In 1863, when Rhode Island Hospital was chartered, no one knew what caused disease or how it spread. Many American physicians bled patients for both physical and mental ailments, ascribing to a 1,600-year-old theory that bleeding restored the balance of “humors” in the body. Surgery was a brutal affair: surgeons had recently discovered the anesthetizing properties of ether, but they performed surgery without gloves, without cleaning their instruments, and in an environment that was anything but sterile.
By 1863, two years of Civil War had taught America’s physicians that it was better to amputate a shattered limb than to try to save it and risk a life-threatening infection. Some attempts were made to model field hospitals after those established by Britain’s Florence Nightingale, who introduced hygienic practices to field hospitals during the Crimean War, saving the lives of thousands who otherwise may have died of cholera and other infectious diseases. Nevertheless, more soldiers died of disease in the Civil War than were killed in action. The Union armies listed 67,000 killed in action; 43,000 dead of wounds received in battle; and 224,000 dead of disease.
American medical schools graduated physicians who knew little more than their patients. The schools did not require students to have a college or high school degree—the only requirement was the ability to pay the tuition. Most schools offered two 16-week terms that consisted of daily lectures. Medical students graduated without ever learning anatomy by dissecting a cadaver and without ever examining a single patient.
Across the Atlantic, two discoveries were about to revolutionize medicine.
In 1864, French chemist Louis Pasteur found that disease was caused by microorganisms —not by unbalanced humors. In1867, British surgeon Joseph Lister published Antiseptic Principle of the Practice of Surgery, which argued that when surgeons washed their hands before surgery and sterilized surgical instruments, fewer patients died of infection. Although Pasteur’s “germ theory” and Joseph Lister’s antiseptic principles were slow to gain acceptance, they ultimately transformed medicine—and changed the world—by proving beyond all doubt that both disease and infections were caused by microorganisms and that disease causing microorganisms could be killed.
By 1900, vaccines had been developed for anthrax, cholera and rabies. Antitoxins had been discovered for tetanus and diphtheria. Aspirin, one of the most widely used medicines in the world, had been developed by a German scientist. And in America, a new idea of physicians had emerged: that physicians should be critical thinkers who collect and evaluate the information they receive from patients. American medical schools broadened their mission—research began to be considered as important as education. This emphasis on research meant that medical schools, which had been freestanding, for-profit entities owned by a group of physicians, needed to become integral parts of universities and hire faculty who, like all university professors, were researchers as well as teachers, and therefore were expected to add to the body of knowledge medical schools could impart to students.
In 1863, when Rhode Island Hospital was chartered, the average life expectancy in America was 38. Today, thanks to Pasteur, Lister, and all those who followed in their footsteps, the average life expectancy has more than doubled and today stands at 78.