the evolution of modern medicine-第35节

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A　step　in　advance　followed　the　objective　study　of　the　changes　wrought　in　the　body　by　disease。　　To　a　few　of　these　the　anatomists　had　already　called　attention。　　Vesalius；　always　keen　in　his　description　of　aberrations　from　the　normal；　was　one　of　the　first　to　describe　internal　aneurysm。　　The　truth　is；　even　the　best　of　men　had　little　or　no　appreciation　of　the　importance　of　the　study　of　these　changes。　Sydenham　scoffs　at　the　value　of　post…mortems。

Again　we　have　to　go　back　to　Italy　for　the　beginning　of　these　studies；　this　time　to　Florence；　in　the　glorious　days　of　Lorenzo　the　Magnificent。　The　pioneer　now　is　not　a　professor　but　a　general　practitioner；　Antonio　Benivieni；　of　whom　we　know　very　little　save　that　he　was　a　friend　of　Marsilio　Ficino　and　of　Angelo　Poliziano；　and　that　he　practiced　in　Florence　during　the　last　third　of　the　fifteenth　century；　dying　in　1502。　　Through　associations　with　the　scholars　of　the　day。　he　had　become　a　student　of　Greek　medicine　and　he　was　not　only　a　shrewd　and　accurate　observer　of　nature　but　a　bold　and　successful　practitioner。　He　had　formed　the　good　habit　of　making　brief　notes　of　his　more　important　cases；　and　after　his　death　these　were　found　by　his　brother　Jerome　and　published　in　1507。＇2＇　This　book　has　a　rare　value　as　the　record　of　the　experience　of　an　unusually　intelligent　practitioner　of　the　period。　There　are　in　all　111　observations；　most　of　them　commendably　brief。　The　only　one　of　any　length　deals　with　the　new　〃Morbus　Gallicus；〃　of　which；　in　the　short　period　between　its　appearance　and　Benivieni's　death；　he　had　seen　enough　to　leave　a　very　accurate　description；　and　it　is　interesting　to　note　that　even　in　those　early　days　mercury　was　employed　for　its　cure。　The　surgical　cases　are　of　exceptional　interest；　and　No。　38　refers　to　a　case　of　angina　for　which　he　performed　a　successful　operation。　This　is　supposed　to　have　been　a　tracheotomy；　and　if　so；　it　is　the　first　in　the　fourteen　centuries　that　had　elapsed　since　the　days　of　Antyllus。＇3＇　There　are　other　important　cases　which　show　that　he　was　a　dexterous　and　fearless　surgeon。　But　the　special　interest　of　the　work　for　us　is　that；　for　the　first　time　in　modern　literature；　we　have　reports　of　post…mortem　examinations　made　specifically　with　a　view　to　finding　out　the　exact　cause　of　death。　Among　the　111　cases；　there　are　post…mortem　records　of　cases　of　gallstones；　abscess　of　the　mesentery；　thrombosis　of　the　mesenteric　veins；　several　cases　of　heart　disease；　senile　gangrene　and　one　of　cor　villosum。　From　no　other　book　do　we　get　so　good　an　idea　of　a　practitioner's　experience　at　this　period；　the　notes　are　plain　and　straightforward；　and　singularly　free　from　all　theoretical　and　therapeutic　vagaries。　He　gives　several　remarkable　instances　of　faith　healing。

＇2＇　De　abditis　nonnullis　ac　mirandis　morborum　et　sanationum　causis。　8th；　Florence；　Gandhi；　1507。

＇3＇　Possibly　it　was　only　a　case　of　angina　Ludovici；　or　retro…pharyngeal　abscess。


To　know　accurately　the　anatomical　changes　that　take　place　in　disease　is　of　importance　both　for　diagnosis　and　for　treatment。　The　man　who　created　the　science；　who　taught　us　to　think　anatomically　of　disease；　was　Morgagni；　whose　〃De　sedibus　et　causis　morborum　per　anatomen　indagatis〃＇4＇　is　one　of　the　great　books　in　our　literature。　During　the　seventeenth　century；　the　practice　of　making　post…mortem　examinations　had　extended　greatly；　and　in　the　〃Sepulchretum　anatomicum〃　of　Bonetus　（1679）；　these　scattered　fragments　are　collected。＇5＇　But　the　work　of　Morgagni　is　of　a　different　type；　for　in　it　are　the　clinical　and　anatomical　observations　of　an　able　physician　during　a　long　and　active　life。　The　work　had　an　interesting　origin。　A　young　friend　interested　in　science　and　in　medicine　was　fond　of　discoursing　with　Morgagni　about　his　preceptors；　particularly　Valsalva　and　Albertini；　and　sometimes　the　young　man　inquired　about　Morgagni's　own　observations　and　thoughts。　Yielding　to　a　strong　wish；　Morgagni　consented　to　write　his　young　friend　familiar　letters　describing　his　experiences。　I　am　sorry　that　Morgagni　does　not　mention　the　name　of　the　man　to　whom　we　are　so　much　indebted；　and　who；　he　states；　was　so　pleased　with　the　letters　that　he　continually　solicited　him　to　send　more　and　more　〃till　he　drew　me　on　so　far　as　the　seventieth；　。　。　。　when　I　begged　them　of　him　in　order　to　revise　their　contents；　he　did　not　return　them；　till　he　had　made　me　solemnly　promise；　that　I　would　not　abridge　any　part　thereof〃　（Preface）。

＇4＇　Venice；　1761。

＇5＇　Boerhaave　remarked　that　if　a　man　wished　to　deserve　or　get　a　medical　degree　from　ONE　medical　author　let　it　be　this。　（James　Atkinson：　Medical　Bibliography；　1834；　268。）


