the evolution of modern medicine(现代医药的演变)-第44节
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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
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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
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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 was at its height； and when
the practical part of his art was overrun and stultified by vile and silly
nostrums〃 （〃Horae Subsecivae；〃 Vol。 I； 4th ed。； Edinburgh； 1882； p。 40）。
Listen to what he says upon the method of the study of medicine： 〃In
writing therefore； such a natural history of diseases； every merely
philosophical hypothesis should be set aside； and the manifest and natural
phenomena； however minute； should be noted with the utmost exactness。
The usefulness of this procedure cannot be easily overrated； as compared
with the subtle inquiries and trifling notions of modern writers； for can
there be a shorter； or indeed any other way of coming at the morbific
causes； or discovering the curative indications than by a certain perception
of the peculiar symptoms？ By these steps and helps it was that the father
of physic； the great Hippocrates； came to excel； his theory being no more
than an exact description or view of nature。 He found that nature alone
often terminates diseases； and works a cure with a few simple medicines；
and often enough with no medicines at all。〃
Towards the end of the century many great clinical teachers arose； of
whom perhaps the most famous was Boerhaave； often spoken of as the
Dutch Hippocrates； who inspired a group of distinguished students。 I have
already referred to the fact that Franciscus Sylvius at Leyden was the first
among the moderns to organize systematic clinical teaching。 Under
Boerhaave； this was so developed that to this Dutch university students
flocked from all parts of Europe。 After teaching botany and chemistry；
Boerhaave succeeded to the chair of physic in 1714。 With an unusually
wide general training； a profound knowledge of the chemistry of the day
and an accurate acquaintance with all aspects of the history of the
profession； he had a strongly objective attitude of mind towards disease；
following closely the methods of Hippocrates and Sydenham。 He adopted
no special system； but studied disease as one of the phenomena of nature。
His clinical lectures； held bi…weekly； became exceedingly popular and
were made attractive not less by the accuracy and care with which the
cases were studied than by the freedom from fanciful doctrines and the
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frank honesty of the man。 He was much greater than his published work
would indicate； and； as is the case with many teachers of the first rank； his
greatest contributions were his pupils。 No other teacher of modern times
has had such a following。 Among his favorite pupils may be mentioned
Haller； the physiologist； and van Swieten and de Haen； the founders of the
Vienna school。
In Italy； too； there were men who caught the new spirit； and
appreciated the v
