Our generation, in this no more self-concentrated than many another,
has prided itself so much on the progress it has achieved in science
that it has in its interest in the insistent present rather neglected
the claims of the history of science. There has been the feeling that
our contemporaries and immediate predecessors have accomplished so
much as to put us far beyond the past and its workers, so that it
would seem almost a waste of time to rehearse the crude notions with
which they occupied themselves. In no one of the sciences is this
truer than in medicine. Yet it seems likely that no more chastening
influence on the zeal for the novel in science, which so often has led
this generation astray, could possibly be exerted than that which will
surely follow from adequate knowledge of scientific history. In
medicine there is no doubt at all that an intimate acquaintance with
the work of the great medical men of the past would save many a
useless investigation into problems that have already been thoroughly
investigated, or at least would help modern workers to begin at a
place much farther on in their researches than is often the custom.
There are other reasons why the knowledge of the history of medicine
cannot but prove of great service to the present generation. We are
entering upon a time when original research as the main business of
selected lives, in contra-distinction to the few hours a day or even a
week that the medical practitioners of a few generations ago could
steal from their busy lives, is becoming more and more the rule. A
consideration then of the methods by which advances in {14} medicine
were made in the past, of the character of the men to whom we owe the
ground-breaking discoveries, of the way in which such discoveries were
accepted or rather rejected by contemporaries, for rejection was
almost the rule, will serve as a mirror for reflections that will
surely be helpful in this day of great institutions of research. It
must not be forgotten, however, that only too often in the past it is
in the large institutions that routine work has been done, while the
occasional genius has sprung up in circumstances that seemed quite
unlikely to be the fostering mother of originality, and there has
taken for the world the precious step into the unknown which
represents a new departure in medical science.
Prof. Osier's declaration that the world's best work was mainly done
by young men was not well received, but no one knew better than he
that this is the most salient fact in the history of medical progress.
There is practically not a single great discovery in medicine that was
not made by a young man under thirty-five. As a rule, indeed, the new
departures in medicine came from men who were well under thirty, some
of them in fact only at the beginning of their third decade of life.
Morgagni's great germinal idea, which made him the father of modern
pathology, came to him when he was a student scarcely more than
twenty. He then began to take notes on all the morbid appearances that
he found in bodies, recognizing very clearly that he must trace out
not only the main cause of the disease, but also the subsidiary
pathological factors that were at work in the production of the
various symptoms of the special case as he had studied it clinically.
This idea is so obvious now as to seem impossible to be missed; yet
scarcely a century ago it constituted the foundation-stone of modern
pathology.
{15}
Auenbrugger, who laid the foundation of modern physical diagnosis by
his observations upon percussion, began the work when he was under
twenty-five, at the Spanish Hospital in Vienna, and carried it out to
a completely successful issue absolutely without any encouragement
from the great masters of the Vienna school. As a matter of fact, they
rather pooh-poohed the idea that this foolish drumming, as one of them
is said to have termed it, could ever amount to anything in enabling
physicians to recognize pathological conditions within the chest. For
twenty-five years after the publication of his little book,
Auenbrugger's discovery attracted no attention. Laennec, who followed
Auenbrugger in the development of physical diagnosis, set himself the
much harder problem of constructing a system of auscultation when he
was in his early twenties, studied the subject for twelve years and
then published the book on it when he was as yet scarcely thirty-five.
He accomplished the revolution in medicine that is due to him, though
he was never strong and died at the early age of forty-six.
These are only striking examples which show what the young man has
accomplished. The same thing was true in other countries. Corrigan
wrote his famous essay on the "Permanent Patency of the Aortic Valve"
when he was only twenty-nine years of age, and the work for it had
been done during the preceding three years, at a hospital in which
there were beds for only six medical patients. Trousseau declared this
the greatest medical work, from a clinical standpoint, that had ever
been accomplished, and hailed young Corrigan as one of the masters of
clinical medicine. He maintained that disease of the aortic valve
should receive the name Corrigan's disease. Stokes, Corrigan's
contemporary and friend in Dublin, wrote his little book on the
stethoscope when he was not yet twenty-one, and at a time when the
{16} distinguished clinicians of the day were all asking if these
young men expected the old physicians to carry this toy about with
them and use it for any serious purpose. Graves, also of the Irish
school of medicine, made some of the clinical observations on which
his reputation is founded, including a short description of
characteristic cases of the affection that still bears his name, when
he was well under thirty-five.
