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in the single instance of the discovery of anaesthesia. In Geneva
and Holland clergymen advocated the practice of vaccination from
their pulpits; in some of the Latin countries religious
processions were formed for receiving vaccination; Jenner’s
birthday was celebrated as a feast in Germany; and the first
child vaccinated in Russia was named “Vaccinov” and educated at
public expense. In six years the discovery had penetrated to the
most remote corners of civilization; it had even reached some
savage nations. And in a few years smallpox had fallen from the
position of the most dreaded of all diseases to that of being
practically the only disease for which a sure and easy preventive
was known.
Honors were showered upon Jenner from the Old and the New World,
and even Napoleon, the bitter hater of the English, was among the
others who honored his name. On one occasion Jenner applied to
the Emperor for the release of certain Englishmen detained in
France. The petition was about to be rejected when the name of
the petitioner was mentioned. “Ah,” said Napoleon, “we can refuse
nothing to that name!”
It is difficult for us of to-day clearly to conceive the
greatness of Jenner’s triumph, for we can only vaguely realize
what a ruthless and ever-present scourge smallpox had been to all
previous generations of men since history began. Despite all
efforts to check it by medication and by direct inoculation, it
swept now and then over the earth as an all-devastating
pestilence, and year by year it claimed one-tenth of all the
beings in Christendom by death as its average quota of victims.
“From smallpox and love but few remain free,” ran the old saw. A
pitted face was almost as much a matter of course a hundred years
ago as a smooth one is to-day.
Little wonder, then, that the world gave eager acceptance to
Jenner’s discovery. No urging was needed to induce the majority
to give it trial; passengers on a burning ship do not hold aloof
from the life-boats. Rich and poor, high and low, sought succor
in vaccination and blessed the name of their deliverer. Of all
the great names that were before the world in the closing days of
the century, there was perhaps no other one at once so widely
known and so uniformly reverenced as that of the great English
physician Edward Jenner. Surely there was no other one that
should be recalled with greater gratitude by posterity.
VIII. NINETEENTH-CENTURY MEDICINE
PHYSICAL DIAGNOSISAlthough Napoleon Bonaparte, First Consul, was not lacking in
self-appreciation, he probably did not realize that in selecting
a physician for his own needs he was markedly influencing the
progress of medical science as a whole. Yet so strangely are
cause and effect adjusted in human affairs that this simple act
of the First Consul had that very unexpected effect. For the man
chosen was the envoy of a new method in medical practice, and the
fame which came to him through being physician to the First
Consul, and subsequently to the Emperor, enabled him to
promulgate the method in a way otherwise impracticable. Hence the
indirect but telling value to medical science of Napoleon’s
selection.
The physician in question was Jean Nicolas de Corvisart. His
novel method was nothing more startling than the now-familiar
procedure of tapping the chest of a patient to elicit sounds
indicative of diseased tissues within. Every one has seen this
done commonly enough in our day, but at the beginning of the
century Corvisart, and perhaps some of his pupils, were probably
the only physicians in the world who resorted to this simple and
useful procedure. Hence Napoleon’s surprise when, on calling in
Corvisart, after becoming somewhat dissatisfied with his other
physicians Pinel and Portal, his physical condition was
interrogated in this strange manner. With characteristic
shrewdness Bonaparte saw the utility of the method, and the
physician who thus attempted to substitute scientific method for
guess-work in the diagnosis of disease at once found favor in his
eyes and was installed as his regular medical adviser.
For fifteen years before this Corvisart had practised percussion,
as the chest-tapping method is called, without succeeding in
convincing the profession of its value. The method itself, it
should be added, had not originated with Corvisart, nor did the
French physician for a moment claim it as his own. The true
originator of the practice was the German physician Avenbrugger,
who published a book about it as early as 1761. This book had
even been translated into French, then the language of
international communication everywhere, by Roziere de la
Chassagne, of Montpellier, in 1770; but no one other than
Corvisart appears to have paid any attention to either original
or translation. It was far otherwise, however, when Corvisart
translated Avenbrugger’s work anew, with important additions of
his own, in 1808.
“I know very well how little reputation is allotted to translator
and commentators,” writes Corvisart, “and I might easily have
elevated myself to the rank of an author if I had elaborated anew
the doctrine of Avenbrugger and published an independent work on
percussion. In this way, however, I should have sacrificed the
name of Avenbrugger to my own vanity, a thing which I am
unwilling to do. It is he, and the beautiful invention which of
right belongs to him, that I desire to recall to life.”[1]
By this time a reaction had set in against the metaphysical
methods in medicine that had previously been so alluring; the
scientific spirit of the time was making itself felt in medical
practice; and this, combined with Corvisart’s fame, brought the
method of percussion into immediate and well-deserved popularity.
Thus was laid the foundation for the method of so-called physical
diagnosis, which is one of the corner-stones of modern medicine.
The method of physical diagnosis as practised in our day was by
no means completed, however, with the work of Corvisart.
