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A History of Science
Williams 
Tome I
Tome II
Tome III Tome IV

Book 4, chapter VIII
Nineteenth-century medicine
Parasitic diseases
Williams
I have just adverted to the fact that Napoleon Bonaparte, as First Consul and as Emperor, was the victim of a malady which caused him to seek the advice of the most distinguished physicians of Paris. It is a little shocking to modern sensibilities to read that these physicians, except Corvisart, diagnosed the distinguished patient's malady as "gale repercutee" - that is to say, in idiomatic English, the itch "struck in." It is hardly necessary to say that no physician of today would make so inconsiderate a diagnosis in the case of a royal patient. If by any chance a distinguished patient were afflicted with the itch, the sagacious physician would carefully hide the fact behind circumlocutions and proceed to eradicate the disease with all despatch. That the physicians of Napoleon did otherwise is evidence that at the beginning of the century the disease in question enjoyed a very different status. At that time itch, instead of being a most plebeian malady, was, so to say, a court disease. It enjoyed a circulation, in high circles and in low, that modern therapeutics has quite denied it; and the physicians of the time gave it a fictitious added importance by ascribing to its influence the existence of almost any obscure malady that came under their observation. Long after Napoleon's time gale continued to hold this proud distinction. For example, the imaginative Dr. Hahnemann did not hesitate to affirm, as a positive maxim, that three-fourths of all the ills that flesh is heir to were in reality nothing but various forms of "gale repercutee."

All of which goes to show how easy it may be for a masked pretender to impose on credulous humanity, for nothing is more clearly established in modern knowledge than the fact that "gale repercutee" was simply a name to hide a profound ignorance; no such disease exists or ever did exist. Gale itself is a sufficiently tangible reality, to be sure, but it is a purely local disease of the skin, due to a perfectly definite cause, and the dire internal conditions formerly ascribed to it have really no causal connection with it whatever. This definite cause, as every one nowadays knows, is nothing more or less than a microscopic insect which has found lodgment on the skin, and has burrowed and made itself at home there. Kill that insect and the disease is no more; hence it has come to be an axiom with the modern physician that the itch is one of the three or four diseases that he positively is able to cure, and that very speedily. But it was far otherwise with the physicians of the first third of our century, because to them the cause of the disease was an absolute mystery.

It is true that here and there a physician had claimed to find an insect lodged in the skin of a sufferer from itch, and two or three times the claim had been made that this was the cause of the malady, but such views were quite ignored by the general profession, and in 1833 it was stated in an authoritative medical treatise that the "cause of gale is absolutely unknown." But even at this time, as it curiously happened, there were certain ignorant laymen who had attained to a bit of medical knowledge that was withheld from the inner circles of the profession. As the peasantry of England before Jenner had known of the curative value of cow-pox over small-pox, so the peasant women of Poland had learned that the annoying skin disease from which they suffered was caused by an almost invisible insect, and, furthermore, had acquired the trick of dislodging the pestiferous little creature with the point of a needle. From them a youth of the country, F. Renucci by name, learned the open secret. He conveyed it to Paris when he went there to study medicine, and in 1834 demonstrated it to his master Alibert. This physician, at first sceptical, soon was convinced, and gave out the discovery to the medical world with an authority that led to early acceptance.

Now the importance of all this, in the present connection, is not at all that it gave the clew to the method of cure of a single disease. What makes the discovery epochal is the fact that it dropped a brand-new idea into the medical ranks - an idea destined, in the long-run, to prove itself a veritable bomb - the idea, namely, that a minute and quite unsuspected animal parasite may be the cause of a well-known, widely prevalent, and important human disease. Of course the full force of this idea could only be appreciated in the light of later knowledge; but even at the time of its coming it sufficed to give a great impetus to that new medical knowledge, based on microscopical studies, which had but recently been made accessible by the inventions of the lens-makers. The new knowledge clarified one very turbid medical pool and pointed the way to the clarification of many others.

Almost at the same time that the Polish medical student was demonstrating the itch mite in Paris, it chanced, curiously enough, that another medical student, this time an Englishman, made an analogous discovery of perhaps even greater importance. Indeed, this English discovery in its initial stages slightly antedated the other, for it was in 1833 that the student in question, James Paget, interne in St. Bartholomew's Hospital, London, while dissecting the muscular tissues of a human subject, found little specks of extraneous matter, which, when taken to the professor of comparative anatomy, Richard Owen, were ascertained, with the aid of the microscope, to be the cocoon of a minute and hitherto unknown insect. Owen named the insect Trichina spiralis. After the discovery was published it transpired that similar specks had been observed by several earlier investigators, but no one had previously suspected or, at any rate, demonstrated their nature. Nor was the full story of the trichina made out for a long time after Owen's discovery. It was not till 1847 that the American anatomist Dr. Joseph Leidy found the cysts of trichina in the tissues of pork; and another decade or so elapsed after that before German workers, chief among whom were Leuckart, Virchow, and Zenker, proved that the parasite gets into the human system through ingestion of infected pork, and that it causes a definite set of symptoms of disease which hitherto had been mistaken for rheumatism, typhoid fever, and other maladies. Then the medical world was agog for a time over the subject of trichinosis; government inspection of pork was established in some parts of Germany; American pork was excluded altogether from France; and the whole subject thus came prominently to public attention. But important as the trichina parasite proved on its own account in the end, its greatest importance, after all, was in the share it played in directing attention at the time of its discovery in 1833 to the subject of microscopic parasites in general.

The decade that followed that discovery was a time of great activity in the study of microscopic organisms and microscopic tissues, and such men as Ehrenberg and Henle and Bory Saint-Vincent and Kolliker and Rokitansky and Remak and Dujardin were widening the bounds of knowledge of this new subject with details that cannot be more than referred to here. But the crowning achievement of the period in this direction was the discovery made by the German, J. L. Schoenlein, in 1839, that a very common and most distressing disease of the scalp, known as favus, is really due to the presence and growth on the scalp of a vegetable organism of microscopic size. Thus it was made clear that not merely animal but also vegetable organisms of obscure, microscopic species have causal relations to the diseases with which mankind is afflicted. This knowledge of the parasites was another long step in the direction of scientific medical knowledge; but the heights to which this knowledge led were not to be scaled, or even recognized, until another generation of workers had entered the field.


 

 

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© Serge Jodra, 2006. - Reproduction interdite.