Johns Hopkins Hospital and University were the product of a great change in the direction of North American philanthropy. Throughout the nineteenth century, most giving by the wealthy had been religiously directed-to churches, seminaries, and other church-based charities. In 1867, however, the Baltimore merchant and financier Johns Hopkins-for reasons not totally known but certainly related to his being an adherent of the education-friendly Quaker sect-had drawn up a will bequeathing his then-vast fortune of $7 million (perhaps $300-$500 million in todayʼs purchasing power) to found a university and a hospital mandated to compare favorably with like institutions anywhere in the world. The Johns Hopkins institutions, created faithfully by trustees after the merchantʼs death in 1873, were secular and scientific and uncompromising in their commitment to excellence. They trained professors and scientists and doctors, not preachers.
In the late nineteenth century surgery began making spectacular progress under the double impact of the introduction of anesthesia and asepsis [keeping the surgical area and instruments relatively free of germs], that made it possible to surgeons to enter most cavities of the body and with the prospect of doing their patients more good than harm. From about the mid-1880s (appendectomies were first performed in 1886, and surgically sutured cures for hernias were first performed in 1887, saving numerous lives), surgery entered its first golden age. More than any other specialty, it became the driving force behind the transformation of hospitals from places for end-of-life care of the indigent into temples for the treatment of rich and poor alike.
Just take the case of a strangulated hernia before surgery could successfully treat it:
Natives in Central Africa suffer much oftener than Europeans from strangulated hernia, in which a portion of the intestines pokes out through the abdominal muscles and becomes blocked, so that it can no longer empty itself. It then becomes enormously inflated with gases which form, and this causes terrible pain. Then after several days of torture death takes place, unless the intestine can be got back through the rupture into the abdomen. Our ancestors were well acquainted with this terrible method of dying, but we no longer see it in Europe because every case is operated upon as soon as it is recognized…But in Africa this terrible death is quite common. There are few who have not as boys seen some man rolling in the sand of his hut and howling with agony until death came to release him. [Albert Schweitzer, On the Edge of the Primeval Forest (1961)]
Returning to the history of Johns Hopkins…When Harvey Cushing removed part of a diseased nerve from the thigh of a distinguished Johns Hopkins scientist, Simon Newcomb, the grateful patient hailed him as a miracle worker who had restored his ability to walk. “Prof. Newcomb believes himself to be entirely cured,” a newspaper reported, “and leaves his crutches at Johns Hopkins as a souvenir just as the poor cripples who are cured by miracles leave theirs at the shrine of St. ann de Beaupre.” When even scientists were said to leave their crutches at Johns Hopkins a new and powerful shrine was in the making.
Cushing also found a way to treat the extreme facial pain of trigeminal neuralgia, a condition that drove many of its victims to madness or suicide. In 1899 Cushing operated on a patient who complained that in the early stages of a spasm he could feel, “a devil twisting a red-hot corkscrew into the corner of the mouth,” and that was just the start of the suffering. Cushing completely eliminated the patientʼs pain by severing the connection between the brain and the trigeminal nerve, and he discovered a better place to sever the nerve on its way to the brain that cut the mortality rate of these operations from about 20% to near zero.
Harvey Cushing also became the first surgeon who could access the human brain at will and with the near certainty of doing more good than harm. He was able to relieve patients of torments that for many centuries had often been considered the product of demonic possession. In some cases he could literally make the lame walk and the blind see. The second patient on whom Cushing operated for trigeminal neuralgia told his surgeon that he felt “resurrected.” Cushing also began removing tumors from the brain that had caused pituitary disorders leading to severe distortions of growth, and became the worldʼs expert on the pituitary gland, previously a mysterious organ.
Meanwhile, Cushingʼs friend George Crile was making efforts to restore patients to life after their hearts had stopped beating, what he called “resurrecting” them. And the surgeons built on one anotherʼs advances.
As the gospel of the new scientific medicine spread, other philanthropists, such as the Baptist, John D. Rockefeller, began to give at least as much money to health causes as to religious ones.
