Page:Encyclopædia Britannica, Ninth Edition, v. 15.djvu/847

HISTORY.] MEDICINE 815 regret the waste of brilliant gifts and profound acquire ments winch they involved. It was fortunate, however, that the accumulation of positive knowledge in medicine did not cease. While Germany and Scotland, as the chief homes of abstract speculation, gave birth to most of the theories, progress in objective science was most marked in other countries, in Italy first, and afterwards in England and France. We must retrace our steps a little to enumerate several distinguished names which, from the nature of the case, hardly admit of classification. In Italy the tradition of the great anatomists and physiologists of the 17th century produced a series of accurate observers and practitioners. Among the first of these were Antonio Maria Valsalva (1666-1723), still better known as an anatomist ; Giovanni Maria Lancisi (1654-1720), also an anatomist, the author of a clas-ical work on the diseases of the heart and aneurisms ; and Ip- polito Francisco Albertini (1662-1738), whose researches on the same class of diseases were no less important. In France Jean Baptiste Se"nac (1693-1770) wrote also an important work on the affections of the heart. Sauvages, otherwise F. B. de Lacroix (1706-67), gave under the title Nosologia Methodica a natural-history classification of diseases ; Jean Astruc (1634-1766) con tributed to the knowledge of general diseases. But the state of medicine in that country till the end of the 18th century was unsatisfactory as compared with some other parts of Europe. In England the brilliancy of the early part of the century in practical medicine was hardly maintained to the end, and presented indeed a certain contrast with the remarkable and unflagging progress of surgery in the same period. The roll of the College of Physicians does not furnish many distinguished names. Among these should bs mentioned John Fothergill (1712-80), who investi- gated the " putrid sore throat " now called diphtheria, and the form of neuralgia popularly known as tic douloureux. A physician of Plymouth, John Huxham (1694-1768), made researches on epidemic fevers, in the spirit of Sydenham and Hippocrates, which are of the highest importance. William Heberden (1710-1801), a London physician, called by Samuel Johnson ultimus Itomctnorum, " the last of our learned physicians," left a rich legacy of practical observations in the Commentaries published after his death. More important in their results than any of these works were the discoveries of EDWARD JENNER (q.v.), respecting the prevention of small-pox by vaccina tion, in which he superseded the partially useful but dangerous practice of inoculation, which had been intro duced into England in 1721. The history of this dis covery need not be told here, but it may be pointed out that, apart from its practical importance, it has had great influence on the scientific study of infectious diseases. The name of John Pringle (1707-82) should also be mentioned as one of the first to study epidemics of fevers occurring in prisons and camps. His work entitled Obser vations on the Diseases of an Army was translated into many European languages, and became the standard authority on the subject. In Germany the only important school of practical medicine was that of Vienna, as revived by Van Swieteu (1700-72), a pupil of Boerhaave, under the patronage | of Maria Theresa. Van Swieten s commentaries on the aphorisms of Boerhaave are thought more valuable than the original text. Other eminent names of the same school are Anton de Haen (1704-76), Anton Storck (1731-1803), Maximilian Stoll (1742-88), and John Peter Frank (1745-1821), father of Joseph Frank before- ( mentioned as an adherent of the Brownian system, and like his son carried away for a time by the new doctrines. This, the old " Vienna School," was not distinguished for any notable discoveries, but for success in clinical teaching, and for its sound method of studying the actual facts of disease during life and after death, which largely contri buted to the establishment of the " positive medicine " of the 19th century. One novelty, however, of the first importance is due to a Vienna physician of the period, Leopold Aveiibrugger (1722-1809), the inventor of the method of recognizFng diseases of the chest by percussion. Avenbrugger s method was that of direct percussion with the tips of the fingers, not that which is now used, of mediate percussion with the intervention of a finger or plessimeter ; but the results of his method were the same, and its value nearly as great. Avenbrugger s great work, the Invention Novitm, was published in 1761. The new practice was received at first with contempt and even ridicule, and afterwards by Stvill and Peter Frank with only grudging approval. It did not receive due recognition till 1808, when Corvisart translated the Invention Novum into French, and Aven brugger s method rapidly attained a European reputation. Surpassed, but not eclipsed, by the still more important art of auscultation introduced by Laennec, it is hardly too much to say that this simple and purely mechanical invention has had more influence on the development of modern medicine than all the " systems " evolved by the most brilliant intellects of the 18th century. Early Part of the Wi Century. It is not possible to carry the history of medicine, in a sketch such as this, beyond the early years of the 19th century, both because the mass of details becomes so large as to require more minute treatment, and because it is difficult as we approach our own times to preserve the necessary historical per spective. It was, however, in this period that what we regard as the modern school of medicine was formed, and took the shape which it has preserved to our own days. The characteristic of the modern school is the adoption in medicine of the methods of research of physical science, and the gradually declining importance attached to theory and abstract reasoning, hypotheses, though not neglected, being used as means of research rather than as ultimate conclu sions. Its method may therefore be called the positive method, or that of rational empiricism. The growth of the new school was first seen in two European countries, in France and England, and must be separately followed in the two. Germany entered the field later. Rise of the Positive School in France. The reform of medicine in France must be dated from the great intel lectual awakening caused by the Revolution, but more definitely starts with the researches in anatomy and physiology of Marie Francois Xavier Bichat (1771-1802). The importance in science of Bichat s classical works, especially of the Anatomic generate, cannot be estimated here ; we can only point out their value as supplying a new basis for pathology or the science of disease. Among the most ardent of his followers was Francois Joseph Victor Broussais (1772-1838), whose theoretical views, partly founded on those of Brown and partly on the so-called vitalist school of Bordeu and Barthez, differed from these essentially in being avowedly based on ana tomical observations. Broussais s chief aim was to find an anatomical basis for all diseases, but he is especially known for his attempt to explain all fevers as a consequence of irritation or inflammation of the intestinal canal (gastro ente rite). A number of other maladies, especially general diseases and those commonly regarded as nervous, were attributed to the same cause. It would be impossible now to trace the steps which led to this wild and long since exploded theory. It led, among other consequences, to an

enormous misuse of bleeding. Leeches were his favourite