carbonic acid increased during physical work, he drew the
conclusion that men who are obliged to perform severe labor
stand in need of a more abundant nourishment than is required by
ordinary workmen in order to recover the carbon which had been
expended in their severe labors; and he immediately urged that
an effort be made to furnish the working class with better
nourishment. The public functionary—he wrote at the end of his
treatise on respiration (published in 1789)—is not the only
individual who works for his country. The man of science, he
added, is also fulfilling his patriotic duty when he teaches, by
his investigations, how the misery which exists in the world may
be alleviated. And if he accomplishes nothing more than to add a
few years, or even only a few days, to the average duration of
the life of man, he still may with justice claim the right to be
given the glorious title of “benefactor of humanity.” (J.
Rosenthal.)
France, at the time when Lavoisier wrote his treatise on respiration,
was in the throes of a great revolution, out of which came the Republic.
But this republic showed no gratitude to Lavoisier for the services
which he had rendered to his country; for, on the 8th of May, 1794, it
executed him without any specific charge having been brought against
him, simply because he had held the hated office of Government Collector
of Taxes. When one of Lavoisier’s personal friends, just before the
prisoner was removed to the guillotine, called the judge’s attention to
his scientific merits, this functionary replied: “We no longer have any
use for men of science.”
Before closing this necessarily brief and somewhat superficial account
of the work accomplished by the great French chemist, Lavoisier, I must
beg permission to refer very briefly to the views which he entertained
on the subject of heat-production. The chief significance of these
studies of the fundamental phenomena of animal life is this: they
afforded for the first time a solid basis for the theory of
heat-production in living animals. This theory, formulated in greater
detail, may be stated in the following terms, which I copy in all
important respects from the memoir published by Rosenthal:—The tissues
which compose the body of the animal, and which are themselves composed
of carbon, hydrogen, oxygen and azote, possess the power of assimilating
a further quantity of oxygen, a quantity somewhat greater than that
which they already contain; and, by reason of this fact, they are able,
as combustion advances, to accomplish two things—_first_, to combine
with the surplus oxygen furnished by respiration; and, _second_, to form
carbonic acid, water and certain azotic matters that are discharged from
the body. It is this process of combustion which gives rise to heat in
the animal’s body and in addition is associated with a certain loss in
its weight. This loss, however, is limited, for the furnishing of new
elements is going on simultaneously with the casting off of the old,
thus restricting the loss of weight.
It is to Lavoisier that the imperishable honor belongs of
formulating the chemical theory of respiration, and of thereby
founding a new era in physiology—the modern era. (Claude
Bernard.)
Too much stress cannot be laid upon the truth of this declaration made
by Claude Bernard, the great modern authority in physiology, concerning
this, the most important advance secured for the science of medicine
during the eighteenth century. But alas! many years had to elapse before
the physiologists of that period were able to appreciate the importance
of Lavoisier’s discovery. Very soon after the announcement of this new
theory the leading chemists of Europe returned almost as a single body
to the old phlogiston doctrine.
Lavoisier’s portrait is shown in the frontispiece of the present volume.
------------------------------------------------------------------------
BOOK VII
MEDICINE IN ENGLAND
------------------------------------------------------------------------
CHAPTER XIV
ENGLISH LEADERS IN MEDICINE AND SURGERY DURING THE EIGHTEENTH AND EARLY
NINETEENTH CENTURIES
FIRST GROUP: FOTHERGILL, ABERNETHY, JAMES AND JOHN DOUGLASS, PERCIVAL
POTT AND SIR ASTLEY COOPER
The desire to start the science of medicine on a new course of growth
seemed to develop at the same time in England that it did on the
continent of Europe—that is, during the first half of the eighteenth
century. The prolonged wars had for a long period of time turned men’s
thoughts entirely aside from scientific inquiries of any kind; but, the
moment the outlook seemed bright for a renewal of peaceful relations
between the warring nations, there arose, among the men of the different
sciences, a strong impulse to resume their normal labors in the various
fields of research. Some of the evidences of the truth of this statement
have been furnished in the earlier pages of the present work, and
already, during the period which we have now reached in this brief
historical sketch, the proofs are not lacking that the first fruits of
this new harvest are before us and that we may safely form some idea as
to their quality.
Of those who should be classed as physicians Fothergill and Abernethy
certainly deserve to be named first. The latter, I am well aware, is
usually classed among the surgeons, and he certainly deserves to be so
classed; but he seems to me to occupy an equally high position as a
medical philosopher.
* * * * *
JOHN FOTHERGILL, one of the most distinguished English physicians of the
eighteenth century, was born at Carr End, Yorkshire, March 8, 1712. He
received his early medical training at Edinburgh, under the teaching of
Monro, Alston, Sinclair and Plummer, all three of whom had been pupils
of Boerhaave, at Leyden, Holland, and was given the degree of Doctor of
Medicine by the University of Edinburgh, in 1736. During the years
immediately following this event, he visited in turn the principal
medical schools of Holland, Germany and France, and then settled
definitively in London. In 1746 he met with marked success in the
treatment of an epidemic of “putrid sore-throat,” which was raging in
England at that period, and which showed a tendency to develop into a
gangrenous condition. The physicians of that day employed largely
purgatives and bloodletting in their treatment of this disease, but
Fothergill depended mainly on the cautious use of emetics, mineral
acids, bitters and light wines, the favorite practice among Spanish
physicians. The success which attended his plan of treatment brought
Fothergill a great increase in reputation as well as in fortune; and
thus he was able, in 1762, to purchase at Upton, in Essex, a large tract
of land which he developed into a splendid garden, where exotic plants
of all sorts were cultivated. He also gathered at this place a very
large collection of zoölogical and mineralogical specimens, which in the
course of time became one of the most complete that was to be found
anywhere in England. From 1765 onward, in order to relieve his health
from the almost constant strain of so much business, he adopted the
habit of absenting himself from London, regularly every year, for a
period of two months; and with this object in view he chose for his
retreat an attractive residence near Carr End, the town in which he was
born. He died on December 26, 1780, at the age of sixty-nine, and
bequeathed his entire fortune—aside from a modest stipend which he left
to his sister—to the poor. The inscription written on his tombstone
reads as follows: “Here lies Doctor Fothergill, who spent two-hundred
thousand guineas for the relief of those in distress.” “I do not
believe,” said the immortal Franklin, “that there ever existed a man who
was better entitled to receive the esteem and veneration of all mankind
than was Fothergill.” (Vicq-d’Azyr, in the Report of the Société Royale,
of Paris.)
Fothergill did not write a single large treatise, but he published, in
the Philosophic Transactions and elsewhere, no fewer than forty-one
short memoirs on a great variety of topics.
* * * * *
JOHN ABERNETHY was born of Irish parents about the year 1764. In 1787 he
was appointed Assistant Surgeon at St. Bartholomew’s Hospital, London,
and was promoted to the position of Surgeon in 1815. From that date to
1827 he served the hospital with great distinction, attaining wide
celebrity as a daring and skilful operator and also as a lecturer of
great power. In his lectures he laid much stress upon two principles:
First, that local diseases had a constitutional origin; and, second,
that this origin could generally be traced to disorders of the digestive
system.
George G. Sigmond, M.D., contributed to the _London Lancet_, of November
11, 1837, a brief but most satisfactory biographic sketch of Abernethy,
and from this I copy such portions of the text as are likely to convey
to my readers a more perfect picture of this great physician and surgeon
than I could possibly provide by resorting to a mere compilation of the
facts. Here is his account:—
Few individuals who have adorned our profession, possessed a
more clear and accurate knowledge of the principles of our
science than Mr. Abernethy, and no one ever explained them with
greater simplicity, or with less of the entanglement of
barbarous and uncouth names; he was, to the highest degree,
plain, and, therefore, thoroughly intelligible. He had none of
the deep learning and research of his two contemporaries, Dr.
Young and Dr. Mason Good, but he was infinitely their superior
in the explanation of his views, for he did not, as they have
done, encumber his writings with the hard and unintelligible
phrases of the Greeks, nor did he attempt to establish systems
founded upon artificial arrangements. He watched the powers of
Nature, he recalled the surgeon to the path of physic, he showed
to him the effect of local disorders upon the constitution, and
the reciprocal operation of constitutional disorders upon local
diseases; he pointed out that the digestive organs may be
affected by local disorder, and that upon the due functioning of
these organs the health of man mainly depends. His object was to
excite, by means of medicine, a more copious and healthy
secretion.... To the knowledge of the necessity of great
attention to the excretions, may chiefly be attributed the
increased longevity of man, and his freedom from many of the
diseases of former days.
Mr. Abernethy’s mode of pursuing his mercurial course [calomel
and blue pill] was cautious and regular. He prescribed only
small doses, taking care that the error so often fallen into, of
increasing the quantity, when any benefit was perceptible,
should be avoided.
His death occurred in 1831.
* * * * *
JAMES DOUGLASS, who was born in Scotland in 1675, died in London in
1742. During his residence in the English metropolis he practiced
midwifery and taught anatomy. He was one of those exceptional men (like
John Hunter, for example) who were able both to practice the art of
medicine and to do a great deal of research work. Among other things he
interested himself in the history of medicine and also took high rank as
a botanist. The following list of the titles of some of his more
important contributions to medical literature illustrate his great
versatility:—“_Myographiae comparatae Specimen_,” or “a comparative
description of all the muscles in a man and in a quadruped,” London,
1707; “Description of an Instrument for Extracting Teeth,” in the
Philosophical Transactions, Vol. V.; “History of the Lateral Operation
for Extracting the Stone by making a Wound near the Great Protuberance
of the Os Ischii,” London, 1726; “A Description of the Peritonaeum and
of that part of the membrana cellularis which lies on its outside, with
an account of the true situation of the abdominal viscera,” London,
1730; “Appendix to the History of the Lateral Operation for the Stone,”
London, 1731.
* * * * *
JOHN DOUGLASS, a younger brother of the preceding, also became
celebrated as a surgeon. He lived in London, was connected with the
Westminster Hospital, and attained special distinction through his
having revived—after the lapse of nearly two centuries—the suprapubic
operation for stone in the bladder (Pierre Franco’s “_haut appareil_”).
His first operation of this nature was performed in 1719. John Douglass
died in 1759.
His best-known published treatise bears the title: “Lithotomia
Douglassiana,” or a “New Method,” etc., London, 1719.
* * * * *
PERCIVAL POTT was born at London on December 26, 1713. Four years later
his father died, leaving his widow and son in possession of very scanty
means. In 1729, when sixteen years of age, Percival was bound an
apprentice to Mr. Nourse, one of the younger surgeons of St.
Bartholomew’s Hospital and a lecturer on anatomy in a private medical
school which he established in the heart of London. As it was Pott’s
duty to prepare the subjects for demonstration he thus enjoyed unusual
opportunities for grounding himself well in the knowledge of anatomy. At
the same time, through his relationship with Mr. Nourse, he found
unlimited opportunities in the hospital for witnessing surgical
operations and for becoming thoroughly familiar with disease in its
different forms. English surgery at this early period was very crude and
unscientific, and—as will be readily understood—most painful. In his
study of different surgical affections Pott followed the plan advocated
by Lord Bacon, viz., to take up one subject or one region of the body at
a time and to devote all his attention to that particular subject or
region until he had exhausted all available sources of information
relating to the subject.
In 1736, having finished his apprenticeship, he began at once making the
necessary preparations for entering upon the practice of his profession.
For his residence and place of business he rented an attractive-looking
house in a good part of London, and took with him his mother and her
daughter by her first husband. Thanks to the brilliancy of his talents,
to an untiring industry and to an attractive personality and agreeable
manners, he soon won for himself a considerable clientèle; while at the
same time acquiring many friends among the most influential members of
his own profession as well as among the élite of London society in
general. These early friendships, says his biographer, proved to be
permanent; indeed, it may be claimed that few physicians acquired and
retained through life more firm or more respectable friends.
In 1744 Pott was elected an Assistant Surgeon, and in 1749 one of the
Principal Surgeons, of St. Bartholomew’s Hospital. From 1744 to 1787 he
was unremitting in the surgical work which he performed in this
institution. One of the most important services which he rendered to the
science of medicine may justly be said to consist in the additions which
he made to the scanty knowledge of that period concerning the nature and
proper treatment of that disease of the spinal column which for many
years has borne the name—in honor of this distinguished surgeon—of
“Pott’s disease of the spine.” His first published memoir concerning the
disease was published in 1779; but it was, as might be expected, only a
preliminary sketch of the subject. Four years later he gave a complete
description of this affection, the importance of which had for such a
long period not been properly appreciated. In 1786 he received from the
Royal College of Surgeons in Edinburgh a diploma accompanied by a letter
expressive of the high degree of appreciation in which he was held by
that institution. This honor was greatly enhanced by the fact that Pott
was the first person on whom it had been conferred.
