_The Age of Renovation (continued).--The Eighteenth Century; General
Considerations. Foundation of Learned Societies, etc. The Royal College
of Surgeons, 1800; the Josephinum, 1785.--The Nineteenth Century.
Realistic Reaction Against Previous Idealism. Influence of Comte, of
Claude Bernard, and of Charles Darwin, 1809-1882. Influence Exerted by
Other Sciences.--Theory of Excitement: Roeschlaub.--Stimolo and
Contrast imolo: Rasori, 1762-1837.--Homoeopathy: Hahnemann,
1753-1843.--Isop-athy, Electrohomoeopathy of Mattei.--Cranioscopy, or
Phrenology: Gall and Spurzheim.--The Physiological Theory: Broussais,
1772-1838.--Paris Pathological School: Cruveilhier, 1791-1873. Andral,
1797-1876. Louis, 17871872. Magendie, 1783-1855. Trousseau, 1801-1866.
Claude Bernard, 1813-1878.--British Medicine: Bell and Hall, Travers,
1783-1858.--Germany, School of Natural Philosophy: Johannes Müller,
1801-1858.--School of Natural History: Schônlein, 1763-1874.--New Vienna
School: Rokitansky, 1804-1878. Skoda, 1805-1881._
That the{230} eighteenth century, up to its close, was the golden age
of medicine, is due to the prevalence during that period of a strong
idealistic undertone, as a result of which any learned occupation caused
the scholar to be held in higher esteem than is the case even to-day.
Medicine was then regarded as _a conscientious vocation_ and not as a
mere business or trade; indeed, general scientific knowledge more widely
prevailed among the better class of the profession, and there was
much less of that one-sided, narrow education that obtains to-day. The
profession, moreover, was not overcrowded; physicians were neither too
few nor too numerous, consequently their social position was higher.
Again, the relations between doctor and patient were more intimate, most
practitioners being of the type described as "family physicians," and
those possessed of the doctorate degree ranked among the gentry rather
than as artisans. They were, for the most part, fully devoted to their
calling; moreover, the State took greater care to protect the people,
so that it became dangerous for strolling vagabonds and imposters to
attempt to trifle with human life and excite the vulgar to the prejudice
of scientific knowledge.
The{231} pursuit of anatomical studies was now facilitated, despite the
fact that students were frequently compelled to take long journeys
in order to obtain the "material" therefor. In the early part of the
century so great was the lack of dissecting material that the great
Haller while in Paris was compelled to purloin his cadavers, and
ultimately, on discovery of this fact, to fly for his life; Hoffmann was
only able to make twenty dissections during twenty-four years; even
in the middle of the century there was only one dissection annually in
Halle; up to 1712 there had been only three dissections in a score
of years--though now subjects can be had there in abundance at a
ridiculously low figure; cadavers were extremely scarce in Vienna as
late as 1765; and for a long time the only places in London where the
study of anatomy could be legally pursued were the College of Physicians
and the College of Surgeons, and the trouble that hampered John Hunter
in this direction is historical. The crime of "Burking" became known in
Hunter's day. Murder was committed, and the victim sold for purposes of
dissection--for at this time, as "body-snatching" was a necessity, those
that purchased cadavers asked few questions, and the fees paid were, of
course, high.
The first clinical institution in Austria was organized in Vienna, in
1754, by Van Swieten, though there was an "ambulatory clinic"
(out-patient department) in Prague nine years before. During the
century, however, hospitals were everywhere in bad condition. In the
Hôtel-Dieu, at Paris, several patients--even as many as six--were
sometimes put in the same bed; the convalescent and the dying found
themselves thus associated; in Vienna the Allgemeines Krankenhaus was
composed of seventeen hospitals that subsequently were amalgamated into
one. In London numerous hospitals were founded, and as the medical staff
of each became eminent they attracted numerous pupils; but later it
became necessary to relieve the hospital wards, and private institutions
for instruction were established by popular{232} teachers, the most
celebrated being the "Windmill Street School of Anatomy," founded by
William Hunter about 1770, and the private school of Sir William
Blizzard, which, established in 1780, developed, five years later, into
the London Hospital Medical School.
While few, if any, of the lectures were compulsory, particularly in the
natural sciences, even more attention than now was bestowed upon the
accessory branches; botany, chemistry, and natural history were the
recreation of many students and physicians. Pupils enjoyed the privilege
of studying what they pleased--as they do practically to-day in the
Portuguese University of Coimbra,--and professors exercised to the
utmost their individuality in teaching. In Spain natural sciences found
no admission, and even so late as 1770 no instruction in these branches
was given, as they were regarded as dangerous to the purity of the
faith; mineralogy for mining purposes was an exception, for even the
most faithful Catholic needs money.
