a history of science-4-第29章

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　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　word；　scientific　empiricism　was　beginning　to　gain　a　hearing　in　medicine　as　against　the　metaphysical　preconceptions　of　the　earlier　generations。


PARASITIC　DISEASES

I　have　just　adverted　to　the　fact　that　Napoleon　Bonaparte；　as　First　Consul　and　as　Emperor；　was　the　victim　of　a　malady　which　caused　him　to　seek　the　advice　of　the　most　distinguished　physicians　of　Paris。　　It　is　a　little　shocking　to　modern　sensibilities　to　read　that　these　physicians；　except　Corvisart；　diagnosed　the　distinguished　patient's　malady　as　〃gale　repercutee〃that　is　to　say；　in　idiomatic　English；　the　itch　〃struck　in。〃　It　is　hardly　necessary　to　say　that　no　physician　of　today　would　make　so　inconsiderate　a　diagnosis　in　the　case　of　a　royal　patient。　If　by　any　chance　a　distinguished　patient　were　afflicted　with　the　itch；　the　sagacious　physician　would　carefully　hide　the　fact　behind　circumlocutions　and　proceed　to　eradicate　the　disease　with　all　despatch。　　That　the　physicians　of　Napoleon　did　otherwise　is　evidence　that　at　the　beginning　of　the　century　the　disease　in　question　enjoyed　a　very　different　status。　　At　that　time　itch；　instead　of　being　a　most　plebeian　malady；　was；　so　to　say；　a　court　disease。　It　enjoyed　a　circulation；　in　high　circles　and　in　low；　that　modern　therapeutics　has　quite　denied　it；　and　the　physicians　of　the　time　gave　it　a　fictitious　added　importance　by　ascribing　to　its　influence　the　existence　of　almost　any　obscure　malady　that　came　under　their　observation。　Long　after　Napoleon's　time　gale　continued　to　hold　this　proud　distinction。　For　example；　the　imaginative　Dr。　Hahnemann　did　not　hesitate　to　affirm；　as　a　positive　maxim；　that　three…fourths　of　all　the　ills　that　flesh　is　heir　to　were　in　reality　nothing　but　various　forms　of　〃gale　repercutee。〃

All　of　which　goes　to　show　how　easy　it　may　be　for　a　masked　pretender　to　impose　on　credulous　humanity；　for　nothing　is　more　clearly　established　in　modern　knowledge　than　the　fact　that　〃gale　repercutee〃　was　simply　a　name　to　hide　a　profound　ignorance；　no　such　disease　exists　or　ever　did　exist。　　Gale　itself　is　a　sufficiently　tangible　reality；　to　be　sure；　but　it　is　a　purely　local　disease　of　the　skin；　due　to　a　perfectly　definite　cause；　and　the　dire　internal　conditions　formerly　ascribed　to　it　have　really　no　causal　connection　with　it　whatever。　This　definite　cause；　as　every　one　nowadays　knows；　is　nothing　more　or　less　than　a　microscopic　insect　which　has　found　lodgment　on　the　skin；　and　has　burrowed　and　made　itself　at　home　there。　Kill　that　insect　and　the　disease　is　no　more；　hence　it　has　come　to　be　an　axiom　with　the　modern　physician　that　the　itch　is　one　of　the　three　or　four　diseases　that　he　positively　is　able　to　cure；　and　that　very　speedily。　　But　it　was　far　otherwise　with　the　physicians　of　the　first　third　of　our　century；　because　to　them　the　cause　of　the　disease　was　an　absolute　mystery。

It　is　true　that　here　and　there　a　physician　had　claimed　to　find　an　insect　lodged　in　the　skin　of　a　sufferer　from　itch；　and　two　or　three　times　the　claim　had　been　made　that　this　was　the　cause　of　the　malady；　but　such　views　were　quite　ignored　by　the　general　profession；　and　in　1833　it　was　stated　in　an　authoritative　medical　treatise　that　the　〃cause　of　gale　is　absolutely　unknown。〃　　But　even　at　this　time；　as　it　curiously　happened；　there　were　certain　ignorant　laymen　who　had　attained　to　a　bit　of　medical　knowledge　that　was　withheld　from　the　inner　circles　of　the　profession。　As　the　peasantry　of　England　before　Jenner　had　known　of　the　curative　value　of　cow…pox　over　small…pox；　so　the　peasant　women　of　Poland　had　learned　that　the　annoying　skin　disease　from　which　they　suffered　was　caused　by　an　almost　invisible　insect；　and；　furthermore；　had　acquired　the　trick　of　dislodging　the　pestiferous　little　creature　with　the　point　of　a　needle。　　From　them　a　youth　of　the　country；　F。　Renucci　by　name；　learned　the　open　secret。　He　conveyed　it　to　Paris　when　he　went　there　to　study　medicine；　and　in　1834　demonstrated　it　to　his　master　Alibert。　　This　physician；　at　first　sceptical；　soon　was　convinced；　and　gave　out　the　discovery　to　the　medical　world　with　an　authority　that　led　to　early　acceptance。