History of Medicine

   

                 INTERNATIONAL MEDICAL CONGRESS OF 1876

 

     In 1876 the United States was 100 years old. To celebrate, Congress authorized a mammoth celebration, an international exhibition in Philadelphia, covering about 285 acres. The Exposition included a medical exhibit: a military hospital, fully built, with pathology specimens, books, instruments, etc. on display. In one room was a scale model of a medical railroad train, with beds and stretchers in some cars and an operating suite, kitchen, and baggage space in others. Such trains were used in the Civil War. Bright red paint on the smokestacks and other locations and red lights at night served as a signal not to attack it, and it never was.

 

Main building, Centennial, covers 21.5 acres (Wikipedia)

   The Philadelphia County Medical Society, not to be outdone, decided to hold an international medical congress concurrently with the Centennial. Doctors from Europe to Japan arrived, along with delegates from the AMA, state medical societies (delegates limited to the number of representatives in Congress), the three military services (Army, Navy, and Marines), the American Public Health Association, a mental hospital association, and the American Association for the Cure of Inebriates. It ran for six days in September 1876.

     The president of the Congress was Samuel D. Gross, the prominent Philadelphia surgeon, celebrated in a painting by Thomas Eakins. Joseph Lister chaired the section on surgery, where he

The Gross Clinic, by Thomas Eakins (Wikipedia)
It hung in the military hospital exhibit (paragraph 
one)

presented his new antiseptic approach to surgery. Alfred Stillé presided over the internal medicine section. He was professor of the theory and practice of medicine at the U. of Penn Medical School and had published an early American text of pathology but was lagging in his acceptance of germ theory.  Robert Barnes, of London, obstetric physician at St. George’s Hospital, presided over obstetrics. Various other specialties were represented, including “sanitary science” (public health, today) and mental illness. The program featured eighty-one papers.

     The Congress met at a time when new findings of bacteriology were upending long-held beliefs and practices. After Joseph Lister lectured on his antiseptic surgery technique, employing carbolic acid liberally as the key antiseptic, attendee comments made it clear that

Joseph Lister (Wikipedia and Wellcome Library)

those who had actually visited Lister in Scotland and seen his results were quite persuaded by the method, as were several more. Others were still doubters and professed to have good results with mere cleanliness. Samuel Gross, unconvinced by Lister, remained silent.     

     In the obstetrics section, puerperal fever was reviewed by William T Lusk, chief of obstetrics at Bellevue Medical College. He agreed on the presence of coccal bacteria in the tissues of puerperal fever victims but was unsure of the mechanism of sepsis. He discussed Semmelweiss’ successful trial of handwashing, adding that he had queried three attendings that did both autopsies and deliveries concurrently. Two had not encountered puerperal fever and one said his death record was “unusually low.” Lusk, conceding that bacteria played a role, concluded that puerperal fever did not have a single cause.

     In fact, there was no bacteriology laboratory in the United States at the time. Even in Europe the science was just beginning and confusion reigned over various bacterial species. Agar plates did not arrive until 1882, allowing more exact speciation. Petri dishes came a few years later.

     Dr. Thomas Satterthwaite, from New York, discussed the germ theory in relation to Sanitary Science (public health). He was equally confused, admitting some relation of certain bacteria to certain diseases, but noting that the air was full of bacteria, with no ill effects. Dr Woodworth, of the Marine Hospital Service, discussed quarantine. He referred to the “morbific causes of infectious diseases”, recommending overall hygiene, cleansing of ships and ports, as well as the presence of informants in foreign ports to report contagious diseases, an innovation later adopted.

     A few other items are of interest. Joseph Woodward, author of a medical and surgical history of the Civil War, noted an average mortality rate from disease (not wounds) among white volunteers in the Civil War of 55 per 1000 mean strength. Among blacks in the last two years of the War, the rate was 211 and 139.8 per 1000. The excess in blacks he attributed to their poor condition before enlistment. As fugitive slaves they were “literally naked and starving”, as he put it. 

     Mercury and potassium iodide remained the treatments for syphilis, with much discussion over dosage and regimens. Dr. George A. Ward, medical director of the Oroya Railroad in Peru, gave an interesting account of verrugas, a stage in what is now known as Bartonellosis, seen in railway workers in the Andes. The Railroad was a venture of Henry Meiggs, the builder of the huge gold-rush-era Meiggs Wharf in San Francisco (burned in the earthquake). He had fled to South America in 1854 to escape crushing debts, only to take up railroad building. 

     A paper on treatment of ulcers recommended taking milk, especially cow’s milk. For bleeding ulcers, better to swallow ice and apply it over the epigastrium. Other medical papers covered “typhomalarial fever” (still considered an entity), diphtheria and the history of American medicine and surgery. 

     Presentations on mental illness dealt with the histology of general paresis (syphilis of the brain) before the infectious cause was understood, the insanity defense in criminal cases, and institutions for care of the insane. Dr. Edward R. Squibb, founder of the Squibb company and an advocate of better drug purity, spoke on the hope of a “universal pharmacopeia”, to standardize medicines worldwide. He realized it was unrealistic at present.

     Except for that of Lister, there were no breakthrough papers at the Congress, and Lister’s presentation had a limited immediate effect on surgical practice. But the seeds of progress had been sown and soon sprouted in surgery's younger generation. 

 

SOURCES:

Ashhurst, J, ed. Transactions of the International Medical Congress, 1876. 

Rutgow, I. “Joseph Lister and His 1876 Tour of America”. 2013; Ann Surgery 257: 1181-7.

Maass, J. “When the New World Dazzled the Old” American Heritage, June 1976, pp 25-8.

Review of International Exhibition, 1876, Official Catalogue. 1876; Amer J Medical Sciences 72: 236-9.