Pott’s biographer (Sir James Earle, Surgeon Extraordinary to the King)
places the following estimate upon his character and upon his
attainments as a surgeon:—
He was the most eminent of his time as a writer, as a teacher,
and as a practitioner in surgery; and his merits in each of
these characters were most extensive. Possessed with an
enthusiastic love of excelling, without which genius is inert,
he was not contented with any kind of mediocrity in himself.
As an author, his language is correct, strong and animated....
He introduces anatomy and physiology, whenever it is necessary,
to illustrate and distinguish diseases; but never confuses his
reader with uncertain hypotheses in pathology, founded on
physiological principles. He was of opinion, and it is the
opinion of Newton, that hypothesis has no place in any physical
science.... His remedies always strongly marked his intention;
they were decided and consistent; and he was the principal
author of that simplicity which distinguishes the present
practice from that of our ancestors....
As a teacher, he had acquired the faculty of speaking readily,
with great point and energy, of delivering the most prolix and
intricate sentences with incredible perspicuity and correctness,
and of enforcing what he said with a most harmonious and
expressive elocution....
As a practioner in surgery, we must apply to him all the
essential qualifications—sound judgment, cool determination and
great manual dexterity....
In the transaction of business there was a freedom and openness
in his manner, which evidently arose from a consciousness that
the opinion which he delivered was founded on experience....
This conduct in all situations was an appeal to the good sense
of mankind. Thus he acquired the universal confidence of the
profession; and, without any accidental or external help, he
raised himself to the greatest dignity which man can attain—the
first rank in a liberal profession.
Percival Pott wrote a treatise on the necessity of amputation in certain
cases, and in this he strongly refutes the opinion of a Prussian army
surgeon who maintained that in almost any case it was not necessary to
amputate. The title of the treatise in which this opinion is expressed
is “_De membrorum amputatione rarissime administranda, aut quasi
abroganda_.” Shortly afterward Dr. Tissot, of Lausanne, Switzerland,
spoke in even stronger terms against this surgical procedure, even going
so far (see his treatise entitled “_Sur l’inutilité de l’amputation des
membres_”) as to urge surgeons to abandon the “murderous and cruel
method of amputation”—Pott’s criticism of the views expressed by these
two writers is most charitable: “However, as we must suppose that the
doctrine which these gentlemen have promulgated arose from humane
motives, and upon a conviction of its being well founded, we must at
least applaud their intention, though we cannot approve their judgment.”
* * * * *
ASTLEY COOPER was born at Brooke, in Norfolk, England, August 23, 1768.
As a boy he was fond of all the sports that are commonly cultivated at
English schools, and even at that early age he manifested a bold and
enterprising spirit, and yet at the same time he was noted for his
social and friendly spirit. His biographer, Pettigrew, who witnessed
many of the operations which Sir Astley performed at Guy’s Hospital in
the earlier years of his career, speaks in strong terms concerning the
impression which he made upon the regular pupils and the casual
physicians who from time to time attended him on his rounds through the
hospital:—
I can never forget the enthusiasm with which he entered upon the
performance of any duty calculated to abridge human suffering.
This enthusiasm, by the generosity of his character, his
familiar manner, and the excellence of his temper, he imparted
to all around him—the pupils imbibed the same spirit; and the
extent of the obligations of the present and of after ages to
Sir Astley Cooper, in thus forming able and spirited surgeons,
can never be accurately estimated.
He was the idol of the Borough School—the pupils followed him in
troops, and, like to Linnaeus, who has been described as
proceeding upon his botanical excursions accompanied by hundreds
of students, so may Sir Astley be depicted traversing the wards
of the hospital with an equal number of pupils, listening with
almost breathless anxiety to catch the observations which fell
from his lips upon the several cases presented to his view. But,
on the days of operation, this feeling was wound up to the
highest pitch—the sight was altogether deeply interesting; the
large theatre of Guy’s crowded to the ceiling—the profound
silence obtained upon his entry—that person so manly and so
truly imposing—and the awful feeling connected with the
occasion—can never be forgotten by any of his pupils. The
elegance of his operation—without the slightest affectation—all
ease—all kindness to the patient, and equally solicitous that
nothing should be hidden from the observation of the
pupils—rapid in execution—masterly in manner—no hurry—no
disorder—the most trifling minutiae attended to—the dressings
generally applied by his own hand ... Sir Astley was, at that
time (about 1805–1810), decidedly one of the first operators of
the day, and this must be taken in its widest sense, for it is
intended to include the planning of the operation, the precision
and dexterity in the mode of its performance, and the readiness
with which all difficulties were met and overcome.
[Illustration:
SIR ASTLEY COOPER
(Copied from a print in the possession of the New York Academy of
Medicine.)
]
Among the contributions which Sir Astley made to the science of medicine
the following deserve to receive special mention:—In 1798 he published
the report of a remarkable case of strangulated hernia in which a part
of the abdominal viscera was protruded into the left cavity of the
chest, through an opening in the diaphragm. The viscera were much
displaced from their natural situation, and the great arch of the colon,
together with a large portion of the omentum, was pushed through the
aperture in the diaphragm. The existence of this opening, which
represented a congenital malformation, was first ascertained after
death. It seems almost needless to add that, even if this unusual
condition of the parts had been known during the patient’s lifetime, no
possible means of relief could have been afforded.
Another of Sir Astley’s contributions—one, namely, which he published in
1804—deals with the subject of inguinal hernia, a topic concerning which
very little was known before Cooper’s time. The Spanish surgeon,
Gimbernat, had—it is true—published at a still earlier date a masterly
description of the anatomy of the parts concerned in this form of
hernia, but the fact had been entirely forgotten until Sir Astley called
attention to its importance. Mr. Lawrence, the distinguished English
surgeon, makes the statement (1806) that “no complete description and
accurate delineation of even the common kinds of hernia, as the
inguinal, femoral, and umbilical, existed previously to the late
excellent works of Camper, Cooper, Scarpa, Hesselbach, Cloquet and
Langenbeck.”
In Vol. I. of the Transactions of the Medico-Chirurgical Society (1808)
will be found a report, by Sir Astley, of two cases of aneurism of the
carotid artery. Pettigrew says that the first of these two cases was
treated by ligature upon the vessel—the first of the kind on record, and
establishing a practice which has since been pursued and successfully
adopted. The second one of the two cases mentioned at the beginning of
this paragraph—also a case of aneurism of the carotid—was treated by
ligature and with a completely successful result. This patient lived
until 1821, at which time Sir Astley published an account of the
dissection made by him of the parts involved in the region of the
earlier aneurism.
Sir Astley Cooper is the first surgeon to whom we are indebted for the
performance of an operation designed to remedy in a measurable degree—in
a few cases even to cure—the malformation known as _Spina bifida_, a
condition which consists of a deficiency of the spinous processes of the
vertebrae by which the theca enclosing the spinal marrow distends and
protrudes to such a degree as to form a tumor, any opening into which
has been commonly considered as necessarily attended by fatal effects.
Sir Astley attributes the successful issue of the cases under his care
to the employment of needles, and not the lancet, to discharge the
fluid.
Many other instructive cases were reported by Sir Astley in later years,
but the lack of space does not permit me to mention them here. It is
enough for me to state that in his “Lectures on the Principles and
Practice of Surgery” (published by Mr. F. Tyrrell, Surgeon of St.
Thomas’s Hospital) very full details are furnished concerning all of Sir
Astley’s operative work.
Among the honors conferred upon this distinguished surgeon during the
later years of his life the following deserve to be mentioned: President
of the College of Surgeons in 1827; Surgeon to the King in 1828; and
Vice-President of the Royal Society in 1830. His income is said to have
risen in 1813 to the very large sum of £21,000 ($105,000). His death
occurred in 1841.
------------------------------------------------------------------------
CHAPTER XV
ENGLISH LEADERS IN MEDICINE AND SURGERY DURING THE EIGHTEENTH AND EARLY
NINETEENTH CENTURIES
SECOND GROUP: WILLIAM AND JOHN HUNTER AND SIR BENJAMIN BRODIE My
information concerning the Hunter Brothers is based upon data
which I found in Pettigrew’s “Medical Portrait Gallery,”
Parkinson’s “Hunterian Reminiscences,” and a few other
published documents.
WILLIAM HUNTER, the elder of the two brothers who attained such marked
distinction in the world of medicine during the eighteenth century, was
born in 1718 in the west of Scotland. During his early manhood he
devoted his attention to the study of theology at the College of
Glasgow; but, losing soon his interest in these studies, he turned his
attention to medicine, a branch of science which he found much more
congenial. His advance in this new field of labor was rapid, for already
at the age of twenty-eight he was invited by a society of naval surgeons
to deliver a course of lectures on operative surgery. Two years later
(in 1748) he became connected with the Middlesex Hospital and the
British Lying-in Hospital, and from that time forward his chief interest
was centred in obstetrics. Rising rapidly in public favor it was not
long before he acquired a large fortune. In 1764 he became Physician
Extraordinary to Queen Charlotte, and in 1768 was appointed Professor of
Anatomy in the Royal Academy.
His greatest work, which was begun in 1751 and published in 1783, bears
the title: “An Anatomical Description of the Human Gravid Uterus and its
Contents.” Pettigrew speaks of this work, which eventually comprised
thirty-four plates (drawn from Hunter’s dissections and engraved by some
of the best English engravers),
as one of the most splendid medical works ever published. It is
not, perhaps too much to say that the engravings have never been
surpassed.... A period of thirty years was necessary, to obtain
sufficient instances to develop all the changes occurring in the
human uterus during the progress of gestation.... The treatise
upon this subject was intended to be a separate production; but
Dr. Hunter did not live to publish it. It remained for his
nephew, Dr. Baillie, to submit this to the profession, which he
did in 1794, as an “Anatomical Description of the Gravid Uterus
and its Contents.”
One of Dr. Hunter’s cherished ideas was to establish in London an
anatomical school upon a most extensive scale; for, strange as it must
now appear, no regular courses of anatomy were given prior to 1746, and
as a consequence surgery and physiology made but slow advancement. As a
first step toward the realization of his pet scheme he submitted a
memorial to the Earl of Bute, the First Lord of the Treasury, setting
forth the great need of such a school, and furnishing with the memorial
a suitable plan for establishing a museum in which the necessary
instruction might be carried on. The memorial and accompanying plan were
submitted to the King, but the proposal eventually fell to the ground.
In view of the lack of interest manifested by the Government, Hunter
decided to devote his own fortune and the collections which he had
gathered up to that time to the establishment of the contemplated
school. Accordingly he purchased an extensive piece of property and
built upon it a large cabinet or institute in which every facility was
provided for anatomical work: laboratories, amphitheatre, etc. In his
will a provision was made that this institute with all its equipment
should remain in London until thirty years had elapsed from the date of
his death, and then it should be transferred to Glasgow. His death
occurred on March 30, 1783.
[Illustration:
WILLIAM HUNTER
(Copied from Thomas J. Pettigrew’s “Medical Portrait Gallery,” Fisher
& Son, London, 1838. The original portrait was painted by Pyne; the
engraving was done by J. Thomson.)
]
The institute which Dr. William Hunter founded was “for the improvement
of anatomical knowledge, surgery and physics,” and it may therefore with
justice be claimed that Dr. William Hunter was the founder of the
anatomical schools of Great Britain upon a rational and extended plan.
His nephew, Dr. Baillie, speaks of him as a teacher and scientific
worker in the following terms:—
No one ever possessed more enthusiasm for his art, more
persevering industry, more acuteness of investigation, more
perspicuity of expression, or, indeed, a greater share of
natural eloquence. He excelled very much any lecturer whom I
have ever heard, in the clearness of his arrangement, the
aptness of his illustrations, and the elegance of his diction.
He was, perhaps, the best teacher of anatomy that ever lived.
* * * * *
JOHN HUNTER, who was born July 14, 1728, was the youngest member of this
large family of children, and, as a natural result, his early education
was greatly neglected. Then, as a further misfortune, he lost his father
by death before he himself had attained his eleventh year. Although he
was regularly sent to school he did little else, up to the age of
twenty, but waste his time. Then, bored to death by the aimless sort of
life he was leading, and learning about this time what a fine reputation
his brother William was building up through the work that he was doing
in London, he asked him by letter whether he could not give him some
regular occupation in his laboratory, stating, at the same time, that if
he could not do this, he (John) would immediately enlist as a soldier.