At the universities medical students were not permitted to go out
without their scholastic cloaks,--a regulation that still obtains in
Spain. That the number of students has enormously multiplied may be seen
from the fact that the little University of Giessen, with scarcely any
medical school at all, has always more students than had Halle in the
days of the famous Hoffmann. In the middle of the last century Würzburg
had at one time but _three_ medical students, while to-day it has in the
neighborhood of five hundred. Even then it was complained that, on
account of the number of students, there was an educated proletariat
arising, and in 1791 it was proposed, in Austria, that the rush for
study should be repressed.
Among the Continental students the revels and bad behavior of past
centuries were not to any great extent corrected; fights and debauchery
were very common, and all sorts of orgies and bacchanals prevailed.
The professors were, in large measure, independent of the State, and a
single{233} individual often represented a number of branches now taught
by special chairs. When indisposed to lecture, they simply posted upon
the blackboard: "_Hodie non legitur_," and this was the end of the
matter. In 1777 Vienna had one hundred and forty-seven medical teachers,
and in Germany there were two to every thirty-nine students. That in
the last century one man often accomplished more than a great number
of average teachers do to-day is amply demonstrated by the lives of
Boerhaave, Haller, and others. Then, too, the Latin tongue was generally
employed for purposes of instruction, though surgeons, for the most
part, lectured in the vernacular; Cullen, in 1770, was the first in
Great Britain to deliver purely medical lectures in English; and as the
clergy gradually retired from the ranks of the profession, Latin more
and more fell into disuse. Strange to say, as the clerical influence
waned, the Jews began to enter medicine, the movement beginning about
1791, in France, under the promulgation of "civil equality" ideas;
previously the Hebrews had been an almost universally suppressed people,
and in Berlin were permitted to enter and leave the city by only one
gate, and were forbidden to learn or write pure German, in consequence
whereof their dialect was an Hebraic-Teutonic jargon, that even to-day
prevails in some portions of western Europe. Educated Jews were few in
number, since attendance upon universities was ordinarily denied them,
although long before they had been admitted at Salamanca, Toledo,
Salernum, and Montpellier. In Austria the prohibition was not removed
until 1789, and even then, so bitter was the prejudice against the
Semitic race, the clergy vigorously protested. It was the same clerical
body that, in 1667, protested with the greatest vehemence against
allowing Hebrew physicians to pass through the gates of Wurtemburg
without paying toll, declaring that it was "better to die with Christ
than be cured by Jews, who were aided by the devil."
Professors{234} were often attached to the courts of their various
sovereigns, and at one time the French court possessed a faculty of
forty-eight physicians, surgeons, and apothecaries, the first two
physicians being required to attend every morning when the king arose;
hence originated the titles, still known in Germany, of "Hofrath" and
"Geheimrath."
Medical fees, as a rule, were very small, though there were exceptional
instances in which enormous sums were bestowed: Joseph II, of Austria,
gave Guerin, who was summoned from Paris in consultation, an honorarium
of 171,000 marks and made him a baronet. Taking all things into
consideration, the income of the average practitioner in the eighteenth
century would be in the neighborhood of $1000, which, however, was
equivalent to three times that amount to-day. Fothergill, whose highest
income in a single year was $25,000, bequeathed to the poor of London
$1,000,000; Sir Astley Cooper had a yearly income of from $75,000 to
$100,000, but it may be remembered that his practice during the first
year netted him just $26, and that it was four years later before his
income reached the sum of $500.
The physician of the last century was, at least, on occasions of moment,
very different from other men, and to be recognized by his dress. A cap
was placed upon his head when he graduated, in recognition of the fact
that physicians at an earlier period belonged to the learned or clerical
profession; and in later life he wore a purplish or scarlet cloak (to
distinguish him from lawyers, whose professional color was yellow,
and from theologians, who then, as now, sported the sombre black).
The regulation full-dress costume of the English physician of the last
century demanded a well-powdered wig, silk coat, knee breeches with
stockings, buckled shoes, lace ruffles, cap, and goldheaded cane, to
which, in cold weather, was added a muff--to preserve his delicacy of
touch.
