A History of Science, vol 4 - Henry Smith Williams (epub e ink reader .txt) 📗

scientific discovery, unless, perhaps,

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 DIAGNOSIS

Although 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 DISEASES

I 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