a history of science-4-第35节

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Honors　were　showered　upon　Jenner　from　the　Old　and　the　New　World；　and　even　Napoleon；　the　bitter　hater　of　the　English；　was　among　the　others　who　honored　his　name。　　On　one　occasion　Jenner　applied　to　the　Emperor　for　the　release　of　certain　Englishmen　detained　in　France。　　The　petition　was　about　to　be　rejected　when　the　name　of　the　petitioner　was　mentioned。　〃Ah；〃　said　Napoleon；　〃we　can　refuse　nothing　to　that　name！〃

It　is　difficult　for　us　of　to…day　clearly　to　conceive　the　greatness　of　Jenner's　triumph；　for　we　can　only　vaguely　realize　what　a　ruthless　and　ever…present　scourge　smallpox　had　been　to　all　previous　generations　of　men　since　history　began。　　Despite　all　efforts　to　check　it　by　medication　and　by　direct　inoculation；　it　swept　now　and　then　over　the　earth　as　an　all…devastating　pestilence；　and　year　by　year　it　claimed　one…tenth　of　all　the　beings　in　Christendom　by　death　as　its　average　quota　of　victims。　〃From　small…pox　and　love　but　few　remain　free；〃　ran　the　old　saw。　A　pitted　face　was　almost　as　much　a　matter　of　course　a　hundred　years　ago　as　a　smooth　one　is　to…day。

Little　wonder；　then；　that　the　world　gave　eager　acceptance　to　Jenner's　discovery。　　No　urging　was　needed　to　induce　the　majority　to　give　it　trial；　passengers　on　a　burning　ship　do　not　hold　aloof　from　the　life…boats。　Rich　and　poor；　high　and　low；　sought　succor　in　vaccination　and　blessed　the　name　of　their　deliverer。　Of　all　the　great　names　that　were　before　the　world　in　the　closing　days　of　the　century；　there　was　perhaps　no　other　one　at　once　so　widely　known　and　so　uniformly　reverenced　as　that　of　the　great　English　physician　Edward　Jenner。　　Surely　there　was　no　other　one　that　should　be　recalled　with　greater　gratitude　by　posterity。



VIII。　NINETEENTH…CENTURY　MEDICINE

PHYSICAL　DIAGNOSIS

Although　Napoleon　Bonaparte；　First　Consul；　was　not　lacking　in　self…appreciation；　he　probably　did　not　realize　that　in　selecting　a　physician　for　his　own　needs　he　was　markedly　influencing　the　progress　of　medical　science　as　a　whole。　　Yet　so　strangely　are　cause　and　effect　adjusted　in　human　affairs　that　this　simple　act　of　the　First　Consul　had　that　very　unexpected　effect。　For　the　man　chosen　was　the　envoy　of　a　new　method　in　medical　practice；　and　the　fame　which　came　to　him　through　being　physician　to　the　First　Consul；　and　subsequently　to　the　Emperor；　enabled　him　to　promulgate　the　method　in　a　way　otherwise　impracticable。　Hence　the　indirect　but　telling　value　to　medical　science　of　Napoleon's　selection。

The　physician　in　question　was　Jean　Nicolas　de　Corvisart。　　His　novel　method　was　nothing　more　startling　than　the　now…familiar　procedure　of　tapping　the　chest　of　a　patient　to　elicit　sounds　indicative　of　diseased　tissues　within。　　Every　one　has　seen　this　done　commonly　enough　in　our　day；　but　at　the　beginning　of　the　century　Corvisart；　and　perhaps　some　of　his　pupils；　were　probably　the　only　physicians　in　the　world　who　resorted　to　this　simple　and　useful　procedure。　Hence　Napoleon's　surprise　when；　on　calling　in　Corvisart；　after　becoming　somewhat　dissatisfied　with　his　other　physicians　Pinel　and　Portal；　his　physical　condition　was　interrogated　in　this　strange　manner。　With　characteristic　shrewdness　Bonaparte　saw　the　utility　of　the　method；　and　the　physician　who　thus　attempted　to　substitute　scientific　method　for　guess…work　in　the　diagnosis　of　disease　at　once　found　favor　in　his　eyes　and　was　installed　as　his　regular　medical　adviser。

For　fifteen　years　before　this　Corvisart　had　practised　percussion；　as　the　chest…tapping　method　is　called；　without　succeeding　in　convincing　the　profession　of　its　value。　　The　method　itself；　it　should　be　added；　had　not　originated　with　Corvisart；　nor　did　the　French　physician　for　a　moment　claim　it　as　his　own。　The　true　originator　of　the　practice　was　the　German　physician　Avenbrugger；　who　published　a　book　about　it　as　early　as　1761。　This　book　had　even　been　translated　into　French；　then　the　language　of　international　communication　everywhere；　by　Roziere　de　la　Chassagne；　of　Montpellier；　in　1770；　but　no　one　other　than　Corvisart　appears　to　have　paid　any　attention　to　either　original　or　translation。　It　was　far　otherwise；　however；　when　Corvisart　translated　Avenbrugger's　work　anew；　with　important　additions　of　his　own；　in　1808。

〃I　know　very　well　how　little　reputation　is　allotted　to　translator　and　commentators；〃　writes　Corvisart；　〃and　I　might　easily　have　elevated　myself　to　the　rank　of　an　author　if　I　had　elaborated　anew　the　doctrine　of　Avenbrugger　and　published　an　independent　work　on　percussion。　In　this　way；　however；　I　should　have　sacrificed　the　name　of　Avenbrugger　to　my　own　vanity；　a　thing　which　I　am　unwilling　to　do。　It　is　he；　and　the　beautiful　invention　which　of　right　belongs　to　him；　that　I　desire　to　recall　to　life。〃＇1＇