Surgeons{235} were still strictly separated from physicians, even in
education; nor were they esteemed as equal in rank, until the French
Revolution brought about the doctrine of civil equality; perhaps this
is one reason why this branch of the medical art made less conspicuous
progress until recent times. The change was brought about, in France, by
the abolition of eighteen universities and fifteen colleges of medicine,
the Royal Society of Medicine (founded in 1776), and the Academy of
Surgery (founded in 1731); but by this abolition charlatanism acquired
such speedy control that the arrangement was soon abandoned. Thus it
came about that surgical instruction was given in special institutions
or in the universities, and the conditions of instruction finally
improved. When the College of St. Come was abolished in 1753 the Société
de Chirurgie, founded in 1731, became the Académie de Chirurgie; and,
when the French Academy was formed in 1795, the Académie was merged into
its medical department. The École Pratique, where Desault and Chopart
taught, was established in 1750 for the practical education of surgeons.
In England the Royal College of Surgeons was not incorporated until
1800. In Austria, in 1785, the Josephinum was opened by Joseph II,
who also erected permanent military hospitals in Prague, Brünn, Milan,
Mantua, Pesth, Olmütz, etc.; he also created the "Joseph's Akademie" in
order to educate military surgeons and thus overcome the defects of
army surgery; the Josephinum unquestionably exerted great influence in
elevating the social and military position of army surgeons and attained
historical importance after Brambilla compelled the recognition of
surgeons as social equals of other members of the medical profession. As
the result of these improvements, the various armies of Europe were soon
furnished with better medical officers. Prior to this, too, the field
hospitals had been as badly mismanaged as their civil prototypes, and
the substitution, in 1793, of movable hospitals, as suggested at{236}
the close of the sixteenth century by Henry IV, of France, was scarcely
an improvement. The whole system suffered from perpetuation of the dual
and distinct functions of the physician and the surgeon, to destroy
which was a part of the design of the Josephinum. How unpleasant was the
position of the army surgeon up to this date may be inferred from the
fact that in 1758 one was subjected to corporeal punishment at the
command of his colonel, and that a general upon his death-bed could
leave orders that fifty blows be given each of his medical staff in case
the post-mortem disproved the diagnosis.
In Austria, at the beginning of the Seven Years' War, all military
surgeons of the Protestant faith were compelled to become Catholics
or leave the service. The condition of the wounded soldiers was as
deplorable as can well be imagined; but upon this subject I cannot
dwell.
The tendency of the nineteenth century seems to be a continuation, and,
perhaps, in some respects, an exaggeration, of the condition obtaining
in France during the previous century; in other words, the world has
become practically an enormous school of pathological anatomy and
diagnosis,--a school inaugurated by Bichat, as representing so-called
scientific or exact medicine. Philosophically this has been a century
of reaction against the idealism of the preceding age; it places the
individual, rather than the idea, in the foregound. The mutual influence
of medicine, philosophy, and the natural sciences is less conspicuous
now than formerly. Recent philosophers who have exercised the greatest
influence are: Schelling, who held to the equality of the real and the
ideal; Hegel, whose supreme principle was absolute reason, of which
religion was regarded as a representation; Hartmann, whose philosophy of
the "unconscious" depends largely upon the results of natural sciences,
embraces Darwinism, and is, in many respects, an extension and
completion of Schopenhauer's{237} pessimism and doctrine of the soul.
But one who has exercised still more influence upon our profession
is Comte, whose positivism contrasted strongly with the idealism and
atheism of Schelling, and who required only this of philosophy,--namely,
that it should work out the general ideas and results of other sciences;
his most important follower was Claude Bernard, and upon these two
the whole exact school of France is based. But the most influential
philosophic doctrines of this or any other century have been those
emanating from Charles Darwin, Herbert Spencer, Ernst Haeckel, Alfred
Wallace, and their contemporaries and followers. Darwin (1809-1882) was
the grandson of Erasmus Darwin, already mentioned, and his _Variation of
Animals and Plants Under Domes-tication, Origin of Species, and Descent
of Man_ have found a place in all modern languages. The system known
by his name is the pure science of nature, is founded upon scientific
investigation, and by its merits alone has found almost universal
acceptance; it has been added to and further elucidated by the efforts
of Haeckel and Spencer.
When it is declared that medicine of the present is influenced by no
system, it is speedily found, on critical analysis, that this is an
error. It necessarily follows the realistic and materialistic as readily
as it did the teachings and doctrines of natural philosophy; and, in
consequence, "medical thought," so called, is just as one-sided to-day
as at any time in the history of the art. The watchword of to-day,
natural specific tendency, veils, but does not take away, its
philosophic principles, and so our ridicule of earlier medical systems
is quite unjustifiable. A modern historian aptly remarks that the
medicine of the present "embraces nothing but a theorem of investigation
by the senses."
Discoveries in botany, the result of better knowledge of natural history
and more accurate habits of study, have influenced{238} modern progress
not a little; have led to better classification and broader knowledge.
