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The man who gave the greatest impetus to the study of scientific
medicine at this time was Bichat； who pointed out that the pathological
changes in disease were not so much in organs as in tissues。 His studies
laid the foundation of modern histology。 He separated the chief constituent
elements of the body into various tissues possessing definite physical and
vital qualities。 〃Sensibility and contractability are the fundamental
qualities of living matter and of the life of our tissues。 Thus Bichat
substituted for vital forces 'vital properties；' that is to say； a series of vital
forces inherent in the different tissues。〃＇11＇ His 〃Anatomic Generale；〃
published in 1802； gave an extraordinary stimulus to the study of the finer
processes of disease； and his famous 〃Recherches sur la Vie et sur la
Mort〃 （1800） dealt a death…blow to old iatromechanical and iatrochemical
views。 His celebrated definition may be quoted： 〃La vie est l'ensemble des
proprietes vitales qui resistent aux proprietes physiques； ou bien la vie est
l'ensemble des fonctions qui resistent a la mort。〃 （Life is the sum of the
vital properties that withstand the physical properties； or； life is the sum of
the functions that withstand death。） Bichat is another pathetic figure in
medical history。 His meteoric career ended in his thirty…first year： he died
a victim of a post…mortem wound infection。 At his death； Corvisart wrote
Napoleon： 〃Bichat has just died at the age of thirty。 That battlefield on
which he fell is one which demands courage and claims many victims。 He
has advanced the science of medicine。 No one at his age has done so much
so well。〃
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＇11＇ E。 Boinet： Les doctrines medicules； leur evolution； Paris； 1907； pp。
85…86。
It was a pupil of Corvisart； Rene Theophile Laennec； who laid the
foundation of modern clinical medicine。 The story of his life is well
known。 A Breton by birth； he had a hard； up…hill struggle as a young man
a struggle of which we have only recently been made aware by the
publication of a charming book by Professor Rouxeau of Nantes
〃Laennec avant 1806。〃 Influenced by Corvisart； he began to combine the
accurate study of cases in the wards with anatomical investigations in the
dead…house。 Before Laennec； the examination of a patient had been largely
by sense of sight； supplemented by that of touch； as in estimating the
degree of fever； or the character of the pulse。 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。
＇*＇ John Forbes's translation of Auenbrugger and part of his translation
of Lacnnec are reprinted in Camac's Epoch…making Contributions； etc。；
1909。Ed。
The pupils and successors of CorvisartBayle； 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；
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THE EVOLUTION OF MODERN MEDICINE
the celebrated Charleston （S。C。） 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
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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 anaesthetic 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
anaesthesia。 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。＇*＇
＇*＇ Cf。 Osler： Proc。 Roy。 Soc。 Med。； XI； Sect。 Hist。 Med。； pp。 65…69；
1918； or； Annals Med。 Hist。； N。Y。； I； 329…332。 Cf。 also Morton's
publications reprinted in Camac's book cited above。Ed。