of cold for anesthesia, Claude Bernard's puncture of the fourth ventricle and his demonstration of the glycogenic function of the liver and of the vasomotor nerves; the discovery of Trichophyton tonsurans and Balantidium coli by Malmsten, the invention of the spirometer by Hutchinson and of the ophthalmoscope by Helmholtz, and the sphygmograph by Vierordt. Altogether Jacobi tells of a host of observations made in a short period of six years. And the list is not one of laboratory discoveries only. It includes important advances in clinical medicine and surgery, as Meigs's discovery of the importance of thrombosis as a cause of death in puerperal women, Marion Sims's vesico-vaginal operation, Detmold's operation for abscesses of the cranial cavity, Walker's work on the infectious nature of secondary syphilis, Romberg's studies of tabes dorsalis, Pravaz's invention of subcutaneous injection, Kuchenmeister's discovery of the connection between tænia and the scolex found in pork, Bigelow's resection of the femur and Bennet's work on leucocythemia.
More could be quoted from Jacobi's impression of this period, but this is enough to show that medicine was advancing not only in the laboratory, but in the clinic. One may, as Jacobi says, "recognize in my fragmentary enumeration, facts of crucial import."
These advances in clinical medicine and surgery were due to several factors; to the increasing use of the methods of physics, chemistry and biology, to the influence of pathology, to the introduction of new procedures in diagnosis, and in surgery, to the facility of operation offered by anesthesia. What a change in the practise of medicine these observations and applications brought about! How different their influence from that of the earlier schools and systems with which we associate the names of Brown, Cullen, Broussais, Hoffman and Stahl!
Such schools and systems, while of interest to the general historian of medicine, offer no assistance to one seeking the lines of advance dependent on investigation or research in medicine. Fortunately for the history of clinical medicine the systematists did not occupy the field to the exclusion of those guided by objective observation, for we find Sydenham (1624-1689) and Boerhaeve (1668-1738) studying disease unbiased by schools or systems, and applying the methods of close observation which we now recognize as those of modern clinical medicine. But although Sydenham and Boerhaeve and their followers aided progress by the addition of some positive knowledge to clinical medicine, their influence on the development of medicine was not great, for they were before the days of Morgagni, Haller, Hunter, Bichat and Rokitansky and the methods associated with these names. Without patho-
- Before and about the time of the period so represented, some of the important contributions made to clinical medicine and pathological anatomy were as follows: aneurism and diseases of the heart by Lancisi, Albertini and Senac; an investigation by Fothergill, of the diseases now known as diphtheria and tic--