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Title: The Dawn of Modern Medicine - An Account of the Revival of the Science and Art of Medicine - Which Took Place in Western Europe During the Latter Half - of the Eighteenth Century and the First Part of the - Nineteenth
Author: Buck, Albert Henry
Language: English
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THE DAWN OF MODERN MEDICINE
FROM THE EARLY PART OF THE EIGHTEENTH
CENTURY TO ABOUT 1860
-------
CONTINUATION OF THE ACCOUNT GIVEN IN THE WORK
ENTITLED “THE GROWTH OF MEDICINE”
------------------------------------------------------------------------
PUBLISHED ON THE FOUNDATION
ESTABLISHED IN MEMORY OF
WILLIAM CHAUNCEY WILLIAMS
OF THE CLASS OF 1822, YALE MEDICAL SCHOOL
AND OF
WILLIAM COOK WILLIAMS
OF THE CLASS OF 1850, YALE MEDICAL SCHOOL
------------------------------------------------------------------------
[Illustration:
PORTRAIT OF ANTOINE LAURENT LAVOISIER
The French chemist and biologist who contributed more than anyone
else to our knowledge of the chemistry and physiology of oxygen.
(Copied from the frontispiece of Volume I of Lavoisier’s “Works,”
published by the French Government in 1864.)
]
------------------------------------------------------------------------
THE DAWN OF MODERN
MEDICINE
AN ACCOUNT OF THE REVIVAL OF THE SCIENCE
AND ART OF MEDICINE WHICH TOOK PLACE
IN WESTERN EUROPE DURING THE LATTER
HALF OF THE EIGHTEENTH
CENTURY AND THE FIRST PART
OF THE NINETEENTH
BY
ALBERT H. BUCK, B.A., M.D.
FORMERLY CLINICAL PROFESSOR OF DISEASES OF THE EAR, COLUMBIA
UNIVERSITY, NEW YORK: CONSULTING AURAL SURGEON,
NEW YORK EYE AND EAR INFIRMARY, ETC.
[Illustration]
NEW HAVEN: YALE UNIVERSITY PRESS
LONDON: HUMPHREY MILFORD
OXFORD UNIVERSITY PRESS
MDCCCCXX
------------------------------------------------------------------------
COPYRIGHT, 1920, BY
YALE UNIVERSITY PRESS
------------------------------------------------------------------------
THE WILLIAMS MEMORIAL PUBLICATION FUND
The present volume is the third work published by the Yale University
Press on the Williams Memorial Publication Fund. This Foundation was
established June 15, 1916, by a gift made to Yale University by Dr.
George C. F. Williams, of Hartford, a member of the Class of 1878, Yale
School of Medicine, where three generations of his family studied—his
father, Dr. William Cook Williams, in the Class of 1850, and his
grandfather, Dr. William Chauncey Williams, in the Class of 1822.
------------------------------------------------------------------------
PREFACE
This work is in the main a continuation of the volume entitled “The
Growth of Medicine,” but it is also intended to serve as an
amplification of the latter part of that work, which, owing to various
circumstances that were in large measure beyond my control, lacked
completeness. The most troublesome of these adverse circumstances was
the fact that I had failed, during a recent visit to Europe, to find
those sources of trustworthy information upon which alone such a
narrative could properly be based; and later still, when I made my first
attempts to construct the text of the present volume, I again
encountered the same kind of obstacles, but in an even greater degree,
and was then strongly disposed to abandon the undertaking altogether. At
this juncture of affairs, however, I was much surprised and pleased to
receive from Mrs. Charles F. Norton, the librarian of Transylvania
College at Lexington, Ky., a letter in which she stated that the college
had in its possession a large collection of medical works which had been
purchased at Paris, France, in 1819, at which period of its history the
institution bore the title of Transylvania University and possessed a
flourishing medical department; and that the president of the
institution would be happy to extend to me every possible facility for
utilizing this great mass of historical material. Shortly afterwards, in
reply to my request that I might be furnished with a partial list of the
books contained in this collection, in order that I might determine how
many of them related to the period in the history of French medicine in
which I was at that time particularly interested,—the period, mainly,
from about 1760 to 1830,—I received a card catalogue of the titles of
over 100 French, English and Latin treatises. This information removed
all doubts from my mind concerning the wisdom of my visiting Lexington,
and I accordingly signified my prompt acceptance of the cordial
invitations extended to me by President Crossfield.
As I write these lines I am prompted to add the further statement that
during my stay at Lexington, which covered a period of seven months, I
received every assistance from the Transylvania College authorities that
I could possibly desire; and in particular I wish to express my deep
sense of gratitude to the librarian, Mrs. Norton, for the interest which
she manifested in my work and for the valuable assistance which she
rendered in hastening its completion.
Cuvier, the celebrated naturalist, in a memoir which he read before the
Royal Institute of France, makes the following statement: “It is not
through a perusal of the insufficient extracts that are commonly made
from the published works of distinguished men, nor through the
incomplete indications which the recital of their discoveries may
furnish, that we derive the greatest pleasure from the eulogies
pronounced after the death of these men. This desirable result is more
likely to be obtained when we are made intimately acquainted with their
individual traits of character,—when we are, so to speak, permitted to
know these men in a social way; when we are given the opportunity of
contemplating, close at hand, their distinct qualities, their virtues,
yes, even their faults,—provided the facts are plainly stated by one who
is skilled in such portraiture. Furthermore, the reader is sure to
derive the greatest pleasure, and also to be the most benefited, when
every page of the eulogy furnishes evidence of the genuine happiness and
wonderful serenity which characterize the lives of those who devote
themselves to the culture of the sciences. Compare these men with those
who have been intent on securing glory through devastating the world,
and note how frequently they live to be septuagenarians or even
octogenarians.” Deeply impressed by the wisdom of the advice thus
briefly given by the celebrated French naturalist, I have striven, in
the following chapters, to act upon it as circumstances might permit.
After making several unsuccessful attempts to classify my chapters
according to the special fields in which the different men attained
distinction, I came to the conclusion that the difficulties which stand
in the way of adopting such a classification are well-nigh
insurmountable; and chief among these difficulties may be mentioned the
fact that many of the leading physicians attained distinction in two or
more different fields. Botany, for example, was frequently combined with
anatomy and surgery; chemistry with physiology; and so on. On the whole,
therefore, it seemed better to rest satisfied, wherever this was found
to be practicable, with the simple subdivision according to geographical
districts—viz., Northern and Central Germany, Austria, Italy, France,
Switzerland and England.
The relatively few Americans who played an important part in advancing
the science and art of medicine during the latter half of the eighteenth
century and the early part of the nineteenth make it preferable, as it
seems to me, to omit all reference to them in the present work, leaving
to the writer of a volume devoted to modern medicine, the duty of
honoring their achievements.
ALBERT H. BUCK.
Cornwall, Orange County, N. Y.
October 3, 1919.
------------------------------------------------------------------------
CONTENTS
PAGE
Preface ix
BOOK I
THÉOPHRASTE RENAUDOT, PHYSICIAN, FOUNDER OF THE FIRST FRENCH NEWSPAPER
Chapter I. Théophraste Renaudot, Physician, 3
Philanthropist, and Founder of the First French
Newspaper
BOOK II
STATE OF MEDICINE IN WESTERN EUROPE AT THE BEGINNING OF THE EIGHTEENTH
CENTURY
Chapter II. Low State of Medical Affairs in 15
Germany at the Beginning of the Eighteenth
Century
Chapter III. Physicians who Attained Distinction 18
in Some of the Departments of Medicine during
the First Half of the Eighteenth Century
Chapter IV. Distinguished Swiss Physicians who 34
Played a Prominent Part in the Development of
the Science and Art of Medicine in Germany
Chapter V. The Earliest Publication in Europe of a 43
Systematic Treatise on Hygiene, Public Health
and Medico-Legal Science
Chapter VI. Two Eminent German Surgeons of the 48
Pre-Antiseptic Period
Chapter VII. A General Survey of German Medicine 52
at the End of the Eighteenth Century
BOOK III
THE VIENNA SCHOOL OF MEDICINE
Chapter VIII. Gerhard Van Swieten 59
Chapter IX. Anton Stoerck, Van Swieten’s 71
Successor, and the Progress of Medical Affairs
at Vienna under the Management of Joseph II
Chapter X. Prochaska, Hyrtl and Rokitansky, Three 79
of the Most Distinguished Teachers at the
Medical School of Vienna during the Early Part
of the Nineteenth Century
BOOK IV
MEDICINE IN ITALY
Chapter XI. Baglivi, Morgagni, Scarpa, 91
Spallanzani, Tissot and Galvani; Italy’s most
Illustrious Physicians during the Eighteenth
Century
BOOK V
SMALL-POX, ONE OF THE WORLD’S GREATEST SCOURGES
Chapter XII. Measures Adopted for the Control of 107
Small-Pox; Inoculation, Vaccination
BOOK VI
AWAKENING OF THE CHEMISTS, PHYSIOLOGISTS AND PATHOLOGISTS
Chapter XIII. The English and French Chemists 119
Contribute Their Share toward the Advance of
Medical Knowledge
BOOK VII
MEDICINE IN ENGLAND
Chapter XIV. English Leaders in Medicine and 129
Surgery during the Eighteenth and Early
Nineteenth Centuries (First Group)
Chapter XV. English Leaders in Medicine and 139
Surgery (Second Group)
Chapter XVI. English Leaders in Medicine and 150
Surgery (Second Group continued)
BOOK VIII
MEDICINE IN FRANCE
Chapter XVII. Bordeu and Bichat; The Beginning of 159
Experimental Physiology and Experimental
Pathology in France
BOOK IX
MEDICINE AT THE HEIGHT OF THE FRENCH REVOLUTION
Chapter XVIII. Types of French Physicians who 171
Flourished about the Time of the Reign of Terror
Chapter XIX. Laënnec and the Invention of the 195
Modern Method of Auscultation; Paul-Joseph
Barthez
Chapter XX. Early Studies of the Disease now 202
Universally called Typhoid Fever: Bretonneau
BOOK X
BROUSSAIS AND BROUSSAISM
Chapter XXI. The Harmful Effects of Broussais’ 207
Teaching
BOOK XI
THE GOLDEN AGE OF SURGERY IN FRANCE
Chapter XXII. J. L. Petit, of Paris, and his 215
Contemporaries in Surgery—Sabatier, Chopart,
Desault and Dupuytren
Chapter XXIII. Workers in Special Departments of 230
Surgery: Demours, Descemet, Delpech, Fauchard,
Jourdain, Gariot
BOOK XII
DESGENETTES AND LARREY, FRANCE’S MOST CELEBRATED MILITARY SURGEONS
Chapter XXIV. Military Surgery in France, as 241
represented by Desgenettes and Baron Larrey
BOOK XIII
A FEW OF THE IMPORTANT HOSPITALS AND THE PRINCIPAL ORGANIZATIONS IN
PARIS FOR TEACHING MEDICINE AND MIDWIFERY
Chapter XXV. Hospital of “La Maternité,” the Great 253
French Midwifery School
Chapter XXVI. Further Details Concerning the Paris 258
Faculté de Médecine and Concerning some of the
Larger Hospitals of Paris
Chapter XXVII. Armand Trousseau, one of the last 265
of France’s Great Clinical Teachers
List of the More Important Authorities Consulted 271
General Index 277
Footnotes 300
------------------------------------------------------------------------
LIST OF ILLUSTRATIONS
Portrait of Antoine Laurent Lavoisier, the French Frontispiece
chemist and biologist who contributed more than
anyone else to our knowledge of the chemistry
and physiology of oxygen. (Copied from the
frontispiece of Volume I of Lavoisier’s “Works,”
published by the French Government in 1864.)
Loudun. This photograph, which was taken from one 4
of the highest points in the village of Loudun,
shows its elevated position above the
surrounding country and affords a bird’s-eye
view of the adjacent river, the Martray.
(Courtesy of Monsieur le Pasteur Paul Barnaud,
of Sainte Foy la Grande [Gironde], France.)
Cardinal Duc de Richelieu. (From a portrait 6
engraved on copper by Nanteuil in 1655.)
Statue of Théophraste Renaudot at Loudun, France. 8
(Courtesy of Monsieur le Pasteur Paul Barnaud,
of Sainte Foy la Grande [Gironde], France.)
Hufeland. (From Eugen Hollaender’s “_Medizin und 28
Plastik_,” by permission.)
Albrecht von Haller 34
Vignette from the title-page of Haller’s 36
“_Elementa Physiologiae_,” Lausanne, 1757
Gerard Freyherr Van Swieten 60
Medal commemorating the discovery of vaccination. 108
(From Eugen Hollaender’s “_Medizin und
Plastik_,” by permission.)
Edward Jenner. (Copied from Thomas J. Pettigrew’s 110
“Medical Portrait Gallery,” London, 1838. The
original portrait was painted by Sir Thomas
Lawrence, Royal Academy.)
Sir Astley Cooper. (Copied from a print in the 136
possession of the New York Academy of Medicine.)
William Hunter. (Copied from Thomas J. Pettigrew’s 140
“Medical Portrait Gallery,” Fisher & Son,
London, 1838. The original portrait was painted
by Pyne; the engraving was done by J. Thomson.)
John Hunter. (Copied from Thomas J. Pettigrew’s 144
“Medical Portrait Gallery,” London, 1838. The
original portrait was painted by Sir Joshua
Reynolds; the engraving was done by G. H.
Adcock.)
Sir Benjamin Collins Brodie, Bart., F.R.S., 148
Sergeant Surgeon to the Queen. (Copied from
Thomas J. Pettigrew’s “Medical Portrait
Gallery,” London, 1838. The original portrait
was painted by H. Room; the engraving was done
by J. Brain.)
Sir Charles Bell. (Copied from a print in the 154
possession of the New York Academy of Medicine.)
Bichat 162
Costume worn by Paris physicians in the eighteenth 172
century. (From Alfred Franklin’s “_La Vie Privée
d’Autrefois_,” Paris, 1892.)
Gaspard Laurent Bayle 182
A candidate for the degree of “Doctor of Medicine” 184
defending his thesis before the examining
committee of the Paris Faculty of Medicine.
(From “_La Vie Universitaire_,” Paris, 1918.)
Corvisart. (Copied from an old French print in the 188
possession of the New York Academy of Medicine.)
Laënnec. (Copied from an old French print in the 196
possession of the New York Academy of Medicine.)
The _Faculté de Médecine_ and the Cathedral at 198
Montpellier, France. (Courtesy of Monsieur le
Pasteur Paul Barnaud, of Sainte Foy la Grande
[Gironde], France.)
The “Court of Honor” of the _Faculté de Médecine_ 200
at Montpellier, France. (Courtesy of Monsieur le
Pasteur Paul Barnaud, of Sainte Foy la Grande
[Gironde], France.)
Montpellier. Vestibule of the _Faculté de 202
Médecine_ at Montpellier, France. (Courtesy of
Monsieur le Pasteur Paul Barnaud, of Sainte Foy
la Grande [Gironde], France.)
Charles A. P. Louis 204
Broussais 208
Jean-Louis Petit 216
Dupuytren 226
Desgenettes 242
Baron Larrey 244
Eighteenth-century plan showing the relations of 258
the Paris _École de Médecine_ to _Hôtel-Dieu_,
the Cathedral of Nôtre Dame and the River Seine.
(Reduced copy of the cut printed in Franklin’s
“_La Vie Privée d’Autrefois_,” Paris, 1892.)
Side of the Paris _Faculté de Médecine_ which 260
fronts on the _Rue de l’École de Médecine_.
(From “_La Vie Universitaire_.”)
View of the former _École de Médecine_ since it 260
has been incorporated with the new structures of
the _Faculté de Médecine_. (From _“La Vie
Universitaire.”_)
Musée Dupuytren. Formerly the refectory of the 260
Convent of the Cordeliers (Franciscans), in the
fifteenth century. (From “_La Vie
Universitaire_.”)
Device of the _École de Médecine de Paris_. 262
(Adopted by the Faculty in 1597.) (Three storks,
each holding a twig of origanum in its beak; and
at the top of the design the motto “_Urbi et
Orbi Salus_” [Health to the City and to all the
World].)
Hôpital Saint-Louis, Paris. Planned and drawn by 264
Claude Chatillon, architect, in 1608. (Copied
from Tenon’s “_Mémoires sur les Hôpitaux de
Paris_,” Paris, 1816; reduced about one-half.)
Trousseau 266
Velpeau. A contemporary of Trousseau and one of 268
France’s most distinguished surgeons. (Copied
from a print in the possession of Transylvania
College, Lexington, Kentucky.)
------------------------------------------------------------------------
BOOK I
FOUNDATION OF THE FIRST NEWSPAPER IN PARIS, FRANCE, AND THE
ESTABLISHMENT OF PRIVATE AGENCIES FOR AIDING THE POOR
------------------------------------------------------------------------
CHAPTER I
THÉOPHRASTE RENAUDOT, PHYSICIAN, PHILANTHROPIST, AND FOUNDER OF THE
FIRST FRENCH NEWSPAPER (1586–1653)
_Prefatory Remarks._—As the present volume purports to deal with events
that occurred chiefly during the eighteenth century, the reader may
think it strange that I should introduce here a sketch which relates to
a physician whose life covers a period nearly one century earlier. My
reason for departing, in this instance, from the proper chronological
order, in the arrangement of my text, is of a twofold nature. In the
first place, I did not discover Gilles de la Tourette’s interesting
memoir—almost the only satisfactory source of information available
concerning Renaudot—until about February 1, 1918—that is, nearly one
year after “The Growth of Medicine” had been published; and, second, on
looking over the principal treatises on the history of medicine, I
failed to find any adequate account of the remarkable work accomplished
by Renaudot. Puschmann, so far as I have been able to learn, is the only
authority who gives this great philanthropist due credit for the
important part which he played in reflecting honor upon our profession.
* * * * *
THÉOPHRASTE RENAUDOT was born at Loudon, a small town in Western France,
picturesquely situated on a high hill about thirty miles northwest of
Poitiers. His parents, who were wealthy Protestants, died while he was
still a mere lad. Théophraste, who inherited the entire fortune left by
his parents, developed at a remarkably early age strong humanitarian
ideas, and it was under the stimulus of these that he shaped his course
in life. With a clear idea of the kind of training that would best fit
him for the work which he proposed to undertake, he decided to study
medicine, as this career, better than any other, would enable him to
accomplish his purpose. Accordingly he went to Montpellier, took the
regular course of instruction in the university, and received the degree
of Doctor of Medicine in 1606, before he had reached his twentieth year.
Recognizing the fact that a physician should be of a certain age before
he can reasonably expect to command the confidence of his fellowmen, he
decided to utilize the time following his graduation in visiting some of
the more important capitals of Europe. The first country which he
visited was Italy, where he undoubtedly gained some familiarity with the
manner in which the _monts-de-piété_ (the prototypes of our modern
pawnbrokers’ shops) were managed under the guiding control of the popes.
It is also highly probable that he visited in turn the universities of
Holland and Belgium as well as the two great English universities—Oxford
and Cambridge. Then, upon his return to France, he went to Paris and
began the study of chemistry at the Collège de Saint-Côme. During his
stay in the French metropolis, he was made painfully aware of the
prevalence of poverty, the streets being filled everywhere with
shameless beggars, and Hôtel-Dieu, the great city hospital, being
overcrowded with the sick, among whom were large numbers of children
affected with contagious diseases and infants starving to death from
lack of wet-nurses. The first thought that occurred to the practical
mind of Renaudot was to find work for many of these poor people; but
when he set about doing this he at once encountered many obstacles; and
finally, in despair over his lack of success, was forced to abandon
further efforts in this direction and return to his home in Loudon.
While there, he frequently met the influential Capucin Monk Leclerc du
Tremblay, commonly known as his “Gray Eminence,” and through him he was
brought to the notice of Cardinal Richelieu, then or soon afterward,
Secretary of State of Marie de Médicis, the queen-mother of Louis XIII.
Although the cardinal, for political reasons, antagonized the Huguenots,
he personally entertained no unfriendly feelings toward men of the
Protestant faith, and consequently he was quite prepared to aid Renaudot
when he laid before him, as he did shortly after his return to Paris,
his schemes for the betterment of the poor in that great city. One of
these schemes called for the establishment of a “_bureau d’adresse ou de
rencontre_,” an office depot where, by the payment of three sous,
anybody was entitled to have the address of his place of business
entered upon the registers of the bureau; and where also employer and
employee might meet for arranging terms. If any person wished to learn
the address of any given place of business, the desired information
would be furnished upon the payment of a fee of the same value; but _no
charge whatever was to be made in the case of a poor person_. This
scheme proved a complete success in a very short time. Then, as a
further step in the development of his _bureau_, Renaudot joined what he
termed “_ventes à grâce troque ou rachapt_”—that is, “sales with the
privilege of exchange or redemption.” This was the first step toward the
establishment of his “_mont-de-piété_,” an institution which was not
fully organized by him at Paris until 1637. The tax upon loans was fixed
at 3 per cent—just enough to pay the expenses of running the bureau. His
motto was: “Loan money without expectation of profit.” His solution of
the social problem was summed up in the following aphorism: “In every
organized community or state the rich shall afford aid to the poor, all
harmony between the two classes ceasing when one of them grows richer at
the expense of the other.”
[Illustration:
Loudun. This photograph, which was taken from one of the highest
points in the village of Loudun, shows its elevated position above
the surrounding country and affords a bird’s-eye view of the
adjacent river, the Martray. (Courtesy of Monsieur le Pasteur Paul
Barnaud, of Sainte Foy la Grande [Gironde], France.)
]
At the time when Renaudot came to Paris, there existed no such thing as
the “_Journal_”—that is, a printed periodical such as he contemplated
and afterward founded. At an interview with Cardinal Richelieu, the
Secretary of State of Louis XIII., Renaudot proposed that all the news
received from the outside world, the king’s edicts, and treaties made
with other nations should be brought together and published at stated
intervals in a single printed sheet. The cardinal at once saw how
important the proposed journal would be for his own interest, especially
if its management were intrusted to a man who agreed with him in regard
to political questions. Then, in addition, the mere fact that it was an
official sheet, the only strictly French periodical, would be of special
value at that moment, when the princes of the blood were forming
alliances with the enemy. So, on May 30, 1631, Louis XIII. granted to
Renaudot “the privilege to make, print and sell, through any agent whom
he might select and wherever it seemed to him best to sell copies, the
news, the official appointments and accounts of all events occurring
both within and outside the kingdom.” The first number of the “_Gazette
de France_”—which was the name that Renaudot gave to his
periodical—appeared on the day mentioned above. The price at which this
sheet of four pages sold was two _liards_.[1]
One year later, the size of the Gazette was increased by the addition of
four separate pages which bore the title, “_Nouvelles_,” and
simultaneously the price of the entire journal (8 pages) was increased
to one sou. It is scarcely necessary to state that the Gazette was
directly inspired by Richelieu, and that even the king occasionally took
a hand in editing it. Gilles de la Tourette, the author of the memoir
from which I have compiled the present brief sketch, says that he
examined all the issues of the Gazette from 1631 to 1653 but failed to
find in them a single _réclame_—advertisement or editorial puff.
From the very day on which it was first published, the Gazette proved a
brilliant success. I should have mentioned, at the beginning of this
sketch, the fact that for a certain length of time Renaudot contributed
liberally from his own funds toward the support of his pet schemes of
benevolence, but it does not appear, in the account given by de la
Tourette, whether the Gazette enterprise should not be counted as one of
these schemes. At the same time, the thought naturally suggests itself
that this physician’s motive in advocating the publishing of an official
newspaper like the Gazette was probably a strong desire to win for his
humanitarian schemes the strong support which the Cardinal and the King
would be able to grant. Whether this be true or not, the idea of
creating an official newspaper under the protection of the highest
authority in France certainly showed far-sighted wisdom on the part of
Renaudot. In 1640,—_i.e._, nine years after the founding of the Gazette
as an official dispenser of political and civic news,—Renaudot changed
its scope by adding to it the character of a medical journal. After
1640, therefore, the Gazette may rightly be classed as representing the
first attempt to publish a medical periodical in France.
[Illustration:
CARDINAL DUC DE RICHELIEU
(From a portrait engraved on copper by Nanteuil in 1655.)
]
Another important feature was added by Renaudot to his philanthropic
scheme in this same year 1640. He obtained from the King a decree
authorizing him to establish a “_Bureau de Consultations Charitables
pour les Pauvres Malades_.” The manner in which this Bureau was to be
conducted may be briefly explained in the following words. At certain
fixed hours fifteen physicians, all of them friends of the founder, and
a smaller number of apothecaries presented themselves at the Bureau,
where, seated at a few separate tables, the physicians listened to the
statements made by the poor people who had come there in the hope of
obtaining relief from their maladies. In the simpler cases, a single
physician was fully equal to the task of prescribing whatever the
patient’s condition called for, but in those of a more obscure nature,
two or three of the physicians present joined in a consultation. After
the question of a suitable treatment had been decided, one of the
apothecaries in attendance prepared the remedy or remedies which had
been prescribed, and at the same time a written statement of the
diagnosis was handed to the patient. If the ailment happened to be of a
surgical nature, the measures required for its treatment were carried
out on the spot. Some of the patients who presented themselves at the
Bureau were easily able to pay for professional advice; and, when such a
person appeared, an opportunity was afforded for dropping into a
suitable box the fee which he or she was disposed to give. This money
was utilized in paying for the remedies furnished the poor. In
exceptional cases, it was perfectly evident that drugs alone could not
afford the desired relief; the need was rather for more and better food.
Fully realizing this need, and acting under his strongly benevolent
impulses, Renaudot not infrequently placed money in the hands of these
suffering dispensary patients when they were about to return to their
homes. The exact amount of these gifts is not known, but they must in
the aggregate have been large; for his biographer says that, in addition
to the sums which his more prosperous patients placed in his hands for
the benefit of the poor, he contributed annually out of his own purse,
toward the maintenance of these free consultations, the sum of 2,000
livres (the “livre” being of about the same value as the franc). The
success of the Bureau was so great that in the course of a few months it
became necessary that a certain number of physicians should be at the
consulting rooms of the institution at all times during the day.
As a natural result of this increase in the Bureau’s popularity the
celebrity of Renaudot also increased, until it extended to every part of
the kingdom; and, as a further result, the institution itself now began
to take on the character of a school for clinical instruction—an
entirely new feature; for at that period no facilities of this kind were
provided by the Paris Faculty of Medicine. When Renaudot observed this
new and unexpected development of the work carried on at the Bureau he
petitioned the King for permission to erect, at his own expense, in the
Faubourg St. Antoine, the most populous quarter of the City of Paris, a
“_Hostel des Consultations Charitables_”—in other words, a free hospital
for the poor.
[Illustration:
Statue of Théophraste Renaudot at Loudun, France. (Courtesy of
Monsieur le Pasteur Paul Barnaud, of Sainte Foy la Grande [Gironde],
France.)
]
Up to the year 1638 Renaudot had got along very amicably with the Paris
Faculty. He had often consulted with them and he had entered the names
of his two sons, Isaac and Eusebius, as students at the medical school.
Furthermore, there could not have existed any prejudice against him on
religious grounds as—upon the advice of Richelieu and Father Joseph
(Leclerc du Tremblay, or “His Gray Eminence”)—his two sons had been
educated in the Roman Catholic faith. It appears, however, that these
favorable considerations were not strong enough to prevent professional
jealousy, on the part of the Paris physicians, from setting to work to
undermine all Renaudot’s good work. The real truth—viz., that the
newcomer’s success was robbing them of some of their paying practice—was
not confessed by these men openly, but instead they objected to his
having, with the King’s permission (granted in 1640), established
furnaces for the manufacture of chemical remedies. They also claimed
that he was injuring the profession of medicine through his doctrine
that good effects were obtainable from the employment of both opium and
antimony as internal remedies, and also through his maintenance of the
new doctrine (1616) of the circulation of the blood. Were not these
professional sins, they claimed, sufficiently heinous to justify them in
summoning him before the magistrates as an impostor? They believed that
they were fully justified in so doing; and accordingly they proceeded
without further delay to bring suit against Renaudot.
It would require much additional space to furnish here even a condensed
account of the events which characterized this disgraceful attack by the
Paris Faculty—and especially by Guy Patin, who was at that time its
Dean—against Renaudot, and I have therefore no hesitation in omitting
all but one or two further details of this part of Renaudot’s history.
In the first place, Cardinal Richelieu and the King stood firmly by
Renaudot to the very end; and, on July 14, 1641, the King’s Council
condemned the Faculty on all points of their charge, and in this manner
granted complete authorization to Renaudot’s work. He himself,
notwithstanding the great victory which he had won over his unscrupulous
enemies, all of them physicians of high social position, resumed his
efforts to win them over to a friendly attitude—not toward himself
individually, but toward the benevolent schemes which he was doing his
best to establish on a firm footing. All his efforts, however, toward
pacification proved of no avail.
Not long afterward Renaudot’s two sons, both of whom had by this time
completed the regular course of studies at the Medical Schools, made a
respectful request to the Faculty for permission to appear before them
for the examination to which all candidates for the degree of Doctor of
Medicine were obliged to submit. In the meantime, as if to show his
approval of the request which Renaudot’s sons had made, Richelieu had
taken Eusebius with him as his physician-in-ordinary when he joined
Louis XIII. at the seat of war in the southern part of France. But
neither this kindly act on the part of the Cardinal, nor any of the
other efforts made by Renaudot’s friends in behalf of his two sons,
seemed to make any impression upon the Faculty. They refused point blank
to grant the desired opportunity for an examination. As a last resort,
Isaac appealed to Parliament “to issue a decree to the effect that the
Faculty of Medicine must confer the degree of M.D. on both Isaac and
Eusebius Renaudot _within fifteen days_; and declaring that, if the
decree should not be obeyed within the prescribed limits of time, the
decree itself should serve as full equivalent for the title in
question.” The Faculty duly entered the decree upon their registers, but
in secret they determined that the two Renaudot brothers should be
excluded from all their official meetings. Théophraste Renaudot
protested and the Faculty of the University of Montpellier pleaded
warmly in his behalf, but it was of no avail. After the death of
Richelieu the Paris Faculty had no difficulty in thwarting nearly all
the excellent schemes of Renaudot. He was obliged to abandon the plan of
building, at his own expense, a hospital, and his two sons were not
permitted to practice medicine in Paris. He continued, however, to edit
the Gazette up to the time of his death in 1653.
Gilles de la Tourette, in his interesting memoir, makes the following
reflection upon the career of this pioneer journalist:—“All the innocent
inventions of this benefactor of humanity are prospering to-day. In
addition to his plan for building a hospital, he was the first to
organize the whole scheme of Public Assistance—viz., charitable
consultations (not unlike our dispensary work) and gratuitous visits at
the residences of the poor. And, in addition to these, he introduced the
_Monts-de-Piété_ into Paris and also his Bureau of Addresses of exchange
and redemption. To this man whose guiding maxim was ‘Lend money to the
poor without expecting any return,’ posterity owes some reparation, and
I hope that soon it will be possible to erect in one of our public
squares a monument that will perpetuate the memory of the greatest
philanthropist of the seventeenth century.”[2]
------------------------------------------------------------------------
BOOK II
MEDICINE IN NORTHERN AND CENTRAL GERMANY DURING THE EIGHTEENTH CENTURY
------------------------------------------------------------------------
CHAPTER II
LOW STATE OF MEDICAL AFFAIRS IN GERMANY AT THE BEGINNING OF THE
EIGHTEENTH CENTURY
The intellectual activity of Germany was very low during the first half
of the eighteenth century, and this statement applies with equal truth
to all the departments of learning. It was only at the time of the
French Revolution and for a few months previous to this period that the
signs of an awakening began to show themselves. The prevailing unrest
and turmoil in the political world are commonly assumed to have
furnished ample cause for this widespread intellectual inactivity; and
yet, on the other hand, it is conceivable that it was these very
disturbances in the domain of politics which had the effect of
stimulating the marked increase in mental activity which soon followed.
This certainly seems to have been true of general literature, for it was
toward the end of the period named that what are admitted to be the
classical works of German authors—for instance, the writings of
Klopstock, Lessing, Herder, Gellert, Wieland, Goethe, Schiller and the
philosopher Kant—were first published. In medicine, says August Hirsch,
one of the leading German historical authorities, other influences,
beside those of a political nature, contributed powerfully toward the
advancement of the science of medicine. The medical students and the
younger practitioners, according to his statements, began at this period
to show evidences of a wish to become more learned in things relating to
their calling and to possess greater refinement in their manners and
habits. Trips were made by them more and more frequently to the leading
cities of France, Italy and England for the purpose of acquiring
additional knowledge of medical science. Thus, little by little, the
medical profession of Germany gained increased standing and respect from
the community. Beginning with Prussia the governments of the different
German states, one after the other, established examinations for the
purpose of determining the fitness of the applicants for the right to
practice medicine. Then, following the example of their rulers, members
of the aristocracy adopted the practice of taking a physician with them
on their travels, and the wish to be chosen for this privileged office
acted upon the younger physicians as a decided stimulus to acquire
greater skill and knowledge. Thus gradually the family physician, in
many instances, came to be considered an adviser of greater importance
than the clergyman. Then, beside, the knowledge that he had acquired
this increased power and that he was held in greater esteem by society,
reacted upon the physician’s character, rendering him more and more
ambitious to excel and to deserve confidence.
While, during the earlier part of the eighteenth century, medical
affairs in Northern and Central Germany were in the condition described
above, there was taking place at Vienna, the capital of Austria, the
most effective revival of medical science of which we possess any
record. Of this important event, however, I will say nothing further at
present. A reasonably full account will be found in one of the later
chapters.
Although I have spoken of the early and middle portions of the
eighteenth century as constituting a barren or stagnant period in the
history of medicine, I would not wish to convey to my readers the
impression that it was a colorless and uneventful period. Far from it.
There was nothing colorless, for example, in Hahnemann’s eventful
career, and yet to all appearances he was not contributing in any way to
the genuine and solid advance of the science of medicine. Then, again,
Hufeland is not commonly supposed to have contributed in any material
degree to the advance of medical science, and yet his “_Makrobiotik_,”
his “Art of Prolonging Life,” is a veritable mine of useful information
that the practitioner of medicine can scarcely afford to classify as
trivial. Hufeland also deserves the credit of having founded one of the
earliest medical journals, a periodical which still, in many of its
numbers that were issued during the later years of the eighteenth
century, furnishes reading matter that to-day possesses the power to
entertain even a twentieth-century reader. At a somewhat later date
(1779) J. Peter Frank founded the first journal or archives distinctly
devoted to hygiene and medico-legal science. Farther on I will supply a
few details concerning these two rather important contributions to
medical knowledge.
Finally, there are a few men who, during this same relatively barren
period of German medical science, made permanently valuable
contributions to our stock of knowledge. Among these stands out
conspicuously Johann Christian Reil (1759–1813). Although lack of space
prevents me from doing anything like full justice to these worthy
representatives of our profession, I will endeavor to furnish in the
next chapter at least sufficient information concerning their work and
characters to enable the reader to place them in their proper niches in
the history of medicine.
------------------------------------------------------------------------
CHAPTER III
PHYSICIANS WHO ATTAINED DISTINCTION IN SOME OF THE DEPARTMENTS OF
MEDICINE DURING THE FIRST HALF OF THE EIGHTEENTH CENTURY
In looking over the list of medical men who attained distinction during
the first half of the eighteenth century, one can scarcely fail to note
two important facts, viz., that they hailed from widely separated
localities in Western Europe,—for example, from England, Holland,
Northern Germany, France, Austria, Switzerland and Italy,—and also that
the advances which they effected in medical knowledge were not confined
to one or two departments of this science but included very nearly all
the fundamental branches. Hence it could not rightly be claimed by a
citizen of any one of these countries that his own nation was entitled
to be considered the leader in this advance. It would be a waste of
time, and would require more space than can be spared for such a
purpose, to furnish here even an incomplete list of the anatomists,
biologists, chemists, pharmacologists, diagnosticians, therapeutists and
surgeons who during the period named took a very active part in the
work. Probably Boerhaave of the University of Leyden, Holland, of whose
career I have given some account in the preceding volume, deserves to be
reckoned one of the first physicians who exerted a strong stimulating
influence upon the movement as a whole. From a superficial examination
of his writings the modern physician finds it difficult to understand
why Boerhaave attained so great a degree of popularity as he
indisputably did,—a popularity, too, which was of the best sort; for
during the period of his professorship both students and practicing
physicians flocked to Leyden from all parts of Europe, and they never
tired of speaking about the great benefit which they derived from
Boerhaave’s teaching. Many of them attributed this popularity more
especially to his practice—which at that time was a novelty—of laying
great stress upon bedside teaching and upon the importance of studying
disease from direct observation of its manifestations in the living
subject. Then, in addition, there is evidence that, as a teacher,
Boerhaave undoubtedly possessed the gift of exerting a personal charm
upon his auditors.[3]
Not a few of those who were privileged to receive instruction from this
celebrated physician became themselves distinguished afterward as
teachers or authors, and thus Boerhaave’s method of teaching was
perpetuated. Among the physicians to whom reference has just been made
were such men as Albrecht von Haller, of Berne, Switzerland, Van
Swieten, of Vienna, and Hoffmann, of Halle, Prussian Saxony, many of
whom are well known to-day in a general way to students of the history
of medicine, but who, nevertheless, in at least a few instances, are
worthy of having their careers described in further detail. In the
following pages I propose to supply biographical sketches of these men
and to show in what respects they exerted a beneficial influence upon
the great body of their confrères, and also to what extent they made
contributions to the science of medicine in its various branches.
It will undoubtedly surprise some of my readers, as it did me, to learn
that during the comparatively barren period of the eighteenth century,
to which brief reference has been made on a previous page, there were in
Northern and Central Germany several anatomists and biologists who did
creditable work as original investigators in these departments of
medicine. Of this small number, however, I shall mention here only
one—Reil. While he spent the greater part of his life in Germany, he was
in reality a native of Holland.
* * * * *
JOHANN CHRISTIAN REIL was born at Rhaude, East Friesland, in 1759. His
father, who was the pastor of the village church, gave his son an
excellent preliminary training, which enabled him, at the age of ten, to
enter the high school (_Gymnasium_) in the neighboring town of Norden.
On attaining his twentieth year, Johann entered the University of
Goettingen, but he remained there only a short time, as he had become
convinced that the Halle University offered greater facilities for those
who intended, as did Reil, to follow a medical career. Three years
later, armed with the degree of Doctor of Medicine, he began the
practice of his profession at Norden. In the course of five years he
managed to build up such a reputation as a successful practitioner that
the University of Halle invited him to occupy the position of Professor
Extraordinary of Clinical Medicine. Then, after the lapse of only a
short year from the time of his acceptance of this invitation, he was
promoted to the full professorship. Almost simultaneously he was
appointed (1789) to the position of City Physician of Halle. It was
probably while serving in the latter capacity that he began to reveal to
the Government that he was not only an excellent physician but also
possessed, at the same time, unusual executive ability.
Between the years 1789 and 1806, at which latter date the German army
met with a disastrous defeat at the hands of the French (battle of
Jena), the almost constant warfare brought all official university work
to a stop. But Reil was not idle during this long period, for it was at
this time that he devoted himself chiefly to laboratory research work
with reference to the anatomy and physiology of the brain and nerves.
The products of this work are recorded in the Archives of Physiology
which Reil published in 1796 in association with Autenrieth, and they
are pronounced by Sudhoff to be masterly. One of the cerebral structures
which Reil was the first to describe is that known to all anatomists as
“the island of Reil.”
Another important series of studies which were made by Reil were
published by him under the title: “On the Diagnosis and Treatment of
Fevers” (Halle and Berlin, 1799–1816; 3d edition, 1820–1828).
Finally, mention should be made of a memoir on “Vital Force” which Reil
published in the first volume of his Archives, in July, 1795; an essay
which—according to Sudhoff—should be read with very close attention, for
it, more than all his other published writings, has carried Reil’s name
(and will continue so to carry it in the future) triumphantly through
the history of the science of biology. The author states his final
conclusion as to the nature of vital force in the following words:
“Every part of an organism accomplishes its work through its own
inherent power, and the latter is a characteristic phenomenon that is
dependent upon the manner in which the material of which it is composed
is mixed and also upon the form that it takes.” Dezeimeris gives a
slightly different rendering of this passage, viz., “It is absurd to
search for the source of life (vital force) elsewhere than in the
tissues themselves, and in them the vital phenomena vary partly
according to the manner in which their elements are mixed and partly
according to the form in which they are arranged.” Farther on in this
volume, as I shall show, Claude Bernard, the distinguished French
biologist, furnishes a third definition of “vital force.”
When the terrible fighting that occurred at the battle of Leipzig in
1813 necessitated the rapid construction and organization of hospitals
large enough to accommodate the many thousands of sick and wounded[4]
that had accumulated after this battle, the King of Prussia promptly
assigned to Reil the entire management of this important business; and
the result proved that he had entrusted this work to the right man.
Reil’s death from typhus fever occurred at Halle on November 12, 1813.
Sudhoff thus sums up the most striking traits of this distinguished
physician’s character: “He was never satisfied with half-way measures,
and bold schemes and great undertakings occupied his thoughts at all
times. At the bedside he gave himself up unreservedly to the interests
of the patient.”
* * * * *
SAMUEL HAHNEMANN was born at Meissen, Saxony, in 1755. Although his
parents were poor he managed to obtain a good education, not only in the
fundamentals usually taught at the schools, but also in the knowledge of
the various languages, such as Latin, Hebrew, Arabic, Spanish, English,
French and Italian. In his medical training he advanced so rapidly that
already at the comparatively early age of thirty-five he was recognized
as one of the leading physicians of Germany. Even Hufeland, who at this
period (about 1790) was the highest medical authority in the nation,
accorded him full confidence both as a man and as a chemist; and yet at
the same time there is no evidence to show that he frankly adopted his
teachings with regard to the new doctrine of homoeopathy.
Hahnemann’s first experiments in relation to the action of drugs—says
Wheeler, the most recent translator of the “Organon”—were made upon
cinchona bark, which at that period was universally admitted to possess
remarkable power in relieving and curing “ague,” as the usual form of
malarial disease was then termed. “Hahnemann’s experiment”—he goes on to
say—“consisted in taking a large dose of cinchona bark while he was in
good health and noting its effects upon his healthy body. To his
surprise he found reproduced upon himself all the chief phenomena (and
even many of the minor symptoms) of a paroxysm of ague. When the attack
passed off, a second dose produced a second paroxysm, and Hahnemann was
presently face to face with the fact that this drug, which so often
cured ague, was capable of reproducing in his own healthy body the
phenomena of ague. Like, in fact, cured like.... As soon as the cinchona
experiment suggested to Hahnemann the possibility that the principle of
like to like (_similia similibus_) might prove a general law of healing,
he began a systematic study of the records of medicine in the search for
instances.... Over and over again he found that a drug prescribed
empirically had proved itself capable of curing conditions similar to
those which it could produce. The records of medicine, in fact, gave
plenty of encouragement to his now dawning belief that _similia
similibus_ is a genuine Law of Cure.”
It is at this point, as it seems to me, that Hahnemann displays the
first and most important defect in his reasoning machinery. He allowed
what seemed to him to be a most important and highly beneficent
therapeutic truth immediately to take possession of his whole
being,—indeed, to take such complete possession that, from this moment
forward, throughout the remainder of his life, he was utterly unable to
weigh with a calm and unprejudiced mind the various facts and
considerations which ultimately relegated homoeopathy to its proper
place in the medico-historical museum, alongside those hoary relics of
methodism, incantations, the weaving of charms, Stahlism, Brunonianism,
etc. In short, he lacked those immensely important mental
characteristics which enabled Harvey to discover the more important
facts relating to the circulation of the blood, and which made it
possible for Jenner to place in the hands of his fellow men an effective
weapon of defense against the deadly ravages of small-pox. If asked to
say what are these characteristics, I would reply: A state of mind so
open and so unprejudiced that it can weigh with absolute fairness all
the evidence laid before it, and an imagination so clever and so fertile
in resources that it is able to invent the means of reproducing at will
all those phenomena which it is desirable to study more closely. These,
I believe, are the characteristics which Hahnemann lacked and which are
absolutely necessary for the creation of a permanently useful creed and
principles of therapeutics.
In Hahnemann’s “Organon,” he provides quite a long series of aphorisms
in which the new doctrine is somewhat fully developed. I have
transcribed, below, a few of these in order that my readers may be able
to learn at first hand just what their author had in mind when he wrote
them.[5]
APHORISM 5.—It may be granted that every disease must depend
upon an alteration in the inner working of the human organism.
This disease can only be mentally conceived through its outward
signs and all that these signs reveal; in no way whatever can
the disease itself be recognized.
APHORISM 6.—... A thing or a condition demands a first proximate
cause only in order to come into existence; where the thing or
condition actually exists it requires no further originating, no
first and proximate cause, for its continued existence. Thus a
disease, once established, endures independently of its
proximate, exciting, primal cause: endures without further need
of its cause: endures even if its cause no longer exists. How,
then, can the removal of the cause be held to be the principal
condition of the cure of the disease?
APHORISM 8.—The unprejudiced observer ... is unable, however
acute he may be, to take note of anything, in any single case of
disease, except the changes in the condition of the body and
soul which are perceptible by the senses, the so-called disease
phenomena, symptoms in fact; in other words, he can note only
such fallings away from a former state of health as are
recognizable by the patient himself, the friends in attendance,
and the physician. All these perceptible signs make up together
the picture of the disease.
APHORISM 9.—... And thus this symptom-complex ... is the only
means whereby it is possible to discover a remedy for it (the
disease), the only means which can indicate the most appropriate
agent of cure.
APHORISM 13.—Now since, when cure is effected through the
removal of the whole range of the perceptible signs and
symptoms, the inward change which caused the symptoms is also
removed (that is, the totality of the disease), it follows that
the physician has only to clear away the entire symptom-complex
in order also to get rid of the inward alteration—in other
words, to remove the whole disease, the disease itself, a feat
which must always be the only aim of the rational healer; for
the essence of the art of medicine consists in compassing the
restoration of health, not in searching for the change in the
inward and hidden things; a quest which can tend to nothing but
fruitless speculation.
And then follows, in the form of an “Author’s Note,” the subjoined
commentary by Hahnemann:—
It is only through a misuse of the desire to reach the eternal,
sown in the spirit of man for nobler purposes, that these
impudent attempts have been made upon the realm of the
impossible, those speculative broodings over the essential
nature of the medicinal powers of drugs, over vitality, over the
invisible working of the organism in health and over the changes
of this hidden inner working which constitute disease—in other
words, over the inner nature and essence of illness.... When the
physician maintains that research into such things is necessary,
then he shows a misconception of the capacities of men and a
misunderstanding of the requisites for the work of healing.
... If only it had served the practice of medicine in the
slightest degree,—if all this subtile investigation had revealed
the true remedy for the least of diseases, it might yet pass for
desirable!
APHORISM 31.—The great homeopathic law of cure rests on this law
of man’s nature, revealed by experience, that diseases are only
destroyed and cured by similar diseases. The homeopathic law may
be thus formulated: that a disease can only be destroyed and
cured by a remedy which has the tendency to produce a similar
disease, for the effects of drugs are in themselves no other
than artificial diseases.
The preceding more or less disconnected portions of the text of
Hahnemann’s great work—“Organon of the Rational Art of Healing”—are
quoted here, not with the idea that they will convey to the reader a
very clear idea of the doctrine of homoeopathy and of the way in which
it is to be applied in the practice of medicine, but rather for the
purpose of showing the extraordinary manner in which Hahnemann utilized
his reasoning powers in his efforts to create a new pathology and a new
system of therapeutics that would harmonize with this new doctrine.
A further inquiry into the manner in which the disciples of Hahnemann
acted upon these principles of homoeopathy in the practice of their
profession establishes the fact that they believed in the remedial
efficiency of doses that contained as small a quantity as the billionth
or the decillionth of a grain of the drug. In a report which he makes to
the Medico-Chirurgical Society of Edinburgh, James J. Simpson, the
distinguished professor of midwifery in the University of that city,
comments (1851–1852) upon these infinitely small doses in the following
terms:—
If a grown-up man were gravely and seriously to assert to the
world that two and two make five, the world would be inclined to
look upon him as doubtfully rational, inasmuch as he defied the
principles of common sense. And when other grown-up men tell the
world that they can cure this or that disease with a billionth
or decillionth of a grain of this or that common and probably
inert drug, they express an opinion perhaps even more intensely
and directly absurd than the doctrine of two and two making
five; but they do not equally see through the absurdity and
impossibility of the more complicated, but equally ridiculous
idea, of the billionth or decillionth of a grain of
oyster-shell, or chamomile, or belladonna, or the like, having
any possible effect whatever upon the economy, for, resting
contented with the mere name, they never once think or dream of
what in reality a billionth or a decillionth amounts to.... For
it is a sum the mere figures of which can scarcely give us any
conception of its infinitesimal amount, viz., 1 followed by
sixty ciphers.... Surely men holding such fantastical doctrines,
are not men mentally fit to be members of such a Society as
this.
In further corroboration of Dr. Simpson’s remarks, I may be permitted to
furnish here a few brief extracts from Jahr’s “Manual of Homoeopathic
Medicine” (Vol. I., pp. 386 et seq.):—
Symptoms produced by common House-Salt.—Rigidity of all the
joints, which crack when they are moved,... Bad effects of a
disappointment.... Frightful dreams of quarrels, murders, fire,
thieves, etc.... Typhus fever with debility.... Awkwardness....
Numbness and insensibility of one side of the nose.... Speech
embarrassed in consequence of the heaviness of the tongue....
Loss of appetite, especially for bread, and repugnance to
tobacco smoke.... Numerous flaws in the nails.... Redness of the
great toe, etc. (The list contains at least thirty additional
symptoms.)
At the present day it is hard to believe that as recently as during the
first half of the nineteenth century there existed an editor who was
willing to publish such childish reading matter as the above. And yet
one is obliged at the same time to admit that the appearance of text
like this in a reputable book furnishes good evidences that there was no
lack of readers to whom the information imparted proved acceptable.
Between the years 1850 and 1860, homoeopathy assumed a good deal of
prominence in the city of New York. Many of the leading families during
this period turned their backs on the regular practitioners,—the
“Allopaths,” as they were then frequently called,—and confided
themselves and their maladies to the care of members of the new school.
This naturally led to much bitterness of feeling between the two groups
of physicians, just as had happened at an earlier date in the larger
towns of England and Scotland; and this condition of things lasted for
at least twenty years. Hostile action on the part of the county and
state medical societies proved of very little use in diminishing the
popularity of the new method of treating diseases; and so it was finally
decided to withdraw all further opposition to the new sect and to see
what an attitude of indifference and the stopping of all persecution
would accomplish. Thanks largely to this wise and sensible policy,
homoeopathy gradually lost its short-lived ascendancy, and the more
sensible members of the community returned to their former allegiance.
What I have said in regard to the rise and fall of homoeopathy in New
York is, I am confident, true in a general way of its fate in most of
the other large cities of the United States, but I am personally
familiar only with the conditions that prevailed in my native city.
I wish that I might speak with a larger measure of authority in regard
to the causes that led to the favorable reception of this new sect in
New York, but I am not able to do this, and I doubt whether anybody
among my contemporaries is able to do much better than merely to suggest
some of the more obvious causes which favored the popularity of the new
school of practice. Among such causes I may mention the fact that in
those days the practitioners of the regular school were in the habit of
prescribing drugs in large doses and with very little effort to render
them palatable. Take, for example, senna tea, of which bad-tasting
medicine the patient was expected to take a large teacupful shortly
after the early crowing of the cock; and if, a day or two later, a
repetition of the same dose was ordered by the attending physician, can
anybody wonder if the remedy was quickly pronounced by the patient much
worse than the disease? Experiences like the one just narrated were by
no means uncommon, and, as a consequence, many families did not hesitate
to transfer their patronage to a class of physicians who never
prescribed any remedy that had a bad smell or taste or that caused the
slightest bodily discomfort. Then, beside, it is a well-known fact that,
during the period now under consideration, the regular practitioners
had, in not a few instances, been guilty of prescribing therapeutic
measures which actually inflicted harm. Such, for example, were the
giving of mercurial preparations in too large doses, the too frequent
resort to bloodletting, etc. For all these reasons, it is not at all
strange that for a period of several years (1850–1875) homoeopathy
flourished in New York. In all fairness, therefore, it may be said that
the great improvement in the manner of administering drugs which took
place, both here and in European countries, during the period from 1860
to 1880, may be attributed indirectly to the influence of the new sect.
Hahnemann died in Paris in 1843, at the age of eighty-eight.
* * * * *
[Illustration:
HUFELAND
(From Eugen Hollaender’s “_Medizin und Plastik_,” by permission.)
]
CHRISTOPH WILHELM HUFELAND, who was born in 1762, at Langensalza, in the
district of Thuringia, Central Germany, founded, about the year 1795, a
medical journal that bore the title, “_Hufeland’s Journal der
Practischen Heilkunde_,”—the first German medical journal that was
devoted largely to matters of interest to the practitioner. It was
published regularly every month and was in almost every respect similar
to the best medical journals of the present day. It was kept in active
circulation up to the time of the founder’s death in 1836, and was
highly appreciated by physicians generally. Hufeland’s reputation,
however, rested less upon this journal, notwithstanding its great
popularity, than it did upon his famous treatise entitled “The Art of
Prolonging Life” (_Makrobiotik_). This book, which has been translated
into every modern language, and which during the past century and a half
has never had a rival in the field of which it treats, continues to-day
to furnish entertaining reading to hundreds of men and women, laymen as
well as physicians, who desire to learn the well-established facts
regarding human longevity. Farther on, I will furnish a few extracts
from both of these publications, thus enabling those of my readers who
have not yet had an opportunity to become acquainted with Hufeland’s
writings or with his work as a journalist, to learn something more
definite about the man.
So far as I am able to ascertain, Hufeland’s only other important
activities were those connected with the positions which he held in the
Universities of Jena (1793–1798) and Berlin (1798–1835). In the former
institution, he held the Chair of Medicine; in the latter he held the
same chair, but he was also acknowledged to be the guiding spirit in all
matters relating to the organization and management of that important
centre of medical education.
Among the items of special interest in Hufeland’s “_Makrobiotik_,” I
find the following:—
On the 2nd of August, 1790, a carabinier named Petit jumped into
the Rhine from one of the windows of the Military Hospital at
Strassburg. Half an hour later,—as nearly as could be learned
from an inquiry that was made at the time of the occurrence,—his
body was taken from the water and carried into the hospital. To
all appearances the man was dead; no evidences of life were
discovered. Nevertheless, efforts were made to revive him. The
body was placed in a thoroughly warmed bed, with the head lying
high up on a pillow, the arms resting on the trunk, and the legs
extended side by side. The only other measures adopted were the
following: At short but regular intervals of time heated cloths
were placed over the region of the stomach and over the legs;
and heated stones wrapped in cloths were placed in different
parts of the bed. At the end of seven or eight minutes a slight
twitching of the man’s upper eyelids was observed, and a short
time afterward his lower jaw, which up to that moment had been
in firm contact with the upper jaw, became separated from it and
permitted a little frothy mucus to escape between the lips.
After this discovery had been made, a little wine was cautiously
introduced into the man’s mouth. Apparently it was swallowed,
and then other small doses of wine were administered, all of
them apparently being swallowed. Under this stimulation the
pulse beats at the wrist became perceptible, and at the end of
one hour the man was able to answer questions.
In his comments upon this interesting case of restoration of life after
apparent death from drowning, Hufeland makes the following remarks:—
It is evident, therefore, that artificial heat acts with the
same vigor immediately after the appearance of what seems to be
death as it does at the very first dawn of life; it gradually
fans into a living flame the few vital sparks which may still be
present in the body.
In the preceding account of the means adopted for resuscitating the
soldier who was believed to be dead from the effects of drowning, no
mention is made of friction of the surface of the body as a procedure of
some value. Hufeland, very properly, lays great stress upon the need of
applying heat. Friction, however, if employed intelligently, may prove a
most efficient adjunct; and, when I use the expression “intelligently,”
I mean that friction may be utilized as a powerful agent for propelling
toward the heart the artificially heated blood contained in the
cutaneous blood-vessels, thus contributing in no small degree toward the
reëstablishment of the circulation. The kind of friction required—it
seems scarcely necessary to say—should always be directed from the
extremities toward the heart.
In another part of the same work Hufeland gives an account of several
instances of exceptional longevity. One of these relates to Terentia,
the wife of Cicero, who, despite the sore trials to which she was
subjected, and despite the occasional attacks of gout with which she was
afflicted, attained the great age of 103. A second instance is that of
Livia, the wife of the Emperor Augustus, a woman who possessed a
domineering and passionate character, but who, nevertheless, was blessed
with a full share of happiness. At the time of her death she was ninety
years old. Two other Roman women are mentioned by Hufeland as having
attained a great age. They were both of them distinguished actresses.
The first one, whose name was Luceia, began her theatrical career at a
very early age and was 112 years old on the occasion of her last
appearance on the stage; her entire theatrical career having covered a
period of one hundred years. Galeria Copiala is the name of the other
actress, who was at the same time famous as a _danseuse_. Ninety years
after her first appearance on the stage she took part in a complimentary
performance in honor of Pompey; and even at a still later date she acted
in a play which was intended to celebrate the distinguished reign of the
Emperor Augustus.
Hufeland mentions further instances of great longevity which he had
gleaned from Jewish history, and from these I select the following:
Abraham lived to be 175 years old, and his wife, Sarah, the only woman
of that remote period of time of whom we possess a precise knowledge,
died at the age of 127; Isaac attained the age of 180; Jacob lived to be
147; Ishmael, a son of Hagar (one of Abraham’s hand-maids) and a man of
warlike habits, attained the age of 137; and Joseph, the next to the
youngest of Jacob’s sons, a political leader and a man of great wisdom,
died at the age of 110. Moses, a man of conspicuous intellectual
capacity and possessing a strong will, lived to be 120 years old. But
even he complained that “the life of a man usually lasts only seventy
years, or, in exceptional instances, eighty years”—a statement, says
Hufeland, which justifies the belief that 3000 years ago the duration of
human life was about the same as it is to-day. Joshua, who led a very
active life and was a good deal of a warrior, died at the age of 110;
Eli, the High Priest, a man of a phlegmatic temperament, lived to be a
little over ninety years of age; and Elisha, who despised all the
conventionalities of life and cared nothing for wealth, lived far beyond
the limit of 100 years.
The Greek philosopher Pythagoras, who recommended care in the choice of
one’s food, moderation in eating, and the cultivation of gymnastic
exercises, attained a good old age. He claimed that after a man reached
his eightieth year, no matter how great an age he might afterward
attain, he should be reckoned among those who have ceased to live.
The measures which Hufeland enumerates as being specially conducive to
longevity are those with which my readers—it may safely be assumed—are
already familiar. The list comprises both those things which a man or a
woman should carefully avoid, and those which often prove helpful in
prolonging the period of one’s life, and which may be summed up in that
old device: “Moderation in all things.”
On turning over the pages of the volume of Hufeland’s Journal in which
are contained the issues of the first half of the year 1833, I came
across the report of a very unusual case that was observed by a Dr.
Heymann in the village of Oldendorf. His report reads as follows:—
A very poor working-woman, who in addition to her poverty was
obliged to live in a house that was overrun with mice, retired
to her bed one night in company with her child who was about
three years old. One of the last things she did, after going to
bed, was to hand to the latter a crust of bread, in the hope
that the little one might thus, by quieting its hunger, fall
asleep more readily. Having done this the mother herself soon
fell asleep. But shortly afterward she was awakened by the
terrified cries of the child, who insisted that there was a
mouse in its throat. Having quickly obtained a light the mother
discovered that not only was the child retching violently, but
that it was bringing up visible quantities of blood from the
stomach. In the contortions caused by the pain the child
indicated the pit of the stomach as the source of all its agony.
The severe pain persisted for about two hours and then suddenly
ceased, but the retching and bringing up of blood continued at
intervals for some time longer. On the following morning the
child was given plenty of sweetened milk to drink. At the end of
forty-eight hours the remains of the mouse were found in the
stool. The creature’s body presented a collapsed appearance and
the skin lacked its covering of fur in several places.
For quite a long time subsequently the child remained in an
ailing condition, with symptoms of disordered digestion. Its
death, however, which occurred at a somewhat later period, was
apparently dependent upon an entirely different disease,—one
that had no connection whatever with the incident just
described.
After reviewing all the evidence in this extraordinary case, Hufeland
sees no reason for doubting the correctness of the preceding report in
all its essential features. As to the manner in which a mouse may find
its way into the human stomach, the following statement is permissible.
To begin with, it is a matter of common knowledge that mice often run
about an occupied bedroom at night in search of food, and that their
sense of smell is extraordinarily acute. Furthermore, it is easy to
understand how a mouse, after tracing the odor of food to the partially
open mouth of a sleeping child, would not hesitate, if pressed by
hunger, to enter that cavity for the purpose of securing possession of
the particles of food lodged therein; and it is also easy to understand
how the intruder might then be caught as in a trap by the closing of the
mouth which spontaneously followed. Under such circumstances the
creature’s choice of the oesophageal route into the stomach as a way of
escape was most natural, and equally so were the efforts made by the
beast—as shown by the pain at the pit of the stomach and by the retching
of a bloody fluid—to gnaw its way through the gastric mucous membrane.
Although Hufeland yielded to the prevailing tendency among German
physicians of the eighteenth century to adopt doctrines, both in
pathology and in therapeutics, which are based upon hypotheses rather
than upon facts established by experimentation, or by direct observation
at the bedside or at the autopsy, and which as a consequence played a
very small part in the genuine advance of the science of medicine, he
nevertheless, as I have tried to show in the preceding pages, should be
classed as a most useful and honorable member of our profession.
Remember—he is reported to have said to his younger confrères—that there
are two maxims which you should keep in mind, viz.:—
1. _Natura sanat, medicus curat morbos_;
(Nature cures disease, the physician merely does what he can to
facilitate the operations of nature);
and
2. _Ne noceas, si prodesse credis._
(In your efforts to afford relief be careful not to do permanent
harm.)
------------------------------------------------------------------------
CHAPTER IV
DISTINGUISHED SWISS PHYSICIANS WHO PLAYED A PROMINENT PART IN THE
DEVELOPMENT OF THE SCIENCE AND ART OF MEDICINE IN GERMANY
Among the men who may properly be included in the present class of
distinguished German physicians I have no hesitation in naming von
Haller and Zimmermann, notwithstanding the fact that both of them were
natives of Switzerland—that is, German Switzerland.
* * * * *
[Illustration:
ALBRECHT VON HALLER
]
ALBRECHT VON HALLER, whose many contributions to the science of medicine
have assured him a permanent and very high position in the temple of
fame, was born October 16, 1708, of parents who belonged to two of the
old patrician families of Berne, Switzerland. In childhood he suffered
from rachitic symptoms and was constantly ailing; but, despite these
drawbacks, he manifested at a very early age evidences of possessing to
an unusual degree certain intellectual gifts and of having a genuine
love for work. Thus, for example, he began—shortly after he had learned
to write—recording in alphabetical order all the words that he had been
taught and the meaning of which had been explained to him. At the age of
ten he prepared for his own use a vocabulary composed of Chaldean,
Hebrew and Greek words, and two years later he compiled, from the
dictionaries of Moreri and Bayle, a collection of concise biographies of
the men who had achieved celebrity in the more important branches of
science, and he surprised his teachers by his ability to compose verses
in Latin as well as in his native language, German. Before he reached
his fifteenth year he had attained considerable distinction, both as an
anatomist and as a poet, a combination of gifts extraordinarily rare. He
received his early training in anatomy and general medicine at the
University of Tübingen, under the guidance of the two Duverneys, father
and son, and of Elias Camerarius, all three of whom were professors of
considerable celebrity in their respective departments. Jean Guichard
Duverney (1691–1759), for example, was the first anatomist to furnish a
complete and very thorough description of the solar plexus.
An incident which occurred during his student days at Tübingen reveals
so strikingly von Haller’s strength of purpose and his unwillingness to
permit anything to divert him from the path which he had decided to
follow, that I shall not hesitate to relate it briefly here. In company
with a few of his fellow students he participated in one of those
beer-drinking bouts which are of such frequent occurrence in German
university towns, and was in due course of time made acquainted with the
legitimate effects that follow such excessive indulgence—effects that
are felt as “seediness” and a sense of physical misery (symptoms to
which the Germans have given the striking but untranslatable name of
_Katzenjammer_). This single experience sufficed to impress upon von
Haller’s mind the folly of such indulgence and he never afterward
permitted himself to take part in an excess of this nature.
Although von Haller, upon the death of his father, had been left with
very slender financial means, he managed, under the guidance of Albinus,
on leaving Tübingen in 1725, to visit Leyden, in Holland, where he was
able to prosecute his anatomical researches and at the same time to
follow the instruction of Boerhaave, who was still at that period in
full possession of his powers as a teacher. Extraordinary as it will
appear to the physicians of to-day, von Haller, when only nineteen years
old, passed successfully the required examinations at Leyden and was
given the degree of Doctor of Medicine (1727).
From Holland von Haller went first to London, where he accepted the
invitation of James Douglas, the anatomist, to assist him in his studies
of the structure of the bones. Then from there he next visited Paris
(1728), where he had for his teachers Le Dran, the distinguished French
surgeon, and Winslow, the well-known anatomist. It was his original
intention to make a prolonged stay in the French metropolis, but,
unfortunately, his ambition to get ahead as fast as possible in the
study of anatomy led him to disregard certain precautions which, in the
early part of the eighteenth century, it was not at all safe for men
interested in this branch of medical science to neglect. Recognizing the
fact that, in order to advance his knowledge of anatomy, he must have a
certain amount of human dissecting material at his command, and finding
that he could procure this material in no other way than by the process
commonly known as “body-snatching,” he decided, in association with one
of the prosectors of the medical school, to adopt that method of
procuring the material needed. The plan was successfully carried out,
the disinterred body was transferred to von Haller’s apartment, and the
two enthusiastic anatomists had already done a certain amount of
dissecting when an unexpected obstacle was encountered. The layman who
occupied the adjoining room overheard enough of the conversation that
was being carried on between von Haller and his friend to suspect
strongly the true nature of the work in which they were engaged. But, to
make sure that his surmise was correct, he bored a peek-hole through the
partition wall, and thus was able to remove from his mind all doubt
about the nature of this work. The police were promptly notified, and
von Haller was summoned to appear before the authorities to answer the
charge of having disobeyed the law relating to dissections of the human
body. Not being able to furnish a satisfactory reply to this charge, and
wishing to escape from the severe penalties that would certainly have
been inflicted upon him had he been apprehended, von Haller went at once
into hiding in Paris and eventually succeeded in making his way over the
border into Switzerland.
[Illustration:
LAUSANNÆ,
Vignette from the title-page of Haller’s “_Elementa Physiologiæ_,”
Lausanne,
1757
]
In 1729 he began the practice of medicine in his native city, after
having taught anatomy for a short time in Basel; but he took only a
subordinate interest in the treatment of disease, his preference being
strongly for the scientific and literary parts of medicine. In 1734 or
soon afterward he published a collection of his own odes and letters in
German verses. These reveal very fully the nobility of his character,
his good sense and the high standard of his philosophy. Dezeimeris says
that von Haller offers the very first example of a man who has been able
to develop to an equal degree his talents of poet and of anatomist.
In 1735 he was appointed Chief Custodian of the Public Library at Berne,
and while he held this office he prepared a _catalogue raisonné_ of all
the books contained in that collection. At the same time he wrote a
classified, chronologically arranged list of the 5000 or more coins and
medals which are preserved in the library.
In 1736 the Hanover Regency offered him the professorship of anatomy,
botany and surgery in the University of Goettingen, and agreed at the
same time to furnish all the money needed for carrying out the extensive
plans which he had formed for improving the facilities for teaching
these branches of medical science. Von Haller unhesitatingly accepted
the invitation, and during the following seventeen years (1736–1753)
devoted his time and his best efforts to the fulfilment of the duties
which his triple chair involved. Not only did anatomy, botany and
surgery greatly thrive during this long period of time, but the
university through his intelligent efforts gained in many other
directions. It was upon his advice, for example, that the beautiful
anatomical theatre at Goettingen was built and equipped. The botanical
garden was another of the creations at Goettingen which owed its
existence to von Haller. If I were to furnish a list of the improvements
which, one after the other, were carried out in the university at his
suggestion I would certainly be obliged to mention among other things
the following: an establishment in which pupils might receive proper
training in anatomical and botanical drawing; the creation of a cabinet
of anatomical specimens and of a college of surgery; and finally the
founding of a school for midwives. In short, it was largely due to von
Haller’s enlightened conception of what such an institution of learning
requires and to his untiring efforts that the University of Goettingen
became, toward the end of the eighteenth century and during the first
half of the nineteenth, one of the leading universities of Europe.
Indeed he might justly be called its founder.
Von Haller’s health suffered under this long strain, and he was
therefore more than justified in asking the Regency of Hanover for
permission to resign and take up his residence in Switzerland. His
request was unhesitatingly granted; and, after resting for a few months
from his recent labors, von Haller resumed those quiet literary
undertakings which he loved so keenly and which enabled him to publish
such famous works as the following:—
“PRIMAE LINEAE PHYSIOLOGIAE” (First Lines of Physiology),
Goettingen, 1747 (also 1751)—the very first systematic treatise
on physiology of which we have any knowledge. A German edition
was not published until 1759–1776.
Commentaries on Boerhaave’s “INSTITUTIONES MEDICINAE,”
1739–1744.
“ELEMENTA PHYSIOLOGIAE CORPORIS HUMANI,” 8 vols., Lausanne,
1757–1766; the most important of all his works.
“BIBLIOTHECA ANATOMICA,” 2 vols., 1774–1777.
“BIBLIOTHECA CHIRURGICA,” 2 vols., 1774–1775.
“BIBLIOTHECA MEDICINAE PRACTICAE,” 4 vols., 1776–1788.
“EXPÉRIENCES SUR LES PARTIES SENSIBLES ET IRRITABLES,” 4 parts,
Lausanne, 1759.
These titles represent only a small part of the numerous books and
elaborate essays published by this tireless worker. In 1749 he was
ennobled by the Emperor, thus gaining the right, so highly esteemed in
Germany, of placing a “von” before his name.
In the middle of the eighteenth century there appears to have existed
considerable confusion in the minds of scientific men regarding the
distinction between the terms “sensibility” and “irritability,” and to
von Haller is due the credit of having once and for all defined the
correct meaning of these words. As early as in 1747, when he published
the first edition of his treatise on physiology, von Haller taught that
the contractile force of muscles is supplied by the nerves, and that in
this way they acquire _irritability_, a force which they cannot exercise
except through the influence of the nerves. Irritability, therefore, is
not a characteristic that originates in muscular tissue but is conferred
upon it by the nerves. Von Haller’s experiments reveal the fact that the
heart possesses the maximum degree of irritability. Next in order come
the intestines and the diaphragm, the ordinary red muscles possessing a
lesser degree of irritability.
In order that the reader may form at least some idea of von Haller’s
manner of treating physiological topics I give below a rough
translation[6] of the first three paragraphs which occur in Chapter XX
of his _Primae Lineae Physiologiae_ (edition of 1751):—
SLEEP
564.—The power which a person in perfect health possesses freely
to exercise the different senses and to perform voluntary
movements is called _wakefulness_ or the state of being awake;
the absence of the power to make voluntary movements and to
utilize the different senses, combined with the quietude of all
of them, bears the name of _sleep_.
565.—In sleep the mind either stops thinking entirely of the
things which have been stored up by the individual in his memory
or which are well-known facts, or else it busies itself
exclusively with certain ideas or with impressions that produce
upon the mind, at the time, pictures almost as vivid as the
actual things or occurrences which they represent would produce.
The term “insomnia” is employed when it is desired to designate
the latter condition of the mind, and the mental pictures thus
presented produce the effect that—although voluntary motions are
at the time all in abeyance, and although the mind is absolutely
quiet in all other respects—there remain certain directions in
which it continues to operate actively, thus producing an
elevation of the spirits (_i.e._, a certain degree of
excitement) and more or less wakefulness. Sometimes a certain
number of voluntary movements are associated with these mental
impressions, and this may occur in such a degree that the organs
of speech and many of the joints—indeed at times all of them—are
compelled to act in harmony with the mental impressions. When
this degree of insomnia is reached the person so affected is
called a “somnambulist.”
566.—But in sleep the distribution of the humors of the body
goes on without let or hindrance; and, similarly, the
circulation of the blood, the peristaltic action of the stomach,
intestines and sphincters, and the respiratory movements
continue their activity. This complex state of affairs—viz., the
coexistence of quietude of certain parts of the body with
continued motion in other parts—has made it difficult to
ascertain the mechanical cause of sleep.[7]
In his investigations into these subjects, von Haller placed his
reliance mainly on vivisections and on experiments made upon animals. “A
single experiment of this nature,” he said, “is often sufficient to
disprove the deceptive conclusions or views that have prevailed through
a period of years.” It is to John Hunter of England, however, says
Puschmann, that the greatest credit is due for the introduction of the
experimental method as a means of ascertaining the truth in questions of
pathology; and von Haller was unquestionably one of the first German
physicians to adopt the method.
Von Haller died at Berne on December 12, 1777.
* * * * *
JOHANN GEORG ZIMMERMANN was born in 1728 at Brugg in the Canton de
Berne, Switzerland. Left an orphan at the age of eighteen, and obliged
without aid from outside to choose the career which he would follow, he
decided to study medicine; and with this object in view he went to
Goettingen, Germany, where he was received into the family of Albrecht
von Haller, who was at that time a professor in the university. Five
years later (1751), when he took his doctor’s degree, he chose for the
subject of his thesis, at von Haller’s suggestion, the doctrine of
irritability. Upon his return to Berne in 1752, he began the practice of
medicine and shortly afterward accepted the position of official
physician for his native town of Brugg. It was during this period of his
life that he wrote those treatises which made his name famous throughout
Germany, viz., “On Solitude,” Zuerich, 1756; “On Experience in the
Practice of Medicine,” Zuerich, 1763 and 1767; “On National Pride,”
Zuerich, 1768 (5th edition); and “On the Epidemic of Dysentery which
prevailed during the year 1765,” Zuerich, 1767 (later edition in 1789).
In 1768, through the influence of Dr. Tissot, of Lausanne, he was given
the appointment of Physician to the King of England at the Court of
Hanover. During the last years of his life he took a great interest in
political events, recognizing with remarkable foresight the approach of
an immense revolution. So strong was his belief that current events
pointed to the approach of such a catastrophe, and so depressing were
the effects of this belief upon his naturally hypochondriac type of
mind, that the last years of his life were thereby rendered most
painful. He died on October 7, 1795, not long after the full effects of
the Reign of Terror had developed in France.
Tissot, who had known Zimmermann well for more than forty years, has
written a most interesting notice of his life and has placed a just
estimate upon the value of his writings. (Dezeimeris.) Sprengel, the
author of a well-known and highly esteemed history of medicine, speaks
in the following terms of Zimmermann’s treatise “On Experience in the
Practice of Medicine”:—
The manly and brilliant style in which it is written, its
fascinating eloquence, and the special talent which the author
displays in rendering marvelously clear—without at the same time
robbing them of any of their accuracy—the most obscure topics,
make this book of Zimmermann’s a veritable chef-d’oeuvre.... The
importance of genuine experience, its difference from false or
blind routine, the advantages which real erudition confers and
the necessity of combining it with experience, the nature of the
obstacles which an observing spirit must overcome, the absolute
need of good observations and the useful qualities which they
should possess, the effects of genius, and the manner in which
conclusions are to be drawn by analogy and by induction—these
are the questions with which the author of this classical
treatise deals.
------------------------------------------------------------------------
CHAPTER V
THE EARLIEST PUBLICATION IN EUROPE OF A SYSTEMATIC TREATISE ON HYGIENE,
PUBLIC HEALTH AND MEDICO-LEGAL SCIENCE
In the early part of the eighteenth century municipal and private-house
sanitation existed in comparatively few cities of Europe, and then only
in the wealthier quarters. Such a thing as sanitary police was
practically unknown, and public health was considered only when the
inhabitants were threatened with a serious epidemic like that of
cholera, the plague, or leprosy. This indifference to public sanitation
persisted down to the end of the nineteenth century. On arriving in
Paris in the spring of 1857, at a time when the city was overcrowded
with travelers, my friend and I were glad to secure a room on the fourth
story of a modest hotel situated in the central part of the city, quite
near the Palais Royal. We found no good reason to complain of the room
itself; it was clean and adequately well ventilated. But the toilet
facilities were such as one might expect to find in a hotel of the
fourteenth or fifteenth century. On the roof of our building a lean-to
had been constructed alongside a broad brick chimney, and this shack,
which was distant at least forty feet from the doorway that led by a
short stair-case to the fourth story of the hotel, could be reached only
over a narrow plank walk that was wholly unprotected by a railing. Then
again, on a bicycling trip which I made in 1896, through the central
part of France, my friend and I experienced more than one surprise of a
similar nature. For example, in several of the smaller towns we found
that the ancient practice of throwing the slops out of the second-story
windows into the middle of the narrow street, still persisted. But, in a
matter of this kind, nothing is to be gained by entering into many
details; “enough is as good as a feast.” I merely wish to emphasize the
fact that even France, where civilization was so far advanced in many
respects, was fearfully slow in adopting the first principles of house
and municipal sanitation. It was only toward the end of the nineteenth
century that London, the birthplace of the finest types of house and
municipal sanitation, began to give serious attention to this subject.
During the early part of the eighteenth century, however, even this
great metropolis was very backward in manifesting any marked desire to
improve the sanitary condition of its dwellings; for, was it not the
Earl of Chesterfield who, at this very period of time (about 1750) made
the statement, in a letter to his natural son, that “the lanes or narrow
passage-ways in Holland are cleaner than the houses are in London?”
It was in Germany, many of my readers will doubtless be surprised to
learn, that the first really serious attempt was made to present to the
world a scientific treatise on this subject, a work which was published
in several consecutive volumes and which even to-day is consulted as a
most trustworthy and remarkably complete authority on municipal and
private-house sanitation. The work referred to was written by J. P.
Frank.
* * * * *
JOHANN PETER FRANK, more commonly spoken of as Peter Frank, was born in
1745 at Rothalben, a village located in territory which at that time
belonged to the Grand Duchy of Baden. He received a good preliminary
training at the High School of Pont-à-Mousson, and then afterward took
courses at the Universities of Heidelberg and Strassburg. His medical
degree was bestowed upon him in 1766 by the first of these institutions,
the subject of his thesis being “Medical Police.” Two years later he
commenced the practice of his profession at the city of Baden-Baden, and
in 1769 was appointed Court Physician at Rastatt.
During these early years of his career he did not lose interest in the
subject which he had chosen for his thesis, but continued to work upon
it until, in 1768, he was ready to submit to a bookseller the manuscript
of Vol. I. The latter, after receiving from a so-called medical expert
an unfavorable report on the quality of the text, expressed his
unwillingness to publish the work. Frank’s discouragement over this
result was so great that he proceeded without delay to throw the
manuscript into the fire. Then, after further reflection, he decided to
begin work afresh on the same theme, and thus it came about that he
devoted the following eleven years to the preparation of a new text for
Vol. I. In 1779 this first volume was published. In 1780, 1783, 1788 and
1813 four more volumes were issued. Volume VI and two supplementary
volumes were issued between the years 1817 and 1819.
“Notwithstanding its defects,” says Puschmann, “this work is one of the
most important, one of the greatest and most creditable pieces of
medical literature of which the Germans may rightfully boast. Blumenbach
called it a classic, the first treatise of its kind and indeed
possessing a unique character.”
Of the other works published by Peter Frank, works which deal with
pathology and the practice of medicine, the most important is that
entitled “_De Curandis Hominum Morbis Epitome_” (“An abridged treatise
on the diseases to which man is liable”). As he progressed with the
writing of this treatise Frank undoubtedly discovered that he could not,
with any degree of satisfaction, accomplish his original design of
compressing what he had to say into an “epitome”; and so, from this time
forward, he carried on the work, without paying any further attention to
his original plan of an abridgment, until the book had reached its sixth
volume; and even then it was not completed.[8] Despite its
incompleteness this work passed through several editions, for it was
highly appreciated for its practical character and for the clearness of
its descriptions of disease.
In 1785 Frank accepted an invitation to take charge of the clinical
instruction at the University of Pavia, in the place of Tissot who
had resigned. Through Frank’s advice and persistent efforts the
medical department of the Pavia University was enriched by the
addition of a chair of physiology and comparative anatomy, an
anatomical theatre capable of seating 400 auditors, and a collection
of pathologico-anatomical preparations to which all the hospitals of
that part of Lombardy were obliged to contribute suitable specimens.
The establishment of a surgical clinic was another of the
improvements in the teaching facilities of the University that
should be credited to Peter Frank. The length of the medical course
was at his suggestion extended to five years. Among his associates
in the Faculty at this period were the following distinguished men:
Scarpa, in the chair of surgery, Scopoli, in that of pharmacology,
and Volta in physics.
In November, 1795, Frank returned to Vienna and was almost immediately
appointed Director of the Allgemeine Krankenhaus and Professor of the
Medical Clinic with a salary of 5,000 florins and the privilege of
occupying rent-free a house that was located in the immediate
neighborhood of the hospital. At the same time the title of Aulic
Councillor (_Hofrath_) was conferred upon him. One of the first
improvements which he effected in the clinic was to have the small wards
for male and female patients materially enlarged so that when
twenty-five or thirty patients were present, as was often the case, the
air might not become noticeably contaminated and thus rendered unfit for
all who were present to breathe.
In his teaching Frank never forgot, on all possible occasions, to
impress upon the students the importance of thinking independently on
the subjects that were brought before them, as in this way they would
learn to distinguish the false from the true. Whenever he discovered
that he had made a mistake in one of his statements he did not hesitate
to confess the fact. His son, Joseph, is responsible for the statement
that his father never seemed to him happier than when he had an
opportunity of making to his auditors some such speech as the following:
“Gentlemen! Strike out this or that line in one of the volumes of my
work! When I wrote it I believed that it was correct; but now I am
convinced that the very opposite is the truth!” When Brunonianism was
first transplanted from Great Britain to the Continent and was received
enthusiastically by many physicians, Frank was not disposed immediately
to accept its teachings, and yet at the same time he did not believe
that it was quite fair to ignore the thing altogether. Not a few men
inferred from this hesitating attitude on his part that he rather
favored Brown’s system. As a matter of fact he was an eclectic in his
views and was always ready to appropriate whatever seemed to him good in
any system or school of doctrines. As Director of the Allgemeine
Krankenhaus he adopted the plan of having the leading physicians and
surgeons of the Clinic first report publicly once a week what were the
important diseases that had come under observation during that period;
and then he would call upon the auditors to discuss the subject freely.
Peter Frank died at his home in Vienna on April 24, 1821.
------------------------------------------------------------------------
CHAPTER VI
TWO EMINENT GERMAN SURGEONS OF THE PRE-ANTISEPTIC PERIOD
JOHANN FRIEDRICH DIEFFENBACH, born in 1794 at Koenigsberg, an important
city of Northern Prussia, received his early medical education in
France; first under Boyer, Dupuytren, Larrey and Magendie, at Paris, and
then later at Montpellier, under Delpech. After his return to Germany in
1823 he devoted his efforts largely to surgery, and soon distinguished
himself so greatly in this department of medicine that in 1840, after
the death of Karl von Graefe, he was chosen his successor in the office
of Director of the University Surgical Clinic at Berlin. His death
occurred in 1847.
Dieffenbach was universally considered a very clever operator,
particularly in the field of plastic surgery. He was distinguished by a
high degree of manual skill, remarkable presence of mind under the most
trying circumstances, and boldness combined with prudence. His triumphs
in the reconstruction of damaged parts of the body, effected largely by
the transplantation of flaps of normal skin, were quite remarkable; he
seemed to know just what steps were required for restoring a mutilated
soft palate, ear, nose, eyelid, etc. But his interest was not confined
to plastic surgery; he also performed successful operations in tenotomy,
myotomy, transfusion of blood, and the injection of drug infusions into
the veins.
* * * * *
The Schleswig-Holstein campaign, says George Korn in his “Progress of
Medicine during the Nineteenth Century,” furnished a great stimulus to
the advance of German surgery, by providing an extensive field for the
activity of such men as von Langenbeck, Stromeyer and his son-in-law,
Esmarch. The scantiness of available space, as well as of satisfactory
sources of information, compels me to give here only the briefest
details concerning these three distinguished surgeons.
* * * * *
The founder of modern German surgery, says George Korn, was BERNHARD VON
LANGENBECK (1810–1887). When he began active work as a surgeon he was
already thoroughly familiar with human anatomy, physiology and
pathology, and with the experimental methods of research. His first
appearance as a teacher was at the University of Goettingen, where he
remained for a few years, and then moved to Berlin, to occupy the chair
of surgery vacated in 1847 by the death of Johann Friedrich Dieffenbach.
In 1882 he gave up his professorship in Berlin and retired to Wiesbaden,
where he spent the remainder of his life in quietude.
Before von Langenbeck’s day much stress was laid in Germany upon the
importance of anatomy in its relationship to the science of surgery. It
was a common practice in the medical schools, for example, to combine in
one the two chairs of anatomy and surgery, and, imbued with the idea
that this viewpoint was the correct one for them to adopt, the leaders
in surgery, with few exceptions, strove to make advances in their branch
of knowledge by cultivating energetically the study of anatomy. The
efforts of von Langenbeck and his followers, on the other hand, were
directed to giving new life to surgery by calling to its aid physiology,
pathological anatomy and pathological histology, as well as experiments
upon animals, sources of information which before von Langenbeck’s time
had been very little utilized by the surgeons. Korn, in his comments
upon the preceding statement, begs the reader not to interpret it as
signifying that von Langenbeck permitted himself to neglect anatomy in
the slightest degree. Quite the contrary, he continued to insist upon it
that a knowledge of anatomy was the most useful foundation upon which a
surgeon could build. As corroborative evidence of the correctness of
Korn’s statement I will quote here the remarks made by an English
physician who visited Goettingen in 1818 (London Quarterly Journal of
Foreign Medicine and Surgery, Vol. 1, 1818–1819):—
We were pleased in observing the great attention which Professor
von Langenbeck paid in these clinical exercises to relative
anatomy. He omitted no opportunity of impressing on the students
that the mere dissection of bodies could never make them good
anatomists, and that, as surgery without the knowledge of
anatomy would be a dangerous art, so anatomy without a constant
reference and application to the living body would be vain and
futile....
The foundation of the surgical hospital at Goettingen is
entirely due to Professor von Langenbeck. In 1807, at his
representations, a certain sum was appropriated to its support
from the Cloister-fund. In 1808 the professor built the present
hospital, which is still his own property, the Hanoverian
Government paying him a yearly rent for it. The beautiful
collection of surgical instruments also belongs to the
professor.... The whole as it now (1818) stands is undoubtedly
the first in Germany. It comprises all instruments that have
ever been used in surgery from the earliest days to the present
time.
Professor von Langenbeck, as a practical surgeon, is unrivalled
in Germany. We have seldom seen a man so enthusiastically
devoted to any pursuit, or who brought to the profession of
surgery more capability of excelling in it.... As an operator,
he is unrivalled in his own country, and we are not aware that
he is excelled in any. He is clear and decisive in his
judgments.
This account certainly places von Langenbeck on a very high pedestal,
and reveals the true reasons of his great popularity as a teacher. Upon
a close analysis these reasons may be stated thus: they were
whole-heartedness in his chosen work; readiness to sacrifice himself, if
necessary, in order to secure every possible advantage for his pupils;
and the possession of the rare gift of knowing how best to impart
knowledge to those who show a strong desire to acquire it. It is not to
be wondered at, therefore, that von Langenbeck was such a favorite with
such pupils as Hueter, Trendelenburg, Gurlt, Luecke, von Esmarch and
Billroth, all of whom in time acquired celebrity as surgeons.
One more point deserves to be mentioned here: von Langenbeck was an
accomplished master in the technique of operative work, and he took
pains to transmit his skill to his pupils. One of his great feats, as
narrated by those who often witnessed incidents of this nature, is
briefly described as follows:—von Langenbeck would appear from time to
time at the operating table dressed in a light summer suit of clothes,
and would immediately proceed to his work without putting on a gown or
taking other measures to protect himself from the soiling which so
frequently is associated with operative work; and yet, when the
operation was completed, the closest observation failed to discover a
single spot of blood or other pathological product upon his clothes. The
narrator of this tale evidently believed, and perhaps rightly, that the
incident showed how thoroughly familiar von Langenbeck was with the
distribution of the blood-vessels that supplied the region upon which he
was operating and also how skilful he was in the handling of his
scalpel. The incident, it should be remembered, occurred many years
before it was thought necessary to take certain precautions against the
spread of infection.
------------------------------------------------------------------------
CHAPTER VII
A GENERAL SURVEY OF GERMAN MEDICINE AT THE END OF THE EIGHTEENTH CENTURY
Among those who read the present chapter there may be some who will
express surprise at the gloomy character of the picture which I draw of
the state of medical affairs in Germany at the period of time now under
consideration. In answer to this implied criticism I would state that I
am in no degree responsible for the unpleasant impression conveyed by
the picture, as I have simply reproduced, without the slightest
exaggeration, the account which such excellent authorities as August
Hirsch, of Berlin, and George Korn, of Munich, give in their published
writings. Furthermore, I have not hesitated to quote, wherever I could
do so without obscuring the clarity of my account, the actual statements
of these authors. However gloomy, therefore, the picture here presented
may appear, this unattractive characteristic must be attributed to the
actual condition of medical affairs in Germany during the period named.
* * * * *
At the end of the eighteenth century and at the beginning of the
nineteenth culture entered upon an entirely new phase of development in
all parts of the civilized world; more quickly in certain parts than in
others because the seeds of such development had already begun there to
take root. In this work of development John Locke, the English
philosopher, was a conspicuous leader. His philosophy formed the
starting-point of the new development of the natural sciences, first in
France and afterward in Germany and other European countries. Voltaire
was the first among the French philosophers to advocate the teachings of
Locke in opposition to those of Descartes (_i.e._, realistic rather than
as the result of _a priori_ reasoning). Condillac, another great French
philosopher (1715–1780), also expressed himself as approving the views
set forth by Voltaire,—that is, in favor of Locke’s philosophy. Diderot
and others among the encyclopaedists sanctioned the same teachings. As
Hirsch expresses it:—
These ideas broke like a thunderstorm over the thinking classes
of France and spread rapidly to the other countries; the French
Revolution cleared the atmosphere in all the different walks of
life; it cast off the fetters of feudalism or at least
materially loosened their hold; it greatly increased tolerance
of religious beliefs and placed limits upon superstition.
At this period of time Germany was still living under deplorable
conditions. The after-effects of the Thirty Years’ War still lingered.
Those Germans who wished to lay some claim to culture were obliged to
think, speak and write in French. The great mass of the people, however,
were still bound hand and foot under the dominion of their spiritual and
state tyrants. The learned classes still cultivated a barbaric Latin in
their university lectures and in their writings. They considered it
beneath their dignity to cultivate their own tongue. In the schools and
universities the teaching had reached a decidedly low ebb. “The
humanistic spirit” had vanished; the teaching was directed to the
acquisition of the science of bread-winning. The Roman Catholic Church
at this time was entirely in the hands of the Jesuits; the Protestant
Church was no longer guided by the high ideals of its founder. A hollow
dogmatism had put a stop to all further search for the truth; the one
important thing was orthodoxy. There had developed a Protestant
hierarchy that exerted as stupefying an influence upon the great mass of
the people as did the Jesuits in the Roman Catholic Church. Superstition
and charlatanry permeated the medical profession. These superstitious
beliefs found lodgment in the minds of even such otherwise great
physicians as Friedrich Hoffmann, Georg Ernst Stahl and Anton de Haen,
one of Boerhaave’s distinguished pupils and a celebrated clinical
teacher.
After the lapse of a few years—that is, in 1842—there was founded a new
German periodical, the _Archiv für Physiologische Heilkunde_, under the
management of Wunderlich and Roser. According to the Prospectus it was
to be devoted to physiological medicine, or—to be more precise—to the
cultivation of physiological methods in the treatment of disease. The
introductory article in the first number of this new periodical bore the
title: “The Defects of German Medicine as Taught to-day and the
Importance of Giving it a Decidedly Scientific Tendency.” From the
convincing style in which the article is written there can be no
mistake, says Petersen, in ascribing its authorship to Karl August
Wunderlich (1815–1877), a member of the Tübingen Faculty of Medicine.
The following brief extracts from this article will suffice to give the
reader a fair idea of this writer’s views on the subject of which he
treats:—
We are establishing to-day an organ which is intended to promote
the interests of physiological medicine. Henceforth it should be
the aim of all enlightened minds to place pathology upon a
physiological basis.[9] Nothing of a dogmatic character may be
tolerated in these pages; every law here promulgated must be
accompanied by proofs showing that it is justified; all the
facts, observations and experiments that have led to its
acceptance as a law must form a part of the account. Although
for a long time past the necessity of following the course here
outlined has been appreciated and has been unostentatiously
adopted by all good observers, nevertheless, it is believed that
the time has now come when this important fundamental truth
should be announced loudly and in no uncertain terms, and should
be defended again and again with untiring energy, until it shall
have received universal acceptance.... People are already
beginning to make a distinction between the doctrines taught in
the books and those which are derived from a direct observation
of what takes place in nature.... But this scepticism is only
too often based upon mere assumptions and consequently fails to
produce any useful results.... We believe that the time has at
last arrived when this sort of scepticism should be organized
into something like a system, and that intelligent criticism
should persevere in testing the correctness of those
observations which have been cited as actual facts and as the
bases upon which the hitherto prevailing medical theories, so it
is claimed, deserve to receive acceptance.
We further believe that to-day is the time when an attempt
should be made to construct, out of the clinical materials that
are now in our possession and that have been brought together
with great care and without bias, _a positive science_, a
science which in the course of time cannot fail to lead to sound
therapeutic methods. This is what we mean by the expression
“PHYSIOLOGICAL MEDICINE.”
Up to this point in his article Wunderlich says nothing to which any of
my readers are likely to object. Quite the contrary; the first
impression which the text makes is something like this: At last
Wunderlich has discovered a road by following which closely one may
eventually develop a really scientific practical medicine. But, when one
reaches the end of the article, one can scarcely fail to experience no
small degree of disappointment on finding that it does not furnish the
slightest evidence of the manner in which the author’s seemingly
admirable scheme is to be realized; nor—as we are assured by Petersen—is
any further enlightenment upon this subject to be found in any of the
succeeding volumes, either in the seven which were published under the
joint editorship of Wunderlich and Roser, or in those which were issued
after Wilhelm Griesinger had been accepted as an associate in the
management of the _Archiv_. The old evil which carried Broussais as it
were by storm into the dictatorship of medical thinking and of medical
practice in France was here being reëstablished in Germany. Men seemed
to find it impossible to go on patiently collecting facts; they could
not resist the temptation to build theories first. So far at least as
the treatment of disease is concerned, we are forced to admit that the
collecting of any large body of facts is well-nigh an impossibility.
Only after the lapse of very many years would it be possible to realize
the desirable results which Wunderlich had in mind.
------------------------------------------------------------------------
BOOK III
THE VIENNA SCHOOL OF MEDICINE
------------------------------------------------------------------------
CHAPTER VIII
GERHARD VAN SWIETEN
(1700–1772)
A short time before his death the Hollander, Gerhard van Swieten, who
was one of the last physicians of European celebrity to give up the
habit of conversing in Latin with his professional brethren, made the
following remark, in a letter which he wrote to one of his friends in
the Medical Faculty of Halle: “Praxis medica quotidie me convincit quot
et quanta sint quae ignoro.” (In my medical practice I realize more and
more clearly every day how many and how important are the things
concerning which I am ignorant.) This epigrammatic remark, which throws
such a flood of light upon the character of van Swieten, may
appropriately be placed at the head of the following brief biographical
sketch of this distinguished founder of the Vienna School of Medicine.
* * * * *
[Illustration:
GERARD FREYHERR VAN SWIETEN
]
VAN SWIETEN’S EARLY PROFESSIONAL CAREER.—Gerhard van Swieten was born at
Leyden, Holland, on May 7, 1700. His parents, who died while he was
still a child, left to him an ample fortune, which enabled him to obtain
an excellent education. His guardians, however, were either negligent or
quite incompetent to look after his best interests during the period of
youth and early manhood; but, despite this fact, his own
industriousness, his native talents, his ambition to excel and his
purity of mind carried him safely and creditably through these early
years. At the age of sixteen he entered the High School of Louvain, near
Brussels, and during the following two years the study of Latin and
Greek and of philosophy chiefly engaged his attention. Then, upon his
return to Leyden, he began in earnest to prepare himself for the career
which he had chosen—viz., that of the practice of medicine. Boerhaave,
who, at that period of time, represented by universal consent the
leading medical authority of the world, was the regular professor of
medicine in the university (1710–1738), and was held in such high esteem
as a teacher that students flocked by hundreds from all parts of Europe
to benefit from his instruction. Among this number were two young
men,—Albrecht von Haller, of Berne, Switzerland, and the subject of the
present sketch,—both of whom afterward became celebrated for the
important parts which they played in the advancement of medical science.
Boerhaave appears to have taken a special liking for the latter and to
have entertained great confidence in his ability as a physician. In
1727, when Boerhaave, by reason of a gouty affection of his legs, began
to experience considerable difficulty in attending to his official
duties in the university, van Swieten, upon whom the degree of Doctor of
Medicine had been conferred only two years previously, was from time to
time authorized by his superior to lecture in his place. As the years
passed by, and as the pupil showed more and more clearly that he was
entirely competent to perform this important duty in behalf of his
teacher, van Swieten came eventually to be accepted as the worthy
interpreter of Boerhaave’s teachings. This practice continued for nearly
twenty years, and with ever increasing confidence in and affection for
the pupil on the part of his distinguished teacher. Boerhaave’s death in
1738, however, put an end to van Swieten’s substitute professorship. All
the available evidence goes to show that Boerhaave hoped that, in the
event of his death, van Swieten would be chosen his successor; but the
records of the university fail to show that the latter held at any time
an official position in the teaching body. During Boerhaave’s lifetime
no opposition of any kind was offered to van Swieten’s continued yet
officially unauthorized occupancy of the Chair of Medicine, although it
was well known that he was a Roman Catholic; but, after Boerhaave’s
death, the most active opposition to van Swieten’s candidacy was
immediately organized by his rivals. The claim was made by them that he
could not legally be chosen to fill the vacant chair, by reason of the
fact that the university had been founded on a Protestant basis and that
consequently it would not be either legal or proper to elect a Roman
Catholic to fill the vacancy. When the personal friends of van Swieten
and a large body of the students begged that, despite the legal
obstacle, he might be chosen the regular successor of Boerhaave, he
himself at once exerted all his authority to stop the movement.
Nevertheless, he felt keenly the loss of his position in the University
of Leyden, for he loved the work of teaching which he had carried on so
successfully during the previous two decades.
Van Swieten’s retirement from the duties of a teacher in the university
brought with it certain important compensations. In the first place he
was now able to devote himself fully to his private practice which had
by this time grown to be very large, and the way was also opened for him
to begin work at once upon his “Commentaries,”—a book of which he
completed the first volume in 1742, and which contained matter of
decided importance in promoting an advance in the science of medicine.
Some authorities claim that if one wishes to obtain a clear
understanding of Boerhaave’s teachings, he will have to read van
Swieten’s elaborate work, which in its completed state consists of five
large volumes.[10] Strange as it may appear, a Dutch translation of the
work has never been published; from which fact two conclusions are
warranted: first, that already as early as 1754 van Swieten must have
severed all connection with his native land; and, second, that the
number of physicians in Holland who might be tempted to purchase a Dutch
version of the work was undoubtedly very small.
In November of the year 1744 van Swieten was called to Brussels to see,
in consultation with her regular medical attendants, the Archduchess
Marianne, wife of Charles Alexander of Lorraine, and the sister of Maria
Theresa, Empress of Germany. She had recently been confined, after
having been in poor health for several months before this event. It was
therefore not surprising that at the delivery, on November 5, the child
was found to be dead. Shortly after the confinement the condition of the
Archduchess became rapidly worse, and it was then that Maria Theresa
sent her own physician, Dr. Engel, from Vienna to consult with van
Swieten and with her sister’s regular medical attendants. It appears
that these two leading physicians frequently disagreed as to what was
the best treatment to adopt; but van Swieten was so tactful in his
advocacy of the measures which he thought advisable and so courteous in
his intercourse with his professional associates that Prince Kaunitz,
the Imperial Austrian Chancellor, who happened to be in Brussels at this
time, wrote to the Empress in strongly commendatory terms of the
impression which van Swieten had made upon him. However, the hope which
the latter had held out with regard to the patient’s ultimate recovery
was not realized; she died on December 12. Notwithstanding his failure
to predict correctly the outcome of the Archduchess’ illness van Swieten
had succeeded so completely in impressing all the patient’s immediate
friends with his skill as a physician and with a genuine esteem for his
personal character that they had only praise to bestow upon the man in
their reports to the Empress. Maria Theresa’s mind was now entirely made
up as to the wisdom of calling van Swieten to Vienna and entrusting to
him the work of reorganizing the hospital management and the university
medical teaching in her capital, matters in which she took a very deep
interest. As soon as the decision reached by the Empress became
generally known in Vienna certain physicians of that city lost no time
in taking steps to thwart her plan. Scheming of this sort, however, had
to be done very cautiously, for it was not safe openly to oppose the
will of the sovereign. The first evidence of the existence of this
intrigue to prevent the appointment of van Swieten to a position of such
commanding importance in the medical world of Vienna appeared in a
Frankfort newspaper of January 9, 1745. After announcing the death of
the Archduchess Marianne at Brussels the article in question added the
following remarks: “The fatal issue, it appears, is to be attributed to
the unsuccessful treatment that was carried out by the local physicians
with whom van Swieten of Leyden was associated as the chief consultant;
it having been predicted from the very first by Dr. Engel, the imperial
Austrian physician, that this treatment, if adopted, would terminate
badly.” The Empress closed her ears to this and all similar calumnious
reports, and wrote to van Swieten that it was her warmest wish that,
when he came to Vienna, he might not experience any unpleasantness. “I
would rather,” she added, “abandon completely my personal interest in
this matter than have you made unhappy by the contemplated visit to
Vienna.” While these gracious words from the Empress were greatly
appreciated by van Swieten he was not willing to appear in Vienna in the
rôle of a censor or a reformer; and so one is not surprised to learn
that he did not take up his residence in the Austrian capital before
June 7, 1745.
* * * * *
VAN SWIETEN’S WORK AS A MEDICAL REFORMER.—So far as the teaching of
medicine was concerned van Swieten found everything in the University in
a state of confusion; indeed, nothing worthy the name of medical science
existed in Vienna at that period of time. He had left a city in which
the teaching of this branch of knowledge had reached a high degree of
development and had come to one where the very foundations of such work
had yet to be laid. He recognized at the first glance just what steps
would have to be taken, and he was much encouraged by the thought that
he could count upon the powerful support which Maria Theresa was only
too glad to give him. According to Mueller, he realized that the most
serious obstacle in his way was sure to be the very great influence
wielded by the Jesuits, who had for many years controlled all
educational matters in the Austrian Empire. He began his work by
delivering a course of lectures on methods of treatment and on
Boerhaave’s Principles of Medicine (“Institutions”), and he managed
within a comparatively short time to attract large numbers of auditors,
in whose minds was thus created a strong interest in the personality of
the lecturer. At the same time van Swieten remained conscious of the
fact that many of the members of the Faculty had not ceased to look upon
him with keenly jealous eyes. In his memorial to the Empress on the
progress which had thus far been made in the study of medicine he wrote:
“Although the Faculty have not included my ‘Commentaries’ in the list of
books which they recommend to the students, they emphasize by this very
act the fact that physicians everywhere—as shown by the publication of
five separate editions and two translations of my book in only six
years—do not agree with these gentlemen in regard to the value of this
work.” The continued favor shown to van Swieten by the Empress and the
consciousness that he was doing his full share toward advancing the
science of medicine compensated in large measure for the ungenerous
spirit which animated his colleagues.
* * * * *
REORGANIZATION OF THE VIENNA MEDICAL SCHOOL.—But van Swieten rendered
valuable services to the university in other ways than by lecturing, by
acting as the Director of the Royal Library, and by serving as the
private physician of the Empress, its great patron. For example, it was
his duty, after a certain time had elapsed, to select additional
professors for the Medical Department, and in this work he also
manifested excellent judgment; but he was not called upon to exercise
this particular function until after he had been settled in Vienna for
about four years. As the first step in building up the teaching force
van Swieten invited Anton de Haen (1703–1776), a native of Leyden and
one of Boerhaave’s former pupils, to carry on the clinical teaching
which he himself had already in some measure organized at the
university. Speaking of de Haen’s qualifications for this important
office, Hecker, the author of a history of modern medicine and a person
entirely competent to pass judgment upon a matter of this kind, makes
the following comments: “Vienna has seen few teachers as well fitted as
de Haen for inspiring enthusiasm and for making clinical teaching
effective, and few so capable as he was of showing his auditors with
persuasive force how they should study Nature by direct observation, and
not from books or lectures. Possessing no inclination whatever to
indulge in social pleasures or in amusements of any kind, he found his
chief enjoyment in tireless work. Knowledge was the priceless treasure
which, by the aid of an unfailing memory and remarkable skill, he sought
to win. Possessing, as he did, a quick temper, he became at times very
angry under even slight provocation. Although such outbursts of temper
did not conduce to his popularity they enabled him to boast that he had
attained his lofty position wholly through merit, and not—as was in some
measure true of van Swieten—through abstention from self-assertion.”
Despite all his faults, adds Hecker, de Haen was a great physician and
an extraordinarily clever teacher. He gained considerable reputation
from the treatise which he published under the title: “Ratio Medendi”
(The Philosophy of Treatment). He was a violent opponent of the practice
of inoculation.
The next six men selected by van Swieten were also distinguished
teachers, well fitted to uphold the growing celebrity of the Vienna
Medical School. They were: Anton von Stoerck, commonly spoken of as van
Swieten’s favorite pupil; Maximilian Stoll, one of de Haen’s pupils;
Lorenz Grasser;[11] Heinrich Crantz, another of van Swieten’s talented
pupils; Robert Laugier; and Nikolaus Joseph Jacquin. While the addition
of these unquestionably strong names to the list of professors in the
medical department of the university was recognized as a move in the
right direction, the retention of a few incompetent teachers led to
considerable worry on the part of van Swieten. Although he was convinced
that it would be better for the University to get rid of these men he
did not dare to act on his own responsibility, fearing the disturbance
that was likely to result from their dismissal. Maria Theresa, to whom
the situation was fully explained, begged him not to hesitate any
longer, but to take whatever steps seemed best for the good of the
university and the public. Thus encouraged, van Swieten proceeded to
remove first one and then another of the men who seriously interfered
with his plans for improving the teaching in the Medical School. In
1757, on the death of Archbishop Trautson, who held the position of
“Protector of the Studies in the University,” this office was abolished.
Already in the preceding year, at van Swieten’s suggestion, the Rector
of the Jesuits was no longer permitted by the Empress to take part in
the regular conferences of the Consistory of the University. Gradually
other members of the Jesuit Order were excluded from the management of
the affairs of the University. Finally, in 1759, van Swieten accepted
the office of Censor of Medical and Philosophical Writings, and up to
the day of his death he performed the duties of his office most
satisfactorily to all concerned. Thus was he made the virtual
Commander-in-Chief of the teaching forces in the Vienna Medical School.
While the changes described above were taking place the Empress, under
the inspiration given by van Swieten, inaugurated certain improvements
in the housing and equipment of the Medical School. In 1752 she gave the
necessary orders for constructing a new building that was to contain a
fine anatomical theatre, a chemical laboratory, lecture rooms for the
different professors, a general assembly hall, etc. This fine structure
was completed and formally inaugurated in April, 1756.
Finally, all the hospitals in Vienna were greatly improved during this
period of time, not only as regards their accommodations and equipment,
but also in respect to their management.
* * * * *
INAUGURATION OF CLINICAL TEACHING.—As the sequel showed, Vienna, under
the inspiring cooperation of the Empress, continued for a long series of
years the Mecca toward which physicians and medical students turned
their steps from all parts of Central and Northern Europe and even from
the United States of America and from Canada. It is now universally
recognized that this extraordinary popularity of the Vienna Medical
School, which began toward the middle of the eighteenth century and has
continued almost up to the present time, was chiefly due to the clinical
teaching which de Haen inaugurated at van Swieten’s suggestion. Sylvius
and, after him, Boerhaave had already given this method a trial at
Leyden, but for various reasons it had not proved entirely satisfactory.
De Haen’s plan was to let each student, at the bedside of the patient,
make his own diagnosis and then whisper it to the professor, who in turn
announced it to the remainder of the class. If the diagnosis proved to
be correct the professor found it unnecessary to say anything additional
on the subject; but, if it happened to be incorrect, he presented the
truth to the class in such a manner as not to give the slightest offence
to the student who had committed the error. This plan encouraged his
pupils to feel confidence that, whenever they made an erroneous
diagnosis, they would not be subjected to ridicule on the part of their
classmates. This exercise in diagnosis was duly followed by an
exposition of the treatment adopted; and, whenever it happened that a
patient whose case had been studied by the class, subsequently died, a
post-mortem examination was conducted in their presence, and appropriate
explanatory remarks were made by the instructor.
In further explanation of the extraordinary popularity which the
clinical teaching at Vienna attained it is interesting to learn that de
Haen (and probably also Stoll, who succeeded him) was in the habit of
rising at an early hour that he might visit the hospital and learn, in
advance of the arrival of the students, how the patients in the section
set apart for teaching purposes were getting on, how their condition
differed from that which they presented at the time of his visit on the
preceding day, and what special provision, if any, should be made for
the approaching clinical lesson. In short, no pains were spared to make
each _séance_ as attractive and as instructive as possible to the
students.
While I am here giving to de Haen and Stoll all the credit that is their
due for the very wise and skilful manner in which they carried out the
teaching of medicine at Vienna it must be remembered that van Swieten
was the real founder of clinical instruction in the famous university;
de Haen and Stoll having simply put in practice the ideas introduced by
him.
At this point in my sketch the question may with propriety be asked,
Where may one find in history another instance of such beneficent
interference on the part of a queen in behalf of a higher standard of
medical education? Certain it is that, without the powerful and
sympathetic assistance which Maria Theresa granted him at every stage of
his work, van Swieten could not have accomplished in so short a period
of time the extraordinary results which I have here briefly recorded.
* * * * *
VAN SWIETEN’S CONTRIBUTIONS TO THERAPEUTICS.—In his treatment of disease
van Swieten practiced conservative methods and prescribed remedies with
great caution and with strong common sense. In the case of small-pox,
for instance, he did not approve of the practice of inoculation as a
method of diminishing the mortality of that disease or possibly of
rendering the severity of its manifestations less pronounced. He
evidently believed the attendant risk to be too great. It was
particularly in his treatment of syphilis, however, that he accomplished
results of a most beneficial character. In St. Mark’s Hospital, in which
patients affected with this disease were lodged, it had been the
rule—previous to the date of van Swieten’s arrival in Vienna—to subject
all the cases, without regard to the severity of the infection, to a
course of mercurial salivation. As a natural result of this plan of
treatment it happened not infrequently that a patient’s life was
severely threatened or that he was left with lifelong sequelae of a
lamentable character. The physician under whose management this mode of
treatment flourished was dismissed from his position by van Swieten as
soon as he was able to overcome the obstacles which stood in his way as
he advanced toward the accomplishment of this end. Maximilian Locher,
who was put in charge of the hospital after the dismissal of his
predecessor, was instructed to use a solution of the bichloride of
mercury in the treatment of the cases that came under his care; and the
results that followed were so astonishingly good that the remedy soon
came to be known everywhere as “Swieten’s” liquor.[12] For many
subsequent years this solution retained its popularity among European
physicians.
As regards the other remedies which van Swieten was in the habit of
employing in his treatment of various maladies it is stated that he
clung persistently to those advocated by Boerhaave and enumerated at the
end of Vol. V of the Commentaries,—remedies which were characterized by
their simplicity and by the fewness of the ingredients that entered into
their composition.
* * * * *
VAN SWIETEN’S CONTRIBUTIONS TO MEDICAL LITERATURE.—In addition to his
famous “Commentaries” van Swieten wrote only one other treatise to which
it seems desirable to call the reader’s attention. I refer to the book
that bears the title “_Constitutiones Epidemicae_” and that was first
published by Stoll after the author’s death. According to the statement
of Mueller “this work is a sort of ‘Physician’s Day-Book,’ covering the
period 1727–1744, and reveals the fact that van Swieten was a very close
observer of the different diseases that came under his notice.... It
constitutes a valuable supplement to the history of Boerhaave’s
therapeutic methods.”
Finally, it should be stated, on the authority of Hecker, that van
Swieten wrote a small manual for the use of military surgeons. It was
published by Johann Thomas Trattnern, Court Printer and Bookseller,
Vienna, Prague and Trieste, 1758. Van Swieten’s name—says Hecker—does
not appear anywhere in the volume; and, furthermore, serious doubts have
been expressed as to the correctness of the claim that van Swieten is
the author of this little manual.
After van Swieten’s death in 1772, the bust of this distinguished
physician, which already three years earlier the sculptor F. X.
Messerschmied had been commissioned by the Empress to prepare, was set
up in the auditorium of the Medical School; and in addition an elaborate
monument in his honor was erected in the _Hofkirche_, the Royal Chapel.
------------------------------------------------------------------------
CHAPTER IX
ANTON STOERCK, VAN SWIETEN’S SUCCESSOR, AND THE PROGRESS OF MEDICAL
AFFAIRS AT VIENNA UNDER THE MANAGEMENT OF JOSEPH II.
After the death of Maria Theresa, in 1780, her son Joseph, who had
previously been associated with his mother in the government of the
empire, became the Emperor in the full sense of that term. Fortunately
for the best interests of the science and art of medicine he had long
been familiar, and fully in sympathy, with the plans and purposes of
Maria Theresa; and he was therefore quite ready to advance the good work
which she had begun. One of his first acts was to remove every possible
disability from those officers and instructors who were non-Catholics,
thus enabling them to gain all the facilities and honors which their
Catholic associates had up to that time enjoyed. In their ultimate
effect upon the growth and prosperity of the university these special
measures undoubtedly were advantageous, but they were carried out with
too great rapidity. According to Puschmann the Emperor strove to
accomplish in a comparatively short period of time what required not
less than a century. His efforts met with strong opposition in certain
quarters, and before his death in 1790 he had the disheartening
experience of witnessing the upsetting of many of his cherished plans.
After his death, however, he received full credit for what he had
attempted; the Viennese speaking of him as “the friend of the poor and
the miserable, the upholder of justice and the champion of spiritual
freedom and of education.”
* * * * *
ANTON STOERCK AND THE MANNER OF TEACHING MEDICINE IN THE UNIVERSITY OF
VIENNA.—Anton Stoerck, van Swieten’s successor, was the first to enjoy
in large measure the fruits of the latter’s reformation of medical
teaching in Vienna. His elder brother, Melchior, had already before this
date been appointed Professor of Theoretical Medicine in the University;
and then, in 1760, Anton himself was elevated to the important position
of Court Physician. He gained his chief distinction, however, through
his enthusiastic cultivation of experimental pharmacology. In this
field, which had previously received very little attention, he was
probably the first to appreciate the fact that the gap between
theoretical medicine and actual practice could be bridged only by a
resort to experimentation. Among the drugs which he tested in this
manner were the following: datura stramonium, hyoscyamus niger L.,
clematis erecta and pulsatilla nigricans L. Van Swieten, so long as his
state of health permitted, encouraged Anton to go on with his
experimental work; de Haen, on the other hand, was rather skeptical
about the success of his efforts.
Ultimately—after van Swieten’s death—Anton Stoerck became the leading
spirit in the affairs of the Vienna medical world. The instruction in
medicine was graded by him, with the Emperor’s consent, in the following
manner: The medical students, before they were permitted to begin the
course of instruction, were obliged to furnish satisfactory evidence of
possessing adequate general scientific knowledge and of having
previously attended lectures in natural history and experimental
physics. In the next place, they were further obliged to attend the
lectures on botany, chemistry, anatomy and physiology, and to pass a
satisfactory examination in these branches before they were permitted to
take up the study of pathology and materia medica. It was only after
having passed a satisfactory examination in these subjects that they
were allowed to receive clinical instruction. At the final examination
they were called upon to make a report on a few cases of actual disease
and to set forth especially the details of the treatment adopted; to
write a certain number of prescriptions; and, finally, to defend
publicly, in the presence of the Rector and the Chancellor of the
University, the Deans of the four Faculties, and one Professor of the
Medical School, a thesis on some medical doctrine. After which the
formal ceremonial of conferring the degree was carried out in the
presence of the same university officials. And here again, the Emperor
effected a most marked reformation; he abolished all those religious
ceremonies which it had been customary to observe in connection with the
bestowal of the degree of M.D. and the right to practice medicine. He
also adopted measures for enlarging the equipment of the University
libraries, and among other things he abolished a large number of
monasteries and turned over their collections of books to the libraries
of the university. Recognizing, as he did, the fact that the proper
training of medical men who intended to follow the career of surgeons
was at that time lamentably inadequate, he instituted, at the earliest
moment practicable, such changes in the teaching, in the duration of the
course, in the requirements for graduation, etc., that the surgeons
would thereafter be on the same level, with regard to education and
practical training, as the physicians.
At first (1780), the Faculty consisted of nine professors, who gave
instruction in the following branches: anatomy, physiology, natural
history, chemistry and botany, general pathology and therapeutics
(including pharmaceutics), internal medicine and clinical instruction,
theoretical surgery, clinical surgery, and obstetrics. In addition to
these there were several assistants and a prosector (demonstrator of
anatomy). The Emperor Joseph II., after expressing serious doubts with
regard to the “possibility of teaching the theory of surgery, bandaging
and the various surgical operations in six months,” gave orders that the
following scheme should be adopted:—
FIRST YEAR: Anatomy and physiology, together with chemistry and
botany (for physicians only) and operative work, bandaging and
obstetrics (for surgeons only).
SECOND YEAR: (For physicians) Materia medica, pathology and
clinical medicine.
(For surgeons) Clinical medicine, clinical surgery, and
obstetrics.
THIRD YEAR: Entirely given up to practical work at the hospital
and the Clinic.
At a later date the course was extended to four years; and from that
time forward, according to Puschmann, surgeons were looked upon with
consideration.
Hirsch, speaking of the majority of physicians of that period, says that
they sought to quiet the demands of the public for satisfactory
information about their maladies by employing, in their responses, the
meaningless terms of Graeco-Latin terminology; and he quotes Immanuel
Kant, the famous Prussian metaphysician, as having expressed the same
idea when he said: “These men thought they were rendering their patients
a great service when they gave them a name for their disease.”
As regards the therapeutic measures which these so-called physicians
employed, Hirsch adds: “they generally consisted of pills and plasters,
drugs of various kinds, clysters and repeated blood-lettings which at
times produced such a degree of exhaustion that only patients with a
strong constitution were able to rally from the effects of this loss of
blood.... The title ‘Doctor of Medicine’ afforded no guarantee that the
individual who bore it possessed the requisite degree of medical
knowledge.” Fortunately for the public there were at that time in almost
every community a few men to whom the description given above does not
in the slightest degree apply. I have already mentioned the names of
several physicians of this higher stamp, and the number of such
honorable representatives of our profession rapidly increases as we
approach the nineteenth century.
* * * * *
REORGANIZATION OF THE HOSPITAL WORK IN VIENNA TOWARD THE END OF THE
EIGHTEENTH CENTURY.—In the preceding sections mention has been made of
the important changes effected by the Emperor Joseph II. in the scheme
of teaching adopted by the Medical Department of the University. It now
remains for me to give some account of his reorganization of the Vienna
hospitals and of his founding that famous general hospital known as _Das
Allgemeine Krankenhaus_. That there was need of reorganization in at
least some of the hospitals is shown by the following anecdote which is
related of Professor Boer, who held the Chair of Obstetrics. When the
authorities who had special charge of the Lying-in Ward complained to
him that he prescribed too liberal a diet for this class of patients, he
replied somewhat impatiently that he could not feed, “with water, Epsom
salts and ‘Arcanum Duplicatum’ [a secret remedy that was popularly
believed to be efficacious], the women who were already a good deal
weakened by their pregnant state as well as by sorrow, anxiety and
insufficient nourishment; for a liberally supplied kitchen and a good
wine cellar were more important than drugs.”
To furnish a complete and satisfactory description of _Das Allgemeine
Krankenhaus_ would require more space than can properly be devoted here
to the consideration of this single topic. Those who take a special
interest in the subject will find full details in Puschmann’s monograph
(See Bibliography); for the majority of readers the following brief
account will probably suffice.
The _Allgemeine Krankenhaus_ consists of a very large group of
three-story buildings in which there are numerous individual spaces
large enough to serve as wards, as small lecture rooms, or as reception
rooms for ambulant patients (eye, ear, throat, skin and minor surgical
cases). The ceilings are usually high and the openings for windows are
of such dimensions as to furnish excellent ventilation and liberal
daylight illumination. Ample facilities are provided for bathing, for
cooking the needed food, and for preparing and dispensing remedies; and
the individual buildings are grouped in such a manner as to afford
numerous small park-like spaces in which the patients may obtain outdoor
exercise or may enjoy the fresh air and some social intercourse with
their fellows. Although in 1784 the buildings were almost ready for
occupancy and the park-like surroundings completed, it was only at a
much later date that the institution was really prepared for the
reception of patients. Somewhere about the year 1830 it had been so
thoroughly organized that physicians and students came from different
parts of the world, and especially from Great Britain and from America,
to enjoy fully those extraordinary facilities for the study of every
possible form of disease which were to be obtained only in the city of
Vienna. Whereas in London, New York, Philadelphia and Boston, it was
necessary at that time for all but a few of the students to waste many
precious hours and much physical strength in traveling from one hospital
to another in order to acquire by direct observation some familiarity
with disease, here in Vienna was provided, in a single group of
buildings, ample provision for all the clinical teaching that the most
eager and serious student of medicine could possibly desire.
* * * * *
NEW METHODS OF DIAGNOSIS, AND FIRST APPEARANCE OF INSTRUCTORS IN SPECIAL
DEPARTMENTS OF MEDICINE AT VIENNA.—It was during van Swieten’s lifetime
that Auenbrugger’s new invention “for detecting, by means of percussion,
the obscure diseases of the chest,” was published for the first time
(1761) in Vienna. The value of this discovery, which was termed by him
“Novum Inventum,” was not appreciated by physicians at that time. Even
van Swieten and de Haen rather looked down on the method; and its
importance was not fully recognized until Corvisart, the celebrated
Paris physician, published a French translation of Auenbrugger’s book in
1808. This work, in which Corvisart gave his own experience and added
many notes and comments, served to popularize Auenbrugger’s method as a
valuable aid to diagnosis in affections of the chest. In his preface
Corvisart announced that he was well aware of the small glory that came
to translators and to those who simply comment on the work of others,
but notwithstanding this fact he preferred that the major part of the
glory should go to Auenbrugger who had rendered such a great service to
the Profession by his invention.
Auenbrugger, who died in 1809 at the age of 87, lived long enough to
enjoy the pleasure of this triumph. His private practice grew to be very
large, and he performed, more often than any other physician of his
time, the operation of thoracentesis. He was universally loved and
respected in Vienna.
One of the first specialties to take root in Vienna toward the end of
the eighteenth century was that of ophthalmology, and the physician who
first succeeded in bringing it to a high stage of development was GEORGE
JOSEPH BEER, who was born at Vienna in 1763. During his student days and
for a short time subsequently he acted as a draughtsman for Joseph
Barth, the professor of anatomy and physiology in the Vienna University,
and in this way he obtained unusual opportunities for acquiring a
knowledge of both the normal and the pathological anatomy of the eye.
Already in 1793 he applied for, and was granted, permission to treat, in
the _Allgemeine Krankenhaus_, such poor people as were suffering from
cataract, and to perform the requisite operations. Each year, during the
months of May and June, a suitable room was gotten ready for Beer in the
hospital, and here, during this most favorable season of the year, he
performed many cataract operations.
In 1812 he received the double appointment of Director of the Eye Clinic
and Professor Extraordinary of Ophthalmology; and from this time forward
he rapidly gathered about him a great crowd of pupils, among whom were
men who—like C. F. von Graefe, Philip von Walther, T. W. G. Benedict, F.
Jaeger, Rosas, Quadri, J. N. Fischer, Mackenzie, Reisinger, Chelius and
others—were soon to be known in every part of Austria, Germany, Italy
and England as the leading eye surgeons of their respective countries.
Beer therefore exerted a most decided influence on the development of
ophthalmology.
Beer’s early writings, the first of which date from the year 1791, also
exerted a great influence. Such, for example, were his “Practical
Observations on the Gray Form of Cataract” and on the “Different Eye
Diseases which Owe their Origin to Some General Disease”; and also his
“Treatise on Diseases of the Eyes.” The last-named passed through
several enlarged and improved editions between 1813 and 1817. In 1799 he
issued a Summary of all the treatises on ophthalmological topics which
had been published up to the end of 1797; and soon afterward he
published an account of his method of extracting a gray cataract
together with its capsule. Still other memoirs of decided value were
published by him in the following years; and among them one especially
deserves to be mentioned, viz., that on the affliction known as
“Pannus,” of which condition he was the first to give a correct
explanation.
In 1819 Beer was stricken with an illness of a serious nature, and two
years later he died. He was succeeded by Anton Rosas, whose death
occurred in 1855.
------------------------------------------------------------------------
CHAPTER X
PROCHASKA, HYRTL AND ROKITANSKY, THREE OF THE MOST DISTINGUISHED
TEACHERS AT THE MEDICAL SCHOOL OF VIENNA DURING THE EARLY PART OF
THE NINETEENTH CENTURY
GEORGE PROCHASKA, born at Lipsitz, Moravia, in 1749, was appointed
Professor of Anatomy and Ophthalmology at the Prague Medical School in
1778. Eight years later he was transferred to the Chair of Physiology.
In 1791 he received the appointment of Professor of Higher Anatomy and
Physiology in the University of Vienna. In 1819 he resigned this chair,
probably owing to poor health; and his death occurred during the
following year.
Between 1780 and 1797 he published, in Latin, important monographs on
the physiology of man. Later, these were thoroughly revised and then
published in German under the title of “Physiology, or the Doctrine of
the Nature of Man.”
Prochaska was esteemed very highly as an eye surgeon of exceptional
skill and wide experience, no fewer than 3000 cataract operations having
been performed by him. His greatest achievements, however, belong in the
domain of physiology. Already as early as in 1797 he hinted at the
possibility that, in the case of the spinal nerves, one of the portions
might transmit centripetal and the other centrifugal impulses. It was
reserved, however, for the great English physiologist, Sir Charles Bell,
to establish firmly, several years later, the law governing these two
currents.
Prochaska’s ideas with regard to the nature of “vital force”—that
question which in those days gave biologists so much trouble—may be
inferred from the following quotations:—
In the performances of the nervous system there occur
manifestations which bear a striking resemblance to the
phenomena produced by electricity.... In my opinion it is not
permissible to conceive of vital force as an independent power,
one that depends upon a single and special principle, but rather
as an aggregation of all the forces of Nature, representing in
one set of instances the cause and in another set the effect of
these forces, and combining in this body of ours, by their
foreordained harmony, to create what we call life. Therefore,
among the powers that are commonly meant when we use the
expression “vital power,” there are no specific forces, but only
the general forces which exist in Nature; but at the same time
they are combined under a special relationship,—in fact, they
are entangled the one with the other in such an inextricable
snarl that it is simply impossible for us to gain a clear
conception of their causes and effects.
Finally, it is quite remarkable, says Puschmann, how closely Prochaska’s
ideas regarding the formation of bone agree with the teachings of our
modern authorities. Here is the paragraph in which he formulates these
ideas in full detail:—
The business of nutrition is carried on in such a manner that,
when new conditions arise, whole organs which for some time
previously were performing useful work, are swept out of
existence, and new ones, better adapted to the work required of
them, are put in their places. As an instance in point we may
mention certain cartilages which, for a limited period of time
during childhood, take the place of bone structures, and which
at the same time play the part of really necessary aids to the
growth of the bone. These cartilages gradually become converted
into the latter tissue, the process reaching the stage of
completion at different times, but yet at a fixed and definite
time for each particular bone. Thus, in the case of the long
bones, the cartilage becomes completely ossified somewhere
between the twenty-second and the twenty-fourth year. This
process of ossification does not consist in a simple hardening
or change of the cartilage into bone; the essential features of
the process may more correctly be described as follows: the
cartilage, in the depths of whose substance bone-tissue centres
are being nourished and are progressively undergoing
development, is steadily being crowded to one side and
ultimately destroyed. At the same time there appear here and
there in the cartilage a few blood-vessels which, so far as one
is able to judge, spring, in the majority of instances, from the
neighboring fully-formed bone substance. And, as a further stage
in the process of growth, there appear alongside the new
blood-vessels centres of ossification, which in due time become
foci of genuine bone tissue. Then, as these foci increase in
size, the surrounding cartilage steadily dwindles in quantity
until nothing remains but a few scattered cavities or hollows,
which persist for only a short time before they disappear
altogether.
Prochaska’s discoveries in regard to the growth of bone excited the
admiration of his contemporaries, and well they might, for they involved
prolonged investigations with the aid of the microscope and much close
and careful thinking. It is safe to say that at this early date (end of
the eighteenth century) original investigations like the one just
described must have been very few indeed in Austria.
* * * * *
CARL ROKITANSKY, who was born at Koeniggratz, Bohemia, in 1804, received
his medical training at the universities of Prague and Vienna. For
several years after he had been given the degree of Doctor of Medicine
he served as an Assistant in the Pathologico-Anatomical Institute, and
in 1832, after the death of Johann Wagner, the Custodian of the Museum
that formed a part of the Institute, he was appointed his successor, not
only in this particular office but also in those which were closely
related to it—viz., the office of Prosector of the Allgemeine
Krankenhaus and that of Judicial Anatomist for the City of Vienna. The
duties which he had to perform in connection with these offices and as
an Instructor in the Medical Faculty of the University left him very
little time for anything else. His pet ambition was, not merely to do
well the work which these different official positions entailed upon
him, but also to build up, so far as in his power lay, a systematized
knowledge of the relationship that subsists between the different
pathological conditions revealed at the post-mortem examination and the
clinical phenomena manifested during the patient’s lifetime. Therefore
he was accustomed to insist that a reasonably full history of the case
should be submitted with every corpse on which he was asked to make a
post-mortem examination. This afterward became a firmly fixed practice
at the hospital. After he had read these case-histories and had compared
them with the facts revealed by the corresponding autopsies he prepared,
at proper intervals, a report on the diseases which were then prevalent
at the hospital. This method of procedure, it will easily be seen,
constituted an important advance beyond the practice of simply studying
and then recording the various pathological lesions which develop in the
different organs of the body. It established a connecting link between
these lesions and the lifetime manifestations of disease; in other
words, it revealed a way in which the medical practitioner at the
bedside might, by a proper use of his reasoning powers, infer from the
symptoms and physical signs what changes were taking place in the unseen
organs of the body. From this time forward, therefore, physicians began
to place before their mental vision—in every case which they were called
upon to treat—a picture of the anatomical changes that were taking place
in the patient’s body, instead of symptom groups. In the words of that
distinguished Tübingen physician, Wunderlich, “Rokitansky was
endeavoring with untiring zeal to convert pathological anatomy into an
anatomical pathology.” The reader will, I am confident, agree with me
when I say that there are very few instances in the history of medicine
where an advance toward a better knowledge of the art of diagnosis is
more clearly revealed than in the work which Rokitansky carried on so
patiently, so conscientiously and so successfully during the early years
of the nineteenth century. Compare the record of the work accomplished
by Morgagni with the remarkable results reached by the Vienna
pathologist, and it will be quickly appreciated how little fitted the
former searcher after truth was to carry out successfully the advance
which Rokitansky effected and which I have tried to describe in these
pages.
Rokitansky’s earliest contributions to medical literature consisted in
quite a large number of memoirs which were published at different times
in the “_Medicinische Jahrbücher des Oestreichischen Staates_.” They
deal with topics like the following: “Incarcerations and
Intussusceptions of the Intestines”; “New Formations of Bone on the
Internal Surface of the Skull in Pregnant Women”; “Spontaneous Rupture
of the Aorta”; “So-called Duplication of the Uterus”; “Strictures of the
Intestinal Canal and Other Abnormal Conditions that give rise to
Constipation and to Ileus”; “Perforating Gastric Ulcer”; “Contributions
to our Knowledge of the Different Forms of the Curvature of the Spine”;
etc. Subsequently he published in three volumes his great work on
Pathological Anatomy; Vol. 3 appearing in 1842 and Vol. 2 in 1844. These
last two volumes were devoted to special pathological anatomy. The first
volume of the series, which deals with general pathological anatomy, was
not published until the year 1846. In these volumes, which are rich in
newly discovered facts, the author keeps constantly in mind the needs of
the general practitioner; and how great was the importance which he
attached to this feature of his work may be inferred from the frequent
reference which he makes to it in other parts of his writings. Thus, for
example, in the Preface to Vol. 1 he says: “In regard to the manner in
which I have planned and constructed the present treatise I will briefly
remark: ‘I have tried from the very beginning, and all through the work,
to look at the subject from the viewpoint of the practicing physician,
and I believe that, in adopting this course, I have accomplished a thing
which was most urgently needed in our time; and I also believe that I
have utilized the gigantic mass of material that was at my disposal in a
worthy manner.’” Then, again, farther on in the Introduction, he says:
“The first attempt to treat the subject of pathological anatomy in the
manner which I have just described,”—an attempt, by the way, that was
crowned with brilliant success,—“was made by Laënnec in his discussion
of the subject of diseases of the chest.”
In strong corroboration of Rokitansky’s belief in the importance of
pathological anatomy stands the statement attributed to the celebrated
anatomist Vesalius, to wit: “I am very sorry not to have devoted to
pathological anatomy the large amount of time and strength which I spent
on physiological anatomy.”
Rudolf Virchow calls Rokitansky the “Linnaeus of pathological anatomy.”
It was my original intention to furnish at this point a few brief
extracts from the original text of Rokitansky’s great treatise, in order
that the reader might learn, from this pathologist’s own words, just how
he managed to teach pathological anatomy in the manner best adapted to
subserve the interests of the practitioner. After looking in vain,
however, for a section of the desired degree of shortness, I came to the
conclusion that it would be better to abandon the attempt altogether and
rest satisfied with a simple enumeration of the captions of some of the
more important subsections that treat of alterations in bone. Here are
those which I selected: “Bone Deficiency and Bone Excess”; “Anomalies in
Size and Shape”; “Bone Atrophy”; “Anomalies of Bone in its Connection
with other Bones”; “Anomalies in Consistence”; “Break in Continuity and
the Manner in which Healing Takes Place”; “Callus Formation and New
Joints”; “Healing of Bone by First Intention”; “Healing of Bone through
the Medium of Suppuration”; “Healing of Wounds in Bone with Loss of
Substance”; “Inflammation of Bone”; and “Bone Caries.”
Not being specially interested in pathological anatomy I have read only
small portions of the text of this celebrated treatise; but, judging
from this superficial examination and from the unanimous testimony given
by men who are expert judges in this department of medical science, I
feel confident that satisfactory answers will be found in this great
work to nearly every question that may arise in a physician’s mind
concerning the pathology of some part of the human body. It is a book,
however, that is intended for reference purposes, and not for reading as
one would read Trousseau’s work; and this undoubtedly explains why, so
far as I am able to discover, no English version of this treatise
exists.
I may here call attention to the fact that the first edition (1842–1846)
of Rokitansky’s treatise contains no cuts, but that of 1855 is well
furnished with illustrations.
After Rokitansky had held for ten years the position of Professor
Extraordinary of Pathological Anatomy in the University of Vienna he was
promoted in 1844 to that of Ordinary Professor.
As an evidence of Rokitansky’s popularity as a teacher I will mention
the following fact. In my student days at the College of Physicians and
Surgeons, New York, my father, the late Dr. Gurdon Buck, frequently
referred to the benefit which he had derived from the lectures and
dead-house instruction which he received from Rokitansky during his stay
in Vienna (about 1833 or 1834). From the statement made by Prof. Alfred
C. Post of New York, I learn that he and my father were Rokitansky’s
first American pupils.
Rokitansky’s death occurred in 1878.
* * * * *
JOSEPH HYRTL was born at Eisenstadt, Hungary, in 1811. His father was a
professional musician (_Capellmeister_) in the service of Prince
Esterhazy. He received his medical training in Vienna, and in 1833,
while he was still only a student in the university, he was given the
appointment of Prosector in the Anatomical Institute. Two years later he
received his doctor’s degree, and in 1837 he was chosen Professor of
Anatomy at the University of Prague. According to Puschmann “Hyrtl
handled his pen with the same skill as he did the scalpel, and also in
his spoken lectures he manifested to a wonderful degree the gift of
making dry facts interesting to his auditors, thus keeping them
fascinated by his remarks and stimulated to advance in that branch of
medical science. The remarkable manner in which the teaching in the
Vienna Medical School increased in popularity at this period of its
history was in no small degree due to the fact that Hyrtl had, a short
time before (in 1845), been called to occupy the chair of anatomy in
that institution.” In confirmation of Puschmann’s estimate of Hyrtl’s
power to write entertainingly upon anatomical and physiological topics
which are commonly classed as “dry” I will furnish here a few extracts
from Hyrtl’s General Treatise on Anatomy. And, if the reader will pardon
me for referring once more to my father’s interest in those who played a
part, either as teacher or as simple friend and companion, in his
student life at Vienna, I will preface these extracts with the statement
that, more than once in the early sixties, I surprised my father reading
with evident pleasure, after the day’s work was over, this very treatise
on anatomy.
In his preface Hyrtl says: “A general treatise on anatomy should not
confine itself to the mere teaching of this branch of the science of
medicine, but should also inspire the students who read the book with a
love for this science and the ambition to make original investigations.”
Speaking about the behavior of an artery after it has been divided with
the knife Hyrtl explains why, in the living body, the complete division
of such a blood-vessel produces a narrowing of the lumen at the point
where it has been divided, whereas a similar division of the vessel, if
carried out upon the dead body, results only in a retraction of the tube
in the direction of its length; in other words, in the corpse the
diameter of the lumen remains unchanged as a result of such division.
From these and other facts (which he mentions, but which the lack of
space compels me to omit) Hyrtl draws the inference that the
contractility of the wall of an artery is a phenomenon that occurs only
in the living vessel. Then he goes on to remark:—
Beginning at the point where the ligature has been applied the
artery loses its symmetrical shape, both above and below the
site of the ligature, as far as to the spot where the next
collateral branch is given off. At first this distortion of the
vessel’s shape is due simply to the fact that its calibre is
filled with clotted blood (provisional obliteration). Later, a
solid plug takes the place of the soft clot. It is composed of
plastic material that, becoming fused with the clot (thrombus),
gradually undergoes organization and permanently attaches itself
to the wall of the artery through actual growth of tissue
(definitive obliteration). Thus there is formed, as the final
result of all these changes, a firm and solid cord the
circumference of which is smaller than that of the artery from
which it springs in direct continuity.
The ligating of one of the larger arteries—as, for example,
the brachial or the crural artery—does not interfere
seriously with the circulation in the parts located below
the point where the ligature has been applied; for the blood
continues to flow into these parts although with diminished
energy, owing to the fact that it is obliged to travel
through roundabout channels (anastomoses).... I once owned a
dog upon whom, in the days of my youthful sinning in the
domain of physiological experimentation, I performed, within
the short period of a single year, the operations of tying
the innominate artery and both crural arteries; and,
notwithstanding the fact that the blood needed by the
adjoining regions was thereby forced to travel to them by
unaccustomed routes, the dog’s health did not seem to be in
any way affected.
Among the anatomical remarks which Hyrtl makes at various points in the
course of his formal treatment of the subject under consideration I find
several that seem to me to be worthy of reproduction here. In one place,
for instance, he makes the statement that voluntary movements of the
auricle of the ear are by no means a rare phenomenon, and in support of
this statement he quotes Haller as mentioning (“Elementa Physiologiae,”
Tomus V., p. 190) many instances of this kind; he also narrates how B.
S. Albinus (1697–1770), the greatest anatomist of the eighteenth century
and a colleague of Boerhaave at the University of Leyden, was in the
habit of removing his wig whenever he wished to exhibit to the students
how great was his control over the movements of the auricle of the ear.
In another place Hyrtl calls attention to the not uncommon error of
giving, to the structureless membrane which Descemet described in 1758,
the name of Membrana Descemetii. According to him it was first described
by the Englishman E. Duddel, twenty-nine years earlier, in his “Disease
of the Horny Coat of the Eye,” London, 1729.
In addition to his famous general treatise on anatomy, of which, in the
course of 38 years, no fewer than 17 editions were printed, Hyrtl
published in 1845 a memoir on the organ of hearing, and in 1860 a
“Manual for the Use of Dissectors.”
His death occurred in 1884.
------------------------------------------------------------------------
BOOK IV
MEDICINE IN ITALY
------------------------------------------------------------------------
CHAPTER XI
BAGLIVI, MORGAGNI, SCARPA, SPALLANZANI, TISSOT AND GALVANI; ITALY’S MOST
ILLUSTRIOUS PHYSICIANS DURING THE EIGHTEENTH CENTURY
GIORGIO BAGLIVI, the most distinguished Italian physician of the
seventeenth century (1669–1707), was probably the first medical author
in that country to lay stress upon the importance of studying disease
through direct observation rather than from books. In his treatise on
the practice of medicine, which was first published in Latin at Rome in
1696 and afterward translated into several modern languages (London,
1704; Paris, 1757), he makes the following remarks:—
There are several obstacles which have hitherto stood in the way
of a more general adoption of the maxim that direct observation
constitutes the best method of studying disease. They are the
following: the widespread contempt for the authority of the
physicians of antiquity; the false opinions and prejudices to
which men became attached as if they were idols; the habit of
making erroneous comparisons and of drawing hasty conclusions,
as well as the formulating of analogies that are based upon
untrustworthy reports; reading books which have been unwisely
chosen or reading without exercising a discerning judgment;
incorrect interpretation of the author’s meaning; the craze for
reducing everything to a system; and the abandonment, by
authors, of the habit of expressing their thoughts in the form
of maxims.
GIOVANNI BATTISTA MORGAGNI, one of the greatest anatomists of the
eighteenth century and the prince of anatomo-pathologists, was born on
February 25, 1682, at Forli, an Italian town situated about forty miles
southeast of Bologna. The death of his father when the boy was only
seven years old made it necessary for his mother to assume entire
control of his early education. She performed this duty so faithfully
and with such excellent judgment that, by the time Giovanni had attained
his fourteenth year, he was so thoroughly familiar with the literature
of Italy, and also of European countries generally, that the Academy of
Forli unhesitatingly accepted him as a member of that organization. Two
years later Giovanni went to Bologna and began the study of medicine
under the guidance of such distinguished teachers as Hyppolyte Albertini
and Antonius Valsalva; and three years later (in 1701) he was given the
degree of Doctor of Medicine.
Morgagni’s biographers say little or nothing about his personal traits
of character and about the manner in which he spent the larger part of
his time during the early years of his professional career. His
published writings, however, make it perfectly clear that almost from
the very first his chief interest was centred in the study of anatomy as
revealed to him by dissections of the dead human body; and, as the years
rolled past, he evidently grew more and more strongly interested in the
changes which take place in the organs and tissues of the body as the
result of accidental injuries and of disease. From these same writings
one learns further that he was in the habit of writing down, with the
most painstaking minuteness, all the various departures from the normal
standard as fast as they revealed themselves to his critical vision. He
left no opportunity for the occurrence of errors due to a defect in his
memory.
In 1706 he published a treatise bearing the title “Adversaria
Anatomica.” It was this work which first laid the foundation of his
reputation. In 1716 he was given the Chair of Anatomy at the University
of Padua, and he continued to hold this position up to the time of his
death in 1771.
Relatively late in life—that is, in 1767—he published his treatise “De
Sedibus et Causis Morborum” (on the seats and causes of different
diseases). This work, says Rokitansky, stands for all time,
notwithstanding its defects, as a monument in honor of its author, by
reason of the great industry and perseverance which it displays, and
because of its wealth of detail, orderliness of arrangement, acuteness
of reasoning, and excellence in the choice of methods,—in short, because
of its originality. Théophile Bonnet’s great work on the same subject
(“Sepulchretum”) was published in 1700, but, like its successor, its
usefulness to-day is limited, at least in large measure, to that of a
huge museum of pathological specimens. Rokitansky, of Vienna, was in
reality the first anatomist who appreciated at its full value the fact
that these lifeless specimens furnish most useful lessons in the theory
and practice of medicine.
* * * * *
LAZARUS SPALLANZANI was born in 1729 at Scandiano, a small town in the
northeastern corner of the Apennines, about fourteen miles from Modena,
Italy. At the age of fifteen he began to study physics, mathematics and
philosophy at the University of Bologna, under the guidance of his
relative, Laura Bassi, one of the most distinguished members of the
Faculty of the Bologna Institute of Science. At the same time he
cultivated a knowledge of Greek, Latin and French, as well as of his
native language. As his father was anxious to have him do so, he also
studied jurisprudence for a certain length of time, but he abandoned
this study when his father, who had been persuaded by Antonio
Vallisnieri, Professor of Natural History at the University of Padua,
that the lad was much better fitted to follow the career of a biologist
than that of a jurist, gave his son full permission to adopt whatever
line of studies best suited his tastes and inclination. Accordingly,
from this time forward Spallanzani devoted himself with increased zest
to the study of mathematics and the dead and living languages.
In 1754 the University of Reggio—a town which is only a few miles
distant from Scandiano—elected him to the Chair of Logic, Mathematics
and Greek; and this position he continued to hold with credit to himself
during the following six years; and during this period he devoted all
his leisure hours to the observation of Nature. In this way he was able
to make a few discoveries concerning the animalcules that are found in
infusions; and it was not long before these discoveries attracted the
attention of those distinguished Swiss naturalists—von Haller, of Berne,
and Bonnet, of Geneva.
In 1760 Spallanzani was invited to occupy a chair in the University of
Modena, and he taught in that institution for a period of eight years.
During his term of office at this institution he published two
memoirs—one on the animal nature of microscopic animalculi, and a second
on the changes effected in the shapes of stones by the action of running
water.
In 1767, the Empress Maria Theresa decided to render the University of
Pavia more effective as a scientific institute, and with this purpose in
view she established certain new professorships, and among the number
one on natural history. As the first incumbent of this new chair she
called (in 1768) Spallanzani, who by this time had acquired a great
reputation in the scientific world as a biologist. His extensive
knowledge in a variety of departments was associated with a remarkable
genius; his methods were simple and easily understood, and—to speak
figuratively—he took his auditors by the hand and led them to a clear
understanding of the truth, or to the point where they could appreciate
that the truth was not far distant and was certainly attainable in the
near future. He possessed the art of interpreting Nature by her own
methods, and by this art he was able to render wonderfully clear all the
subjects with which he dealt in his lectures. All those who heard him
speak gave him credit for being at times positively eloquent.
Lack of space will not permit me to furnish more than a few details of
the original investigations which he made at this period of his career.
Although at first glance it may be thought that Spallanzani’s work had
very little to do with the science of medicine, on closer examination it
will be seen that a study of the vital processes in the lower forms of
life (which was Spallanzani’s chief occupation) are largely the same as
those which characterize the higher forms, and therefore—since great
difficulties attend the study of the same processes in man—it is of the
very greatest importance that the search for light on this subject
should be conducted on the lower organisms, even on the minute organisms
which are found in stagnant water. Spallanzani was therefore engaged, in
a very direct manner, in laying the foundations of the true science of
medicine. Von Haller, the great Swiss pioneer in biology, was fully
aware of this fact when he dedicated the fourth volume of his “Elementa
Physiologiae”
To that most illustrious man, Lazarus Spallanzani, to whom
credit is due for the fact that, although he had already
explored the most minute and inaccessible of Nature’s pathways,
he still sought to learn whether the existing limits of our
knowledge of the truth might not be extended.[13]
In 1780, during his residence at Pavia, Spallanzani published two new
volumes containing memoirs on vegetable and animal physiology. In one of
these he discusses with great thoroughness the subject of digestion, and
describes the difficult experiments which he made, largely upon birds,
in order to ascertain the nature of this process. In this manner he
ascertained that, in a very large number of animals (insects excepted),
digestion is effected by a juice or fluid which dissolves the alimentary
substances that have been introduced into the stomach. “One is filled
with admiration,”—says his biographer and friend, Jean Senebier, of
Geneva, Switzerland,—“as one peruses Spallanzani’s account of this
series of experiments, and notices with what scrupulous care he
formulates the conclusions which he draws from them with regard to the
causes of the phenomena observed.” And yet, in 1786, John Hunter, the
distinguished English anatomist and biologist, published a memoir
(“Observations on Certain Points of the Animal Economy”) in which he
dissents—somewhat sharply, says Senebier—from these conclusions. In 1788
Spallanzani published his reply to the observations made by Hunter and
in this he points out, “with a logic so clear and convincing that it
permits of no reply,” the errors of the English physiologist’s
criticism.
In several other published memoirs Spallanzani deals with the problems
of generation, the circulation of the blood, the respiration, etc.
To this very brief and imperfect sketch of one of the greatest
biologists of the eighteenth century, I will simply add the statement:
His death occurred, after a brief illness, February 11, 1799. In the
parish church of Scandiano there has been erected a magnificent
mausoleum in honor of Spallanzani.
* * * * *
ANTONIO SCARPA (1747–1832), a native of Motta near Treviso, Northern
Italy, received his medical education at the University of Padua. He was
particularly devoted to the study of anatomy, and, already in the second
year of the course, he had made such progress that he was allowed to act
as one of the prosectors. Morgagni, who was his teacher, became very
much attached to him and did everything in his power to advance Scarpa’s
interests. While he was still in the student stage of his career Scarpa
went to Bologna and devoted himself for a few months to the cultivation
of surgery. On his return to Padua he passed successfully the required
examinations and was given the degree of Doctor of Medicine. Not long
afterward he was called to fill the Chair of Anatomy and Surgery at the
Medical School of Modena. After eight years of service in that
institution he resigned and then visited France and England for the
purpose of gaining further knowledge in those branches of medicine in
which he was specially interested. In 1783 he accepted a call from the
University of Pavia to occupy the Chair of Anatomy, and remained
undisturbed in this position for twelve years. In the year 1796,
however, at the time when Pavia became a part of the newly founded
Cisalpine Republic, Scarpa was asked to take the oath of allegiance to
the new government, an oath which was required of all the functionaries
of the university. Not being willing to do this he was obliged to resign
his professorship. In 1805, Napoleon, after being crowned King of Italy
at Milan, passed through Pavia on his way back to Paris. On this
occasion he asked to have the university professors presented to him,
and, failing to find Scarpa among those who attended the reception, he
asked what had become of him, for his great reputation as an anatomist
was well known to him. Then he learned how Scarpa had been compelled, by
reason of his unwillingness to sign the oath, to resign his position in
the university. “Well,” replied Napoleon, “what if he did refuse to take
the oath, and what have political opinions to do with teaching anatomy?
Scarpa confers honor upon the University and upon the country which I
now govern, and I wish that he be restored to his former position.” He
was accordingly restored to his professorship and during the following
seven years—that is, up to 1812—Scarpa continued his work of teaching
anatomy and of conducting the surgical clinic. During the later years of
his life he was a great sufferer from calculous nephritis and chronic
disease of the urinary bladder, and these diseases finally caused his
death on October 31, 1832.
Dezeimeris, in his estimate of the part played by Scarpa in advancing
the science of medicine, lays particular stress upon the following two
things: first, he was very active and persisted in his efforts to
impress upon surgeons the importance of considering a knowledge of
anatomy as affording the only safe and sure route to progress in the
surgical art; and, second, he furnished a number of beautiful examples
that showed the necessity of throwing additional light upon the
different diseases by the employment of demonstrations in topographical
and pathological anatomy.
His more important published works are—aside from the value of the
text—_chefs-d’oeuvre_ of iconography. Such, for example, are the
following: “De Structura Fenestrae Rotundae Auris etc.,” Modena, 1772;
“De Grangliis et Plexubus Nervorum,” Modena, 1779; “Anatomicae
Disquisitiones de Auditu et Olfactu,” Pavia, 1789; and “Opuscoli di
Chirurgia,” Pavia, 1825–1832, 3 vols.
* * * * *
SAMUEL-AUGUSTE-ANDRÉ-DAVID TISSOT (1728). The Tissots are of Italian
origin. Alessandro Tissoni, the youngest son of one of the first
families of Spoleto, accompanied Prince Louis on his crusade to the Holy
Land in 1147, and, after escaping from the disasters incident to the
siege of Damascus, he managed to regain his native land along with the
forlorn remnants of Louis’ army. As he had joined the expedition
contrary to the wishes of his parents he felt that it would not do for
him to return to Spoleto. At first, therefore, he was a homeless
wanderer in his own country. Fortunately for him, however, three of his
companions in arms bequeathed to him all their property just before they
died from their wounds; and consequently one of his first cares, after
he returned to Italy, was to gain possession of his legacies. In the
case of one of the three men there was a sister living, and so—partly
from love and partly in order to escape any unpleasant legal
complications—Alessandro married her, and the couple took possession of
the deceased brother’s landed property. Some of this property, it so
happened, was located in Franche-Comté, near the present city of
Besançon, and it was while he resided in this part of France (1152) that
he changed his name to Tissot, thus putting an end to the possibility
that his relatives in Spoleto would ever be able successfully to claim
any part of his property. Samuel-André’s father, Pierre Tissot, a land
surveyor who resided in Grancy, not far from Lausanne, entered his son’s
name (May 15, 1741) at the Academy of Geneva, in the department of
belles-lettres. In August, 1745, he received the degree of M.A., and on
the fourteenth of the following month of September he started on his
journey to Montpellier where he was to study medicine. Four years later
he passed all his examinations creditably and was given the degree of
M.D. He chose Lausanne as his place of residence, and was successful, at
the end of one year, in obtaining the position of Physician of the Poor.
Early in 1745 he made the acquaintance of Albrecht von Haller, the
celebrated physiologist of Berne, and about the same time he became
deeply attached to Dr. Théodore Tronchin, a native of Geneva, but
engaged in active practice at Paris. These two men were the most
distinguished Swiss Physicians of that period.
Eynard, Tissot’s biographer, says that up to the end of his life he
preferred to carry on his epistolary correspondence in Latin; and yet at
the same time he was the author of several medical treatises that were
extremely popular. One of them in particular (“L’Avis au Peuple”) passed
through many French editions,[14] and was translated, in the course of
the next twenty-five years, into all the leading European languages.
Strange as it may appear to us moderns, this book was not written
originally for the general public, but only for the peasants of the
Canton de Vaud, who were constantly falling victims to charlatans and
itinerant quacks; and yet the universities of Goettingen and Giessen
recommended the work as proper reading matter for their students. In
order to show the high degree of esteem in which Tissot was held by his
fellow citizens of Lausanne, the authorities conferred on him the rights
and privileges of citizenship “on account of his praiseworthy efforts to
improve the condition of its inhabitants”; and as, in the course of
time, the limits of the city were extended, the name “_Avenue Dr.
Tissot_” was bestowed on one of its finest residence streets.
In 1765 Stanislas Augustus, King of Poland, invited Tissot to accept the
office of First Physician of his Majesty at Warsaw. Although the
invitation was couched in the most friendly terms, Tissot was not
willing to leave his beloved Lausanne. All sorts of influences were
brought into play by the King to make him change his mind, but his
resolution remained fixed. In his reply to the letter Tissot said:—
My first reason for declining your highly flattering offer is
this: I am very much attached to my father and mother and to my
uncle, who have brought me up from infancy with the tenderest
care, and who, owing to their advanced age, are likely at any
time to need my aid and advice, and who would be heartbroken if
I were to go far away from them. My second reason consists in
the sentiment that I am not in any way fitted to fill such a
position with entire satisfaction to all the interests
concerned, for it involves many important duties beside that of
watching over your health—as, for example, the superintendence
of the different institutions in your kingdom which are devoted
to the preservation of the health of your subjects; the duty of
reporting to you any evidences of mismanagement that I may
discover and the suggestion of such new measures as are likely
to remedy any such deficiencies; the promotion of the efficiency
of your schools of medicine, surgery, midwifery, pharmacy, etc.;
and, last of all, there is the important consideration that my
position here in Lausanne is in every respect most satisfactory
to me. Why, then, should I abandon these surroundings in which
my life is most happy, for a position in which I might easily
lose a large part of this happiness?
Notwithstanding Tissot’s decided refusal to accept the flattering offer
made by King Stanislas, the latter did not give up all hope of
persuading him eventually to accept the position of First Physician.
Three times in succession, at short intervals, he sent him a renewal of
the invitation, each time adding some fresh inducement in the hope of
overcoming Tissot’s objections; and, just as the latter had nearly made
up his mind to yield to the King’s urgent request—the death of his
much-beloved uncle a few days previously having removed one of the
strongest obstacles in the way of his acceptance—the ruling authorities
of the Academy of Lausanne notified him that a Chair of Medicine had
been created by them and that he had been appointed its first occupant.
Stanislas then at last recognized that he must definitely abandon his
cherished project, and he accordingly sent a fine portrait of himself to
Tissot, with a charming letter in which he said:—
I am truly afflicted by your decision, but I take comfort in the
thought that probably my persistent efforts to bring you to
Warsaw had something to do with hastening the decision of the
Berne authorities to establish the Chair of Medicine at Lausanne
for your benefit. I congratulate you on your good fortune and
your compatriots on their having had the wisdom to appreciate
the value of your services to Switzerland. I pray God, Monsieur
Tissot, that He may have you in safe keeping.
STANISLAS AUGUSTUS, KING
Warsaw, March 5, 1765.
Lausanne in 1765, it should here be stated, still recognized the Bernese
Government as its overlord. It was only at a somewhat later date that it
acquired entire independence.
In closing this brief account of Tissot’s correspondence with the King
of Poland, I ought to add that it was largely through the intercession
of Albrecht von Haller, the distinguished physiologist and himself a
citizen of the Swiss metropolis, that the senators at Berne were induced
to found a Chair of Medicine at Lausanne for the express purpose of
preventing Tissot from leaving Switzerland. I also should state that
Tissot himself was entirely ignorant at the time that von Haller had
been instrumental in effecting the establishment of this new
professorship at Lausanne.
Here is an anecdote which is told by Lantier in his book “Les Voyageurs
en Suisse.” While it relates only indirectly to Tissot it furnishes an
amusing illustration of what may easily happen in the experience of any
physician who has a large office practice:—
A certain Adolphe D. called at Tissot’s residence and rang the
door bell. An elderly female servant, who opened the door, said
that her master, the doctor, was not at home. “But,” she added,
“if you have come to consult him about some malady, I warn you
that you will lose your money and have nothing to show for your
trouble. For the past twenty years I have had a pain in my
stomach, and the doctor has not been able to cure it.” Tissot,
to whom I related the incident, joined me in a hearty laugh over
the affair.
In November, 1779, Tissot was urged to visit Paris in company with his
adopted son, who was studying medicine. Believing that the young student
would be greatly benefited by such a visit to the French capital he at
once decided to undertake the trip. But, very soon after his arrival in
Paris, he discovered that he was to have no rest so long as he remained
there. His celebrity brought him almost at once many people who wished
to consult him about their ailments. Often, says his biographer, the Rue
des Petits Augustins, where his temporary residence was located, was
filled with a long line of carriages belonging to the distinguished
patients who awaited their turn to interview the great physician from
Lausanne. This sort of medical practice was not at all to his taste; and
when he was not busy with professional work he was attending an endless
series of dinners and receptions. At the end of a few months he returned
to Lausanne, and would have been well pleased to remain there
permanently; but he soon recognized that, in the interest of his adopted
son, he should take up his residence in some German or Italian city
where there was a university. Just at this juncture of affairs Borsieri,
the distinguished Professor of the Theory and Practice of Medicine at
the University of Pavia, Tuscany, a man well advanced in years, sent in
his resignation. Whereupon Joseph II., Holy Roman Emperor and King of
Austria, immediately urged his brother Leopold II., Duke of Tuscany, to
offer the position to Dr. Tissot. The latter took the invitation
seriously under consideration and in due course of time accepted. His
honorarium was fixed at 3000 German florins (about $1500 U. S. currency)
and in addition he was accorded various important privileges—such, for
example, as a suitably furnished residence; a ward equipped with six
beds and arranged in such a manner that clinical instruction might be
conveniently given in it; and the right to carry on private practice in
the district of Milan and also outside the limits of that district
whenever this could be done without interfering with his duties at the
university. Further, he was permitted to resign his chair at the end of
two years if he should so desire. Finally, he was reimbursed for all his
traveling expenses, and was absolved from attendance upon any functions
or ceremonies that might conflict with his conscientious scruples as a
Protestant. For a Government that was strictly under the control of the
Roman Catholic Church these terms were remarkably liberal.
Tissot appears to have been very successful, both as a teacher and in
his social relations with the people whom he met during his short stay
of two years at Pavia. In a letter which Spallanzani wrote on December
31, 1781, to Charles Bonnet, the distinguished naturalist of Geneva, he
speaks of Tissot’s arrival at Pavia in the following terms:—
He seems to be pleased with our university, with our colleagues,
and with our students. Everybody in Pavia likes him. His
lectures are most instructive and well adapted to the character
of our young men who have come hither from every part of Italy
to profit from the teaching of this Swiss Hippocrates. Apart
from the knowledge which he possesses, and which certainly is
very extensive, Monsieur Tissot is the most polished, the most
amiable man I have ever met.
It would be a pleasure to furnish here a _résumé_ of the detailed
account which Tissot’s biographer gives of his lectures and of his most
practical clinical instruction, but I perceive that I have already drawn
out my sketch to an inordinate length, and I must therefore stop at this
point. I will simply add one more item of information. Early in 1783
Tissot publicly announced his intention of resigning his professorship
at the end of the period of service that had originally been agreed
upon—viz., two years; and on June 12 of the same year, at which date the
academic year ended, he delivered his farewell address to the students
of the university. To perpetuate the memory of this occasion those
students who were permanent residents of Pavia set up in one of the
lecture rooms a suitably inscribed marble tablet; those who came from
other parts of Europe (72 in all) prepared their memorial in the form of
a small printed volume (104 pages) of sonnets written in Latin, Greek,
Italian, German, French and English, and grouped together under the
title:—
_Sentimenti d’Affetto e di Riconoscenza Degli Studenti di
medicina Verso il Loro Immortale Precettore, il Signor S. A. D.
Tissot._
On the 21st of June, 1783, in company with his nephew, Tissot left Pavia
for Switzerland by way of the Simplon Pass.
Already in 1794 his health began to show unmistakable signs of breaking
down under the influence of a progressive pulmonary tuberculosis, and it
was not long afterward that his death occurred (June 13, 1797) at his
residence in Lausanne.
* * * * *
ALOYSIUS GALVANI, born at Bologna, Italy, on September 9, 1759, and
appointed public lecturer in anatomy at the university in 1762,
published in 1791 a treatise in which he announced his discovery of a
new force to which he gave the name of animal electricity, but which
subsequently received that of “galvanism” in honor of its discoverer,—a
name which it has retained ever since. By a mere accident Galvani
discovered the fact that when two different metals—iron and copper, for
example—are brought in contact with muscular tissue there results from
this contact a force, seemingly an electric current, which causes the
muscle to contract. Six years later—that is, in 1797—the Cisalpine
Republic was formed by the joining together of what were known as the
Cispadane and the Transpadane Republics—two political organizations that
occupied respectively, as their names imply, territories situated the
one on the north side and the other on the south side of the river Po,
and both of which organizations owed their existence to the action of
Napoleon Bonaparte. When the professors of the University of Bologna,
which was located in the Transpadane territory, were called upon to
swear allegiance to the new republic, Galvani was the only member of the
Faculty who refused to take the oath, and as a consequence he lost his
professorship. His death occurred in 1798.
------------------------------------------------------------------------
BOOK V
SMALL-POX, ONE OF THE WORLD’S GREATEST SCOURGES
------------------------------------------------------------------------
CHAPTER XII
MEASURES ADOPTED FOR THE CONTROL OF SMALL-POX
I. INOCULATION
About the year 922 of the present era the Arabian physician Rhazes wrote
and published (in MS.) the earliest known report of the malady now
called Variola or Small-Pox. From this fact the inference should not be
drawn that the disease first came into existence in the time of Rhazes,
for it can scarcely be doubted that it had already existed in the East
for ages before the period mentioned. Since the thirteenth century it
has appeared repeatedly in epidemic form in widely separated countries,
causing, especially among the eastern nations, a fearful mortality.
Sydenham, the great English physician, succeeded during the seventeenth
century in devising a method of treatment that in some degree diminished
the mortality of this affection, at least in Great Britain. It was,
however, in no sense a preventive procedure, and the spread of small-pox
continued unchecked until Jenner, in 1796, introduced vaccination; and
even then the efficiency of this method was not promptly acknowledged by
the Medical Profession; indeed, several years had to elapse before even
the best London physicians, the men who possessed the most complete
facilities for ascertaining the whole truth with regard to Jenner and
his new method, became convinced that a great and most efficacious
protection against small-pox had at last been found. In the
meantime—that is, for almost half a century—the procedure known as
“inoculation” was accepted by the upper classes of the community in all
parts of Europe as affording the maximum amount of protection attainable
against the disease.
There were in Europe, during the last half of the eighteenth century,
two physicians—BARON THOMAS DIMSDALE, an Englishman, and DR. THÉODORE
TRONCHIN, of Geneva and Paris—who obtained considerable celebrity as
inoculators.
The first-named, BARON THOMAS DIMSDALE, was born in 1712 and began to
practice his profession in 1734 at Hertford, twenty-four miles north of
London. Already as early as in 1741 he had acquired so great a
reputation for his success, both in performing the operation and in
carrying the patient safely through the resulting infection,—that is,
through the attack of small-pox thus artificially produced,—that he was
sent for to inoculate first the Czarina of Russia, then the Grand Duke
Paul, and subsequently the children of many of the first families of the
Russian Empire. Shortly after his return to England he was made a member
of the Royal Society, and at a still later date the city of Hertford
chose him as their representative in the House of Commons. In 1781, on
the occasion of his second visit to Russia, he inoculated the Czar
Alexander and the Grand Duke Constantine. His death occurred on December
30, 1800.
Among Dimsdale’s published works relating to small-pox and inoculation
the following deserve to receive special mention: “The Present Method of
Inoculating for the Small-Pox”, London, 1766, 1767 and 1772; “Thoughts
on General and Partial Inoculation,” London, 1776; and “Account of a
Voyage to Russia and Report of the Procedure Carried out in the Cases of
Catherine and Paul.”
Baron Dimsdale, it seems scarcely necessary to add, was not the inventor
of the practice of inoculation but simply the individual who revived and
made popular, first in England and afterward on the continent of Europe
(more particularly in Russia), a practice which long before had been
employed in China.
[Illustration:
Medal commemorating the discovery of vaccination. From Eugen
Hollaender’s “_Medizin und Plastik_,” by permission.
]
THÉODORE TRONCHIN, the second inoculator mentioned above, was a native
of Geneva, Switzerland,[15] and was highly esteemed in France as a
practitioner of medicine during the period that is now under
consideration (1750–1785). Furthermore, it was widely known that he was
the family physician of Louis Philippe, Duke of Orleans, as well as the
medical adviser and intimate friend of Voltaire, both of which facts
undoubtedly aided him in gaining popularity among the members of the
fashionable set of Paris. It is therefore easy to understand why, when
he espoused the cause of inoculation, he should have so rapidly attained
celebrity as a successful inoculator, not only in Paris but also
throughout Europe. On the other hand, it is not at all clear why the
inoculation method should have been looked upon with any favor by the
educated classes, for it soon became increasingly evident that the
operation was attended with considerable risk through the danger of
introducing other infective agents into the system; and, in addition, no
satisfactory evidence was forthcoming that these inoculations possessed
the slightest degree of genuine protective power. To-day we are unable
to discover in this procedure any other advantages than the
following:—The patient is thereby enabled to select the time when, and
the surroundings in which, he or she will submit to an attack of
small-pox; for, it must be remembered, no well-grounded hope was held
out by the inoculators of the eighteenth century that the artificially
produced disease would prove less fatal than that which is acquired
accidentally. And yet some such hope was apparently cherished by the
people of that period, for Benjamin Franklin, writing in 1788, makes the
following remark in relation to this very question:—
In 1736 I lost one of my sons, a fine boy of four years old, by
the small-pox, taken in the common way. I long regretted
bitterly, and still regret, that I had not given it to him by
inoculation. This I mention for the sake of parents who omit
that operation, on the supposition that they never should
forgive themselves if a child died under it; my example showing
that the regret may be the same either way, and that, therefore,
the safer should be chosen.
These bitter regrets expressed by Franklin show plainly that he, like
others of his time, had strong confidence in the efficiency of
inoculation.
II. VACCINATION
EDWARD JENNER, the discoverer of vaccination as an effective means of
protection against small-pox, was born at Berkeley, Gloucestershire,
England, on May 17, 1749. After the death of his parents while he was
still a mere child, Edward passed under the guardianship of his eldest
brother, the Rev. Stephen Jenner, and was brought up by him with
affectionate care and judicious guidance. At a very early age he showed
a decided taste for natural history; and after leaving school he began
to receive instruction in the elements of surgery and pharmacy from a
Mr. Ludlow, an eminent surgeon of Sodbury, near Bristol. As the next
step in his education he spent two years under the direction of the
celebrated experimental pathologist, John Hunter, of London, in whose
family he resided for two years. He was about twenty-one years of age
when he went to London.
Already at this early period he showed unmistakable evidences of being a
close observer, scrupulous and accurate in his examination of the
objects of his studies. He was also gifted with much enterprise and
perseverance, characteristics which greatly aided him in mastering
difficulties that would have seriously obstructed the progress of an
individual possessing an inferior mind. Mr. Hunter, who was at this time
in the prime of life, completely won the affection and respect of his
pupil, who particularly admired the boldness and independence of his
teacher’s character. Jenner was peculiarly alive to virtues of this
kind. After completing his professional studies in London he retired
from Hunter’s house, but the intimate relations which had been
established between these two men persisted up to the time of the
latter’s death in October, 1793.
[Illustration:
EDWARD JENNER
(Copied from Thomas J. Pettigrew’s “Medical Portrait Gallery,” London,
1838. The original portrait was painted by Sir Thomas Lawrence,
Royal Academy.)
]
Immediately after his return from London Jenner took up his residence
with his brother Stephen, at Berkeley, and began his career as a
practitioner of medicine. At the same time, as opportunity afforded, he
continued to pursue his favorite studies in natural history. Thus, in a
comparatively short period of time, he accumulated a series of specimens
illustrative of comparative anatomy, and sufficiently numerous to form a
museum of no inconsiderable magnitude.
In describing the manner in which Jenner’s attention was first seriously
directed to the subject of cow-pox Dr. Baron, his biographer, uses the
following language:—
Jenner was pursuing his professional education in the house of
his master at Sodbury; a young country-woman came to seek
advice; the subject of small-pox was mentioned in her presence;
she immediately observed, “I cannot take that disease, for I
have had cow-pox.” This incident riveted the attention of
Jenner. It was the first time that the popular notion, which was
not at all uncommon in the district, had been brought home to
him with force and influence. Most happily the impression which
was then made was never effaced. Young as he was, and
insufficiently acquainted with any of the laws of physiology or
pathology, he dwelt with deep interest on the communication
which had been casually made known to him by a peasant, and
partly foresaw the vast consequences which were involved in so
remarkable a phenomenon. He was the more stimulated to
meditations of this sort by frequent opportunities of witnessing
the ravages of small-pox; and by retaining the most vivid and
painful recollections of the severe discipline which he himself
had not long before passed through, preparatory to his
inoculation for that disease. “There was”—to use his own
words—“bleeding till the blood was thin; purging till the body
was wasted to a skeleton; and starving on vegetable diet to keep
it so.” The possibility of averting such evils could not arise
in a mind like Jenner’s without possessing it fully; and he
resolved to let no opportunity escape of acquiring knowledge on
so important a subject.... It was not till some years after his
return from London that he had an opportunity of examining into
the truth of the traditions respecting cow-pox. This was about
the year 1775, a date which corresponds with the period
specified by him in his tract on “The Origin of Vaccine
Inoculation.”
Although during the following five years Jenner’s efforts to learn the
full truth about cow-pox brought him very little nearer the goal which
he was aiming to reach, he nevertheless pursued with zeal and vigor his
studies concerning the nature of this disease and concerning its
relations to small-pox. Among the facts which he ascertained during this
period the following deserve to receive mention here: (1) There are
several different diseases to which milkers are liable when they handle
infected cows; but (2) only one of them possesses the power of
furnishing protection against small-pox. The discovery of these facts
made it easy to understand why vaccination with the virus of what was
commonly called cow-pox not infrequently failed to protect the
individual so vaccinated from genuine small-pox.
As a result of still further investigations Jenner felt warranted in
drawing the conclusion that small-pox, cow-pox and swine-pox had a
common origin,—in fact, were varieties of the same disease. Dr. Baron
mentions the following incidents or experiences as affording a strong
corroboration of the truth of the statements just made:—
In November, 1789, Jenner inoculated his eldest son Edward, who
was then about one year and a half old, with swine-pox matter.
The progress of the disease seemed similar to that which arises
from the insertion of true small-pox matter when the disease is
very slight. He sickened on the eighth day; a few pustules
appeared; they were late and were slow in their progress and
small. Subsequently, at five or six different periods, variolous
matter was carefully inserted into his arms without the
slightest inflammation being excited in the part.
On April 7, 1791, variolous matter was again inserted by two
small incisions through the cutis.
April 9, parts evidently inflamed.
April 10, an efflorescence of the size of a shilling spread
around the inferior wound.
April 11, the incision assumed a kind of erysipelatous
elevation; the efflorescence much increased.
April 12, still further increase in the efflorescence; a vesicle
about the size of a large split pea, and containing a brownish
clear fluid, had also formed close to the superior incision; and
a still larger one was visible near the edge of the inferior
incision. The erysipelas extended to the shoulder and then
quickly subsided. The child showed no signs of indisposition the
whole time.
In March, 1792, a fresh inoculation was made. A well-marked
inflammatory reaction followed.
At a later date Jenner learned that there were
well-authenticated instances to prove that when the true cow-pox
broke out among cattle at a dairy and was communicated to the
milkers, even they had subsequently contracted small-pox. The
discovery of this fact perplexed him greatly. Indeed, in the
case of most men the discovery would probably have led to the
abandonment of all further experimentation. But Jenner did not
allow himself to be discouraged. It occurred to him that the
virus of the cow-pox itself might have undergone some change
whereby its specific virtues were lost; that, in this
deteriorated state, it might have been capable of producing only
a local disease upon the hand, but no such influence upon the
constitution as is requisite to render the individual
unsusceptible of contracting small-pox. In other words, he
believed it possible that the same cow might one day communicate
a genuine and efficacious preventive, and, the next, nothing but
a local affection that would exert no beneficial influence
whatever on the constitution. This most ingenious and forcible
reasoning, supported by analogies drawn from the well-known
properties of the virus of small-pox itself, received an ample
confirmation from experience, and was the basis on which some of
the fundamental rules for the practice of vaccination were
founded. It was ascertained that it was only in a certain state
of the pustule that virus was afforded capable of imparting to
the constitution its protecting power; that matter taken after
this period might excite a local disease, but not of such a sort
as to render the individual proof against the effects of
variolous contagion.
In 1796 Jenner had an opportunity to carry his investigations a step
further.
“Hitherto,” says his biographer, “he had only observed the
casual disease and investigated its laws; it yet remained to be
proved whether it was possible to propagate the affection by
artificial inoculation from one human being to another, and
thereby, at will, communicate security to all who were liable to
small-pox. An opportunity occurred, on the fourteenth of May,
1796, of instituting this experiment. Matter was taken from the
hand of Sarah Nelmes who had been infected by her master’s cows,
and inserted by two superficial incisions into the arms of James
Phipps, a healthy boy eight years old. He went through the
disease apparently in a regular and satisfactory manner; but the
most agitating part of the trial still remained to be performed.
It was needful to ascertain whether he was secure from the
contagion of small-pox. This point, so full of anxiety to Dr.
Jenner, was fairly put to issue on the first of the following
July. Variolous matter, immediately taken from a pustule, was
carefully inserted by several incisions, but no disease
followed.”
Shortly afterward Jenner wrote to his friend Gardner:—
You will be gratified in hearing that I have at length
accomplished what I have been so long waiting for, viz., the
passing of the vaccine virus (the virus of cow-pox) from one
human being to another by the ordinary mode of inoculation.... I
was astonished at the close resemblance of the pustules, in some
of their stages, to the variolous pustules. But now listen to
the most delightful part of my story. The boy has since been
inoculated for the small-pox, which, as I ventured to predict,
produced no effect. I shall now pursue my experiments with
redoubled ardor.
My readers can easily imagine with what deep anxiety mingled with an
intense desire for a completely successful result, Jenner, from this
time forward, prosecuted his labors. Unfortunately, he was not able,
owing to the disappearance of cow-pox from the dairies of the region in
which he lived, to resume his experimental work before the spring of
1798. He was also not willing to make a public announcement of the
important results which he had obtained until he should have amply
confirmed their accuracy by further experimentation. It was therefore
not until during the early part of the summer of 1798 that he issued a
printed pamphlet of a little more than seventy pages, in the quarto
form, and bearing the title “An Inquiry into the Causes and Effects of
the Variolae Vaccinae.”
On April 24, 1798, about two months before the publication of his
pamphlet, Jenner repaired to London for the purposes of exhibiting the
cow-pox and of demonstrating to his professional friends the truth of
his assertions. Although he remained in the metropolis nearly three
months he was unable to procure a single person on whom he could exhibit
the vaccine disease.
Some of the cow-pox virus which Jenner carried with him was consigned to
Mr. Cline, a London physician, who, toward the end of July, inserted it
by two punctures into the hip of a child. A few days later he reported
that “the cow-pox experiment had succeeded admirably.”
As happens in practically every important discovery in therapeutics,
there arose soon in many quarters serious doubts as to the prophylactic
powers of the method advocated by Jenner. Some men even went so far as
to question the accuracy of his statements and to impugn his authority
to advocate the practice of vaccination. On the other hand, there were
many, and they too of the most learned and respectable, who immediately
did justice to the merits of Jenner, and who cordially acknowledged the
many important consequences which were involved in the subject that he
had so ably and so modestly brought before them.
From a letter which Jenner wrote to one of his friends only a few weeks
after he had published the “Inquiry” it appears that already at that
early date he foresaw the probability that there would occur, in the
further evolution of vaccination as a prophylactic measure, those very
complications which, from that time to the present, have interfered so
seriously with the universal acceptance of this procedure as a measure
of vast beneficence to the human race. These so-called complications
were, in the great majority of instances, manifestations of septic
infection, brought about by carelessness in the handling of the
inoculation wound; but this fact was not at all appreciated in Jenner’s
time. During the years immediately following that in which the discovery
of the new procedure was announced to the physicians of England
vaccination made fairly rapid progress in public favor. Already as early
as in June, 1800, Jenner, while on a visit to Oxford, was there
presented, by the leading physicians of that city, with a testimonial in
which it was declared that cow-pox is an effectual prophylactic agent
against the small-pox. Two years later the English Parliament voted
Jenner a grant of £10,000 as a reward for the very valuable discovery
which he had made and for his prolonged labors in rendering the
procedure of great utility to the public.
Strange as it may appear to those who are not familiar with the lives of
the most meritorious and most unselfish physicians of bygone centuries
this bestowal of £10,000 by Parliament upon Jenner did not add
materially to his comfort; in the long run it rather detracted from it.
Some of his friends, shortly after he had received the Parliamentary
grant of money, induced him to give up his country practice and
establish himself in the fashionable part of London; they maintained
that his widespread reputation as the discoverer of vaccination and as
the physician most capable of conducting this operation in the safest
and most effective manner, would speedily bring him a large increase in
private practice. Such, however, did not prove to be the case; and
Jenner—who, unfortunately, had been overpersuaded to follow this
advice,—after the lapse of three or four years, and appreciating the
fact that his income was not large enough for such a style of living,
removed his residence, first to Cheltenham and not long afterward to
Berkeley. He died of cerebral apoplexy in the spring of 1823.
A medal commemorating the discovery of vaccination is pictured in the
figure which faces page 108.
------------------------------------------------------------------------
BOOK VI
AWAKENING OF THE CHEMISTS, PHYSIOLOGISTS
AND PATHOLOGISTS
------------------------------------------------------------------------
CHAPTER XIII
THE ENGLISH AND FRENCH CHEMISTS CONTRIBUTE THEIR SHARE TOWARD THE
ADVANCE OF MEDICAL KNOWLEDGE
During the latter part of the eighteenth century the chemists of England
and France manifested a new and decidedly stronger interest in their
branch of natural science; indeed, they seemed to have suddenly
appreciated the fact that observation and experience afforded the only
route by which they might secure a genuine and useful increase of their
stock of knowledge. In the departments of physiology and pathology, for
example,—not to mention also that of therapeutics,—there were at that
period many questions which still remained unsettled and which could not
be satisfactorily answered until a further advance had been made in the
existing knowledge of chemistry. Hence the great importance of the
movement to which I have just referred. To cite only one of these
unsettled questions I will mention here that relating to the nature of
the change which occurs in the blood when it loses its venous hue after
passing through the lungs, and also, _vice versa_, when it loses its
arterial color after passing through the tissues in other parts of the
body. Harvey’s discovery had gone no further than to reveal the pathway
of the blood in its winding course throughout the body, but now
physiology demanded an explanation of the changes which this fluid
undergoes in its travels along that pathway. The answer to this last
question, as will now be shown, was not gained through the efforts of a
single individual but by the researches that were made by several very
able English and French scientists, more particularly by Joseph
Priestley, the English chemist, and by Lavoisier, the French biologist
and chemist. During the preceding fifty or sixty years the physicians of
Europe had been obliged, for want of a more satisfactory explanation, to
accept Stahl’s phlogiston theory (that all combustible materials contain
an element to which he applied the name of “phlogiston”), at least as a
basis or starting-point for the desired explanation.
* * * * *
JOSEPH PRIESTLEY, who was born at Fieldhead, near Leeds, England, in
1733, received his early education at a Dissenting school; and in 1755
he became a Dissenting minister at Needham Market. So far as the
available evidence affords any clear indication of Priestley’s bent of
character the inference is permissible that he was first and chiefly a
scientist, but yet possessing a profoundly religious type of mind which
the influences surrounding his boyhood doubtless helped to intensify.
Thus, during his ministerial work he managed to devote a large part of
his time to original investigations in the domain of chemistry; and, as
early as in the year 1774, he succeeded in obtaining a gaseous product
to which he gave the name of “dephlogisticated air.”[16] A detailed
description of this discovery of oxygen—the name which was given to the
new gas at a later date—will be found in Vol. 2 of the second edition of
Priestley’s “Experiments and Observations on Different Kinds of Air,”
London, 1784. Broadly speaking, Priestley obtained the new product by
heating the red oxide of mercury. Subsequently he discovered that
respiration took place more easily, and that combustion progressed more
actively, in the presence of this gas. But it is to the French chemist
Lavoisier that we owe the knowledge of the full significance of oxygen.
On the other hand, it was the English chemist Cavendish who confirmed
Priestley’s discovery that atmospheric air is composed of water and
different acids. Lavoisier, it is claimed, discovered that all the acids
which he examined contain oxygen.
Speaking, at a later date, of his attempt to produce a work on the
chemistry of the air, Priestley says: “I find it absolutely impossible
to produce such a work that shall be anything like complete. My first
publication I acknowledged to be very imperfect, and the present, I am
as ready to acknowledge, is still more so. But, paradoxical as it may
seem, this will ever be the case in the progress of natural science, so
long as the works of God are, like himself, infinite and inexhaustible.
In completing one discovery we never fail to get an imperfect knowledge
of others, of which we could have no idea before; so that we cannot
solve one doubt without creating several new ones. Travelling on this
ground resembles Pope’s description of travelling among the Alps, with
this difference, that here there is not only a _succession_, but an
_increase_ of new objects and new difficulties.”
Here is the description to which Priestley refers:—
So, pleas’d at first the tow’ring Alps we try,
Mount o’er the vales, and seem to tread the sky.
Th’ eternal snows appear already past,
And the first clouds and mountains seem the last,
But, those attained, we tremble to survey
The growing labours of the lengthen’d way.
Th’ increasing prospect tires our wand’ring eyes,
Hills peep o’er hills, and Alps on Alps arise.
On the 14th of July, 1791, there occurred a serious riot at Birmingham,
where Priestley was at that time settled as a Dissenting minister. On
that day a banquet was being given in honor of the French Revolution,
those who organized this feast being in large measure Episcopalians.
There were numerous fraudulent cards of invitation which, rumor said,
were issued by Priestley. On the occasion itself numerous toasts were
offered in which sentiments antagonistic to those generally entertained
by the originators of the feast, were expressed. As the festival
progressed the crowd became more and more excited and everybody seemed
to be imbued with the idea that in some way or other Priestley was mixed
up in the matter. The truth was, however, he had nothing whatever to do
with it, was not present at the banquet, and even did not know that such
a feast was being given. Nevertheless, the crowd would not listen to
reason, and insisted that Priestley was the cause of the whole trouble.
Accordingly they secured lighted torches and hastened to Priestley’s
house which was located about half a mile from the city limits, and
proceeded to set it on fire. Thus were destroyed, in the course of a few
minutes, all his books, all his valuable scientific apparatus, all the
registers of experiments covering a period of eleven years of
unremitting toil. Priestley, who was then nearly seventy years old, lost
practically everything that he possessed. For three days the rioting
continued, many of the houses of Priestley’s friends being also
destroyed by fire. Even the daily newspapers asserted that among
Priestley’s papers were found evidences showing that a great conspiracy
existed,—but for what evil purpose it was not stated. Insults of all
sorts were heaped upon the innocent man, until finally he was compelled,
by the situation of affairs in Birmingham, to leave the country.
Fortunately for him, Priestley’s brother-in-law left him in his will the
sum of £10,000 and also an annuity of £200. Thus provided for, Priestley
left England in 1794 and settled in Pennsylvania. His death occurred in
1804.
* * * * *
ANTOINE LAURENT LAVOISIER was born in 1743 at Paris, and at an early age
displayed a fondness for serious scientific studies. In 1768, although
he had attained only his twenty-fifth year, he was chosen a member of
the French Academy of the Sciences; and a very short time afterward he
received the appointment of _Fermier Général_ (Government Collector of
Taxes), an appointment which showed how highly he was esteemed for his
ability as well as for his integrity. At first, Lavoisier, like nearly
all his contemporaries, accepted Stahl’s phlogiston doctrine and his
views with regard to animism (see pp. 432 and 433 of my work entitled:
“The Growth of Medicine”); but gradually he entertained more and more
serious doubts with regard to their correctness, and finally he came out
boldly as an opponent of these doctrines. The experiments which he
himself made, as well as those which were carried out by other
scientists of the same period, forced him to conclude that, in all
chemical processes, no such thing as an actual creation of something new
takes place, nor is anything ever lost. This truth, he claimed, applies
as well to living beings as to inanimate objects. In the middle of the
eighteenth century the treatises on chemistry did not acknowledge this
teaching as true. Vauquelin, for example, pointed to what he believed to
be a fact, viz., that animals actually produce lime, inasmuch as hens—so
he claimed—produce more lime than they ingest with their food.
Lavoisier’s remarkable experiments showed that Stahl’s doctrine of
animism, as well as the phlogiston theory, was untenable. Stahl
maintained, for example, that there exists in all combustible bodies a
special element which is set free during the combustion of such bodies,
and to this element—as I have already stated on a previous page—he gave
the name of “phlogiston.” Lavoisier, on the other hand, made it clear
that combustion represents simply the combination of the two elements,
carbon and oxygen; and at the same time he showed that the act of
respiration in animals is a species of combustion, in the course of
which oxygen combines with certain elements of the body to form water
and carbonic acid. He did not, however, rest satisfied with these
results, but—aided by Seguin—pushed his experiments to the point where
he demonstrated the quantities of gas expired both by man and by
animals; thus greatly increasing our knowledge of the phenomena of life.
Furthermore, Lavoisier was also the discoverer of a method of analysis
(still employed to-day) by means of which it is possible to demonstrate
the important fact that all organic bodies are composed of carbon,
hydrogen and oxygen, sometimes in association with azote (lifeless
matter). In a word, he brought physiological chemistry to such a stage
of perfection that his successors have been able only to make additions
to the facts which he discovered, but not to alter them in any essential
respect.
Lavoisier’s mind seemed always preoccupied with questions relating to
the grandeur and progress of humanity in its entirety. Here is a single
example of the truth of this statement:—
When he learned from his own observations that the exhalation of
carbonic acid increased during physical work, he drew the
conclusion that men who are obliged to perform severe labor
stand in need of a more abundant nourishment than is required by
ordinary workmen in order to recover the carbon which had been
expended in their severe labors; and he immediately urged that
an effort be made to furnish the working class with better
nourishment. The public functionary—he wrote at the end of his
treatise on respiration (published in 1789)—is not the only
individual who works for his country. The man of science, he
added, is also fulfilling his patriotic duty when he teaches, by
his investigations, how the misery which exists in the world may
be alleviated. And if he accomplishes nothing more than to add a
few years, or even only a few days, to the average duration of
the life of man, he still may with justice claim the right to be
given the glorious title of “benefactor of humanity.” (J.
Rosenthal.)
France, at the time when Lavoisier wrote his treatise on respiration,
was in the throes of a great revolution, out of which came the Republic.
But this republic showed no gratitude to Lavoisier for the services
which he had rendered to his country; for, on the 8th of May, 1794, it
executed him without any specific charge having been brought against
him, simply because he had held the hated office of Government Collector
of Taxes. When one of Lavoisier’s personal friends, just before the
prisoner was removed to the guillotine, called the judge’s attention to
his scientific merits, this functionary replied: “We no longer have any
use for men of science.”
Before closing this necessarily brief and somewhat superficial account
of the work accomplished by the great French chemist, Lavoisier, I must
beg permission to refer very briefly to the views which he entertained
on the subject of heat-production. The chief significance of these
studies of the fundamental phenomena of animal life is this: they
afforded for the first time a solid basis for the theory of
heat-production in living animals. This theory, formulated in greater
detail, may be stated in the following terms, which I copy in all
important respects from the memoir published by Rosenthal:—The tissues
which compose the body of the animal, and which are themselves composed
of carbon, hydrogen, oxygen and azote, possess the power of assimilating
a further quantity of oxygen, a quantity somewhat greater than that
which they already contain; and, by reason of this fact, they are able,
as combustion advances, to accomplish two things—_first_, to combine
with the surplus oxygen furnished by respiration; and, _second_, to form
carbonic acid, water and certain azotic matters that are discharged from
the body. It is this process of combustion which gives rise to heat in
the animal’s body and in addition is associated with a certain loss in
its weight. This loss, however, is limited, for the furnishing of new
elements is going on simultaneously with the casting off of the old,
thus restricting the loss of weight.
It is to Lavoisier that the imperishable honor belongs of
formulating the chemical theory of respiration, and of thereby
founding a new era in physiology—the modern era. (Claude
Bernard.)
Too much stress cannot be laid upon the truth of this declaration made
by Claude Bernard, the great modern authority in physiology, concerning
this, the most important advance secured for the science of medicine
during the eighteenth century. But alas! many years had to elapse before
the physiologists of that period were able to appreciate the importance
of Lavoisier’s discovery. Very soon after the announcement of this new
theory the leading chemists of Europe returned almost as a single body
to the old phlogiston doctrine.
Lavoisier’s portrait is shown in the frontispiece of the present volume.
------------------------------------------------------------------------
BOOK VII
MEDICINE IN ENGLAND
------------------------------------------------------------------------
CHAPTER XIV
ENGLISH LEADERS IN MEDICINE AND SURGERY DURING THE EIGHTEENTH AND EARLY
NINETEENTH CENTURIES
FIRST GROUP: FOTHERGILL, ABERNETHY, JAMES AND JOHN DOUGLASS, PERCIVAL
POTT AND SIR ASTLEY COOPER
The desire to start the science of medicine on a new course of growth
seemed to develop at the same time in England that it did on the
continent of Europe—that is, during the first half of the eighteenth
century. The prolonged wars had for a long period of time turned men’s
thoughts entirely aside from scientific inquiries of any kind; but, the
moment the outlook seemed bright for a renewal of peaceful relations
between the warring nations, there arose, among the men of the different
sciences, a strong impulse to resume their normal labors in the various
fields of research. Some of the evidences of the truth of this statement
have been furnished in the earlier pages of the present work, and
already, during the period which we have now reached in this brief
historical sketch, the proofs are not lacking that the first fruits of
this new harvest are before us and that we may safely form some idea as
to their quality.
Of those who should be classed as physicians Fothergill and Abernethy
certainly deserve to be named first. The latter, I am well aware, is
usually classed among the surgeons, and he certainly deserves to be so
classed; but he seems to me to occupy an equally high position as a
medical philosopher.
* * * * *
JOHN FOTHERGILL, one of the most distinguished English physicians of the
eighteenth century, was born at Carr End, Yorkshire, March 8, 1712. He
received his early medical training at Edinburgh, under the teaching of
Monro, Alston, Sinclair and Plummer, all three of whom had been pupils
of Boerhaave, at Leyden, Holland, and was given the degree of Doctor of
Medicine by the University of Edinburgh, in 1736. During the years
immediately following this event, he visited in turn the principal
medical schools of Holland, Germany and France, and then settled
definitively in London. In 1746 he met with marked success in the
treatment of an epidemic of “putrid sore-throat,” which was raging in
England at that period, and which showed a tendency to develop into a
gangrenous condition. The physicians of that day employed largely
purgatives and bloodletting in their treatment of this disease, but
Fothergill depended mainly on the cautious use of emetics, mineral
acids, bitters and light wines, the favorite practice among Spanish
physicians. The success which attended his plan of treatment brought
Fothergill a great increase in reputation as well as in fortune; and
thus he was able, in 1762, to purchase at Upton, in Essex, a large tract
of land which he developed into a splendid garden, where exotic plants
of all sorts were cultivated. He also gathered at this place a very
large collection of zoölogical and mineralogical specimens, which in the
course of time became one of the most complete that was to be found
anywhere in England. From 1765 onward, in order to relieve his health
from the almost constant strain of so much business, he adopted the
habit of absenting himself from London, regularly every year, for a
period of two months; and with this object in view he chose for his
retreat an attractive residence near Carr End, the town in which he was
born. He died on December 26, 1780, at the age of sixty-nine, and
bequeathed his entire fortune—aside from a modest stipend which he left
to his sister—to the poor. The inscription written on his tombstone
reads as follows: “Here lies Doctor Fothergill, who spent two-hundred
thousand guineas for the relief of those in distress.” “I do not
believe,” said the immortal Franklin, “that there ever existed a man who
was better entitled to receive the esteem and veneration of all mankind
than was Fothergill.” (Vicq-d’Azyr, in the Report of the Société Royale,
of Paris.)
Fothergill did not write a single large treatise, but he published, in
the Philosophic Transactions and elsewhere, no fewer than forty-one
short memoirs on a great variety of topics.
* * * * *
JOHN ABERNETHY was born of Irish parents about the year 1764. In 1787 he
was appointed Assistant Surgeon at St. Bartholomew’s Hospital, London,
and was promoted to the position of Surgeon in 1815. From that date to
1827 he served the hospital with great distinction, attaining wide
celebrity as a daring and skilful operator and also as a lecturer of
great power. In his lectures he laid much stress upon two principles:
First, that local diseases had a constitutional origin; and, second,
that this origin could generally be traced to disorders of the digestive
system.
George G. Sigmond, M.D., contributed to the _London Lancet_, of November
11, 1837, a brief but most satisfactory biographic sketch of Abernethy,
and from this I copy such portions of the text as are likely to convey
to my readers a more perfect picture of this great physician and surgeon
than I could possibly provide by resorting to a mere compilation of the
facts. Here is his account:—
Few individuals who have adorned our profession, possessed a
more clear and accurate knowledge of the principles of our
science than Mr. Abernethy, and no one ever explained them with
greater simplicity, or with less of the entanglement of
barbarous and uncouth names; he was, to the highest degree,
plain, and, therefore, thoroughly intelligible. He had none of
the deep learning and research of his two contemporaries, Dr.
Young and Dr. Mason Good, but he was infinitely their superior
in the explanation of his views, for he did not, as they have
done, encumber his writings with the hard and unintelligible
phrases of the Greeks, nor did he attempt to establish systems
founded upon artificial arrangements. He watched the powers of
Nature, he recalled the surgeon to the path of physic, he showed
to him the effect of local disorders upon the constitution, and
the reciprocal operation of constitutional disorders upon local
diseases; he pointed out that the digestive organs may be
affected by local disorder, and that upon the due functioning of
these organs the health of man mainly depends. His object was to
excite, by means of medicine, a more copious and healthy
secretion.... To the knowledge of the necessity of great
attention to the excretions, may chiefly be attributed the
increased longevity of man, and his freedom from many of the
diseases of former days.
Mr. Abernethy’s mode of pursuing his mercurial course [calomel
and blue pill] was cautious and regular. He prescribed only
small doses, taking care that the error so often fallen into, of
increasing the quantity, when any benefit was perceptible,
should be avoided.
His death occurred in 1831.
* * * * *
JAMES DOUGLASS, who was born in Scotland in 1675, died in London in
1742. During his residence in the English metropolis he practiced
midwifery and taught anatomy. He was one of those exceptional men (like
John Hunter, for example) who were able both to practice the art of
medicine and to do a great deal of research work. Among other things he
interested himself in the history of medicine and also took high rank as
a botanist. The following list of the titles of some of his more
important contributions to medical literature illustrate his great
versatility:—“_Myographiae comparatae Specimen_,” or “a comparative
description of all the muscles in a man and in a quadruped,” London,
1707; “Description of an Instrument for Extracting Teeth,” in the
Philosophical Transactions, Vol. V.; “History of the Lateral Operation
for Extracting the Stone by making a Wound near the Great Protuberance
of the Os Ischii,” London, 1726; “A Description of the Peritonaeum and
of that part of the membrana cellularis which lies on its outside, with
an account of the true situation of the abdominal viscera,” London,
1730; “Appendix to the History of the Lateral Operation for the Stone,”
London, 1731.
* * * * *
JOHN DOUGLASS, a younger brother of the preceding, also became
celebrated as a surgeon. He lived in London, was connected with the
Westminster Hospital, and attained special distinction through his
having revived—after the lapse of nearly two centuries—the suprapubic
operation for stone in the bladder (Pierre Franco’s “_haut appareil_”).
His first operation of this nature was performed in 1719. John Douglass
died in 1759.
His best-known published treatise bears the title: “Lithotomia
Douglassiana,” or a “New Method,” etc., London, 1719.
* * * * *
PERCIVAL POTT was born at London on December 26, 1713. Four years later
his father died, leaving his widow and son in possession of very scanty
means. In 1729, when sixteen years of age, Percival was bound an
apprentice to Mr. Nourse, one of the younger surgeons of St.
Bartholomew’s Hospital and a lecturer on anatomy in a private medical
school which he established in the heart of London. As it was Pott’s
duty to prepare the subjects for demonstration he thus enjoyed unusual
opportunities for grounding himself well in the knowledge of anatomy. At
the same time, through his relationship with Mr. Nourse, he found
unlimited opportunities in the hospital for witnessing surgical
operations and for becoming thoroughly familiar with disease in its
different forms. English surgery at this early period was very crude and
unscientific, and—as will be readily understood—most painful. In his
study of different surgical affections Pott followed the plan advocated
by Lord Bacon, viz., to take up one subject or one region of the body at
a time and to devote all his attention to that particular subject or
region until he had exhausted all available sources of information
relating to the subject.
In 1736, having finished his apprenticeship, he began at once making the
necessary preparations for entering upon the practice of his profession.
For his residence and place of business he rented an attractive-looking
house in a good part of London, and took with him his mother and her
daughter by her first husband. Thanks to the brilliancy of his talents,
to an untiring industry and to an attractive personality and agreeable
manners, he soon won for himself a considerable clientèle; while at the
same time acquiring many friends among the most influential members of
his own profession as well as among the élite of London society in
general. These early friendships, says his biographer, proved to be
permanent; indeed, it may be claimed that few physicians acquired and
retained through life more firm or more respectable friends.
In 1744 Pott was elected an Assistant Surgeon, and in 1749 one of the
Principal Surgeons, of St. Bartholomew’s Hospital. From 1744 to 1787 he
was unremitting in the surgical work which he performed in this
institution. One of the most important services which he rendered to the
science of medicine may justly be said to consist in the additions which
he made to the scanty knowledge of that period concerning the nature and
proper treatment of that disease of the spinal column which for many
years has borne the name—in honor of this distinguished surgeon—of
“Pott’s disease of the spine.” His first published memoir concerning the
disease was published in 1779; but it was, as might be expected, only a
preliminary sketch of the subject. Four years later he gave a complete
description of this affection, the importance of which had for such a
long period not been properly appreciated. In 1786 he received from the
Royal College of Surgeons in Edinburgh a diploma accompanied by a letter
expressive of the high degree of appreciation in which he was held by
that institution. This honor was greatly enhanced by the fact that Pott
was the first person on whom it had been conferred.
Pott’s biographer (Sir James Earle, Surgeon Extraordinary to the King)
places the following estimate upon his character and upon his
attainments as a surgeon:—
He was the most eminent of his time as a writer, as a teacher,
and as a practitioner in surgery; and his merits in each of
these characters were most extensive. Possessed with an
enthusiastic love of excelling, without which genius is inert,
he was not contented with any kind of mediocrity in himself.
As an author, his language is correct, strong and animated....
He introduces anatomy and physiology, whenever it is necessary,
to illustrate and distinguish diseases; but never confuses his
reader with uncertain hypotheses in pathology, founded on
physiological principles. He was of opinion, and it is the
opinion of Newton, that hypothesis has no place in any physical
science.... His remedies always strongly marked his intention;
they were decided and consistent; and he was the principal
author of that simplicity which distinguishes the present
practice from that of our ancestors....
As a teacher, he had acquired the faculty of speaking readily,
with great point and energy, of delivering the most prolix and
intricate sentences with incredible perspicuity and correctness,
and of enforcing what he said with a most harmonious and
expressive elocution....
As a practioner in surgery, we must apply to him all the
essential qualifications—sound judgment, cool determination and
great manual dexterity....
In the transaction of business there was a freedom and openness
in his manner, which evidently arose from a consciousness that
the opinion which he delivered was founded on experience....
This conduct in all situations was an appeal to the good sense
of mankind. Thus he acquired the universal confidence of the
profession; and, without any accidental or external help, he
raised himself to the greatest dignity which man can attain—the
first rank in a liberal profession.
Percival Pott wrote a treatise on the necessity of amputation in certain
cases, and in this he strongly refutes the opinion of a Prussian army
surgeon who maintained that in almost any case it was not necessary to
amputate. The title of the treatise in which this opinion is expressed
is “_De membrorum amputatione rarissime administranda, aut quasi
abroganda_.” Shortly afterward Dr. Tissot, of Lausanne, Switzerland,
spoke in even stronger terms against this surgical procedure, even going
so far (see his treatise entitled “_Sur l’inutilité de l’amputation des
membres_”) as to urge surgeons to abandon the “murderous and cruel
method of amputation”—Pott’s criticism of the views expressed by these
two writers is most charitable: “However, as we must suppose that the
doctrine which these gentlemen have promulgated arose from humane
motives, and upon a conviction of its being well founded, we must at
least applaud their intention, though we cannot approve their judgment.”
* * * * *
ASTLEY COOPER was born at Brooke, in Norfolk, England, August 23, 1768.
As a boy he was fond of all the sports that are commonly cultivated at
English schools, and even at that early age he manifested a bold and
enterprising spirit, and yet at the same time he was noted for his
social and friendly spirit. His biographer, Pettigrew, who witnessed
many of the operations which Sir Astley performed at Guy’s Hospital in
the earlier years of his career, speaks in strong terms concerning the
impression which he made upon the regular pupils and the casual
physicians who from time to time attended him on his rounds through the
hospital:—
I can never forget the enthusiasm with which he entered upon the
performance of any duty calculated to abridge human suffering.
This enthusiasm, by the generosity of his character, his
familiar manner, and the excellence of his temper, he imparted
to all around him—the pupils imbibed the same spirit; and the
extent of the obligations of the present and of after ages to
Sir Astley Cooper, in thus forming able and spirited surgeons,
can never be accurately estimated.
He was the idol of the Borough School—the pupils followed him in
troops, and, like to Linnaeus, who has been described as
proceeding upon his botanical excursions accompanied by hundreds
of students, so may Sir Astley be depicted traversing the wards
of the hospital with an equal number of pupils, listening with
almost breathless anxiety to catch the observations which fell
from his lips upon the several cases presented to his view. But,
on the days of operation, this feeling was wound up to the
highest pitch—the sight was altogether deeply interesting; the
large theatre of Guy’s crowded to the ceiling—the profound
silence obtained upon his entry—that person so manly and so
truly imposing—and the awful feeling connected with the
occasion—can never be forgotten by any of his pupils. The
elegance of his operation—without the slightest affectation—all
ease—all kindness to the patient, and equally solicitous that
nothing should be hidden from the observation of the
pupils—rapid in execution—masterly in manner—no hurry—no
disorder—the most trifling minutiae attended to—the dressings
generally applied by his own hand ... Sir Astley was, at that
time (about 1805–1810), decidedly one of the first operators of
the day, and this must be taken in its widest sense, for it is
intended to include the planning of the operation, the precision
and dexterity in the mode of its performance, and the readiness
with which all difficulties were met and overcome.
[Illustration:
SIR ASTLEY COOPER
(Copied from a print in the possession of the New York Academy of
Medicine.)
]
Among the contributions which Sir Astley made to the science of medicine
the following deserve to receive special mention:—In 1798 he published
the report of a remarkable case of strangulated hernia in which a part
of the abdominal viscera was protruded into the left cavity of the
chest, through an opening in the diaphragm. The viscera were much
displaced from their natural situation, and the great arch of the colon,
together with a large portion of the omentum, was pushed through the
aperture in the diaphragm. The existence of this opening, which
represented a congenital malformation, was first ascertained after
death. It seems almost needless to add that, even if this unusual
condition of the parts had been known during the patient’s lifetime, no
possible means of relief could have been afforded.
Another of Sir Astley’s contributions—one, namely, which he published in
1804—deals with the subject of inguinal hernia, a topic concerning which
very little was known before Cooper’s time. The Spanish surgeon,
Gimbernat, had—it is true—published at a still earlier date a masterly
description of the anatomy of the parts concerned in this form of
hernia, but the fact had been entirely forgotten until Sir Astley called
attention to its importance. Mr. Lawrence, the distinguished English
surgeon, makes the statement (1806) that “no complete description and
accurate delineation of even the common kinds of hernia, as the
inguinal, femoral, and umbilical, existed previously to the late
excellent works of Camper, Cooper, Scarpa, Hesselbach, Cloquet and
Langenbeck.”
In Vol. I. of the Transactions of the Medico-Chirurgical Society (1808)
will be found a report, by Sir Astley, of two cases of aneurism of the
carotid artery. Pettigrew says that the first of these two cases was
treated by ligature upon the vessel—the first of the kind on record, and
establishing a practice which has since been pursued and successfully
adopted. The second one of the two cases mentioned at the beginning of
this paragraph—also a case of aneurism of the carotid—was treated by
ligature and with a completely successful result. This patient lived
until 1821, at which time Sir Astley published an account of the
dissection made by him of the parts involved in the region of the
earlier aneurism.
Sir Astley Cooper is the first surgeon to whom we are indebted for the
performance of an operation designed to remedy in a measurable degree—in
a few cases even to cure—the malformation known as _Spina bifida_, a
condition which consists of a deficiency of the spinous processes of the
vertebrae by which the theca enclosing the spinal marrow distends and
protrudes to such a degree as to form a tumor, any opening into which
has been commonly considered as necessarily attended by fatal effects.
Sir Astley attributes the successful issue of the cases under his care
to the employment of needles, and not the lancet, to discharge the
fluid.
Many other instructive cases were reported by Sir Astley in later years,
but the lack of space does not permit me to mention them here. It is
enough for me to state that in his “Lectures on the Principles and
Practice of Surgery” (published by Mr. F. Tyrrell, Surgeon of St.
Thomas’s Hospital) very full details are furnished concerning all of Sir
Astley’s operative work.
Among the honors conferred upon this distinguished surgeon during the
later years of his life the following deserve to be mentioned: President
of the College of Surgeons in 1827; Surgeon to the King in 1828; and
Vice-President of the Royal Society in 1830. His income is said to have
risen in 1813 to the very large sum of £21,000 ($105,000). His death
occurred in 1841.
------------------------------------------------------------------------
CHAPTER XV
ENGLISH LEADERS IN MEDICINE AND SURGERY DURING THE EIGHTEENTH AND EARLY
NINETEENTH CENTURIES
SECOND GROUP: WILLIAM AND JOHN HUNTER AND SIR BENJAMIN BRODIE My
information concerning the Hunter Brothers is based upon data
which I found in Pettigrew’s “Medical Portrait Gallery,”
Parkinson’s “Hunterian Reminiscences,” and a few other
published documents.
WILLIAM HUNTER, the elder of the two brothers who attained such marked
distinction in the world of medicine during the eighteenth century, was
born in 1718 in the west of Scotland. During his early manhood he
devoted his attention to the study of theology at the College of
Glasgow; but, losing soon his interest in these studies, he turned his
attention to medicine, a branch of science which he found much more
congenial. His advance in this new field of labor was rapid, for already
at the age of twenty-eight he was invited by a society of naval surgeons
to deliver a course of lectures on operative surgery. Two years later
(in 1748) he became connected with the Middlesex Hospital and the
British Lying-in Hospital, and from that time forward his chief interest
was centred in obstetrics. Rising rapidly in public favor it was not
long before he acquired a large fortune. In 1764 he became Physician
Extraordinary to Queen Charlotte, and in 1768 was appointed Professor of
Anatomy in the Royal Academy.
His greatest work, which was begun in 1751 and published in 1783, bears
the title: “An Anatomical Description of the Human Gravid Uterus and its
Contents.” Pettigrew speaks of this work, which eventually comprised
thirty-four plates (drawn from Hunter’s dissections and engraved by some
of the best English engravers),
as one of the most splendid medical works ever published. It is
not, perhaps too much to say that the engravings have never been
surpassed.... A period of thirty years was necessary, to obtain
sufficient instances to develop all the changes occurring in the
human uterus during the progress of gestation.... The treatise
upon this subject was intended to be a separate production; but
Dr. Hunter did not live to publish it. It remained for his
nephew, Dr. Baillie, to submit this to the profession, which he
did in 1794, as an “Anatomical Description of the Gravid Uterus
and its Contents.”
One of Dr. Hunter’s cherished ideas was to establish in London an
anatomical school upon a most extensive scale; for, strange as it must
now appear, no regular courses of anatomy were given prior to 1746, and
as a consequence surgery and physiology made but slow advancement. As a
first step toward the realization of his pet scheme he submitted a
memorial to the Earl of Bute, the First Lord of the Treasury, setting
forth the great need of such a school, and furnishing with the memorial
a suitable plan for establishing a museum in which the necessary
instruction might be carried on. The memorial and accompanying plan were
submitted to the King, but the proposal eventually fell to the ground.
In view of the lack of interest manifested by the Government, Hunter
decided to devote his own fortune and the collections which he had
gathered up to that time to the establishment of the contemplated
school. Accordingly he purchased an extensive piece of property and
built upon it a large cabinet or institute in which every facility was
provided for anatomical work: laboratories, amphitheatre, etc. In his
will a provision was made that this institute with all its equipment
should remain in London until thirty years had elapsed from the date of
his death, and then it should be transferred to Glasgow. His death
occurred on March 30, 1783.
[Illustration:
WILLIAM HUNTER
(Copied from Thomas J. Pettigrew’s “Medical Portrait Gallery,” Fisher
& Son, London, 1838. The original portrait was painted by Pyne; the
engraving was done by J. Thomson.)
]
The institute which Dr. William Hunter founded was “for the improvement
of anatomical knowledge, surgery and physics,” and it may therefore with
justice be claimed that Dr. William Hunter was the founder of the
anatomical schools of Great Britain upon a rational and extended plan.
His nephew, Dr. Baillie, speaks of him as a teacher and scientific
worker in the following terms:—
No one ever possessed more enthusiasm for his art, more
persevering industry, more acuteness of investigation, more
perspicuity of expression, or, indeed, a greater share of
natural eloquence. He excelled very much any lecturer whom I
have ever heard, in the clearness of his arrangement, the
aptness of his illustrations, and the elegance of his diction.
He was, perhaps, the best teacher of anatomy that ever lived.
* * * * *
JOHN HUNTER, who was born July 14, 1728, was the youngest member of this
large family of children, and, as a natural result, his early education
was greatly neglected. Then, as a further misfortune, he lost his father
by death before he himself had attained his eleventh year. Although he
was regularly sent to school he did little else, up to the age of
twenty, but waste his time. Then, bored to death by the aimless sort of
life he was leading, and learning about this time what a fine reputation
his brother William was building up through the work that he was doing
in London, he asked him by letter whether he could not give him some
regular occupation in his laboratory, stating, at the same time, that if
he could not do this, he (John) would immediately enlist as a soldier.
William wrote to his brother to come on to London and he would see what
he could do for him. Immediately after John’s arrival in the great
metropolis he was given anatomical work to do, and, to the astonishment
of his brother William, he soon displayed such a remarkable degree of
skill as a dissector that there could no longer be any reasonable doubt
about his ability to gain eminence in this line of work; and so he was
encouraged to give it a full trial. William took special pains to point
out to his brother the best technical methods of procedure, and in every
possible manner aided him in his efforts to advance. Thus, for example,
he gained admission for him to Oxford University, and in due time
obtained opportunities for him to witness the operative work of the
leading surgeons in several of the London hospitals. With the lapse of
time, during the following years John became more and more closely
associated with his brother in his different activities,—lecturing in
his place whenever he was called away by other matters of importance,
making those beautiful anatomical specimens which even to-day are such a
striking feature of the Hunter Museum in London, and guiding the
students in their work of dissecting. But the field in which he
displayed a tireless activity, and in which up to the very end he gained
the greatest personal satisfaction from his labors, was that of
comparative anatomy and experimental physiology and pathology. It was in
this field that he performed the largest amount of original work, and
almost always with a view to learning how the different classes of
animals were equipped for the performance of one and the same function.
About the year 1761 his health began to give way and he was obliged to
spend nearly two years in efforts to regain it. With this object in
view, he accepted the position of surgeon in the army, and during the
period covered by the years 1761 and 1762 visited Belle-Isle, on the
west coast of France, and also Portugal. On his return to England with
improved health he resumed work on the anatomy of the uterus and
especially on the lymphatics of that organ, and made not a few actual
discoveries in this his new field. This work was conducted by him with
great zest, and as a result he soon began to be the recipient of honors
from different scientific societies. He was made a member of the Royal
Society of London, and associate of the Society of London Surgeons and
also of several German and French scientific societies, and Attending
Surgeon of St. George’s Hospital, Surgeon Extraordinary to the King,
Surgeon-General of the English Army, etc. In 1783 he experienced his
first attack of _angina pectoris_, and these attacks continued to occur
with increasing frequency until the final one, which ended his life on
October 16, 1793.
In his biographical notice of John Hunter, Odier quotes Lavater, the
famous physiognomist, as saying—after he had gazed for a few moments on
Hunter’s portrait: “This man is accustomed to do his own thinking.”
Lavater’s judgment, adds Dezeimeris, is amply justified by the facts.
“No matter what was the subject upon which he wrote—whether surgery,
medicine or physiology—he always added to it a certain measure of
originality. In reading his writings one is constantly tempted to
question the correctness of the opinion which one may have previously
formed with regard to the particular subject under consideration, and it
is in this respect—viz., by suggesting thought—that Hunter rendered very
great services to his art. And yet, at the same time, it is precisely in
his writings that the evidences of neglect in his early education stand
out in the strongest relief; a neglect which showed itself most
conspicuously in incorrectness, obscurity and slovenliness of style.”
(Dezeimeris.) This critic adds that ample proof of the correctness of
this judgment may be found in Hunter’s treatise “On the Blood and
Inflammation,”—a book which is “full of grand and beautiful ideas that
are literally choked in a chaos of conflicting conceptions, unfinished
phrases, new words or words used in a sense different from that in which
they are commonly employed.” I should add here, however, that the fault
of which the biographer last quoted complains appears to be entirely
absent in certain of Hunter’s reports of cases, as for instance in that
which contains the account of a fractured thigh. At the same time it
must be admitted that the physician who presumably prepared this report
from notes which he took when Hunter delivered the lectures upon which
the report is based, may have so edited the text as completely to
eliminate the objectionable features. In our ignorance of the exact
truth, it is more agreeable to assume that, in this particular instance,
the lecturer revealed his ability to avoid entirely the faults to which
the critic refers and to set forth the facts and his accompanying
comments with perfect clearness.
Here follows the report as it is printed in the “Hunterian
Reminiscences”:—
Granulation is not always confined to a breach of the solids by
suppuration; for parts are capable of making new animal matter
internally, in cases where it ought to have been healed by the
first intention. What gave me the first idea of this was the
following case, and the appearance observed on dissection, as
exhibited in the preparation of the parts.
CASE.—I was called to a man with a fractured thigh, and employed
the usual means, but without success, for no union of the
fractured parts was formed in the usual time; and at about the
end of four weeks the man died with some other complaint. Upon
examination of the parts I found that the upper end of the bone
rode considerably over the under, and, consequently, there was a
great cavity in the soft parts, the parietes of which were
thickened by the adhesive inflammation, though not so much as if
the parts had been better disposed for the adhesive
inflammation. There was no extravasated blood, nor matter, nor
coagulable lymph, to be found, except a few threads, which
probably were the remains of some extravasated blood. Here the
parts had lost two chances of being united, the one by the
extravasated blood, the other by the coagulable lymph thrown out
by the adhesive inflammation; and nature had here begun a third,
which was that of forming granulations of new animal matter on
the ends of the bones, and the surface of the surrounding
cavity; and adhesions, you see, have taken place between the
bones and soft parts, by which the bones would have been united
by bony case: hence we find that granulation may take place
without suppuration. This mode of union by granulation is much
more extensive, I believe, than has been imagined; this third
bond of union taking place when the parts have missed the first
and second, as just mentioned. In the exposure of cavities of
abscesses we have granulations going on hand in hand, and
following suppuration. As the suppurative inflammation follows
injuries with exposure, it seems that this inflammation is in
general necessary to granulation in these cases. Granulation is
an accretion of new animal matter, the old vessels being
extended, and new ones formed, the vessels passing from one edge
of the surface toward the other. Granulations are always of the
same nature with the part on which they are formed: if that is
diseased, as with any specific disease, so are they also. The
granulating surface is convex, and covered with prominent
points; the colour is of a deep florid red, but, when unhealthy,
is of a livid colour, which, perhaps, may be produced by the
circulation through them being exceedingly slow; this change of
colour may also be an effect of difference of position.
[Illustration:
JOHN HUNTER
(Copied from Thomas J. Pettigrew’s “Medical Portrait Gallery,” London,
1838. The original portrait was painted by Sir Joshua Reynolds; the
engraving was done by G. H. Adcock.)
]
Hunter’s biographer in the “New International Encyclopaedia” speaks of
him as a man of great industry, the boldest and best operating surgeon
of his day as well as the greatest anatomist known and a marvelous
zoölogist.
Some idea of the intensity of Hunter’s devotion to the cause of science
may be obtained from a perusal of the following incident, which is
related in A. M. W. Stirling’s “Coke of Norfolk and His Friends”:[17]
Epping Place may be said to have been the centre of his [Coke’s]
operations; and there was in these days a celebrated Irish giant
O’Brien or O’Bryne who came to live there solely for the sake of
joining Mr. Coke’s hounds whenever he allowed himself any
recreation. O’Brien was eight feet high in 1780 and apparently
went on growing, for in 1782 he measured two inches more and
after his death in 1783 he was found to measure eight feet four
inches, yet no other member of his family was unusually tall. He
was crazy about hunting and became so attached to Jones, Mr.
Coke’s huntsman, that he paid the latter a visit at Holkam and
was there solemnly introduced by Jones to Mr. Coke and his
guests. O’Brien’s end was curious. With extreme simplicity he
invested all his property in a single banknote of seven hundred
pounds which, needless to say, he lost; and grief at his loss
combined with excessive drinking brought about his death. John
Hunter, the celebrated surgeon, was extremely anxious to secure
his skeleton; and learning that the giant was dying he set his
men to watch the house in order to be sure of getting the body.
O’Brien hearing of this, and having a horror of being dissected,
left orders that his corpse should be watched night and day
until a lead coffin could be made, in which it was to be
conveyed to the Downs and sunk in twenty fathoms of water.
O’Brien died, and his body started for the Nee, escorted by a
walking wake of thirty Irishmen who drank deeply _en route_.
Howison, Hunter’s man, who watched closely, informed the surgeon
when he might catch the bodyguard off duty at the public house,
and Hunter went thither to bribe them. He offered fifty guineas
to one of the men to allow the body to be kidnapped, and the man
consented on his own account, but said that he must first
consult with his companions, who, perceiving Hunter’s eagerness,
raised their price, first to one hundred pounds and finally to
five hundred before they would agree. Hunter borrowed the money
to pay them, and the coffin consequently went on its way filled
with stones, while the body of the dead giant journeyed back to
London in a spring cart, until John Hunter’s own carriage met
it, after dark, and drove it to his house in Earl’s Court.
There, for fear of detection, he did not dare to dissect it;
but, separating the flesh from the bones by boiling and cutting,
he quickly skeletonized it. Hence in the Museum of the Royal
College of Surgeons may be seen, to-day, the skeleton—brown from
boiling—of the giant whose greatest joy when living was a gallop
with Mr. Coke’s hounds and the friendship of Mr. Coke’s
huntsman.
At the time of Hunter’s death, his museum contained 10,563 specimens and
preparations illustrative of human and comparative anatomy, physiology,
pathology and natural history. He died, however, in comparative poverty,
and his collection was purchased, two years after his death, by the
Government for £15,000 and was presented to the Royal College of
Surgeons.
John Hunter, says Pettigrew, had some very good ideas regarding the
educational training of the pupils who placed themselves under his
guidance. One of these is revealed in his practice of receiving certain
pupils into his house. In this way several of England’s most
distinguished physicians came to be, for varying periods of time,
inmates of his home, and among this number—to mention only a single
instance—was Dr. Jenner, the inventor of vaccination. One or more
physicians from the United States—if I am rightly informed—also enjoyed
this privilege. Valuable as this practice must have been to those who
were thus given the opportunity of frequent informal intercourse with a
most inspiring master, it certainly could not have been an easy matter,
even in those more primitive days, to fit these pupils into the régime
of the teacher’s home life; and, under the conditions of modern life,
the arrangement would certainly prove impracticable.
* * * * *
BENJAMIN COLLINS BRODIE was born at Milford, near Salisbury, England, on
June 9, 1783. In 1803, when he was twenty years of age, he became Sir
Everard Home’s pupil at St. George’s Hospital, London. Two years later
he began to assist Mr. Wilson in teaching anatomy, and during the
following four years he filled the position of Demonstrator of Anatomy.
In 1808, a year and a half before he began private practice, he was
appointed assistant to Sir Everard Home at St. George’s Hospital, and
retained the position up to the time (1822) when he was appointed full
surgeon at that institution. About six months after Mr. Brodie received
his appointment as Assistant Surgeon, he began lecturing on surgery and
continued giving instruction on this subject up to 1830. In addition, he
gave clinical lectures regularly to large classes, and this most
important part of his work, which he began in 1813, was kept up by him
through a long period of years. In 1819 he was appointed Professor of
Anatomy and Surgery to the Royal College of Surgeons, a position which
he held until 1823. In that year, upon the death of Sir Everard Home, he
was appointed one of the Serjeant-Surgeons to the King. Two years later
a baronetcy was conferred upon him, an honor which gave him the right to
be addressed as Sir Benjamin Brodie.
In the history of medicine one can find only a few instances of men who
were very clever surgeons and at the same time highly gifted
physiologists. A study of the life and writings of Sir Benjamin Brodie
reveals clearly that he is a conspicuous instance of this kind. The very
limited space at my command does not permit me to furnish more than a
few incomplete proofs of the truth of what I have just stated. Such are,
for example, the following:—
In 1810 Sir Benjamin Brodie delivered the Croonian lecture before the
Royal Society, the subject chosen being “On some Physiological
Researches respecting the Influence of the Brain on the Action of the
Heart, and on the Generation of Animal Heat.” His experiments, according
to the account given by his biographer, “go to show that if respiration
can be maintained, even artificially, the heart will continue to
contract with strength and frequency, even though the spinal cord be
divided from the brain.” Sir Brodie contrived an apparatus to effect
this, and at the same time carefully noted the circumstances connected
with the secretion of the urine, which in these experiments was found to
be suppressed. The conclusions he has drawn from this inquiry, conducted
with great precision and detailed with equal perspicuity, are the
following:—
1. The influence of the brain is not directly necessary to the
action of the heart.
2. When the brain is injured or removed, the action of the heart
ceases, only because respiration is under its influence; and if
under these circumstances respiration is artificially produced,
the circulation will still continue.
3. When the influence of the brain is cut off, the secretion
of urine appears to cease, and no heat is generated;
notwithstanding the functions of respiration and the
circulation of the blood continue to be performed, and the
usual changes in the appearance of the blood are produced in
the lungs.
4. When the air respired is colder than the natural temperature
of the animal, the effect of respiration is not to generate, but
to diminish animal heat.
In 1811 Sir Benjamin Brodie reported to the Royal Society the results of
various experiments which he made on the different modes in which death
is produced by certain vegetable poisons (for example, alcohol; the
essential oil of bitter almonds; the juice of the leaves of aconite; the
infusion of tobacco; the empyreumatic oil of tobacco; the curare; etc.).
During the following year he reported to the same society the results of
a similar series of experiments which he made upon the effects produced
by certain mineral poisons (for example, arsenic, muriate of barytes,
tartar emetic, and corrosive sublimate).
The preceding brief references to the experimental work carried on by
Sir Benjamin Brodie must suffice to show how thoroughly he deserved to
be ranked as one of the leading English experimental physiologists of
his day.
[Illustration:
SIR BENJAMIN COLLINS BRODIE, BART., F.R.S.
Sergeant Surgeon to the Queen
(Copied from Thomas J. Pettigrew’s “Medical Portrait Gallery,” London,
1838. The original portrait was painted by H. Room; the engraving
was done by J. Brain.)
]
Among Sir Benjamin Brodie’s contributions to the science of surgery are
many that may be classed as of the first importance. Such, for example,
are his researches respecting the diseases of the joints; his remarks on
a case of ununited fracture of the femur, in the course of which he
praises the method of treatment first proposed by Dr. Physick of
Philadelphia; his observations on the treatment of varicose veins of the
legs; pathological and surgical observations relating to injuries of the
brain—a contribution of very great value; and pathological and surgical
observations on the diseases of the joints. The latter treatise, which
already, in 1836, had reached its fourth edition, is mentioned by his
biographer as “a book which must ever form an essential part of the
library of every surgeon.”
Like all his predecessors who have given instruction in the art of
surgery, from John Hunter to Desault, Sir Benjamin Brodie laid great
stress upon the importance of an intimate knowledge of anatomy and
physiology—of the inseparable connection of these branches of science,
and of the interest derivable from a contemplation of the organization
and functions of animal bodies, the laws which regulate the phenomena of
life and the changes which matter undergoes, and the form which it
assumes when associated with this mysterious and active principle....
“He believes them to be incapable of explanation, except on the
hypothesis of there being in living bodies something superadded to
organization, without which, he says, ‘they would be as incapable of
executing their functions as the pendulum of a clock would be of
vibrating, or its wheels of revolving, if they were deprived of the
spring or weight, in which the cause of their motion resides.’”
(Pettigrew.)
The matters referred to above are only a few of those which Sir Benjamin
Brodie has discussed in so instructive a manner in the numerous short
essays and larger treatises which he published between the years 1809
and 1837. His death occurred in 1862.
------------------------------------------------------------------------
CHAPTER XVI
ENGLISH LEADERS IN MEDICINE AND SURGERY
SECOND GROUP (CONTINUED): SIR CHARLES BELL AND JOHN BELL
Among the contemporaries of Sir Benjamin Brodie there were several
London surgeons who, by reason of the important parts which they played
in building up this branch of the science and art of medicine, fully
deserve such consideration in the present review as my limited space
will permit, and also as the sources of information upon which I am
forced to depend for guidance may or may not prove helpful. Most
fortunately for me at this juncture of affairs was the finding—among the
rich treasures of the Medical Library of the former Transylvania
University, at Lexington, Kentucky—of Professor Roux’s account of a
visit which he made to the English metropolis in 1814 for the purpose of
learning at first hand precisely how the English surgeons of that day
were dealing with the more important problems which they were called
upon to solve. A more competent and fair-minded authority than Dr. Roux
could scarcely have been found at that time for the task which he set
before himself. In the first place he was himself an eminent surgeon, in
fact the Professor of Anatomy, Physiology and Surgery at the _Faculté de
Médecine_ of Paris, and at the same time he was wholly free from the
animosity which most naturally pervaded a large part of the French
nation in 1814 (just before the battle of Waterloo). And the very best
evidence that he performed his judicial task to the entire satisfaction
of the medical men of Great Britain is to be found in the fact that an
English translation of his elaborate report reached a second edition in
1816. I therefore feel confident that, in basing my résumé largely upon
Dr. Roux’s report regarding the condition of English surgery in the
second decade of the nineteenth century, I shall not go far astray from
the truth.
In his review of past events in the broad domain of surgery Roux says
that the English attribute the first idea of the circular amputation of
limbs to Cheselden, whereas the French give the credit for this
operation to J. L. Petit. Then there are other operations which were
devised or revived simultaneously by English and French surgeons—as, for
example, in external aneurism, the tying of the diseased artery above
the tumor (Desault and John Hunter), and the operation for _Fistula in
ano_—an operation which was brought to the greatest degree of simplicity
by Pott, Desault and some others.
On the other hand, there are many operations which were devised or
perfected exclusively by French surgeons—for example, the method of
extracting the crystalline lens, by Daviel; the treatment of fistula
lachrymalis by dilating the nasal canal; the treatment of strangulated
hernia by Goursand, Pipelet, Louis and others; the lateral operation
(perinaeal) for removal of a calculus in the bladder; the operation of
Frère Jacques; hypogastric lithotomy by Pierre Franco, and perfected by
Frère Côme; etc.
The English surgeons may similarly claim priority in proposing certain
operations, as for example, that of perforation of the _os unguis_ for
establishing an artificial passage for the tears, by Woolhouse;
Cheselden created the operation of the artificial pupil; he is also to
be credited with the operation of perforating the duct of Steno, on the
inside of the mouth and some distance from its natural orifice, for the
relief of salivary fistula; Pott’s description of and treatment for what
is known as Pott’s disease of the spine; etc.
Then, passing from what may be termed the history of ancient English
surgery, Roux devotes his attention next to the work which was being
done, at the time of his visit to London, by some of the leading
surgeons of that city; and among his most striking brief comments I find
the following: “There are many able surgeons in London at the present
time”; and “The English seem to have a strong taste for surgery.”
Farther on, he discusses at greater length the reasons why the English
surgeons maintain such pleasant relations with one another, and notes
with pleasure how greatly the prevalence of such professional harmony
conduces to the general advancement of the science and art of
surgery—or, for that matter, to the advancement of any art or science.
His words read as follows:—
If anything can contribute to keep alive the taste for an art or
science, to extend its progress, and to make a greater number of
men excel in it, is it not that those who cultivate it should
live in perfect intelligence together; that they should compose
one family; that they have frequent meetings with one another,
in which each one, sacrificing his own private interest, brings,
without pride or without presumption, the fruit of his own
reflections; that, strangers to the arts of intrigue, and, never
giving their minds to the vile insinuations of envy, they should
rival one another only in zeal and knowledge? Well, this
fraternal spirit, this absence of all jealous rivalry; and more,
an ardent desire to communicate, reciprocally, their views,
their thoughts, exists in a very high degree amongst the men who
are at this moment the honour of medicine and surgery at London.
This is what I have observed by being amongst them, I will not
say with surprise, but with the highest satisfaction. To these
common sentiments is joined, on the part of those men already
advanced in their career, an esteem altogether peculiar, for
those whose reputation is but beginning; and, on the part of the
latter, the greatest regard, the most sincere respect for those
who were their masters.
At this point I beg to remind my readers that effective surgical
anaesthesia had not yet at that early period been discovered, and this
fact, I scarcely need to add, must have deterred many men from
undertaking some of the more serious surgical operations.
At the end of Roux’s account he sums up the results of his observations
of English surgery in the following words:—
If I must conclude by a summary opinion, I would say that, with
respect to the art of surgery, as with respect to its habits and
institutions; in whatever light we consider it, England is the
place for contrasts. By the side of the most brilliant features,
English surgery exhibits glaring imperfections—French surgery is
more generally good.
While we are now considering various matters relating to the condition
of surgery in England and her colonies during the early part of the
nineteenth century, it may not seem out of place to mention here a
discovery which was announced just about that time, and which, I
suspect, is known to-day to comparatively few American physicians.
During the eighteenth century the opinion was widely held that
gonorrhoea is simply one of the manifestations of syphilis and that
consequently mercury is required for its cure. The existence of such a
belief among the physicians of that day explains the following statement
which I find printed in Vol. I. of the Quarterly Journal of Foreign
Medicine and Surgery for 1818:—“Dr. Francis Balfour, a physician highly
esteemed in Calcutta, states that when he was a student in Edinburgh he
attempted to establish the idea that gonorrhoea is a disease distinct
from syphilis and does not require mercury for its cure. He put forward
this doctrine in a paper which he presented to the Medical Society of
Edinburgh, and which still, we believe, graces its records. This was as
early as the year 1766. Next year he made it the subject of his
inaugural dissertation.... It was nearly twenty years after this period
that Benjamin Bell, by his ingenious and able investigations, supported
and further confirmed the opinion, and thus contributed much to bring it
into public notoriety and favour.”
At the time of Dr. Roux’s visit to London CHARLES BELL, who had taken up
his residence in that city in 1804, was already well advanced on the
high road to distinction as a surgeon. Born at Edinburgh, Scotland, in
1774, he had attained considerable reputation as an anatomist and
physiologist by the publication (1798–1800) (in association with his
brother, John Bell) of a very useful “System of Dissection of the Human
Body,” in which he describes not only the normal conditions but also the
alterations produced by disease. The text is interspersed with
instructive remarks concerning human physiology. Particularly clear and
interesting—says his biographer—are the descriptions which Bell gives of
the structure of the heart and blood-vessels. He refutes in strong terms
the teachings of Hunter regarding the vital force of the blood and the
doctrine of Crawford with regard to animal heat; and “his explanation of
the physiology of respiration is the clearest and most satisfactory of
any of the accounts that are to be found in the textbooks.”
In the domain of experimental physiology Charles Bell discovered, at a
later date, that, in the case of certain nerve trunks (_e.g._, the
trigeminus), what appeared to be a _single nerve_ was in reality made up
of two entirely different (physiologically speaking) nerves, one of
which is now termed the _portio major_, while the other bears the name
of _portio minor_. Bell also demonstrated experimentally the important
law that the anterior roots of the spinal cord nerves are the outgoing
(centrifugal) motor nerves, the posterior the incoming (centripetal)
sensible nerves. These results were subsequently fully confirmed by the
great German physiologist, Johannes Mueller. In ancient times the
question was often discussed whether one and the same nerve might not
carry both sensory and motor impulses. The discovery just mentioned is
one of the most important ever made in physiology.
Great as was the reputation attained by Charles Bell as an experimental
physiologist,—a reputation which won for him the honor of knighthood on
the accession of William IV. to the throne,—he soon, as was predicted by
Roux, became one of the most celebrated surgeons of London. His work as
an operator was carried on chiefly at the Middlesex Hospital. Roux
speaks of him as a “graceful operator without being affected.”
As an author he should be credited with the following
treatises:—“Anatomy of Expression” (1806); “System of Operative
Surgery”; “Animal Mechanics” (1828); “Nervous System” (1830).
[Illustration:
SIR CHARLES BELL
(Copied from a print in the possession of the New York Academy of
Medicine.)
]
Sir Charles Bell’s death occurred in 1842.
Sir Charles Bell’s older brother, JOHN BELL, born at Edinburgh in 1763,
was also a distinguished anatomist and surgeon. After traveling for a
short time in Russia and the north of Europe he returned to Edinburgh in
1786 and began to deliver lectures on surgery and midwifery. From this
time forward his private practice as a consulting and operating surgeon
steadily increased, until finally, in 1796, he was obliged to
discontinue his lectures and devote his entire time to his patients and
to the preparation of the several publications of which he was the
author. Early in 1816 he was thrown by a spirited horse, and was so
seriously injured that he never entirely recovered from the effects of
the accident. His death occurred in 1820.
Among the works which he published the following deserve to receive
special mention: “The Anatomy of the Human Body” (1793–1802), in the
third edition of which work (1811) are to be found a number of plates
that were drawn by his brother, Charles Bell; “Engravings of the Bones,
Muscles and Joints,” drawn and engraved by himself (1794); “The
Principles of Surgery” (1801–1808); and “Letters on Professional
Character.”
Speaking of the second volume of the first-mentioned work (“The
Anatomy,” etc.) Sprengel, the author of an important German history of
medicine, says: “It is remarkable in two respects, viz., for the unusual
number of interesting facts which it contains and also for the marked
excellence of the plates that accompany the text.”
------------------------------------------------------------------------
BOOK VIII
MEDICINE IN FRANCE
------------------------------------------------------------------------
CHAPTER XVII
BORDEU AND BICHAT; THE BEGINNING OF EXPERIMENTAL PHYSIOLOGY AND
EXPERIMENTAL PATHOLOGY IN FRANCE
THÉOPHILE BORDEU was born at Iseste, in the region of the Pyrenees, on
February 22, 1722. He received his preparatory education at the College
of the Jesuits, in Pau. Later, he entered the Medical School at
Montpellier, and received his doctor’s degree from that institution in
1744. After graduation he devoted much of his time to giving instruction
in anatomy, believing, as he did, in Seneca’s motto—“Doceo ut Discam” (I
teach in order that I may learn). Notwithstanding the demands made upon
his time by his private practice and by his numerous other engagements
(inspection of the mineral springs in the neighboring region, courses of
lectures to midwives, etc.) he managed to accomplish considerable
research work, and one of the first fruits of these original studies is
to be found in a _mémoire_ which he wrote on the articulations of the
bones of the face. This treatise, which he sent to the _Académie Royale
des Sciences_, was received with marked favor, as shown by the facts
that it was published by that body in their _Recueil des Savans
Étrangers_ and that its author was elected a Corresponding Member. In
this treatise Bordeu calls attention to the fact that all the bones
which form the background of the face are arranged in such a manner as
to offer efficient resistance to the repeated upward impulses of the
lower jaw, which impulses, acting upon the superior dental arch, have a
constant tendency to push upward or to drive apart outwardly the bones
into which the teeth of this arch are implanted. To appreciate fully the
very creditable character of this essay the reader must remember that
Bordeu had not yet reached his thirtieth year and that the ideas which
he sets forth in this essay are the strict product of his own thinking
and anatomical researches.
In 1752 Bordeu moved to Paris, and soon afterward published one of his
best contributions to the science of medicine, viz., a monograph
entitled: “_Recherches Anatomiques sur la Position des Glandes, et sur
leur Action_.” The publication of this important and exhaustive mémoire
occurred so soon after its author reached Paris that one is justified in
assuming that all or the greater part of the research work upon which
the essay is based was carried on at Montpellier. The object aimed at by
Bordeu in this _mémoire_ was to prove that
“the secretions which issue from these glandular organs
represent a veritable elaboration of the liquid the elements of
which are supplied by the blood, and are not merely a simple
separation, as the term ‘secretion’ would seem to imply. This
function,” says Bordeu, “is the result of the activities
belonging properly to the gland as an organ, and does not in any
sense—as some would have us believe—represent a mere mechanical
relationship between the blood-vessels of the gland and the
volume of the globules (blood corpuscles) that are carried into
the organ through them. Nor does the function represent in the
slightest degree the result of a chemical affinity between the
fluid product secreted and the substance of the gland.
Furthermore, the excretion (_i.e._, the expulsion) of this fluid
product is due wholly to the vital action of the glandular
organ; for it is a well-known fact that the adjacent muscles and
organs occupy such positions in relation to the glands
themselves that they are quite powerless to compress them and
thus to favor expulsion of the fluid which they have secreted.
Indeed, their influence is of quite the contrary character;
instead of compressing these organs in the manner claimed they
do no more than to communicate to them from time to time such
trifling shocks and movements as favor their glandular
activity.... Modern physiologists have added nothing of
importance to what Bordeu has set forth in this _mémoire_, which
deserves to be looked upon as one of the finest monuments that
has ever been erected in honor of the science of man.”
(Richerand.)
Bordeu’s _mémoire_, it seems, created a great sensation among the
physicians of Paris, many of whom were still at that period ardent
supporters of the mechanical and chemical doctrines taught by Boerhaave;
and, as a matter of course, there was also unbounded curiosity among the
better-educated physicians of the capital to see and make the
acquaintance of the newcomer—this “young athlete,” as Richerand calls
him,—who had not feared to enter the lists against such a formidable
array of adversaries. The marked popularity that fell to Bordeu’s lot as
a private practitioner in Paris after this brilliant beginning was not,
however, of long continuance. Professional jealousy rarely fails to
develop promptly when a physician manifests his ability to win patients
from those of his colleagues who, for a certain number of years, have
been established in practice, and this is precisely what happened in
Bordeu’s case. The new _mémoires_ which he published during the
succeeding years—one on the pulse (in 1756), a second on “Metallic
Colic” (in 1761–1763), a third on the “Colic of Poitou” (a year or two
later), and a fourth on the “History of Medicine” (in 1768)—showed
unmistakable evidences of the great talents which he possessed, but they
attracted comparatively little attention and did not add to his
popularity as a private practitioner. Furthermore, he derived very
little if any material advantage from his appointment as one of the
attending physicians at _La Charité_ hospital.
The last two years of his relatively short life were attended with not a
little suffering from attacks of gout, which compelled him to give up
his private practice and to live exclusively upon the scant income which
he derived from the small fortune (80,000 francs—$16,000) that
represented his savings from a practice that had apparently been quite
successful. His death occurred from cerebral apoplexy on November 23,
1776, when he was not quite fifty-four years old.
Bordeu did not live to see the ultimate triumph of his ideas with regard
to the true nature of the secretions supplied by glands. The careful
consideration of what this author has written upon the applications of
the accessory sciences (chemistry and mechanics) to physiology should
put us on our guard, says Richerand, against drawing incorrect
conclusions with reference to the nature of vital processes.
* * * * *
[Illustration:
BICHAT
]
MARIE FRANÇOIS-XAVIER BICHAT was born on November 11, 1771, at
Thoirette, France, in the Department of the Jura. His father, who was a
practicing physician at the neighboring town of Poncin, and who at the
same time held the office of mayor, was a man of considerable
cultivation. Cherishing, as he did, the hope that his son might
eventually adopt medicine as his vocation, he planned the latter’s
education with special reference to this possibility; and, as medicine
proved to be the very vocation which the son preferred, all this
well-planned training counted as so much valuable time gained. François,
who showed himself to be an apt scholar, made most satisfactory progress
in all the prescribed studies of early boyhood, and after passing
creditably through the regular course of the _Collège de Nantua_, a
thriving town among the western foot-hills of the Jura range of
mountains, he began the study of medicine at Lyons, in 1791. At first he
devoted himself almost exclusively to anatomy and surgery. Marc-Antoine
Petit, the celebrated surgeon of the Hôtel-Dieu of Lyons, was his
teacher in these branches of medical science, and from the very first
took special pains to aid his pupil in his studies in every possible
manner. François manifested an unusual degree of interest in anatomy, a
branch of medical science to which at that period only those who had the
intention of practicing surgery paid any attention; and in addition he
developed, almost at the very start, a strong disposition to learn the
precise purpose of each tissue and organ as it was encountered in the
course of his dissections. In other words, François-Xavier Bichat was
already, at the early age of twenty, making original investigations in
the department of physiology. This fact, says his biographer, should be
classed as something very remarkable, for, at the period which we are
now considering, practically not one of the students of medicine was
giving any thought except to the wonderful surgical work that had been
accomplished, a few years earlier, by the famous Parisian surgeon, J. L.
Petit (1674–1750), by F. de Lapeyronie of Montpellier (1678–1747), by S.
F. Morand of Paris (1697–1793), by the famous lithotomist, Frère Côme
(1703–1781), of whose achievements I gave a brief account in “The Growth
of Medicine,” and by another celebrated teacher of surgery in Paris,
viz., Pierre-Joseph Desault, who, during the period which we are now
considering occupied by far the most conspicuous position among the men
classed as healers of disease, and who, by the very prominence of his
position, compelled almost everybody who took any interest in medicine
to keep their eyes riveted on him. These and other circumstances that
happened to exist at that period strongly favored among the younger men
a leaning toward the career of surgeon. One of these favoring
circumstances was the need of army surgeons, for France was in the
throes of the French Revolution. It was therefore not strange that at
first Bichat devoted the greater part of his time and thought to the
fundamental work of a surgeon’s training. A little later he accepted a
subordinate position at the Hôtel-Dieu of Lyons, under Marc-Antoine
Petit, the head surgeon of that great hospital. Favored in every
legitimate way by this eminent and most kindly surgeon, young Bichat
made rapid progress. But there arrived a time, shortly after the siege
of Lyons, when it was no longer safe for a young man to remain in Lyons,
and so Bichat was forced to flee to Paris. There he joined the crowd of
students who were regularly following the practical instruction given by
Desault.
It was at that time an established custom in the medical school for
certain pupils, who had been previously selected for this work, to read
(in turn) to the assembled group of students, just before the arrival of
the attending surgeon, a _résumé_ of the previous day’s lecture. In this
way the man whose turn it was to read the _résumé_ which he had
prepared, secured a most valuable bit of training, and those who simply
listened were afforded an excellent opportunity for refreshing their
memories with regard to the lecture of the previous day. On these
occasions the First Assistant was always present and was therefore in a
position to report to his Chief just how successfully each reader of
such a review had performed the duty assigned to him. At one of his
lectures Desault entered more elaborately than usual into a description
of his manner of treating fracture of the clavicle, demonstrating among
other things the proper manner of applying what has since become known
as “Desault’s bandage.” The student who had been assigned to the duty of
preparing a _résumé_ of that day’s lecture happened to be absent on that
particular occasion, and so the First Assistant asked the members of the
class whether perhaps one of their number would be willing to act as a
substitute. Bichat volunteered his services, and he thereupon prepared a
_résumé_ which, when read on the following day, proved to be so clearly
expressed and covered the ground so thoroughly that the class, after
listening to it in profound silence, expressed its approval by the most
pronounced applause. When Desault was told by his First Assistant,
Manouty, of what had happened he was very impatient to make Bichat’s
acquaintance; and, after he had talked with the latter for a short time,
he became so impressed with the extent of the knowledge which he had
already acquired, with his earnestness of purpose, and with his
amiability of character, that he did not hesitate to invite him to
become one of his household. Indeed, the favorable impression which
Bichat made upon him led him promptly to decide that, if nothing
happened later to change the impression which he had first received, he
would do all in his power to make this young man his successor.
This kindly reception on the part of his honored preceptor made a deep
and most cheering impression on Bichat and stimulated him to put forth
his best powers to justify the confidence shown by Desault. At the
latter’s request he took charge of part of Desault’s private practice,
and he also accepted the position of Hospital Attending Physician to the
Outside Poor. Furthermore, he acted as Desault’s corresponding
secretary, answering for him all the requests for advice that came to
him from every district of France. Then, in addition, he assisted him in
all his operations in private practice. Finally, as if he were not
already burdened to the limit of his strength with all this mass of
work, he not infrequently spent a portion of the night in aiding Desault
to solve various problems in experimental surgery, problems relating
chiefly to diseases of the bones. Whenever a lull occurred in this
series of engrossing labors he devoted all the available time to the
performance of operations upon the cadaver and to experiments in
relation to physiological problems that suggested themselves to his own
mind.
Already as early as in 1797—that is, when he was twenty-six years of
age—Bichat gave his first course in anatomy. The room in which the
instruction was given was quite small, for he was confident that only a
few pupils would feel disposed to subscribe for such a course, and in
addition no provision for laboratory work had been made. At first, the
teaching was limited to simple demonstrations, but very soon discussions
with regard to physiological questions began to occupy some of the time
of the sessions. Finally, Bichat found it desirable now and then to
carry out experiments on living animals, in order to verify certain
seemingly well-known facts and also to determine the exact points at
which new investigations should be instituted. When this first course in
anatomy came to an end he surprised his friends by beginning a course on
operative surgery. “I wish,” he remarked to one of his intimates, “to
demonstrate that even a young man may be quite as capable as one of
mature age, to operate with the requisite degree of precision.” The
course proved a great success, and demonstrated perfectly the truth of
his statement.
Under all this strain upon his vital energy, it soon began to be
apparent that Bichat’s health was giving way, and it was not long before
a pulmonary or bronchial hemorrhage forced him to desist from his work.
At one time, indeed, his physical condition was such as to make his
friends fear for his life. In the course of a few months, however, he
seemed to regain his health; and then he forthwith made arrangements for
a much more complete course in anatomy than that which he had carried
through so successfully the year before. A laboratory provided with
accommodations for eighty dissectors was constructed, and, before the
course began, every one of these eighty seats was engaged. (This was in
1798.)
It was a great source of amazement to his friends—and it continues to be
a great source of amazement to the physicians of the present day—how
Bichat managed to accomplish successfully such a number of things as he,
at this early period of his life and with a decidedly precarious state
of health, had taken in hand.
One thing was now very noticeable, namely, that he was devoting a much
larger part of his time and attention to experimental physiology—that
is, to the phenomena and the laws of life—than he had hitherto done to
anatomy. After he had finished the work which belonged properly to the
daylight hours he devoted no small portion of the nighttime to the work
of revising the writings of his beloved teacher and friend, Desault.
Among the anatomical structures about which almost nothing was known
toward the end of the eighteenth century, but of which the structure and
functions were fully exposed to light by Bichat’s labors, the synovial
membranes deserve to receive the very first mention. His researches
concerning these membranes were first made known in the public lectures
which he was giving at that time to the medical students, but they did
not appear in print until a later date, viz., in the second volume of
the “_Recueil de la Société Médicale d’Émulation_.”
At a somewhat later period Bichat abandoned all further attempts to
cultivate either the knowledge or the practice of surgery, and
concentrated all his efforts upon the extension of our knowledge of the
principles of physiology. He made very careful researches into the
nature and functions of serous membranes, and published the results of
his labors in a volume which met with great favor at the hands of a
large part of the medical profession, and yet at the same time brought
out strong manifestations of envy on the part of other physicians. As
Buisson justly remarks, these manifestations of envy furnished the very
best sort of proof that Bichat, who paid no attention whatever to these
criticisms, had done his work remarkably well.[18]
In the same year (1800) Bichat published a third treatise, under the
title “_Recherches Physiologiques sur la Vie et la Mort_.” (A later
edition appeared in 1805.)
One day, as Bichat was descending the main staircase of Hôtel-Dieu, his
foot slipped and he fell in such a manner as to strike his head with
considerable force against one of the steps. When somebody came to his
assistance it was found that he was unconscious. In a short time,
however, consciousness returned, and Bichat was able, though with some
difficulty, to regain his home. On the following day he suffered from a
severe headache, but insisted, nevertheless, on making a few
professional calls. The exhaustion which he felt after making these
visits compelled him to take to his bed as soon as he reached his
residence. Death took place on the fourteenth day after the occurrence
of the accident; that is, on July 22, 1802.
Bonaparte, who was at that time First Consul of the French Republic,
gave orders, upon hearing the news of Bichat’s death, that a monument
should be erected in the vestibule of Hôtel-Dieu to commemorate the
distinguished services rendered to humanity in that institution by
Desault and Bichat. The following is the inscription which it bears:—
_Ce marbre dédié a la Mémoire des Citoyens Desault et Bichat a
été posé pour attester la reconnaissance de leur contemporains,
pour les services qu’ils ont rendus, le premier à la Chirurgie
Française dont il est le restaurateur, le second à la Médecine
qu’il a enrichée de plusieurs ouvrages utiles, et dont il eût
aggrandi le domaine si l’impitoyable mort ne l’eût frappé dans
sa 31me année.[19]_
Aside from his scientific attainments and from his untiring zeal in
prosecuting his researches in anatomy and physiology, Bichat possessed
certain traits of character which caused him to be greatly beloved by
his pupils. He was of a very kindly disposition, and it was not an easy
matter to excite him to anger or even to cause him to show impatience.
* * * * *
The first feeble beginnings of experimental physiology are to be
credited to the Swiss physician, Albrecht von Haller, whose death
occurred in 1777. Then followed, a few years later, the more serious
efforts that were made in the same field of scientific inquiry by John
Hunter, of England. The real birth of this new science, however, took
place in France, under the fostering care of Lavoisier, Bichat, Magendie
and others. The establishment in Paris, by Bichat, of a large laboratory
where such research work could be carried on advantageously, constituted
the first act in the creation of an organized experimental physiology.
Several years later (1867), Claude Bernard induced Monsieur Duruy, who
was at that time Minister of Public Instruction in France, to establish
at the _Jardin des Plantes_ a laboratory where general physiology might
be studied experimentally.
------------------------------------------------------------------------
BOOK IX
MEDICINE AT THE HEIGHT OF THE FRENCH REVOLUTION
------------------------------------------------------------------------
CHAPTER XVIII
TYPES OF FRENCH PHYSICIANS WHO FLOURISHED ABOUT THE TIME OF THE REIGN OF
TERROR
LOUIS-GUILLAUME LEMONNIER, member of the Academy of the Sciences and
First Physician of the King (Louis XV. and also Louis XVI.), was born at
Paris, June 27, 1717. His father and his brother were both of them
members of the Academy, the former in his character of Professor of
Physics at Harcourt, and the latter as one of the most celebrated
astronomers of France. At the age of twenty-two he was sent (1739), with
Carsini de Thury and Lacaille, to the south of France to extend the
meridian of the Observatory of Paris, the task of making scientific
observations along the route followed by his superior associates being
specially assigned to him. He noted the existence of mines of ochre,
coal, iron, antimony and amethysts in Auvergne, of mineral waters in
Mont-d’Or, and of mines of iron in Roussillon. He also made analyses of
the mineral waters of Barèges, and determined the poisonous nature of
certain species of mushrooms. In the same year he received the
appointment of Physician to the Hospital at St. Germain-en-Laye, near
Paris.
During this period of his career Lemonnier made the acquaintance of an
expert floral gardener by the name of Richard, and in his company soon
developed a keen interest in flowers and garden plants. The Duke of
Ayen, who was one of the King’s favorites and well known for his love of
flowers as well as for his boldness of speech in telling the truth to
the royal household, made frequent visits to Richard’s garden and in
this way acquired a friendship for Lemonnier, who entertained him
greatly with his talks about botanical matters and about the cultivation
of trees. As a result the Duke’s extensive park in time became the home
of rare plants and numerous species of noble trees, many of which were
still flourishing during Cuvier’s time. After a while Louis XV. was
induced by the Duke to accompany him on some of his visits to Richard’s
garden, and on one of these occasions the King asked that Lemonnier
should be introduced to him, as he wished to become acquainted with the
man who had so successfully aided the Duke in establishing an attractive
botanical garden. At this first interview Lemonnier made a most
favorable impression upon the King,—so favorable, indeed, that the
latter, after a few further interviews had taken place, placed this
physician and enthusiastic botanist in charge of the botanical garden at
the Trianon, in Versailles; and not long afterward he appointed him his
First Physician, a position which carried with it a liberal salary.
Cuvier, in accounting for the enthusiastic love for botany which
develops in certain men, makes the following remarks:—
In our dealing with plants nothing of a painful nature is
encountered; no sad images are ever presented to our eyes; there
is absolutely nothing to recall to our minds our passions, our
disappointments, our misfortunes; love is never associated with
jealousy, beauty exists without vanity, force is never
accompanied by tyranny, and death takes place without agony; in
brief, there is nothing to remind one of the human species.
The only use that Lemonnier made of his pleasant relationship with the
King was to secure his sanction of the plan of sending competent
botanists to different parts of the globe with instructions to bring or
send back rare plants, first to the Trianon garden at Versailles and,
after the death of Louis XV. (in 1774), to the Jardin du Roi (Jardin des
Plantes) at Paris. In accordance with this scheme men were despatched to
Persia, to the coasts and islands of the Mediterranean, to the banks of
the Euphrates, to Cayenne in South America, to the Atlas Mountains, to
Liban, to China and to the East Indies.
[Illustration:
Costume worn by Paris physicians in the eighteenth century.
(From Alfred Franklin’s “_La Vie Privée d’Autrefois_,” Paris, 1892.)
]
As Lemonnier was not in the habit of publishing anything on botanical
subjects, he was comparatively unknown to the public. Were it not for
this fact, says Cuvier, he would easily have taken rank among the most
celebrated botanists of France. When his friends chided him for having
neglected to avail himself of this mode of obtaining well-earned
recognition he replied that the time spent in instructing others is lost
so far as his own self-instruction is concerned. Furthermore, he was
timid in regard to publishing. “There is sure to be a great deal of
unjust criticism about anything a man may write, and I cannot easily
bear such injustice. I therefore prefer to keep silence.”
Upon the death of Louis XV. Lemonnier lost his position of First
Physician to the King and he was not reappointed by Louis XVI. until
1788. Thus, during a period of fourteen years, he was deprived of the
large salary which is attached to that position, and was obliged to live
upon the relatively small income which he derived from private practice.
During the continuance of his official connection with the Court he
invariably refused to accept any fees from those individuals who
belonged to the Court circle but yet held no official position. On the
other hand, he was most generous in giving the best of his service,
gratis, to the poor. As a consequence, his popularity among the lower
classes was very great. He reaped the reward for this disinterestedness
on the occasion when the mob, in 1792, invaded Versailles and carried
off the King and Marie Antoinette to Paris. As soon as the palace was
vacated Lemonnier sought safety in one of the small pavilions in the
adjoining park; but the rabble broke into the building and were carrying
off Lemonnier as a prisoner when suddenly a man, who seemed to be one of
the leaders of the mob, stepped out from the crowd and ordered the
physician to follow him. Thus Lemonnier was conducted to his room in the
Luxembourg palace in Paris, all the time under the guidance of this
strange, rough-looking man, who nevertheless, when they arrived at the
Luxembourg, acknowledged to the doctor that he intended, from the very
first, to save his life if he possibly could, because he was sure, “from
the kindly and venerable expression of his countenance, that he could
not possibly have had anything to do with the abuses of which the rabble
complained so bitterly.” Thus was Lemonnier rewarded for all his past
services to the poor of Paris and Versailles.
During the last years of his life—he was eighty-two years old when he
died—he enjoyed, in the quiet society of his former friends, who stood
by him faithfully to the end, what he termed the happiest years of his
life.
* * * * *
CHARLES LOUIS DUMAS, born at Lyons, France, on February 8, 1765, was the
son of a practicing surgeon. At the age of seventeen he began the study
of medicine at Montpellier, Barthez and Grimaud being at that time the
most distinguished members of the Medical Faculty of that university.
From the very first he manifested a keen interest in his studies. In
1785 he received the degree of Doctor of Medicine, the title of his
graduating thesis being: “An Essay on Life, or the Vital Faculties.” In
1787 he visited Paris, and during the following two years devoted his
attention chiefly to chemistry and to the study of human anatomy. It was
during this period that he became warmly attached to Vicq-d’Azyr.
In 1790 he returned to Montpellier and took part in a competition for
the chair of surgery left vacant by the death of Sabatier. Although the
judges decided in favor of another competitor they were most favorably
impressed with the talents which Dumas exhibited. A year later, upon the
death of Barthélemy Vigaroux, Dumas accepted the position of
Vice-Professor of Surgery in the same university, but, owing to the
political troubles which developed at this time in Lyons, he was obliged
to resign his chair at the end of one year and return to his native
city. After the termination of the siege of Lyons he was expelled from
the city, narrowly escaping with his life. In 1793 all teaching of
medicine at the University of Montpellier ceased, and two years later a
new school of medicine was organized, and the duty of teaching anatomy
and physiology was assigned to Dumas. In 1798 he was chosen President of
the school and Dean of the Faculty of Medicine of Montpellier. He died
on March 28, 1813, at the early age of forty-seven.
The more important of the treatises written and published by Dumas are
the following:—“_Principes de Physiologie_,” Paris, 1800–1803, 4 vols.,
and “_Doctrine Générale des Maladies Chroniques_, etc.,” Montpellier,
1812, and a second edition (2 vols.) in 1824.
* * * * *
PIERRE-JEAN-GEORGES CABANIS was born June 5, 1757, at the village of
Conac, in the Department of Corrèze, France. During his early youth he
gave no evidence whatever of possessing an inclination to study, but at
the age of fourteen he was taken to Paris, and then, for the first time,
he manifested great eagerness to acquire all kinds of knowledge. After
having completed his preliminary course of literary training he accepted
the position of private secretary to Prince Massalsky, Bishop of Wilna,
and accompanied him on his return to Poland. A residence of two years in
that distracted country convinced him, however, that he had better
return to France and seek there for an opening to some useful career.
Accordingly he went to Paris, and, upon learning that a prize for a
French translation, in verse, of a part of Homer’s Iliad had been
offered by the _Académie Française_, he devoted all his time and energy
to the writing of such a translation. Richerand, from whose eulogy on
Cabanis I have derived most of the information furnished in the present
sketch, does not state whether these efforts were or were not rewarded
by the capture of the coveted prize. His account, however, makes it
perfectly clear that Cabanis was an enthusiastic admirer of the poetry
of Homer and that he would gladly have devoted his life to the
cultivation of literature if he had not, at the same time, been deeply
impressed with the idea that a good citizen should devote a large share
of his time and his talents to things of real use to his fellow men and
to his native or adopted country. Accordingly, in due course of time, he
set aside his purely literary employment and began in earnest the study
of medicine, to which vocation he now transferred his allegiance with
all the ardor of which he was capable. Hippocrates, whose accurate
descriptions of disease and whose high standard of professional duty
excited his admiration as much as had the writings of Homer, furnished
him with the first models that were to serve as guides in his newly
chosen career. To add to his good fortune he had the privilege of
studying medicine under the guidance of Dubreuil, a teacher of the very
highest order, a philosopher, and a man of whom the pupil always spoke
in strong terms of admiration and affection.
After taking his doctor’s degree in 1784 Cabanis devoted all his
energies, during the few years which elapsed between this event and the
breaking out of the French Revolution, to the practice of his
profession. Aside from these duties he accepted only one official
responsibility, viz., that of Administrator of the Hospitals of Paris,
and this duty he performed with entire success. It is a fact worth
noting that he was one of Mirabeau’s intimate friends, and he believed
thoroughly in the principles of the French Revolution, but he did not
approve of the excesses which characterized its progress.
Some idea of the importance of the position which Cabanis held in the
esteem of his associates in the Parisian world of science and politics
may be gained from the following statements:—Early in his career he was
introduced by Turgot, the former Controller-General, to Madame
Helvétius, the widow of the well-known _littérateur_, Claude Adrien
Helvétius, and a woman whose weekly receptions (_salons_) brought
together at frequent intervals some of the most famous men at that time
residing in Paris. Thus he became acquainted with Franklin and
Jefferson, of the United States, as well as with Diderot and d’Alembert,
the famous writers connected with the French Encyclopædia. He was also
presented to Voltaire, who received him in the most kindly manner.
Although from 1789 to the end of his life he published a number of
useful pamphlets on different topics connected with public affairs and
especially with public charitable institutions and undertakings, he
rarely permitted his name to appear as the author of such essays. In
1799, when the Consulate was entrusted with the government of France,
Cabanis accepted a seat in the Senate and took an active interest in
public questions. During the last three years of his life the
increasingly bad state of his health did not permit him to do much work
of any kind; and finally, on May 6, 1808, an attack of cerebral apoplexy
put an end to his life.
The two most important works published by Cabanis are the
following:—“_Rapports du Physique et du Moral de l’Homme_,” Paris, 1802
(2d edition in 1805); and “_Du Degré de Certitude de la Médecine_,”
Paris, 1797 (3d edition in 1819).
* * * * *
FÉLIX VICQ-D’AZYR, who was born in 1748, was distinguished chiefly as an
anatomist and physiologist, and also as a writer on scientific topics.
The Faculty of Paris, not being pleased with his rapid advance in
popular favor, refused to allow him the privilege of lecturing in their
anatomical theatre. Then Antoine Petit, who was at that time Professor
of Anatomy at the “_Jardin du Roi_,”—an institution which was located in
what is now known as the Jardin des Plantes and was in a limited sense a
rival of the _École de Médecine_,—befriended him and did everything in
his power to make him successor to himself in the Chair of Anatomy. In
this attempt, however, Petit failed, for Portal, whose candidacy was
backed by the more influential Buffon, eventually received the
appointment. Just at this juncture of affairs Vicq-d’Azyr met with a
stroke of good luck. A niece of the celebrated naturalist, Daubenton,
who spent a large part of his long life in work connected with the
Jardin du Roi, happened one day to have a fainting fit just as she was
passing in front of Vicq-d’Azyr’s residence. This physician, who chanced
to be at home when the fainting occurred, did everything in his power to
restore the lady to consciousness; and in this he was perfectly
successful. In fact, not many months elapsed before they were married;
and from this time forward Daubenton did everything in his power to
advance Vicq-d’Azyr’s career as a scientist. He aided him, for example,
in procuring a great variety of foreign animals which the latter needed
for his researches in comparative anatomy; and, in addition, he promoted
his candidacy for membership in the _Académie des Sciences_, to which
organization he received an election in 1774. Soon afterward he gained
the esteem and friendship of Lassonne, the First Physician of the King,
and through his influence Vicq-d’Azyr was commissioned to carry
assistance to the people living in certain districts of France where an
epidemic disease was raging. Later, Lassonne aided him in organizing the
_Société Royale de Médecine_, the function of which was to perfect all
the departments of medical activity. Eventually Vicq-d’Azyr was made
_Secrétaire Perpetuel_ of this society. The Faculty, as had happened
before under similar circumstances, showed itself jealous of this new
organization, and systematically did all in its power to undermine the
influence of Vicq-d’Azyr, whom it recognized as the guiding spirit of
the scheme. Despite these malicious efforts the public at large,
recognizing their origin and the mean spirit of jealousy which prompted
them, lost no opportunity of bestowing praise upon Vicq-d’Azyr. In 1788
the _Académie Française_ chose him as Buffon’s successor, and in 1789 he
succeeded Lassonne as the First Physician of the Queen.
Vicq-d’Azyr’s purely scientific writings are very numerous and of marked
importance. They cover a wide extent of subjects—medicine, anatomy (both
human and comparative), and the veterinary art. His death occurred on
June 25, 1794, from some acute affection of the chest.
The treatises and memoirs which he wrote were first published separately
at different dates, but in 1805 a fairly complete collection was
published at Paris by Moreau.
* * * * *
JEAN-NOEL HALLÉ, born at Paris, France, toward the end of the eighteenth
century, was one of the most distinguished physicians of that period.
Cuvier, the famous naturalist and the author of the biography upon which
the present sketch is based, makes the following statement:—
Those physicians who can steer their way successfully through
such a maze of difficulties as existed during the French
Revolution, and who at the same time can inspire their patients
with a feeling of entire confidence in their ability to bring
them safely back to health, deserve our highest admiration and
respect. But when we wish, in giving an account of a physician
of this calibre, to furnish clear proofs of the truth of what we
say, we find it exceedingly difficult to produce the necessary
evidence. The names of three such men occur to me, viz., Hallé,
Corvisart and Pinel.
In the further course of his narrative Cuvier states that, in his
charitable gifts to the poor, Hallé studiously concealed from them the
source of the aid which they received. Many a patient, he adds, upon his
recovery from the attack for which the doctor had treated him, was
astonished to find that all the expenses incurred during his illness had
in some mysterious manner been defrayed. “How rarely indeed,” says
Cuvier, “does one learn of such a perfect carrying out of the
injunction: ‘Let not thy right hand know what thy left hand doeth.’”
About the year 1794 Hallé’s father and his grandfather were made members
of the Order of Saint-Michael, an honor which conferred nobility not
only upon them but also upon himself. Unfortunately for the doctor, who
was residing in Paris at the time, this patent of nobility made him
subject to the new law which had been passed by the Convention, and
which drove into exile all members of the nobility. An exception,
however, was made in his case because he held the office of Physician to
the Poor, and also—doubtless—because he was universally known throughout
Paris to be a staunch friend of the poor. Having thus received
permission to remain in the capital Hallé at once bethought himself how
he might aid those unfortunates who were confined in prison. He was
permitted, for example, to visit Malesherbes, Minister Turbot’s
associate, who was awaiting his death by the guillotine. Not only was he
thus enabled to speak words of comfort to the unfortunate prisoner, but
he received from him such farewell messages for his distressed family
and friends as he desired to send. Hallé was also one of those friends
of Lavoisier who interfered actively, but in vain, to save his life from
the executioner’s block. Those were terrible times and it required great
courage to do what Hallé did in behalf of these innocent victims of the
murderous Jacobins.
Fourcroy, the celebrated chemist and naturalist, who was authorized by
the Convention in 1794 and 1795 to organize a new _École de Médecine_,
to take the place of the one which the rabble had destroyed in 1783,
appointed Hallé Professor of Medical Physics and Hygiene. Then, later
still (1796), Corvisart, who by that time was in the full exercise of
his functions as medical adviser to Bonaparte,[20] appointed Hallé his
associate in the professorship at the Collège de France. Shortly
afterward he gave up the Chair entirely to Hallé.
Between the years 1800 and 1812 Hallé, more than any other French
physician, exerted his influence—and with decided success—in overcoming
the remaining opposition to vaccination, not only in France but also in
Italy.
Corvisart left to Hallé in his will the portrait of Stoll, the
distinguished Vienna professor, and added a memorandum to the effect
that he made this gift because he esteemed Hallé more highly than he did
any other physician.
Many anecdotes have been told concerning the peculiarities of Hallé in
his dealings with patients. The following two may perhaps prove of
interest to my readers:—If, for example, the patient happened to be an
artist, Hallé refused to accept a fee from him; and, when asked why he
did this, he replied: “Because from way back I belong to a family of
artists.” Then, in the second place, he was not willing to accept fees
from ecclesiastics. “If they have only just enough to live upon, they
should not be subjected to any diminution of that small stipend. On the
other hand, if they have more than is absolutely necessary for their
legitimate living expenses, this excess belongs to the poor.” The
following anecdote is told of one of his experiences:—
One day, when he returned to his office, worn out with a hard
day’s practice, he was told that a lady was waiting to consult
him. “Ask her,” he said to the attendant, “kindly to consult
some other physician, as I am too tired to see her.” She sent
back word that she had not the courage to do this, as she was
not able to pay for the services of this other physician. “If
that is the case,” Hallé promptly replied, “tell her I will see
her.” To himself he said: “I have no right to send her away.”
Hallé’s death occurred on February 11, 1822. Laënnec succeeded him at
the Collège de France.
* * * * *
GASPARD LAURENT BAYLE was born on August 18, 1774, at the village of
Vernet in the Department of the Basses-Alps. The country in this part of
France is very picturesque but not at all fertile; lofty mountains
surround it on all sides. At an early age Gaspard manifested a high
degree of intelligence and a strong inclination to study natural
phenomena. He was barely ten years old when he began making a collection
of insects, and he even went so far as to give names to the individual
species. He was only twelve years old when he was sent to the High
School of Embrun; and in this institution he made such advances in his
studies that the principal, Father Rossignol, a Jesuit, looked upon him
as one of the most promising of the pupils under his charge; more than
this, he felt a strong affection for the boy. As the curriculum of the
school studies did not include mathematics and natural history Father
Rossignol took particular pains to furnish Gaspard with instruction in
these branches of knowledge. The warm friendship which thus developed
between the scholar and his instructor, continued unbroken up to the
time of the latter’s death in 1813.
Laboring under the impression that it was his duty to become a priest
Gaspard enrolled his name at the theological seminary in 1790, and
devoted the following year to the study of philosophy and theology; but,
after the lapse of a certain length of time, doubts began to enter his
mind as to the wisdom of the choice which he had made, and accordingly,
after consultation with his father and older brother, both of whom were
lawyers, he abandoned the study of theology and entered his brother’s
law office.
In 1793, when the storms of the French Revolution had reached their acme
of violence, young Bayle, who was then only nineteen years old, attended
a political meeting at Embrun and made such a stirring appeal to the
mountaineers there assembled, in regard to their duty as Republicans,
that he completely won their confidence, and was accordingly chosen to
represent them at the approaching reception of the Proconsuls Barras and
Fréron, who had been sent by the Convention to persuade the inhabitants
of that district to carry out the violent measures which had been
planned against the city of Digne. The Proconsuls, who in the meantime
had arrived at Digne, quickly discovered that public sentiment was not
in favor of the measures advocated by the Convention; and accordingly,
in the fear that an uprising of the citizens might imperil their own
lives, they promptly fled from that city; but, before leaving, they made
arrangements for the arrest of the young orator who had produced such a
strongly antagonistic impression upon the people. As soon as Bayle’s
father and brother had learned these facts they quickly took all the
steps necessary for secretly getting Gaspard out of Digne and sending
him as speedily as possible to Montpellier, where—by enrolling himself
among the students of Medicine—they believed that he might reasonably
expect to escape the clutches of Barras and Fréron. These measures
proved successful, and thus Bayle’s life was saved and his attention
diverted from the Law to Medicine, a career in which he was destined to
gain great credit.
After spending three years at Montpellier Bayle was sent, as an
_Officier de Santé_, to serve at a military hospital temporarily
established at Nice, in the south of France. And here let me remark,
parenthetically, that this title should not be translated by the
corresponding English term “Health Officer.” In 1795 a new type of
medical school was established in France, the object of this innovation
being to provide a class of practitioners who could meet all the
ordinary medical needs of the peasants at a charge considerably less
than that demanded by the graduates of the high schools. The course in
these new schools covered a period of only two years, and the graduates
were classed as “_Officiers de Santé_.”
[Illustration:
GASPARD LAURENT BAYLE
]
As Bayle’s duties here at Nice were not very exacting he divided the
time which he had at his disposal between the bedside observation of
cases of actual disease and the study of treatises relating to
pathology. In 1798 he went to Paris and followed several courses of
instruction, more particularly that given by Corvisart on pathological
anatomy. In 1799, at a competitive examination, he won the position of
Assistant in Anatomy, and from that time forward he devoted a large part
of his time to the work of making post-mortem examinations.
In 1802 Bayle received his degree of Doctor of Medicine. The thesis
which he wrote on this occasion created a great sensation, partly
because it described an entirely new form of gangrene, and even more on
account of the philosophic manner in which he defended all his
statements when called upon to do so at the public cross-examination
which, at all the foreign universities, commonly precedes the bestowal
of the degree upon the candidate. Two of Bayle’s friends who were
present on this occasion, secured shorthand notes of the discussion that
took place between the candidate and the professors (Petit-Radel, Pinel,
Alphonse Leroy and Percy) whose duty it was to question him with regard
to the views put forward in the thesis. The report based upon these
shorthand notes covers nine printed pages of the biographic sketch which
lies before me, and is not—as will readily be appreciated by my
readers—suitable for reproduction here in its entirety; nor would a
digest of such a report serve any useful purpose. The most that seems to
me permissible under the circumstances is to furnish here two or three
brief extracts, from a perusal of which it will be possible to form at
least some idea of the character of this cross-examination. It should be
stated, however, by way of preface, that Professor Petit-Radel had, just
before the discussion began, raised objections to Bayle’s failure, in
his thesis, to include in his list of inflammatory affections “the
whitish engorgements observed at times in different organs”; and he then
added the following remark: “You are not disposed, I assume, to
recognize the existence of Boerhaave’s ‘white inflammation.’”
(Here follows the first part of the stenographic report of the
cross-examination.)
BAYLE: “If in the affection to which you refer the swelling is
accompanied by pain, and if it terminates by undergoing
resolution or by suppuration, then I should say that it bore
some relationship to inflammation; but if there is neither
redness, pain, fever, nor suppuration, I should declare that it
possesses none of the characters which distinguish inflammatory
affections, and that consequently this so-called ‘white
inflammation’ should be considered by us as something imaginary.
At the same time I should not like to have anybody get the
impression, from what I have said, that I deny the existence of
such things as white tumors or swellings, indolent in character,
and either elastic or permitting the pressure of a finger to
leave the mark called ‘pitting’; I simply wish to emphasize the
fact that these affections do not manifest any of the
characteristics of an inflammatory disturbance.”
PETIT-RADEL: “Do you not believe that there exist certain kinds
of humors which possess the power of giving rise to a white
variety of inflammation?”
BAYLE: “As I do not know what this ‘white inflammation’ really
is, you must not expect me to entertain a clear idea of what its
immediate causes are; and even if I were personally familiar
with this type of ‘inflammation,’ it is more than likely that I
would wander far from the truth if I were to attempt to define
the particular kind of humor which causes this affection. It is
easy to say that bile, or some other humor that possesses a
sufficiently acrid character, is the exciting cause; and then I
might print what I have to say on the subject in a beautiful
book.[21] But of what use are all these hypothetical deductions;
why resort to pure operations of the imagination when we seek to
explain natural phenomena? Is it not better to say simply ‘I do
not know’ than to erect a pompous edifice on a foundation of
moving sand?”
PETIT-RADEL: “Very well, let us speak now of the treatment which
you recommend. Was it a wise thing to prescribe bleeding and
purgatives in the treatment of the gangrenous pustule which you
describe in your thesis?” etc.
[Illustration:
A candidate for the degree of “Doctor of Medicine” defending his
thesis before the examining committee of the Paris Faculty of
Medicine.
(From “_La Vie Universitaire_,” Paris, 1918.)
]
The remainder of the stenographic report is fully as interesting as the
first part, but I do not feel warranted in omitting equally important
text in order to find room for the report in its entirety. I will simply
state that, before the cross-examination was completed, Bayle had boldly
expressed the opinion that “there is nothing more harmful to the advance
of practical medicine than the cultivation of the spirit of system.”
Not long after Bayle received his degree of M.D. he succeeded in
obtaining, as the result of a competitive examination, one of the two
positions of House Physician (“_elève interne_”) which existed at La
Charité Hospital; and here, having at his disposal an extraordinary
amount of valuable material both clinical and pathological, and being
aided by the experienced guidance of Corvisart and Dumangin, he enjoyed
for about two years the most extensive opportunity for self-culture
which it is possible for a young physician—Bayle was only twenty-eight
in 1802—to have placed at his disposal. Being very industrious and also
extremely ambitious to excel he accumulated a great stock of knowledge
concerning the different forms of disease to which human beings are
subject. Not only did he store this knowledge up in the chambers of his
mind, but he also kept written records of everything that seemed to
possess value, for use at a later period of his life. This fact should
be remembered, for those who have had occasion to consult the numerous
treatises which Bayle has published, cannot have failed to wonder that
he should have been able to furnish so many and so complete histories of
cases that came under his personal observation. But alas! he failed to
realize that this sort of work was sapping his strength, and he also
seemed to ignore the fact that he was carrying within himself the seeds
of a pulmonary disease which was sure sooner or later to put an end to
his labors. Already as early as in August, 1804, he was seized with such
a violent nostalgia, such an irresistible longing for his beloved
mountains, that he was obliged to drop all work at _La Charité_ and
return to his home in the south of France. In addition to the nostalgia
there were loss of flesh, insomnia and a sense of oppression in the
chest. This change of scene, air and occupation proved rapidly
beneficial, for, at the end of fifteen days, he felt much stronger and
was able to sleep much more soundly than for many previous weeks. His
morale, too, was markedly improved; his hunger for mountain scenery and
air was now satisfied. Then, for several years after his return to
Paris, he remained in comparatively good health, and was able to attend
to an enormous amount of hospital and private practice, in addition to
literary work. But in 1813 the threatening chest symptoms again
compelled him to visit his beloved Alps and to spend several months with
his wife and children in their mountain home. This time, however, the
improvement in his health was much less pronounced than it was in 1804,
and very soon he found that he would have to abandon all active work.
His death took place on May 11, 1816, at the early age of forty-two.
According to the statement of Bayle’s biographer it was the unanimous
opinion of all the physicians who had come in frequent contact with him
during his professional career, especially in the course of his official
work at _La Charité_, that no physician of equally varied and great
attainments had previously been seen in Paris. Professors Chomel and
Cayol, and the famous Laënnec maintained that this was not too great
praise to bestow upon Bayle.
Of his published writings I shall mention here only a few of those which
attained some celebrity, viz.: “_Remarques sur les Tubercules_,” in the
_Journal de Médecine, Chirurgie, et Pharmacie_, tome 6, p. 1; tome 9, p.
427; and tome 10, p. 32.—“_Traité des Maladies Cancéreuses_,” 2 vols.,
Paris, 1833. (One of the earliest and certainly one of the most
elaborate treatises on this subject that is to be found in the entire
range of medical literature.)—“_Mémoire sur l’oedème de la Glotte_,” in
the _Dictionnaire des Sciences Médicales_.
* * * * *
JEAN-NICOLAS CORVISART, who was born February 15, 1775, at Drécourt, a
village in the Department of Ardennes, N. E. France, was destined by his
father to follow in his footsteps, in the career of an attorney; but the
son disliked the work more and more as time went on. Finally, he found
an opportunity of attending one of the lectures of Antoine Petit, who
was one of the most eloquent lecturers on anatomy in France during the
eighteenth century. He was completely fascinated by what he heard, and
at once determined that this was the only profession that he cared to
adopt. Accordingly, during the next few months he made a practice of
rising very early in the morning and finishing the clerical work which
had been assigned to him in his father’s office; thus gaining time to
attend the lectures of Petit, Louis, Desault and Vicq-d’Azyr. When the
father discovered what his son had been doing he made up his mind that
it would be useless to make any further attempts to keep him occupied
with work calculated to fit him for the career of an attorney.
Accordingly he allowed him to follow the regular course of studies
prescribed for those who intended to become physicians. At that early
date (about 1770), however, the regular medical course of training
carried out by the Faculty of Medicine was most unsatisfactory. For
example, the so-called regular course of lectures was not well adapted
to form an adequate basis of education for the student of medicine, and,
in addition, there was nothing that could be called clinical teaching.
In short, the student was obliged to pick up the knowledge which he
needed, in large measure by the exercise of his own wits. But Corvisart
was both eager to learn and very persevering, and he possessed such a
genius for picking out as his guides the very men who were best fitted
for imparting useful knowledge, that he managed to make satisfactory
advances despite all these obstacles. The instructors in whom he placed
the greatest confidence were Desbois de Rochefort, Head Physician of La
Charité Hospital, and Desault, Chief Surgeon of Hôtel-Dieu. These two
men, says Cuvier, were the most distinguished medical men of their day
in the art of curing disease. Desbois de Rochefort, for example, was the
first of the Parisian physicians to give regular clinical instruction in
the hospital with which he was connected, and Corvisart followed this
instruction regularly throughout a period of several years. He was also
present at most of the post-mortem examinations which took place during
de Rochefort’s service; in fact, he took the very deepest interest in
this part of the work. A prick of one of his fingers while he was
dissecting caused an infection which nearly cost him his life. It was on
this occasion that Desault, by his skill and by his untiring efforts to
control the manifestations of the disease, rendered him splendid
service.
[Illustration:
CORVISART
(Copied from an old French print in the possession of the New York
Academy of Medicine.)
]
Under such persistent and intelligent training it was not long before
Corvisart was himself able to give courses of instruction in anatomy and
physiology,—courses which rapidly became very popular with the students.
So far as dress was concerned, Molière succeeded in driving out of
fashion the gown and pointed bonnet which the physicians of that day
were still, in accordance with the custom of centuries, wearing; but he
failed to induce them to abandon the wig which they were expected to
wear when engaged in actual service in the hospital wards. This practice
continued in force until Hallé and Corvisart both got themselves into
trouble by refusing to wear a wig. In the case of Corvisart the
following story is told:—A well-known Paris lady (Madame Necker) had
just founded a fine hospital to which Corvisart hoped to be appointed
the Physician-in-Chief. When he first appeared in one of the wards in
his natural hair, the lady founder was much shocked, and declared
positively that she was not willing to assume the responsibility of
sanctioning any such novelty. Corvisart remained firm in his resolution
and the position was given to another physician.
Compensation for this disappointment, says Cuvier, came to Corvisart
soon afterward, in the following manner:—Père Potentine, the Superior of
the monks connected with La Charité Hospital, had been struck with the
faithful manner in which Corvisart had cared for the sick under his
charge. So, when Desbois-Rochefort, the pioneer clinical teacher in
Paris, died in 1788, he quickly determined that he would, if possible,
secure for Corvisart the important position which had just been vacated.
His efforts proved successful, and in a short time the new appointee was
attracting to La Charité a large number of students who were just as
appreciative of Corvisart’s clinical teachings as they had been of the
instruction given by his predecessor.
A few years later still—in 1802—he was asked to see in consultation
Bonaparte, who was suffering from an acute pulmonary attack; and on this
occasion he had the good fortune not only to discover the real cause of
the trouble but also to recommend the measures which resulted in curing
the disease.
Despite his great success, both as a teacher and as a practitioner,
Corvisart experienced his full share of professional disappointments,
and was, in consequence, often very much depressed by them. He was wont
to express in very plain terms his dislike for those treatises in which
the author assigned to each disease a list of sharply defined
characteristics, and which caused the reader to believe that the course
which it pursued was invariably the same; which spoke of disease, in
short, in such a manner as to convey to young men the impression that
the science of medicine was one of the physical sciences, and that both
diseases and the remedies to be employed might well be reduced to a
comparatively few forms. No such simplicity exists in nature; the number
of combinations is infinite, and each day the combination is likely to
be completely changed. The numerous autopsies which he had made
convinced Corvisart that similarly the internal changes vary just as
greatly as do the external signs and symptoms.
The two most important treatises of which Corvisart was the author are
his “Treatise on Diseases of the Heart” and his “Commentary on
Auenbrugger’s Work.” Nowhere in medical literature, says Cuvier, will
one find a more methodical or a more clearly written treatise on this
subject than the first of these treatises. In the second one the author
analyzes the different alterations in the lungs, bronchi and pleura
which may be distinguished by means of Auenbrugger’s method. In the form
which Corvisart has given to this second work we obtain the clearest
evidence of his generous character. Rather than rob this man who had
long been dead, and who was entirely unknown to him, of even a small
portion of what was his due, Corvisart preferred—to use the expression
employed by Cuvier—to immolate his own glory. It appears that before he
had learned anything whatever about the work that Auenbrugger had
published in 1763, he had himself made the majority of the discoveries
set forth in that author’s treatise and was making preparations to
publish them to the world. Just at this moment, however, he unexpectedly
found a copy of a French translation of Auenbrugger’s dissertation,
whereupon he abandoned his original plan and published instead the
“Commentaries.” In his preface he gives the following explanation of the
course which he adopted:—“I might have—if I had so wished—sacrificed the
name of Auenbrugger to my own vanity; but my object is to revive the
knowledge of his splendid and legitimate discovery.”
In 1789 Corvisart published the MSS. which Desbois de Rochefort had left
to him as trustee. Already in 1788, as stated on a previous page, he had
been appointed, by a unanimous vote, Physician to La Charité Hospital.
From the very start he took up with enthusiasm the work of clinical
instruction in this hospital, and kept it up for nearly twenty years,
thus gaining for himself—according to Dupuytren—the reputation of being
the leading medical practitioner of his day, and adding great
distinction to French medicine. In 1795, when the first _École de
Médecine_ was created, he was made “Clinical Professor of Medicine”; and
from this time forward, for a period of several years, he carried on the
work of clinical teaching practically without a rival.
In addition to the positions which he held at _l’École de Médecine_ and
at La Charité Hospital Corvisart was connected in some teaching capacity
with the _Collège de France_. At first he gave instruction in this
institution only in the theory of medicine, but after 1795 he was
formally installed in the College as a teacher of practical medicine;
and from this time forward he was able so to arrange his lectures that
those students who attended his clinical instruction at La Charité,
would be able to hear him, later in the day, explain more fully the
diagnosis, treatment, etc., which he had adopted in the morning. In his
manner of conducting these sittings Corvisart was largely guided by
Stoll’s “Aphorisms,” a practical work which combined the genius of
Boerhaave and that of Stoll,—a work in which problems and demonstrated
truth were most happily combined. Corvisart was so impressed with the
value of this treatise (“Aphorisms”) that he published a translation of
it in 1797.
As a lecturer Corvisart possessed an animated and sparkling style of
delivery and great clearness of expression. When asked why he improvised
these lectures before the students, instead of writing them out
beforehand, he said: “In lecturing I like to feel absolutely at my ease
and not to be under the restraint which one feels after a formal
preparation beforehand.”
In the hospital it was his practice to submit to the students for
inspection and consideration only the most serious and the most typical
cases. From the bedside he went, in company with the entire class, to
the amphitheatre, and there entered upon a more complete description and
discussion of what they had witnessed in the ward. If the patient died,
then he took them with him to the dead-house and showed them whatever
the autopsy revealed. Before doing so, however, he read to them a brief
history of the case, in order to refresh their memory. Then, after the
autopsy had been completed, he reviewed and compared the two sets of
facts. As the author of this particular eulogy remarks, “One can imagine
with what intense interest the students followed this last act in the
course of instruction which Corvisart gave them.”
When Bonaparte was made Emperor of France one of his early acts was to
appoint Corvisart, who had been instrumental in effecting his recovery
from a serious pulmonary attack, his First Physician. This position was
not, as might easily be imagined, that of a mere personal adviser; it
was a much more important office, or at least it became so in the hands
of Dr. Corvisart. He felt very strongly that he must use this great
increase in his personal influence, not for himself nor for his
immediate circle of friends, but for the benefit of the nation and for
the advancement of the science of medicine. As an illustration of the
spirit in which Corvisart interpreted the attitude which he should
maintain in the face of his new responsibilities I will mention the
following incident:—On one occasion, when the Emperor startled him with
the announcement that he held in his hands the official appointment of
his brother to a position connected with the Government, Corvisart
remarked: “Allow me, your Majesty, to decline, for my brother, this
position; he does not possess the necessary capacity. I know that he is
poor, but that is a matter which concerns only myself.” After Corvisart
left the room Napoleon, turning to one of his ministers who happened to
be present, asked him: “Do you know of many men like this man?” On
another occasion, when Corvisart happened to be the subject of
conversation, the Emperor remarked: “He is an honest and skilful man,
but a little brusque.”