William wrote to his brother to come on to London and he would see what
he could do for him. Immediately after John’s arrival in the great
metropolis he was given anatomical work to do, and, to the astonishment
of his brother William, he soon displayed such a remarkable degree of
skill as a dissector that there could no longer be any reasonable doubt
about his ability to gain eminence in this line of work; and so he was
encouraged to give it a full trial. William took special pains to point
out to his brother the best technical methods of procedure, and in every
possible manner aided him in his efforts to advance. Thus, for example,
he gained admission for him to Oxford University, and in due time
obtained opportunities for him to witness the operative work of the
leading surgeons in several of the London hospitals. With the lapse of
time, during the following years John became more and more closely
associated with his brother in his different activities,—lecturing in
his place whenever he was called away by other matters of importance,
making those beautiful anatomical specimens which even to-day are such a
striking feature of the Hunter Museum in London, and guiding the
students in their work of dissecting. But the field in which he
displayed a tireless activity, and in which up to the very end he gained
the greatest personal satisfaction from his labors, was that of
comparative anatomy and experimental physiology and pathology. It was in
this field that he performed the largest amount of original work, and
almost always with a view to learning how the different classes of
animals were equipped for the performance of one and the same function.
About the year 1761 his health began to give way and he was obliged to
spend nearly two years in efforts to regain it. With this object in
view, he accepted the position of surgeon in the army, and during the
period covered by the years 1761 and 1762 visited Belle-Isle, on the
west coast of France, and also Portugal. On his return to England with
improved health he resumed work on the anatomy of the uterus and
especially on the lymphatics of that organ, and made not a few actual
discoveries in this his new field. This work was conducted by him with
great zest, and as a result he soon began to be the recipient of honors
from different scientific societies. He was made a member of the Royal
Society of London, and associate of the Society of London Surgeons and
also of several German and French scientific societies, and Attending
Surgeon of St. George’s Hospital, Surgeon Extraordinary to the King,
Surgeon-General of the English Army, etc. In 1783 he experienced his
first attack of _angina pectoris_, and these attacks continued to occur
with increasing frequency until the final one, which ended his life on
October 16, 1793.
In his biographical notice of John Hunter, Odier quotes Lavater, the
famous physiognomist, as saying—after he had gazed for a few moments on
Hunter’s portrait: “This man is accustomed to do his own thinking.”
Lavater’s judgment, adds Dezeimeris, is amply justified by the facts.
“No matter what was the subject upon which he wrote—whether surgery,
medicine or physiology—he always added to it a certain measure of
originality. In reading his writings one is constantly tempted to
question the correctness of the opinion which one may have previously
formed with regard to the particular subject under consideration, and it
is in this respect—viz., by suggesting thought—that Hunter rendered very
great services to his art. And yet, at the same time, it is precisely in
his writings that the evidences of neglect in his early education stand
out in the strongest relief; a neglect which showed itself most
conspicuously in incorrectness, obscurity and slovenliness of style.”
(Dezeimeris.) This critic adds that ample proof of the correctness of
this judgment may be found in Hunter’s treatise “On the Blood and
Inflammation,”—a book which is “full of grand and beautiful ideas that
are literally choked in a chaos of conflicting conceptions, unfinished
phrases, new words or words used in a sense different from that in which
they are commonly employed.” I should add here, however, that the fault
of which the biographer last quoted complains appears to be entirely
absent in certain of Hunter’s reports of cases, as for instance in that
which contains the account of a fractured thigh. At the same time it
must be admitted that the physician who presumably prepared this report
from notes which he took when Hunter delivered the lectures upon which
the report is based, may have so edited the text as completely to
eliminate the objectionable features. In our ignorance of the exact
truth, it is more agreeable to assume that, in this particular instance,
the lecturer revealed his ability to avoid entirely the faults to which
the critic refers and to set forth the facts and his accompanying
comments with perfect clearness.
Here follows the report as it is printed in the “Hunterian
Reminiscences”:—
Granulation is not always confined to a breach of the solids by
suppuration; for parts are capable of making new animal matter
internally, in cases where it ought to have been healed by the
first intention. What gave me the first idea of this was the
following case, and the appearance observed on dissection, as
exhibited in the preparation of the parts.
CASE.—I was called to a man with a fractured thigh, and employed
the usual means, but without success, for no union of the
fractured parts was formed in the usual time; and at about the
end of four weeks the man died with some other complaint. Upon
examination of the parts I found that the upper end of the bone
rode considerably over the under, and, consequently, there was a
great cavity in the soft parts, the parietes of which were
thickened by the adhesive inflammation, though not so much as if
the parts had been better disposed for the adhesive
inflammation. There was no extravasated blood, nor matter, nor
coagulable lymph, to be found, except a few threads, which
probably were the remains of some extravasated blood. Here the
parts had lost two chances of being united, the one by the
extravasated blood, the other by the coagulable lymph thrown out
by the adhesive inflammation; and nature had here begun a third,
which was that of forming granulations of new animal matter on
the ends of the bones, and the surface of the surrounding
cavity; and adhesions, you see, have taken place between the
bones and soft parts, by which the bones would have been united
by bony case: hence we find that granulation may take place
without suppuration. This mode of union by granulation is much
more extensive, I believe, than has been imagined; this third
bond of union taking place when the parts have missed the first
and second, as just mentioned. In the exposure of cavities of
abscesses we have granulations going on hand in hand, and
following suppuration. As the suppurative inflammation follows
injuries with exposure, it seems that this inflammation is in
general necessary to granulation in these cases. Granulation is
an accretion of new animal matter, the old vessels being
extended, and new ones formed, the vessels passing from one edge
of the surface toward the other. Granulations are always of the
same nature with the part on which they are formed: if that is
diseased, as with any specific disease, so are they also. The
granulating surface is convex, and covered with prominent
points; the colour is of a deep florid red, but, when unhealthy,
is of a livid colour, which, perhaps, may be produced by the
circulation through them being exceedingly slow; this change of
colour may also be an effect of difference of position.
[Illustration:
JOHN HUNTER
(Copied from Thomas J. Pettigrew’s “Medical Portrait Gallery,” London,
1838. The original portrait was painted by Sir Joshua Reynolds; the
engraving was done by G. H. Adcock.)
]
Hunter’s biographer in the “New International Encyclopaedia” speaks of
him as a man of great industry, the boldest and best operating surgeon
of his day as well as the greatest anatomist known and a marvelous
zoölogist.
Some idea of the intensity of Hunter’s devotion to the cause of science
may be obtained from a perusal of the following incident, which is
related in A. M. W. Stirling’s “Coke of Norfolk and His Friends”:[17]
Epping Place may be said to have been the centre of his [Coke’s]
operations; and there was in these days a celebrated Irish giant
O’Brien or O’Bryne who came to live there solely for the sake of
joining Mr. Coke’s hounds whenever he allowed himself any
recreation. O’Brien was eight feet high in 1780 and apparently
went on growing, for in 1782 he measured two inches more and
after his death in 1783 he was found to measure eight feet four
inches, yet no other member of his family was unusually tall. He
was crazy about hunting and became so attached to Jones, Mr.
Coke’s huntsman, that he paid the latter a visit at Holkam and
was there solemnly introduced by Jones to Mr. Coke and his
guests. O’Brien’s end was curious. With extreme simplicity he
invested all his property in a single banknote of seven hundred
pounds which, needless to say, he lost; and grief at his loss
combined with excessive drinking brought about his death. John
Hunter, the celebrated surgeon, was extremely anxious to secure
his skeleton; and learning that the giant was dying he set his
men to watch the house in order to be sure of getting the body.
O’Brien hearing of this, and having a horror of being dissected,
left orders that his corpse should be watched night and day
until a lead coffin could be made, in which it was to be
conveyed to the Downs and sunk in twenty fathoms of water.
O’Brien died, and his body started for the Nee, escorted by a
walking wake of thirty Irishmen who drank deeply _en route_.
Howison, Hunter’s man, who watched closely, informed the surgeon
when he might catch the bodyguard off duty at the public house,
and Hunter went thither to bribe them. He offered fifty guineas
to one of the men to allow the body to be kidnapped, and the man
consented on his own account, but said that he must first
consult with his companions, who, perceiving Hunter’s eagerness,
raised their price, first to one hundred pounds and finally to
five hundred before they would agree. Hunter borrowed the money
to pay them, and the coffin consequently went on its way filled
with stones, while the body of the dead giant journeyed back to
London in a spring cart, until John Hunter’s own carriage met
it, after dark, and drove it to his house in Earl’s Court.
There, for fear of detection, he did not dare to dissect it;
but, separating the flesh from the bones by boiling and cutting,
he quickly skeletonized it. Hence in the Museum of the Royal
College of Surgeons may be seen, to-day, the skeleton—brown from
boiling—of the giant whose greatest joy when living was a gallop
with Mr. Coke’s hounds and the friendship of Mr. Coke’s
huntsman.
At the time of Hunter’s death, his museum contained 10,563 specimens and
preparations illustrative of human and comparative anatomy, physiology,
pathology and natural history. He died, however, in comparative poverty,
and his collection was purchased, two years after his death, by the
Government for £15,000 and was presented to the Royal College of
Surgeons.
John Hunter, says Pettigrew, had some very good ideas regarding the
educational training of the pupils who placed themselves under his
guidance. One of these is revealed in his practice of receiving certain
pupils into his house. In this way several of England’s most
distinguished physicians came to be, for varying periods of time,
inmates of his home, and among this number—to mention only a single
instance—was Dr. Jenner, the inventor of vaccination. One or more
physicians from the United States—if I am rightly informed—also enjoyed
this privilege. Valuable as this practice must have been to those who
were thus given the opportunity of frequent informal intercourse with a
most inspiring master, it certainly could not have been an easy matter,
even in those more primitive days, to fit these pupils into the régime
of the teacher’s home life; and, under the conditions of modern life,
the arrangement would certainly prove impracticable.
* * * * *
BENJAMIN COLLINS BRODIE was born at Milford, near Salisbury, England, on
June 9, 1783. In 1803, when he was twenty years of age, he became Sir
Everard Home’s pupil at St. George’s Hospital, London. Two years later
he began to assist Mr. Wilson in teaching anatomy, and during the
following four years he filled the position of Demonstrator of Anatomy.
In 1808, a year and a half before he began private practice, he was
appointed assistant to Sir Everard Home at St. George’s Hospital, and
retained the position up to the time (1822) when he was appointed full
surgeon at that institution. About six months after Mr. Brodie received
his appointment as Assistant Surgeon, he began lecturing on surgery and
continued giving instruction on this subject up to 1830. In addition, he
gave clinical lectures regularly to large classes, and this most
important part of his work, which he began in 1813, was kept up by him
through a long period of years. In 1819 he was appointed Professor of
Anatomy and Surgery to the Royal College of Surgeons, a position which
he held until 1823. In that year, upon the death of Sir Everard Home, he
was appointed one of the Serjeant-Surgeons to the King. Two years later
a baronetcy was conferred upon him, an honor which gave him the right to
be addressed as Sir Benjamin Brodie.
In the history of medicine one can find only a few instances of men who
were very clever surgeons and at the same time highly gifted
physiologists. A study of the life and writings of Sir Benjamin Brodie
reveals clearly that he is a conspicuous instance of this kind. The very
limited space at my command does not permit me to furnish more than a
few incomplete proofs of the truth of what I have just stated. Such are,
for example, the following:—
In 1810 Sir Benjamin Brodie delivered the Croonian lecture before the
Royal Society, the subject chosen being “On some Physiological
Researches respecting the Influence of the Brain on the Action of the
Heart, and on the Generation of Animal Heat.” His experiments, according
to the account given by his biographer, “go to show that if respiration
can be maintained, even artificially, the heart will continue to
contract with strength and frequency, even though the spinal cord be
divided from the brain.” Sir Brodie contrived an apparatus to effect
this, and at the same time carefully noted the circumstances connected
with the secretion of the urine, which in these experiments was found to
be suppressed. The conclusions he has drawn from this inquiry, conducted
with great precision and detailed with equal perspicuity, are the
following:—
1. The influence of the brain is not directly necessary to the
action of the heart.
2. When the brain is injured or removed, the action of the heart
ceases, only because respiration is under its influence; and if
under these circumstances respiration is artificially produced,
the circulation will still continue.
3. When the influence of the brain is cut off, the secretion
of urine appears to cease, and no heat is generated;
notwithstanding the functions of respiration and the
circulation of the blood continue to be performed, and the
usual changes in the appearance of the blood are produced in
the lungs.
4. When the air respired is colder than the natural temperature
of the animal, the effect of respiration is not to generate, but
to diminish animal heat.
In 1811 Sir Benjamin Brodie reported to the Royal Society the results of
various experiments which he made on the different modes in which death
is produced by certain vegetable poisons (for example, alcohol; the
essential oil of bitter almonds; the juice of the leaves of aconite; the
infusion of tobacco; the empyreumatic oil of tobacco; the curare; etc.).
During the following year he reported to the same society the results of
a similar series of experiments which he made upon the effects produced
by certain mineral poisons (for example, arsenic, muriate of barytes,
tartar emetic, and corrosive sublimate).
The preceding brief references to the experimental work carried on by
Sir Benjamin Brodie must suffice to show how thoroughly he deserved to
be ranked as one of the leading English experimental physiologists of
his day.
