When did the age of modern medicine begin? It’s hard to put your finger on but medical advancements did not occur all at once. Furthermore, what is meant by modern medicine? One fairly common definition that I would use is the point at which medicine stood a better chance of helping patients than harming them.
In the 1700s leeches and bloodletting were common. The practice of bloodletting precedes the Germ Theory of disease. Prior to the understanding germs, doctors believed illness was caused by an imbalance of the body’s “humors”, including blood, phlegm, black bile, and yellow bile. Doctors would attempt to restore balance by draining or purging the patient. President George Washington’s physicians famously removed 2.5 quarts of his blood to reduce unhealthy humors from his body, likely hastening his Death on December 14, 1799.
Back in 1799, Washington’s physicians justified the removal of more than 80 ounces of his blood (2.365 liters or 40 percent of his total blood volume) over a 12-hour period in order to reduce the massive inflammation of his windpipe and constrict the blood vessels in the region. Theories of humoralism and inflammation aside, this massive blood loss — along with the accompanying dehydration, electrolyte imbalance, and viscous blood flow — could not have helped the president’s dire condition.
At this late date, it is all too easy to criticize Washington’s doctors. Indeed, even in real time and for decades thereafter, critics complained that the physicians bled Washington to death. But the truth of the matter is that they did the best they could, against a pathologically implacable foe, using now antiquated and discredited theories of medical practice.
An exhibition called “The Dawn of Modern Medicine,” was on display at the Bruce Museum in Greenwich, Connecticut in 2019. It focused on medical discoveries over a 120-year period that began only a couple weeks after George Washington’s doctors bled him to death.
The exhibition focuses on the decades between 1800 and 1920, which allows museum-goers to witness the development of “real” medicine, such as the first X-rays (1895), the first use of surgical anesthesia (1846), and the acceptance of Louis Pasteur’s Germ Theory (1880s). “So many things we take for granted were created at this time,” explains the museum’s curator of science, Dr. Daniel Ksepka. Because such inventions were new, they undoubtedly inspired fear in the Victorian patients introduced to them. For example, an early X-ray machine from 1900, with its bulbous glass tube, says Ksepka, “looks like something from a ‘Frankenstein’ movie!”
It’s hard to fathom that the concept of germs only came about in the 1850s and the theory was controversial.
A transitional period began in the late 1850s with the work of Louis Pasteur. This work was later extended by Robert Koch in the 1880s. By the end of that decade, the miasma theory was struggling to compete with the germ theory of disease. Viruses were initially discovered in the 1890s.
Then there is medical education. Abraham Flexner is the father of modern medical education. The model of medical education sought by Flexner was an elitist one that placed university research above patient care.
The quality of the student body was assured by requiring that all students had a university education prior to admission to medical school. It is no wonder that Flexner chose Hopkins as his gold standard with which all other schools were compared in his survey of American medical schools.
Equipped with extensive book knowledge and not a few prejudices and preconceptions, Flexner demonstrated near superhuman industry and energy in carrying out his review of American/Canadian medical education. He crisscrossed the United States and evaluated institutions from the point of view of an educator and not a medical practitioner.
Schools were assigned to one of three categories on the basis of his evaluation: A first group consisted of those that compared favorably with Hopkins; a second tier was comprised of those schools considered substandard but which could be salvaged by supplying financial assistance to correct the deficiencies; and a third group was rated of such poor quality that closure was indicated. The latter was the fate of one-third of American medical schools in the aftermath of the report.
His famous (or was it infamous) Flexner Report of 1910 ultimately resulted in closure of nearly 60% of medical schools, including more than 70% of medical schools that taught black students. Roughly a decade after his landmark report, only 66 of the original 155 medical colleges in the United States and Canada remained open.
In his day Flexner was hailed as a medical education reformer, who transformed American and Canadian medical education into the gold standard modeled after German medical schools and Johns Hopkins University. Today his legacy is slightly (but only slightly) more mixed.
There was maldevelopment in the structure of medical education in America in the aftermath of the Flexner Report. The profession’s infatuation with the hyper-rational world of German medicine created an excellence in science that was not balanced by a comparable excellence in clinical caring. Flexner’s corpus was all nerves without the life blood of caring.
Even in his day there were a few critics.
The most vocal challenger and naysayer was William Osler, who was subsequently seconded by Harvey Cushing. Osler believed that the focus of such physicians would be too narrow, they would live lives apart with other thoughts and other ways . He was apprehensive that a generation of clinical prigs would be created, individuals who were removed from the realities and messy details of their patients’ lives. Osler believed that the Flexnerians had their priorities wrong in situating the advancement of knowledge as the overriding aspiration of the academic physician. He placed the welfare of patients and the education of students to that effect as more important priorities…
I’ve heard opinions that Flexner closed medical colleges of quackery. I also heard opinions that substandard medical schools produced doctors that were better than nothing and that over time the substandard medical schools would have conformed to more scientific methodology. The messy details of how modern medicine evolved are interesting. To read more about the history of modern medicine see: