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the evolution of modern medicine(�峇�匳勞議處延)-及44何蛍

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!!!!隆堋響頼��紗秘慕禰厮宴和肝写偬堋響��




medical degree from ONE medical author let it be this。 ��James Atkinson�此�

Medical Bibliography�察�1834�察�268。�� 

       Born    in  1682�察  �Morgagni      studied    at  Bologna    under    Valsalva    and 

Albertini。   In   1711�察  �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�察�appeared in his eightieth year�察�and represents the accumulated 

experience of a long life。 Though written in the form of letters�察�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   arteriesaffections     of   the 

pericardium�察     �diseases    of   the  valves�察   �ulceration�察  �rupture�察   �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�察�

but   the   combination   of   clinical   with   anatomical   records。   What   could   be 

more correct than this account of angina pectorisprobably the first in the 

literature�拭 �A lady forty´two years of age�察�who for a long time�察�had been a 

valetudinarian�察�and within the same period�察�on using pretty quick exercise 

of body�察�she was subject to attacks of violent anguish in the upper part of 

the chest on the left side�察�accompanied with a difficulty of breathing�察�and 

numbness of   the left   arm�察  �but   these paroxysms   soon   subsided   when   she 

ceased   from   exertion。   In   these   circumstances�察  �but   with   cheerfulness   of 

mind�察�she undertook a journey from Venice�察�purposing to travel along the 

continent�察�when she was seized with a paroxysm�察�and died on the spot。 I 

examined   the   body   on   the   following   day。。。。   The   aorta   was   considerably 

dilated at   its   curvature�察  �and�察 �in   places�察�through its   whole   tract�察�the inner 

surface was unequal and ossified。 These appearances were propagated into 

the arteria innominata。 The aortic valves were indurated。。。。; He  remarks�察�

;The delay of blood in  the aorta�察�in the  heart�察�in the pulmonary  vessels�察�

and in the vena cave�察�would occasion the symptoms of which the woman 

complained   during   life�察  �namely�察  �the   violent   uneasiness�察  �the   difficulty   of 



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breathing�察�and the numbness of the arm。;��6�А�

     ��6�А  �Cooke's     Morgagni�察     �Vol。   1�察 �pp。   417´418。     I  cannot    too   warmly 

commend   to   young   clinicians   the   reading   of   Morgagni。   English   editions 

are   availableAlexander's   three´volume   translation   of   1769   and   Cooke's 

Abridgement   ��London�察  �1822���察  �of   which   there   was   an   American   edition 

published in Boston in 1824。 

       Morgagni's       life  had    as   much     influence     as   his  work。     In   close 

correspondence with the leading men of the day�察�with the young and rising 

teachers and workers�察�his methods must have been a great inspiration�察�and 

he   came   just   at   the   right   time。   The   profession   was   literally   ravaged   by 

theories�察�schools and systemsiatromechanics�察�iatrochemistry�察�humoralism�察�

the   animism   of   Stahl�察  �the   vitalistic   doctrines   of   Van   Helmont   and   his 

followers and   into this   metaphysical   confusion   Morgagni   came   like   an 

old     Greek     with    his   clear    observation�察     �sensible    thinking     and    ripe 

scholarship。   Sprengel   well   remarks   that   ;it   is   hard   to   say   whether   one 

should   admire   most   his   rare   dexterity   and   quickness   in   dissection�察  �his 

unimpeachable love of truth and justice in his estimation of the work of 

others�察�his extensive scholarship and rich classical style or his downright 

common sense and manly speech。; 

