Medical America in the Nineteenth Century: Readings from the Literature

The Factors of Disease and Death after Injuries, Parturition, and Surgical Operations

SAMUEL D. GROSS THE FACTORS OF DISEASE AND DEATH AFTER INJURIES, PARTURITION, AND SURGICAL OPERATIONS Editor's Note Samuel D. Gross (1805-84) was one of America's leading surgeons of the nineteenth century. Part of his fame, no doubt, was owing to his ever-active pen. Born and educated in Pennsylvania, Gross taught in four medical schools, but was most closely identified with medicine in Philadelphia. As early as 1839 he published an important work on pathology, Elements of Pathological Anatomy/ that went through several editions and revisions. His large, two volume surgical text, A System of Surgery: Pathological, Diagnostic, Therapeutic, and Operative ? first appeared in 1859. It was a standard for years; the sixth edition appeared in 1882. The following paper by Gross illustrates the difficulties which a theory and practice, such as antisepsis, faced in the years after its enunciation by Joseph Lister. Gross deals with a number of problems that interested the surgeons of his day: hospitals and hospital infection, theories of the etiology of infectious diseases , hygiene, and nursing. His paper is a good example of the kind of discussion that the germ theory received in the days when Pasteur had already demonstrated its scientific nature and Joseph Lister its practical application, but when the so-called golden age of bacteriology was still a few years in the future. Gross, one must remember, was one of the leading medical men in the country at this time. Erichsen in 1874 called him the Nestor of American surgeons. The difficulties encountered by the germ theory, then, were no less when a man of Gross's stature said, regarding blood poisoning, that science was dumb. It would be unfair to say that it was Gross who was dumb, but certainly he was not among the earliest to accept what was becoming more obvious almost month by month. He was nearing the end of an illustrious career, and he had little need for a new method of treating wounds. As he tells us in the following paper, his results, measured in terms of his time, were very good indeed. Bibliographical Note Of Gross's many historical writings two are of most interest here: "A century of American medicine, 1776-1876, II. Surgery," Am. J. Med. Scl 71 (1876) 431-84; and his Autobiography, 2 vols., Philadelphia: Barrie, 1887. Reports and Papers, A.P.H.A. 2 (1874-75): 400-14. A discourse before the American Public Health Association at its meeting in Philadelphia, November 10, 1874. 1 Samuel D. Gross, Elements of Pathological Anatomy, 2 vols. (Boston: Marsh, Capen, Lyon, Webb, and Drew, 1839). 2 Samuel D. Gross, A System of Surgery: Pathological, Diagnostic, Therapeutic, Operative , 2 vols. (Philadelphia: Blanchard and Lea,1859). 190 SAMUEL D. GROSS 191 Science is the patrimony of mankind; she stretches forth her right hand and her left in her efforts to develop knowledge, and to utilize it for the benefit of the human race. Until within a comparatively recent period, philosophers and scientists were contented to occupy themselves with the study of the grosser elements of matter, as they appeared to the unassisted eye; but in our generation new objects have engaged their attention, and instruments, of the most delicate construction, have been devised for the investigation and examination of the most minute entities, the very existence of which was not even suspected by the most enlightened of our forefathers. How far the facts revealed by these researches have contributed to the extension of our knowledge of sanitary science is familiar to every intelligent person. Without their aid we should still literally be groping in the dark respecting many points of essential importance to the health and the lives of the people. The dangers which constantly beset us in our daily walks in city, town, and country are better understood; the noxious weeds which everywhere so cunningly intertwine their leaves with those of the rose and the lily are more easily discerned; and if, in consequence of the knowledge thus derived, we do not live longer, certain it is that we live more securely and more happily. The great enemies to health and life, after injuries, parturition, and surgical operations, are septicemia, pyemia, erysipelas, and hospital gangrene, diseasesall more or less intimately connected with, if not directly dependent upon, bloodpoisoning , itself the result of the influence of vitiated air acting upon the part and system, the pernicious effects being so much the greater in proportion to the crowded condition of a hospital and...