Science meets medicine

DiagnosisDiagnosis
Through the nineteenth century the European medical profession drew ever closer to emerging scientific disciplines. These promised an increased ability to access information about the body and treat its ills.
The idea that changes in a patient's temperature, breathing or heartbeat might offer insights into the development of illness or disease is a long-standing one. These functions had traditionally been determined by the patient's subjective report and the doctor's judgement. Now, for many, the art of diagnosis was to be considered a science, hence instruments were sought that could record, visually display and preserve data.
The last decades of the nineteenth century saw numerous new instruments join the thermometer and stethoscope as non-invasive tools used to access information about the way the body worked. These, as well as new chemical tests designed to reveal the functioning of internal organs such as the kidneys and bladder, were powerful new ways in which the medical profession could find out about the internal state of the body during life - not just at autopsy.
While their original names are often unfamiliar (the sphygmograph, for example, was used for measuring blood pressure), variations of many of these instruments remain the fundamental tools of medical diagnosis.
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Russell urine test case, with a urinometer, 1900. The 'chemical profile' of urine can help diagnose numerous illnesses of the blood, kidneys, digestive system, and hormonal glands.
One of the original stethoscopes belonging to the French physician René Théophile Hyacinthe Laënnec (1781-1826). Laënnec used the stethoscope to listen to patients' hearts and lungs and demonstrated its importance in diagnosing diseases of the lungs, heart and vascular system.
Vital signs
The pulse has been regarded as the basic sign of life across most times and cultures, and feeling the pulse is a standard part of all the great medical traditions. Generally, this occurs at an individual level, with the doctor feeling a patient's pulse by holding the wrist. Interpreting the meaning of the pulse therefore relies on the individual skill and judgment of the practitioner. In most traditions it is the 'quality' and rhythm of the pulse that is important. In Western medicine, the emphasis is on the rate and regularity of the pulse.
The search for a more standardised method of determining and visually displaying the movement of the blood around the body led to the development, from the 1860s, of sphygmographs, sphygmomanometers and the less successful sphygmometers. All of these took their names from the Greek sphugmo, for pulse. Sphygmographs worked by transmitting the movement of the pulse to a long lever that traced a curve onto prepared paper. The line had a pattern that showed the rate of the pulse and the force of the heartbeat.
Sphygmographs were used more by medical scientists than in clinical practice. Doctors found them cumbersome and difficult to use accurately - as well as intimidating for the patient. However, the ability to see variations and abnormalities in the circulation of blood and the heartbeat was of enormous value to the development of experimental physiology and cardiology.
In contrast, by the turn of the nineteenth century, the sphygmomanometer, which measures blood pressure, had become a standard diagnostic tool.
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In 1881 the English physician and homeopath, Robert Ellis Dudgeon (1820-1904) introduced a new, highly portable sphygmograph. Dudgeon's sphygmograph was strapped to the wrist. The pulse at the wrist caused a metal strip to move a stylus, transmitting a record of the pulse onto smoked paper.
Dudgeon's instrument quickly became popular since it was compact and easy to use.
The sphygmograph traces an undulating line, which represents a record of blood pressure and pulse over time. The first practical version was devised in 1860 by the French physician Etienne-Jules Marey (1830-1904).
The Italian professor Scipione Riva Rocci (1863-1937) created a sphygmomanometer in 1896 that used an inflatable arm cuff and a vertical gauge to measure the pressure of the blood. Modern blood pressure devices are based on this model.
A sphygmomanometer from 1880, made by Samuel Siegfried Karl Ritter von Basch. The bulb was used to apply pressure to the radial artery until the pulse disappeared. The changes in blood pressure could then be read off the barometer dial.
Measurements
Diagnostic tools were part of a more general shift in medical practice. Interactions between doctors and patients, the types of information collected, and the ways in which that information was displayed and preserved were all changing. Measurements taken by instruments were increasingly regarded as a more reliable guide to the patient's condition than the patient's own report of what she or he was feeling.
The pulse, blood pressure and temperature were transformed into data contained in numbers, graphs and charts. The electrical signals that coordinate the heart's beats were recorded photographically with electrocardiographs. All of these techniques enabled doctors to monitor the progress of a condition over time, see the effects of medication and share this information with their colleagues. By comparing data from many patients, doctors were able to build up a picture of how different diseases typically behaved.