Osler began to argue that medicine, a universal and borderless brotherhood, had done more than any other profession, including the church, to alleviate the ills of suffering humanity. Speaking in 1905 Osler said,
In little more than a century a united profession, working in many lands, has done more for the race than has ever before been accomplished by any other body of men. So great have been these gifts that we have almost lost our appreciation of them. Vaccination, sanitation, anaesthesia, antiseptic surgery, the new science of bacteriology, and the new art in therapeutics [one might add the discovery of necessary vitamins and minerals and treatments for their deficiences to the list] have effected a revolution in our civilisation.
At its best, Osler argued, medicine (or rather a faith in medicine) could even effect cures in the gray areas where mind and body interacted to create hysterical paralysis, neurasthenia, and like disorders. If patients had as much faith in their physicians as they did in their clergy, if they had faith in “Saint” Johns Hopkins Hospital, they would experience the same “cures” that “faith healers” offered. “I have had cases any one of which could have been worthy of a shrine or made the germ of a pilgrimage,” Osler wrote in his essay, “The Faith That Heals,” and went on to give an instance.
For more than ten years a girl lay paralysed in a New Jersey town. A devoted mother and loving sisters had worn out lives in her service. She had never been out of bed unless when lifted by one of her physicians…The new surrounding of a hospital, the positive assurance the she could get well with a few simple measures sufficed, and within a fortnight she walked round the hospital square. This is a type of modern miracle that makes one appreciate how readily well meaning people may be deceived as to the true nature of the cure effected at the shrine of a saint. Who could deny the miracle? And miracle it was, but not brought about by any supernatural means
Osler even suggested, “The less the clergy have to do with the bodily complaints of neurasthenic and hysterial persons the better for their peace of mind and for the reputation of the Cloth.”
Another example involved Oslerʼs ability to fascinate children:
[A child had severe whooping-cough and bronchitis, was unable to eat and unresponsive to parents and nurses. Recovery seemed unlikely. Osler walked in with his doctorʼs robes, and to the small child this man in the white robe fascinated him.] Osler sat down, peeled a peach, sugared it, and cut it in pieces. He then pressed it bit by bit with a fork into the entranced patient, telling him to eat it up, and that he would not be sick but would find it did him good as it was a most special fruit. The child ate. When leaving Osler patted the boyʼs father on the back and told him, “Iʼm sorry, Ernest, but I donʼt think I shall see the body again, thereʼs very little chance when theyʼre as bad as that.” Happily events turned out otherwise, and for the next forty days this constantly busy man [Osler] came to see the child, and for each of these forty days he put on his doctorʼs robes in the hall before going in to the sick room. After some two or three days, recovery began to be obvious and the small body always ate or drank and retained some nourishment which Osler gave him with his own hands. If the value of personal approach, the quick turning to effect of an accidental psychological advantage (in this case decor), the consideration and extra trouble required to meet the needs of an individual patient, were ever well illustrated, here it was in its finest flower. It would, I submit, be impossible to find a fairer example of healing as an art. [Patrick Mallan, “Billy O,” in Oxford Medicine, ed. Kenneth Dewhurst (London: Sandford, 1970, 94-99]
The great triumphs to come, in Oslerʼs view, would involve medicine actually being able to cure organic disorders, not just cut nerves to relieve excruciating pain, or remove tumors, or restart hearts (as mentioned earlier). Having witnessed the dawn of bacteriology, he could see, for example, that science would one day discover antibacterial agents that would cure tuberculosis or cholera or pneumonia.
In the 1890s experimental work in several centers discovered that patients suffering from cretinism and myxedema were suffering a thyroid deficiency, so they gave the patients thyroid extract, which came to be known as the first “miracle treatment” of an organic disorder. The unfortunate young victims of cretinism were formerly doomed to live in “hopeless imbecility” an “unspeakable affliction to their parents and to their relatives.” Before and after photos of the first patients “emphasized as words cannot the magical transformation which follows treatment.” Medical science was beginning to unravel the mysteries of the secretions of hormones from glands, raising the prospect of elevating organotherapy from quackery to serious therapy. Then Osler added, prophetically, “and as our knowledge of the pancreatic function and carbohydrate metabolism become more accurate we shall probably be able to place the treatment of diabetes on a sure foundation.”
In 1922 a substance was isolated from the pancreas that appeared to work in the treatment of diabetic animals, and it was administered to a diabetic human child with results that were immediate and spectacular-a “resurrection.”
SOURCE: The Making of Modern Medicine: Turning Points in the Treatment of Disease by Michael Bliss
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