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Chapter V. Elias Samuel Cooper and 19th Century Medicine

Elias Samuel Cooper and 19th Century Medicine

From the time when Dr. Elias Cooper began to practice medicine in Illinois in the early 1840's, his professional outlook and actions reflected the medical environment within which he pursued his career. Therefore, if we are to assess his limitations and achievements, and those of the medical college he founded, we must be familiar with the state of medical knowledge and the public health in his day.

As to the public health, It is well to remember that throughout the period of colonization and westward migration, infectious diseases were a more serious menace to the early settlers than all other hazards of their rigorous lives. For example, immigrants from England to America in the 1600's were nearly driven out by disease before they gained a foothold on the eastern coast of the continent. The first permanent English colony, established at Jamestown, Virginia, in 1607, consisted of 104 men and boys. Within six months 51 had died of disease and starvation. [1] As previously mentioned, the second permanent English colony was founded by the Pilgrims who landed at the present site of Plymouth on the shore of Massachusetts Bay in 1620. They were a party of 102 men, women and children. Soon after their arrival "the great sickness" descended upon them and within six months 62 had died. [2] The principal cause of the high rate of illness and death among these and later settlers was rampant infection that spread rapidly because of poor sanitation, inadequate shelter and malnutrition. No one then knew that microorganisms or "germs" existed and were the cause of infection, and there were of course no effective preventive or treatment measures.

Furthermore, the cause of infection and the principles of prevention and treatment were still unknown 200 years later when immigrants, including the Cooper and Lane families, poured into the Northwest Territory in the early 1800's. Soon thereafter it was recognized that a mysterious and often lethal fever was prevalent among the settlers, especially in Illinois but also throughout the Ohio and Mississippi Valleys. Reliable statistics are not available but contemporary reports of widespread febrile illness are convincing. In the fall of 1823 Ohio newspapers reported that more than half of the 165,000 people living within fifty miles of Columbus were ill. James Flint, an English traveler, wrote that in the fall of 1820 one-third of the inhabitants of Vincennes, Indiana, and the neighboring countryside were sick in bed. Fevers of one kind or another were so frequent and severe around Indianapolis, Indiana, in the summer and fall of 1821 that an estimated one eighth of the population died. Six months later, the Indianapolis Gazette stated that 900 of the 1000 townspeople were or had been sick. [3] In Pike County Illinois, located on the Mississippi River, a fierce epidemic of fever killed 80 percent of the earlier settlers during the 1820s. [4]

Gershon Flagg, an English immigrant writing in 1819 from Edwardsville in southwestern Illinois about ten miles east of the Mississippi, echoed the sentiments of many settlers in the river valley: [5]

The principle objection I have to this Country is its unhealthiness. The months of Aug. and Sept. are generally very sickly. I was taken sick with the fever and ague 15 Sept which lasted me nearly two months. I shall try it one season more and if I do not have my health better than I have the season past I shall sell my property and leave the country.

A letter from a correspondent in the fertile valley of the Sangamon River in central Illinois not far south of Peoria, written in about 1825, included the following comment: [6]

In this country, life is at least fifty per cent below par in the months of August and September. I have thought that I ran as great a risk every season which I spend here as in an ordinary battle. I really believe it seldom happens that a greater proportion of any army falls victim to the sword during a campaign than there has of the inhabitants of Illinois to disease during a season I have been here.

