the evolution of modern medicine(现代医药的演变)-第43节
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＇40＇ Silvanus P。 Thompson： Gilbert of Colchester； Father of Electrical
Science； London； Chiswick Press； 1903； p。 3。
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CHAPTER V
THE RISE AND DEVELOPMENT OF MODERN MEDICINE
THE middle of the seventeenth century saw the profession thus far on
its waycertain objective features of disease were known； the art of
careful observation had been cultivated； many empirical remedies had
been discovered； the coarser structure of man's body had been well
worked out； and a good beginning had been made in the knowledge of
how the machinery workednothing more。 What disease really was；
where it was； how it was caused； had not even begun to be discussed
intelligently。
An empirical discovery of the first importance marks the middle of the
century。 The story of cinchona is of special interest； as it was the first great
specific in disease to be discovered。 In 1638； the wife of the Viceroy of
Peru； the Countess of Chinchon； lay sick of an intermittent fever in the
Palace of Lima。 A friend of her husband's； who had become acquainted
with the virtues； in fever； of the bark of a certain tree； sent a parcel of it to
the Viceroy； and the remedy administered by her physician； Don Juan del
Vego； rapidly effected a cure。 In 1640； the Countess returned to Spain；
bringing with her a supply of quina bark； which thus became known in
Europe as 〃the Countess's Powder〃 （pulvis Comitissae）。 A little later； her
doctor followed； bringing additional quantities。 Later in the century； the
Jesuit Fathers sent parcels of the bark to Rome； whence it was distributed
to the priests of the community and used for the cure of ague； hence the
name of 〃Jesuits' bark。〃 Its value was early recognized by Sydenham and
by Locke。 At first there was a great deal of opposition； and the Protestants
did not like it because of its introduction by the Jesuits。 The famous quack；
Robert Talbor； sold the secret of preparing quinquina to Louis XIV in 1679
for two thousand louis d'or； a pension and a title。 That the profession was
divided in opinion on the subject was probably due to sophistication； or to
the importation of other and inert barks。 It was well into the eighteenth
century before its virtues were universally acknowledged。 The tree itself
was not described until 1738； and Linnaeus established the genus
〃Chinchona〃 in honor of the Countess。＇1＇
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＇1＇ Clements R。 Markham： Peruvian Bark； John Murray； London； 1880；
Memoir of the Lady Anna di Osoria； Countess of Chinchona and Vice…
Queen of Peru； 1874。
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
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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）。
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＇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 Atki