     Upon   this   solid   foundation   the   morbid   anatomy   of   modern   clinical 

medicine   was   built。   Many   of   Morgagni's   contemporaries   did   not   fully 

appreciate   the   change   that   was   in   progress�察  �and   the   value   of   the   new 

method of correlating the clinical symptoms and the morbid appearances。 

After all�察�it was only the extension of the Hippocratic method of careful 

observation the study of facts from which reasonable conclusions could 

be drawn。 In every generation there had been men of this typeI dare say 

many   more   than   we   realizemen   of   the   Benivieni   character�察  �thoroughly 

practical�察�clear´headed physicians。 A model of this sort arose in England in 

the   middle   of   the   seventeenth   century�察  �Thomas   Sydenham   ��1624´1689���察�

who took men back to Hippocrates�察�just as Harvey had led them back to 

Galen。      Sydenham       broke     with    authority     and    went    to   nature。    It  is 

extraordinary how he could have been so emancipated from dogmas and 

theories of all sorts。 He laid down the fundamental proposition�察�and acted 

upon it�察�that ;all disease could be described as natural history。; To do him 



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justice we must remember�察�as Dr。 John Brown says�察 �in the midst of what 

a mass of errors and prejudices�察�of theories actively mischievous�察�he was 

placed�察�at a time when the mania of hypothesis was at its height�察�and when 

the   practical   part   of   his   art   was   overrun   and   stultified   by   vile   and   silly 

nostrums; �─�Horae Subsecivae�察─�Vol。 I�察�4th ed。�察�Edinburgh�察�1882�察�p。 40��。 

     Listen to what he says upon the method of the study of medicine�此 �In 

writing      therefore�察   �such    a   natural    history    of   diseases�察   �every    merely 

philosophical hypothesis should be set aside�察�and the manifest and natural 

phenomena�察�however minute�察�should be noted with the utmost exactness。 

The usefulness of this procedure cannot be easily overrated�察�as compared 

with   the   subtle   inquiries   and   trifling   notions   of   modern   writers�察  �for   can 

there   be   a   shorter�察  �or   indeed   any   other   way   of   coming   at   the   morbific 

causes�察�or discovering the curative indications than by a certain perception 

of the peculiar symptoms�拭�By these steps and helps it was that the father 

of physic�察�the great Hippocrates�察�came to excel�察�his theory being no more 

than   an   exact   description   or   view   of   nature。   He   found   that   nature   alone 

often terminates diseases�察�and works a cure with a few simple medicines�察�

and often enough with no medicines at all。; 

     Towards the end of the century many great clinical teachers arose�察�of 

whom   perhaps   the   most   famous   was   Boerhaave�察  �often   spoken   of   as   the 

Dutch Hippocrates�察�who inspired a group of distinguished students。 I have 

already referred to the fact that Franciscus Sylvius at Leyden was the first 

among       the   moderns      to   organize    systematic      clinical   teaching。     Under 

Boerhaave�察  �this   was   so   developed   that   to   this   Dutch   university   students 

flocked   from   all   parts   of   Europe。   After   teaching   botany   and   chemistry�察�

Boerhaave   succeeded   to   the   chair   of   physic   in   1714。  With   an   unusually 

wide general training�察�a profound knowledge of the chemistry of the day 

and     an   accurate    acquaintance       with   all  aspects    of   the   history    of  the 

profession�察�he had a strongly objective attitude of mind towards disease�察�

following closely the methods of Hippocrates and Sydenham。 He adopted 

no special system�察�but studied disease as one of the phenomena of nature。 

His   clinical   lectures�察  �held   bi´weekly�察  �became   exceedingly   popular   and 

were   made   attractive   not   less   by   the   accuracy   and   care   with   which   the 

cases   were   studied   than   by   the   freedom   from   fanciful   doctrines   and   the 



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frank honesty of the man。 He was much greater than his published work 

would indicate�察�and�察�as is the case with many teachers of the first rank�察�his 

greatest contributions were his pupils。 No other teacher of modern times 

has had   such   a   following。 Among   his   favorite   pupils   may  be   mentioned 

Haller�察�the physiologist�察�and van Swieten and de Haen�察�the founders of the 

Vienna school。 

     In   Italy�察 �too�察  �there   were    men     who    caught    the   new    spirit�察 �and 

appreciated      the   v
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隆堋響頼��紗秘慕禰厮宴和肝写偬堋響��
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