Born　in　1682；　Morgagni　studied　at　Bologna　under　Valsalva　and　Albertini。　　In　1711；　he　was　elected　professor　of　medicine　at　Padua。　　He　published　numerous　anatomical　observations　and　several　smaller　works　of　less　importance。　　The　great　work　which　has　made　his　name　immortal　in　the　profession；　appeared　in　his　eightieth　year；　and　represents　the　accumulated　experience　of　a　long　life。　Though　written　in　the　form　of　letters；　the　work　is　arranged　systematically　and　has　an　index　of　exceptional　value。　From　no　section　does　one　get　a　better　idea　of　the　character　and　scope　of　the　work　than　from　that　relating　to　the　heart　and　arteriesaffections　of　the　pericardium；　diseases　of　the　valves；　ulceration；　rupture；　dilation　and　hypertrophy　and　affections　of　the　aorta　are　very　fully　described。　The　section　on　aneurysm　of　the　aorta　remains　one　of　the　best　ever　written。　　It　is　not　the　anatomical　observations　alone　that　make　the　work　of　unusual　value；　but　the　combination　of　clinical　with　anatomical　records。　What　could　be　more　correct　than　this　account　of　angina　pectorisprobably　the　first　in　the　literature？　〃A　lady　forty…two　years　of　age；　who　for　a　long　time；　had　been　a　valetudinarian；　and　within　the　same　period；　on　using　pretty　quick　exercise　of　body；　she　was　subject　to　attacks　of　violent　anguish　in　the　upper　part　of　the　chest　on　the　left　side；　accompanied　with　a　difficulty　of　breathing；　and　numbness　of　the　left　arm；　but　these　paroxysms　soon　subsided　when　she　ceased　from　exertion。　In　these　circumstances；　but　with　cheerfulness　of　mind；　she　undertook　a　journey　from　Venice；　purposing　to　travel　along　the　continent；　when　she　was　seized　with　a　paroxysm；　and　died　on　the　spot。　I　examined　the　body　on　the　following　day。。。。　The　aorta　was　considerably　dilated　at　its　curvature；　and；　in　places；　through　its　whole　tract；　the　inner　surface　was　unequal　and　ossified。　These　appearances　were　propagated　into　the　arteria　innominata。　The　aortic　valves　were　indurated。。。。〃　He　remarks；　〃The　delay　of　blood　in　the　aorta；　in　the　heart；　in　the　pulmonary　vessels；　and　in　the　vena　cave；　would　occasion　the　symptoms　of　which　the　woman　complained　during　life；　namely；　the　violent　uneasiness；　the　difficulty　of　breathing；　and　the　numbness　of　the　arm。〃＇6＇

＇6＇　Cooke's　Morgagni；　Vol。　1；　pp。　417…418。　I　cannot　too　warmly　commend　to　young　clinicians　the　reading　of　Morgagni。　　English　editions　are　availableAlexander's　three…volume　translation　of　1769　and　Cooke's　Abridgement　（London；　1822）；　of　which　there　was　an　American　edition　published　in　Boston　in　1824。


Morgagni's　life　had　as　much　influence　as　his　work。　In　close　correspondence　with　the　leading　men　of　the　day；　with　the　young　and　rising　teachers　and　workers；　his　methods　must　have　been　a　great　inspiration；　and　he　came　just　at　the　right　time。　The　profession　was　literally　ravaged　by　theories；　schools　and　systemsiatromechanics；　iatrochemistry；　humoralism；　the　animism　of　Stahl；　the　vitalistic　doctrines　of　Van　Helmont　and　his　followers　and　into　this　metaphysical　confusion　Morgagni　came　like　an　old　Greek　with　his　clear　observation；　sensible　thinking　and　ripe　scholarship。　Sprengel　well　remarks　that　〃it　is　hard　to　say　whether　one　should　admire　most　his　rare　dexterity　and　quickness　in　dissection；　his　unimpeachable　love　of　truth　and　justice　in　his　estimation　of　the　work　of　others；　his　extensive　scholarship　and　rich　classical　style　or　his　downright　common　sense　and　manly　speech。〃

Upon　this　solid　foundation　the　morbid　anatomy　of　modern　clinical　medicine　was　built。　　Many　of　Morgagni's　contemporaries　did　not　fully　appreciate　the　change　that　was　in　progress；　and　the　value　of　the　new　method　of　correlating　the　clinical　symptoms　and　the　morbid　appearances。　　After　all；　it　was　only　the　extension　of　the　Hippocratic　method　of　careful　observation　the　study　of　facts　from　which　reasonable　conclusions　could　be　drawn。　In　every　generation　there　had　been　men　of　this　typeI　dare　say　many　more　than　we　realizemen　of　the　Benivieni　character；　thoroughly　practical；　clear…headed　physicians。　　A　model　of　this　sort　arose　in　England　in　the　middle　of　the　seventeenth　century；　Thomas　Sydenham　（1624…1689）；　who　took　men　back　to　Hippocrates；　just　as　Harvey　had　led　them　back　to　Galen。　　Sydenham　broke　with　authority　and　went　to　nature。　　It　is　extraordinary　how　he　could　have　been　so　emancipated　from　dogmas　and　theories　of　all　sorts。　He　laid　down　the　fundamental　proposition；　and　acted　upon　it；　that　〃all　disease　could　be　described　as　natural　history。〃　To　do　him　justice　we　must　remember；　as　Dr。　John　Brown　says；　〃in　the　midst　of　what　a　mass　of　errors　and　prejudices；　of　theories　actively　mischievous；　he　was　placed；　at　a　time　when　the　mania　of　hypothesis　w