Modern Medicine : Part 4

The Evolution of Modern Medicine
by William Osler

(Page 9 of 12)

Auenbrugger's "Inventum novum" of percussion, recognized by Corvisart, extended the field; but the discovery of auscultation by Laennec, and the publication of his work - "De l'Auscultation Mediate," 1819, - marked an era in the study of medicine. The clinical recognition of individual diseases had made really very little progress; with the stethoscope begins the day of physical diagnosis. The clinical pathology of the heart, lungs and abdomen was revolutionized. Laennec's book is in the category of the eight or ten greatest contributions to the science of medicine. His description of tuberculosis is perhaps the most masterly chapter in clinical medicine. This revolution was effected by a simple extension of the Hippocratic method from the bed to the dead-house, and by correlating the signs and symptoms of a disease with its anatomical appearances.

The pupils and successors of Corvisart - Bayle, Andral, Bouillaud, Chomel, Piorry, Bretonneau, Rayer, Cruveilhier and Trousseau - brought a new spirit into the profession. Everywhere the investigation of disease by clinical-pathological methods widened enormously the diagnostic powers of the physician. By this method Richard Bright, in 1836, opened a new chapter on the relation of disease of the kidney to dropsy, and to albuminous urine. It had already been shown by Blackwell and by Wells, the celebrated Charleston physician, in 1811, that the urine contained albumin in many cases of dropsy, but it was not until Bright began a careful investigation of the bodies of patients who had presented these symptoms, that he discovered the association of various forms of disease of the kidney with anasarca and albuminous urine. In no direction was the harvest of this combined study more abundant than in the complicated and confused subject of fever.

The work of Louis and of his pupils, W.W. Gerhard and others, revealed the distinction between typhus and typhoid fever, and so cleared up one of the most obscure problems in pathology. By Morgagni's method of "anatomical thinking," Skoda in Vienna, Schonlein in Berlin, Graves and Stokes in Dublin, Marshall Hall, C. J. B. Williams and many others introduced the new and exact methods of the French and created a new clinical medicine. A very strong impetus was given by the researches of Virchow on cellular pathology, which removed the seats of disease from the tissues, as taught by Bichat, to the individual elements, the cells. The introduction of the use of the microscope in clinical work widened greatly our powers of diagnosis, and we obtained thereby a very much clearer conception of the actual processes of disease.

In another way, too, medicine was greatly helped by the rise of experimental pathology, which had been introduced by John Hunter, was carried along by Magendie and others, and reached its culmination in the epoch-making researches of Claude Bernard. Not only were valuable studies made on the action of drugs, but also our knowledge of cardiac pathology was revolutionized by the work of Traube, Cohnheim and others. In no direction did the experimental method effect such a revolution as in our knowledge of the functions of the brain. Clinical neurology, which had received a great impetus by the studies of Todd, Romberg, Lockhart Clarke, Duchenne and Weir Mitchell, was completely revolutionized by the experimental work of Hitzig, Fritsch and Ferrier on the localization of functions in the brain. Under Charcot, the school of French neurologists gave great accuracy to the diagnosis of obscure affections of the brain and spinal cord, and the combined results of the new anatomical, physiological and experimental work have rendered clear and definite what was formerly the most obscure and complicated section of internal medicine.

The end of the fifth decade of the century is marked by a discovery of supreme importance. Humphry Davy had noted the effects of nitrous oxide. The exhilarating influence of sulphuric ether had been casually studied, and Long of Georgia had made patients inhale the vapor until anesthetic and had performed operations upon them when in this state; but it was not until October 16, 1846, in the Massachusetts General Hospital, that Morton, in a public operating room, rendered a patient insensible with ether and demonstrated the utility of surgical anesthesia. The rival claims of priority no longer interest us, but the occasion is one of the most memorable in the history of the race. It is well that our colleagues celebrate Ether Day in Boston - no more precious boon has ever been granted to suffering humanity.

In 1857, a young man, Louis Pasteur, sent to the Lille Scientific Society a paper on "Lactic Acid Fermentation" and in December of the same year presented to the Academy of Sciences in Paris a paper on "Alcoholic Fermentation" in which he concluded that "the deduplication of sugar into alcohol and carbonic acid is correlative to a phenomenon of life." A new era in medicine dates from those two publications. The story of Pasteur's life should be read by every student. It is one of the glories of human literature, and, as a record of achievement and of nobility of character, is almost without an equal.

At the middle of the last century we did not know much more of the actual causes of the great scourges of the race, the plagues, the fevers and the pestilences, than did the Greeks. Here comes Pasteur's great work. Before him Egyptian darkness; with his advent a light that brightens more and more as the years give us ever fuller knowledge. The facts that fevers were catching, that epidemics spread, that infection could remain attached to articles of clothing, etc., all gave support to the view that the actual cause was something alive, a contagium vivum. It was really a very old view, the germs of which may be found in the Fathers, but which was first clearly expressed - so far as I know - by Fracastorius, the Veronese physician, in the sixteenth century, who spoke of the seeds of contagion passing from one person to another; and he first drew a parallel between the processes of contagion and the fermentation of wine. This was more than one hundred years before Kircher, Leeuwenhoek and others began to use the microscope and to see animalcula, etc., in water, and so give a basis for the "infinitely little" view of the nature of disease germs. And it was a study of the processes of fermentation that led Pasteur to the sure ground on which we now stand.

Out of these researches arose a famous battle which kept Pasteur hard at work for four or five years - the struggle over spontaneous generation. It was an old warfare, but the microscope had revealed a new world, and the experiments on fermentation had lent great weight to the omne vivum ex ovo doctrine. The famous Italians, Redi and Spallanzani, had led the way in their experiments, and the latter had reached the conclusion that there is no vegetable and no animal that has not its own germ. But heterogenesis became the burning question, and Pouchet in France, and Bastian in England, led the opposition to Pasteur. The many famous experiments carried conviction to the minds of scientific men, and destroyed forever the old belief in spontaneous generation.

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).