Further examples might well be cited, but they will be met with in the
course of this book. The history of most of the sciences is like
medicine in this respect, and it is to young men that the great
ground-breaking ideas come. How true this is in biology can be noted
even from the lives of the physician-biologists that are included in
this volume. Theodore Schwann, the father of the cell doctrine, did
all the work for which he deserves the name of founder of modern
biology when he was scarcely more than thirty. Part of the best of it
was accomplished before he was twenty-five. Claude Bernard had shown
the precious metal of his originality before he was far on in his
twenties. Pasteur, the most original genius of them all, began his
work when he was scarcely more than a boy, and though every five years
of a long life was filled with original observations of the most
precious kind, his genius had received the bent which it was to follow
from the successful accomplishment of observations during his third
and fourth decades.
In these modern days, when the education of the young man for medicine
is not supposed to be finished until he is nearly thirty, it is easy
to understand that perhaps the precious years in which originality
might manifest itself are already past before he gets out of the
swaddling clothes of enforced instruction from others. As has been
very well said, it is possible to smother whatever of the
investigating {17} spirit and original initiative there may be in a
young man by attempting to teach him too much of what the present
generation knows. Unfortunately, it happens only too often even in
this wise generation of ours that it is not so much the ignorance of
mankind that makes them ridiculous as the knowing so many things that
are not so. The number of things that the young man has to learn and
that are taught him, often with the assurance that they are almost
gospel truth in medicine, and yet that he finds before he has been
long out of school or indeed sometimes before he leaves school, to be
at best opinions, is entirely too great. The saving grace for the
correction of this constantly recurring fault in education is
undoubtedly a knowledge of the development of medicine in the past and
a recognition of the fact that the accepted truth of any one
generation proves after all often enough to be only apparent.
After the false impression that it is to older men we owe progress in
medicine, perhaps the most universally accepted apparent truth is that
the investigating spirit is communicable, and that the pupils of a
great master may be expected to carry on his work and add almost as
much as he has done to the great body of medical knowledge during the
generation immediately following his work. It would naturally be
expected, for instance, that Morgagni having laid the foundations of
modern pathology and connected pathological observation with clinical
observation the great development in modern diagnosis would have come
down in Italy. This was not true, however. The next great step
connecting bedside observations with postmortem appearances was made
by Auenbrugger in Vienna in distant Austria. Auenbrugger's work having
been successfully accomplished it might reasonably be supposed that he
himself or some of those who had seen his successful diagnosis of
thoracic conditions {18} by percussion would take the next step and
discover auscultation. This, however, did not happen in Germany, but
in France. It is true that Laennec's work was done under the influence
of Corvisart, who revived Auenbrugger's work and gave it to the world
once more, and that in a way, therefore, Laennec may be considered an
indirect pupil of Auenbrugger; but the fact stands that the two
discoveries of percussion and auscultation were made at an interval of
nearly fifty years and at a distance of more than a thousand miles
from each other.
On the other hand, Laennec having solved the wonderful mystery of the
significance of the sounds within the chest as far as they concern
pulmonary diseases might have been expected to do as much also for
heart disease. Even genius, however, is able it seems to take only one
step into the unknown. Auenbrugger did not discover auscultation,
though it apparently lay so near at hand. Laennec did not solve the
riddle of heart murmurs, though for most of us they do not present any
more difficulty than the wonderfully successful recognition of the
significance of _rales_ of various kinds in which Laennec never
failed. The problem of heart diagnosis was to be solved by Corrigan
and the Irish school of medicine hundreds of miles away, though they
were doing their work about the same time that Laennec was making his
observations in Paris. Curiously enough just during the same decade
Richard Bright, in England, was studying out the problem of kidney
disease, and, as a young man, teaching the world nearly as much about
it as it has ever learned, though, in the seventy-five years that have
passed since, so much of investigation has been devoted to the
subject.
No one nation can claim the palm of superiority in the matter of
original investigation. The spirit of genius breathes where it will,
and unfortunately it is incommunicable. {19} Students may think they
absorb all that the master has to give them, and that they are ready
to go on with his work where he left it. They do actually seem to
their own generation to make distinct progress in medicine. When the
situation is analyzed fifty or a hundred years afterward, however, it
is found that only the master's work counts, and that much of what
seems to be advance was only a skirmishing here and there along the
lines laid down by him, but without any material progress for true
science.
This same peculiarity is manifest, also, not only in the history of
sciences allied to medicine, but in that of all the physical sciences.
