Modern Medicine : Part 1

The Evolution of Modern Medicine
by William Osler

(Page 6 of 12)

The Rise and Development of Modern Medicine

The middle of the seventeenth century saw the profession thus far on its way - certain objective features of disease were known, the art of careful observation had been cultivated, many empirical remedies had been discovered, the coarser structure of man's body had been well worked out, and a good beginning had been made in the knowledge of how the machinery worked - nothing more. What disease really was, where it was, how it was caused, had not even begun to be discussed intelligently.

An empirical discovery of the first importance marks the middle of the century. The story of cinchona is of special interest, as it was the first great specific in disease to be discovered. In 1638, the wife of the Viceroy of Peru, the Countess of Chinchon, lay sick of an intermittent fever in the Palace of Lima. A friend of her husband's, who had become acquainted with the virtues, in fever, of the bark of a certain tree, sent a parcel of it to the Viceroy, and the remedy administered by her physician, Don Juan del Vego, rapidly effected a cure. In 1640, the Countess returned to Spain, bringing with her a supply of quina bark, which thus became known in Europe as "the Countess's Powder".

A little later, her doctor followed, bringing additional quantities. Later in the century, the Jesuit Fathers sent parcels of the bark to Rome, whence it was distributed to the priests of the community and used for the cure of ague; hence the name of "Jesuits' bark." Its value was early recognized by Sydenham and by Locke. At first there was a great deal of opposition, and the Protestants did not like it because of its introduction by the Jesuits. The famous quack, Robert Talbor, sold the secret of preparing quinquina to Louis XIV in 1679 for two thousand louis d'or, a pension and a title. That the profession was divided in opinion on the subject was probably due to sophistication, or to the importation of other and inert barks. It was well into the eighteenth century before its virtues were universally acknowledged. The tree itself was not described until 1738, and Linnaeus established the genus "Chinchona" in honor of the Countess.

A step in advance followed the objective study of the changes wrought in the body by disease. To a few of these the anatomists had already called attention. Vesalius, always keen in his description of aberrations from the normal, was one of the first to describe internal aneurysm. The truth is, even the best of men had little or no appreciation of the importance of the study of these changes. Sydenham scoffs at the value of post-mortems.

Again we have to go back to Italy for the beginning of these studies, this time to Florence, in the glorious days of Lorenzo the Magnificent. The pioneer now is not a professor but a general practitioner, Antonio Benivieni, of whom we know very little save that he was a friend of Marsilio Ficino and of Angelo Poliziano, and that he practiced in Florence during the last third of the fifteenth century, dying in 1502. Through associations with the scholars of the day, he had become a student of Greek medicine and he was not only a shrewd and accurate observer of nature but a bold and successful practitioner. He had formed the good habit of making brief notes of his more important cases, and after his death these were found by his brother Jerome and published in 1507. This book has a rare value as the record of the experience of an unusually intelligent practitioner of the period. There are in all 111 observations, most of them commendably brief. The only one of any length deals with the new "Morbus Gallicus," of which, in the short period between its appearance and Benivieni's death, he had seen enough to leave a very accurate description; and it is interesting to note that even in those early days mercury was employed for its cure.

The surgical cases are of exceptional interest, and No. 38 refers to a case of angina for which he performed a successful operation. This is supposed to have been a tracheotomy, and if so, it is the first in the fourteen centuries that had elapsed since the days of Antyllus. There are other important cases which show that he was a dexterous and fearless surgeon. But the special interest of the work for us is that, for the first time in modern literature, we have reports of post-mortem examinations made specifically with a view to finding out the exact cause of death. Among the 111 cases, there are post-mortem records of cases of gallstones, abscess of the mesentery, thrombosis of the mesenteric veins, several cases of heart disease, senile gangrene and one of cor villosum. From no other book do we get so good an idea of a practitioner's experience at this period; the notes are plain and straightforward, and singularly free from all theoretical and therapeutic vagaries. He gives several remarkable instances of faith healing.

To know accurately the anatomical changes that take place in disease is of importance both for diagnosis and for treatment. The man who created the science, who taught us to think anatomically of disease, was Morgagni, whose "De sedibus et causis morborum per anatomen indagatis" is one of the great books in our literature. During the seventeenth century, the practice of making post-mortem examinations had extended greatly, and in the "Sepulchretum anatomicum" of Bonetus, these scattered fragments are collected. But the work of Morgagni is of a different type, for in it are the clinical and anatomical observations of an able physician during a long and active life. The work had an interesting origin.

A young friend interested in science and in medicine was fond of discoursing with Morgagni about his preceptors, particularly Valsalva and Albertini, and sometimes the young man inquired about Morgagni's own observations and thoughts. Yielding to a strong wish, Morgagni consented to write his young friend familiar letters describing his experiences. I am sorry that Morgagni does not mention the name of the man to whom we are so much indebted, and who, he states, was so pleased with the letters that he continually solicited him to send more and more "till he drew me on so far as the seventieth; . . . when I begged them of him in order to revise their contents; he did not return them, till he had made me solemnly promise, that I would not abridge any part thereof".

Born in 1682, Morgagni studied at Bologna under Valsalva and Albertini. In 1711, he was elected professor of medicine at Padua. He published numerous anatomical observations and several smaller works of less importance. The great work which has made his name immortal in the profession, appeared in his eightieth year, and represents the accumulated experience of a long life. Though written in the form of letters, the work is arranged systematically and has an index of exceptional value. From no section does one get a better idea of the character and scope of the work than from that relating to the heart and arteries - affections of the pericardium, diseases of the valves, ulceration, rupture, dilation and hypertrophy and affections of the aorta are very fully described. The section on aneurysm of the aorta remains one of the best ever written. It is not the anatomical observations alone that make the work of unusual value, but the combination of clinical with anatomical records.

About the Author

William Osler (1849 - 1919) was a Canadian physician. He has been called one of the greatest icons of modern medicine and the Father of Modern Medicine (which is what he himself considered Avicenna to be).