By　this　time　a　reaction　had　set　in　against　the　metaphysical　methods　in　medicine　that　had　previously　been　so　alluring；　the　scientific　spirit　of　the　time　was　making　itself　felt　in　medical　practice；　and　this；　combined　with　Corvisart's　fame；　brought　the　method　of　percussion　into　immediate　and　well…deserved　popularity。　Thus　was　laid　the　foundation　for　the　method　of　so…called　physical　diagnosis；　which　is　one　of　the　corner…stones　of　modern　medicine。

The　method　of　physical　diagnosis　as　practised　in　our　day　was　by　no　means　completed；　however；　with　the　work　of　Corvisart。　　Percussion　alone　tells　much　less　than　half　the　story　that　may　be　elicited　from　the　organs　of　the　chest　by　proper　interrogation。　　The　remainder　of　the　story　can　only　be　learned　by　applying　the　ear　itself　to　the　chest；　directly　or　indirectly。　Simple　as　this　seems；　no　one　thought　of　practising　it　for　some　years　after　Corvisart　had　shown　the　value　of　percussion。

Then；　in　1815；　another　Paris　physician；　Rene　Theophile　Hyacinthe　Laennec；　discovered；　almost　by　accident；　that　the　sound　of　the　heart…beat　could　be　heard　surprisingly　through　a　cylinder　of　paper　held　to　the　ear　and　against　the　patient's　chest。　　Acting　on　the　hint　thus　received；　Laennec　substituted　a　hollow　cylinder　of　wood　for　the　paper；　and　found　himself　provided　with　an　instrument　through　which　not　merely　heart　sounds　but　murmurs　of　the　lungs　in　respiration　could　be　heard　with　almost　startling　distinctness。

The　possibility　of　associating　the　varying　chest　sounds　with　diseased　conditions　of　the　organs　within　appealed　to　the　fertile　mind　of　Laennec　as　opening　new　vistas　in　therapeutics；　which　he　determined　to　enter　to　the　fullest　extent　practicable。　His　connection　with　the　hospitals　of　Paris　gave　him　full　opportunity　in　this　direction；　and　his　labors　of　the　next　few　years　served　not　merely　to　establish　the　value　of　the　new　method　as　an　aid　to　diagnosis；　but　laid　the　foundation　also　for　the　science　of　morbid　anatomy。　　In　1819　Laennec　published　the　results　of　his　labors　in　a　work　called　Traite　d'Auscultation　Mediate；＇2＇　a　work　which　forms　one　of　the　landmarks　of　scientific　medicine。　By　mediate　auscultation　is　meant；　of　course；　the　interrogation　of　the　chest　with　the　aid　of　the　little　instrument　already　referred　to；　an　instrument　which　its　originator　thought　hardly　worth　naming　until　various　barbarous　appellations　were　applied　to　it　by　others；　after　which　Laennec　decided　to　call　it　the　stethoscope；　a　name　which　it　has　ever　since　retained。

In　subsequent　years　the　form　of　the　stethoscope；　as　usually　employed；　was　modified　and　its　value　augmented　by　a　binauricular　attachment；　and　in　very　recent　years　a　further　improvement　has　been　made　through　application　of　the　principle　of　the　telephone；　but　the　essentials　of　auscultation　with　the　stethoscope　were　established　in　much　detail　by　Laennec；　and　the　honor　must　always　be　his　of　thus　taking　one　of　the　longest　single　steps　by　which　practical　medicine　has　in　our　century　acquired　the　right　to　be　considered　a　rational　science。　Laennec's　efforts　cost　him　his　life；　for　he　died　in　1826　of　a　lung　disease　acquired　in　the　course　of　his　hospital　practice；　but　even　before　this　his　fame　was　universal；　and　the　value　of　his　method　had　been　recognized　all　over　the　world。　　Not　long　after；　in　1828；　yet　another　French　physician；　Piorry；　perfected　the　method　of　percussion　by　introducing　the　custom　of　tapping；　not　the　chest　directly；　but　the　finger　or　a　small　metal　or　hard…rubber　plate　held　against　the　chest…mediate　percussion；　in　short。　　This　perfected　the　methods　of　physical　diagnosis　of　diseases　of　the　chest　in　all　essentials；　and　from　that　day　till　this　percussion　and　auscultation　have　held　an　unquestioned　place　in　the　regular　armamentarium　of　the　physician。

Coupled　with　the　new　method　of　physical　diagnosis　in　the　effort　to　substitute　knowledge　for　guess…work　came　the　studies　of　the　experimental　physiologistsin　particular；　Marshall　Hall　in　England　and　Francois　Magendie　in　France；　and　the　joint　efforts　of　these　various　workers　led　presently　to　the　abandonment　of　those　severe　and　often　irrational　depletive　methodsblood…letting　and　the　likethat　had　previously　dominated　medical　practice。　To　this　end　also　the　〃statistical　method；〃　introduced　by　Louis　and　his　followers；　largely　contributed；　and　by　the　close　of　the　first　third　of　our　century　the　idea　was　gaining　ground　that　the　province　of　therapeutics　is　to　aid　nature　in　combating　disease；　and　that　this　may　often　be　accomplished　better　by　simple　means　than　by　the　heroic　measures　hitherto　thought　necessary。　　In　a　wo