A very striking example is to be found in the story of the rise of
electrical science, which took place almost at the same period as that
which saw the rise of clinical medicine. Origins in electricity date
from Franklin's work here in America and Galvani and Volta's
observations in Italy. It might quite naturally have been expected
that the further progress of electrical science would come in either
of these countries. The next great discoveries, however, were
separated by long distances and a considerable interval of time. After
Volta came the demonstration by Oersted, in Denmark, of the identity
of magnetism with electricity. It was not in Denmark, however, that
the problems connected with this principle were worked out, but by
Ampere in France. In the mean time, Cavendish and Faraday, working
quite independently of their Continental colleagues, were making
significant strides in electricity in England.
When the problem of the resistance to the passage of electricity in a
conductor was to be studied, another nation supplied the man for the
opportunity. Ohm had never been in contact with any of these great
contemporaries and did his work entirely by himself. It is a curious
confirmation of what we have stated with regard to the young man in
{20} medicine and the making of great discoveries that practically all
these founders in electricity were under thirty-five when their best
original work was accomplished.
From a series of biographies of great medical discoverers, certain
salient traits stand out so as to attract attention even from the
cursory reader. The essence of significant work in medicine consists
of observation, not theory. It has always been the custom to theorize
much and unfortunately to observe but little. Long ago John Ruskin
said that the hardest thing in the world for a man to do is to see
something and to tell it simply as he saw it. Certainly this has been
true in medicine. The men who have had eyes, and have used them, have
impressed their names upon the history of progressive scientific
advance. The theorists have never contributed anything worth while to
the body of medical truth.
While this is readily acknowledged by every generation, with regard to
the past, it is curious to note how different is the appreciation of
each generation for the theorist as opposed to the observer. Medical
theorists have always been honored by their contemporaries unless
their theories were utterly outlandish, and even then they have had
many disciples, and have seldom been without honor and never, with
sorrow for the foolishness of men be it said, without emolument. The
observer, however, has but rarely been in favor with his
contemporaries. Not infrequently the observation that he made appeared
to be so obvious that his fellows could not think that it represented
a great truth. As a consequence they have usually derided him for
attempting to make them see a significance in his observation that
they could not think was there. Huxley once stated the phases through
which a new scientific truth ordinarily passes. At first it is said to
be trivial and insignificant, then as it attracts more attention {21}
it is declared to be in contradiction with hitherto known truth.
Finally it is declared to be after all only in other terms what the
world has always believed in the matter. Certainly through these
stages all the great discoveries in medicine have gone. So true is
this, that if what seems to be a new truth in medicine is accepted at
once, and willingly, there is more than a suspicion that it is not
really a new discovery but only a modification of something hitherto
well known.
All the great discoverers in medicine have practically without
exception met, if not with opposition, surely with neglect of their
work. We smile complacently now at the generation that considered the
stethoscope a toy, and asked derisively if they should be expected to
carry it about with them. The next generation, however, having grown
accustomed to the stethoscope, refused quite as inconsequentially to
have anything to do with the thermometer. They refused to carry these
glass things around with them in order to test the fever that patients
might have, since they claimed they were able to accomplish this
purpose quite as well by means of their educated touch. The generation
of medical men is not yet passed who refused to credit the thought
that the diagnosis of diphtheria would ever be made only by the
microscope and culture methods, and who considered that they could
tell very well what was diphtheria, and what not, from the appearance
of the throat.
Of course similar opposition was the fate meted out to every
distinguished scientific discoverer, and so I suppose medical men
cannot complain. His contemporaries said of Galvani that he had made
of himself a dancing master for frogs, because he continued his
observations on the legs of these animals in order to solve the
problems of animal {22} electricity. Pasteur's demonstration that
there was no such thing as spontaneous generation, served at first
only to bring down on his devoted head the aspersions of most of the
distinguished scientific men in Europe. When that genius, the
physician Robert Mayer, discovered the conservation of energy as the
result of his acute observation, that blood drawn by venesection in
the tropics was redder than that drawn in colder climates, he found
that scientific circles were not only not ready to accept his
demonstration, but that he was looked upon as a visionary, somewhat as
one who thought that he had solved the problem of squaring the circle
or the endless puzzle of perpetual motion.
Fortunately these men have as a rule had a physical and mental force
that enabled them to go on in spite of the opposition or derision of
their contemporaries. It is rather a curious fact that most of the
great medical discoverers were born in the country and were as a rule
the sons of rather poor parents. Many of them were so situated that
they had to begin to make their own livelihood to some extent at least
at the beginning of their third decade of life. Far from proving a
hindrance to their original work, this necessity seems rather to have
been one of the sources of inspiration that spurred them on to
successful efforts in their investigations.