Among his numerous acts of generosity toward his friends and benefactors
there were some which showed that he did not forget his teachers nor
even the hospitals. He established at _l’École de Médecine_ a prize fund
which had for its purpose to aid those who found it impossible, through
lack of funds, to continue their scientific experiments.
Finally, it should not be forgotten that it was Corvisart who suggested
to Bonaparte,[22] the First Consul, the propriety of erecting at
Hôtel-Dieu the monument in honor of Desault and Bichat. (See page 167.)
By reason of the various responsibilities which very soon began to
burden Corvisart he was obliged to give up, one after the other, his
clinical teaching and finally his practice; it had become impossible for
him to do justice to so many things. Thus, he resigned his Chair of
Clinical Medicine in 1807, and in 1814, after the fall of Napoleon, he
retired to his countryseat, where he hoped to regain in some measure the
health which had begun to break down under the numerous burdens which he
had been carrying. His death occurred on September 18, 1821.
From among the comments that were published by his contemporaries soon
after Corvisart’s death I select the following as well adapted to
complete the portrait of this remarkable man:—
Among his professional brethren Corvisart was admitted to have gained a
high degree of skill in the power to diagnose diseases of the chest by
means of percussion, and especially to have advanced our knowledge of
affections of the heart and its annexes. No less important are the
services which he rendered to physicians through his valuable and
inspiriting clinical teaching. It was particularly in this form of
teaching that he showed in what a rare degree he possessed the power of
interesting his auditors in the case which happened to be at that moment
under consideration. Corvisart was equally successful as a teacher of
pathological anatomy, and nobody, since the time of Bichat, did more
than he to develop in France the love of researches in pathological
anatomy. However, despite their fascination with the study of the
pathological lesions presented by the different organs of the body after
death, these pupils rarely seemed anxious to harmonize them with the
symptoms manifested by the patient during his lifetime. They persisted
in forgetting the remarks made by their teacher on this very point, to
wit:—
The most desirable thing, the thing which we should particularly
strive to find out because it is that which is most important in
practical medicine, is not what are the peculiarities
discernible in the cadaver, but to recognize the existence of
these pathological lesions from certain signs and symptoms
manifested during life.
The only works which Corvisart has handed down to posterity are the
following:—
“Essai sur les maladies et les lésions organiques du coeur et
des gros vaisseaux,” Paris, 1806. (3d edition, 1818.)
“Nouvelle méthode pour reconnaître les maladies internes de la
poitrine, par la percussion de cette cavité,” par Auenbrugger;
ouvrage traduit du latin et commenté par J. N. Corvisart, Paris,
1808.
Corvisart’s comments constitute a large and important part of the book
last mentioned, and virtually make of it an original work by Corvisart.
Auenbrugger’s original treatise was published in 1763 and was then,
according to Dezeimeris, entirely forgotten, notwithstanding the fact
that in 1770 it was translated into French by Rozière de la Chassagne.
Auenbrugger was the first physician who recognized the fact that, by
percussion of the walls of the chest, a diagnosis may be made of some of
the diseases affecting the organs contained therein. Corvisart practiced
Auenbrugger’s percussion method during a period of twenty years and was
in the habit of demonstrating it to the numerous students who attended
his courses in clinical medicine. It was this long experience in the
practice of percussion that enabled him to extend, correct and modify
the method as it was set forth in Auenbrugger’s little treatise. If he
had not done this and had not published the results in his French
translation (of 1808), Auenbrugger would not have won the credit for his
glorious discovery. The delicately considerate manner in which Corvisart
engineered the whole scheme throws a flood of light upon the noble
character of Napoleon’s First Physician.
------------------------------------------------------------------------
CHAPTER XIX
LAËNNEC AND THE INVENTION OF THE MODERN METHOD OF AUSCULTATION;
PAUL-JOSEPH BARTHEZ
RENÉ THÉOPHILE HYACINTHE LAËNNEC (1781–1826) was born at Quimper in
Brittany, France. I am not able to furnish any details concerning his
early history. His subsequent career as a physician, however, and
especially his writings, show very clearly that he must have received a
very careful and thorough education. Previous to 1816 auscultation of
the chest was carried out in the same manner as it was in the time of
Hippocrates,—that is, by applying the examiner’s ear, either directly or
through an interposed piece of linen, to the surface of the skin
overlying the particular part which he was desirous of examining.
In 1816 I was consulted [writes Laënnec] by a young woman who
presented certain general symptoms that pointed to the existence
of some disease of the heart, and in whom, by reason of her
_embonpoint_, simple palpation and percussion could scarcely be
expected to furnish satisfactory information in regard to the
nature of the disorder. The age and sex of the patient not
permitting me to make such an examination as I have just
mentioned I was compelled to adopt some other measure; and I
then recalled to mind the acoustic phenomenon with which
everybody is familiar, to-wit: if the ear be applied to one end
of a wooden beam it will perceive with perfect distinctness the
sound made by the scratching of a pin’s point on the opposite
end of the beam. From this circumstance I inferred that in the
present case I might advantageously utilize the principle
underlying this phenomenon. Accordingly I rolled up into a
cylinder-shaped, stiff-walled tube several sheets of
writing-paper, and, resting one end of the cylinder on the skin
of the precordial region, I applied my ear to the other end of
the tube. I found to my surprise and pleasure that I was now
able to hear the pulsations of the heart much more distinctly
than I had ever before heard them when I applied my ear directly
to the chest-wall.
This first experience made such a deep impression on the mind of Laënnec
that he promptly instituted a series of experiments which had for their
object (1) the determination of the form of instrument that would best
answer the desired purpose, and (2) the discovery of the various cardiac
and pulmonary conditions that might advantageously be studied by the use
of this instrument. Such were the first steps taken in one of the most
useful medical discoveries of which we have any record. Auscultation,
the importance of which had been dimly foreseen by Hippocrates the
Great, became now for the first time, in the early part of the
nineteenth century, one of the most effective aids to the physician in
ascertaining the true nature and extent of certain diseases located in
the cavity of the chest, in watching their progress, and in regulating
their treatment in accordance with the physical conditions revealed by
the aid of the method. The history of medicine has few more important
events to record than this discovery made by Laënnec, one of France’s
greatest physicians.
As a result of the experiments to which I have just referred there was
soon substituted for the crude thin-walled paper cylinder a solid column
of light wood, hollowed out centrally throughout its length by a narrow
tubular channel. To this new instrument the name “stethoscope” was
given. It would require too great an amount of space to give here the
full and very explicit instructions supplied by Laënnec regarding the
manner in which this instrument is to be employed in actual practice;
and, furthermore, they are to be found in the best modern textbooks
which deal with diseases of the chest.
[Illustration:
LAËNNEC
(Copied from an old French print in the possession of the New York
Academy of Medicine.)
]
Stethoscopic auscultation is by no means the simple operation which many
physicians believe it to be. It is an art which must be learned through
long practice, and is attainable to its fullest extent only by those who
possess, in the first place, a thorough knowledge of the anatomy of the
organs contained within the thoracic cavity,—both the gross anatomical
relations of the different organs and the minute structure of the
different subdivisions of the pulmonary mass. A good knowledge of the
mode of action of all this vascular and respiratory machinery, under
normal conditions, is also necessary. He who really becomes an expert in
the art of successful auscultation must necessarily be equipped with a
knowledge of the different acoustic phenomena that present themselves to
the examiner’s hearing under the various pathological states to which
both the heart and the lungs are liable. All these facts are brought out
with great fulness of detail by Laënnec in the second edition (1826) of
his treatise. (I have not examined the English translation of Laënnec’s
treatise, but presumably all these details have been accurately
reproduced in that version.) A man without a delicate sense of hearing
and a well-trained imagination,—which latter gift may truly be said to
be possessed by comparatively few of those who practice medicine,—will
soon confess to himself that he is able to gain only a very meagre
modicum of satisfactory information from the practice of the art of
auscultation.
Laënnec reports a large number of cases in which various pulmonary and
pleural disorders developed as complications of the original affection,
and in each such case he mentions in full detail all the phenomena that
were discovered on auscultation and percussion of the chest. Some of
these histories are extremely interesting; they constitute a rich mine
of clinical data from which the practicing physician may draw a great
fund of useful information. A mere list of the headings of these reports
would fill several of the pages of this treatise. From the statements
already made the reader is likely to infer that Laënnec is particularly
strong in his presentation of the facts relating to the pathological
anatomy of pulmonary and cardiac diseases, as well as in his treatment
of the subject of auscultation in all its phases; and in drawing this
inference he would be wholly in the right. Laënnec’s treatise furnishes
an exhaustive and thoroughly practical discussion of the various
diseases of the heart and lungs, and stands for all time as a glorious
monument in his honor.
Magendie, speaking before a class of medical students at Hôtel-Dieu
about the difficulties which the physician occasionally encounters in
his efforts to interpret correctly the significance of certain sounds
heard during auscultation, narrates the following experience:—
Here, gentlemen, is the heart of a young woman who recently died
in this hospital. I believe that I have already published an
account of her case, which is one of exceptional interest; but,
however this may be, I remember perfectly well all the details
of the results ascertained (during life) by a careful
auscultation of her heart. The first sound was heard without any
difficulty, but the second one was entirely lacking. What, it
will be asked, was the cause of this phenomenon? At first I was
disposed to believe that she was affected with hydrothorax, but,
when I came to make a more careful examination, I was obliged to
reject this hypothesis; and, although I suspected that the
absence of the second sound was due to an obstacle of a
mechanical nature,—one that nullified the stroke communicated by
the heart to the sternum,—I was unable to form any idea as to
the real nature of this obstacle. The present autopsy furnishes
the desired explanation. As a result of a former attack of
pericarditis the anterior surface of the heart was covered with
a thick layer of false membranes; ... the tip of the organ, on
the other hand, still preserved its usual smooth and polished
aspect.... In my judgment the interposition of false membranes,
which had been deposited upon the surface of the heart, acted as
a cushion, thus preventing the transmission of the sound by
annulling the shock which would otherwise result from the blow
upon the sternum. Lower down, at the tip of the organ, where no
false membranes had been deposited, the blow upon the thorax,
caused with each systole of the heart, produced the normal
degree of noise.
(From Magendie’s “_Leçons sur les Phénomènes Physiques de la
Vie_.”)
I should perhaps add here the statement that Laënnec’s researches into
the question of auscultation of the chest were made at the Necker
Hospital in Paris, and extended over a period of eighteen years.
[Illustration:
The _Faculté de Médecine_ and the Cathedral at Montpellier, France.
(Courtesy of Monsieur le Pasteur Paul Barnaud, of Sainte Foy la Grande
[Gironde], France.)
]
* * * * *
PAUL-JOSEPH BARTHEZ, one of the most distinguished physicians of France
during the eighteenth century, was born at Montpellier on December 11,
1734. His father, who was a civil engineer and well known as a clever
mathematician, practiced his profession at Narbonne, and it was there
that the son spent the first years of his life. At a very early age he
manifested a decided love for study, and his parents took great pains
with his education. During the period of youth he displayed two marked
characteristics—sincerity and very little inclination to indulge in
social pleasures. On more than one occasion he submitted to chastisement
rather than to tell a lie. As he advanced in age he showed a marked
tendency to choose an ecclesiastical career, but his father was not at
all disposed to encourage him in such a choice, and finally induced him
to give the preference to medicine. Accordingly, Paul-Joseph, during the
month of November, 1750, was enrolled as a medical student at the
University of Montpellier. Three years later he passed the required
examinations with great credit and was given the degree of Doctor of
Medicine. In 1761 he made his first appearance at Montpellier as a
lecturer and met with a fair degree of success. Up to this time he had
experienced a good deal of anxiety caused by his pecuniary troubles, but
during the succeeding years his practice steadily increased and he was
soon relieved from this source of trouble. In 1781, after the death of
Dr. Tronchin, he was called to Paris to take the doctor’s place as the
private physician of the Duke of Orleans. In the meantime, despite the
greatly disturbed condition of political affairs in Paris, and also
despite the persistent efforts of his enemies to drive him out of the
capital, Barthez managed to accumulate a fortune amply sufficient for
all his reasonable needs. In 1802 the First Consul, Bonaparte, appointed
him and Corvisart Government Physicians,—Barthez for Montpellier and the
southern part of France, and Corvisart for Paris and the northern part;
and, a little later, Barthez was appointed Bonaparte’s Consulting
Physician.
Toward the end of his life Barthez suffered a great deal from bladder
trouble, which proved eventually to be dependent upon the presence of a
calculus. Instead of submitting at this time to a surgical operation,
the only measure that offered him any chance of permanent relief, he put
his faith in the use of lithontriptics; and then, when these proved to
be impotent to give him relief, he expressed his willingness to submit
to an operation. But by that time his general condition had become so
unfavorable that it was not considered safe to operate. His death
occurred on October 15, 1806, after he had passed through several weeks
of very great suffering.
In order that one may form a correct estimate of Barthez’ professional
career it is necessary that certain facts should be borne in mind. In
the first place, he was endowed with a prodigious memory, a remarkable
capacity for grasping facts, unlimited patience in studying their
different aspects, great ability in ascertaining their relations to one
another, and wonderful facility in following out the connections between
abstract ideas. Then, in addition, his acquaintance with both ancient
and modern languages made it easy for him to familiarize himself with
the sayings of the philosophers and scientific men of all times and
countries.
[Illustration:
The “Court of Honor” of the _Faculté de Médecine_ at Montpellier,
France.
(Courtesy of Monsieur le Pasteur Paul Barnaud, of Sainte Foy la Grande
[Gironde], France.)
]
In 1785, after the death of Imbert, who at that time occupied the
important position of Chancellor of the University of Montpellier, the
highest medical office in the southern half of France, Barthez was
chosen his successor.
Were it not for the difficulty presented by the lack of space I should
be glad to add here, by way of example, a reproduction, in English, of
one of Barthez’ “_Consultations_,” some of which are most instructive,
and which furnish at the same time an excellent picture of the manner of
procedure followed by this celebrated French diagnostician and teacher
of the science and art of medicine. Merely to furnish a _résumé_ of one
of these chapters would not serve a sufficiently useful purpose, and I
must therefore abstain from making any attempt whatever to supply the
desired portrayal. To those, however, who are interested more
particularly in the subject of syphilis I will venture to suggest the
perusal of Consultation XXXVI. (pp. 381–396), in which Barthez gives a
very complete report of the infection, with that disease, of an entire
family (father, mother and several children). This report is well worth
reading. In addition to the “_Consultations de Médecine_,” which was
published in 1820 by Lordat, Barthez wrote the following treatises:—
“_Nouveaux Eléments de la Science de l’Homme_,” Montpellier, 1778 (1
vol.); Paris, 1806 (2 vols.); “_Traité des Maladies Goutteuses_,” Paris,
1802 (2 vols.); “_Nouvelle Mécanique des Mouvements de l’Homme et des
Animaux_,” Carcassonne, 1798; “_Discours sur le Génie d’Hippocrate_,”
Montpellier, 1801.[23]
------------------------------------------------------------------------
CHAPTER XX
EARLY STUDIES OF THE DISEASE NOW UNIVERSALLY CALLED TYPHOID FEVER
Up to the year 1829 the disease now universally called “typhoid fever”
was known by a great variety of names, all of them more or less
objectionable and therefore not acceptable to the majority of
physicians. Here are a few specimens of these terms: “gastritis” or
“gastro-enteritis”; “enteric fever”; “slow nervous fever”;
“gastroentero-cephalitis”; “abdominal typhus”; “pathogenic fever,” etc.
It is only in the last-mentioned name that we find evidence of an
attempt—only a very feeble attempt, it is true—to suggest some
connection between the term proposed and the real cause of the disease.
Chomel, in 1834, very quickly disposed of the first two names suggested
when he wrote: “At the present time no physician who is a careful
observer of disease and who at the same time is well versed in
pathological anatomy, looks upon typhoid fever as a gastritis or a
gastro-enteritis.” At about the same time Philippe Pinel, the
distinguished author of the work entitled “_Nosographie Philosophique_,”
made the following statement with regard to typhoid fever: “In this
disease one cannot fail to observe that there exists, toward the end of
the small intestine, a violent inflammation of the mucous membrane.” To
go back farther still in the history of medicine I will mention here the
fact that Galen attributed this and other epidemic fevers to the
drinking of infected water. Huxham and Pringle, two of the best English
authorities on fevers, frequently mention, as a cause of typhoid fever,
the drinking of polluted water in which are contained decomposing animal
matters. So far as I am able to ascertain, however, Johann Peter Frank
was the first to throw doubt upon the correctness of this mode of
causation, or at least upon the correctness of the form in which the
statement is made. Putridity alone, he says, does not satisfactorily
explain the characteristic features of the disease. “The cause of these
nervous fevers,” he adds, “is not to be found in putrid matter but
rather in some principle, or primary element, which easily combines with
it,—an element the nature of which is unknown to us.” Putrid matter,
then, was recognized by Frank as being simply the vehicle of the cause
of the disease (viz., a special _contagium vivum_). Budd, in 1856, held
very much the same view; and Murchison, in 1857, agreed in the main with
Budd.
[Illustration:
Montpellier. Vestibule of the _Faculté de Médecine_ at Montpellier,
France.
(Courtesy of Monsieur le Pasteur Paul Barnaud, of Sainte Foy la Grande
[Gironde], France.)
]
The next suggestion of a new name for typhoid fever came from
Bretonneau, of Tours, France; his proposition being that the disease
should be called “_Dothiénentérite_” (from δοθιὴν, the Greek word for
pimple, and έντερον, intestine). Certain authors attributed the
associated fever to these pimple-like lesions in the small intestine,
but Bretonneau held that the latter are the products of an infection and
not the cause of the fever; and that view has been universally accepted
as correct ever since his time. This new term for typhoid fever,
however, was not favorably received, and was very soon forgotten. On the
other hand, the expression “typhoid fever” (from τῦφος, stupor, and
εὶδος, form), which simply described the most noteworthy feature of the
disease, was promptly adopted. Charles A. P. Louis,[24] Chief of Clinic
at the _École de Médecine_ of Paris, and Member of the _Académie Royale
de Médecine_, to whom we are indebted for the final settlement of this
troublesome question, gives the following brief account of the
considerations which led him to urge the final acceptance of the term
“typhoid fever”: “After seeking carefully for a term that would express
the anatomical features of this disease, without jarring too decidedly
upon the ear, as ‘_dothiénentérite_’ does, and having failed to discover
any better expression than ‘typhoid fever,’ I finally decided to employ
it in preference to all others.” And since that time no physician has
succeeded in supplanting it with a term more acceptable to the
Profession. As to the real underlying cause of typhoid fever I shall
have nothing to say, as this is a matter which belongs strictly to the
domain of modern medicine; and I have no wish to trespass upon the
territory of the writer of this most important section of the history of
medicine.
As to the contagiousness of typhoid fever Louis states that, out of 117
cases which he had observed, there were only three that might be imputed
to contagion.
A few words more concerning Charles A. P. Louis, to whom I have already
referred briefly in connection with the subject of selecting a suitable
name for typhoid fever. Marshall Hall, the famous English physician,
characterizes him as the greatest pathologist of any nation or of any
age. In another place he says:—
Monsieur Louis is the Bacon of Medicine; he has taught us how to
observe, and how to deduce important laws from the facts
observed.... Monsieur Louis is a man of such talent, labour,
exactness, truth, and probity, as I never met with in any other
man. His labours I shall consider as the chief ornament of these
lectures, and my chief claim to your consideration.
In still another place Marshall Hall quotes Louis’ own account of the
early years of his professional career, as follows:—
After having practised as a physician in a foreign country, I
returned to France, at the age of thirty-three, determined to
give myself up to the observation of disease; and, in order to
obtain my end more effectually, I resolved to forego all other
employment. I pursued this course for nearly seven years; in
other words, during that time I devoted myself exclusively to
the observation of all the cases admitted into St. John’s and
St. Joseph’s wards at the hospital of _La Charité_. Three years
elapsed before I ventured to publish, at the request of a
friend, my first memoir, on the perforation of the small
intestines; my object being to observe for myself, and not to
describe what I might have observed.
[Illustration:
CHARLES A. P. LOUIS
]
------------------------------------------------------------------------
BOOK X
BROUSSAIS AND BROUSSAISM
------------------------------------------------------------------------
CHAPTER XXI
THE HARMFUL EFFECTS OF BROUSSAIS’ TEACHING
FRANÇOIS JOSEPH VICTOR BROUSSAIS was born in 1772 at Saint-Malo, a
seaport on the north coast of France, in the Department of
Ille-et-Vilaine (formerly a part of Brittany). His early medical
training was obtained at Paris, where he attended for a short time one
of the courses of instruction given by Bichat. On reaching the age of
forty-two he entered the service of the Military Hospital at
Val-de-Grâce, and not long afterward was chosen Professor of General and
Special Pathology and Therapeutics at the University of Paris. The
lectures which he delivered on these subjects so fascinated the students
and the numerous physicians who attended the course in increasing
numbers, that—as Pagel expresses it—a general impression was created,
during a period of several successive years, that the whole of French
medicine was represented in the person and doctrines of Broussais. The
correctness of Pagel’s statement is corroborated by the following
extract from “J. L. H. P’s sketches”:—
Monsieur Broussais is unquestionably the most remarkable medical
writer of the present age. Splendid works, celebrated lectures,
and a great number of proselytes, have in a few years spread far
and wide his name and his opinions.... There are, on the other
hand, many physicians, who, too old to return now to their
studies, and witnessing with no pleasure all these innovations,
say that the professor of Val-de-Grâce is only a sectary, in
whom passion holds the place of genius, and hardihood of
force.... His brutal attacks on men, whether dead or
living,—French or foreigners, surrounded with the esteem and
admiration of all,—have found approval only among the personal
enemies of the contemporaries whom he criticises, and this too
in a generation greedy of novelty, and imposed upon by his rough
manners and bold speech.
The extract also shows that not a few French physicians refused to
accept the “fascinating” doctrines promulgated by Broussais, and
reported by him to be “founded on physiological principles.” As
Broussaism played such an important part, during the early years of the
nineteenth century, in hindering the advance of the real science of
medicine, my readers will pardon me, I am sure, if I devote considerable
space in the attempt to elucidate the meaning of Broussaism. These
revolutionary ideas regarding “physiological medicine” were first
published in book form in 1816. Two later editions followed,—one in 1821
and another in 1829. The text is arranged in the form of propositions or
“physiological principles,” of which there are 568. Pagel describes them
as “not being related in the remotest degree to modern physiology.” In
the following paragraphs I have reproduced (in the form of translations)
a few of these “_Propositions de Médecine_” as they are printed in the
edition of 1829:—
A. PROPOSITIONS BELONGING TO THE DOMAIN OF PHYSIOLOGY
II.—Heat, from whatever source it may be derived, is the first
and most important of all stimuli; and, when it ceases to exert
its vitalizing power upon the economy, all other stimuli lose
their power to produce any effect upon it.
IV.—If heat is withdrawn for a certain period of time all those
phenomena of the economy which are of a conservative, reparative
or medicative nature cease all activity; and the same is true
when oxygen is withdrawn.
XX.—Assimilation, which is a phenomenon of the very first order,
cannot be explained by the assumption that it is due to the
action of sensibility and contractility; it should be looked
upon only as a manifestation of a creative force,—as an act of
vital chemistry.
XLII.—Instinct consists of nervous impulses or stimuli—sometimes
associated with consciousness and sometimes not—which originate
in one of the viscera, and which call upon the central nerve
power to execute such acts as are necessary to the exercise of
the functions of that viscus.
XLIV.—Acts which are originated by instinct are most frequently
observed in infants, and are witnessed with diminishing
frequency as the child’s intelligence becomes more perfect.
XLVII.—As may be said with equal truth of insanity the passions
furnish an example of the triumph of the viscera—that is to say,
of instinct—over intelligence; and, on the other hand, it is
well-known that the passions themselves produce insanity.
LI.—The intellectual faculties may be exercised without any
participation of passion, but never without an accompaniment of
either pleasure or pain.
LXIV.—An excess of haematosis or sanguification in an organ
increases at first the sum total of its vitality, but this
increase is subject to limitations. If, for example, the
excitation is kept up beyond a certain length of time the
continued hyperaemia establishes in that organ a condition which
deserves to be called disease.
B. PROPOSITIONS BELONGING TO THE DOMAIN OF PATHOLOGY
XCIX.—When irritation causes the blood to accumulate in a part
or tissue, and when, further, this accumulation of blood is
accompanied by such an exceptional degree of swelling, redness
and heat as to threaten the disorganization of the part thus
irritated, it is customary to apply to this complex phenomenon
the name of “inflammation.”
CXXVII.—Tubercles, cancers, etc., of the brain owe their origin
to a chronic inflammation of that organ.
CLXVIII.—I have never seen tubercles of the lungs except in
cases where these lesions had developed from an antecedent
inflammation; and it does not appear to me that the tubercles
which are observed in the lungs of infants at birth, may rightly
be considered as having originated independently of
inflammation.
CXCV.—All the different varieties of acute and subacute
inflammation possess the power to produce cancer.
CCCVII.—He who does not know how to manage properly a case of
irritability of the stomach will never be able to treat
successfully any other malady. In short, the key to a knowledge
of pathology is to be found in an intimate acquaintance with
gastritis and gastro-enteritis.
CCCXLII.—Pulmonary phthisis may be prevented by putting an end,
by means of antiphlogistic remedies and revulsives, soon after
its presence is discovered, to any existing irritation of the
respiratory apparatus.
[Illustration:
BROUSSAIS
]
These dozen or more of Broussais’ “_Propositions_” or fundamental
medical doctrines should suffice, it seems to me, to give the reader a
correct idea of the kind of physiology and pathology that found favor in
France during the third and fourth decades of the nineteenth century,
and that too despite the thoroughly sound and admirably logical, but
less fascinating, teachings of such authorities as Morgagni, Bichat, Ch.
A. P. Louis, Bayle, Corvisart and Laënnec.
It was toward the end of this same year (1821) that Laënnec began
teaching his new method of auscultating the chest by means of the
stethoscope—which had first been made known to the world by Auenbrugger
in 1761, but which had been completely ignored until Corvisart published
a French translation of Auenbrugger’s book in 1808. As early, however,
as in 1819 Laënnec had published reports of a number of instances in
which, by means chiefly of this method of exploration, he had correctly
diagnosed the presence of tuberculous and other deposits in the lungs of
certain patients. The publication of these reports evidently excited
very much the wrath of Broussais, for in the new edition of his book
(viz., that of 1821) he criticises Laënnec’s statements most unjustly
and in a manner that reveals how completely his mind was saturated with
the belief that what he calls “inflammation” is at the bottom of most of
the pathological phenomena encountered in medical practice. Lack of
space will not permit me to quote here more than one or two of
Broussais’ comments on the conditions reported by Laënnec:—
The pathological alterations, considered by themselves, are
simply curiosities, and are not of the slightest utility to
anybody who may feel disposed to study them; because they are
all either the products of simple inflammation, or else they owe
their origin to some cause which does not fall legitimately in
the domain of physiological pathology.
(Copied from pp. 674, 676, 677, and 679 of Vol. II., edition of
1821.)
Further on in the same volume, speaking of melanotic cancers, Broussais
says:—
... this is all that it is important for the physician to know;
and, as to what Monsieur Laënnec has written about black
cancers, I may say that it is simply the product of his
imagination, a gloomy romance, which I found difficulty in
reading from the beginning to the end.
It seems proper that I should furnish some information concerning
Broussais’ methods of treatment in different diseases. In the last
analysis it will be found that in nearly all cases he adopted such
remedial measures as tended to allay or arrest inflammatory action.
Thus, in beginning pulmonary consumption he prescribed the application
of leeches to the infraclavicular region; in jaundice they were to be
applied in the hypochondriac region, in pharyngitis and tonsillitis to
the side of the neck, in dysentery to the anus, in articular rheumatism
to the neighborhood of the affected joint, and, in maladies that were
not distinctly localized, the epigastrium was the region to be chosen by
preference. When simple irritation was present Broussais prescribed
revulsives—such, for example, as blisters, emetics and laxatives. As a
rule, however, he gave the preference to direct antiphlogistic measures.
He is credited with having had a profound contempt for the _vis
medicatrix naturae_. It was said that his pupils showed a tendency to
push his pathologic teachings to an extreme. Desruelles, for instance,
was in the habit of treating his syphilitic cases, not with mercury or
any other of the specific remedies commonly employed at that period, but
with leeches applied locally.
As early as in 1816 Broussais announced that, as a result of his
doctrine, “the mortality of Val-de-Grâce had greatly diminished, to the
grand astonishment and admiration of the world.” This assertion not
having been noticed, Monsieur Broussais, in 1821, went a step further.
He then predicted, in the Preface to his “_Examen des Doctrines_,” that
his doctrine would soon exert an influence on population more marked
than that exerted by vaccination. This was pretty strong, but not,
however, sufficient; for in 1822, “the Prospectus of _Les Annales de la
Médecine Physiologique_ declared that, in the hospitals where the
physiological doctrine was adopted, the mortality was only one in
thirty, while in the others it amounted to one in five.” These results,
which caused great astonishment, induced Monsieur Brasquet, a physician,
to inspect the records with a view to ascertaining the exact facts. Thus
it was discovered that, during the five years from 1815 to 1819,
Monsieur Broussais had lost more patients than his contemporaries had
lost during the same period; his mean mortality having been one in
thirteen. (The results of Monsieur Brasquet’s inquiry were published in
the _Revue Médicale_.) “Monsieur Broussais replied in _Les Annales de la
Médecine Physiologique_, but his reply was not at all satisfactory. He
did not deny the correctness of the figures published in the _Revue
Médicale_, but he maintained that they proved nothing against him.” The
proof, however, that he had lost _one patient in thirteen_, and not _one
in thirty_, as he had claimed, remained unshaken.
It was probably this experience that marked the beginning of the
downfall of the doctrine known as “Broussaism”; but many years had to
elapse before this doctrine vanished entirely from the accepted medical
textbooks. August Hirsch, in his “History of the Medical Sciences in
Germany” (1893), passes the following judgment upon Broussais’ work:
“Under the title of ‘Physiological Medicine’ Broussais presented to the
world a system which for narrowness of scope, for arbitrariness and for
the perniciousness of the treatment which was deduced from the premisses
that grew out of the theory, could be compared only with Rasori’s
therapeutic method.”
Broussais died in 1835.
------------------------------------------------------------------------
BOOK XI
THE GOLDEN AGE OF SURGERY IN FRANCE
------------------------------------------------------------------------
CHAPTER XXII
J. L. PETIT, OF PARIS, AND HIS CONTEMPORARIES IN SURGERY—SABATIER,
CHOPART, DESAULT AND DUPUYTREN
In the history of surgery in France there is a conspicuous absence of
distinguished names from the list of men who succeeded Ambroise Paré,
until we reach that of J. L. Petit, a surgeon whose career shows him to
have been worthy of all the praise and esteem which the French have
lavishly bestowed upon him.
* * * * *
JEAN-LOUIS PETIT was born at Paris in 1674, and already at the early age
of twelve manifested a strong inclination to adopt a surgical career. By
the time he had reached his sixteenth year he had become so expert as a
dissector that he was entrusted with the duties of a demonstrator of
anatomy, a position which he filled to the entire satisfaction of both
the students and the superior authorities of the medical school. Two
years later,—that is, in 1692,—he entered the military service and was
given the position of Army Surgeon. He was present at the siege of
Namur, and served through all the succeeding campaigns up to the year
1697, at which time he was placed in charge of the Military Hospital at
Tournay. In 1700 he retired from the army and returned to Paris, where
he engaged in private practice and at the same time gave instruction in
anatomy and surgery. From this time forward his reputation as a skilful
surgeon rose rapidly until he was universally acknowledged to be the
leading surgeon of the capital, a fact which was confirmed by his
election to the position of Director of the Royal Academy of Surgery.
It was said of him by a very competent critic (A. Richet) that Petit was
one of the boldest and most skilful surgeons of his day. He possessed a
profound knowledge of the anatomy of almost every region of the body,
and at the same time was remarkably skilful in the handling of his
bistouri. He also seemed to possess, on the spur of the moment, an
intuitive knowledge of what he should do in any situation of affairs
that might suddenly develop in the course of an operation. The
reflections which he made as he progressed in the work with which he
happened to be busied, were most original, and led somebody to say of
him, on a certain occasion: “He must have invented surgery.” On reading
his treatise on surgical maladies one is struck with the originality of
his remarks, with the profoundness of his thinking, and with the
closeness and accuracy of his observations. His writings make most
attractive reading for the surgeon.
In order that my readers may judge for themselves how cleverly and how
wisely Petit dealt with some of the surgical problems which presented
themselves for solution in the course of his private practice I will
give here, in the form of very brief translations, three instances which
seem to me to possess to-day a peculiar interest in that they reveal the
important fact that a correct diagnosis may occasionally be made without
the aid of some of the complicated and expensive machinery which not a
few of our modern surgeons think indispensable to the ascertainment of
the truth. I should perhaps modify this last remark by stating that the
extraordinary cleverness and practical wisdom exhibited by J. L. Petit
are gifts not often bestowed by Nature upon physicians, and that
therefore the X-ray and other modern inventions which compensate for the
infrequency of such gifts, are to be considered in the light of very
important blessings conferred upon suffering humanity.
[Illustration:
JEAN-LOUIS PETIT
]
(1) “The man, whose case history I am about to relate, said that
the symptoms from which he had suffered, during the preceding
twelve months, were the following: a frequent but dry cough,
with loss of appetite; almost constant thirst; difficulty in
obtaining sleep; night-sweats, more marked in the region of the
head and neck than elsewhere; and irregular chills and fever.
The physicians whom he had consulted were led to believe that he
was affected with consumption, and they treated him in
accordance with this belief, but so far without success.—On
examination I found that two of his teeth were carious, and I
advised their extraction. A rapid restoration of the patient’s
health followed in less than a fortnight.”
(2) “The late Princess of Condé had interested herself greatly
in a young girl whom she had taken into her service. Upon her
return to Paris she took the girl with her, in the hope that the
physicians of that city would be able to cure her of the
hemicrania (‘_Migraine_’) from which the girl had frequently
suffered during the preceding five years. Bloodletting was the
remedy adopted at that period for nearly every malady, and these
Paris physicians let her have a full taste of this remedy,
prescribing in rather rapid succession twenty such bleedings,
the arm, the foot and the region of the throat being the
localities selected for this operation. Medical students were
thought to be quite sufficiently competent for the management of
the arm and foot bloodlettings, but it was I who was obliged to
officiate when it became necessary to carry out the bleeding
from the neck. As this was the first occasion on which I saw the
patient I asked her a number of questions in order to learn the
more important facts concerning her malady; and then, failing to
discover any that seemed to me to justify the numerous bleedings
to which she had been subjected, I examined her mouth, not as a
casual matter, but because she had told me about having
experienced a sense of heaviness and numbness in her lower jaw.
Observing some irregularity in the arrangement of her teeth I
counted them, and discovered that there were eighteen instead of
the sixteen which are usually present; and it also seemed to me
that the second molar tooth on each side was crowding the
others. After stating these facts to the Princess, and obtaining
her approval of the step which I proposed to carry out, I had
the two molars extracted; whereupon, to the great astonishment
of her ladyship and all of us, the girl found herself, at the
end of twenty-four hours, entirely cured of a malady which had
often, during the preceding five or six years, been so
distressing that she could not perform her regular duties.”
(Copied from Petit’s “_Traité des Maladies Chirurgicales_,”
etc.)
(3) In another part of the same volume Petit reports in detail
the history of a case of middle-ear inflammation in which, after
the lapse of a few weeks, there developed symptoms that pointed
very strongly to the presence of a subdural collection of pus
behind and above the inflamed middle-ear. Whereupon, at a
consultation that was held between the physicians in attendance
upon this patient, Petit urged the desirability of trephining
the skull in order to give vent to the contents of this assumed
abscess. Such a proposition, however, was promptly voted down by
the other consultants. (The events here described, it should be
remembered, occurred somewhere between 1750 and 1774.) Two or
three weeks later, the patient’s pain having become in the
meantime more severe, the timid consultants at last withdrew
their opposition, and Petit performed the trephining with
success. Much foul-smelling pus was evacuated, and after the
lapse of a few weeks the patient was pronounced cured.
It would be easy to furnish here, from the printed record already
mentioned, additional instances showing the courage, wisdom and skill
exhibited by J. L. Petit in his practice of the art of surgery. But the
instances already cited amply suffice, as it appears to me, to show the
admirable character of the man and his right to be considered the worthy
successor of Ambroise Paré.
Petit’s death occurred in 1760.
Petit made comparatively few contributions to medical literature, and of
these the shorter ones will be found in the “_Journal des Savants_,” the
“_Recueil des Mémoires de l’Académie des Sciences_,” and the “_Mémoires
de l’Académie Royale de Chirurgie_.” His great work, which was published
in three volumes at Paris in 1774 (also a later edition in 1790), bears
the title: “_Traité des Maladies Chirurgicales et des Opérations qui
leur Conviennent_.”
* * * * *
RAPHAEL-BIENVENU SABATIER was born at Paris on October 11, 1732. His
father, Pierre Sabatier, was one of the earliest members of the
_Académie Royale de Chirurgie_, and it was therefore quite natural that
Raphael chose medicine for his profession. There was nothing remarkable
about his early career. He worked hard at his studies of anatomy and
cultivated at the same time experimental physiology. At the age of
twenty-four he succeeded Balleul as Professor of Anatomy at the Royal
College of Surgery. In 1773 he was made a member of the _Académie des
Sciences_, and a few years later, when the war broke out, he was ordered
to report, as a consulting surgeon, at the headquarters of the Army of
the North, at Mons. But, his strength not permitting him to perform the
duties of this new position for any length of time, he was soon allowed
to return to his private practice. Toward the end of his life Napoleon
appointed him one of his consulting surgeons, and at about the same
period of time the decoration of the Legion of Honor was conferred on
him. When the _École de Santé_ was established he accepted the Chair of
Operative Surgery. His death occurred on July 19, 1811.
Sabatier was highly esteemed by his professional brethren. Unlike
Desault he brought forward no new inventions or methods of treatment,
but he constantly sought how he might introduce some little improvement
in existing well-established methods. He was not of an enthusiastic
temperament and rarely did anything to call forth opposition on the part
of his associates. As a consequence he led a most peaceful life.
Sabatier’s contributions to medical literature were fairly numerous, and
among them the following deserve to receive particular mention:—
“_Traité d’Anatomie_,” 3 vols., Paris, 1764.
“_De la Médecine Opératoire_,” 3 vols., Paris, 1796; a second
edition appeared in 1810; and a third (in 4 vols.) in 1821–1824.
* * * * *
FRANÇOIS CHOPART was born at Paris in 1743. During his youth he received
a thorough preliminary training. From the very beginning of his medical
course he showed a decided preference for surgery. Then, for a certain
length of time, he served as an _interne_ at Hôtel-Dieu. Afterward he
was transferred first to La Pitié Hospital and then to Bicêtre, where he
devoted his attention mainly to syphilitic affections. In 1767 he
divided the prize offered by the _Académie de Chirurgie_ for the best
memoir on the subject of “The Nature and Treatment of Wens.” In 1768 he
was given an “Honorable Mention” for his memoir on “Injuries of the Head
produced by Contrecoup.” In 1770, after passing with great credit the
examinations required, he was given on July 20, 1770, the degree of
Master of Surgery; and only one year later he was appointed Professor of
Practical Surgery. His pupils were very much attached to him on account
of the interest which he manifested in their work and because his
teaching was so methodical and was so clearly delivered. On March 13,
1782, he was chosen successor to Bordenave, the Professor of Physiology;
and a little later he was elected to the Chair of External Pathology.
While on a visit to England he made the acquaintance of John Hunter, and
kept up an active correspondence with him during the following years. He
was also one of Desault’s intimate friends. Being open-minded and frank
he got along pleasantly with all who came in contact with him. He died
in 1795 from an attack of cholera morbus.
Among his writings which deserve special mention are the following:
“_Traité des Maladies Chirurgicales et des Opérations qui leur
Conviennent_,” Paris, 1780, 2 vols.; and “_Traité des Maladies des Voies
Urinaires_,” Paris, 2 vols., 1701, and a later edition in 1821.
Chopart is known to American and English surgeons chiefly through the
fact that he devised an amputation of the foot which is commonly known
as “Chopart’s amputation.” The procedure is thus briefly described by
Dr. Thomas L. Stedman in his Medical Dictionary: “Disarticulation at the
metatarsal joint, leaving only the astragalus and calcaneum, with the
soft parts of the sole of the foot to cover the stump.”
* * * * *
PIERRE-JOSEPH DESAULT was born on February 6, 1744, at Magny-Vernois, a
small village in the Department of Haute-Saone, on the western slope of
the Vosges mountains. At the time of his birth his parents were living
upon the income derived from a modest fortune, and they found it very
difficult to support their family of seven. As soon as Pierre was old
enough to receive regular instruction he was placed under the care of a
private teacher at the neighboring village of Lure, the chief centre of
that district. In this way he acquired an elementary knowledge of Latin
and was fitted, by the time he reached the age of twelve, to enter the
fifth form or class at the Jesuits’ college in Lure. His favorite study,
as soon became evident, was mathematics, and this branch of knowledge he
cultivated with such assiduity and success that already at the age of
seventeen he had reached the point where all the elementary treatises to
which he had access no longer afforded him any satisfaction. At a
somewhat later period of his life, when he could no longer receive help
from his parents, this decided preference for mathematics stood him in
good stead, enabling him to contribute to his own support by giving
lessons in geometry. It also aided him in making useful applications of
its principles to the art which he was soon to cultivate with such
conspicuous success—viz., surgery. He took special delight at this time
in the perusal of Borelli’s celebrated treatise “on the movements of
animals,” and even went so far as to write a long commentary on this
work. Nothing, however, is now known about the fate of this document, as
Desault never published it nor showed at any time a wish to become an
author.
Bichat, from whose eulogy of Desault I have derived most of the facts
which are reported in the present brief sketch, says that during the
years immediately preceding the period which is now under consideration,
surgery was cultivated by artisans rather than by artists; and that, in
consequence of this situation of affairs, it was very slow in making any
advances which were worthy to be characterized as genuine steps of
progress. “Genius, when not appreciated, escapes as mere froth; its
efforts result in nothing unless glory is the reward. Little by little,
as the public learned more and more how great was its need of surgery,
this art began to receive a larger share of consideration; and thus, as
it became more honorable, it was cultivated to an ever greater degree,
and as a result it advanced at a more rapid pace toward perfection. In
its different branches, which were all working to accomplish some useful
purpose, new discoveries were constantly being made, and thus it came
about that from the middle of the eighteenth century onward French
surgery rapidly outdistanced the surgery of all the other nations.”
(Bichat.)
It was at this period that Desault began his career as a surgeon, and in
the course of that career he did at least his full share in the work of
supplying the deficiencies that were observed in some of the methods
commonly employed at that period, in removing the positive defects that
were discovered in others, and in devising entirely new procedures. At
the same time Desault did not fail to recognize the importance of making
the foundations of his knowledge as solid and firm as possible, and with
this idea in mind he spent all the time that he could possibly spare
from the clinical lessons which he was then giving, in utilizing the
anatomical material available in the dead-house of the hospital. As his
rivals stuck closely to the old methods of instruction, and in addition
were not endowed with his remarkable gifts of teaching, of drawing all
sorts of interesting inferences from the anatomical relations of the
part or limb that was under consideration at the moment, Desault rapidly
outdistanced all his competitors. He was, so far as I am able to learn
from the printed records of this period (1766), the pioneer of this
particular type of instruction (anatomical, pathological and clinical)
in surgery in the great Paris hospital Hôtel-Dieu. The young men who
attended these courses in ever increasing numbers were fascinated by
what they heard and saw,—for Desault always taught with the cadaver or
the living subject before him,—and it soon became very noticeable that
the attendance upon the lectures given by his rivals (_i.e._, the
regular professors) was falling off. Actuated by bitter jealousy these
men managed at first to have his permit to teach taken away from him.
But Antoine Louis and La Martinière, two of the most influential
surgeons of Paris, at that period, interfered and so arranged matters
that Desault was able to resume his private courses. In fact, Louis made
it clear, by his presence at several of the sessions, that he approved
of this teaching and that he proposed to protect Desault against all
interference on the part of rivals. Desault’s method of teaching, says
Bichat, constituted the first development, in France, of what is now
known as surgical anatomy, a very extensive and important department of
the art of surgery.
Another striking feature of Desault’s manner of giving instruction is to
be found in his invariable practice of demonstrating, whenever it was
possible for him to obtain the materials necessary for doing this, the
alterations which are produced in a part by disease or by accidental
injuries, and also the influence exerted by these lesions upon the
neighboring tissues or organs. In these demonstrations he never allowed
his mind to wander in the direction of pointing out something akin to a
discovery in pathology; he stuck closely to the questions that were
under immediate consideration, thus giving preference, over everything
else, to what was of chief importance to the students.
By thus conducting his teaching always with an eye single to the best
interests of his pupils Desault became, in the course of a very few
years, the most celebrated teacher of surgical anatomy in France. His
rivals laid stress upon this particular feature of his fame in the hope
of thereby belittling, in public estimation, the equally important
celebrity, which he was now shortly to attain, of being also a great
surgeon. It is in some such words as these which I am using that Bichat,
who was his favorite pupil and righthand man during this period of his
career, records the efforts made by his jealous rivals to interfere with
Desault’s professional success.
In the early stages of his career as a surgeon Desault gave instruction
in operative surgery, but in a comparatively short time he advanced
beyond this stage and showed that he possessed considerable originality.
He invented a very effective method of treating a fractured clavicle by
the application, to the shoulder, the elbow and the chest, of a bandage
which even to this day is known as “Desault’s bandage.” In planning this
bandage its inventor first calculated with great care the forces which
play the principal part in causing the displacement of the two segments
of the fractured clavicle. This manner of attacking the problem of how
best to treat such a fracture was, so Bichat declares, not that which
had usually been followed by his predecessors, but it nevertheless
proved to be the correct way of finding the right remedy. He believed,
for example, that, inasmuch as the external segment or fragment is
pulled downward by the weight of the shoulder and forward and inward by
the action of the muscles, the right course to pursue must, first, be to
furnish proper support to the shoulder, and at the same time to draw the
external fragment outward and backward. He realized that by the
employment of continuing extension it would be practicable to effect
these results. So, placing a cushion over the chest, to serve in some
measure as a point or angle of resistance, and resting the arm firmly
against it, he was able, by pressing the lower part of the arm closer to
the chest, to cause the upper part, together with the fragment attached,
to stand out from this part of the trunk. Thus, as it were by a single
stroke, he succeeded in obtaining a result which, for a very long period
of time, had eluded the best efforts of the surgeon’s art. This was a
great triumph for Desault, but its importance was not immediately
appreciated. The bandage was successfully used at the Salpétrière, one
of the larger hospitals of Paris, but the full recognition of its value
came only after the lapse of many years,—indeed, not until after the
death of its inventor. To-day it occupies an important place in the
history of surgery.
Of the other improvements in surgical procedures that we owe to Desault
I will mention here only one—that of ligating the exposed ends of the
larger arteries which had been divided in the course of the amputation
of a limb. Ambroise Paré, it will be remembered, was the first to
introduce this practice in France (early in the seventeenth century),
but it failed to meet with general acceptance and was then abandoned for
more than a century. At Bicêtre, another of the large hospitals of
Paris, the practice of immediately ligating the divided blood-vessels
after an amputation was first revived by Desault, and not long afterward
Ferrand also introduced the revived method at Hôtel-Dieu. From this time
onward it became the standard method of procedure.
In 1788 Desault succeeded Ferrand as Chief Surgeon of Hôtel-Dieu, and
from this time forward, for five years, he conducted with great success
regular instruction in clinical surgery. Then, toward the end of May,
1793, he was thrown into the prison of the Luxembourg, the charge
brought against him being that he had refused to give his professional
services to those wounded in the affair of the previous 10th of August.
He was retained as a prisoner only three or four days; but from this
time to the day of his death (June 1, 1795) he was kept in almost
constant fear of being prosecuted, and was consequently prevented in
large degree from doing any useful work in surgery.
In his analysis of Desault’s career as a surgeon Bichat calls attention
to the fact that the establishment of a clinical school at Hôtel-Dieu
was not the only benefit which he conferred upon that hospital. He did
much more than this; he improved the arrangement and the ventilation of
the different wards, established better methods of distributing the food
systematically among the patients, increased their comfort by making
rules whereby their wants would be more promptly supplied, etc. All
matters of this nature occupied the first place in his thoughts and
drove out of his mind, long before he died, all ambition to accumulate a
fortune. Despite the stormy conditions which prevailed during the
Revolution and which upset completely all the existing arrangements in
Paris, he managed to keep up a good part of his clinical courses.
Speaking of Desault’s personal traits of character Bichat says that he
was somewhat quick-tempered, but that he promptly got over his bad
temper and was then once more gentle and reasonable in his speech.
He had his full share of enemies. In nearly all cases this enmity sprung
from jealousy. But what really great man, adds Bichat, ever passed
through life without being annoyed by enemies through jealousy? On the
other hand, Desault had excellent friends, men who—as he expressed
it—were the joy of his life.
Desault was not of a scientific turn of mind; he never wrote articles or
took active part in any discussions. Some of the best of the pupils who
attended his courses took full notes of his lectures, and these, after
Bichat had revised them and edited them, were published under the title
of “The Surgical Works of Desault.”
* * * * *
GUILLAUME DUPUYTREN was born at Pierre Buffière, France, October 5,
1778. He commenced the study of anatomy and physiology at an unusually
early age, and was appointed Prosector at the Paris _École de Santé_
before he had reached his eighteenth year. In 1802, very soon after he
had received the degree of Doctor of Surgery, he was given the
appointment of Attending Surgeon to Hôtel-Dieu. Of this early period of
his career very little need be said. He lost none of his enthusiasm for
his chosen work and was recognized by all his associates as a surgeon of
great promise. From the position of simple attending surgeon at
Hôtel-Dieu he rose in 1808 to that of Adjunct Surgeon-in-Chief. Finally,
in 1815, after the death of Pelletan, he was made full Surgeon-in-Chief
of that great hospital. So far as it was possible for Dupuytren to
advance in the endeavor to gain official recognition as a surgeon, he
had by this time risen to the highest point that it was practicable for
him to reach. Let us now consider some of the other aspects of his
career.
[Illustration:
DUPUYTREN
]
After the death of Bichat in 1802 Dupuytren turned his attention from
what was supposed to be normal anatomy to pathological anatomy. The
change was greatly favored by the fact that, in the course of his
regular work as prosector, he was constantly encountering all sorts of
pathological conditions, and thus he gradually acquired a strong
interest in pathological problems. Pathological anatomy, as newly
interpreted, was no longer a mere observing of the abnormal changes
which take place in different structures and organs of the body,—the
sort of “cold work” which had occupied in large measure the minds of
Bartholinus, Mangetus, Bonnet of Geneva, Morgagni of Bologna, and
Lieutard, and which involved practically no study of the origin of such
changes,—but what might be termed a living pathological anatomy, in
which the effort is made to ascertain the beginning, the gradual
progress and the termination of the process. Ample material for this
sort of study was constantly passing through Dupuytren’s hands, and he
made the most of his opportunities. Professor LeClerc, who is my chief
authority for the present sketch of Dupuytren, says that by means of
this new pathological anatomy much light was thrown upon both diagnosis
and symptomatology. At first the courses which Dupuytren gave in the
_École de Santé_ ran in large degree parallel with those of Bichat, but
after the latter’s death Dupuytren had the field almost entirely to
himself. He taught anatomy, pathological anatomy, and physiology, and
increased the interest in his teaching, on the part of the pupils, by
furnishing a variety of facts drawn from his wide experience. His great
skill as a dissector enabled him to demonstrate all sorts of fine
details—as, for example, not merely a limited portion of a nerve, but
nerves throughout their entire course.
After Dupuytren became full Surgeon-in-Chief at Hôtel-Dieu he ceased
teaching operative surgery and devoted himself largely to clinical
surgery. He adopted the habit of visiting the hospital at an early hour,
long before the time appointed for the arrival of the class, and thus he
was able to examine the patients leisurely and to give all the necessary
instructions to his assistants. By the time the class arrived he was
entirely ready to receive them. He was extremely punctual in attending
to his hospital duties.
In 1814 Dupuytren took an active part in caring for the wounded soldiers
on the field of battle; and again in 1830, during the civic disorders of
that period, he had the care, at Hôtel-Dieu, of many cases of wounds
from firearms.
A French physician whose identity is concealed under the initials J. L.
H. P., has published a very complete pen-portrait of Dupuytren’s most
prominent personal and professional characteristics, and Elisha
Bartlett, M.D., of Boston, has furnished us with an excellent English
translation of this work. From this book I shall take the liberty of
quoting here several sections that seem to me to be particularly
interesting.
Monsieur Dupuytren is, in my opinion a surgeon of the
most exalted merit.... He has a _coup d’oeil_ of most
admirable precision, a sure and steady hand, a coolness and
self-possession always imperturbable, and that innate instinct
or tact so necessary in all the arts. A man is born surgeon or
physician, as a man is born poet or painter.... Monsieur
Dupuytren is particularly remarkable for his diagnostic
foresight.... Arrived at the bedside of the patient, his fine
senses are all awake; in a few minutes of question and
researches, his examination is finished. One might often believe
that he has given to the case only a superficial attention, but
his subsequent lecture will prove that he has seen everything
and seen it thoroughly.... He describes a pathological
alteration, yet hidden in the interior of an organ, as though it
were visible, and, when the scalpel has dissected and uncovered
it, the truth of his description is verified by all who witness
it.... Monsieur Dupuytren is not less skilful in treating
surgical diseases than he is in detecting them.... I do not fear
that I shall be accused of exaggeration in saying that very few
surgeons have given proof of so much surgical genius in the
invention of modes of operating or so much expertness in their
execution. Monsieur Dupuytren possesses in the highest degree a
creative and inventive spirit....
So much for Monsieur Dupuytren as a practitioner; Let us now
consider him as an instructor....
Since 1815, the surgical clinic of Hôtel-Dieu has lost none of
its ancient reputation. No other clinical course in France can
be compared to this, whether for the number of students, the
abundance of cases, or, finally, for the genius of the
professor. In effect, Monsieur Dupuytren comprehends perfectly
in what clinical instruction consists; a thing that ought to be
somewhat difficult, seeing how few there are who succeed in it.
Lessons of clinical surgery have no resemblance to a course of
surgery.... A clinic is altogether a different thing. The
professor has need here to speak continually without
preparation, because the material of his lesson cannot be
regulated by himself, in advance, but is dependent upon chance,
which brings him, to-day, a strangulated hernia, to-morrow, a
fracture; and, in the same day, four or five different cases....
An excellent practitioner, Monsieur Dupuytren thus really
possesses the most essential quality of a clinical professor.
But to this first fundamental qualification others ought to be
united. The professor ought to have a free command of language
and the talent of extemporaneous speaking; he should possess a
memory sufficiently good to recall distinctly all the
circumstances of diseases, and the peculiarities of the
different treatments that he has directed; it is necessary,
that, thoroughly understanding the necessity and obligations of
his instruction, he should accustom himself to return every day
to things which he has a thousand times repeated, unmindful of
the fatigue resulting from such repetition; above all, he should
remember that he is occupied with inexperienced hearers, to whom
it is not sufficient to say things imperfectly; hearers who may
easily be dazzled and led astray, but who ought to be
instructed, an end that cannot be attained without patience. In
respect to all these things, Monsieur Dupuytren is almost
irreproachable.... As to myself, instructed by my personal
experience, and by the numerous comparisons that I have made, I
do not hesitate to believe and to say that the clinic of
Monsieur Dupuytren may be offered as a model of this kind of
instruction.
In his memoir concerning the medical schools of Paris, John Gross, an
English surgeon, says that no lectures at the _École de Médecine_ were
so numerously attended as were those delivered by Dupuytren on operative
medicine. He adds that at the lecture which he attended on the operation
for inguinal hernia, there were present about 1200 students, the
greatest number that the theatre is capable of containing. “But I must
confess that I have seldom learnt less from any good practical lecture
than I did from this. I was too far off to distinguish well what I saw,
or comprehend what I heard; and I returned home with a feeling of
regret, that what is grand should be so far remote from what is most
useful.”
Dupuytren’s health began to break down in 1833, and he was obliged to
take a trip to Italy. A certain amount of improvement resulted from this
journey, but only for a brief period of time. On February 7, 1835, he
died, leaving in his will the sum of 200,000 francs to _l’École de
Médecine_ for the establishment of a chair of pathological anatomy.
Before his death, however, he assented to the proposition that the
_École_ should assume the responsibility of providing funds sufficient
for founding the professorship and thus enable the authorities to
utilize the legacy in establishing an anatomical museum, the _Musée
Dupuytren_, where all sorts of pathological specimens may be carefully
preserved and exposed to view in well-constructed cabinets. (See
photograph of this museum in the plate facing page 260.)
------------------------------------------------------------------------
CHAPTER XXIII
WORKERS IN SPECIAL DEPARTMENTS OF SURGERY: DEMOURS, DESCEMET, DELPECH,
FAUCHARD, JOURDAIN, GARIOT
In modern times such special departments as those devoted to the care of
the teeth, mouth and jaws, to the remedying of defective eyesight and
other affections of the eyes, to the care of the organ of hearing, and
to the cure of the different disorders of the pharynx, larynx and nasal
cavities, have assumed the importance of independent fields of surgical
activity, and as such they demand and are receiving to-day the attention
which they deserve. But during the eighteenth century the practicing
physician was expected to possess the knowledge and skill necessary for
the relief or cure of all such bodily ills, and he was forced to accept
the duties growing out of these problems as a regular part of his day’s
work. In the estimation of the general public the holder of the degree
of M.D. was credited—up to a comparatively recent date—with the
possession of knowledge sufficient for the cure of _all_ bodily ills;
and one can now easily imagine how greatly most of these men must have
suffered from the feeling that they were playing a false and ignoble
part whenever they accepted—as they did in many cases of this nature—a
degree of responsibility which they were wholly unable to bear.