[Illustration:
SIR BENJAMIN COLLINS BRODIE, BART., F.R.S.
Sergeant Surgeon to the Queen
(Copied from Thomas J. Pettigrew’s “Medical Portrait Gallery,” London,
1838. The original portrait was painted by H. Room; the engraving
was done by J. Brain.)
]
Among Sir Benjamin Brodie’s contributions to the science of surgery are
many that may be classed as of the first importance. Such, for example,
are his researches respecting the diseases of the joints; his remarks on
a case of ununited fracture of the femur, in the course of which he
praises the method of treatment first proposed by Dr. Physick of
Philadelphia; his observations on the treatment of varicose veins of the
legs; pathological and surgical observations relating to injuries of the
brain—a contribution of very great value; and pathological and surgical
observations on the diseases of the joints. The latter treatise, which
already, in 1836, had reached its fourth edition, is mentioned by his
biographer as “a book which must ever form an essential part of the
library of every surgeon.”
Like all his predecessors who have given instruction in the art of
surgery, from John Hunter to Desault, Sir Benjamin Brodie laid great
stress upon the importance of an intimate knowledge of anatomy and
physiology—of the inseparable connection of these branches of science,
and of the interest derivable from a contemplation of the organization
and functions of animal bodies, the laws which regulate the phenomena of
life and the changes which matter undergoes, and the form which it
assumes when associated with this mysterious and active principle....
“He believes them to be incapable of explanation, except on the
hypothesis of there being in living bodies something superadded to
organization, without which, he says, ‘they would be as incapable of
executing their functions as the pendulum of a clock would be of
vibrating, or its wheels of revolving, if they were deprived of the
spring or weight, in which the cause of their motion resides.’”
(Pettigrew.)
The matters referred to above are only a few of those which Sir Benjamin
Brodie has discussed in so instructive a manner in the numerous short
essays and larger treatises which he published between the years 1809
and 1837. His death occurred in 1862.
------------------------------------------------------------------------
CHAPTER XVI
ENGLISH LEADERS IN MEDICINE AND SURGERY
SECOND GROUP (CONTINUED): SIR CHARLES BELL AND JOHN BELL
Among the contemporaries of Sir Benjamin Brodie there were several
London surgeons who, by reason of the important parts which they played
in building up this branch of the science and art of medicine, fully
deserve such consideration in the present review as my limited space
will permit, and also as the sources of information upon which I am
forced to depend for guidance may or may not prove helpful. Most
fortunately for me at this juncture of affairs was the finding—among the
rich treasures of the Medical Library of the former Transylvania
University, at Lexington, Kentucky—of Professor Roux’s account of a
visit which he made to the English metropolis in 1814 for the purpose of
learning at first hand precisely how the English surgeons of that day
were dealing with the more important problems which they were called
upon to solve. A more competent and fair-minded authority than Dr. Roux
could scarcely have been found at that time for the task which he set
before himself. In the first place he was himself an eminent surgeon, in
fact the Professor of Anatomy, Physiology and Surgery at the _Faculté de
Médecine_ of Paris, and at the same time he was wholly free from the
animosity which most naturally pervaded a large part of the French
nation in 1814 (just before the battle of Waterloo). And the very best
evidence that he performed his judicial task to the entire satisfaction
of the medical men of Great Britain is to be found in the fact that an
English translation of his elaborate report reached a second edition in
1816. I therefore feel confident that, in basing my résumé largely upon
Dr. Roux’s report regarding the condition of English surgery in the
second decade of the nineteenth century, I shall not go far astray from
the truth.
In his review of past events in the broad domain of surgery Roux says
that the English attribute the first idea of the circular amputation of
limbs to Cheselden, whereas the French give the credit for this
operation to J. L. Petit. Then there are other operations which were
devised or revived simultaneously by English and French surgeons—as, for
example, in external aneurism, the tying of the diseased artery above
the tumor (Desault and John Hunter), and the operation for _Fistula in
ano_—an operation which was brought to the greatest degree of simplicity
by Pott, Desault and some others.
On the other hand, there are many operations which were devised or
perfected exclusively by French surgeons—for example, the method of
extracting the crystalline lens, by Daviel; the treatment of fistula
lachrymalis by dilating the nasal canal; the treatment of strangulated
hernia by Goursand, Pipelet, Louis and others; the lateral operation
(perinaeal) for removal of a calculus in the bladder; the operation of
Frère Jacques; hypogastric lithotomy by Pierre Franco, and perfected by
Frère Côme; etc.
The English surgeons may similarly claim priority in proposing certain
operations, as for example, that of perforation of the _os unguis_ for
establishing an artificial passage for the tears, by Woolhouse;
Cheselden created the operation of the artificial pupil; he is also to
be credited with the operation of perforating the duct of Steno, on the
inside of the mouth and some distance from its natural orifice, for the
relief of salivary fistula; Pott’s description of and treatment for what
is known as Pott’s disease of the spine; etc.
Then, passing from what may be termed the history of ancient English
surgery, Roux devotes his attention next to the work which was being
done, at the time of his visit to London, by some of the leading
surgeons of that city; and among his most striking brief comments I find
the following: “There are many able surgeons in London at the present
time”; and “The English seem to have a strong taste for surgery.”
Farther on, he discusses at greater length the reasons why the English
surgeons maintain such pleasant relations with one another, and notes
with pleasure how greatly the prevalence of such professional harmony
conduces to the general advancement of the science and art of
surgery—or, for that matter, to the advancement of any art or science.
His words read as follows:—
If anything can contribute to keep alive the taste for an art or
science, to extend its progress, and to make a greater number of
men excel in it, is it not that those who cultivate it should
live in perfect intelligence together; that they should compose
one family; that they have frequent meetings with one another,
in which each one, sacrificing his own private interest, brings,
without pride or without presumption, the fruit of his own
reflections; that, strangers to the arts of intrigue, and, never
giving their minds to the vile insinuations of envy, they should
rival one another only in zeal and knowledge? Well, this
fraternal spirit, this absence of all jealous rivalry; and more,
an ardent desire to communicate, reciprocally, their views,
their thoughts, exists in a very high degree amongst the men who
are at this moment the honour of medicine and surgery at London.
This is what I have observed by being amongst them, I will not
say with surprise, but with the highest satisfaction. To these
common sentiments is joined, on the part of those men already
advanced in their career, an esteem altogether peculiar, for
those whose reputation is but beginning; and, on the part of the
latter, the greatest regard, the most sincere respect for those
who were their masters.
At this point I beg to remind my readers that effective surgical
anaesthesia had not yet at that early period been discovered, and this
fact, I scarcely need to add, must have deterred many men from
undertaking some of the more serious surgical operations.
At the end of Roux’s account he sums up the results of his observations
of English surgery in the following words:—
If I must conclude by a summary opinion, I would say that, with
respect to the art of surgery, as with respect to its habits and
institutions; in whatever light we consider it, England is the
place for contrasts. By the side of the most brilliant features,
English surgery exhibits glaring imperfections—French surgery is
more generally good.
While we are now considering various matters relating to the condition
of surgery in England and her colonies during the early part of the
nineteenth century, it may not seem out of place to mention here a
discovery which was announced just about that time, and which, I
suspect, is known to-day to comparatively few American physicians.
During the eighteenth century the opinion was widely held that
gonorrhoea is simply one of the manifestations of syphilis and that
consequently mercury is required for its cure. The existence of such a
belief among the physicians of that day explains the following statement
which I find printed in Vol. I. of the Quarterly Journal of Foreign
Medicine and Surgery for 1818:—“Dr. Francis Balfour, a physician highly
esteemed in Calcutta, states that when he was a student in Edinburgh he
attempted to establish the idea that gonorrhoea is a disease distinct
from syphilis and does not require mercury for its cure. He put forward
this doctrine in a paper which he presented to the Medical Society of
Edinburgh, and which still, we believe, graces its records. This was as
early as the year 1766. Next year he made it the subject of his
inaugural dissertation.... It was nearly twenty years after this period
that Benjamin Bell, by his ingenious and able investigations, supported
and further confirmed the opinion, and thus contributed much to bring it
into public notoriety and favour.”
At the time of Dr. Roux’s visit to London CHARLES BELL, who had taken up
his residence in that city in 1804, was already well advanced on the
high road to distinction as a surgeon. Born at Edinburgh, Scotland, in
1774, he had attained considerable reputation as an anatomist and
physiologist by the publication (1798–1800) (in association with his
brother, John Bell) of a very useful “System of Dissection of the Human
Body,” in which he describes not only the normal conditions but also the
alterations produced by disease. The text is interspersed with
instructive remarks concerning human physiology. Particularly clear and
interesting—says his biographer—are the descriptions which Bell gives of
the structure of the heart and blood-vessels. He refutes in strong terms
the teachings of Hunter regarding the vital force of the blood and the
doctrine of Crawford with regard to animal heat; and “his explanation of
the physiology of respiration is the clearest and most satisfactory of
any of the accounts that are to be found in the textbooks.”
In the domain of experimental physiology Charles Bell discovered, at a
later date, that, in the case of certain nerve trunks (_e.g._, the
trigeminus), what appeared to be a _single nerve_ was in reality made up
of two entirely different (physiologically speaking) nerves, one of
which is now termed the _portio major_, while the other bears the name
of _portio minor_. Bell also demonstrated experimentally the important
law that the anterior roots of the spinal cord nerves are the outgoing
(centrifugal) motor nerves, the posterior the incoming (centripetal)
sensible nerves. These results were subsequently fully confirmed by the
great German physiologist, Johannes Mueller. In ancient times the
question was often discussed whether one and the same nerve might not
carry both sensory and motor impulses. The discovery just mentioned is
one of the most important ever made in physiology.
Great as was the reputation attained by Charles Bell as an experimental
physiologist,—a reputation which won for him the honor of knighthood on
the accession of William IV. to the throne,—he soon, as was predicted by
Roux, became one of the most celebrated surgeons of London. His work as
an operator was carried on chiefly at the Middlesex Hospital. Roux
speaks of him as a “graceful operator without being affected.”
As an author he should be credited with the following
treatises:—“Anatomy of Expression” (1806); “System of Operative
Surgery”; “Animal Mechanics” (1828); “Nervous System” (1830).
[Illustration:
SIR CHARLES BELL
(Copied from a print in the possession of the New York Academy of
Medicine.)
]
Sir Charles Bell’s death occurred in 1842.
Sir Charles Bell’s older brother, JOHN BELL, born at Edinburgh in 1763,
was also a distinguished anatomist and surgeon. After traveling for a
short time in Russia and the north of Europe he returned to Edinburgh in
1786 and began to deliver lectures on surgery and midwifery. From this
time forward his private practice as a consulting and operating surgeon
steadily increased, until finally, in 1796, he was obliged to
discontinue his lectures and devote his entire time to his patients and
to the preparation of the several publications of which he was the
author. Early in 1816 he was thrown by a spirited horse, and was so
seriously injured that he never entirely recovered from the effects of
the accident. His death occurred in 1820.
Among the works which he published the following deserve to receive
special mention: “The Anatomy of the Human Body” (1793–1802), in the
third edition of which work (1811) are to be found a number of plates
that were drawn by his brother, Charles Bell; “Engravings of the Bones,
Muscles and Joints,” drawn and engraved by himself (1794); “The
Principles of Surgery” (1801–1808); and “Letters on Professional
Character.”
Speaking of the second volume of the first-mentioned work (“The
Anatomy,” etc.) Sprengel, the author of an important German history of
medicine, says: “It is remarkable in two respects, viz., for the unusual
number of interesting facts which it contains and also for the marked
excellence of the plates that accompany the text.”
------------------------------------------------------------------------
BOOK VIII
MEDICINE IN FRANCE
------------------------------------------------------------------------
CHAPTER XVII
BORDEU AND BICHAT; THE BEGINNING OF EXPERIMENTAL PHYSIOLOGY AND
EXPERIMENTAL PATHOLOGY IN FRANCE
THÉOPHILE BORDEU was born at Iseste, in the region of the Pyrenees, on
February 22, 1722. He received his preparatory education at the College
of the Jesuits, in Pau. Later, he entered the Medical School at
Montpellier, and received his doctor’s degree from that institution in
1744. After graduation he devoted much of his time to giving instruction
in anatomy, believing, as he did, in Seneca’s motto—“Doceo ut Discam” (I
teach in order that I may learn). Notwithstanding the demands made upon
his time by his private practice and by his numerous other engagements
(inspection of the mineral springs in the neighboring region, courses of
lectures to midwives, etc.) he managed to accomplish considerable
research work, and one of the first fruits of these original studies is
to be found in a _mémoire_ which he wrote on the articulations of the
bones of the face. This treatise, which he sent to the _Académie Royale
des Sciences_, was received with marked favor, as shown by the facts
that it was published by that body in their _Recueil des Savans
Étrangers_ and that its author was elected a Corresponding Member. In
this treatise Bordeu calls attention to the fact that all the bones
which form the background of the face are arranged in such a manner as
to offer efficient resistance to the repeated upward impulses of the
lower jaw, which impulses, acting upon the superior dental arch, have a
constant tendency to push upward or to drive apart outwardly the bones
into which the teeth of this arch are implanted. To appreciate fully the
very creditable character of this essay the reader must remember that
Bordeu had not yet reached his thirtieth year and that the ideas which
he sets forth in this essay are the strict product of his own thinking
and anatomical researches.
