THE FAMOUS MEDICAL CONGRESS

OF 1881

 

Leaders in the medical world of the nineteenth century convened international medical conferences every few years, partly to exchange and discuss new developments in medicine and partly, so it seems, to showcase the country hosting the congress. Born out of the French Medical Congresses, the first International Congress convened in Paris in 1867 during the Paris Exposition. The largest of the medical extravaganzas was the Seventh International Medical Congress, held in London in 1881. Over 3,000 names from numerous countries filled the registration book. The names included luminaries such as James Paget (president of the Congress), William Jenner (currently president of the Royal Society of Medicine), Joseph Lister, Thomas Huxley, Rudolf Virchow, Louis Pasteur,

James Paget in 1881 (Wikipedia)

Robert Koch, Jean Marie Charcot, Bernard von Langenbeck and, from America, John Shaw Billings, Samuel Gross, Austin Flint, and William Osler.   

Queen Victoria served as patron of the Congress and the Prince of Wales opened the proceedings on August 2 with his cousin the crown prince of Prussia at his side. The principal organizer was Sir William MacCormac, a prominent surgeon who had, with the American surgeon, J. Marion Sims, led the Anglo-American Ambulance Service during the Franco-Prussian War, caring for the wounded from both sides. Sadly, female physicians were absent from the Congress in spite of an appeal from 43 women licensed to practice medicine in their respective countries and the presence in London of the Medical School for Women.

         The germ theory of disease, despite doubters, was reasonably established and many papers dealt with the role of bacteria in disease. Robert Koch startled the participants with his demonstration of the use of solid culture media to isolate individual bacteria, prompting Pasteur to famously remark, “C’est un grand progress, Monsieur.” Pasteur himself gave papers on vaccines against chicken cholera and anthrax, major milestones in disease prevention. In the surgical section, Lister’s antiseptic techniques were discussed in depth. By this time many surgeons, especially in Germany, had adopted the carbolic acid solutions and sprays, acknowledging the importance of bacteria in wound infections. Primary closure of wounds without drainage, especially in abdominal surgery, was controversial, with some surgeons reporting infections and even carbolic acid poisoning after surgery. Lister held to his principles but commented that perhaps the spray could be dispensed with, an unexpected statement.

         Sir Henry Thompson, England’s first urologist (see essay of January 2023), and Henry Bigelow from Boston discussed lithotrity, the non-invasive technique for dealing with bladder stones, disagreeing mainly over the size of the instruments used. On public health, known then as “state medicine,” John Shaw Billings spoke about yellow fever, claiming that it could be transmitted from person to person and through contaminated clothing and similar articles.  Then a doctor working in West Africa opined that the disease arose from local causes and was not directly transmissible. The debate was not resolved until the Walter Reed project in 1900. Austin Flint spoke on the need to standardize the terminology used for physical diagnosis. Thomas Huxley spoke eloquently on the need for medical students to learn the workings of the human body through the study of basic sciences such as physiology and chemistry in order to understand treatment of diseases. John Shaw Billings (founder of what became the National Library of Medicine) held the podium again with a talk on the development of medical literature. William Osler presented cases of “exudative endocarditis” in which he noted the constant presence of bacteria but was doubtful of their significance.

John Shaw Billings, portrait in
the National Library of Medicine
(Wikipedia)

         A major problem discussed at the Congress was vivisection. England had recently passed the Cruelty to Animals Act (1876), a rather comprehensive law restricting vivisection. The medical profession viewed this as an impediment to progress and the Congress passed a resolution favoring vivisection, stating that experiments on animals have been of great service to medicine and “are indispensable for its further progress.” Cautioning on the need to avoid inflicting unnecessary pain, the resolution continued, “it is not desirable to restrict competent persons in the performance of such experiments.” 

         Several museums allowed physicians to examine preserved specimens, illustrations, and even a few patients. Illustrations by Sir Charles Bell of wounds encountered during the battle of Waterloo were a main attraction.

Charles Bell's drawing of war wound
(Wellcome Library)

         The only sour note at the Congress was news of President Garfield who had been shot on July 2, one month before the opening. The London medical press carried weekly bulletins on his depressing medical status.

         Entertainment was not neglected at the Congress. The Lord Mayor of London gave a banquet for 300 guests one evening and a later one for 3500 guests in the Guildhall, the latter lit by electric lights – a novelty at the time. Numerous dignitaries organized their own parties, one in Kew Gardens. The Royal College of Surgeons threw a large reception in their spacious museum, again illuminated with electric lights, that “had a somewhat ghastly effect” (Lancet report). One reception resulted in a notable artwork: that of the Baroness Burdette-Coutts, a wealthy heiress. She invited 100 selected guests and memorialized the occasion in a painting (below) that now hangs in the Wellcome Library. 

Garden Party (Wellcome Library)

     

Key to many of the figures in the painting

         

      On the final evening the guests dined at the opulent Crystal Palace, after which a magnificent display of fireworks that included fiery portraits of Paget, Charcot, and von Langenbeck, lit up the sky.

Crystal Palace in 1851, a huge structure (Wikipedia)

      It was a memorable Congress (described as a “week’s carnival of medical science” in The Lancet), attended by a Who’s Who of the medical world, enriched by the latest in bacteriology and surgery, and, not least, by extravagant entertainment.

 

SOURCES:

 

Sakula, A, “Baroness Burdette-Coutts’ Garden Party: The International Medical Congress, London, 1881,” Medical History 1982; 26: 183-190.

 

The Lancet, August 13-27, 1881.

 

Hunt, E M, “The Sanitary Significance of the International Medical Congress of 1881.” Public Health Papers and Reports 1881; 7: 353-67.