Most of them were what would be called handy men, in the sense that
they could use their hands to work out their ideas mechanically. This
was typically true of Galvani, who had to construct his own first
electrical instruments, and of Laennec, who took pride in making his
own stethoscopes. So many of them made by his own hands are still
extant, that a number of museums have the opportunity to hold
specimens of his handiwork. Auenbrugger and Johann Mueller and Pasteur
are further examples of this same handiness. Claude {23} Bernard
exhibited this quality very early in life and continued to exercise it
all during his career.
Nor was their ingenuity limited to material things. Many of them were
interested in literary and artistic work of various kinds. Morgagni
was considered a literary light in his generation. Auenbrugger
composed a musical comedy which had a distinct success, even in music
loving Vienna. The Empress Maria Theresa said that she supposed he
would now continue to write musical comedies; but Auenbrugger replied,
with more candor than gallantry, that he had something better to do.
Claude Bernard composed a play that shows distinct evidence of
literary talent. It seems fortunate indeed that he was diverted from
his original intention of following literature as a career, and took
up medicine. Many of the others, as, for instance, Graves and Stokes,
were excellent judges of art, critics of real knowledge and genuine
appreciation; and indeed it may be said that none of them was ever so
absorbed in his vocation of medicine as not to have much more than a
passing interest in some of the great phases of intellectual activity
quite apart from his professional work, or from scientific knowledge:
an avocation to which he turned for the only true recreation of mind
there is--a change of work.
This seems all the more worth while calling attention to in our
strenuous age, because it is sometimes considered a mistake for a
physician to show that he is interested in intellectual pursuits of
any kind apart from his professional work. It is supposed that no one
is capable of dividing his attention in this way and yet do justice to
his profession and his patients. As a matter of fact it has well been
said that no really great physician has ever been a narrow specialist
in the sense that he knew only medicine well; there was always at
least one other department of intellectual {24} attainment with which
he had made himself so familiar as to be an authority in it. It is not
the lopsided who make great athletes, and it is not the one-sided man
who succeeds in doing really great work. Practically all the great
physicians have had favorite hobbies to which they have turned for
relaxation, for surely no one understands better than physicians that
recreation consists not in that impossibility, the doing of nothing,
but in resting the mind by doing something quite different from what
it has been engaged at before.
There is another phase of the lives of these great men of medicine
that is so different from what is ordinarily thought to be the rule
with physicians, that it seems worth while emphasizing at the end of
this introduction. All these great discoverers have been men of
constructive imagination, men who might have been distinguished
litterateurs very probably, had they applied themselves in that field.
All of them have had too much imagination to be materialists, that is,
to consider that they could know nothing except what they learned from
the matter with which their studies were taken up. All these great
discoverers in medicine have been simple, sincere, faithful believers,
ready to express their trust in an overruling Providence, and in a
hereafter that they knew only by faith, it is true, but which was for
that reason none the less distinctly recognized. While it is usually
considered that medicine leads men's minds away from orthodox thinking
in the great matter of the relationship of the creature to the
Creator, all these men have been not only ready to acknowledge their
personal obligations to Him, but have furnished exemplary models of
what the recognition of such obligations can make of human lives.
There is an old proverb that runs _Ubi tres medici ibi duo
athei_,--where there are three physicians there are at least two
atheists. This has made many a heartache for fond mothers {25} when
they found their sons had determined on becoming physicians. If the
present series of sketches is to be taken as any argument, however, it
is only the small minds among physicians who become atheists. They are
not able to see their way clearly from the material they work in to
the higher things that prove a source of strength and consolation to
the great minds while they are busy making medicine for their own and
subsequent generations. Certainly no more thoroughly representative
group of the makers of nineteenth century clinical medicine could have
been selected than those whose sketches are here given. They are from
all the nations who have contributed materially to modern medical
advance, yet all of them were deeply religious men. There is another
and equally important point with regard to them. It is their relations
to their fellows. Without exception they were men beloved by those
around them for their unselfish devotion not only to science, but also
to their brother men. In the midst of their occupations the thought
that has been the profoundest consolation for all of them without
exception has been that they were accomplishing something by which
their fellow-men would be saved suffering and by which human life
would be made more happy. A study of their careers cannot fail to show
the young physician the ideals he must cherish if he would have real
and not apparent success and happiness in life.
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