In 1752 Bordeu moved to Paris, and soon afterward published one of his
best contributions to the science of medicine, viz., a monograph
entitled: “_Recherches Anatomiques sur la Position des Glandes, et sur
leur Action_.” The publication of this important and exhaustive mémoire
occurred so soon after its author reached Paris that one is justified in
assuming that all or the greater part of the research work upon which
the essay is based was carried on at Montpellier. The object aimed at by
Bordeu in this _mémoire_ was to prove that
“the secretions which issue from these glandular organs
represent a veritable elaboration of the liquid the elements of
which are supplied by the blood, and are not merely a simple
separation, as the term ‘secretion’ would seem to imply. This
function,” says Bordeu, “is the result of the activities
belonging properly to the gland as an organ, and does not in any
sense—as some would have us believe—represent a mere mechanical
relationship between the blood-vessels of the gland and the
volume of the globules (blood corpuscles) that are carried into
the organ through them. Nor does the function represent in the
slightest degree the result of a chemical affinity between the
fluid product secreted and the substance of the gland.
Furthermore, the excretion (_i.e._, the expulsion) of this fluid
product is due wholly to the vital action of the glandular
organ; for it is a well-known fact that the adjacent muscles and
organs occupy such positions in relation to the glands
themselves that they are quite powerless to compress them and
thus to favor expulsion of the fluid which they have secreted.
Indeed, their influence is of quite the contrary character;
instead of compressing these organs in the manner claimed they
do no more than to communicate to them from time to time such
trifling shocks and movements as favor their glandular
activity.... Modern physiologists have added nothing of
importance to what Bordeu has set forth in this _mémoire_, which
deserves to be looked upon as one of the finest monuments that
has ever been erected in honor of the science of man.”
(Richerand.)
Bordeu’s _mémoire_, it seems, created a great sensation among the
physicians of Paris, many of whom were still at that period ardent
supporters of the mechanical and chemical doctrines taught by Boerhaave;
and, as a matter of course, there was also unbounded curiosity among the
better-educated physicians of the capital to see and make the
acquaintance of the newcomer—this “young athlete,” as Richerand calls
him,—who had not feared to enter the lists against such a formidable
array of adversaries. The marked popularity that fell to Bordeu’s lot as
a private practitioner in Paris after this brilliant beginning was not,
however, of long continuance. Professional jealousy rarely fails to
develop promptly when a physician manifests his ability to win patients
from those of his colleagues who, for a certain number of years, have
been established in practice, and this is precisely what happened in
Bordeu’s case. The new _mémoires_ which he published during the
succeeding years—one on the pulse (in 1756), a second on “Metallic
Colic” (in 1761–1763), a third on the “Colic of Poitou” (a year or two
later), and a fourth on the “History of Medicine” (in 1768)—showed
unmistakable evidences of the great talents which he possessed, but they
attracted comparatively little attention and did not add to his
popularity as a private practitioner. Furthermore, he derived very
little if any material advantage from his appointment as one of the
attending physicians at _La Charité_ hospital.
The last two years of his relatively short life were attended with not a
little suffering from attacks of gout, which compelled him to give up
his private practice and to live exclusively upon the scant income which
he derived from the small fortune (80,000 francs—$16,000) that
represented his savings from a practice that had apparently been quite
successful. His death occurred from cerebral apoplexy on November 23,
1776, when he was not quite fifty-four years old.
Bordeu did not live to see the ultimate triumph of his ideas with regard
to the true nature of the secretions supplied by glands. The careful
consideration of what this author has written upon the applications of
the accessory sciences (chemistry and mechanics) to physiology should
put us on our guard, says Richerand, against drawing incorrect
conclusions with reference to the nature of vital processes.
* * * * *
[Illustration:
BICHAT
]
MARIE FRANÇOIS-XAVIER BICHAT was born on November 11, 1771, at
Thoirette, France, in the Department of the Jura. His father, who was a
practicing physician at the neighboring town of Poncin, and who at the
same time held the office of mayor, was a man of considerable
cultivation. Cherishing, as he did, the hope that his son might
eventually adopt medicine as his vocation, he planned the latter’s
education with special reference to this possibility; and, as medicine
proved to be the very vocation which the son preferred, all this
well-planned training counted as so much valuable time gained. François,
who showed himself to be an apt scholar, made most satisfactory progress
in all the prescribed studies of early boyhood, and after passing
creditably through the regular course of the _Collège de Nantua_, a
thriving town among the western foot-hills of the Jura range of
mountains, he began the study of medicine at Lyons, in 1791. At first he
devoted himself almost exclusively to anatomy and surgery. Marc-Antoine
Petit, the celebrated surgeon of the Hôtel-Dieu of Lyons, was his
teacher in these branches of medical science, and from the very first
took special pains to aid his pupil in his studies in every possible
manner. François manifested an unusual degree of interest in anatomy, a
branch of medical science to which at that period only those who had the
intention of practicing surgery paid any attention; and in addition he
developed, almost at the very start, a strong disposition to learn the
precise purpose of each tissue and organ as it was encountered in the
course of his dissections. In other words, François-Xavier Bichat was
already, at the early age of twenty, making original investigations in
the department of physiology. This fact, says his biographer, should be
classed as something very remarkable, for, at the period which we are
now considering, practically not one of the students of medicine was
giving any thought except to the wonderful surgical work that had been
accomplished, a few years earlier, by the famous Parisian surgeon, J. L.
Petit (1674–1750), by F. de Lapeyronie of Montpellier (1678–1747), by S.
F. Morand of Paris (1697–1793), by the famous lithotomist, Frère Côme
(1703–1781), of whose achievements I gave a brief account in “The Growth
of Medicine,” and by another celebrated teacher of surgery in Paris,
viz., Pierre-Joseph Desault, who, during the period which we are now
considering occupied by far the most conspicuous position among the men
classed as healers of disease, and who, by the very prominence of his
position, compelled almost everybody who took any interest in medicine
to keep their eyes riveted on him. These and other circumstances that
happened to exist at that period strongly favored among the younger men
a leaning toward the career of surgeon. One of these favoring
circumstances was the need of army surgeons, for France was in the
throes of the French Revolution. It was therefore not strange that at
first Bichat devoted the greater part of his time and thought to the
fundamental work of a surgeon’s training. A little later he accepted a
subordinate position at the Hôtel-Dieu of Lyons, under Marc-Antoine
Petit, the head surgeon of that great hospital. Favored in every
legitimate way by this eminent and most kindly surgeon, young Bichat
made rapid progress. But there arrived a time, shortly after the siege
of Lyons, when it was no longer safe for a young man to remain in Lyons,
and so Bichat was forced to flee to Paris. There he joined the crowd of
students who were regularly following the practical instruction given by
Desault.
It was at that time an established custom in the medical school for
certain pupils, who had been previously selected for this work, to read
(in turn) to the assembled group of students, just before the arrival of
the attending surgeon, a _résumé_ of the previous day’s lecture. In this
way the man whose turn it was to read the _résumé_ which he had
prepared, secured a most valuable bit of training, and those who simply
listened were afforded an excellent opportunity for refreshing their
memories with regard to the lecture of the previous day. On these
occasions the First Assistant was always present and was therefore in a
position to report to his Chief just how successfully each reader of
such a review had performed the duty assigned to him. At one of his
lectures Desault entered more elaborately than usual into a description
of his manner of treating fracture of the clavicle, demonstrating among
other things the proper manner of applying what has since become known
as “Desault’s bandage.” The student who had been assigned to the duty of
preparing a _résumé_ of that day’s lecture happened to be absent on that
particular occasion, and so the First Assistant asked the members of the
class whether perhaps one of their number would be willing to act as a
substitute. Bichat volunteered his services, and he thereupon prepared a
_résumé_ which, when read on the following day, proved to be so clearly
expressed and covered the ground so thoroughly that the class, after
listening to it in profound silence, expressed its approval by the most
pronounced applause. When Desault was told by his First Assistant,
Manouty, of what had happened he was very impatient to make Bichat’s
acquaintance; and, after he had talked with the latter for a short time,
he became so impressed with the extent of the knowledge which he had
already acquired, with his earnestness of purpose, and with his
amiability of character, that he did not hesitate to invite him to
become one of his household. Indeed, the favorable impression which
Bichat made upon him led him promptly to decide that, if nothing
happened later to change the impression which he had first received, he
would do all in his power to make this young man his successor.
This kindly reception on the part of his honored preceptor made a deep
and most cheering impression on Bichat and stimulated him to put forth
his best powers to justify the confidence shown by Desault. At the
latter’s request he took charge of part of Desault’s private practice,
and he also accepted the position of Hospital Attending Physician to the
Outside Poor. Furthermore, he acted as Desault’s corresponding
secretary, answering for him all the requests for advice that came to
him from every district of France. Then, in addition, he assisted him in
all his operations in private practice. Finally, as if he were not
already burdened to the limit of his strength with all this mass of
work, he not infrequently spent a portion of the night in aiding Desault
to solve various problems in experimental surgery, problems relating
chiefly to diseases of the bones. Whenever a lull occurred in this
series of engrossing labors he devoted all the available time to the
performance of operations upon the cadaver and to experiments in
relation to physiological problems that suggested themselves to his own
mind.
Already as early as in 1797—that is, when he was twenty-six years of
age—Bichat gave his first course in anatomy. The room in which the
instruction was given was quite small, for he was confident that only a
few pupils would feel disposed to subscribe for such a course, and in
addition no provision for laboratory work had been made. At first, the
teaching was limited to simple demonstrations, but very soon discussions
with regard to physiological questions began to occupy some of the time
of the sessions. Finally, Bichat found it desirable now and then to
carry out experiments on living animals, in order to verify certain
seemingly well-known facts and also to determine the exact points at
which new investigations should be instituted. When this first course in
anatomy came to an end he surprised his friends by beginning a course on
operative surgery. “I wish,” he remarked to one of his intimates, “to
demonstrate that even a young man may be quite as capable as one of
mature age, to operate with the requisite degree of precision.” The
course proved a great success, and demonstrated perfectly the truth of
his statement.
Under all this strain upon his vital energy, it soon began to be
apparent that Bichat’s health was giving way, and it was not long before
a pulmonary or bronchial hemorrhage forced him to desist from his work.
At one time, indeed, his physical condition was such as to make his
friends fear for his life. In the course of a few months, however, he
seemed to regain his health; and then he forthwith made arrangements for
a much more complete course in anatomy than that which he had carried
through so successfully the year before. A laboratory provided with
accommodations for eighty dissectors was constructed, and, before the
course began, every one of these eighty seats was engaged. (This was in
1798.)
It was a great source of amazement to his friends—and it continues to be
a great source of amazement to the physicians of the present day—how
Bichat managed to accomplish successfully such a number of things as he,
at this early period of his life and with a decidedly precarious state
of health, had taken in hand.
One thing was now very noticeable, namely, that he was devoting a much
larger part of his time and attention to experimental physiology—that
is, to the phenomena and the laws of life—than he had hitherto done to
anatomy. After he had finished the work which belonged properly to the
daylight hours he devoted no small portion of the nighttime to the work
of revising the writings of his beloved teacher and friend, Desault.
Among the anatomical structures about which almost nothing was known
toward the end of the eighteenth century, but of which the structure and
functions were fully exposed to light by Bichat’s labors, the synovial
membranes deserve to receive the very first mention. His researches
concerning these membranes were first made known in the public lectures
which he was giving at that time to the medical students, but they did
not appear in print until a later date, viz., in the second volume of
the “_Recueil de la Société Médicale d’Émulation_.”
At a somewhat later period Bichat abandoned all further attempts to
cultivate either the knowledge or the practice of surgery, and
concentrated all his efforts upon the extension of our knowledge of the
principles of physiology. He made very careful researches into the
nature and functions of serous membranes, and published the results of
his labors in a volume which met with great favor at the hands of a
large part of the medical profession, and yet at the same time brought
out strong manifestations of envy on the part of other physicians. As
Buisson justly remarks, these manifestations of envy furnished the very
best sort of proof that Bichat, who paid no attention whatever to these
criticisms, had done his work remarkably well.[18]
In the same year (1800) Bichat published a third treatise, under the
title “_Recherches Physiologiques sur la Vie et la Mort_.” (A later
edition appeared in 1805.)
