the evolution of modern medicine-第37节
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linical teaching whose method remains in vogue today in Francethe ward visit； followed by a systematic lecture in the amphitheatre。 There were still lectures on Hippocrates three times a week； and bleeding was the principal plan of treatment： one morning Frank saw thirty patients； out of one hundred and twelve； bled！ Corvisart was the strong clinician of his generation； and his accurate studies on the heart were among the first that had concentrated attention upon a special organ。 To him； too； is due the reintroduction of the art of percussion in internal disease discovered by Auenbrugger in 1761。
＇10＇ Joseph Frank： Reise nach Paris ＇etc。＇； Wien； 1804…05。
The man who gave the greatest impetus to the study of scientific medicine at this time was Bichat； who pointed out that the pathological changes in disease were not so much in organs as in tissues。 His studies laid the foundation of modern histology。 He separated the chief constituent elements of the body into various tissues possessing definite physical and vital qualities。 〃Sensibility and contractability are the fundamental qualities of living matter and of the life of our tissues。 Thus Bichat substituted for vital forces 'vital properties；' that is to say； a series of vital forces inherent in the different tissues。〃＇11＇ His 〃Anatomic Generale；〃 published in 1802； gave an extraordinary stimulus to the study of the finer processes of disease； and his famous 〃Recherches sur la Vie et sur la Mort〃 （1800） dealt a death…blow to old iatromechanical and iatrochemical views。 His celebrated definition may be quoted： 〃La vie est l'ensemble des proprietes vitales qui resistent aux proprietes physiques； ou bien la vie est l'ensemble des fonctions qui resistent a la mort。〃 （Life is the sum of the vital properties that withstand the physical properties； or； life is the sum of the functions that withstand death。） Bichat is another pathetic figure in medical history。 His meteoric career ended in his thirty…first year： he died a victim of a post…mortem wound infection。 At his death； Corvisart wrote Napoleon： 〃Bichat has just died at the age of thirty。 That battlefield on which he fell is one which demands courage and claims many victims。 He has advanced the science of medicine。 No one at his age has done so much so well。〃
＇11＇ E。 Boinet： Les doctrines medicules； leur evolution； Paris； 1907； pp。 85…86。
It was a pupil of Corvisart； Rene Theophile Laennec； who laid the foundation of modern clinical medicine。 The story of his life is well known。 A Breton by birth； he had a hard； up…hill struggle as a young mana struggle of which we have only recently been made aware by the publication of a charming book by Professor Rouxeau of Nantes〃Laennec avant 1806。〃 Influenced by Corvisart； he began to combine the accurate study of cases in the wards with anatomical investigations in the dead…house。 Before Laennec； the examination of a patient had been largely by sense of sight； supplemented by that of touch； as in estimating the degree of fever； or the character of the pulse。 Auenbrugger's 〃Inventum novum〃 of percussion； recognized by Corvisart； extended the field； but the discovery of auscultation by Laennec； and the publication of his work〃De l'Auscultation Mediate；〃 1819；marked an era in the study of medicine。 The clinical recognition of individual diseases had made really very little progress； with the stethoscope begins the day of physical diagnosis。 The clinical pathology of the heart； lungs and abdomen was revolutionized。 Laennec's book is in the category of the eight or ten greatest contributions to the science of medicine。＇*＇ His description of tuberculosis is perhaps the most masterly chapter in clinical medicine。 This revolution was effected by a simple extension of the Hippocratic method from the bed to the dead…house； and by correlating the signs and symptoms of a disease with its anatomical appearances。
＇*＇ John Forbes's translation of Auenbrugger and part of his translation of Lacnnec are reprinted in Camac's Epoch…making Contributions； etc。； 1909。Ed。