         

         

 

OBSTETRICS COMES TO THE COLONIES

 

         Obstetrics in American colonial times was practiced almost exclusively by midwives, whose medical knowledge and skills were generally low. Though the rare physician performed deliveries, the first American doctor to have formal training in obstetrics was William Shippen, Jr. He was also the first American professor of anatomy, a position he held at the newly opened College of Medicine of the University of Pennsylvania.

         After graduating from the College of New Jersey (later

William Shippen, Jr.  (Wikipedia)

Princeton University), young Schippen apprenticed for four years with his physician father in Philadelphia. For further study, he embarked, in 1758, to London. Possibly through family connections, he secured a position as student at St. Thomas’ Hospital, across the street from Guy’s Hospital and near London Bridge. There he made rounds with the surgical and medical staff, read widely, and often traveled to St. Bartholomew’s Hospital to watch Percival Pott operate. He seems to have decided early on a career in obstetrics and anatomy. He took midwifery instruction from a Dr. Colin Mackenzie, a former student of William Smellie, one of the first in England to practice obstetrics (or man-midwifery, as it was called). Mackenzie, less well known today, was highly regarded and a friend of William and John Hunter. Shippen's training with Mackenzie included valuable hands-on experience in his extensive practice.

For anatomy studies, Shippen enrolled in William Hunter’s

William Hunter  (Wikipedia)

 

 

private anatomy classes, considered the best in London. He moved into Hunter’s house in Covent Garden where the lectures and dissection took place. The students not only dissected, they practiced surgical operations on cadavers and injected waxy or oily solutions into vessels to demonstrate vascular patterns, a technique borrowed from the Dutch. It was these injections, done mainly by John Hunter, that first

John Hunter  (Wikipedia

demonstrated the separation of the maternal and fetal circulations of the pregnant mother. William Hunter also taught midwifery to Shippen, though his private practice and duties as Physician Extraordinary to Queen Charlotte limited his time. Shippen also benefitted from long conversations into the night with John Hunter, who found the young American an apt pupil.

 

Anatomy lecture at William Hunter's Anatomy School (Wellcome Library)

Shippen did not neglect pleasure in London. He frequented theatrical performances, from David Garrick’s Shakespearian dramas to low comedy, at the Drury Lane and Covent Garden theaters adjacent to the anatomy school. He attended the coronation of King George III. His easy personality helped him win invitations to dinners or weekend stays. He dined with Thomas Penn, proprietor of the colony, and Benjamin Franklin took him to the Royal Society and presented him at court. Shippen easily fell in with Franklin’s friend, Dr. John Fothergill, one of London’s most respected physicians.

John Fothergill (Wikipedia)

Fothergill, a Quaker, had an interest in Americans and in promoting medicine in America. He encouraged William to open a medical school in Pennsylvania.

William skipped study on the continent (the Seven Years War curtailed travel) and traveled to Edinburgh for a year, absorbing the lectures of William Cullen and the Monros. After receiving an MD degree in 1761, he married a woman from Virginia and sailed with her back to Philadelphia. He carried a letter from Dr. Fothergill recommending that the Pennsylvania Hospital start a medical school with Shippen as professor of anatomy. Fothergill had sent over copious anatomical drawings and skeletal parts as an inducement. The hospital demurred on the medical school but allowed Shippen to begin a private course in anatomy. It was well attended by the local doctors.

In 1765, Shippen began a course in midwifery, the first of its kind, open to men and women. He had initiated a small lying-in facility for poor people and used this for practical instruction in addition to giving lectures enhanced by models of female anatomy.

Shippen's lectures, taken by a student (Nat. Libr. Med)

Lectures also covered the circulation and nutrition of the fetus, labor, use of instruments (he was conservative), and diseases of women and children near birth. To maintain dignity in the profession, he urged a “grave deportment” during accouchements and warned against alcohol use.

That same year, another Pennsylvanian, John Morgan, returned from medical studies in Edinburgh, London, and the continent. He presented a second proposal to the Pennsylvania Hospital to open a

John Morgan (Wikipedia)

medical school. This time the trustees, now possessing a letter from Thomas Penn recommending the school, agreed and the first medical school in America opened later in the year. The Professorship of the Theory and Practice of Physick went to Morgan and Shippen was soon appointed Professor of Anatomy and Surgery. The first steps toward formal medical education in America had begun. Shippen continued with his midwifery school. The Pennsylvania Hospital did not acquire lying-in facilities and a separate department until 1803.

The American Revolution interrupted work at the school. Unfortunately, considerable hostility developed between Shippen and Morgan during the war. Both were appointed, at different times, to head the Army medical services, both were accused of incompetence or graft, and Shippen underwent a court-marshal, though he was exonerated. After the war, both remained on the faculty and Shippen continued his extensive obstetrical practice, imparting skills to the next generation of doctors and midwives. His open personality attracted such dignitaries as Washington, Hamilton, and John Adams, who all stayed at “Shippen House” in Philadelphia. He continued to teach, to dispel many myths about childbirth, and to promote the profession of man-midwifery. He did not write papers or books or carry out research, however, as many pioneers in their fields do. Only lecture notes and reminiscences remain to testify to his stature as the first professional obstetrician in America.

 

Note: No essay in May. I will be traveling. See you in June.

 

SOURCES:

Corner, Betsy C, William Shippen, Jr.: Pioneer inn American Medical Education. 1951; American Philosophical Society.

Thoms, H, “The Beginnings of Obstetrics in America.” Yale J Biol Med, 1932; 4: 665-75.

Scheffey, L C, “The Earlier History and the Transition Period of Obstetrics and Gynecology in Philadelphia.” Ann Med History, 1940; 2(3): 215-224.