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Daniel Drake (1785-1852) on Autumnal Fever (Malaria)

This "fever", so baffling to the doctors of the region, occurred chiefly in marshy locations along the many rivers and creeks where there were clouds of mosquitoes. The illness struck mainly in the fall of the year and was characterized by episodes of chills (ague), fever and sweating that tended to recur at regular intervals of from daily to every 48 or 72 hours (i.e., quotidian, tertian or quartan). Although usually subsiding spontaneously within a few weeks or months, it often followed a chronic, debilitating and sometimes fatal course with intermittent seasonal relapses over a period of years, reducing the patient to a pale, wasted and lethargic invalid. Malignant, fulminant variants of the fever were also not infrequent, resulting in prostration, coma and death within a few days. [7] [8]

The menacing fever to which we refer was malaria. It was the scourge of the Northwest until late in the 1800's, and the most important endemic disease from the standpoint of prevalence the world has known from antiquity to the present day. Ancient writers described its typical intermittent episodes of chills and fever. A Chinese scholar spoke of its recurrent paroxysms three thousand years ago. Hindu sages in India recognized the disease. Hippocrates (460-370 B.C.) wrote of it as common in Greece in the fifth century B.C. Alexander the Great (356-323) died of a fever in Babylon at the age of 33. It was probably malaria. [9] [10] [11] [12]

Although present as a devastating pestilence throughout Eurasia and Africa from the earliest historic times, the New World was free of malaria until around 1500. At about this time it was brought to the Americas from Europe and Africa by the Spaniards and their slaves whose red blood cells, infected with the malarial parasite, were taken up by the bite of the ubiquitous Anopheles mosquitoes and transmitted thereby to an endless chain of human carriers. [13] The disease was unknown among the Indians in the Ohio Valley and the Northwest until after the arrival there of European immigrants. In Illinois, the incidence of malaria was at a low level from the first settlements in about 1700 until 1760 when it rose within a decade to epidemico-endemic proportions and held that position for about 80 years. It then began a slow decline in the 1850's, and virtually disappeared from the state by 1900. [14]

From this brief introduction to malaria as the major health problem in Illinois and the Northwest in the 1840's, we can turn for further insight into the contemporary state of medical knowledge to Drake's discourse on Principal Diseases of the Interior Valley of North America, 1850 [15] In this comprehensive, landmark study which we cited earlier, Drake states that the common endemic fever of his day (which we now know as malaria) was variously called autumnal, bilious, intermittent, remittent, congestive, miasmatic, malarial, marsh, malignant, chill-fever, ague, fever and ague, dumb ague or , simply, "the Fever". The number of names for the disease reflects the confusion over its etiology and behavior. Drake prefers to call it "autumnal fever." [16]

Keeping in mind that it was still unknown in Drake's time that microorganisms were the cause of infectious diseases, we can appreciate his problem in trying to explain the origin of this troublesome fever. He calls attention to the following three possibilities. He first mentions the Meteoric Hypothesis whose advocates ascribed the disease to the combined action of a hot, humid and electrical atmosphere. They claimed that these conditions alone were sufficient to cause the fever, and they did not accept the idea that a "special agent" of some kind was involved in its induction or spread. Drake himself rejected the meteoric concept. [17]

He next discusses the Malarial Hypothesis which was based on the commonly held opinion that the agent responsible for the fever was a noxious gas (malaria in Italian) exuding from decaying organic matter such as found in swamps and other wetlands. In support of this view Drake points out that "heat, water, and dead vegetable and animal forms" have been shown always to be present wherever autumnal fever prevails. Yet, he cautions, "while the conditions under which autumnal fever appears are sufficiently clear to observation, the existence of a special gaseous agent, resulting from them, remains to be proved." [18]

Finally, Drake presents his own Vegeto-Animalcular Hypothesis, explaining that: [19]

I have united two words to express an hypothesis which ascribes autumnal fever to living organic forms, too small to be seen with the naked eye; and which may belong either to the vegetable or animal kingdom, or partake of the characters of both. . .

The microscope has revealed the existence of a countless variety of organic forms which surround and penetrate the bodies of larger animals and plants, whether living, or dead and decaying, inhabit all waters, salt and fresh, and swarm in the atmosphere; buoyed up and moving by their own organs, or sustained by their levity, and wafted about by currents of the air. . . . The power of reproduction of these microscopic creatures, is still more wonderful than their minuteness. . . .