The natural system of de Candolle (1778-1841) of Geneva, and of
Endlicher, of Vienna, called into existence the so-called natural
historical school of medicine; the researches into plant-cells by
Schleiden and Baumgartner, and the almost contemporaneous discovery of
animal cells by Schwann became, in course of time, the origin of recent
cellular pathology; then came microscopic botany, and the influence of
the lower fungi in the production of fermentation and putrefaction.
Similarly too, the laws of physics have been shown to have an
inseparable connection with anatomy and physiology, and their study has
become a most important aid in the experimental researches of
to-day; through Helmholz they brought in the ophthalmoscope; thermal
electricity, for the discovery of which medicine is indebted to Seebeck;
a better knowledge of optics, thanks to Fraunhofer, who was equally
expert in electricity; spectrum analysis, invented by Kirchhoff; and
the varied efforts of Faraday, Graham Bell, Thomas Alva Edison, and
Daguerre, the latter better known for his invention of photography.
Finally, medicine is immeasurably indebted to Tyndall and Huxley for
their teaching of the correlation and conservation of energy.
Chemistry also has performed its share, and, as applied to physiology,
is a discovery almost wholly within the present century. The new
nomenclature serves a practical purpose in that it is now possible to
portray chemical combinations and isomerism in a graphic, and at least,
semi-comprehensive way. Among the chemists may be specially mentioned
Bertholet, whose laws are as well known as they are succinct; Humboldt;
Berzelius; Dumas; Chevreuil, who recently died at the age of almost one
hundred years; Magendie; Orfila, the toxicologist; Gmelin, eminent
in physiological chemistry; Rose, perfecter of organic analysis;
Wohler,{239} who first made organic alkaloids; Bunsen; Sir Humphry Davy;
Marsh; Faraday; Graham; Young, who first showed the industrial value of
coal; and Gay-Lussac.
Upon medicine, zoology also, with comparative anatomy and physiology,
has had a wonderful influence; here may be noted the names of Cuvier,
Oken, Bilharz, Brehm, Wagner, Leuckart, Richard Owen, William Carpenter,
and last, but by no means least, Thomas Huxley.
But perhaps the most significant feature of the age has been the
wonderful development of scientific associations and the publication of
medical and scientific literature. Whether these have yet reached their
climax is perhaps an open question, but the consequent widening circle
of readers, as well as of writers, seems to imply that there will be for
a long time to come no lack of activity in this direction. In the United
States more than in any other country medical societies and associations
innumerable have sprung up, and to such a degree that (in the eastern
States at least) there are few counties that cannot boast of a medical
organization.
During the present century foreign universities have decreased in
number, partly owing to consolidations and partly by surrender of
charters; for instance, the old University of Ingolstadt was united
with that of Landshut, and in 1827 was removed to Munich; in 1816 the
University of Wurtemburg was united with that of Halle; the University
of Bonn was abolished in 1792, but revived in 1818. A few new
universities, like that of Zürich, have been founded. In the quaint
old town of Prague the old German university was, in 1883, divided, and
there now exist in that city two universities side by side, in one of
which German is spoken, in the other Bohemian.
It will thus be seen that the nineteenth century is essentially an era
of modern science, with whose dawn was sounded the death-knell of the
"demon of disease" and his twin{240} brother "visitation." In 1801 the
first experiment in steam-navigation took place upon the Thames. In 1807
the slave-trade in England was abolished by Parliament. The theological
part has entirely faded out of medicine; and the era of accurate
scientific experimentation which long since dawned, is now, so far as
we can see, at its height, since it is difficult to conceive of much
improvement upon its methods under existing conditions, or of greater
enthusiasm than has been already manifested.
Now, regarding some of the systems and theories of this age. The systems
of the past have been more or less long-lived,--as, for instance, those
of Dogmatism and of Galen,--while as we come closer to the present they
become more ephemeral. Those of the early part of the present century
took root in the soil of the eighteenth,--for instance, the so-called
_theory of excitement_ of Roeschlaub (1768-1835), which endeavored
to mold into one the Brunonian errors and the fancies of Schelling.
According to it, life depends upon irritability, but is inherent in the
organism as an independent feature; so it recognizes both irritability
and solidism, while Brown considered the former alone, adding, as an
after-thought, a chemical or qualitative potency (oxygen), in order to
account for alterations of quality. Roeschlaub inclined first toward
natural philosophy, then, owing to an inherent theological and polemical
bias (he was originally intended for the church), to mysticism and
theosophy; finally, with a courage almost unexampled, he upset all
his former teachings by admitting he was mistaken. To him was opposed
Hufeland, who wrote on the _Lengthening of Life_, was noted for a
warm and benevolent heart, and possessed no small penetration, as is
evidenced by his aphorism, "Successful treatment requires one-third
science and two-thirds '_savoir faire_.'"