The pupils and successors of CorvisartBayle； Andral； Bouillaud； Chomel； Piorry； Bretonneau； Rayer； Cruveilhier and Trousseau brought a new spirit into the profession。 Everywhere the investigation of disease by clinical…pathological methods widened enormously the diagnostic powers of the physician。 By this method Richard Bright； in 1836； opened a new chapter on the relation of disease of the kidney to dropsy； and to albuminous urine。 It had already been shown by Blackwell and by Wells； the celebrated Charleston （S。C。） physician； in 1811； that the urine contained albumin in many cases of dropsy； but it was not until Bright began a careful investigation of the bodies of patients who had presented these symptoms； that he discovered the association of various forms of disease of the kidney with anasarca and albuminous urine。 In no direction was the harvest of this combined study more abundant than in the complicated and confused subject of fever。 The work of Louis and of his pupils； W。W。 Gerhard and others； revealed the distinction between typhus and typhoid fever； and so cleared up one of the most obscure problems in pathology。 By Morgagni's method of 〃anatomical thinking；〃 Skoda in Vienna； Schonlein in Berlin； Graves and Stokes in Dublin； Marshall Hall； C。 J。 B。 Williams and many others introduced the new and exact methods of the French and created a new clinical medicine。 A very strong impetus was given by the researches of Virchow on cellular pathology； which removed the seats of disease from the tissues； as taught by Bichat； to the individual elements； the cells。 The introduction of the use of the microscope in clinical work widened greatly our powers of diagnosis； and we obtained thereby a very much clearer conception of the actual processes of disease。 In another way； too； medicine was greatly helped by the rise of experimental pathology； which had been introduced by John Hunter； was carried along by Magendie and others； and reached its culmination in the epoch…making researches of Claude Bernard。 Not only were valuable studies made on the action of drugs； but also our knowledge of cardiac pathology was revolutionized by the work of Traube； Cohnheim and others。 In no direction did the experimental method effect such a revolution as in our knowledge of the functions of the brain。 Clinical neurology； which had received a great impetus by the studies of Todd； Romberg； Lockhart Clarke； Duchenne and Weir Mitchell； was completely revolutionized by the experimental work of Hitzig； Fritsch and Ferrier on the localization of functions in the brain。 Under Charcot； the school of French neurologists gave great accuracy to the diagnosis of obscure affections of the brain and spinal cord； and the combined results of the new anatomical； physiological and experimental work have rendered clear and definite what was formerly the most obscure and complicated section of internal medicine。 The end of the fifth decade of the century is marked by a discovery of supreme importance。 Humphry Davy had noted the effects of nitrous oxide。 The exhilarating influence of sulphuric ether had been casually studied； and Long of Georgia had made patients inhale the vapor until anaesthetic and had performed operations upon them when in this state； but it was not until October 16； 1846； in the Massachusetts General Hospital； that Morton； in a public operating room； rendered a patient insensible with ether and demonstrated the utility of surgical anaesthesia。 The rival claims of priority no longer interest us； but the occasion is one of the most memorable in the history of the race。 It is well that our colleagues celebrate Ether Day in Boston no more precious boon has ever been granted to suffering humanity。＇*＇
＇*＇ Cf。 Osler： Proc。 Roy。 Soc。 Med。； XI； Sect。 Hist。 Med。； pp。 65…69； 1918； or； Annals Med。 Hist。； N。Y。； I； 329…332。 Cf。 also Morton's publications reprinted in Camac's book cited above。Ed。
In 1857； a young man； Louis Pasteur； sent to the Lille Scientific Society a paper on 〃Lactic Acid Fermentation〃 and in December of the same year presented to the Academy of Sciences in Paris a paper on 〃Alcoholic Fermentation〃 in which he concluded that 〃the deduplication of sugar into alcohol and carbonic acid is correlative to a phenomenon of life。〃 A new era in medicine dates from those two publications。 The story of Pasteur's life should be read by every student。＇*＇ It is one of the glories of human literature； and； as a record of achievement and of nobility of character； is almost without an equal。
＇*＇ Osler wrote a preface for the 1911 English edition of the Life by Vallery…Radot。Ed。
At the middle of the last century we did not know much more of the actual causes of the great scourges of the race； the plagues； the fevers and the pestilences； than did the Greeks。 Here comes Pasteur's great work。 Before him Egyptian darkness； with his advent a light that brightens more and more as the years give us ever fuller knowledge。 The facts that fevers were catching； that epidemics spread； that infection could remain attached to articles of clothing； etc。； all gave support to the view that the actual cause was something alive； a contagium vi
