Page:Encyclopædia Britannica, Ninth Edition, v. 15.djvu/848

816 MEDICINE [HISTORY. instruments, and so much so that he is said to have used 100,000 in his own hospital wards during one year. He was equalled if not surpassed in this excess by his follower Bouillaud, known for his important work on heart diseases. Broussais s system, to which he gave the name of " Me decine Physiologique" did much indirect good, in fixing attention upon morbid changes in the organs, and thus led to the rise of the strongly opposed anatomical and pathological school of Corvisart, Laennec, and Bayle. Jean Nicolas Corvisart (,1755-1821) has already been mentioned as the translator and introducer into France of Avenbrugger s work on percussion. He introduced some improvements in the method, but the only real advance was the introduction of mediate percussion by Piorry in 1828. The discovery had, however, yet to be completed by that of auscultation, or listening to sounds produced in the chest by breathing, the movements of the heart, &c. The combination of these methods constitutes what is now known as physical diagnosis. Ren6 Th6ophHe Hyacinths Laennec (1781-182G) was the inventor of this most important perhaps of all methods of medical research. Except for some trifling notices of sounds heard in certain diseases, this method was entirely new. It was definitely expounded in an almost complete form in his work De I auscultation mediate, published in 1819. Laennec attached undue importance to the use of the stethoscope, and laid too much weight on specific signs of specific diseases ; otherwise his method in its main features has remained unchanged. The result of his discovery was an entire revolution in the knowledge of diseases of the chest ; but it would be a mistake to forget that an essential factor in this revolution was the simultaneous study of the con dition of the diseased organs as seen after death. Without the latter, it is difficult to see how the information con veyed by sounds could ever have been verified. This increase of knowledge is therefore due, not to auscultation alone, but to auscultation combined with morbid anatomy. In the case of Laennec himself this qualification takes nothing from his fame, for he studied so minutely the relations of post-mortem appearances to symptoms during life that, had he not discovered auscultation, his researches in morbid anatomy would have made him famous. The pathologico-anatomical method was also followed with great zeal and success by Gaspard Laurent Bayle (1774- 1816), whose researches on tubercle, and the changes of the lungs and other organs in consumption, are the founda tion of most that has been done since his time. It was of course antecedent to the discovery of auscultation. Start ing from these men arose a school of physicians who endeavoured to give to the study of symptoms the same precision as belonged to anatomical observations, and by the combination of both methods made a new era in clinical medicine. Among these were Chomel (1788- 1858), Louis (1787-1872), Cruveilhier (1791-1874), and Andral (1797-1876). Louis, by his researches on pul monary consumption and typhoid fever, had the chief merit of refuting the doctrines of Broussais. In another respect also he aided in establishing an exact science of medicine by the introduction of the numerical or statistical method. By this method only can the fallacies which are attendant on drawing conclusions from isolated cases be avoided ; and thus the chief objection which has been made to regarding medicine as an inductive science has been removed. Louis s method was improved and systematized by Gavarret ; and its utility is now universally recognized. Space does not permit us to trace further the history of this brilliant period of French medicine, during which the superiority of the school of Paris could hardly be contested. We can only mention the names of Bretonneau (1771- 1862), Rostan (1790-18C6), D Alibert (1766-1837), Rayer (1793-1867), and Trousseau (1801-1866), the eloquent and popular teacher. English Medicine from 1800 t3 1840. The progress of medicine in England during this period displays the same characteristics as at other times, viz., a gradual and unin terrupted development, without startling changes such as are caused by the sudden rise or fall of a new school. Hardly any theoretical system is of English birth ; Erasmus Darwin (1731-1802), the grandfather of the great Charles Darwin, alone makes an exception. In his Zoonomia (1794) he expounded a theory of life and disease which had some resemblance to that of Brown, though arrived at (he says) by a different chain of reasoning. Darwin s work shows, however, the tendency to connect medicine with physical science, which was an immediate consequence of the scientific discoveries of the end of the 18th century, when Priestley and Cavendish in England exercised the same influence as Lavoisier in France. The English school of medicine was also profoundly stirred by the teachings of the two brothers William and John Hunter, especially the latter, who must therefore be briefly mentioned, though their own researches were chiefly concerned with subjects lying a little outside the limits of this sketch. William Hunter (1718-1783) was known in London as a brilliant teacher of anatomy and successful obstetric physician ; his younger brother and pupil, John Hunter (1728-1793), was also a teacher of anatomy, and practised as a surgeon. His immense contributions to anatomy and pathology cannot be estimated here, but his services in stimulating research and training investi gators belong to the history of general medicine. They are sufficiently evidenced by the fact that Jenner and Baillie were his pupils. The same scientific bent is seen in the greater attention paid to morbid anatomy (which dates from Baillie), and the more scientific method of studying diseases. An instance of the latter is the work of Robert Willan (1757-1812) on diseases of the skin, a department of medicine in which abstract and hypothetical views had been especially injurious. Willan, by following the natural- history method of Sydenham, at once put the study on a sound basis; and his work has been the starting point of the most important modern researches. About the same time William Charles Wells (1757-1817), a scientific investigator of remarkable power, and the author of a cele brated essay on dew, published observations on alterations in the urine, which, though little noticed at the time, were of great value as assisting in the important discovery made some years afterwards by Bright. These observers, and others who cannot be mentioned here, belong to the period when English medicine was still little influenced by the French school. Shortly after 1815, however, when the Continent was again open to English travellers, many English doctors studied in Paris, and the discoveries of their great French contemporaries began to be known. The method of auscultation was soon intro duced into this country by pupils of Laennec. John Forbes in 1824, and William Stokes of Dublin in 1825, published treatises on the use of the stethoscope. Forbes also translated the works of Laennec and Avenbrugger, and an entire revolution was soon effected in the knowledge of diseases of the chest. James Hope and Peter Mere Latham further developed this subject, and the former was also known for his researches in morbid anatomy. The com bination of clinical and anatomical research led, as in-the hands of the great French physicians, to important dis coveries by English investigators. The discovery by Richrrd Bright (1789-1858) of the disease of the kidneys known by his name, has proved to be one of the most

momentous of this century. It was published in Reports of