, which in the 1830s and afterward resulted in a rash of basic scientific discoveries that were soon converted into technological improvements that affected everybody.
The development of the steam engine was important in encouraging scientists to work out its theoretical foundations, a preoccupation that led to thermodynamics, the science of the relationship between heat and mechanical energy. The laws of thermodynamics were at the core of nineteenth-century physics. In biology, the Frenchman Louis Pasteur (LWEE pas-TOOR) formulated the germ theory of disease, which had enormous practical applications in the development of modern scientific medical practices (see “A Revolution in Health Care” later in this chapter). In chemistry, in the 1860s, the Russian Dmitri Mendeleyev (di-MEE-tree men-duh-LAY-ef) (1834-1907) classified all the material elements then known on the basis of their atomic weights and provided the systematic foundation for the periodic law. The Englishman Michael Faraday (1791-1867) discovered the phenomenon of electromagnetic induction and put together a primitive generator that laid the foundation for the use of electricity, although economically efficient generators were not built until the 1870s.
The steadily increasing and often dramatic material gains generated by science and technology led to a growing faith in the benefits of science. The popularity of scientific and technological achievement produced a widespread acceptance of the scientific method, based on observation, experiment, and logical analysis, as the only path to objective truth and objective reality. This in turn undermined the faith of many people in religious revelation and truth. It is no accident that the nineteenth century was an age of increasing secularization, particularly evident in the growth of materialism, the belief that everything mental, spiritual, or ideal was simply a result of physical forces. Truth was to be found in the concrete material existence of human beings and not, as the Romantics imagined, in revelations gained by feeling or intuitive flashes. The importance of materialism was strikingly evident in the most important scientific event of the nineteenth century, the development of the theory of organic evolution according to natural selection. On the theories of Charles Darwin could be built a picture of humans as material beings that were simply part of the natural world.
Charles Darwin (1809-1882), like many of the great scientists of the nineteenth century, was a scientific amateur. Born into an upper-middle-class family, he studied theology at Cambridge University while pursuing an intense side interest in geology and biology. In 1831, at the age of twenty-two, his hobby became his vocation when he accepted an appointment as a naturalist to study animals and plants on an official Royal Navy scientific expedition aboard the H.M.S. Beagle. Its purpose was to survey and study the landmasses of South America and the South Pacific. Darwin’s specific job was to study the structure of various forms of plant and animal life. He was able to observe animals on islands virtually untouched by external influence and compare them with animals on the mainland. As a result, Darwin came to discard the notion of a special creation and to believe that animals evolved over time and in response to their environment. When he returned to Britain, he eventually formulated an explanation for evolution in the principle of natural selection, a theory that he presented in 1859 in his celebrated book, On the Origin of Species by Means of Natural Selection.
THE THEORY of EVOLUTION The basic idea of Darwin’s book was that all plants and animals had evolved over a long period of time from earlier and simpler forms of life, a principle known as organic evolution. Darwin was important in explaining how this natural process worked. He took the first step from Thomas Malthus’s theory of population: in every species, “many more individuals of each species are born than can possibly survive.” This results in a “struggle for existence.” Darwin believed that “as more individuals are produced than can possibly survive, there must in every case be a struggle for existence, either one individual with another of the same species, or with the individuals of distinct species, or with the physical conditions of life.” Those who succeeded in this struggle for existence had adapted better to their environment, a process made possible by the appearance of “variants.” Chance variations that occurred in the process of inheritance enabled some organisms to be more adaptable to the environment than others, a process that Darwin called natural selection: “Owing to this struggle [for existence], variations, however slight,... if they be in any degree profitable to the individuals of a species, in their infinitely complex relations to other organic beings and to their physical conditions of life, will tend to the preservation of such individuals, and will generally be inherited by the offspring.” Those that were naturally selected for survival (“survival of the fit”) survived. The unfit did not and became extinct. The fit who survived propagated and passed on the variations that enabled them to survive until, from Darwin’s point of view, a new separate species emerged.
In On the Origin of Species, Darwin discussed plant and animal species only. He was not concerned with humans themselves and only later applied his theory of natural selection to humans. In The Descent of Man, published in 1871, he argued for the animal origins of human beings: “man is the co-descendant with other mammals of a common progenitor.” Humans were not an exception to the rule governing other species (see the box above).