In the present chapter I shall discuss very briefly only these three
specialties: eye surgery, orthopedic surgery and dental surgery.
In the Middle Ages there seem to have been at least two men who were
really skilled in eye surgery and who were widely known in the southern
portion of Europe as possessing exceptional knowledge and skill in the
treatment of this class of maladies. I refer to Pierre Franco, of
Lausanne and Orange, and to Demosthenes of Marseilles. (Brief references
to the work of these two will be found in the volume on “The Growth of
Medicine.”) Then at Vienna, Austria, as I have stated on a previous
page, there were, in the early part of the eighteenth century, Beer,
Rosas, and perhaps one or two others, who did excellent work in eye
surgery, and whose writings on this subject are still to-day held in
high esteem as trustworthy authorities. In France, on the other hand,
there were only two men who, in the early part of the eighteenth
century, seem to have devoted their time and skill to the relief of
affections of the eye—viz., Demours and Descemet.
* * * * *
PIERRE DEMOURS was born at Marseilles in the early part of the
eighteenth century, began the study of medicine at Avignon, and then
went to Paris for the completion of his professional training. He
received his doctor’s degree, however, at Avignon in 1728, probably
because the graduation fees in the latter city were not so large as
those required in Paris. At a still later date he returned to the
capital for the further prosecution of his professional studies, and
while there he was given the appointment of Assistant to Duverney, the
celebrated anatomist, who at that period, despite his advanced age
(eighty years), was still actively engaged in research work. Two years
later, upon Duverney’s death, Demours was invited to accept the
associated positions of Demonstrator and Custodian of the Cabinet of
Natural History at the Jardin du Roi. He had occupied these positions
only a short time when Jean-Louis Petit, the celebrated French surgeon,
who had observed the excellent character of the work performed by
Demours, advised him to direct his studies more particularly to the
anatomy and maladies of the eyes. Demours was quite ready to accept this
advice, and thus it came about that in a few years he acquired
considerable reputation as a successful practitioner in affections of
the eye, a reputation which he continued to hold up to the time of his
death on June 26, 1795.
Among the contributions which Demours made to the literature of
ophthalmology the following deserve to receive special mention:—
Letter to Petit giving the report of an eye complication that
developed as the result of an inoculation with the virus of
small-pox; together with an account of some new observations
relating to the anatomy of the eye and a few general comments on
diseases of that organ; Paris, 1767.
A new series of remarks upon certain features in the anatomy of
the cornea; Paris, 1770.
Observations on the structure of the _corpus vitreum_; Paris,
1741.
Observations on the cornea; Paris, 1741.
Dissertation on the mechanism of the movements of the pupil and
on certain characteristics of the _fibrae rectae_ of the uvea,
in “_Mémoires des Savans Étrangers_,” tome II.; and the
following articles in the “_Journal de Médecine_” edited by
Vandermonde: “On an affection of the eyes which sometimes
develops after a perfectly faultless cataract operation
(extraction),” in tome XVI.; “Reply to Monsieur Descemet’s
article on the cartilaginous layer of the cornea,” in tomes
XXXI. and XXXIII.
* * * * *
JEAN DESCEMET, born at Paris on April 20, 1732, was the pupil and friend
of Duhamel-Dumonceau, one of the greatest teachers of that period and an
enthusiastic scientist, but not a physician. Vicq-d’Azyr says that the
list of the papers which he published during his lifetime (he was
eighty-two years old at the time of his death) is very long and reveals
the fact that he was interested in a great variety of topics, the
majority of them relating to commerce, the arts, vegetable physiology,
agriculture, and marine questions. To Descemet the influence of such a
powerful mind, so enthusiastic and yet so precise in all its operations,
could not fail to have been very great, and one of its earliest effects
was to lead him to take a strong interest in botany and in anatomical
research work. His graduation thesis, which—in accordance with the
prevailing custom—he publicly defended early in 1758, dealt with the
subject of the minute anatomy of the cornea and the lens. As the
investigations which he made in regard to these important structures
were strictly original, the scientific authorities accorded to him the
honor of having his name attached to the membrane which lines the
internal face of the transparent cornea, and which at the same time
envelopes the aqueous humor. The reason why this membrane was selected
by preference was this: Descemet was believed to have been the first
person to describe in great detail this previously unknown structure.
Demours, in 1767, published an article in which he claimed that the
honor of this discovery belonged to him and not to Descemet. I cannot
pretend to decide upon the justice of this claim; but, so far as I am
able to learn, nobody has in modern times seriously disputed the
propriety of retaining the name “Descemet’s membrane.”[25]
Descemet was held in high esteem by all his associates in the Paris
Faculty of Medicine. He was generally recognized by the medical men of
France to be a skilled anatomist and a careful and trustworthy observer.
The various offices which he held at one time or another in the course
of his active life give further proof of the correctness of the estimate
which I have furnished of this admirable French physician. His death
occurred at Paris in 1810.
Among his published writings the following deserve to receive special
mention:—
“_An sola lens crystallina cataractae sedes?_”—Paris, 1758.
“Catalogues of the garden plants cultivated by the apothecaries
of Paris,” Paris, 1759.
“Mémoire et observations sur la choroïde, etc.,” in “_Mémoires
des Savans Étrangers de l’Academie Royale des Sciences_,” tome
V., 1768.
In the last-named article valuable information is furnished with regard
to the membrane which bears his name. Here, for instance, is revealed
the fact that with advancing age the attachment of the membrane to the
cornea gradually becomes less firm until finally, at the age of about
sixty, it becomes completely detached.
* * * * *
JACQUES DELPECH was born at Toulouse, in the south-western part of
France, in 1772. After he had completed his preliminary studies at
Toulouse he went to Montpellier, took the regular course in medicine at
the university, and was given the degree of Doctor in Surgery in 1801.
While residing in that city he acted as an _Officier de Santé_ in one of
the military hospitals. The following year he was given the position of
Instructor in Anatomy at the Toulouse Medical School, which at that
period bore the title of “_Société de Médecine et de Pharmacie_.” It was
here that he first manifested his great gifts as a teacher, his success
in this respect being truly remarkable. In 1812 he offered himself,
along with several other competitors, as a candidate for the chair of
clinical surgery in the Faculty of the Montpellier Medical School, and
was given this coveted position. It should be stated, however, that
previous to this event, for a period of several years following his
brief service as an instructor in anatomy at Toulouse, he had devoted
himself with great zeal and thoroughness to the study of surgery in
Paris, and was therefore specially well prepared for this competitive
test. In the new field in which, from this time forward to the end of
his career, he worked with unflagging enthusiasm, Delpech had ample
opportunity to show to the world his great talents as a teacher of
surgery.
There was one branch of surgical work in which he took a greater
interest than in all the others, made many ingenious discoveries, and
thus gained great distinction; I refer to the pathology and treatment of
deformities, the science of orthopedics. He not only built up a large
practice in cases of this nature, but he also wrote a valuable treatise
on the subject. This work, which was published in Paris in 1828–1829,
bears the title: “_De l’Orthomorphie, par Rapport à l’Espèce Humaine, ou
Recherches Anatomico-Pathologiques sur les Causes, les Moyens de
Prévenir, Ceux de Guérir les Principales Difformités, et sur les
Véritables Fondemens de l’Art Appelé Orthopédique_.” It is, briefly
stated, a complete treatise on the pathology and treatment of
deformities of the human frame, one of the first (possibly the very
first) of its kind published in a modern language. From statements which
he makes in the course of his text it appears that Delpech recognized at
an early date that it is upon the muscles surrounding a joint that its
solidity is chiefly dependent, and consequently that all lesions
involving the muscular apparatus in the neighborhood of a joint are very
potent factors in the causation of deformities. In addition, he states
that the absence of exact fitting of two opposite articular surfaces,
one upon the other, during the period of development of the skeleton,
constitutes another and very important cause of deformities both in the
limbs and in the trunk. To these general causes, he says, there may be
added the following: muscular debility, the effects produced by certain
attitudes of the body, by the paralysis and also by the contractures of
certain muscles, by the effects of rheumatism, by softening of the
bones, etc.
In other sections of the treatise he discusses in a most practical and
interesting manner the subjects of diagnosis and treatment of
deformities. In the remarkable orthopedic hospital which he established
in Montpellier he treated, with enthusiasm and untiring faithfulness,
large numbers of patients suffering from deformities of all sorts, thus
gaining a wide experience in this particular class of cases, and
constantly increasing his skill in treating them successfully.
In the earlier years of his practice Delpech also published an important
paper on the subject of hospital gangrene, under the title: “_Mémoire
sur la Complication des Plaies et des Ulcères, Connue sous le Nom de
‘Pourriture d’Hôpital’_”; Paris, 1815. This memoir is esteemed by his
biographer to be the best treatise that had been written on hospital
gangrene up to the year 1834.
Delpech, says his biographer, will always be classed as one of the most
distinguished professors of the Medical School of Montpellier during the
early part of the nineteenth century.
On the 28th of October, 1832, he was assassinated by a merchant of
Bordeaux upon whom he had operated for varicocele during the preceding
year, and who, immediately after killing his victim, destroyed his own
life.
* * * * *
PIERRE FAUCHARD, A. JOURDAIN AND J. B. GARIOT.—Although it is the
general belief that dentistry did not become a separate and independent
branch of surgical practice until a comparatively recent date, there is
nevertheless some evidence that efforts were made by certain surgeons,
many years ago, to engage in this special field of work. The earliest
record of this fact, so far as I have been able to discover, is
furnished by Francis Gribble in his book entitled: “Lake Geneva and its
Literary Landmarks.” According to his statement a dentist, toward the
end of the sixteenth century, applied to the Governing Body of Geneva,
Switzerland, for permission to settle in that city and practice his
profession. As the civic authorities, however, did not appear to
comprehend just how much risk, either to the bodies or to the souls of
the Genevese, was involved in granting the desired permission, they
referred the question to Théodore de Bèze, the great theologist, who, in
the temporary absence of John Calvin, was acting as the Syndic or Mayor
of the city. We are not told by Gribble how the matter was at last
decided, but there can be scarcely any doubt that the dentist was
finally permitted to hang out his shingle and go to work.
The explorations made among the ruins of ancient Egypt show that even at
that remote period, three or four hundred years before the Christian
Era, there were men who knew how to fill carious cavities in human teeth
and to perform other surgical acts which call for the skill and
knowledge of the practical dentist. But the discovery of such isolated
facts does not demonstrate clearly that dentistry was practiced at that
early period as a special department of the surgical art; and,
furthermore, many centuries after that date elapsed before there was
discovered any further evidence that dentistry had survived during the
long intervening period. In fact, the records do not throw much light on
this subject until we reach the seventeenth century. Then it appears
that a certain Alexandre Poteler, during the latter part of that
century, attained considerable celebrity, in France, as a skilful and
experienced dental surgeon. Further details concerning this man are
lacking.
Sprengel, in his history of medicine, mentions the names of several
men—Germans, French and English—who during the early part of the
eighteenth century occasionally performed operations in the field of
dentistry, but among this number I find only three who appear to have
attained eminence in their special line of work—viz., Pierre Fauchard,
A. Jourdain, and J. B. Gariot. I will furnish here the few details which
I have been able to obtain concerning the career of these men.
* * * * *
PIERRE FAUCHARD was born in France toward the end of the seventeenth
century. After receiving the regular training of a physician he entered
the service of the Royal Navy, ultimately attaining the rank of
Surgeon-Major. Subsequently, having first taken a special course of
instruction under Alexandre Poteler, he settled at Paris and practiced
dentistry in that city for a period of more than fifty years. During the
course of his career he published a treatise on the surgery of the
mouth, and in the preparation of this work he received efficient aid
from Jean Devaux (1649–1729), one of the most learned surgeons of his
time in France. This treatise, according to the testimony of his
biographer, contains many reports of cases which were observed by
Fauchard in actual practice; and, he adds, the book still possesses
considerable value as a work of reference. Among the unusual
pathological conditions described and occasionally pictured the
following deserve to receive special mention:—“Abscess or Softening of
the Dental Pulp without Recognizable Alteration of the Cortical
Substance” (relief was obtained by trephining the tooth); “Defective
Teeth of Many Different Kinds,” and the proper manner of remedying such
defects, both in cases where only a part of the tooth is defective, and
also in those where it is found necessary to supply an entire tooth or
even several teeth; “On the Art of Remedying Defects in the Palate”; “On
the More Extensive Employment of Lead Fillings, etc.” The treatise here
referred to bears the following title: “_Le Chirurgien Dentiste, ou
Traité des Dents_, etc.,” with 40 engraved plates; 2 vols., Paris, 1728;
a second edition, which was published in 1746, contains many important
additions.
* * * * *
ANSELME-LOUIS-BERNARD-BRECHILLET JOURDAIN, who was born in Paris,
November 28, 1734, was one of the most distinguished French physicians
of the eighteenth century who devoted himself largely to the study and
practice of dentistry. He was also interested in medical science
generally, having acted for several years as an associate editor of the
_Journal de Médecine_. Among the treatises which he wrote on topics
relating to dentistry the following deserve to receive special
mention:—“_Nouveaux Élémens d’Odontalgie_,” Paris, 1756; “_Traité des
Dépôts dans le Sinus Maxillaire, des Fractures et des Caries de l’Une et
de l’Autre Mâchoire; Suivi de Réflexions et d’Observations sur Toutes
les Opérations de l’Art du Dentiste_,” Paris, 1760; “_Essai sur la
Formation des Dents, Comparée avec Celle des Os, Suivi de Plusieurs
Expériences, tant sur les Os que sur les Parties qui Entrent dans leur
Constitution_,” Paris, 1766; and “_Traité des Maladies et des Opérations
Réellement Chirurgicales de la Bouche et des Parties qui y
Correspondent, Suivi de Notes, d’Observations Interessantes, tant
Anciennes que Modernes_,” Paris, 1772, 2 vols.
Jourdain’s death occurred on January 7, 1816.
* * * * *
JEAN-BAPTISTE GARIOT was born in France during the latter half of the
eighteenth century. The French records furnish very scanty information
concerning his professional career. For example, among other matters of
minor importance, it is stated that he was a member of the Royal College
at Madrid, that he was the dentist of the King of Spain, and that he
published a treatise which bears the following title: “_Traité des
Maladies de la Bouche_,” together with an account of the structure and
functions of the parts that enter into the formation of the mouth, the
diseases to which these parts are liable, the means that may be employed
for maintaining them in health and beauty, and the different operations
which belong specially to the domain of the dentist; with 15 plates,
Paris, 1805.
------------------------------------------------------------------------
BOOK XII
DESGENETTES AND LARREY, FRANCE’S MOST CELEBRATED MILITARY SURGEONS
------------------------------------------------------------------------
CHAPTER XXIV
MILITARY SURGERY
The two most distinguished military surgeons in Europe during the
eighteenth and nineteenth centuries were Desgenettes and Baron Larrey,
both of them natives of France.
* * * * *
AIMÉ-NICOLAS DUFRICHE DESGENETTES was born at Alençon, France, in 1762.
His early medical training was obtained at the University of
Montpellier, and the degree of Doctor of Medicine was bestowed upon him
in 1789. Four years later he entered the French military service and
participated in the campaign of Egypt and Syria, during which he rapidly
rose to the position of Chief Physician in that part of the army which
was officially designated as the Army of Italy. In 1802, after the close
of the campaign, he was appointed First Physician of the Military
Hospital at Paris, and at the same time was given the position of
General Inspector of the Health Department of the Armies. From that time
to the year 1814 he visited, in his official capacity, Russia, Prussia
and Spain; and amid scenes of carnage and destruction he never failed to
display the character of a high-minded physician, a benevolent and
guardian spirit. His career as a medical officer was largely that of a
man of action, who exhibited at the same time a keen sympathy for those
who stood in need of his services. To quote the words of his biographer,
“he extended his cares to the sick of all nations,—to the Turk and the
Christian, to the men of the South as well as to those of the North,
and, as disinterested also as the Great Hippocrates, he retired poor
from his labors, though he might easily have made himself rich. Often
placed in opposition to military power and faction, he always exhibited
an unwavering inflexibility and energy of character. His thorough
knowledge of men and things, his skill in the practice of his art, and
his vigorous and unbending mind distinguished him for more than twenty
years at the head of the medical service of the French armies.”
This splendid showing, I venture to remark, could scarcely have been
realized if Bonaparte had not been endowed with two admirable traits of
character. In the first place, he seemed to possess almost infallibly
correct judgment in his choice of men who were to act as generals or as
chief surgeons of his various armies; and then, in the second place, he
was in the habit of supporting these men loyally whenever, later on in
their career, disputes arose as to the wisdom or patriotic purpose of
their decisions. The history of the wars that occurred from 1793 to
1814, between France and the different European nations which opposed
her, abounds in instances that confirm the truth of what I have just
stated. Corvisart, it is also highly probable, deserves much of the
credit for Bonaparte’s loyal treatment of his chief army surgeons.
The biographer of Desgenettes relates two occurrences which throw
additional light upon the nobility of character of this admirable
physician. These occurrences are briefly narrated as follows:—
A contagious disease appeared in the Army of the East and spread
rapidly from one man to another. The soldiers were struck with
terror and despair, and were ready to die, merely because they
considered death imminent and inevitable.... Monsieur
Desgenettes assured them that the hideous buboes with which they
were covered were not symptoms of the plague, and he proved it.
How? By the following heroic experiment. He took the matter of
these buboes and inoculated himself in the presence of the
soldiers. This proof was conclusive in their eyes, hope was
again kindled in their bosoms, and the mortality diminished.
Here is one of those brilliant actions which history delights to
preserve and transmit from age to age.
[Illustration:
DESGENETTES
]
On another occasion Desgenettes manifested equally great courage. The
occurrence is narrated by his biographer in these words:—
Made prisoner in the retreat from Russia, he demanded boldly his
liberty, not as a favor, but as a right; he invoked the
sacredness of his ministry and in particular the cares which he
had lavished alike on the Russians and on the French. An
imperial ukase immediately rendered him his liberty. The Emperor
Alexander called him into his presence and expressed to him his
sentiments of high esteem and regard. He received soon after
from Sweden the order of the Polar Star.
Desgenettes’ death occurred in 1837. He made no contributions to medical
literature; and his enemies brought against him the charge that, when he
delivered a lecture, he spoiled it by telling too many anecdotes about
the different wars in which he took part.
* * * * *
JEAN-DOMINIQUE LARREY was born in 1776 at Baudéan, a French village at
the foot of the Pyrenees. At the age of thirteen years, shortly after
the death of his father, he quitted his native village and came under
the care of his uncle, Alexis Larrey, who was Surgeon-Major and
Professor at the Hospital of Grave, near Toulouse. Under the wise and
kindly guidance of the latter he pursued his studies so earnestly and
with such intelligence that he was able, on attaining his twentieth
year, to pass successfully the examinations required for an appointment
to the position of Assistant Surgeon in the French Navy.
The sloop-of-war “_La Vigilante_,” the vessel in which he gained his
first experience in the naval service, met with disaster and Larrey was
nearly shipwrecked. As soon as possible after this thrilling experience
he went to Paris and took service in the great Hospital of Hôtel-Dieu,
under the orders of the famous surgeon Desault. This was at the
beginning of the severe winter of 1789, an eventful time in the history
of France. The Revolution was now in full swing, and Larrey not only was
an eye-witness of the troubles which characterized its early stages, but
he also had the opportunity, under the orders of Desault, to render
professional service to the first victims of those tragic days. Three
years afterward, while serving in the Army of the Rhine, under the
command of Marshal Luckner, he was able to put to good use all the
admirable surgical training which he had received under Desault at the
Hôtel-Dieu.
When Larrey was about twenty-one years old and while he was attached to
that part of the French Army which was then stationed in the vicinity of
Milan and Venice, he interested himself actively in the establishment of
an army ambulance service. Already three or four years earlier he had
become sensible of the inconveniences of the French ambulances which
were then in use. In the first place, these vehicles were of such a type
as to be ill-suited to the work which they were intended to perform;
they were too heavy to be driven with reasonable speed to and from the
battlefield, and they were also so rigidly constructed that at every
irregularity in the ground over which the wheels passed the wounded
soldier experienced a painful jolt. Then, in the second place, aside
from the faulty construction of these vehicles, the regulations
governing their management were so badly planned as to leave the wounded
lying unaided on the battlefield sometimes for several hours together.
It was customary, for example, to station the ambulances at a spot about
three miles distant from the troops who were shortly to engage in
combat, and they were not despatched to the battlefield until after the
fighting had ended. In this way hours often elapsed before the wounded
could receive any aid whatever from the surgeon.
In working out a solution of this complex problem Larrey’s very
practical mind quickly reached certain conclusions: first, that it was
most important to remove the wounded from the battlefield to a place of
safety much earlier than had hitherto been the custom; and, second, that
the type of ambulance then universally employed was altogether too heavy
and too rigid to serve well the purposes for which it was needed. He
realized fully that this last part of the problem was the more important
part, and that, if he could invent a less ponderous and at the same time
more elastic vehicle for use as the field ambulance, he would by this
very act be placed in a position where he could effect in a large
measure a solution of the second half of the problem.
[Illustration:
BARON LARREY
]
Larrey promptly set about the work of providing a new type of field
ambulance and in a short time was successful in obtaining a most useful
vehicle for the purpose. It is described by his biographer in the
following words:—
This invention of Larrey’s was a kind of carriage hung on
springs, uniting great strength and solidity with lightness.
Such indeed was its lightness that it was able to follow all the
movements of the advance guard with as much speed as flying
artillery. These _ambulances volantes_, as they were called,
were first used by the French in a defile of the Rhine near
Koenigstein. Here the ambulances invented by the talented and
benevolent French surgeon bore the wounded rapidly away from the
neighborhood of the enemy instead of leaving them either to die
or to sustain a protracted agony on the field of battle.
In this work of inventing a field ambulance of a greatly improved
pattern Larrey revealed an exceptionally fine trait of character, viz.,
a strong desire to utilize his talents and the opportunities afforded by
his official position for the benefit of his fellow men, both the
wounded of the French army and those of the enemy forces. He revealed
the same trait in many other ways—as, for instance, when he took
infinite pains, after a battle, to provide proper shelter, food and care
for the wounded in the town or village nearest to the site of the
conflict, and that too in a part of the country which belonged to the
enemy. He revealed it again in the fighting which took place in Eastern
Prussia and in the course of the numerous retreats which Napoleon’s army
was forced to make in the Russian campaign.
Among the incidents which occurred during that long and disastrous
retreat of the remnants of Napoleon’s army from Moscow there was one
which reveals in a very clear light the high sense of duty that
characterized Larrey’s actions as Surgeon-in-Chief of the French Army
and the complete faith which the individual soldiers composing that
army—or at least the better disposed among them—placed in his
disinterested and loyal service in their behalf. The incident to which I
have reference occurred while the disorganized French troops were
crossing the Beresina River and is thus described by Larrey’s
biographer:—
The Russian general arrived at the head of 50,000 men and began
the fire among the division of General Partonneaux, the soldiers
of which division immediately wished to cross the Bridge all at
once. The conveyances collided with one another, and some of the
unfortunate men were crushed, while others, losing all spirit,
threw themselves into the stream.... There was throughout a
frightful mixture of imprecations, of clashings, and of
strugglings, whence arose indescribable disorder and a breaking
of the overloaded bridge. The Russian Army approached, and with
its formidable artillery tore the ranks of the French mob of
soldiers.... In this immense disaster what had become of the
distinguished Surgeon-in-Chief of the Grand Army? After having
crossed over the Beresina with the Imperial Guard, he discovered
that requisites for the sick and wounded of his countrymen had
been left on the opposite bank. With equal humanity and heroism,
he recrossed the river, and hardly had he done so when he was
surrounded by a wildly excited crowd. He was almost suffocated
in the midst of it.... No sooner was he recognized than he was
carried back with great rapidity in the arms of the soldiers
across the river. On all parts was heard the cry, in nearly
these words, “Let us save him who saved us!” The soldiers almost
forgot their own safety in their desire to preserve an officer
whose tender kindness they had so often experienced.
I believe that I have now shown with sufficient fulness of detail what
were the prominent characteristics of Larrey as a man and as an
executive army medical officer. It still remains for me to furnish some
evidence of the excellent judgment which he displayed in his work as a
practical surgeon.
In one of the French hospitals, during the war, Larrey’s attention was
called to a Russian soldier who had been shot in the forehead by an iron
ball weighing 217 grammes. This projectile had pierced the frontal bone
above and a little to the outside of the right eyebrow, and had
penetrated into the interior of the skull. Despite the bulk of this iron
ball, the opening which was perceptible in the bone did not exceed six
or eight millimeters in diameter, and, by introducing a small probe, one
might feel the ball. The smallness of the opening in the bone, says
Larrey, may be explained by the elasticity of the osseous fibres, some
of which the ball would have to push aside in order completely to
penetrate the outer table of the frontal bone, and which consequently
would yield instead of fracturing. In the present case the bony angles
at the edge of the circular opening were cut away by the surgeon and the
opening itself was made large enough to permit the removal of the ball
by means of an elevator and pincers. A great quantity of coagulated
blood and some small fragments of bone were then evacuated. The brain
itself presented at this spot a depression of about seven millimeters in
depth. In a short period of time the wound healed, and apparently
complete recovery followed.
In order to judge correctly of the credit which rightfully belongs to
Larrey for his successful treatment of this case of gunshot wound of the
skull and underlying brain, one must remember that in the early part of
the nineteenth century it was considered a very bold surgical act to
operate upon the injured brain, and particularly so in the almost
complete absence of adequate surgical equipment.
As an instance of Larrey’s quickness in meeting an emergency I will
narrate here very briefly an experience which he had at Smolensk,
Russia. When the French troops entered that city, after a severe battle,
they found that the inhabitants had already fled, owing in part to the
fact that many of their dwellings had been destroyed by fire. Larrey, as
soon as was practicable, converted fifteen of the largest buildings
which had not been devastated by the flames, into hospitals for the
wounded. Unfortunately, all supplies or stores of any kind had either
been destroyed by the enemy or removed by them in their orderly and
premeditated retreat. For the large number of wounded there was a
deficiency of linen and splints; but Larrey discovered a store of
archives in one of the buildings which had escaped the fire, and he
promptly substituted sheets of paper for linen and utilized the thick
parchment covers for splints. He toiled with little intermission night
and day, and the French surgeons generally, in imitation of their chief,
were indefatigable in their attention to the wounded, who were about
10,000 in number.
Las Cases, in his “Memorial of St. Helena,” published after he had
returned to Europe, reports Napoleon as having uttered the following
words on October 23, 1816: “What a man, what a brave and worthy man is
Larrey! What care was given by him to the army in Egypt and everywhere!
I have conceived for him the highest esteem. If the army were to raise a
column to the memory of any one, it should be to the memory of Larrey.
He has left in my mind the idea of a truly honest man.” In his will
Napoleon wrote: “I bequeath to the Surgeon-in-Chief of the French Army,
Larrey, 100,000 francs. He is the most virtuous man I have ever known.”
The reader will pardon me, I am sure, if I furnish here additional proof
of Larrey’s sound judgment in questions of a purely surgical nature. He
insisted, for example, on the importance of promptly resorting to
amputation in cases where the gunshot wound had caused a complicated
fracture of the bone or had inflicted serious destruction of the soft
parts; and he particularly recommended this course of action in the case
of individuals who were cachectic or below par. He expressed himself in
favor of the circular incision in preference to that which was intended
to furnish flaps. (From “_Mémoire sur les Amputations, etc._,” Paris,
1797.)
In another place Larrey mentions, somewhat in detail, the reasons why
primary amputations are to be given the preference in military surgery.
They are the following:—
(1) The inconvenience which attends the transportation of the
wounded from the field of battle to the military hospitals on
badly constructed carriages; the jarring of these wagons
produces such disorder in the wounds and in all the nerves, that
the greater part of the wounded perish on the way, especially if
it be long, and the heat or cold of the weather be extreme.
(2) The danger of remaining long in the hospitals. This risk is
much diminished by amputation; it converts a gunshot wound into
one which is capable of being speedily healed, and obviates the
causes that produce the hospital fever and gangrene.
(3) In case the wounded are of necessity abandoned on the field
of battle: In this event it is important that amputation should
have been performed, because—when it is completed—they [the
wounded] may remain several days without being dressed, and the
subsequent dressings are more easily accomplished. Moreover, it
often happens that these unfortunate persons do not find
surgeons sufficiently skilful to operate, as we have seen among
some nations whose military hospitals were not organized like
ours. (From Vol. 2 of Larrey’s “Memoirs of Military Surgery.”)
(In judging the quality of the advice given here the reader should not
overlook the fact that it was pronounced in the early part of the
nineteenth century.)
Larrey’s death occurred on July 24, 1842. A few years previous to this
date he had received the title of Baron.
------------------------------------------------------------------------
BOOK XIII
A FEW OF THE IMPORTANT HOSPITALS AND THE PRINCIPAL ORGANIZATIONS IN
PARIS FOR TEACHING MEDICINE AND MIDWIFERY
------------------------------------------------------------------------
CHAPTER XXV
HOSPITAL OF “LA MATERNITÉ,” THE GREAT FRENCH MIDWIFERY SCHOOL
John Cross, the author of an excellent memoir entitled “Sketches of the
Medical Schools of Paris,” has written such a full and satisfactory
account of _la Maternité_ and its admirable teaching machinery that I
shall not hesitate to use it freely as my guide in preparing this and
the following chapters. I am the more ready to adopt this course
because, first, I have had no personal experience whatever with this
department of medical science, and, second, because Dr. Cross’ account
is not compiled from the writings of other physicians, but is based upon
his own personal observations and upon information which he derived at
first hand from Monsieur Chaussier, the Physician-in-Chief of the
hospital. Here is what he writes (1815) upon this important subject:—
The midwifery department of _l’Hôpital de la Maternité_ is
converted to an admirable purpose by being made a school for the
educating of _Sages-Femmes_ (midwives); and I was not a little
surprised at my first entering this hospital with Monsieur
Chaussier, the Physician-in-Chief, to find the wards crowded
with female students. This midwifery-school was founded about
twelve years ago (about 1803), since which time young women have
come annually from all parts of France to study there. Some
pursue their education at their own expense; but most of them
are chosen by the _Prefets_ of the different _Départements_ of
France or by the governors of country hospitals, by whom all
expenses are paid. For six-hundred francs these women are
lodged, boarded and educated, during one year. They reside in
the hospital, and cannot go out of its precincts without
permission. After a twelve-months residence and an examination,
they receive their diplomas from _l’École de Médecine_—or the
_Faculté de Médecine_—to practice as midwives.... They follow
the Physician and Surgeon in their daily visits, and each pupil
makes a clinical report in writing of the patients under her
care. The accuracy and minuteness of some of these reports,
presented to Monsieur Chaussier during his visit, could not have
been greater if they had been made by an experienced
practitioner....
During the first five years of the existence of this _École
d’Accouchement_, nearly five-hundred well-educated women were
sent to practice midwifery in different parts of France.... In
June, 1814, the month in which the new students are admitted,
and those who have finished their education are dismissed,
one-hundred and thirty, who had followed the lectures and
practice of midwifery at _la Maternité_ during the preceding
year, were examined, and received certificates of their being
qualified to practice as _accoucheuses_.... Monsieur
Baudelocque was, to the time of his death, a zealous promoter
of this school of midwifery, and a copy of his catechism _sur
les Accouchements_ is given to each pupil as soon as she is
admitted. This school is an institution which, from the
novelty and excellence of the plan, the manner in which it is
carried on, and the benefits that must spring from it to
society, does honor to the country which has founded and
supported it.... _Les Élèves Sages-Femmes_ who reside for
twelve months at _l’Hôpital de la Maternité_, and about whose
instruction so much pains are taken and so much attention
bestowed by the medical men attached to it, are, there can be
little doubt, quite as good practitioners at the completion of
their education, as the male students in midwifery in any
country.
What is here written by Dr. Cross refers to the condition of _la
Maternité_ as he found it in 1815,—that is, after the institution had
been in successful operation for nearly if not quite twenty years. To go
back to the time when it was first organized I should state that, upon
the breaking up and disorganization of the _Faculté de Médecine_ and the
_École de Chirurgie_, there was erected, upon the ruins of these,
_l’École de Santé_, in which Baudelocque was given the place of
Professor of Obstetrics; and at the same time he was appointed
“Surgeon-in-Chief and Accoucheur” of the recently established
_Maternité_. From the very first both the general public and the great
majority of physicians reposed almost absolute confidence in
Baudelocque, and consequently it is not strange that he was the guiding
spirit in the development of this important hospital and training
school.
Sprengel, the author of one of the earliest and best histories of
medicine, gives unlimited praise to Baudelocque for the clearness,
practical character and conciseness of his writings on the subject of
midwifery. His treatise on obstetrics, he adds, is decidedly superior to
that of the English surgeon, Thomas Denman, whose writings, which cover
the same field, were published at about the same period of time.
As to the details of the management of _la Maternité_, the mortality
experienced, the number of infants born, etc.... I must refer the reader
to Dr. Cross’ memoir, in which he gives, in addition, an account of the
somewhat similar work done at the famous Dublin Lying-in Hospital. There
remain, however, a number of interesting details concerning the life and
career of Baudelocque which cannot well be omitted from this sketch, and
I will therefore proceed at once to supply them here.
Professional jealousy, which seems to have existed in those days in a
particularly virulent form, left Baudelocque very little peace of mind
and undermined his health to a serious degree. One of the most striking
experiences of this nature is the following:—
A certain Dr. Sacombe set out to increase his reputation—or, rather, to
gain notoriety for himself—by attacking violently all those physicians
who sanctioned the operation of Caesarian section as permissible in
certain cases; and, inasmuch as Baudelocque was the most distinguished
one among these physicians, he directed his most violent efforts against
him. There having recently occurred, in the latter’s practice, a case of
tedious labor in which it had been found necessary to remove the head of
the foetus by amputation, Dr. Sacombe intimated that Baudelocque in this
instance had been guilty of what apparently amounted to a double murder.
Both public opinion and the courts were very prompt in judging this to
be an infamous calumny on the part of the accuser. Although Baudelocque
was completely exonerated from the charge, he nevertheless suffered
keenly from the brutality of this attack upon his character. In fact, it
was believed that the cerebral affection from which he died on May 2,
1810, was brought on by the worry which was associated with Dr.
Sacombe’s attack. Shortly before his death the news reached him that he
had been chosen to take charge of the _Accouchement_ of the Empress,
Marie Louise, but even this vindication failed to be of any benefit at
that late hour.
The two most important treatises published by Baudelocque are the
following: “_Principes de l’Art par Réponses, en Faveur des Élèves
Sages-Femmes_,” Paris, 1775. This work was written entirely for the
guidance of midwives, the Government purchasing 6000 copies. “_l’Art des
Accouchements_,” Paris, 1781, 2 vols. Later editions were published in
1789, 1796, 1807, 1815 and 1822. Baudelocque also published a number of
memoirs and reports of cases.
The success of _la Maternité_ as the great French Lying-in Hospital and
Training School for Midwives was probably as much due to the wise and
painstaking management of the widow Lachapelle as to the skill and great
experience of Baudelocque. It is therefore only fitting that I should
give here a brief biographic sketch of this admirable woman.
* * * * *
VEUVE LACHAPELLE, whose maiden name was Marie-Louise Dugès, was born at
Paris on January 1, 1769. Her mother, Marie Jonet, was at first a sworn
midwife (“_Sage-Femme Jurée_”) at the Chatelet Hospital, but later
(1775) she was promoted to the position of Midwife-in-Chief of
Hôtel-Dieu, the largest hospital in Paris. Madame Jonet made her home in
Hôtel-Dieu, and she performed the duties of her very responsible office
with such zeal, such conspicuous ability, and such faithfulness that the
Government awarded her, when she retired after a long service, a liberal
pension. The daughter Marie, who had been brought up with great care
under the constant supervision of her mother, and who had lived from day
to day as it were in the midst of pregnant women and women actually
undergoing confinement, absorbed unconsciously a great deal of
information, both theoretical and practical, concerning the art of
midwifery. Although she married, in 1792, Monsieur Lachapelle, the
Resident Surgeon of the Hôpital Saint-Louis, she continued her residence
at Hôtel-Dieu, with her mother, to whom she was strongly attached; and
after the death of her husband, which occurred not long after they had
been married, this attachment rather increased. Madame Lachapelle, who
from this time onward was known as _Veuve Lachapelle_, showed such a
keen interest in her work and performed all her hospital duties with
such skill and such excellent judgment that in 1795 the Government
appointed her the Associate Chief Midwife of Hôtel-Dieu.
At a somewhat later date, during the administration of Minister Chaptal,
the Maternité Hospital was organized, and Madame Lachapelle was made the
Resident Directress of the new institution. Baudelocque was appointed
Surgeon-in-Chief and Professor of Obstetrics, and Madame Lachapelle was
given the position, under him, of Instructress in Midwifery. François
Chaussier, Baudelocque’s successor and one of the most distinguished
French physicians of that period, declared that Madame Lachapelle was a
most successful teacher of the art of midwifery, and added that her
usefulness in this field extended far beyond the period of her active
connection with the Maternité Hospital; for she had made a regular
practice, during her residence in that institution, of keeping an
immense number of carefully prepared records of the cases which came
under her observation, and these, which form the basis of the volumes
published after her death, by her nephew, constitute—as Chaussier
believes—a most useful work of reference, second in value only to the
great work of Baudelocque.
Veuve Lachapelle’s death occurred on October 4, 1821. The work referred
to in the preceding paragraph bears the following title: “_Pratique des
Accouchemens, ou Mémoires et Observations Choisies sur les Points les
plus Importans de l’Art_,” publiées par Antoine Dugès, neveu de
l’auteur, Paris, 1821–1825, 3 vols.
------------------------------------------------------------------------
CHAPTER XXVI
FURTHER DETAILS CONCERNING THE PARIS FACULTÉ DE MÉDECINE AND CONCERNING
SOME OF THE LARGER HOSPITALS OF PARIS
The present chapter is intended to supply, in as condensed a form as
possible, some of the facts relating to the growth of the Paris School
of Medicine, and also information concerning one or two of the larger
hospitals of Paris. As such details are not likely to possess interest
for more than a comparatively small number of my readers I
unhesitatingly advise all others to skip this chapter.
“The Medical Schools[26] of the _Rue de la Bûcherie_,” says Chereau,
“are still in existence to-day (1866), although somewhat altered in
appearance. They stand at the angle formed by the Rue de la Bûcherie and
the Rue de l’Hôtel Colbert. These buildings, however, masquerade under
singular forms. Since the day when our fathers in medicine abandoned the
Temple of Aesculapius (1775) it has been put to a great variety of uses,
such as a public _lavoir_, a tap room, a _cabaret_ where thieves meet,
rooms equipped each with a number of beds, and a _lupanar_, where the
fee charged was twenty sous a sitting; the room in which Riolan taught
anatomy converted into a low-down billiard saloon; the ground over which
Femel walked, soaked with all sorts of nasty fluids; the office in which
sat the employés of the school—those vigilant guardians of the rights
and dignity of the Faculty—plastered with police ordinances; the chapel,
in which the doctors were wont piously to attend mass, now occupied as a
miserable lodging-house; etc.”
[Illustration:
Eighteenth-century plan showing the relations of the Paris _École de
Médecine_ to _Hôtel-Dieu_, the Cathedral of Nôtre Dame and the River
Seine.
(Reduced copy of the cut printed in Franklin’s “_La Vie Privée
d’Autrefois_,” 1892.)
]
In 1808 the _Faculté de Médecine_ was given the splendid quarters of the
_Collège de l’Académie de Chirurgie_, where it is still to-day located.
Clinical instruction was carried on at Hôtel-Dieu, La Charité and
certain other hospitals. The school itself is no longer called “_l’École
de Médecine_,” but “_la Faculté de Médecine_,” and the old building,
suitably modified, has been preserved—not as a part of the present
school, but as a sort of clubroom or social hall for the use of all the
university students. (See accompanying illustrations facing page 260.)
* * * * *
ÉCOLES DE SANTÉ.—When the statement was made before the Convention that
the Army of the Republic had lost about 600 medical officers, and that
the troops in the eastern Pyrenees were almost entirely without
physicians and surgeons, a law was passed (December 4, 1794) authorizing
the organization at Paris, Montpellier and Strassburg, of three medical
institutes or secondary medical schools (designated as “_Écoles de
Santé_”). They were originally intended to be simply temporary
organizations where “_officiers de santé_” might be trained for service
in the hospitals,—more particularly the military and naval hospitals.
Each of the _Départements_ of France was entitled to send one pupil to
be educated at one of these military medical schools, at the expense of
the nation, for a period of three years. In accordance with this scheme
Paris received 300 pupils, Montpellier 150, and Strassburg 100. Owing to
the lack of places or schools where young men might, at their own
expense, be trained as physicians, it soon became necessary to permit
men of this class to attend these schools. And so in 1796 the Medical
School at Paris was reorganized and provision made for the following
twelve professorships:—
Anatomy and Physiology.
Medical Chemistry and Pharmacy.
Medical Physics and Hygiene.
Surgical Pathology.
Pathology of Internal Diseases.
Medical Natural History.
Operative Surgery.
Surgical Clinic.
Clinic of Internal Diseases.
Clinic for Final Stage of Students’ Training.
Obstetrics.
History of Medicine and Medico-Legal Science.
In 1798 a chair for pathological anatomy was added, and there were also
organized several special clinics—one, for example, for sexual diseases;
and among the names of the professors who taught at this period are to
be found those of Sabatier, Chopart, Pinel, Corvisart, Baudelocque,
Lassus, and P. A. O. Mahon. The last-named lectured on the history of
medicine. No fees were charged for tuition. Under this new régime the
Paris Medical School rapidly rose in favor, until in 1799 the attendance
had reached the extraordinary total of 1500. In addition to the regular
students who expected to receive a medical diploma if they passed a
satisfactory examination at the end of the course, there was a large
attendance of quacks, at all three of these schools (Paris, Montpellier
and Strassburg). Neither a diploma nor any special permit, however, was
required of those who wished to engage in the practice of medicine. This
state of affairs soon led to frightful abuses, and the Convention
accordingly passed a new law (March 10, 1803), which stated that, for
the future, only those who had passed a satisfactory examination in the
fundamental branches (anatomy, physiology, pathology, materia medica,
pharmacy, chemistry, hygiene, obstetrics, surgery and internal medicine)
would be permitted to engage in practice. The duration of this course of
training was four years, and the candidate was further required to
furnish satisfactory evidence that he had completed the regular Lyceum
course of studies (equivalent to the undergraduate course at one of our
American Colleges) before he entered upon the medical course.
[Illustration:
1. The side of the Paris _Faculté de Médecine_ which fronts on the
_Rue de l’École de Médecine_.
(From “_La Vie Universitaire_.”)
]
[Illustration:
2. View of the former _École de Médecine_ since it has been
incorporated with the new structures of the _Faculté de Médecine_.
(From “_La Vie Universitaire_.”)
]
[Illustration:
3. Musée Dupuytren. Formerly the refectory of the Convent of the
Cordeliers (Franciscans), built in the fifteenth century.
(From “_La Vie Universitaire_.”)
]
On the plea that the people who dwelt in the country districts live
simpler lives, etc., and consequently are subject to illnesses of a less
complicated nature, there was passed by the National Convention another
law in accordance with which a lower grade of doctors was
created—_i.e._, practitioners who were called _Officiers de Santé_. At
first these men were given permission to practice after they had
completed the third year of the regular course of studies, but later
they were absolved from the necessity of taking any part of the regular
course, provided they could show that they had spent five years in work
connected with a hospital or had been in the service of a regular
physician during a period of six years. Gradually, as the number of the
regular physicians increased and as the country became more prosperous,
the _Officiers de Santé_ diminished in number. In 1847 there were 7456
such practitioners, but already in 1872 the number had fallen to 4653.
On the other hand, the regular doctors of medicine had increased during
the same period from 10,643 to 10,766.
In 1864 an attempt was made in the French Parliament to abolish the
institution of _Officiers de Santé_, but one of the members, Bonjean,
opposed the motion and it fell through. The argument which he brought
forward and which is quoted by Puschmann, is essentially the following:—
When simple people belonging to the poorer class of the
community are taken ill they want a physician who is himself
simple and poor like themselves, a man who is able to comprehend
the language and the needs of his modest patients, and who,
because of his low birth, because of the fact that he has been
habituated from early childhood to the plain and simple living
of the peasant’s cottage, and also because he has been put to
comparatively small expense to secure the grade which permits
him to practice the profession of medicine, is quite contented
to accept a modest fee for his services. The _Officier de Santé_
is, for all these reasons, admirably fitted to fulfil his
mission of modest devotion; for him, under these circumstances
it will be comparatively easy to act as the confidant, the
counsellor, and the sympathetic friend of the patient.
It is not possible for me to state (1919) how far the recent war has
upset all the arrangements mentioned above.
* * * * *
PARISIAN HOSPITALS.—Of the three large hospitals which existed in Paris
at the beginning of the nineteenth century—the _Hôtel-Dieu_, _la
Charité_ and _la Salpétrière_—I am not able to furnish more than a few
scanty details. According to an editorial which I find in the _London
Lancet_ for November 25, 1837, the management of the English hospitals
destined for the relief of the sick poor during the period now under
consideration was inferior to that of the similar institutions in
France. There are good reasons for believing, however, that, after the
lapse of a few years, the English hospitals became in every respect the
equals of those in France. In Tenon’s elaborate report on the Parisian
hospitals examined by him in 1816 I find it stated that _la Salpétrière_
was used in part as a prison and in part as an asylum for the insane;
but, in another part of this report, he states that at one time this
hospital sheltered as many as 8000 persons, the great majority of whom
were legitimate hospital patients.
Of _Hôtel-Dieu_ John Cross, in his memoir concerning medical education
in Paris, makes the following remarks:—
The patients at _l’Hôtel-Dieu_ vary in number from 1500 to 2000,
and generally approach near to the latter number. Beside the
wards for medical and surgical patients, there is a ward for the
reception of women actually in labor or suffering abortion. The
medical patients are far the most numerous, and eight or nine
physicians are attached to _Hôtel-Dieu_.... The number of
dressers is not limited; when I was at _l’Hôtel-Dieu_, above
one-hundred were attached to it.... _Les élèves internes_ of the
Parisian hospitals correspond to our house-surgeons; the number
of them to each hospital is limited, and at _l’Hôtel-Dieu_ there
are nearly twenty. They have their separate apartments in the
hospital, are boarded in it, and have, beside board and lodging,
an annual salary of about twenty guineas each. They may retain
their situation for two years.
[Illustration:
Device of the _École de Médecine de Paris_. (Adopted by the Faculty in
1597.) (Three storks, each holding a twig of origanum in its beak;
and at the top of the design the motto “_Urbi et Orbi Salus_”
[Health to the City and to all the World].)
]
Paris possesses a fourth large hospital, which as regards architectural
beauty and the great consideration shown by the architect for a wise and
convenient disposition of the different available spaces, certainly
stands first among the hospitals of the French capital. I have
introduced here a reduced copy of the plan of this hospital (_Hôpital
Saint-Louis_), which dates back to the seventeenth century, but, much as
I should like to do so, I am not able to furnish a description of the
details relating to the precise purposes and the management of the
institution at the present time. It is said to be largely devoted to the
treatment of affections of the skin.
* * * * *
TENON’S CRITICISMS ON HÔTEL-DIEU AND HÔPITAL SAINT-LOUIS.—Speaking of
the wards in the Hôpital Saint-Louis Tenon, who wrote his treatise in
1786, says that it was a mistake to make the ceilings only eleven feet
high; they should have been sixteen feet high. He commends strongly the
complete separation of the hospital from the adjacent city by high
surrounding walls. Only one _kind_ of contagion, he says, should be
admitted into any single ward. This precaution had not previously been
observed. In the Hôpital Saint-Louis the water-closet arrangements were
about as bad as they could possibly be. The same remark applies to
Hôtel-Dieu, where overcrowding was at times scandalously bad. In the
latter hospital there are, in the wards destined for men, 600 beds—of
which number 378 are beds of the larger size, and 222 of the smaller. In
the wards for women, he adds, the same predominance of large beds
exists—viz., 355 larger beds, 264 of the smaller size.
Tenon says emphatically: “Beds for two or more persons should not be
permitted in any hospital. These beds, on certain occasions, are
occupied by four—yes, even by six persons—and as a result they are
infested by vermin. Sleep is practically unattainable under such
circumstances.”[27]
GROUND PLAN OF THE HÔPITAL SAINT-LOUIS
Planned by the architect Claude Chastillon, of Paris, in 1608.
A. Wall surrounding hospital grounds.
B. Main entrance.
C, D. Court separating the first and second enclosed spaces.
C. Entrance to second enclosure, through the porter’s lodge.
D. One of the four buildings placed at the corners of the principal
square; the members of the Religious Sisterhood occupy the
building as their convent.
E. Gallery of communication between the convent and the wards of the
hospital.
F. Another of the four corner buildings; it is destined for the use of
the priests and the surgeons, and communicates with the hospital
wards by means of a covered gallery like that shown at E.
G. Entrance to men’s promenade, to the reservoir, and to the cemetery.
H, I. Buildings in which may be lodged, during the prevalence of an
epidemic, such citizens as may be affected with some contagious
disease.
K, L, M, and N. Gardens belonging respectively to pavilions L, H, F,
and D.
O. Lodge occupied by four gardeners.
P. Royal pavilion, not used after the Revolution.
Q. Open space planted with trees.
S. Church.
T. Kitchen, etc.
U. Bakery, wine cellars, etc.
V, X. Lodging rooms for cooks and bakers.
[Illustration:
Hôpital Saint-Louis, Paris. Planned and drawn by Claude Chatillon,
architect, in 1608.
(Copied from Tenon’s “_Mémoires sur les Hôpitaux de Paris_,” Paris,
1816; reduced about one-half.)
]
------------------------------------------------------------------------
CHAPTER XXVII.
ARMAND TROUSSEAU, ONE OF THE LAST OF FRANCE’S GREAT CLINICAL TEACHERS
In the preface to his “_Bibliothèque de Thérapeutique_,” which was
published first in 1828, A. L. J. Bayle says that the art of treating
diseases has been greatly neglected, in comparison with the enthusiastic
efforts made to promote some of the other branches of the science of
medicine, especially that of pathological anatomy; and, as a result,
this art has in reality actually retrograded. Indeed, he goes on to say,
quite a large number of agents which, up to a recent date, had been
considered efficient remedies, have been entirely forgotten or even, in
some instances, proscribed. This unfortunate tendency, he adds, may be
attributed to many different causes. One of the most important of these,
he believes, is to be found in the fact that certain physicians have
allowed the idea to take root in their minds that the lesions which have
been discovered in the different organs of the body at post-mortem
examinations were the cause of the symptoms that, taken in the
aggregate, constitute the particular disease under consideration; and,
acting under the influence of this idea, they have assumed that their
therapeutic efforts should be directed solely to these lesions.
“Experience has not confirmed the correctness of this theory; on the
contrary, it has shown that, if pathological anatomy is useful to the
practitioner, it is chiefly so because it throws light upon the course
and prognosis of certain diseases, and not because it has furnished a
basis upon which the treatment may be built up.”
There is still another equally strong reason, says Bayle, why the art of
therapeutics has been prevented from making a satisfactory advance,
viz., the propagation of the physiological doctrine (Broussaism), a
doctrine which admits the existence of practically only one
disease—_irritation_, in its varying degrees of intensity, together with
a single class of remedies—_anti-irritants_. Modern therapeutists reject
most of these ideas, and experience also shows that, in the matter of
therapeutics, these anti-irritants often produce harmful results. “A
treatise on therapeutics,” he goes on to say, “should contain the
substance of all the good memoirs that have been published on the
treatment of the different diseases and on the remedies employed; it
should also mention all the circumstances which indicate or
contra-indicate the employment of remedial agents, the best forms in
which the latter may be administered, all the cases in which they have
succeeded in affording relief as well as all those in which they have
failed to accomplish this result; all the authors who have written on
the subject under consideration; and, finally whatever additional facts
may give the practitioner confidence in the reality of the results
proclaimed.”
There came under public notice, at about this period of time, a French
physician who evidently held very much the same beliefs as were put
forward by A. L. J. Bayle and which I have very briefly stated in the
preceding paragraph. I refer to ARMAND TROUSSEAU, who was born (1801) in
Western France, and who received his early medical training under that
prince of physicians, Bretonneau, of Tours. In association with his
friend, Hermann Pidoux, he published (in two volumes, Paris, 1836–1839)
an excellent treatise on materia medica and therapeutics. The spirit
which guided him in the preparation of this treatise is well expressed
in his own words as follows:—
Medicine is both a science and an art.... It is an art when it
becomes necessary to apply it to a human being who is ill, and
this is especially true when the manner of treatment is under
consideration. It is in this art that the physician reveals how
much talent he possesses; he reveals himself as a true artist by
the particular form of remedial preparation which he decides to
administer to his patient, by the felicitous choice which he
makes between remedies, and by the favorable manner in which he
combines them.
[Illustration:
TROUSSEAU
]
Dujardin-Beaumetz then adds the important statement that in his belief
Trousseau was—at the time when he gave utterance to these words—the
living personification of the truth of what he said, for nobody had
carried the therapeutic art to a higher state of perfection than he had.
To this statement may be added, with perfect truth, the opinion held by
many of his contemporaries to the effect that the publication of the
Trousseau-Pidoux treatise promoted effectively the growth of a sound and
trustworthy therapeutic code. The mere fact that in 1875 this treatise
had already reached its ninth edition furnishes strongly corroborative
proof of the correctness of this opinion.
The scantiness of the space which I consider it proper to devote to this
single memoir appears to me to justify the omission, from this point
onward, of everything that does not add to the description of
Trousseau’s career as one of the greatest clinical teachers in the
domain of internal medicine in France. I am the more strongly impelled
to adopt this course because so many of my personal friends among the
physicians who returned to New York, during the years 1860–1864, spoke
in such terms of praise of the success attained by Trousseau in this
particular branch of medical education.
His profound earnestness as a clinical teacher and his incessant
watchfulness over the interests and rights of the patients who served as
material for his bedside lectures are brought out so clearly in one of
his addresses to the class at the beginning of one of his regular
courses that I shall be pardoned, I am sure, for reproducing it here in
considerable fulness of detail:—
Gentlemen:—Before making any remarks to you about my service at
the hospital I feel impelled to tell you what I understand by
the expression ‘clinical instruction’ and to put before you what
I consider to be the respective duties of the professor and of
those who regularly follow his lessons.—It is for me a very
pleasant thing, as you may readily imagine, to see, crowding
around the beds in the ward and seated on the benches of the
amphitheatre, a large number of pupils; but the consciousness
that I am fulfilling a useful mission and am sowing in the minds
of these young men ideas that will later be fertilized, affords
me a much greater pleasure. However, both as regards the
professor and also as regards the pupils who listen to his
teaching, there are needed certain conditions in the absence of
which the clinical instruction must necessarily prove sterile.
Although clinical instruction represents the crowning stage of
your medical studies, I would not have you believe that this
particular part of your medical training should not be begun
until you reach the last period of your student career. From the
very day when a young man decides that he wants to be a
physician he should lose no opportunity of visiting hospitals.
It is desirable that he should see sick people—not occasionally,
but as frequently as possible. The materials which are thus at
first stored in one’s memory in a confused and disorderly
condition are nevertheless excellent materials. While they may
not to-day appear to possess a useful character, you will find
them at a later period stored away among the genuine treasures
lodged in your memory. To-day I have reached the period of old
age, and yet I remember distinctly the patients whom I saw
forty-three years ago when I took the very first steps in my
career of physician; I recall the most important symptoms, the
pathological lesions, even in some cases the patient’s name or
the number of the bed which he occupied. The recollections are
at times of service to me, they even afford me instruction, and
occasionally you may hear me refer to them at our bedside
conferences. I therefore urge upon even the youngest among you,
the practice of visiting regularly every day the hospital. On
the whole I believe that you will find it more profitable to
give the preference at first to the medical rather than to the
surgical wards.... You will not derive real profit from
frequenting the latter until after you have acquired some
knowledge in anatomy, whereas the possession of a few
superficial conceptions regarding physiology will be found
sufficient for the student who is beginning his first medical
studies.
Little by little you will find that you are becoming more and
more able to judge, from a mere inspection of the patient’s face
and expression, how serious is the malady with which he is
affected; you will learn how to feel his pulse and to appreciate
correctly its different qualities; and you will begin to acquire
some knowledge of auscultation and percussion; etc....
I cannot too often repeat to you the fact that a knowledge of
anatomy is not to be acquired by listening to lectures upon the
subject; in order to gain such knowledge you should have before
you, a human cadaver—a cadaver around which sit two or three
other students besides yourself, all busily engaged in the work
of dissecting, and near you there should be an older and more
experienced pupil upon whom you can depend for guidance.
Similarly, knowledge of actual disease is to be learned by the
student only at the hospital, and with the aid of one of the
resident physicians or of a chief of staff, who is competent to
teach you how a patient should be questioned and how a
systematic examination of the case should be conducted.... And
here let me remind you that the patients who are to be found in
our wards are poor people, people who are compelled by their
suffering and by their lack of money to take refuge in a
hospital. A knowledge of this situation of affairs should lead
us to show them some consideration and respect. So far as the
men are concerned I admit that it is permissible for us to treat
them with less delicacy. From the viewpoint of modesty there is
very little indelicacy in removing the clothes from a man in
order to make an examination of the surface of his body; on the
other hand, it is not right to do this if the examination is at
all likely to affect his health unfavorably. And now that we are
discussing this subject, I am obliged to confess that young men
are only too apt to forget that, after the clothing has been
removed from a man whose skin is wet with perspiration, it is
very dangerous to expose him even for a short time to the
contact of a chilly air. It is also not permissible, even in the
interest of science, to prolong a physical examination or to
carry out the manipulations required in auscultation and
percussion if you find that it is exhausting the poor patient’s
strength. In the latter case it is better to leave the
examination incomplete than to increase the feebleness of a
patient who is already in such a state of weakness....
[Illustration:
VELPEAU
A contemporary of Trousseau and one of France’s most distinguished
surgeons.
(Copied from a print in the possession of Transylvania College,
Lexington, Kentucky.)