One day, as Bichat was descending the main staircase of Hôtel-Dieu, his
foot slipped and he fell in such a manner as to strike his head with
considerable force against one of the steps. When somebody came to his
assistance it was found that he was unconscious. In a short time,
however, consciousness returned, and Bichat was able, though with some
difficulty, to regain his home. On the following day he suffered from a
severe headache, but insisted, nevertheless, on making a few
professional calls. The exhaustion which he felt after making these
visits compelled him to take to his bed as soon as he reached his
residence. Death took place on the fourteenth day after the occurrence
of the accident; that is, on July 22, 1802.
Bonaparte, who was at that time First Consul of the French Republic,
gave orders, upon hearing the news of Bichat’s death, that a monument
should be erected in the vestibule of Hôtel-Dieu to commemorate the
distinguished services rendered to humanity in that institution by
Desault and Bichat. The following is the inscription which it bears:—
_Ce marbre dédié a la Mémoire des Citoyens Desault et Bichat a
été posé pour attester la reconnaissance de leur contemporains,
pour les services qu’ils ont rendus, le premier à la Chirurgie
Française dont il est le restaurateur, le second à la Médecine
qu’il a enrichée de plusieurs ouvrages utiles, et dont il eût
aggrandi le domaine si l’impitoyable mort ne l’eût frappé dans
sa 31me année.[19]_
Aside from his scientific attainments and from his untiring zeal in
prosecuting his researches in anatomy and physiology, Bichat possessed
certain traits of character which caused him to be greatly beloved by
his pupils. He was of a very kindly disposition, and it was not an easy
matter to excite him to anger or even to cause him to show impatience.
* * * * *
The first feeble beginnings of experimental physiology are to be
credited to the Swiss physician, Albrecht von Haller, whose death
occurred in 1777. Then followed, a few years later, the more serious
efforts that were made in the same field of scientific inquiry by John
Hunter, of England. The real birth of this new science, however, took
place in France, under the fostering care of Lavoisier, Bichat, Magendie
and others. The establishment in Paris, by Bichat, of a large laboratory
where such research work could be carried on advantageously, constituted
the first act in the creation of an organized experimental physiology.
Several years later (1867), Claude Bernard induced Monsieur Duruy, who
was at that time Minister of Public Instruction in France, to establish
at the _Jardin des Plantes_ a laboratory where general physiology might
be studied experimentally.
------------------------------------------------------------------------
BOOK IX
MEDICINE AT THE HEIGHT OF THE FRENCH REVOLUTION
------------------------------------------------------------------------
CHAPTER XVIII
TYPES OF FRENCH PHYSICIANS WHO FLOURISHED ABOUT THE TIME OF THE REIGN OF
TERROR
LOUIS-GUILLAUME LEMONNIER, member of the Academy of the Sciences and
First Physician of the King (Louis XV. and also Louis XVI.), was born at
Paris, June 27, 1717. His father and his brother were both of them
members of the Academy, the former in his character of Professor of
Physics at Harcourt, and the latter as one of the most celebrated
astronomers of France. At the age of twenty-two he was sent (1739), with
Carsini de Thury and Lacaille, to the south of France to extend the
meridian of the Observatory of Paris, the task of making scientific
observations along the route followed by his superior associates being
specially assigned to him. He noted the existence of mines of ochre,
coal, iron, antimony and amethysts in Auvergne, of mineral waters in
Mont-d’Or, and of mines of iron in Roussillon. He also made analyses of
the mineral waters of Barèges, and determined the poisonous nature of
certain species of mushrooms. In the same year he received the
appointment of Physician to the Hospital at St. Germain-en-Laye, near
Paris.
During this period of his career Lemonnier made the acquaintance of an
expert floral gardener by the name of Richard, and in his company soon
developed a keen interest in flowers and garden plants. The Duke of
Ayen, who was one of the King’s favorites and well known for his love of
flowers as well as for his boldness of speech in telling the truth to
the royal household, made frequent visits to Richard’s garden and in
this way acquired a friendship for Lemonnier, who entertained him
greatly with his talks about botanical matters and about the cultivation
of trees. As a result the Duke’s extensive park in time became the home
of rare plants and numerous species of noble trees, many of which were
still flourishing during Cuvier’s time. After a while Louis XV. was
induced by the Duke to accompany him on some of his visits to Richard’s
garden, and on one of these occasions the King asked that Lemonnier
should be introduced to him, as he wished to become acquainted with the
man who had so successfully aided the Duke in establishing an attractive
botanical garden. At this first interview Lemonnier made a most
favorable impression upon the King,—so favorable, indeed, that the
latter, after a few further interviews had taken place, placed this
physician and enthusiastic botanist in charge of the botanical garden at
the Trianon, in Versailles; and not long afterward he appointed him his
First Physician, a position which carried with it a liberal salary.
Cuvier, in accounting for the enthusiastic love for botany which
develops in certain men, makes the following remarks:—
In our dealing with plants nothing of a painful nature is
encountered; no sad images are ever presented to our eyes; there
is absolutely nothing to recall to our minds our passions, our
disappointments, our misfortunes; love is never associated with
jealousy, beauty exists without vanity, force is never
accompanied by tyranny, and death takes place without agony; in
brief, there is nothing to remind one of the human species.
The only use that Lemonnier made of his pleasant relationship with the
King was to secure his sanction of the plan of sending competent
botanists to different parts of the globe with instructions to bring or
send back rare plants, first to the Trianon garden at Versailles and,
after the death of Louis XV. (in 1774), to the Jardin du Roi (Jardin des
Plantes) at Paris. In accordance with this scheme men were despatched to
Persia, to the coasts and islands of the Mediterranean, to the banks of
the Euphrates, to Cayenne in South America, to the Atlas Mountains, to
Liban, to China and to the East Indies.
[Illustration:
Costume worn by Paris physicians in the eighteenth century.
(From Alfred Franklin’s “_La Vie Privée d’Autrefois_,” Paris, 1892.)
]
As Lemonnier was not in the habit of publishing anything on botanical
subjects, he was comparatively unknown to the public. Were it not for
this fact, says Cuvier, he would easily have taken rank among the most
celebrated botanists of France. When his friends chided him for having
neglected to avail himself of this mode of obtaining well-earned
recognition he replied that the time spent in instructing others is lost
so far as his own self-instruction is concerned. Furthermore, he was
timid in regard to publishing. “There is sure to be a great deal of
unjust criticism about anything a man may write, and I cannot easily
bear such injustice. I therefore prefer to keep silence.”
Upon the death of Louis XV. Lemonnier lost his position of First
Physician to the King and he was not reappointed by Louis XVI. until
1788. Thus, during a period of fourteen years, he was deprived of the
large salary which is attached to that position, and was obliged to live
upon the relatively small income which he derived from private practice.
During the continuance of his official connection with the Court he
invariably refused to accept any fees from those individuals who
belonged to the Court circle but yet held no official position. On the
other hand, he was most generous in giving the best of his service,
gratis, to the poor. As a consequence, his popularity among the lower
classes was very great. He reaped the reward for this disinterestedness
on the occasion when the mob, in 1792, invaded Versailles and carried
off the King and Marie Antoinette to Paris. As soon as the palace was
vacated Lemonnier sought safety in one of the small pavilions in the
adjoining park; but the rabble broke into the building and were carrying
off Lemonnier as a prisoner when suddenly a man, who seemed to be one of
the leaders of the mob, stepped out from the crowd and ordered the
physician to follow him. Thus Lemonnier was conducted to his room in the
Luxembourg palace in Paris, all the time under the guidance of this
strange, rough-looking man, who nevertheless, when they arrived at the
Luxembourg, acknowledged to the doctor that he intended, from the very
first, to save his life if he possibly could, because he was sure, “from
the kindly and venerable expression of his countenance, that he could
not possibly have had anything to do with the abuses of which the rabble
complained so bitterly.” Thus was Lemonnier rewarded for all his past
services to the poor of Paris and Versailles.
During the last years of his life—he was eighty-two years old when he
died—he enjoyed, in the quiet society of his former friends, who stood
by him faithfully to the end, what he termed the happiest years of his
life.
* * * * *
CHARLES LOUIS DUMAS, born at Lyons, France, on February 8, 1765, was the
son of a practicing surgeon. At the age of seventeen he began the study
of medicine at Montpellier, Barthez and Grimaud being at that time the
most distinguished members of the Medical Faculty of that university.
From the very first he manifested a keen interest in his studies. In
1785 he received the degree of Doctor of Medicine, the title of his
graduating thesis being: “An Essay on Life, or the Vital Faculties.” In
1787 he visited Paris, and during the following two years devoted his
attention chiefly to chemistry and to the study of human anatomy. It was
during this period that he became warmly attached to Vicq-d’Azyr.
In 1790 he returned to Montpellier and took part in a competition for
the chair of surgery left vacant by the death of Sabatier. Although the
judges decided in favor of another competitor they were most favorably
impressed with the talents which Dumas exhibited. A year later, upon the
death of Barthélemy Vigaroux, Dumas accepted the position of
Vice-Professor of Surgery in the same university, but, owing to the
political troubles which developed at this time in Lyons, he was obliged
to resign his chair at the end of one year and return to his native
city. After the termination of the siege of Lyons he was expelled from
the city, narrowly escaping with his life. In 1793 all teaching of
medicine at the University of Montpellier ceased, and two years later a
new school of medicine was organized, and the duty of teaching anatomy
and physiology was assigned to Dumas. In 1798 he was chosen President of
the school and Dean of the Faculty of Medicine of Montpellier. He died
on March 28, 1813, at the early age of forty-seven.
The more important of the treatises written and published by Dumas are
the following:—“_Principes de Physiologie_,” Paris, 1800–1803, 4 vols.,
and “_Doctrine Générale des Maladies Chroniques_, etc.,” Montpellier,
1812, and a second edition (2 vols.) in 1824.
* * * * *
PIERRE-JEAN-GEORGES CABANIS was born June 5, 1757, at the village of
Conac, in the Department of Corrèze, France. During his early youth he
gave no evidence whatever of possessing an inclination to study, but at
the age of fourteen he was taken to Paris, and then, for the first time,
he manifested great eagerness to acquire all kinds of knowledge. After
having completed his preliminary course of literary training he accepted
the position of private secretary to Prince Massalsky, Bishop of Wilna,
and accompanied him on his return to Poland. A residence of two years in
that distracted country convinced him, however, that he had better
return to France and seek there for an opening to some useful career.
Accordingly he went to Paris, and, upon learning that a prize for a
French translation, in verse, of a part of Homer’s Iliad had been
offered by the _Académie Française_, he devoted all his time and energy
to the writing of such a translation. Richerand, from whose eulogy on
Cabanis I have derived most of the information furnished in the present
sketch, does not state whether these efforts were or were not rewarded
by the capture of the coveted prize. His account, however, makes it
perfectly clear that Cabanis was an enthusiastic admirer of the poetry
of Homer and that he would gladly have devoted his life to the
cultivation of literature if he had not, at the same time, been deeply
impressed with the idea that a good citizen should devote a large share
of his time and his talents to things of real use to his fellow men and
to his native or adopted country. Accordingly, in due course of time, he
set aside his purely literary employment and began in earnest the study
of medicine, to which vocation he now transferred his allegiance with
all the ardor of which he was capable. Hippocrates, whose accurate
descriptions of disease and whose high standard of professional duty
excited his admiration as much as had the writings of Homer, furnished
him with the first models that were to serve as guides in his newly
chosen career. To add to his good fortune he had the privilege of
studying medicine under the guidance of Dubreuil, a teacher of the very
highest order, a philosopher, and a man of whom the pupil always spoke
in strong terms of admiration and affection.
After taking his doctor’s degree in 1784 Cabanis devoted all his
energies, during the few years which elapsed between this event and the
breaking out of the French Revolution, to the practice of his
profession. Aside from these duties he accepted only one official
responsibility, viz., that of Administrator of the Hospitals of Paris,
and this duty he performed with entire success. It is a fact worth
noting that he was one of Mirabeau’s intimate friends, and he believed
thoroughly in the principles of the French Revolution, but he did not
approve of the excesses which characterized its progress.
Some idea of the importance of the position which Cabanis held in the
esteem of his associates in the Parisian world of science and politics
may be gained from the following statements:—Early in his career he was
introduced by Turgot, the former Controller-General, to Madame
Helvétius, the widow of the well-known _littérateur_, Claude Adrien
Helvétius, and a woman whose weekly receptions (_salons_) brought
together at frequent intervals some of the most famous men at that time
residing in Paris. Thus he became acquainted with Franklin and
Jefferson, of the United States, as well as with Diderot and d’Alembert,
the famous writers connected with the French Encyclopædia. He was also
presented to Voltaire, who received him in the most kindly manner.
