the evolution of modern medicine(现代医药的演变)-第45节
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In Italy； too； there were men who caught the new spirit； and
appreciated the value of combining morbid anatomy with clinical
medicine。 Lancisi； one of the early students of disease of the heart； left an
excellent monograph on the subject； and was the first to call special
attention to the association of syphilis with cardio…vascular disease。 A
younger contemporary of his at Rome； Baglivi； was unceasing in his call
to the profession to return to Hippocratic methods； to stop reading
philosophical theories and to give up what he calls the 〃fatal itch〃 to make
systems。
The Leyden methods of instruction were carried far and wide
throughout Europe； into Edinburgh by John Rutherford； who began to
teach at the Royal Infirmary in 1747； and was followed by Whytt and by
Cullen； into England by William Saunders of Guy's Hospital。
Unfortunately the great majority of clinicians could not get away from the
theoretical conceptions of disease； and Cullen's theory of spasm and atony
exercised a profound influence on practice； particularly in this country；
where it had the warm advocacy of Benjamin Rush。 Even more
widespread became the theories of a pupil of Cullen's； John Brown； who
regarded excitability as the fundamental property of all living creatures：
too much of this excitability produced what were known as sthenic
maladies； too little； asthenic； on which principles practice was plain
enough。 Few systems of medicine have ever stirred such bitter controversy；
particularly on the Continent； and in Charles Creighton's account of
Brown＇7＇ we read that as late as 1802 the University of Gottingen was so
convulsed by controversies as to the merits of the Brunonian system that
contending factions of students in enormous numbers； not unaided by the
professors； met in combat in the streets on two consecutive days and had
to be dispersed by a troop of Hanoverian horse。
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＇7＇ Dictionary of National Biography； London； 1886； VII； 14…17。
But the man who combined the qualities of Vesalius； Harvey and
Morgagni in an extraordinary personality was John Hunter。 He was； in the
first place； a naturalist to whom pathological processes were only a small
part of a stupendous whole； governed by law； which； however； could never
be understood until the facts had been accumulated； tabulated and
systematized。 By his example； by his prodigious industry； and by his
suggestive experiments he led men again into the old paths of Aristotle；
Galen and Harvey。 He made all thinking physicians naturalists； and he lent
a dignity to the study of organic life； and re…established a close union
between medicine and the natural sciences。 Both in Britain and Greater
Britain； he laid the foundation of the great collections and museums；
particularly those connected with the medical schools。 The Wistar…Horner
and the Warren Museums in this country originated with men greatly
influenced by Hunter。 He was； moreover； the intellectual father of that
interesting group of men on this side of the Atlantic who； while practising
as physicians； devoted much time and labor to the study of natural history；
such men as Benjamin Smith Barton； David Hossack； Jacob Bigelow；
Richard Harlan； John D。 Godman； Samuel George Morton； John Collins
Warren； Samuel L。 Mitchill and J。 Ailken Meigs。 He gave an immense
impetus in Great Britain to the study of morbid anatomy； and his nephew；
Matthew Baillie； published the first important book on the subject in the
English language。
Before the eighteenth century closed practical medicine had made
great advance。 Smallpox； though not one of the great scourges like plague
or cholera； was a prevalent and much dreaded disease； and in civilized
countries few reached adult life without an attack。 Edward Jenner； a
practitioner in Gloucestershire； and the pupil to whom John Hunter gave
the famous advice： 〃Don't think； try！〃 had noticed that milkmaids who had
been infected with cowpox from the udder of the cow were insusceptible
to smallpox。 I show you here the hand of Sarah Nelmes with cowpox；
1796。 A vague notion had prevailed among the dairies from time
immemorial that this disease was a preventive of the smallpox。 Jenner put
the matter to the test of experiment。 Let me quote here his own words：
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〃The first experiment was made upon a lad of the name of Phipps； in
whose arm a little vaccine virus was inserted； taken from the hand of a
young woman who had been accidentally infected by a cow。
Notwithstanding the resemblance which the pustule； thus excited on the
boy's arm； bore to variolous inoculation； yet as the indisposition attending
it was barely perceptible； I could scarcely persuade myself the patient was
secure from the Small Pox。 However； on his being inoculated some
months afterwards； it proved that he was secure。〃＇8＇ The results of his
experiments were published in a famous small quarto volume in 1798。＇*＇
From this date； smallpox has been under control。 Thanks to Jenner； not a
single person in this audience is pockmarked！ A hundred and twenty…five
years ago； the faces of more than half of you would have been scarred。 We
now know the principle upon which protection is secured： an active
acquired immunity follows upon an attack of a disease of a similar nature。
Smallpox and cowpox are closely allied and the substances formed in the
blood by the one are resistant to the virus of the other。 I do not see how
any reasonable person can oppose vaccination or decry its benefits。 I show
you the mortality figures＇9＇ of the Prussian Army and of the German
Empire。 A comparison with the statistics of the armies of other European
countries in which revaccination is not so thoroughly carried out is most
convincing of its efficacy。
＇8＇ Edward Jenner： The Origin of the Vaccine Inoculation； London；
1801。
＇*＇ Reprinted by Camac： Epoch…making Contributions to Medicine；
etc。； 1909。Ed。
＇9＇ Jockmann： Pocken und Vaccinationlehre； 1913。
The early years of the century saw the rise of modern clinical
medicine in Paris。 In the art of observation men had come to a standstill。 I
doubt very much whether Corvisart in 1800 was any more skilful in
recognizing a case of pneumonia than was Aretaeus in the second century
A。 D。 But disease had come to be more systematically studied； special
clinics were organized； and teaching became much more thorough。
Anyone who wishes to have a picture of the medical schools in Europe in
the first few years of the century； should read the account of the travels of
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Joseph Frank of Vienna。＇10＇ The description of Corvisart is of a pioneer in
clinical 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 th