Percussion alone tells much less than half the story that may be
elicited from the organs of the chest by proper interrogation.
The remainder of the story can only be learned by applying the
ear itself to the chest, directly or indirectly. Simple as this
seems, no one thought of practising it for some years after
Corvisart had shown the value of percussion.
Then, in 1815, another Paris physician, Rene Theophile Hyacinthe
Laennec, discovered, almost by accident, that the sound of the
heart-beat could be heard surprisingly through a cylinder of
paper held to the ear and against the patient’s chest. Acting on
the hint thus received, Laennec substituted a hollow cylinder of
wood for the paper, and found himself provided with an instrument
through which not merely heart sounds but murmurs of the lungs in
respiration could be heard with almost startling distinctness.
The possibility of associating the varying chest sounds with
diseased conditions of the organs within appealed to the fertile
mind of Laennec as opening new vistas in therapeutics, which he
determined to enter to the fullest extent practicable. His
connection with the hospitals of Paris gave him full opportunity
in this direction, and his labors of the next few years served
not merely to establish the value of the new method as an aid to
diagnosis, but laid the foundation also for the science of morbid
anatomy. In 1819 Laennec published the results of his labors in
a work called Traite d’Auscultation Mediate,[2] a work which
forms one of the landmarks of scientific medicine. By mediate
auscultation is meant, of course, the interrogation of the chest
with the aid of the little instrument already referred to, an
instrument which its originator thought hardly worth naming until
various barbarous appellations were applied to it by others,
after which Laennec decided to call it the stethoscope, a name
which it has ever since retained.
In subsequent years the form of the stethoscope, as usually
employed, was modified and its value augmented by a binauricular
attachment, and in very recent years a further improvement has
been made through application of the principle of the telephone;
but the essentials of auscultation with the stethoscope were
established in much detail by Laennec, and the honor must always
be his of thus taking one of the longest single steps by which
practical medicine has in our century acquired the right to be
considered a rational science. Laennec’s efforts cost him his
life, for he died in 1826 of a lung disease acquired in the
course of his hospital practice; but even before this his fame
was universal, and the value of his method had been recognized
all over the world. Not long after, in 1828, yet another French
physician, Piorry, perfected the method of percussion by
introducing the custom of tapping, not the chest directly, but
the finger or a small metal or hard-rubber plate held against the
chest-mediate percussion, in short. This perfected the methods
of physical diagnosis of diseases of the chest in all essentials;
and from that day till this percussion and auscultation have held
an unquestioned place in the regular armamentarium of the
physician.
Coupled with the new method of physical diagnosis in the effort
to substitute knowledge for guess-work came the studies of the
experimental physiologists—in particular, Marshall Hall in
England and Francois Magendie in France; and the joint efforts of
these various workers led presently to the abandonment of those
severe and often irrational depletive methods—blood-letting and
the like—that had previously dominated medical practice. To this
end also the “statistical method,” introduced by Louis and his
followers, largely contributed; and by the close of the first
third of our century the idea was gaining ground that the
province of therapeutics is to aid nature in combating disease,
and that this may often be accomplished better by simple means
than by the heroic measures hitherto thought necessary. In a
word, scientific empiricism was beginning to gain a hearing in
medicine as against the metaphysical preconceptions of the
earlier generations.
PARASITIC DISEASESI have just adverted to the fact that Napoleon Bonaparte, as
First Consul and as Emperor, was the victim of a malady which
caused him to seek the advice of the most distinguished
physicians of Paris. It is a little shocking to modern
sensibilities to read that these physicians, except Corvisart,
diagnosed the distinguished patient’s malady as “gale
repercutee”—that is to say, in idiomatic English, the itch
“struck in.” It is hardly necessary to say that no physician of
today would make so inconsiderate a diagnosis in the case of a
royal patient. If by any chance a distinguished patient were
afflicted with the itch, the sagacious physician would carefully
hide the fact behind circumlocutions and proceed to eradicate the
disease with all despatch. That the physicians of Napoleon did
otherwise is evidence that at the beginning of the century the
disease in question enjoyed a very different status. At that
time itch, instead of being a most plebeian malady, was, so to
say, a court disease. It enjoyed a circulation, in high circles
and in low, that modern therapeutics has quite denied it; and the
physicians of the time gave it a fictitious added importance by
ascribing to its influence the existence of almost any obscure
malady that came under their observation. Long after Napoleon’s
time gale continued to hold this proud distinction. For example,
the imaginative Dr. Hahnemann did not hesitate to affirm, as a
positive maxim, that three-fourths of all the ills that flesh is
heir to were in reality nothing but various forms of “gale
repercutee.”
All of which goes to show how easy it may be for a masked
pretender to impose on credulous humanity, for nothing is more
clearly established in modern knowledge than the fact that “gale
repercutee” was simply a name to hide a profound ignorance; no
such disease exists or ever did exist. Gale itself is a
sufficiently tangible
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