Although from 1789 to the end of his life he published a number of
useful pamphlets on different topics connected with public affairs and
especially with public charitable institutions and undertakings, he
rarely permitted his name to appear as the author of such essays. In
1799, when the Consulate was entrusted with the government of France,
Cabanis accepted a seat in the Senate and took an active interest in
public questions. During the last three years of his life the
increasingly bad state of his health did not permit him to do much work
of any kind; and finally, on May 6, 1808, an attack of cerebral apoplexy
put an end to his life.
The two most important works published by Cabanis are the
following:—“_Rapports du Physique et du Moral de l’Homme_,” Paris, 1802
(2d edition in 1805); and “_Du Degré de Certitude de la Médecine_,”
Paris, 1797 (3d edition in 1819).
* * * * *
FÉLIX VICQ-D’AZYR, who was born in 1748, was distinguished chiefly as an
anatomist and physiologist, and also as a writer on scientific topics.
The Faculty of Paris, not being pleased with his rapid advance in
popular favor, refused to allow him the privilege of lecturing in their
anatomical theatre. Then Antoine Petit, who was at that time Professor
of Anatomy at the “_Jardin du Roi_,”—an institution which was located in
what is now known as the Jardin des Plantes and was in a limited sense a
rival of the _École de Médecine_,—befriended him and did everything in
his power to make him successor to himself in the Chair of Anatomy. In
this attempt, however, Petit failed, for Portal, whose candidacy was
backed by the more influential Buffon, eventually received the
appointment. Just at this juncture of affairs Vicq-d’Azyr met with a
stroke of good luck. A niece of the celebrated naturalist, Daubenton,
who spent a large part of his long life in work connected with the
Jardin du Roi, happened one day to have a fainting fit just as she was
passing in front of Vicq-d’Azyr’s residence. This physician, who chanced
to be at home when the fainting occurred, did everything in his power to
restore the lady to consciousness; and in this he was perfectly
successful. In fact, not many months elapsed before they were married;
and from this time forward Daubenton did everything in his power to
advance Vicq-d’Azyr’s career as a scientist. He aided him, for example,
in procuring a great variety of foreign animals which the latter needed
for his researches in comparative anatomy; and, in addition, he promoted
his candidacy for membership in the _Académie des Sciences_, to which
organization he received an election in 1774. Soon afterward he gained
the esteem and friendship of Lassonne, the First Physician of the King,
and through his influence Vicq-d’Azyr was commissioned to carry
assistance to the people living in certain districts of France where an
epidemic disease was raging. Later, Lassonne aided him in organizing the
_Société Royale de Médecine_, the function of which was to perfect all
the departments of medical activity. Eventually Vicq-d’Azyr was made
_Secrétaire Perpetuel_ of this society. The Faculty, as had happened
before under similar circumstances, showed itself jealous of this new
organization, and systematically did all in its power to undermine the
influence of Vicq-d’Azyr, whom it recognized as the guiding spirit of
the scheme. Despite these malicious efforts the public at large,
recognizing their origin and the mean spirit of jealousy which prompted
them, lost no opportunity of bestowing praise upon Vicq-d’Azyr. In 1788
the _Académie Française_ chose him as Buffon’s successor, and in 1789 he
succeeded Lassonne as the First Physician of the Queen.
Vicq-d’Azyr’s purely scientific writings are very numerous and of marked
importance. They cover a wide extent of subjects—medicine, anatomy (both
human and comparative), and the veterinary art. His death occurred on
June 25, 1794, from some acute affection of the chest.
The treatises and memoirs which he wrote were first published separately
at different dates, but in 1805 a fairly complete collection was
published at Paris by Moreau.
* * * * *
JEAN-NOEL HALLÉ, born at Paris, France, toward the end of the eighteenth
century, was one of the most distinguished physicians of that period.
Cuvier, the famous naturalist and the author of the biography upon which
the present sketch is based, makes the following statement:—
Those physicians who can steer their way successfully through
such a maze of difficulties as existed during the French
Revolution, and who at the same time can inspire their patients
with a feeling of entire confidence in their ability to bring
them safely back to health, deserve our highest admiration and
respect. But when we wish, in giving an account of a physician
of this calibre, to furnish clear proofs of the truth of what we
say, we find it exceedingly difficult to produce the necessary
evidence. The names of three such men occur to me, viz., Hallé,
Corvisart and Pinel.
In the further course of his narrative Cuvier states that, in his
charitable gifts to the poor, Hallé studiously concealed from them the
source of the aid which they received. Many a patient, he adds, upon his
recovery from the attack for which the doctor had treated him, was
astonished to find that all the expenses incurred during his illness had
in some mysterious manner been defrayed. “How rarely indeed,” says
Cuvier, “does one learn of such a perfect carrying out of the
injunction: ‘Let not thy right hand know what thy left hand doeth.’”
About the year 1794 Hallé’s father and his grandfather were made members
of the Order of Saint-Michael, an honor which conferred nobility not
only upon them but also upon himself. Unfortunately for the doctor, who
was residing in Paris at the time, this patent of nobility made him
subject to the new law which had been passed by the Convention, and
which drove into exile all members of the nobility. An exception,
however, was made in his case because he held the office of Physician to
the Poor, and also—doubtless—because he was universally known throughout
Paris to be a staunch friend of the poor. Having thus received
permission to remain in the capital Hallé at once bethought himself how
he might aid those unfortunates who were confined in prison. He was
permitted, for example, to visit Malesherbes, Minister Turbot’s
associate, who was awaiting his death by the guillotine. Not only was he
thus enabled to speak words of comfort to the unfortunate prisoner, but
he received from him such farewell messages for his distressed family
and friends as he desired to send. Hallé was also one of those friends
of Lavoisier who interfered actively, but in vain, to save his life from
the executioner’s block. Those were terrible times and it required great
courage to do what Hallé did in behalf of these innocent victims of the
murderous Jacobins.
Fourcroy, the celebrated chemist and naturalist, who was authorized by
the Convention in 1794 and 1795 to organize a new _École de Médecine_,
to take the place of the one which the rabble had destroyed in 1783,
appointed Hallé Professor of Medical Physics and Hygiene. Then, later
still (1796), Corvisart, who by that time was in the full exercise of
his functions as medical adviser to Bonaparte,[20] appointed Hallé his
associate in the professorship at the Collège de France. Shortly
afterward he gave up the Chair entirely to Hallé.
Between the years 1800 and 1812 Hallé, more than any other French
physician, exerted his influence—and with decided success—in overcoming
the remaining opposition to vaccination, not only in France but also in
Italy.
Corvisart left to Hallé in his will the portrait of Stoll, the
distinguished Vienna professor, and added a memorandum to the effect
that he made this gift because he esteemed Hallé more highly than he did
any other physician.
Many anecdotes have been told concerning the peculiarities of Hallé in
his dealings with patients. The following two may perhaps prove of
interest to my readers:—If, for example, the patient happened to be an
artist, Hallé refused to accept a fee from him; and, when asked why he
did this, he replied: “Because from way back I belong to a family of
artists.” Then, in the second place, he was not willing to accept fees
from ecclesiastics. “If they have only just enough to live upon, they
should not be subjected to any diminution of that small stipend. On the
other hand, if they have more than is absolutely necessary for their
legitimate living expenses, this excess belongs to the poor.” The
following anecdote is told of one of his experiences:—
One day, when he returned to his office, worn out with a hard
day’s practice, he was told that a lady was waiting to consult
him. “Ask her,” he said to the attendant, “kindly to consult
some other physician, as I am too tired to see her.” She sent
back word that she had not the courage to do this, as she was
not able to pay for the services of this other physician. “If
that is the case,” Hallé promptly replied, “tell her I will see
her.” To himself he said: “I have no right to send her away.”
Hallé’s death occurred on February 11, 1822. Laënnec succeeded him at
the Collège de France.
* * * * *
GASPARD LAURENT BAYLE was born on August 18, 1774, at the village of
Vernet in the Department of the Basses-Alps. The country in this part of
France is very picturesque but not at all fertile; lofty mountains
surround it on all sides. At an early age Gaspard manifested a high
degree of intelligence and a strong inclination to study natural
phenomena. He was barely ten years old when he began making a collection
of insects, and he even went so far as to give names to the individual
species. He was only twelve years old when he was sent to the High
School of Embrun; and in this institution he made such advances in his
studies that the principal, Father Rossignol, a Jesuit, looked upon him
as one of the most promising of the pupils under his charge; more than
this, he felt a strong affection for the boy. As the curriculum of the
school studies did not include mathematics and natural history Father
Rossignol took particular pains to furnish Gaspard with instruction in
these branches of knowledge. The warm friendship which thus developed
between the scholar and his instructor, continued unbroken up to the
time of the latter’s death in 1813.
Laboring under the impression that it was his duty to become a priest
Gaspard enrolled his name at the theological seminary in 1790, and
devoted the following year to the study of philosophy and theology; but,
after the lapse of a certain length of time, doubts began to enter his
mind as to the wisdom of the choice which he had made, and accordingly,
after consultation with his father and older brother, both of whom were
lawyers, he abandoned the study of theology and entered his brother’s
law office.
In 1793, when the storms of the French Revolution had reached their acme
of violence, young Bayle, who was then only nineteen years old, attended
a political meeting at Embrun and made such a stirring appeal to the
mountaineers there assembled, in regard to their duty as Republicans,
that he completely won their confidence, and was accordingly chosen to
represent them at the approaching reception of the Proconsuls Barras and
Fréron, who had been sent by the Convention to persuade the inhabitants
of that district to carry out the violent measures which had been
planned against the city of Digne. The Proconsuls, who in the meantime
had arrived at Digne, quickly discovered that public sentiment was not
in favor of the measures advocated by the Convention; and accordingly,
in the fear that an uprising of the citizens might imperil their own
lives, they promptly fled from that city; but, before leaving, they made
arrangements for the arrest of the young orator who had produced such a
strongly antagonistic impression upon the people. As soon as Bayle’s
father and brother had learned these facts they quickly took all the
steps necessary for secretly getting Gaspard out of Digne and sending
him as speedily as possible to Montpellier, where—by enrolling himself
among the students of Medicine—they believed that he might reasonably
expect to escape the clutches of Barras and Fréron. These measures
proved successful, and thus Bayle’s life was saved and his attention
diverted from the Law to Medicine, a career in which he was destined to
gain great credit.
After spending three years at Montpellier Bayle was sent, as an
_Officier de Santé_, to serve at a military hospital temporarily
established at Nice, in the south of France. And here let me remark,
parenthetically, that this title should not be translated by the
corresponding English term “Health Officer.” In 1795 a new type of
medical school was established in France, the object of this innovation
being to provide a class of practitioners who could meet all the
ordinary medical needs of the peasants at a charge considerably less
than that demanded by the graduates of the high schools. The course in
these new schools covered a period of only two years, and the graduates
were classed as “_Officiers de Santé_.”
[Illustration:
GASPARD LAURENT BAYLE
]
As Bayle’s duties here at Nice were not very exacting he divided the
time which he had at his disposal between the bedside observation of
cases of actual disease and the study of treatises relating to
pathology. In 1798 he went to Paris and followed several courses of
instruction, more particularly that given by Corvisart on pathological
anatomy. In 1799, at a competitive examination, he won the position of
Assistant in Anatomy, and from that time forward he devoted a large part
of his time to the work of making post-mortem examinations.
In 1802 Bayle received his degree of Doctor of Medicine. The thesis
which he wrote on this occasion created a great sensation, partly
because it described an entirely new form of gangrene, and even more on
account of the philosophic manner in which he defended all his
statements when called upon to do so at the public cross-examination
which, at all the foreign universities, commonly precedes the bestowal
of the degree upon the candidate. Two of Bayle’s friends who were
present on this occasion, secured shorthand notes of the discussion that
took place between the candidate and the professors (Petit-Radel, Pinel,
Alphonse Leroy and Percy) whose duty it was to question him with regard
to the views put forward in the thesis. The report based upon these
shorthand notes covers nine printed pages of the biographic sketch which
lies before me, and is not—as will readily be appreciated by my
readers—suitable for reproduction here in its entirety; nor would a
digest of such a report serve any useful purpose. The most that seems to
me permissible under the circumstances is to furnish here two or three
brief extracts, from a perusal of which it will be possible to form at
least some idea of the character of this cross-examination. It should be
stated, however, by way of preface, that Professor Petit-Radel had, just
before the discussion began, raised objections to Bayle’s failure, in
his thesis, to include in his list of inflammatory affections “the
whitish engorgements observed at times in different organs”; and he then
added the following remark: “You are not disposed, I assume, to
recognize the existence of Boerhaave’s ‘white inflammation.’”
(Here follows the first part of the stenographic report of the
cross-examination.)
BAYLE: “If in the affection to which you refer the swelling is
accompanied by pain, and if it terminates by undergoing
resolution or by suppuration, then I should say that it bore
some relationship to inflammation; but if there is neither
redness, pain, fever, nor suppuration, I should declare that it
possesses none of the characters which distinguish inflammatory
affections, and that consequently this so-called ‘white
inflammation’ should be considered by us as something imaginary.