Specialist scientists also played an increasing role in diagnosis - often without direct contact with patients. From the 1880s blood and urine samples began to be routinely sent to clinical laboratories for analysis. As the organisms causing diseases such as tuberculosis (1882) and syphilis (1905) were identified, chemical laboratories became central to diagnostic practice.
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Patient charts, which showed changes in temperature, pulse and respiration, allowed doctors to identify common patterns that characterised specific diseases, and to compare data from numerous cases.
An early electrocardiograph machine (1912) manufactured by Cambridge Scientific Instruments in association with Willem Einthoven. The image shows a patient with his limbs immersed in tubs of electrolyte solution (usually saline). This is most probably a demonstration for a trade catalogue.
Photographs taken by physiologist Augustus Waller, between 1884 and 1903. These electrocardiograms detect and record the tiny electrical signals that coordinate the heart's beats and can indicate heart disorders.
X-ray vision
The most dramatic evidence of the medical profession's ability to get access to information about the body's internal workings came from the introduction of X-rays. X-rays were discovered by Wilhelm Röntgen, a German professor of physics, in 1895. The technology relied on the extent to which different parts of the body allowed the rays to pass through, depending on their density. The images produced when X-rays went through the body could be captured on photographic plates.
X-rays had an immediate impact in medical practice, since they allowed unprecedented access to the internal structures of the living body. Within weeks of Röntgen's findings, pictures were being taken of broken limbs, foreign objects such as bullets or needles lodged within the body, gall stones and lesions on the chest. By the beginning of the twentieth century the potential dangers of X-rays had also become obvious, and an ongoing debate began over their risks and benefits.
Some physicians also argued against their use on more philosophical grounds. They believed that medicine was in danger of becoming too reliant on specialised science and technology, ignoring the need for general practitioners.
The X-ray also had immediate popular appeal. It quickly became fashionable to have X-ray portraits taken - especially of hands laden with jewellery. Sales of equipment claiming to see through clothes and of 'X-ray proof' underwear soared.
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X-ray photograph taken by Röntgen in December 1895, believed to be of his wife's hand. This is the oldest surviving X-ray image of a part of the human body.
An early New York X-ray studio, run by electricians. 'Bone portraits' were made for interested clients. Such studios may also have provided services to local hospitals.
Tests were designed to discover the strength of rays, like this radiograph of coins in purse. The public feared the potential of X-rays to reveal hidden secrets or be used with criminal intent.
Punch cartoon plays on middle class fears that their servants might invade their privacy. The text accompanying the cartoon says: 'The March of Science. Interesting result attained, with aid of Röntgen rays, by a first-floor lodger when photographing his sitting-room door.' The lodger sees a maid listening at his door.
This early German X-ray tube is of the form originally used by Wilhelm Röntgen, the discoverer of X-rays, in his research.
Setting standards
New diagnostic instruments measuring body functions also revealed that what was normal for an individual could vary dramatically. It became important for doctors to determine the ranges of normal functioning within the larger population. This had an importance beyond medicine, as by the late nineteenth century the ability to evaluate the potential long term health of apparently healthy individuals was important to employers, military services and insurers.
By the early 1900s the most useful predictors of longevity were determined to be blood pressure and 'vital capacity', the ability of the lungs to take in and expel air. Lung diseases, especially consumption (tuberculosis), were of major concern, and spirometers could be used to measure 'vital capacity'. Similarly, blood-pressure equipment was used as a predictor of future heart and vascular diseases. Insurers and general practitioners used these instruments very differently. Insurance companies were interested in determining what was 'normal', not making diagnoses about specific diseases.
Establishing the variations of normal functioning, according to age, weight or other factors, for sections of the population therefore became a priority. Data was collected from thousands of people and analysed statistically in order to set standards. Falling outside these standard measurements could have dramatic consequences. It might determine whether or not an individual was offered health insurance, given a job or even cleared for military service.
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Naval recruits undergoing medical examinations.
Spirometers were used to measure the amount of air held by the lungs, which indicates the health of the respiratory system.