A History of Science — Volume 4

by Henry Smith Williams; Edward Huntington Williams

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 physiologists—in 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 methods—blood-letting and the like—that 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.