At the same time I should not like to have anybody get the
impression, from what I have said, that I deny the existence of
such things as white tumors or swellings, indolent in character,
and either elastic or permitting the pressure of a finger to
leave the mark called ‘pitting’; I simply wish to emphasize the
fact that these affections do not manifest any of the
characteristics of an inflammatory disturbance.”
PETIT-RADEL: “Do you not believe that there exist certain kinds
of humors which possess the power of giving rise to a white
variety of inflammation?”
BAYLE: “As I do not know what this ‘white inflammation’ really
is, you must not expect me to entertain a clear idea of what its
immediate causes are; and even if I were personally familiar
with this type of ‘inflammation,’ it is more than likely that I
would wander far from the truth if I were to attempt to define
the particular kind of humor which causes this affection. It is
easy to say that bile, or some other humor that possesses a
sufficiently acrid character, is the exciting cause; and then I
might print what I have to say on the subject in a beautiful
book.[21] But of what use are all these hypothetical deductions;
why resort to pure operations of the imagination when we seek to
explain natural phenomena? Is it not better to say simply ‘I do
not know’ than to erect a pompous edifice on a foundation of
moving sand?”
PETIT-RADEL: “Very well, let us speak now of the treatment which
you recommend. Was it a wise thing to prescribe bleeding and
purgatives in the treatment of the gangrenous pustule which you
describe in your thesis?” etc.
[Illustration:
A candidate for the degree of “Doctor of Medicine” defending his
thesis before the examining committee of the Paris Faculty of
Medicine.
(From “_La Vie Universitaire_,” Paris, 1918.)
]
The remainder of the stenographic report is fully as interesting as the
first part, but I do not feel warranted in omitting equally important
text in order to find room for the report in its entirety. I will simply
state that, before the cross-examination was completed, Bayle had boldly
expressed the opinion that “there is nothing more harmful to the advance
of practical medicine than the cultivation of the spirit of system.”
Not long after Bayle received his degree of M.D. he succeeded in
obtaining, as the result of a competitive examination, one of the two
positions of House Physician (“_elève interne_”) which existed at La
Charité Hospital; and here, having at his disposal an extraordinary
amount of valuable material both clinical and pathological, and being
aided by the experienced guidance of Corvisart and Dumangin, he enjoyed
for about two years the most extensive opportunity for self-culture
which it is possible for a young physician—Bayle was only twenty-eight
in 1802—to have placed at his disposal. Being very industrious and also
extremely ambitious to excel he accumulated a great stock of knowledge
concerning the different forms of disease to which human beings are
subject. Not only did he store this knowledge up in the chambers of his
mind, but he also kept written records of everything that seemed to
possess value, for use at a later period of his life. This fact should
be remembered, for those who have had occasion to consult the numerous
treatises which Bayle has published, cannot have failed to wonder that
he should have been able to furnish so many and so complete histories of
cases that came under his personal observation. But alas! he failed to
realize that this sort of work was sapping his strength, and he also
seemed to ignore the fact that he was carrying within himself the seeds
of a pulmonary disease which was sure sooner or later to put an end to
his labors. Already as early as in August, 1804, he was seized with such
a violent nostalgia, such an irresistible longing for his beloved
mountains, that he was obliged to drop all work at _La Charité_ and
return to his home in the south of France. In addition to the nostalgia
there were loss of flesh, insomnia and a sense of oppression in the
chest. This change of scene, air and occupation proved rapidly
beneficial, for, at the end of fifteen days, he felt much stronger and
was able to sleep much more soundly than for many previous weeks. His
morale, too, was markedly improved; his hunger for mountain scenery and
air was now satisfied. Then, for several years after his return to
Paris, he remained in comparatively good health, and was able to attend
to an enormous amount of hospital and private practice, in addition to
literary work. But in 1813 the threatening chest symptoms again
compelled him to visit his beloved Alps and to spend several months with
his wife and children in their mountain home. This time, however, the
improvement in his health was much less pronounced than it was in 1804,
and very soon he found that he would have to abandon all active work.
His death took place on May 11, 1816, at the early age of forty-two.
According to the statement of Bayle’s biographer it was the unanimous
opinion of all the physicians who had come in frequent contact with him
during his professional career, especially in the course of his official
work at _La Charité_, that no physician of equally varied and great
attainments had previously been seen in Paris. Professors Chomel and
Cayol, and the famous Laënnec maintained that this was not too great
praise to bestow upon Bayle.
Of his published writings I shall mention here only a few of those which
attained some celebrity, viz.: “_Remarques sur les Tubercules_,” in the
_Journal de Médecine, Chirurgie, et Pharmacie_, tome 6, p. 1; tome 9, p.
427; and tome 10, p. 32.—“_Traité des Maladies Cancéreuses_,” 2 vols.,
Paris, 1833. (One of the earliest and certainly one of the most
elaborate treatises on this subject that is to be found in the entire
range of medical literature.)—“_Mémoire sur l’oedème de la Glotte_,” in
the _Dictionnaire des Sciences Médicales_.
* * * * *
JEAN-NICOLAS CORVISART, who was born February 15, 1775, at Drécourt, a
village in the Department of Ardennes, N. E. France, was destined by his
father to follow in his footsteps, in the career of an attorney; but the
son disliked the work more and more as time went on. Finally, he found
an opportunity of attending one of the lectures of Antoine Petit, who
was one of the most eloquent lecturers on anatomy in France during the
eighteenth century. He was completely fascinated by what he heard, and
at once determined that this was the only profession that he cared to
adopt. Accordingly, during the next few months he made a practice of
rising very early in the morning and finishing the clerical work which
had been assigned to him in his father’s office; thus gaining time to
attend the lectures of Petit, Louis, Desault and Vicq-d’Azyr. When the
father discovered what his son had been doing he made up his mind that
it would be useless to make any further attempts to keep him occupied
with work calculated to fit him for the career of an attorney.
Accordingly he allowed him to follow the regular course of studies
prescribed for those who intended to become physicians. At that early
date (about 1770), however, the regular medical course of training
carried out by the Faculty of Medicine was most unsatisfactory. For
example, the so-called regular course of lectures was not well adapted
to form an adequate basis of education for the student of medicine, and,
in addition, there was nothing that could be called clinical teaching.
In short, the student was obliged to pick up the knowledge which he
needed, in large measure by the exercise of his own wits. But Corvisart
was both eager to learn and very persevering, and he possessed such a
genius for picking out as his guides the very men who were best fitted
for imparting useful knowledge, that he managed to make satisfactory
advances despite all these obstacles. The instructors in whom he placed
the greatest confidence were Desbois de Rochefort, Head Physician of La
Charité Hospital, and Desault, Chief Surgeon of Hôtel-Dieu. These two
men, says Cuvier, were the most distinguished medical men of their day
in the art of curing disease. Desbois de Rochefort, for example, was the
first of the Parisian physicians to give regular clinical instruction in
the hospital with which he was connected, and Corvisart followed this
instruction regularly throughout a period of several years. He was also
present at most of the post-mortem examinations which took place during
de Rochefort’s service; in fact, he took the very deepest interest in
this part of the work. A prick of one of his fingers while he was
dissecting caused an infection which nearly cost him his life. It was on
this occasion that Desault, by his skill and by his untiring efforts to
control the manifestations of the disease, rendered him splendid
service.
[Illustration:
CORVISART
(Copied from an old French print in the possession of the New York
Academy of Medicine.)
]
Under such persistent and intelligent training it was not long before
Corvisart was himself able to give courses of instruction in anatomy and
physiology,—courses which rapidly became very popular with the students.
So far as dress was concerned, Molière succeeded in driving out of
fashion the gown and pointed bonnet which the physicians of that day
were still, in accordance with the custom of centuries, wearing; but he
failed to induce them to abandon the wig which they were expected to
wear when engaged in actual service in the hospital wards. This practice
continued in force until Hallé and Corvisart both got themselves into
trouble by refusing to wear a wig. In the case of Corvisart the
following story is told:—A well-known Paris lady (Madame Necker) had
just founded a fine hospital to which Corvisart hoped to be appointed
the Physician-in-Chief. When he first appeared in one of the wards in
his natural hair, the lady founder was much shocked, and declared
positively that she was not willing to assume the responsibility of
sanctioning any such novelty. Corvisart remained firm in his resolution
and the position was given to another physician.
Compensation for this disappointment, says Cuvier, came to Corvisart
soon afterward, in the following manner:—Père Potentine, the Superior of
the monks connected with La Charité Hospital, had been struck with the
faithful manner in which Corvisart had cared for the sick under his
charge. So, when Desbois-Rochefort, the pioneer clinical teacher in
Paris, died in 1788, he quickly determined that he would, if possible,
secure for Corvisart the important position which had just been vacated.
His efforts proved successful, and in a short time the new appointee was
attracting to La Charité a large number of students who were just as
appreciative of Corvisart’s clinical teachings as they had been of the
instruction given by his predecessor.
A few years later still—in 1802—he was asked to see in consultation
Bonaparte, who was suffering from an acute pulmonary attack; and on this
occasion he had the good fortune not only to discover the real cause of
the trouble but also to recommend the measures which resulted in curing
the disease.
Despite his great success, both as a teacher and as a practitioner,
Corvisart experienced his full share of professional disappointments,
and was, in consequence, often very much depressed by them. He was wont
to express in very plain terms his dislike for those treatises in which
the author assigned to each disease a list of sharply defined
characteristics, and which caused the reader to believe that the course
which it pursued was invariably the same; which spoke of disease, in
short, in such a manner as to convey to young men the impression that
the science of medicine was one of the physical sciences, and that both
diseases and the remedies to be employed might well be reduced to a
comparatively few forms. No such simplicity exists in nature; the number
of combinations is infinite, and each day the combination is likely to
be completely changed. The numerous autopsies which he had made
convinced Corvisart that similarly the internal changes vary just as
greatly as do the external signs and symptoms.
The two most important treatises of which Corvisart was the author are
his “Treatise on Diseases of the Heart” and his “Commentary on
Auenbrugger’s Work.” Nowhere in medical literature, says Cuvier, will
one find a more methodical or a more clearly written treatise on this
subject than the first of these treatises. In the second one the author
analyzes the different alterations in the lungs, bronchi and pleura
which may be distinguished by means of Auenbrugger’s method. In the form
which Corvisart has given to this second work we obtain the clearest
evidence of his generous character. Rather than rob this man who had
long been dead, and who was entirely unknown to him, of even a small
portion of what was his due, Corvisart preferred—to use the expression
employed by Cuvier—to immolate his own glory. It appears that before he
had learned anything whatever about the work that Auenbrugger had
published in 1763, he had himself made the majority of the discoveries
set forth in that author’s treatise and was making preparations to
publish them to the world. Just at this moment, however, he unexpectedly
found a copy of a French translation of Auenbrugger’s dissertation,
whereupon he abandoned his original plan and published instead the
“Commentaries.” In his preface he gives the following explanation of the
course which he adopted:—“I might have—if I had so wished—sacrificed the
name of Auenbrugger to my own vanity; but my object is to revive the
knowledge of his splendid and legitimate discovery.”
In 1789 Corvisart published the MSS. which Desbois de Rochefort had left
to him as trustee. Already in 1788, as stated on a previous page, he had
been appointed, by a unanimous vote, Physician to La Charité Hospital.
From the very start he took up with enthusiasm the work of clinical
instruction in this hospital, and kept it up for nearly twenty years,
thus gaining for himself—according to Dupuytren—the reputation of being
the leading medical practitioner of his day, and adding great
distinction to French medicine. In 1795, when the first _École de
Médecine_ was created, he was made “Clinical Professor of Medicine”; and
from this time forward, for a period of several years, he carried on the
work of clinical teaching practically without a rival.
In addition to the positions which he held at _l’École de Médecine_ and
at La Charité Hospital Corvisart was connected in some teaching capacity
with the _Collège de France_. At first he gave instruction in this
institution only in the theory of medicine, but after 1795 he was
formally installed in the College as a teacher of practical medicine;
and from this time forward he was able so to arrange his lectures that
those students who attended his clinical instruction at La Charité,
would be able to hear him, later in the day, explain more fully the
diagnosis, treatment, etc., which he had adopted in the morning. In his
manner of conducting these sittings Corvisart was largely guided by
Stoll’s “Aphorisms,” a practical work which combined the genius of
Boerhaave and that of Stoll,—a work in which problems and demonstrated
truth were most happily combined. Corvisart was so impressed with the
value of this treatise (“Aphorisms”) that he published a translation of
it in 1797.
As a lecturer Corvisart possessed an animated and sparkling style of
delivery and great clearness of expression. When asked why he improvised
these lectures before the students, instead of writing them out
beforehand, he said: “In lecturing I like to feel absolutely at my ease
and not to be under the restraint which one feels after a formal
preparation beforehand.”