Darwin’s ideas were highly controversial at first. Some people fretted that Darwin’s theory made human beings ordinary products of nature rather than unique beings. Others were disturbed by the implications of life as a struggle for survival, of “nature red in tooth and claw.” Was there a place in the Darwinian world for moral values? For those who believed in a rational order in the world, Darwin’s theory seemed to eliminate purpose and design from the universe. Gradually, however, scientists and other intellectuals began to accept Darwin’s theory. In the process, some people even tried to apply Darwin’s ideas to society, yet another example of science’s increasing prestige.
The application of natural science to the field of medicine in the nineteenth century led to revolutionary breakthroughs in health care. The first steps toward a more scientific basis for medicine were taken in Paris hospitals during the first half of the nineteenth century. Clinical observation, consisting of an active physical examination of patients, was combined with the knowledge gained from detailed autopsies to create a new clinical medicine.
PASTEUR, KOCH, AND GERMS The major breakthrough toward a scientific medicine occurred with the discovery of microorganisms, or germs, as the agents causing disease. The germ theory of disease was largely the work of Louis Pasteur (1822-1895). Pasteur was not a doctor but a chemist who approached medical problems in a scientific fashion. In 1857, Pasteur became director of scientific studies at the École Normale in Paris. There he conducted experiments that proved microorganisms of various kinds were responsible for the process of fermentation, thereby launching the science of bacteriology.
Government and private industry soon perceived the inherent practical value of Pasteur’s work. His examination of a disease threatening the wine industry led to the development in 1863 of a process – subsequently known as pasteurization – for heating a product to destroy the organisms causing spoilage. In 1877, Pasteur turned his attention to human diseases. His desire to do more than simply identify disease-producing organisms led him in 1885 to a preventive vaccination against rabies. In the 1890s, the principle of vaccination was extended to diphtheria, typhoid fever, cholera, and plague, creating a modern immunological science.
Robert Koch (ROH-berr KAWKH) (1843-1910), a German physician, took the study of bacteriology even further with his work on anthrax and tuberculosis. Koch developed new methods of culturing bacteria and staining microscope slides for examination. In 1882, his work led to the discovery of tuberculosis bacteria. Koch artificially reproduced these bacteria in animals, removed them, and re-infected healthy guinea pigs, successfully demonstrating that a specific bacterium was the causative agent of the disease. Koch and his students identified the specific organisms of at least twenty-one diseases, including gonorrhea, typhoid, pneumonia, meningitis, plague, and cholera.
The work of Pasteur, Koch, and the others who followed them in isolating the specific bacteriological causes of numerous diseases had a far-reaching impact. By providing a rational means of treating and preventing infectious diseases, they transformed the medical world. Both the practice of surgery and public health experienced a renaissance.
NEW SURGICAL PRACTICES Surgeons had already achieved a new professionalism by the end of the eighteenth century (see Chapter 17), but the discovery of germs and the introduction of anesthesia created a new environment for surgical operations. Surgeons had traditionally set broken bones, treated wounds, and amputated limbs, usually as a result of injuries in war. One major obstacle to more successful surgery was the inevitable postoperative infection, which was especially rampant in hospitals.
Joseph Lister (1827-1912), who developed the antiseptic principle, was one of the first people to deal with this problem. Following the work of Pasteur, Lister perceived that bacteria might enter a wound and cause infection. His use of carbolic acid, a newly discovered disinfectant, proved remarkably effective in eliminating infections during surgery. Lister’s discoveries dramatically transformed surgery wards, as patients no longer succumbed regularly to what was called “hospital gangrene.”
The second great barrier to large-scale surgery stemmed from the inability to lessen the pain of the patient. Alcohol and opiates had been used for centuries during surgical operations, but even their use did not allow unhurried operative maneuvers. After experiments with numerous agents, sulfuric ether was first used successfully in an operation at the Massachusetts General Hospital in 1846 (see the box above). Within a year, chloroform began to rival ether as an anesthetic agent.