_Stimolo_ and _contrastimolo_ were titles applied to a theory advanced
by Rasori (1762-1837), of Milan, that combined Methodism with Brunonism;
by Baas it is characterized{241} as a "genuine blot upon the human heart
beyond any other of the various systems." Long centuries of experience
and the conclusions of great and venerable minds may go for naught, as
Rasori abundantly demonstrated. The theories of Brown were then taught
as his own to his classes in Pavia, showing he was not above plagiarism;
his _stimolo_ corresponded to the sthenic diathesis devised by Brown,
while his system consisted of an endeavor to make a diagnosis by
watching the effects of drugs. Bleeding was held to be the best measure;
if it did the patient good, the sthenic diathesis was assumed; if it
made him worse, the asthenic was certain. He gave enormous doses of
powerful drugs--sixty grains of gamboge, and from two to three ounces of
saltpeter in a single day. Is it strange that homoeopathy or any other
heterodox system sprang up in the midst of such measures? It is an old
saying that there is no folly which will not secure a following; and,
strange to say, Rasori had a numerous and an eminent one.
As just intimated, Homoeopathy was the natural reaction against such
heroic measures; in the rebound the other extreme was reached, even to
practical therapeutic nihilism. Now, instead of venesection and drastic
medication, came the theories expounded by Hahnemann (1753-1843), which
_denied disease, admitting only symptoms_. This apostle of homoeopathy
was the son of a porcelain-painter in Meissen; he studied in Leipzig and
in Vienna, and later practiced in various cities, including Dresden and
Leipzig. "_Similia similibus curantur_" was not original with him, as it
long before had been formulated by Hippocrates, and later by Paracelsus.
Of the life and labors of Hahnemann, much might be told; but this is not
the time or place to go into the subject.
[Illustration: 0262]
An offshoot of homoeopathy, which demands only the harshest criticism,
is Isopathy,--perhaps the filthiest theory ever invented,--according
to which like is to be cured by like,{242} and to such an extent that
small-pox is to be treated by variolous pus, tape-worm by the ingestion
of the proglottides, etc.
Another of the rankest of fraudulent outgrowths is the so-called
Electrohomceopathic system of Count Mattei, who prates of "red,"
"blue" and "green" electricity,--a theory that, in spite of its utter
idiocy, has attracted a considerable following and earned a fortune for
its chief promoter.
Another of the vagaries of the earlier portion of the present century,
and that still survives, in a weak way, is Cranioscopy, or Phrenology.
Gall expounded his doctrines at Vienna as early as 1796, but, being
expelled, went to Germany, where he was joined by Spurzheim, who, though
much{243} more of a student and scientist, accepted the doctrine of
the former with enthusiasm; and it was chiefly due to the efforts of
Spurzheim that phrenology was introduced into England, and later (1832)
into America. Gall assumed to locate twenty-seven different organs
alongside of each other in the brain, and held that external markings
on the skull were guides to the development of the various parts. Every
neophyte in anatomy knows how little foundation there is for such a
doctrine, but for a time it attracted great attention, and there
are to-day certain men and women who make their living out of this
imposition.
The Physiological Theory of Medicine was originated by Broussais
(1772-1838), and combined the views of Pinel and Bichat with the
"sympathetic" view of Hoffmann, the "concealed inflammation" of Stoll,
and the theory of inflammation held by Marcus. Broussais had been a
pupil of Bichat. In 1814 he began hospital teaching, and in 1831 was
made professor. Personally very vain, quick-tempered, even belligerent,
as a therapeutist he was a man of routine. He was, perhaps, best known
shortly before his death, when delivering lectures on phrenology.
According to him, life depends upon external irritation, produced
by heat, which excites new chemical processes, while these in turn
stimulate regeneration, assimilation, as well as contractility, and
sensibility. When the functions supported by heat cease, death ensues.
