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:—