Being aware that microscopists were then describing a variety of tiny life forms, Drake goes on to postulate that the fever results when these microscopic "animalcules" or vegetable "germs" are introduced through the lungs into the blood. There they act as a noxious agent on the solids of the blood and on the vast internal surface of the circulatory system to produce an irritability or inflammation manifested in the patient by the characteristic symptoms of the disease.

He concludes by saying: [20]

I think that the etiological history of autumnal fever can be more successfully explained by the vegeto-animalcular hypothesis than the malarial. But both, in the present state of our knowledge, must stand as mere hypotheses. Neither can claim the rank of a theory; nor will it be entitled to the confidence of the profession until many additional facts are brought to its support. . . . Ignorant, however, as we are of any definite, efficient cause for autumnal fever, I am a full believer in its existence, and shall speak of it as a specific agent, known only by its effects on the living body.

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Perspective on 19th Century Medicine

These speculations of Drake in 1850 regarding the cause of malaria, although very astute for his day, are evidence of the limited scope of medical knowledge only 150 years ago with respect to infectious disease, the major cause of illness and death worldwide. The 1850's were also the period when Elias Cooper practiced surgery in Peoria and planned his move to San Francisco where he inaugurated medical education on the Pacific Coast.

In retrospect, it is clear that Drake's work on malaria and Cooper's Peoria interlude coincided with a mid-century watershed in medical history. In so far as one can determine the chronology of such an occurrence, it was at about this time that medicine entered its Modern Era. European and American medicine were emerging from their preoccupation with baseless medical systems and useless traditional remedies. Theoretical doctrines were being subjected for the first time to scientific scrutiny. Conventional therapy such as blood-letting was being evaluated by objective clinical studies, often involving the correlation of bedside and autopsy findings, a process then diligently pursued in the large urban hospitals of Europe. Most importantly, there was an increasing flow of information and discoveries from the new basic sciences of microscopic anatomy, physiology, pathology and pharmacology. [21] [22]

As a means of shedding further light on this momentous change, now recognized as the renaissance of medicine, we shall review that breakthrough which had the greatest significance for mankind - conception and verification of the germ theory - a subject to which we have already been introduced by Dr. Drake. How better to demonstrate the slow progress of medicine, and the humble state of medical knowledge in 1850, than to trace the evolution of the germ theory from Fracastorius in the 16th century to Pasteur, Lister and Koch at the end of the 19th, 300 years later? Certainly Cooper's contributions will be more fully understood and appreciated when viewed against the backdrop of historic medical events that had boundless implications not only for the public health, but also for medical education.

The vegeto-animalcular hypothesis was not original with Drake but evolved through a succession of observations beginning with those of Heironymus Fracastorius of Verona. Educated at Padua, he was a renaissance man of many talents, and was acclaimed as an astronomer, geographer, botanist, mathematician, philosopher, poet and physician. It is from his poem on Syphilis that the name of that disease is derived. In his greatest work on Contagion, dating from 1546 and before the invention of the microscope, he advanced the theory that many diseases are caused by transmissible, self-propagating entities called "germs". He conceived of these "germs" not as living organisms but as chemical substances that could evaporate or diffuse in the atmosphere, and spread from person to person by direct contact, by fomites or by transmission at a distance. He postulated that each disease is specific and is caused by a specific "germ" that propagates itself in the tissues of the infected host, causing the disease by setting up chemical, putrefactive changes in those tissues. These and other features of Fracastorius's theory of contagion are remarkably modern except for his idea that "germs" were chemical substances rather than living organisms. [23]

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Athanasius Kirchir (1602-1680)