Health depends upon moderate action of external irritants; disease, upon
either their weakness or their extraordinary strength. He saw nothing
ontological about disease. In therapeutics he admitted the healing power
of Nature, but regarded the physician not as a minister, but as a lord
of Nature. Febrile and inflammatory diseases were all treated by the
withdrawal of nourishment, carried to the extreme. His most powerful
antiphlogistic treatment consisted in the application of leeches to the
abdomen,{244} and to robust individuals he applied from thirty to fifty
at once It is not, then, to be wondered at that, in consequence of his
so-called "hirudinomania," leeches became very scarce In the year 1833
forty-one million five hundred thousand leeches were imported into
France, while in 1824 one-twentieth of this number sufficed to supply
the demand. Even in cases of worms, the abdominal integument had to pay
its blood-tribute, particularly if enteritis prevailed. He only allowed
a spare diet of mucilaginous and acid drinks. In mercurial France and
Italy he gained numerous followers, but they were few and far between
in practical, hard-headed Germany and England. His best follower was
Bouillaud (1797-1881), who adopted the symptomatic nature of fever and
the sanguinary therapeutics of his master, but used the lancet more than
the leech. As the homoeopaths regard Hahnemann, so Bouillaud looked up
to Broussais as the Messiah of medicine and science, which, as Baas says
were "already greatly overstocked with Messiahs."
Contemporaneous with the school of Broussais, and its antagonist in all
respects, was the Paris School of Pathological Anatomy and Diagnosis,
which has given tone to all medical art. It made it the duty of the
physician to search for changes in the human body, to investigate the
local products of disease, and assigned to medicine the duty of removing
these products. The tendency of its teaching was to treat the patient
rather as a living cadaver than as a sentient being endowed with vital
forces, and the charge which Asclepiades once falsely made against
Hippocrates was revived upon new grounds. Kratzmann wrote some years
ago: "In France every one experiments on the sick, less to attain the
best method of cure than to enrich science with an interesting discovery
and to advance the accuracy of diagnosis by some new physical sign."
The seductiveness of this system promoted still more onesidedness, which
finally almost attained the belief that the science{245} of medicine
really originated in the Anatomical School of Paris.
The forerunners of this school were Bichat and Pinel, and its proper
founders were Corvisart, Dupuytren, and Laënnec. There was also Bayle,
who was first to apply the ear to the thorax in disease of the heart,
and thus became the predecessor of Laënnec and Chomel. He was the
godfather of typhoid fever, and from being a famous clinician became
later a great pathologist. The most celebrated adherent of the method,
however, was Cruveilhier (1791-1873), professor first in Montpellier and
then in Paris, who revived the Anatomical Society founded by Bichat,
and wrote his first essays as the result of Dupuytren's advice; finally,
there came from his pen the famous treatise on _Pathological Anatomy_,
with its magnificent plates,--a work begun in 1830 and not fully
completed until 1864. Like Morgagni, he associated general and
pathological anatomy with bedside observations; also established a class
of inflammations to which belong gangrene and atony, and a certain class
of neuroses and fevers, and endeavored to investigate the different
steps in the development of lesions, not simply their final products.
His teachings concerning pyæmia and phlebitis, which had been first
studied by John Hunter, excited great attention, and he even came to the
one-sided conclusion that "phlebitis rules the whole of pathology."
He was the first to observe that its suppurative form does not occur
primarily, but is secondary to coagulation of the blood.
The ablest representative of this school, and one who, perhaps, more
than any other man, made Paris a Mecca to which foreigners made their
pilgrimages, was Andral (1797-1876),--the son of a physician and the
most noted and indefatigable investigator and thinker of his time.
Between 1823 and 1840 were published the five volumes of his _Medical
Clinic_, which made him famous. He taught, in opposition to Broussais,
the existence of primary diseases{246} of the blood, the so-called
dyscrasiæ; made physiology subservient to pathology; was the creator of
the chemistry of the blood; and in therapeutics was wedded to emetics
and cathartics, ascribing little importance to abstraction of blood.
The first man to apply the Numerical Method to pathology, and who
brought about the downfall of Broussais, was Louis (1787-1872), who
had studied in Russia, but came to Paris while still a young man. He
expressed his principle in the following words: "As often as I have
formed an _a priori_ idea and had afterward opportunity to prove the
facts, I have invariably found that my idea was false. In pathology
as well as in therapeutics numerical analysis is a useful practice. By
numbers only can be obtained the frequency of conditions or this or that
symptom; by a definite enumeration alone is it possible to utilize the
special relations of age, sex, constitution of our patients, to settle
that this or that symptom occurs so often in one hundred or one thousand
cases." This system he applied to etiology, symptomatology, prognosis,
therapeutics, and pathological anatomy. He discarded blisters and
condemned large bleedings, but fell into other errors, carrying his
numerical method to an unjustifiable extreme.
Next to Andral and Louis should be mentioned Magendie (1783-1855),
Professor of General Pathology in the College de France, and physician
to the Hôtel-Dieu, who was a representative of the new French medicine,
and introduced experiments into both pathology and physiology; he was
the pioneer in experimental pharmacodynamics, which occupies itself
largely with alkalies, a large number of which he introduced into
practice. He was a solid humoralist in pathology, a most accurate
diagnostician, but (it is charged) "was too simple in therapeutics"! As
a result of his intravenous injections of putrefactive material, he had
the terms "pyæmia," "icliorrhæmia," and "metastasis" introduced into
pathology.