]
It was my intention to introduce at this point a citation from
Trousseau’s “_Clinique de l’Hôtel-Dieu_” of sufficient length to reveal
fairly well his manner of conducting clinical instruction at the bedside
of a patient. My decision to do this was based upon the assumption that
I should find among the printed accounts of these supposedly impromptu
lectures one or more which would serve the required purpose. I soon
discovered, however, that not a trace of the off-hand character of such
instruction remained in these reports. As they appeared in print they
were elaborate and quite exhaustive memoirs, suited for the edification
of men who had already long since passed the undergraduate stage of
medical training, and I was therefore obliged to abandon the plan which
I had so much desired to carry out. If I had, from the very first, given
more serious thought to the scheme which I had in mind I would have
quickly realized the fact that no teacher of wide experience and
universally recognized as an authority in the diagnosis and treatment of
disease would be likely to commit to print lessons which were meant to
be useful to medical students who had only just reached the threshold of
their professional career.
Trousseau died on June 23, 1867, in his seventy-second year. The only
important treatises which he published are the two which I have already
mentioned.
------------------------------------------------------------------------
LIST OF THE MORE IMPORTANT AUTHORITIES CONSULTED
ALIBERT, J. L.: ÉLOGES HISTORIQUES, ETC., Paris, 1806.
BAGLIVI: THE PRACTICE OF PHYSIC REDUCED TO THE ANCIENT WAY OF
OBSERVATIONS, translated from the Latin, London, 1704.
BARON, JOHN: THE LIFE OF EDWARD JENNER, 2 vols., London, 1838.
BARTHEZ, P. J.: NOUVEAUX ELÉMENS DE LA SCIENCE DE L’HOMME, Montpellier,
1778; Paris, 1806.
—— CONSULTATIONS DE MÉDECINE (ouvrage posthume), Paris, 1820.
BAUDELOCQUE, JEAN-LOUIS: L’ART DES ACCOUCHEMENS, 2 vols., Paris, 1807.
BAYLE, A. L. J.: BIBLIOTHÈQUE DE THÉRAPEUTIQUE, 4 vols., Paris,
1828–1837.
BAYLE, G. L.: TRAITÉ DES MALADIES CANCÉREUSES; OUVRAGE POSTHUME, Vol.
I., Paris, 1833.
BÉCLARD, P. A.: ADDITIONS TO THE GENERAL ANATOMY OF XAVIER BICHAT,
Translated from the French by George Hayward, M.D., Boston, 1823.
BELL, SIR CHARLES: INSTITUTES OF SURGERY, 2 vols., Edinburgh, 1838.
BERNARD, CLAUDE: LEÇONS SUR LES PHÉNOMÈNES DE LA VIE COMMUNS AUX ANIMAUX
ET AUX VÉGÉTAUX, Paris, 1878.
BONNET, THÉOPHILE: SEPULCHRETUM, 3 vols., Lyons, 1700.—A still earlier
edition (1675) exists.
BORDEU: (See under RICHERAND.)
BOUILLAUD, J.: CLINIQUE MÉDICALE DE L’HÔPITAL DE LA CHARITÉ, 2 vols.,
Paris, 1837.
BOUILLET, J.: PRÉCIS D’HISTOIRE DE LA MÉDECINE, Paris, 1883.
BRETONNEAU ET SES CORRESPONDANTS, 2 vols., Paris, 1891. (Review in the
_Revue Scientifique_ of July 23, 1892.)
BROUSSAIS, F. J. V.: EXAMEN DES DOCTRINES MÉDICALES, troisième edition,
4 vols., Paris, 1829–1834.
BUDD: TYPHOID FEVER, ITS NATURE, MODE OF SPREADING, AND PREVENTION,
London, 1873.
BUISSON, F. R.: PRÉCIS HISTORIQUE SUR BICHAT, in Vol. I. of this
Author’s Anatomie Générale, Paris, 1801.
CABANIS, P. J. G.: DU DEGRÉ DE CERTITUDE DE LA MÉDECINE, 3d edition,
Paris, 1819. (Also contains Richerand’s eulogy of Cabanis.)
CARTER, H. W.: A SHORT ACCOUNT OF SOME OF THE PRINCIPAL HOSPITALS OF
FRANCE, ITALY, SWITZERLAND, AND THE NETHERLANDS, London, 1819.
CHEREAU, ACHILLE: NOTICE SUR LES ANCIENNES ÉCOLES DE MÉDECINE DE LA RUE
DE LA BÛCHERIE, Paris, 1866.
CHOMEL: LEÇONS SUR LA FIÈVRE TYPHOÏDE, 1834. At a still earlier date
(1821) Chomel published a general treatise on Fevers.
CORRY: LIFE OF JOSEPH PRIESTLEY, 1804.
CROSS, JOHN: SKETCHES OF THE MEDICAL SCHOOLS OF PARIS, London, 1815.
CUVIER: ÉLOGES HISTORIQUES LUS DANS LES SÉANCES PUBLIQUES DE L’INSTITUT
ROYAL DE FRANCE, 3 vols., Strassbourg, 1819.
DAREMBERG, CHARLES: HISTOIRE DES SCIENCES MÉDICALES, Vol. 2, Paris,
1870.
DEZEIMERIS, OLLIVIER ET RAIGE-DELORME: DICT. HISTORIQUE DE LA MÉD. ANC.
ET MOD., 3 vols., Paris, 1828–1837.
DUJARDIN-BEAUMETZ: “LEÇONS DE CLINIQUE THÉRAPEUTIQUE,” Paris, 1883.
DUPUYTREN, see under PAILLARD ET MARX.
EYNARD, THÉODORE: ESSAI SUR LA VIE DE TISSOT, Lausanne, 1839.
FRANK, JOHANN PETER: SYSTEM EINER VOLLSTÄNDIGEN MEDICINISCHEN POLIZEY, 6
vols., Mannheim, 1780–1788.
FRANKLIN, BENJAMIN: LIFE AND WRITINGS OF, Published by J. M. Dent &
Sons, London and New York, 1908.
GAZETTE MÉDICALE DE PARIS, Tome III., 1835.
GILLES DE LA TOURETTE: THÉOPHRASTE RENAUDOT, Plon et Cie., Paris, 1884.
Reviewed in _La Revue Scientifique_, April 9, 1892.
GRIBBLE, FRANCIS: LAKE GENEVA AND ITS LITERARY LANDMARKS, Westminster,
England, 1901.
GUARDIA, J. M.: LA MÉDECINE À TRAVERS LES SIÈCLES, Paris, 1865.
GUÉNEAU DE MUSSY: CLINIQUE MÉDICALE, Vol. III., Traité Théorique et
Pratique de la Fièvre Typhoïde ou Dothiénentérique, Paris, 1884.
GUEYRARD: LA DOCTRINE HOMOEOPATHIQUE EXAMINÉE SOUS LES RAPPORTS
THÉORIQUE ET PRATIQUE, Bruxelles, 1834.
HAESER, H.: LEHRBUCH DER GESCHICHTE DER MEDICIN, Zweite Ausgabe, Jena,
1868 (3d edition, 1875).
HAHNEMANN, SAMUEL: ORGANON OF THE RATIONAL ART OF HEALING, translated
from the German by C. E. Wheeler; published by C. M. Dent & Sons,
London, 1913.
VON HALLER, ALBRECHT: BIBLIOTHECA MEDICINAE, 4 vols.; PRIMAE LINEAE
PHYSIOLOGIAE, Goettingen, 1751; and a later edition of this work in
two volumes, printed at Lausanne, Switzerland.
HECKER: GESCHICHTE DER NEUEREN HEILKUNDE, Berlin, 1839.
HIRSCH, AUGUST: GESCHICHTE DER MED. WISSENSCHAFTEN IN DEUTSCHLAND,
Muenchen and Leipzig, 1893.
HOLLAENDER, EUGEN: PLASTIK UND MEDIZIN, Stuttgart, 1912.
HUFELAND, CHRISTOPH WILHELM: KUNST DAS MENSCHLICHE LEBEN ZU VERLAENGEREN
(MAKROBIOTIK), Berlin, 1823, 5th edition.
HUNTERIAN REMINISCENCES, from notes taken by James Parkinson; London,
1833. (These notes were taken from a course of lectures delivered by
the late John Hunter in 1785.)
HYRTL, JOSEPH: LEHRBUCH DER ANATOMIE DES MENSCHEN, Wien, 1873.
JACKSON, SIR GEORGE, K. C. H.: DIARIES AND LETTERS, 2 vols., London,
1872.
J. L. H. P.: SKETCHES OF THE CHARACTER AND WRITING OF EMINENT LIVING
SURGEONS AND PHYSICIANS OF PARIS, translated from the French by
Elisha Bartlett, M.D., Boston, Mass., 1831.
JAHR: MANUAL OF HOMOEOPATHIC MEDICINE, Vol. I.
KORN, GEORG: DIE HEILKUNDE IM NEUENZEHNTEN JAHRHUNDERT, Berlin, 1899.
LAËNNEC, R. T. H.: TRAITÉ DE L’AUSCULTATION MÉDIATE ET DES MALADIES DES
POUMONS ET DU COEUR, deuxième édition, 2 vols., Paris. 1826.
LARREY, BARON: MÉMOIRE SUR LES AMPUTATIONS DES MEMBRES À LA SUITE DES
COUPS DE FEU, Paris, 1797.
—— MÉMOIRES DE CHIRURGIE MILITAIRE, ET CAMPAGNES, 3 vols., Paris, 1812.
LAS CASES: MÉMOIRES D’E. A. D., COMTE DE LAS CASES, 1819.
LAVOISIER, ANTOINE LAURENT: “OEUVRES DE LAVOISIER PUBLIÉES PAR LES SOINS
DE SON EXCELLENCE LE MINISTRE DE L’INSTRUCTION PUBLIQUE ET DES
CULTES,” 6 vols., quarto, Paris, 1864.
LITTRÉ: DICTIONNAIRE DE MÉDECINE, DE CHIRURGIE, DE PHARMACIE, DE L’ART
VÉTÉRINAIRE ET DES SCIENCES QUI S’Y RAPPORTENT, Paris, 1886.
LONDON LANCET, THE, of NOV. 25, 1837; editorial comparing the management
of the large hospitals in the two countries—France and England.
LOUIS, CH. A. P.: RECHERCHES ANATOMIQUES, PATHOLOGIQUES ET
THÉRAPEUTIQUES SUR LA MALADIE CONNUE SOUS LES NOMS DE
GASTRO-ENTÉRITE, FIÈVRE PUTRIDE, ADYNAMIQUE, ATAXIQUE, TYPHOÏDE,
ETC., Paris, 1829.
MAGENDIE, M.: LEÇONS SUR LES PHÉNOMÈNES PHYSIQUES DE LA VIE, Paris,
1855.
MARSHALL HALL: LECTURES ON THE THEORY AND THE PRACTICE OF MEDICINE, in
the _Lancet_, London, Oct. 7, 1837.
MÉMOIRES DE L’ACADÉMIE ROYALE DE MÉDECINE, Vol. I., Paris, 1828.
MIQUEL, A.: LETTRES À UN MÉDECIN DE PROVINCE OU EXPOSITION CRITIQUE DE
LA DOCTRINE MÉDICALE DE MONSIEUR BROUSSAIS, 2me édition, Paris,
1826.
MONFALCON, I.: PRÉCIS DE BIBLIOGRAPHIE MÉDICALE, Paris, 1827.
MORGAGNI: DE SEDIBUS ET CAUSIS MORBORUM, 1767. An English version of
this work, in 3 volumes, was published at London in 1769, and a
French version was issued a few years later.
MUELLER, WILLIBALD: BIOGRAPHIE VON GERHARD VAN SWIETEN, Wien, 1883.
PAGEL, JULIUS: EINFUEHRUNG IN DIE GESCHICHTE DER MEDIZIN, Berlin, 1898.
PAILLARD ET MARX: TRAITÉ DES BLESSURES PAR ARMES DE GUERRE, D’APRÈS LES
LEÇONS CLINIQUES DE MONSIEUR LE BARON DUPUYTREN, 2 vols., Paris,
1834.
PETERSEN, JULIUS: HAUPTMOMENTE IN DER GESCHICHTLICHEN ENTWICKELUNG DER
MED. THERAPIE, Copenhagen, 1877.
PETIT, J. L.: TRAITÉ DES MALADIES CHIRURGICALES, ET DES OPÉRATIONS QUI
LEUR CONVIENNENT, Nouvelle édition, Paris, 1790.
PETTIGREW, THOMAS J.: MEDICAL PORTRAIT GALLERY. (BIOGRAPHICAL MEMOIRS OF
THE MOST CELEBRATED PHYSICIANS, SURGEONS, ETC., WHO HAVE CONTRIBUTED
TO THE ADVANCEMENT OF MEDICAL SCIENCE.) 2 vols., London, 1838.
PINEL: NOSOGRAPHIE PHILOSOPHIQUE, Paris, 1798.
POTAIN: LA MÉDECINE EN PROVINCE (containing certain data relating to
Bretonneau, of Tours); in the _Revue Scientifique_ of Nov. 10, 1894.
POTT, PERCIVAL: CHIRURGICAL WORKS, 2 vols., Philadelphia, 1819.
PRIESTLEY, JOSEPH: EXPERIMENTS AND OBSERVATIONS ON DIFFERENT KINDS OF
AIR, 2d edition, London, 1775.
PUSCHMANN, THEODOR: DIE MEDICIN IN WIEN WAEHREND DIE LETZEN 100 JAHRE,
Wien, 1884. —— GESCHICHTE DES MEDICINISCHEN UNTERRICHTS, Leipzig,
1889.
QUARTERLY JOURNAL OF FOREIGN MEDICINE AND SURGERY, Vol. I., London,
1818–1819.
REVUE SCIENTIFIQUE for March 24, 1894. (Article on the proportion of
homoeopathic practitioners to those of the regular school in some of
the cities of the United States.)
RICHERAND: OEUVRES COMPLÈTES DE BORDEU, PRÉCÉDÉES D’UNE NOTICE SUR SA
VIE ET SUR SES OUVRAGES, 2 vols., Paris, 1818.
RICHET, A.: L’HISTOIRE DE LA CHIRURGIE, in the _Revue Scientifique_,
Nov. 19, 1892.
ROKITANSKY, CARL: PATHOLOGISCHE ANATOMIE, 3 vols., 1855. (Illustrations
in the edition of 1855, but not in the first edition.)
ROSENTHAL, J., article in the _Revue Scientifique_ of Jan. 10, 1801.
ROUX, P. J.: NARRATIVE OF A JOURNEY TO LONDON IN 1814; Translated from
the French, 2d edition, London, 1816.
SCHEUTHAUER, GUSTAV: article on CARL ROKITANSKY, in _Hirsch and Gurlt’s
Biographisches Lexikon_.
SCHULTZ, C. H., Article on HOMOEOPATHY in _Hufeland’s Journal der
Praktischen Medicin_, Bd. LXIX., No. 5.
VON SIEBOLD: VERSUCH EINER GESCHICHTE DER GEBURTSHUELFE, Berlin, 1845.
SIGMOND, GEORGE G.: ON THE EFFECTS OF MERCURY, in the _Lancet_, London,
Nov. 11, 1837.
SIMPSON: HOMOEOPATHY, ETC., 3d edition, 1853.
SPALLANZANI: MÉMOIRES SUR LA RESPIRATION; traduits de l’Italien par Jean
Senebier, Genève, 1803.
SPIESS, G. A.: J. B. VAN HELMONT’S SYSTEM DER MEDICIN, Frankfort am
Main, 1840.
SPRENGEL, KURT: HISTOIRE DE LA MÉDECINE, Paris, 1815. (Traduite de
l’Allemand par A. J. L. Jourdan.)
SUDHOFF, KARL: J. C. REIL VON DER LEBENSKRAFT, Leipzig, 1910.
TENON, M.: MÉMOIRES SUR LES HÔPITAUX DE PARIS, Paris, 1816.
TROUSSEAU, ARMAND: CLINIQUE MÉDICALE DE L’HÔTEL-DIEU DE PARIS, 3d
edition, 3 vols., Paris, 1868.
TROUSSEAU ET PIDOUX: TRAITÉ DE THÉRAPEUTIQUE ET DE MATIÈRE MÉDICALE, 9th
edition, 2 vols., Paris, 1875.
VELPEAU: TRAITMENT DES MAUX DE GORGE ET DE QUELQUES INFLAMMATIONS DES
AUTRES MEMBRANES MUQUEUSES PAR LE SULFATE D’ALUMINE ET DE POTASSE,
in the _Gazette Médicale de Paris_, 4 avril, 1835.
WUNDERLICH UND ROSER: ARCHIV FUER PHYSIOLOGISCHE HEILKUNDE, Bd. I.,
1841.
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GENERAL INDEX
A
ABDOMINAL TYPHUS, one of the early names given to typhoid fever, 202
ABERNETHY, JOHN, celebrated English surgeon of the 18th and early 19th
centuries, 131
ABRAHAM, long life of, 31
“ADVERSARIA ANATOMICA,” the title of Morgagni’s first published
treatise, 92
ALBERTINI, HYPPOLYTE, 92
ALBINUS, 35
ALCOHOL, how death is produced by, 148
ALLGEMEINE KRANKENHAUS, the, at Vienna, reorganized by the Emperor,
Joseph II., 74
ALLOPATHS, the, 26
ALSTON, 130
AMBULANCE, field, invented by Baron Larrey, 244
AMPUTATION OF LIMBS, circular, credited by the English to Cheselden,
151
credited by the French to J. L. Petit, 151
AMPUTATIONS, primary, highly recommended by Baron Larrey in military
surgery, 248
ANATOMY AND PHYSIOLOGY, great stress laid by Sir Benjamin Brodie on the
importance, to surgeons, of an intimate knowledge of, 149
ANIMALCULES found in infusions, 93
ARCHIV FÜR PHYSIOLOGISCHE HEILKUNDE, founded in 1842, 54
ARSENIC, how death is produced by, 148
AUENBRUGGER, 189, 194
novum inventum of, 76
AURICLE, voluntary movements of, 87
AUSCULTATION, difficulties encountered by the physician in his efforts
to interpret correctly the significance of certain sounds heard
during, 198
modern method of, 195, 210
AUTENRIETH, associated with Reil in editing the Archives of Physiology,
20
AUTHORITIES quoted, list of, 271
“AVIS AU PEUPLE,” title of Tissot’s most popular medical treatise, 99
AYEN, DUKE OF, an enthusiastic botanist, 171
AZOTE, lifeless matter, 123
B
BAGLIVI, GIORGIO, celebrated Italian physician of the 17th century, 91
BALFOUR, a distinguished physician of Calcutta, attempted in 1818 to
establish the idea that gonorrhoea is a disease distinct from
syphilis, 153
BARON, DR., biographer of Sir Edward Jenner, 111
BARTHEZ, PAUL-JOSEPH, Chancellor of the University of Montpellier, 198
BARTLETT, ELISHA, of Boston, Mass., translator of J. L. H. P.’s
biography of Dupuytren, 227
BASSI LAURA, distinguished Italian scientist, 93
BAUDELOCQUE, Professor of Obstetrics at _La Maternité_ in Paris, 254,
260
chosen to take charge of the accouchement of the Empress, Marie
Louise, 256
BAYLE, A. L. J., author of a treatise entitled “_Bibliothèque de
Thérapeutique_,” 265
BAYLE, GASPARD LAURENT, distinguished French physician, 182
(Portrait 182)
BEER, GEORG JOSEF, celebrated ophthalmologist of Vienna, Austria, 77,
231
BELL, BENJAMIN, 153
BELL, SIR CHARLES, 153
becomes one of the most celebrated surgeons of London, 154
demonstrates an important law concerning the nature of the spinal
cord nerves, 154
first person to establish the law governing centrifugal and
centripetal nerve impulses, 79
(Portrait 154)
BELL, JOHN, distinguished English anatomist, 155
BENEDICT, T. W. G., 77
BERNARD, CLAUDE, on the nature of vital force, 21
(See also under Claude Bernard)
BICHAT, MARIE FRANÇOIS-XAVIER, 162, 164, 210
devotes much time to experimental physiology, 166
(Portrait, 162)
BILLROTH, 50
BLUMENBACH, 45
BOER, Professor of Obstetrics at Vienna, 75
BOERHAAVE, 18, 35, 60
“Aphorisms,” 61
“Institutions of Medicine,” 63
BONE FORMATION, as explained by Prochaska, 80
BONNET, THÉOPHILE, author of the famous treatise on pathological
anatomy, entitled “_Sepulchretum_,” 93
BORDEU, THÉOPHILE, one of the earliest French physicians to engage in
research work, 159, 160
on the position of the glands and their action, 160
suffered greatly from gout, 161
BORSIERI, Professor of the Theory and Practice of Medicine at Pavia,
102
BOTANY, reasons for the enthusiastic love for this branch of science
which some men appear to possess, 172
BRAIN, injuries of, Sir Benjamin Brodie’s observations on the treatment
of, 149
BRASQUET demonstrated the erroneous nature of Broussais’ statistics,
212
BRETONNEAU, proposed the name “_Dothiénentérite_” for typhoid fever,
203
BRODIE, SIR BENJAMIN COLLINS, Professor of Anatomy and Surgery in the
Royal College of Surgeons, London, 147
one of the leading English experimental physiologists, 148
(Portrait, 148)
BROUSSAIS, FRANÇOIS JOSEPH VICTOR, physician connected with the
Military Hospital at Val-de-Grâce, and, later, Professor of General
and Special Pathology and Therapeutics at the University of Paris,
55, 207
misstatements made by, hastened his downfall, 211
(Portrait, 208)
profound contempt of, for the _vis medicatrix naturae_, 211
propositions belonging to the domain of physiology, 208
propositions belonging to the domain of pathology, 209
BROUSSAISM, 208
according to A. L. J. Bayle, Broussaism greatly hindered the art of
therapeutics from making a satisfactory advance, 265
important part played by, in hindering the real advance of medical
science, 208
BRUNONIANISM, 23, 47
BUREAU D’ADRESSE OU DE RENCONTRE, 5
C
CABANIS, PIERRE-JEAN-GEORGES, 175
CAMERARIUS, ELIAS, 35
CARDIAC AND PULMONARY DISEASES, pathological anatomy of, 197
CAROTID ARTERY, first ligated by Sir Astley Cooper, 137
CATARACT operations by Prof. Beer at the _Allgemeine Krankenhaus_ in
Vienna, 77
CAVENDISH, the English chemist who confirmed Priestley’s discovery that
atmospheric air is composed of water and different acids, 120
CHARITÉ, LA, one of the larger Paris hospitals, 261
CHEREAU, 258
CHESELDEN credited by the English with having been the first to perform
the circular amputation of limbs, 151
CHEST, auscultation of, 196
CHESTERFIELD, EARL OF, 44
CHOMEL, 202
CHOPART, FRANÇOIS, widely known by his advocacy of the operation called
“Chopart’s amputation” of the foot, 220, 260
CINCHONA bark, remedial effects of, suggested to Hahnemann the doctrine
of _similia similibus_, 22
CIRCULAR amputation of limbs, 151
CISALPINE REPUBLIC, formation of, 104
CLAUDE BERNARD, 125
on the nature of vital force, 21
CLAUDE CHASTILLON, architect of the _Hôpital Saint-Louis_ at Paris, 263
CLAVICLE, fracture of, Desault’s bandage in the treatment of, 164, 223
CLINICAL teaching inaugurated in the Vienna Medical School, 66
CONDILLAC favors Locke’s philosophy, 53
COOPER, SIR ASTLEY, distinguished English surgeon of the 18th and early
19th century, 135
(Portrait 136)
CORVISART, JEAN-NICOLAS, 76, 186, 188, 191, 260
appointed “First Physician” to Napoleon Bonaparte, 191
refuses to wear a wig while on duty at the Necker Hospital, 188
translator of Auenbrugger’s treatise, 186
(Portrait 188)
COW-POX VIRUS, 114
CRANTZ, HEINRICH, 65
CROSS, DR. JOHN, personal observations of the service rendered at _La
Maternité_ hospital in Paris, 253, 262
testimony of, with regard to Dupuytren, 229
CRYSTALLINE LENS, method of extracting perfected by the French surgeon,
Daviel, 151
CURE, Law of, by Hahnemann, 23
CUVIER, the naturalist, x
explains why some men become so enamored with the science of botany,
172
D
DAUBENTON, celebrated French naturalist, 177
DAVIEL, 151
DE HAEN, ANTON, 53
his treatise, “_Ratio Medendi_,” 65
DELPECH, JACQUES, 233
assassinated by a former patient, 235
became famous as an authority in orthopedic surgery, 234
DEMOSTHENES, distinguished eye surgeon of Marseilles, France, 231
DEMOURS, famous French ophthalmologist, 231
DENMAN, THOMAS, English author of a treatise on obstetrics, 255
DENTAL SURGERY, distinguished French authorities in, 236
DEPHLOGISTICATED air (oxygen) discovered by Joseph Priestley, 120
DESAULT, PIERRE-JOSEPH, distinguished French surgeon, 163, 221
established a clinical school at Hôtel-Dieu of Paris, 225
introduced the practice of ligating the exposed ends of the larger
arteries immediately after an amputation, 224
inventor of Desault’s bandage, for use in the treatment of fractures
of the clavicle, 164, 223
DESCARTES, French philosopher, advocates _à priori_ reasoning in
preference to realistic philosophy, 52
DESCEMET, distinguished French botanist and anatomist, 231, 232
also successful as a practitioner in maladies of the eye, 233
“DESCEMET’S MEMBRANE,” according to Hyrtl, should be named “Duddel’s
membrane,” 87
“DE SEDIBUS ET CAUSIS MORBORUM,” the title of Morgagni’s famous work,
92
DESGENETTES, AIMÉ-NICOLAS DU-FRICHE, a distinguished French military
surgeon, 241
in the retreat of the French Army from Russia, he was taken prisoner,
but was immediately released by order of the Emperor Alexander,
242
(Portrait 242)
DESRUELLES, one of Broussais’ pupils, did not employ mercury in his
treatment of syphilis, but applied leeches locally, 211
DEVAUX, JEAN, a learned French surgeon of the 17th century, 237
DEZEIMERIS, 37, 42, 97
DIDEROT favors Locke’s philosophy, 53
DIEFFENBACH, JOHANN FRIEDRICH, 48
DIMSDALE and TRONCHIN, the two earliest European advocates of
inoculation in small-pox, 108
“DOCEO UT DISCAM,” Seneca’s motto, 159
“DOTHIÉNENTÉRITE” the name proposed by Bretonneau for typhoid fever,
203
DOUGLASS, JAMES, distinguished Scotch anatomist and surgeon of the 18th
century, 35, 132
DOUGLASS, JOHN, younger brother of James, revived the supra-pubic
operation for stone in the bladder, 132
DROWNING, case of recovery, 29
DUBLIN LYING-IN HOSPITAL, 255
DUDDEL, E., an Englishman, was the first to describe the membrane
commonly known as “Descemet’s membrane,” 87
DUMAS, CHARLES LOUIS, Dean of the Faculty of Medicine at Montpellier,
174
DUPUYTREN, GUILLAUME, one of the great surgeons at the Hôtel-Dieu of
Paris, 226
founder of the _Musée Dupuytren_, 229
(Photograph of the Museum, 260)
(Portrait 226)
very successful as a clinical teacher, 228
DUVERNEYS, father and son, 35
E
ÉCOLE DE MÉDECINE, the old, of Paris, has now been transformed into a
sort of social hall for the use of all the university students, 259
(Picture of device, 262)
(Views, 258, 260)
ÉCOLES DE SANTÉ, in France, 259
ELI, the High Priest, long life of, 31
ELISHA, long life of, 31
ENGEL, DR., of Vienna, 62
ENTERIC FEVER, one of the first names given to typhoid fever, 202
ESMARCH, 49, 50
F
FACE, articulations of the bones of the, 159
FACULTÉ DE MÉDECINE, the, of Paris, was housed in 1808 in the quarters
of the _Collège de l’Académie de Chirurgie_, 258
FAUCHARD, PIERRE, author of a treatise on the surgery of the mouth, 237
FEMUR, ununited fracture of, 149
Dr. Physick’s treatment of, 149
FERRAND, distinguished French surgeon of the 18th century, 224
FISTULA IN ANO, operation for, 151
FORLI, the Academy of, 92
FOTHERGILL, JOHN, one of the most distinguished English physicians of
the 18th century, 129
Benjamin Franklin’s estimate of the man, 130
bequeathed his entire fortune to the poor, 130
FOUR-YEAR course adopted by Vienna School of Medicine toward end of
18th century, 74
FRANCO, PIERRE, of Lausanne, Switzerland, and Orange, France, 151, 231
FRANK, JOHANN PETER, founder of the first treatise distinctly devoted
to hygiene and medico-legal science, 17, 44
FRANKLIN, BENJAMIN, remarks of, concerning inoculation, 109
FRENCH PHYSICIANS, types of, who flourished about the time of the
“Reign of Terror,” 171
FRENCH REVOLUTION, Medicine at the height of the, 170
FRÈRE CÔME, 151
FRÈRE JACQUES, 151
G
GALERIA COPIALA, long life of, 30
GALVANI, ALOYSIUS, lecturer on anatomy at the University of Bologna,
103
GALVANISM, 104
GANGRENE, hospital, 235
GARIOT, JEAN-BAPTISTE, dentist to the King of Spain during the 18th
century, 238
author of a treatise on diseases of the mouth, 238
GASSER, LORENZ, 65
GASSERIAN GANGLION, a term invented by A. R. B. Hirsch, 65
GASTRITIS, one of the first names given to the disease now commonly
called “typhoid fever,” 202
GASTRO-ENTERO-CEPHALITIS, one of the first names given to typhoid
fever, 202
GAZETTE DE FRANCE, founding of the, 6
GERMANS, cultured, obliged to think, speak and write in French at the
end of the 18th century, 53
GERMANY, low state of medical affairs in, at the beginning of the 18th
century, 15, 52
GIANT, the famous Irish, whose skeleton was secured by John Hunter for
his museum in London, 145
GILLES DE LA TOURETTE, 10
GIMBERNAT, a distinguished Spanish surgeon, 137
GLANDS, position of, and their action, 160
GOETTINGEN, University of, 37
GONORRHOEA, during the 18th century, commonly believed to be one of the
manifestations of syphilis, 153
GOUDAREAU, author of a French translation of J. P. Frank’s treatise, 45
GRAECO-LATIN terminology adopted by physicians in conversation with
their patients not approved by Kant, the metaphysician, 74
GRIESINGER, WILHELM, 55
GURLT, VON, 50
GUY PATIN, 9
H
HAEN, ANTON DE, 53, 64
HAHNEMANN, SAMUEL, 22
HALL, MARSHALL, 204
HALLÉ, JEAN-NOËL, distinguished French Physician, 178
very successful in overcoming the opposition in France and Italy to
vaccination, 180
HALLER, ALBRECHT VON, 19, 34
(Portrait 34)
treatises published by, 38
HEART AND LUNGS, diseases of, full discussion of, by Laënnec, 197
HEAT-PRODUCTION in living animals, Lavoisier’s theory of, 124
HERNIA, different kinds of, 137
HIRSCH, AUGUST, 15, 52, 74
exposed the perniciousness of Broussais’ treatment, 212
HIRSCH, A. R. B., invented the term “Gasserian ganglion,” 65
HOFFMANN, FRIEDRICH, of Halle, Prussia, 19, 53
HOFRATH, Aulic Councillor, 46
HOLY LAND, Prince Louis’ crusade to, in 1147, 98
HOMOEOPATHY, 22
in the city of New York in the years 1850–1870, 26
HÔPITAL SAINT-LOUIS, at Paris, 262
(Illustration, 264)
HOSPITAL work in Vienna reorganized toward end of 18th century, 74
HOSPITALS, Parisian, 261
HOSTEL DES CONSULTATIONS CHARITABLES, 8
HÔTEL-DIEU, the great hospital of Paris, 4, 261
(Illustration, 258)
HUETER, 50
HUFELAND, CHRISTOPH WILHELM, 16, 28
author of “The Art of Prolonging Life,” 16
(Portrait 28)
HUNTER, JOHN, the English anatomist and biologist, 40, 95
(Portrait 144)
younger brother of William, and a great anatomist, physiologist and
operating surgeon; also the founder of Hunter’s Museum in London,
141
HUNTER, WILLIAM, distinguished English surgeon and anatomist, 139
founder of the anatomical schools of Great Britain, 141
(Portrait 140)
HYGIENE, first journal devoted to, 17
HYPOTHESES, rather than facts, should not serve as the basis of
doctrines in either pathology or therapeutics, 33
HYRTL, JOSEPH, distinguished Professor of Anatomy at the Vienna Medical
School, 85
on the changes which take place in an artery after it has been
ligated or divided with the knife, 86
on voluntary movements of the auricle, 87
I
INFLAMMATION believed by Broussais to be at the bottom of most of the
pathological phenomena encountered in the practice of medicine, 210
INOCULATING for the small-pox, 108
INSOMNIA defined by A. von Haller, 39
IRRITABILITY AND SENSIBILITY, distinction between these terms, 38
ISAAC, long life of, 31
ISHMAEL, long life of, 31
ITALY, Medicine in, 89
J
JACQUIN, NICOLAUS JOSEPH, 65
JAEGER, F., one of the distinguished Vienna ophthalmologists, 77
JAHR’S Manual of Homoeopathic Medicine, 26
JENNER, SIR EDWARD, discoverer of vaccination as a means of protection
against small-pox, 110
(Portrait 110)
receives a grant of £10,000 from the English Parliament, 115
JESUIT ORDER gradually excluded from the control of affairs in the
Vienna University, 66
J. L. H. P., sketches of French medical men by, 207
JOINTS, diseases of, researches of Sir Benjamin Brodie respecting, 148,
149
JONET, MARIE, _Sage-Femme Jurée_ at the Chatelet Hospital in Paris, 256
JOSEPH, FATHER—Leclerc du Tremblay, 8
JOSEPH, son of Jacob, long life of, 31
JOSEPH II., EMPEROR, successor of his mother, Maria Theresa, 71
JOSHUA, long life of, 31
JOURDAIN, ANSELME-LOUIS-BERNARD-BRECHILLET, distinguished French dental
surgeon of the 18th century, 238
K
KANT, IMMANUEL, the famous Prussian metaphysician, 74
KATZENJAMMER, 35
KAUNITZ, PRINCE, Imperial Austrian Chancellor, 62
KORN, GEORG, 48, 52
L
LACHAPELLE, VEUVE, Associate Midwife-in-Chief of Hôtel-Dieu, 256
LAËNNEC, RENÉ THÉOPHILE HYACINTHE, inventor of the modern method of
auscultation, 195
on the pathological anatomy of diseases of the chest, 83
treatise of, on auscultation, 197
(Portrait 196)
LANGENBECK, VON, 48, 49
LARREY, BARON JEAN-DOMINIQUE, distinguished French military surgeon,
and inventor of an improved type of field ambulance, 243, 244
advocated strongly primary amputations in military surgery, 248
great resourcefulness of, under difficulties, 247
highly commended by the Emperor Napoleon, 247
(Portrait 244)
showed his high character when the French troops retreated during the
Russian campaign, 245
LASSUS, 260
LATIN, barbaric, employed by the Germans in their university lectures
at the end of the 18th century, 53
LAUGIER, ROBERT, 65
LAUSANNE, in 1765, still recognized the Bernese Government as its
overlord, 100
LAVOISIER, ANTOINE LAURENT, invented the term “oxygen” and described
its full significance, 120, 122.
(For portrait see Frontispiece.)
discovered the important fact that all organic bodies are composed of
carbon, hydrogen and oxygen, 123
credited with having formulated the chemical theory of respiration,
125
discovered also that all the acids contain oxygen, 120
formulates the theory of heat-production in living animals, 124
Government collector of taxes in the early part of his career, 122
guillotined on May 8, 1794, 124
maintains that combustion represents simply the combination of the
two elements, carbon and oxygen, 123
one of the first to cultivate experimental physiology, 168
proves that the act of respiration in animals is a species of
combustion, in the course of which oxygen combines with certain
elements of the body to form water and carbonic acid, 123
proves also that Stahl’s doctrine of animism, as well as the
phlogiston theory, is untenable, 123
LE CLERC, biographer of Dupuytren, 226
LECLERC DU TREMBLAY, Capucin monk, known as “His Gray Eminence,” 4
LE DRAN, distinguished French surgeon, 36
LEIPZIG, battle of, 21
LEMONNIER, LOUIS GUILLAUME, a French physician who ardently cultivated
the science of botany, 171
life saved from the violence of the mob in 1782, 173
LIARD, value of the, 6
“LIFE, THE ART OF PROLONGING,” title of famous treatise written by
Hufeland, 28
LITHOTOMIA DOUGLASSIANA, 133
LIVIA, long life of, 30
LIVRE, value of the, 8
LOANING money to the poor at a low rate of interest (Renaudot’s
saggestion), 5
LOCHER, MAXIMILIAN, 68
LOCKE, JOHN, the English philosopher, 52
LONGEVITY, instances of exceptional, 30
LOUDON, Western France, birthplace of Renaudot, 3
(Views of city and vicinity, 4)
LOUIS, ANTOINE, celebrated Parisian surgeon, 203
LOUIS, CHARLES A. P., Chief of Clinic at the Paris _École de Médecine_,
187, 203, 210
(Portrait 204)
LOUIS PHILIPPE, Duke of Orleans, 109
LOUIS XIII, 4, 6
LOUVAIN, High School of, 59
LUCEIA, long life of, 30
LUECKE, 50
M
MACKENZIE, the distinguished ophthalmologist, 77
MAGENDIE, one of the first French scientists to cultivate experimental
physiology, 168
on the difficulties of interpreting correctly the significance of
certain sounds heard during auscultation, 198
MAHON, P. A. O., 260
MAKROBIOTIK, the Art of Prolonging Life, Hufeland’s famous treatise,
16, 28
MARIA THERESA, Empress of Germany, 61
beneficent interference on the part of, in behalf of a higher
standard of medical education, 66, 68, 94
MARIANNE, ARCHDUCHESS, 61
MARSHALL, HALL], 204
MATERNITÉ, LA, the great French midwifery school at Paris, 253
MEDICAL literature, German, low state of, at the beginning of the 18th
century, 15
MEDICAL periodical, the first French, 7
MEDICI, MARIE DE’, 4
MEMBRANA DESCEMETII erroneously so named, 87
MERCURIAL SALIVATION, frequency of, before Van Swieten’s time, 68
MERCURY, red oxide of, when heated, produces oxygen (Priestley), 120
MIDWIFERY as taught at _La Maternité_, the great French midwifery
school, 253
MILITARY SURGERY, 241
MONRO, 130
MONTPELLIER, views of, 198, 200, 202
MONTS-DE-PIÉTÉ, when first established at Paris, 5
MONUMENT erected in Hôtel-Dieu in honor of Desault and Bichat, 167, 192
MORGAGNI, GIOVANNI BATTISTA, one of the greatest anatomists of the 18th
century, 91
teachings of, 210
MOSES, long life of, 31
MOUSE, alive, case of swallowing of, 32
MOUTH, surgery of the, 237
MUELLER, JOHANNES, 154
MUELLER, WILLIBALD, author of Van Swieten’s biography, 63
N
NAPOLEON at the University of Pavia in 1805, 96
“NATURE cures disease” (Hufeland), 33
NECKER, MADAME, founder of a hospital in Paris, 188
NEWSPAPER, the, first founded in Paris, France, 5
NORTON, MRS. CHARLES F., Librarian, Transylvania College, Lexington,
Kentucky, ix
“NOSOGRAPHIE PHILOSOPHIQUE,” Pinel’s celebrated treatise, 202
“NOVUM INVENTUM,” the, of Auenbrugger, 76
O
O’BRIEN, the celebrated Irish giant, 145
OFFICIERS DE SANTÉ, 259
OPHTHALMOLOGY, one of the first specialties to take root in Vienna, 77
“ORGANON of the Rational Art of Healing,” Hahnemann’s great work, 22,
23, 25
ORTHOPEDIC SURGERY, 234
OS UNGUIS, perforation of, by Woolhouse, 151
OXYGEN, the full significance of which term was made known to the world
by Lavoisier some time after Priestley’s discovery, 120
P
PAGEL, statement of, with regard to Broussais, 207
PALATE, the art of remedying defects of the, 237
PANNUS, first correct description of, by Beer, of Vienna, 78
PARÉ, AMBROISE, 224
PATHOGENIC fever, one of the early names given to typhoid fever, 202
PATHOLOGICAL propositions advanced by Broussais, 209
PAVIA, University of, 45
Maria Theresa, Empress of Germany, takes a strong interest in its
prosperity, 94
PERCUSSION method of Auenbrugger, 193
PÈRE POTENTINE, 188
PETERSEN, 55
PETIT, J. L., famous surgeon of Paris, 162, 215
credited by the French with having been the first to perform the
circular amputation of limbs, 151
(Portrait 216)
successful treatment of a case of hemicrania, 217
trephining of skull for subdural abscess resulting from middle-ear
inflammation, 217
PETIT, MARC-ANTOINE, celebrated French surgeon, 162
PETIT-RADEL, 183
PHLOGISTON theory of Stahl, 120
PHYSICK, DR., of Philadelphia, treatment of ununited fracture of the
femur by, 149
PHYSIOLOGICAL propositions advanced by Broussais, 208
PHYSIOLOGY, animal and vegetable, 95
experimental, cultivated largely by Bichat, 166
experimental, first cultivated by Albrecht von Haller, 168
PIARROU DE CHAMOUSSET, who built a hospital in which every patient had
a bed to himself or herself, 263
PINEL, PHILIPPE, author of the work entitled “_Nosogrophie
Philosophique_,” 202, 260
POLICE, Medical, 44
POPE’S description of travelling among the Alps, 121
POTT, PERCIVAL, famous English surgeon, the first to publish a complete
memoir of the disease now commonly known as “Pott’s disease of the
spine,” 133
PRIESTLEY, JOSEPH, discoverer of “dephlogisticated air” (oxygen), 120
also discovered that respiration takes place more easily, and that
combustion progresses more actively, in the presence of this gas,
120
house at Birmingham, England, burned by rioters, 122
in 1794 emigrates to Pennsylvania, 122
PRIMAE LINEAE PHYSIOLOGIAE, the title of the first systematic treatise
on physiology, 38
PROCHASKA, GEORG, 79
his explanation of bone formation, 80
ideas of, with regard to the nature of vital force, 79
PULMONARY and cardiac diseases, pathological anatomy of, 177
PUSCHMANN, 3, 45, 75, 85
PUTRIDITY alone, according to Peter Frank, not the cause of typhoid
fever, but rather the vehicle of a special _contagium vivum_, 203
PYTHAGORAS, views of, with regard to eating, physical exercise, etc.,
31
R
RASORI’S THERAPEUTIC METHOD resembles that of Broussais, 212
“RECHERCHES PHYSIOLOGIQUES SUR LA VIE ET LA MORT” (Bichat), 167
REIL, JOHANN CHRISTIAN, 17, 19
on the diagnosis and treatment of fevers, 20
on “vital force,” 20
RELIGIOUS BELIEFS, tolerance of, increased by the French Revolution, 53
RENAUDOT, THÉOPHRASTE, founder of the first French newspaper, 3
his sons, Isaac and Eusebius, 8, 10
(Statue, 8)
RESPIRATION, Lavoisier’s chemical theory of, 125
RICHELIEU, CARDINAL, 4
(Portrait, 6)
RICHET, A., opinion of, with regard to J. L. Petit’s qualifications as
a surgeon, 215
ROKITANSKY, CARL, Professor of Pathological Anatomy in the Vienna
Medical School, 81, 92, 93
called by Rudolf Virchow “the Linnaeus of pathological anatomy,” 84
contributions of, to medical literature, 82
ROSAS, ANTON, the distinguished Vienna ophthalmologist, 77, 231
ROUX, well-known French surgeon, report of, regarding the condition of
English surgery in the early part of the 19th century, 151
ROUX, PROFESSOR, member of the Paris _Faculté de Médecine_, visits
London in 1814 for the purpose of ascertaining by personal
observation how the English surgeons are dealing with the more
important problems in surgery, 150
S
SABATIER, RAPHAËL-BIENVENU, distinguished French surgeon of the 18th
century, 218, 260
SACOMBE, DR., charges Baudelocque with criminal practice in performing
the operation of Caesarian section, 255
both the courts and public opinion promptly judged this charge to be
an infamous calumny, 255
SAINT-LOUIS, HÔPITAL, at Paris, 262
SALIVATION, mercurial, frequency of, before van Swieten’s time, 68
SALPÉTRIÈRE, LA, one of the larger hospitals at Paris, 261
SANITATION, house and municipal, first treatise upon, published in
Germany toward the end of the 18th century, 44
SANTÉ, ÉCOLES DE, 259
SANTÉ, OFFICIERS DE, 259
SARAH, Abraham’s wife, long life of, 31
SCARPA, ANTONIO, the Italian anatomist, 46, 96
refusal of, to take the oath of allegiance to the newly established
Cisalpine Republic, 96
SCHEELE, WILLIAM, also mentioned as a discoverer of oxygen, 120
SCHLESWIG-HOLSTEIN CAMPAIGN, 48
SCOPOLI, 46
SENEBIER, JEAN, of Geneva, Switzerland, 95
SENECA’S MOTTO, “_Doceo ut discam_,” 159
SENSIBILITY AND IRRITABILITY, the distinction between these terms, 38
“SEPULCHRETUM,” title of Bonnet’s famous treatise, 93
SIMILIA SIMILIBUS, believed by Hahnemann to be a general law of
healing, 22
SIMPSON, JAMES J., Professor of Midwifery in the University of
Edinburgh, 25
SINGLE BEDS, the establishment of, as the only desirable ones in
hospitals, 263
SLEEP, von Haller’s definition of the term, 39
SLOW NERVOUS FEVER, one of the first names given to typhoid fever, 202
SMALL-POX, earliest mention of, by Rhazes, in A. D. 922, 107
measures adopted for the control of, 107
SOMNAMBULISM DEFINED by von Haller, 40
“SORE-THROAT, PUTRID,” epidemic of, in 1746, 130
SPALLANZANI, LAZARUS, distinguished Italian biologist, 93
letter of, concerning Dr. Tissot, 102
SPINA BIFIDA first successfully treated by Sir Astley Cooper, 138
SPRENGEL, 42, 155, 255
STAGNANT WATER, minute organisms found in, 95
STAHL, GEORG ERNST, 53
phlogiston theory of, 120
STAHLISM, 23
STANISLAS AUGUSTUS, King of Poland, a great admirer of Dr. Tissot, 99
STENO, DUCT OF, operation for perforating, 151
STETHOSCOPE, as perfected by Laënnec, 196
STOERCK, ANTON, 65, 71
STOLL’S “APHORISMS,” 190
STONES, shape of, affected by running water, 94
STROMEYER, 48
SUDHOFF, on character of Johann Christian Reil, 21
SUPERSTITION diminished by the French Revolution, 53
SUPRAPUBIC OPERATION for stone in the bladder revived by John Douglass,
132
SURGEONS, ENGLISH, pleasant relations among, 152
SURGERY, the golden age of, in France, 213
SURGICAL ANATOMY taught with great success by Desault, 223
SWISS PHYSICIANS of prominence during the 18th century, 34
SYLVIUS, attempt of, to inaugurate clinical teaching at the University
of Leyden, 67
SYNOVIAL MEMBRANES, 166
SYPHILIS affecting an entire family, 200
T
TENON’S CRITICISMS on _Hôtel-Dieu_ and _Hôpital Saint-Louis_ at Paris,
263
TERENTIA, long life of, 30
THÉOPHRASTE RENAUDOT, founder of the first French newspaper, 3
THORACENTESIS very frequently performed by Auenbrugger of Vienna, 76
TISSONI, original name of Tissot, 97
TISSOT, SAMUEL-AUGUSTE-ANDRÉ-DAVID, Swiss physician of Italian origin,
41, 97, 135
amusing incident at Lausanne relating to, 101
visit to Paris, 101
TRANSYLVANIA UNIVERSITY at Lexington, Kentucky, IX
TRAUBE, LUDWIG, 54
TRAUTSON, ARCHBISHOP, 66
TRENDELENBURG, 50
TRONCHIN, THÉODORE, of Geneva, Switzerland, 98, 108
TROUSSEAU, ARMAND, author of the treatise entitled “Clinique de
l’Hôtel-Dieu,” 269;
and also (in association with Hermann Pidoux) of a treatise on
materia medica and therapeutics, 266
(Portrait 266)
TUBERCULOUS DEPOSITS in the lungs, diagnosed by auscultation, 210
TYPHOID FEVER, the term finally decided upon for this disease, 203
contagiousness of, 204
early studies of, 202
first names given to the disease, 202
V
VACCINATION, for the prevention of small-pox, introduced by Jenner in
1796, 110
picture of a medal commemorating the discovery of, 108
VALLISNIERI, ANTONIO, distinguished Italian naturalist, 93
VALSALVA, ANTONIUS, 92
VAN SWIETEN, GERHARD, 19, 59
as a medical reformer, 63
commentaries of, on Boerhaave’s teachings, 61
composition of, 69
contributions of, to medical literature, 68, 69
liquor, use of, in the treatment of syphilis, 68
(Portrait 60)
VARICOSE VEINS of the leg, Sir Benjamin Brodie’s treatment of, 149
VARIOLAE VACCINAE, an inquiry into the causes and effects of the, 114
VEGETABLE POISONS, experiments made by Sir Benjamin Brodie on the
different modes in which death is produced by, 148
VELPEAU (Portrait 268)
VENTES _à grâce troque ou rachapt_, 5
VESALIUS, 83
VICQ-D’AZYR, FELIX, distinguished French anatomist and physiologist,
130, 177
VIENNA, revival of medical science at, in early part of the 18th
century, 16
VIENNA SCHOOL OF MEDICINE, 57
reorganization of, 64
scheme of teaching adopted by, in 1780, 73
VITAL FORCE, memoir on, by Reil, 20
explained by Prochaska, 79
nature of, 21
VOLTA, 46
VOLTAIRE, 263
advocates the teachings of John Locke, 52
VON GRAEFE, C. F., the distinguished ophthalmologist, 77
VON GRAEFE, KARL, director of the Surgical Clinic of Berlin, 48
VON HALLER, ALBRECHT, 19, 34, 38, 95, 101
the first to cultivate experimental physiology, 168
VON LANGENBECK, 48, 49
VON WALTHER, PHILIP, 77
W
WAKEFULNESS DEFINED by von Haller, 39
WATER, INFECTED, drinking of, mentioned by Galen as the cause of
various epidemic fevers, 202
WHEELER, translator of Hahnemann’s “Organon,” 22
“WHITE INFLAMMATION,” Boerhaave’s, 183
WILLIAMS MEMORIAL PUBLICATION FUND, VII
WINSLOW, distinguished anatomist, 36
WOOLHOUSE, the first surgeon to perform the operation of perforating
the _os unguis_, 151
WUNDERLICH, KARL AUGUST, 54
Z
ZIMMERMANN, JOHANN GEORG, 41
------------------------------------------------------------------------
Footnotes
-----
Footnote 1:
The _liard_ was a small copper coin worth at that time one-quarter of
a _sou_. The latter coin was about as large as a silver quarter of a
dollar or a one-shilling piece (English money).
Footnote 2:
The view of the small town of Loudun (see opposite page 4), which has
been copied from a photograph of quite recent date, shows that Gilles
de la Tourette’s hope has already been realized.
Footnote 3:
See Haller’s comments on Boerhaave’s personality, at bottom of page
445 of “The Growth of Medicine.”
Footnote 4:
In the city of Leipzig alone there were no fewer than 30,000 wounded
and sick soldiers belonging to all the different nations engaged in
the war.
Footnote 5:
The following quotations are from Wheeler’s English Translation of the
Organon.
Footnote 6:
Several weeks after I had sent my completed manuscript to New Haven I
received, from a London dealer in second-hand books, a catalogue in
which the following item appears:—
Haller (Albrecht von) First Lines of Physiology. Translated
from the Third Latin Edition. To which is added a Translation
of the Index composed for the Edinburgh Edition printed under
the Inspection of Dr. William Cullen. Edinburgh, 1801.
It is evident, therefore, that I was in error when, after a very
limited search, I was led to believe that no English version of the
“_Primae Lineae_” exists, and accordingly I ventured to translate a
few brief selections of the text.—A. H. B.
Footnote 7:
To make sure that any errors rightly chargeable to me as translator
shall not be imputed to von Haller I will add here the original Latin
text.—A. H. B.
CHAPTER XX. SOMNUS.
SECTION 564.—Aptitudo ad sensus et motus voluntarios libere exercendos
in sanis organis, VIGILIA vocatur: ineptitudo ad eosdem et quies
omnium cum sanis organis SOMNI nomen fert.
SECTION 565.—In somno anima vel omnino nihil cogitat, quod memoria
retineatur, quodque notum fit, vel unice occupatur in speciebus,
sensorio communi receptis, quarum vividae repraesentationes in mente
eo tempore omnino similes perceptiones producunt, quales objectorum
externorum impressiones insensuum organa faciunt. Hae
repraesentationes INSOMNIA vocantur, et efficiunt, ut reliquo toto
emporio sensuum et voluntariorum motuum quiescente, aliqua tamen
particula aperta sit, spiritibus perfluatur, et vigilet. Aliquando cum
his perceptionibus animae aliqui motus voluntarii conjunguntur, ut
loquelae organa, ut artus multi, omnesve, ad nutum illarum
preceptionum regantur. Huc SOMNAMBULI.
SECTION 566.—Sed in somno pergit omnium humorum in corpore humano
distributio, circulatio, vis peristaltica ventriculi, intestinorum,
sphincterum, respiratio denique ipsa simili modo exercetur. Haec
compositio in quiete certarum partium, aliarum motu, cognitionem
causae mechanicae somni difficilem reddidit.
Footnote 8:
A French physician by the name of Goudareau has published a
translation of the work under the title: “TRAITé DE MéDECINE
PRATIQUE,” 2 vols., Paris, 1820–1822.
Footnote 9:
At this point one of Wunderlich’s critics makes the comment that
Ludwig Traube may more justly be considered the real founder of
experimental pathology in Germany.
Footnote 10:
“COMMENTARIA IN HERM. BOERHAAVE APHORISMOS DE COGNOSCENDIS ET CURANDIS
MORBIS,” Paris, 1755–1773, 5 vols. in quarto. There exist also English
and French translations of these commentaries.
Footnote 11:
It has often been stated that Lorenz Gasser was the discoverer of the
nodal swelling of the trigeminal nerve which bears the name of
“Gasserian ganglion.” Hyrtl, however, declares that the credit for
this discovery belongs to A. R. B. Hirsch, a Viennese anatomist, who
named it in honor of his teacher, Lorenz Gasser, Professor of Anatomy
in the University of Vienna.—A. H. B.
Footnote 12:
A solution of bichloride of mercury, 4; chloride of sodium and
chloride of ammonium, each 1; water 500.
Footnote 13:
“Illustrissimo viro Lazaro Spallanzani summo naturae in minimis et
difficilimis, indagatori, ob ejus in veri finibus extendendis, merita,
D. D. D. Hallerus.”
[The letters D. D. D. are an abbreviation for “dat, donat, dedicat,”
commonly employed in inscriptions.]
Footnote 14:
Those of 1775 and later years, printed by Grasset, of Lausanne, are
considered the best.
Footnote 15:
At the period which is now under consideration Geneva belonged
strictly to France. It was not until the year 1815 that it was
incorporated with the Confederation of Swiss Cantons.
Footnote 16:
Some authorities state that William Scheele made the same discovery
independently in 1775.
Footnote 17:
Published, in 1908, by John Lane, New York and London; and, for the
reader’s further enlightenment, it should be stated that “Thomas
William Coke of Holkam, Norfolk, England, was a famous country
gentleman who lived from 1754 to 1842, becoming, late in life, the
Earl of Leicester. He was known throughout the world of his time as a
scientific and accomplished agriculturist. Owning great country
estates he was a skillful sportsman, and as an influential member of
Parliament sided with the Americans and against George III and his
ministers in our Revolution.”
Footnote 18:
The title of this memoir is: “_TRAITÉ DES MEMBRANES EN GÉNÉRAL ET DES
DIVERSES MEMBRANES EN PARTICULIER_,” Paris, 1800.
Footnote 19:
Free Translation into English.—“This monument has been erected in
honor of citizens Desault and Bichat by their contemporaries, who wish
in this manner to show their appreciation of the valuable services
which these two men have rendered to medicine: Desault by the
important part which he played in renewing the life and vigor of
French Surgery, and Bichat by his untiring efforts, both by teaching
and by research work, to extend the limits of the domain of Medicine.
Successful as were these efforts the results would certainly have been
much greater if death had not put an end to his work before Bichat had
completed his 31st year.”
Footnote 20:
Bonaparte was not made Emperor until 1804.
Footnote 21:
This—says the author of the biographical sketch from which I derive my
information—is a bit of sarcasm suggested to Bayle’s mind by the fact
that Petit-Radel was well-known at that period to be particularly fond
of favoring systems in his contributions to medical literature.
Footnote 22:
See foot-note on page 180.
Footnote 23:
For additional information concerning Montpellier’s famous _Faculté de
Médecine_, see farther on under the heading “Jacques Delpech” (page
233).—A. H. B.
Footnote 24:
To prevent confusion I beg to remind the reader that there were two
men living in Paris at this period who both bore the name of Louis and
who were almost equally celebrated, viz., Antoine Louis, the surgeon,
and Charles A. P. Louis, the subject of the present remarks.
Footnote 25:
As stated on page 87 the Vienna anatomist, Hyrtl, claims that Duddal,
an English physician, was the first person who described this
membrane.
Footnote 26:
By the word “schools” Chereau evidently means the buildings in which
the different classrooms were located.—A. H. B.
Footnote 27:
Voltaire says (p. 328 of “_Pages Choisies des Grands Écrivains_,”
Paris, Librairie Armand Colin, 1910): “That Piarrou de Chamousset
(1717–1773), a wealthy philanthropist, built a model hospital in which
every patient had a bed to himself or herself. Since that time the
practice of putting two patients in one bed has been abandoned.”
------------------------------------------------------------------------
PRINTED IN THE UNITED STATES OF AMERICA
------------------------------------------------------------------------
● Transcriber’s Notes:
○ The footnotes were gathered and placed at the end of the book. An
entry was added to the Table of Contents for the footnotes.
○ Missing or obscured punctuation was silently corrected.
○ Typographical errors were silently corrected.
○ Inconsistent spelling and hyphenation were made consistent only
when a predominant form was found in this book.
○ Text that was in italics is enclosed by underscores (_italics_).
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