While the changes described above were taking place the Empress, under the inspiration given by van Swieten, inaugurated certain improvements in the housing and equipment of the Medical School. In 1752 she gave the necessary orders for constructing a new building that was to contain a fine anatomical theatre, a chemical laboratory, lecture rooms for the different professors, a general assembly hall, etc. This fine structure was completed and formally inaugurated in April, 1756.
Finally, all the hospitals in Vienna were greatly improved during this period of time, not only as regards their accommodations and equipment, but also in respect to their management.
Inauguration of Clinical Teaching.—As the sequel showed, Vienna, under the inspiring cooperation of the Empress, continued for a long series of years the Mecca toward which physicians and medical students turned their steps from all parts of Central and Northern Europe and even from the United States of America and from Canada. It is now universally recognized that this extraordinary popularity of the Vienna Medical School, which began toward the middle of the eighteenth century and has continued almost up to the present time, was chiefly due to the clinical teaching which de Haen inaugurated at van Swieten’s suggestion. Sylvius and, after him, Boerhaave had already given this method a trial at Leyden, but for various reasons it had not proved entirely satisfactory. De Haen’s plan was to let each student, at the bedside of the patient, make his own diagnosis and then whisper it to the professor, who in turn announced it to the remainder of the class. If the diagnosis proved to be correct the professor found it unnecessary to say anything additional on the subject; but, if it happened to be incorrect, he presented the truth to the class in such a manner as not to give the slightest offence to the student who had committed the error. This plan encouraged his pupils to feel confidence that, whenever they made an erroneous diagnosis, they would not be subjected to ridicule on the part of their classmates. This exercise in diagnosis was duly followed by an exposition of the treatment adopted; and, whenever it happened that a patient whose case had been studied by the class, subsequently died, a post-mortem examination was conducted in their presence, and appropriate explanatory remarks were made by the instructor.
In further explanation of the extraordinary popularity which the clinical teaching at Vienna attained it is interesting to learn that de Haen (and probably also Stoll, who succeeded him) was in the habit of rising at an early hour that he might visit the hospital and learn, in advance of the arrival of the students, how the patients in the section set apart for teaching purposes were getting on, how their condition differed from that which they presented at the time of his visit on the preceding day, and what special provision, if any, should be made for the approaching clinical lesson. In short, no pains were spared to make each séance as attractive and as instructive as possible to the students.
While I am here giving to de Haen and Stoll all the credit that is their due for the very wise and skilful manner in which they carried out the teaching of medicine at Vienna it must be remembered that van Swieten was the real founder of clinical instruction in the famous university; de Haen and Stoll having simply put in practice the ideas introduced by him.
At this point in my sketch the question may with propriety be asked, Where may one find in history another instance of such beneficent interference on the part of a queen in behalf of a higher standard of medical education? Certain it is that, without the powerful and sympathetic assistance which Maria Theresa granted him at every stage of his work, van Swieten could not have accomplished in so short a period of time the extraordinary results which I have here briefly recorded.
Van Swieten’s Contributions to Therapeutics.—In his treatment of disease van Swieten practiced conservative methods and prescribed remedies with great caution and with strong common sense. In the case of small-pox, for instance, he did not approve of the practice of inoculation as a method of diminishing the mortality of that disease or possibly of rendering the severity of its manifestations less pronounced. He evidently believed the attendant risk to be too great. It was particularly in his treatment of syphilis, however, that he accomplished results of a most beneficial character. In St. Mark’s Hospital, in which patients affected with this disease were lodged, it had been the rule—previous to the date of van Swieten’s arrival in Vienna—to subject all the cases, without regard to the severity of the infection, to a course of mercurial salivation. As a natural result of this plan of treatment it happened not infrequently that a patient’s life was severely threatened or that he was left with lifelong sequelae of a lamentable character. The physician under whose management this mode of treatment flourished was dismissed from his position by van Swieten as soon as he was able to overcome the obstacles which stood in his way as he advanced toward the accomplishment of this end. Maximilian Locher, who was put in charge of the hospital after the dismissal of his predecessor, was instructed to use a solution of the bichloride of mercury in the treatment of the cases that came under his care; and the results that followed were so astonishingly good that the remedy soon came to be known everywhere as “Swieten’s” liquor.[[12]] For many subsequent years this solution retained its popularity among European physicians.
As regards the other remedies which van Swieten was in the habit of employing in his treatment of various maladies it is stated that he clung persistently to those advocated by Boerhaave and enumerated at the end of Vol. V of the Commentaries,—remedies which were characterized by their simplicity and by the fewness of the ingredients that entered into their composition.