Trousseau{247} (1801-1866), of Tours, also became professor in the Paris
Faculty, and rendered especial service in his studies of croup and the
employment therefor of tracheotomy, though his chief fame rests upon
his merit as a clinical teacher and the publication of clinical lectures
which are still models in every way of accurate, forcible teaching.
Claude Bernard (1813-1878) became the successor of Magendie, and even
more famous as an experimenter in pathology, physiology, and anatomy.
Originally a poet, he finally turned to medicine and science, and in
1869 became a member of the French Academy.
One of the results of the French fondness for pathological anatomy was
an outgrowth, unfortunate in some respects, of specialism, which made
its appearance early and spread to other countries, particularly to
Germany, so that to-day there is scarcely an organ in the body which
has not only its special student, but its special representative in
medicine. It would be of interest to go over some of the various organs
and count those who have become most renowned in the study of their
diseases, but that is beyond the scope of this volume.
As Baas says, England, after her excessive participation in the
iatrochemistrv and iatromechanics of the seventeenth century, with a
devotion that extended far into the eighteenth, seemed then to lose all
confidence in systems and schools of medicine, inasmuch as since that
time no system or so-called school has gained in Great Britain any large
or permanent band of followers; even Brunonianism did not succeed in
this respect. This form of conservatism is a characteristic of the
British race. But while schools have not risen, individuals have
formulated hypotheses or doctrines that at least attracted attention, if
not followers. For instance, John Mason Goode (1764-1827) formulated an
intricate nosological arrangement in his long-popular text-book entitled
_The Study of Medicine_, and{248} also arranged a classification of
diseases now almost forgotten.
In 1816 Sir Charles Bell (1774-1842) made the memorable discovery that
the posterior roots of the spinal nerves preside over sensation, and the
anterior over motion; and this attracted anew the attention of English
physicians to the nervous system, and was rewarded by the later
discovery of reflex action or reflex phenomena, communicated to the
Royal Society in 1863 by Marshall Hall. Both discoveries were important,
and both were duly rewarded by yet others.
Benjamin Travers (1783-1858) seems to have been greatly influenced by
the first of these discoveries, and led thereby to pay special attention
to what he termed "constitutional irritation"; his studies on this
subject are often quoted to-day, and are well worthy of perusal; he
understood by this term a process (in strong contrast with inflammation)
which subsides without hyperæmia and without plastic exudate, but which,
on the other hand, may occasion liquid products and result in neoplasms.
Contemporaries of Travers were: Abram Colles; John Cheyne (1777-1830),
of Dublin, who wrote on _Diseases of Children_ and described
"Cheyne-Stokes respiration." William Stokes (1804-1878), also of Dublin,
who distinguished himself in 1857 by a great work, entitled _A Treatise
on the Diagnosis and Treatment of Diseases of the Chest_; Robert Graves
(1797-1853), Professor of Medicine in the King's and Queen's College,
Dublin, who published clinical lectures of his own, besides many
clinical reports in connection with Stokes. Graves was one of the
first to oppose the "absolute diet" of the earlier physicians in the
management of febrile maladies, and requested that his epitaph should
have but one line--"He fed fevers!"
"The School of Natural Philosophy" was the title applied to a system
which, in Germany, ran parallel with that of Broussais, being the
legitimate outcome of the medical{249} philosophy of the eighteenth
century which had originated there, and also a revival of opposition
thereto on the side of realism. It led into speculative extremes, which
finally sobered down, because of the meaningless scholastic phrases
often introduced, and thus broke a path for the subsequent enthusiasm
in behalf of French positivism in medicine. Those who constituted this
school were, for the most part, men of importance, but were followed
by a number of imbecile representatives. Use was made of the abstract
doctrine of the philosophy of identity and the imponderables, such as
electricity, mechanical forces, and magnetism, contrasted with which
were the dimensions of matter and certain qualities, like sensibility,
irritability, etc. Perhaps the greatest influence of this teaching was
in the department of embryology and physiology, where Johannes Müller
displayed his remarkable activity. Among the most distinguished
representatives of the natural-philosophy school was Oken (1779-1851),
of Bavaria, who subsequently taught in Munich, Jena, and Zürich, and
published a large work on natural history, which did much for the
popularization of this science; he explained that the skull is made up
from a series of vertebræ; also discovered the Wolffian bodies, and was
such a power in his way that Agassiz characterized him not only as "a
master in the art of teaching," but as "a courageous and ruling spirit."