NEW PUBLIC HEALTH MEASURES Although the great discoveries of bacteriology came after the emergence of the first public health movement, they significantly furthered its development. Based on the principle of preventive rather than curative medicine, the urban public health movement of the 1840s and 1850s was largely a response to the cholera epidemic (see Chapter 23). One medical man, in fact, called cholera “our best ally” in furthering public hygiene. The pre-bacteriological hygiene movement focused on providing clean water, adequate sewage disposal, and less crowded housing conditions. Bacterial discoveries led to greater emphasis on preventive measures, such as the pasteurization of milk, improved purification of water supplies, immunization against disease, and control of waterborne diseases. The public health movement also resulted in the government’s hiring medical doctors not just to treat people but to deal with issues of public health as well.
NEW MEDICAL SCHOOLS The new scientific developments also had an important impact on the training of doctors for professional careers in health care. Although there were a few medical schools at the beginning of the nineteenth century, most medical instruction was still done by a system of apprenticeship. In the course of the nineteenth century, virtually every Western country founded new medical schools, but attempts to impose uniform standards on them through certifying bodies met considerable resistance. Entrance requirements were virtually nonexistent, and degrees were granted after several months of lectures. Professional organizations founded around midcentury, such as the British Medical Association in 1832, the American Medical Association in 1847, and the German Doctors’ Society in 1872, attempted to elevate professional standards but achieved little until the end of the century. The establishment of the Johns Hopkins University School of Medicine in 1893, with its four-year graded curriculum, clinical training for advanced students, and use of laboratories for teaching purposes, provided a new model for medical training that finally became standard practice in the twentieth century.
WOMEN AND MEDICAL SCHOOLS During most of the nineteenth century, medical schools in Europe and the United States were closed to female students. When Harriet Hunt applied to Harvard Medical School, the male students drew up resolutions that prevented her admission:
Resolved, that no woman of true delicacy would be willing in the presence of men to listen to the discussion of subjects that necessarily come under consideration of the students of medicine.
Resolved, that we object to having the company of any female forced upon us, who is disposed to unsex herself, and to sacrifice her modesty by appearing with men in the lecture room.
Elizabeth Blackwell (1821-1910) achieved the first major breakthrough for women in medicine. Although she had been admitted to the Geneva College of Medicine in New York by mistake, Blackwell’s perseverance and intelligence won her the respect of her fellow male students. She received her M.D. degree in 1849 and eventually established a clinic in New York City.
European women experienced difficulties similar to Blackwell’s. In Britain, Elizabeth Garret and Sophia Jex-Blake had to struggle for years before they were finally admitted to the practice of medicine. The unwillingness of medical schools to open their doors to women led to the formation of separate medical schools for women. The Female Medical College of Pennsylvania, established in 1850, was the first in the United States, and the London School of Medicine for Women was founded in 1874. But even after graduation from such institutions, women faced obstacles when they tried to practice as doctors. Many were denied licenses, and hospitals often closed their doors to them. In Britain, Parliament finally capitulated to pressure and passed a bill in 1876 giving women the right to take qualifying examinations. Soon women were entering medical schools in ever-larger numbers. By the 1890s, universities in Great Britain, Sweden, Denmark, Norway, Finland, Russia, and Belgium were admitting women to medical training and practice. Germany and Austria did not do so until after 1900. Even then, medical associations refused to accept women as equals in the medical profession. Women were not given full membership in the American Medical Association until 1915.
The importance of science in the nineteenth century perhaps made it inevitable that a scientific approach would be applied to the realm of human activity. The attempt to apply the methods of science systematically to the study of society was perhaps most evident in the work of the Frenchman Auguste Comte (ow-GOOST KOHNT) (1798-1857). His major work, System of Positive Philosophy, was published between 1837 and 1842 but had its real impact after 1850.
Comte created a system of “positive knowledge” based on a hierarchy of all the sciences. Mathematics was the foundation on which the physical sciences, earth sciences, and biological sciences were built. At the top was sociology, the science of human society, which for Comte incorporated economics, anthropology, history, and social psychology. Comte saw sociology’s task as a difficult one. The discovery of the general laws of society would have to be based on the collection and analysis of data on humans and their social environment. Although his schemes were often complex and dense, Comte played an important role in the growing popularity of science and materialism in the mid-nineteenth century.