The invention of the microscope by Galileo in 1609 revealed a previously invisible world full of tiny objects which fascinated the scientists of the time. Athanasius Kirchir, a German-born Jesuit priest, had a primitive microscope with which he thought he found living organisms or "worms" not visible to the naked eye in fluid from the dead bodies of plague victims. Since his microscope could not possibly have visualized bacteria, the swarming microscopic animals (animalcules) which he described as "worms" were probably insect larvae or rouleaux of red blood-corpuscles. Nevertheless, it is significant that Kirchir went on to conclude (erroneously) in his treatise Scrutium Pestis of 1658 (On the Origin, Causes and Behavior of Plague) that plague was transmitted from person to person along lines already laid out by Fracastorius, but with the altered premise that the infecting agent was living effluvia rather than a chemical substance (It was not until the 1890's that the plague bacillus was identified and its transmission by rat fleas demonstrated.) [24] In any case, Kirchir may be credited with the first really effective presentation of the theory that living organisms are the primary cause of infectious disease. There is, however, yet another major flaw in Kirchir's concept of contagium animatum (living contagion). He believed that the living germs of disease were spontaneously generated in decomposing organic matter - a question not resolved until the theory of spontaneous generation was ultimately demolished by Pasteur late in the 1800's. [25]

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Francesco Redi (1620-1698)

The widely held concept of spontaneous generation was at least questioned but by no means seriously challenged by the experiments of the Italian Francesco Redi. Born at Arezzo, he graduated at Pisa in medicine and philosophy in 1647, and practiced with great success as a physician in Florence. He was also a poet, philologist and naturalist of note. His major contribution to science was Experiments on the Generation of Insects (1668) in which he reports that when flies are allowed to swarm on meat in a jar, maggots appear in the meat as if by spontaneous generation; whereas, when a gauze is placed over the mouth of the jar, forcing the attracted flies to swarm on the gauze, they lay eggs on the gauze and there the maggots form. Meanwhile the meat within the jar putrefies but produces no maggots. These and similar experiments led Redi to conclude that in all cases where living matter is apparently produced from dead matter, the real explanation is that seeds of the animals or plants generated in the dead matter have been introduced from the outside. The doctrine of biogenesis broached by Redi's simple experiments began thereafter to gain some acceptance. Nevertheless, majority opinion for the next 200 years continued to favor the dogma of spontaneous generation of putrefaction and infection, thus bearing witness to the glacial pace of change in the scientific world prior to the mid 19th century. [26]

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Antony van Leeuwenhoek (1632-1723)

It remained for Antony van Leeuwenhoek, a draper by trade in Delft, Holland, with superior microscopes of his own construction, to discover the entirely new world of bacteria, and provide for the first time an objective basis for the theory of a "living contagion". This self-trained amateur microscopist, who created microscopes surpassing all those hitherto devised, regularly communicated his findings to the Royal Society of London. His Letter 18 (October 9, 1676) to the Royal Society is the classic document in which not only were protozoa described, but bacteria were also clearly seen and unmistakably identified as "incredibly small; nay, so small in my sight, that I judged that even if 100 of these very wee animals lay stretched out one against another, they could not reach to the length of a grain of coarse sand". Although Leeuwenhoek himself did not associate these "wee animals" with the causation of disease, others began to do so, but only in theory. [27]

We can now see that both the concept of contagion by living organisms (the germ theory of disease), and a promising direction for basic research into that vital issue (by use of the microscope), had emerged by 1700. Nevertheless, proof of the germ theory was delayed for over 150 years until the microbial origin of infection was conclusively established by the work of Pasteur, Lister and Koch.

Meanwhile, during the long century and a half between Leeuwenhoek and Pasteur, physicians like Drake continued to search for an explanation of contagion and for a method to control it. Among these physicians were two whose contributions have earned them the distinction of being considered forerunners of Lister in their successful clinical approach to the prevention of an infection. They were Oliver Wendell Holmes of Boston and Ignaz Philip Semmelweis of Vienna. Their deductions about the contagiousness of puerperal fever brought them to the threshold of affirming its microbial origin - a threshold that Lister was later able to cross as a result of Pasteur's discoveries.

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