Others of this school were: von Walther (1782-1849), eminent as a
surgeon; Dollinger (1770-1841), of Bamberg, the distinguished leader
of the Old Catholics; Reil and Procliaska, anatomists; Troxler and
Schelling, philosophers and anatomists; Treviranus, the microscopist;
Malfatti, Kilian, Spindler; Schmidt, of Vienna; and others too numerous
to mention.
As a successor to the School of Natural Philosophy came the School
of Natural History (1831-1850). which made important concessions to
realism; its most prominent members were from South Germany. This school
was based{250} partially upon the philosophy of Nature, and expired
almost suddenly. One of its most eminent exponents was Krukenberg,
whose therapeutic creed was that "Physicians should be filled with
pious reverence toward Nature; the organism is a whole, and must be
contemplated in this sense; medical art is, undoubtedly, capable of
decisive action, but let us not mistake that in many cases its activity
is quite superfluous, in very many null and inadequate, and in many
injurious." This school was the expression of the turn medicine was
compelled to take in order to escape the after-effects of the one-sided,
ideal, systematizing tendency of the eighteenth century (whose final
outcome was natural philosophy), and to square itself with the realism
and positivism of the nineteenth.
Schonlein (1763-1874), of Bamberg, outlined a system that taught
pathological and anatomical revelations as concrete expressions of the
independent entity disease, whose relation to the organism is as that
of a parasite sojourning temporarily in it; he also constructed a
classification of diseases, something after the manner of the botanical
classification of de Candolle. One of his best-known pupils was Canstadt
(1807-1850), whose _Jahresbericht_ has preserved his name. Siebert,
of Jena, famous as a diagnostician, and Haeser, the medical historian,
belonged to this school.
An offshoot of the French school of pathological anatomy and diagnosis
was the so-called New Vienna School, which aided the French system in
obtaining high recognition in German medicine, and gained its first
influence from the labors of Wünderlich (1815-1857); next to whom should
be mentioned Baron von Rokitansky (1804-1878),--a Bohemian,--one of the
most famous men in modern times, and who exercised a profound influence,
even in foreign countries,--particularly in Italy and Russia. Von
Rokitansky worked for a long time in miserable quarters in Vienna, but
finally a magnificent building was{251} specially erected for him.
He was loaded with honors, and took his seat in the Austrian House of
Deputies. Two sons are well known in medicine to-day, and two more
have achieved reputation as singers,--a circumstance which the father
embodied in the _bon mot_ that "two of his sons howled and two of
them healed." He transplanted into Vienna the tendency of the earliest
pathologico-anatomical school, which captivated all by its novelty and
interest, and in the post-mortem room and the clinical-lecture room he
converted medicine in Germany to the realism of the nineteenth century.
He was, indeed, the Van Swieten of his time in his influence upon
educational affairs. His works are distinguished by simplicity,
clearness, and logical order. He performed more than thirty thousand
autopsies; for fourteen years he studied the defects of the septum of
the heart and the comparative anatomy of the uterus and genito-urinary
organs, yet paid little attention to the microscope or to applied
medicine. He was a pathologist, pure and simple.
A friend and co-laborer,--Skoda (1803-1881),--also a Bohemian, was
little, if any, less famous. In 1839 he gave to the world his famous
work on _Auscultation and Percussion_; in 1847 became professor at
Prague, and was the first man to lecture in German. In spite of his
bachelor peculiarities, his taciturnity, and his heedlessness, he was
very popular, and left a fortune,--quite in contrast to Rokitansky,
who died poor. His scientific merit was based upon the fact that he
overthrew the specific and pathognomonic arrangement of sounds, as
taught by the French, and substituted therefor a category, based upon
the physical constitution and shape of organs and tissues. He endeavored
to develop a strictly scientific system of physics out of the empirical
French doctrine of physical signs, and in his work on _Physical
Diagnosis_ he displayed an independent spirit, though as one who had
received his impulse from France. He was the first in Germany to insist
upon the merits{252} of Avenbrugger, and was the leading diagnostician
of his time of the new Vienna school. Skoda was the first for whom was
created, in Vienna, a specialty after the French model,--that is, a
special division for patients suffering from thoracic diseases. Great
as he was, we must yet lay it up against him that through his
influence,--first in Vienna and afterward throughout Germany,--practical
medicine degenerated into simple diagnosis, and that, by his
observations on the natural course of disease, undisturbed by
therapeutics, he became the founder and exponent of expectant or
nihilistic therapeutics,--the harbinger of a very cheerless period in
the history of medicine.