Nearly fifty years after the publication of Auenbrugger's book, Laennec completed the development of the diagnostic methods necessary for the differentiation of chest diseases by the discovery of auscultation. His was the greatest work ever done in clinical medicine. The solution of the meaning of the multitude of sounds that can be heard in the human chest required a genius for observation, and almost infinite patience. Laennec spent twelve years at the task, and then published his books on the subject. Practically nothing of importance has been added to his methods and results in the more than three-quarters of a century of active attention that has been given to medicine since that time. Laennec did not expect that his discovery would be taken up by his contemporaries. He even refers to the cool reception which had been given to [{404}] Auenbrugger's work, and deprecates the fact that a man who had done so much for mankind should have met with such neglect and lack of appreciation, and even the contempt of his colleagues in medicine, who could not bring themselves to think that his method of "drumming on the chest," as they called it, could ever mean much for the recognition of disease. [Footnote 47]
[Footnote 47: Makers of Modern Medicine, by James J. Walsh, M.D., Ph.D., LL.D. Fordham University Press, New York, 1907.]
In the preface of his book Laennec, like Auenbrugger, prophesies that his work will not receive the attention that it deserves, and attempts to lessen the effect of the derision that will be meted out to it by calmly stating his expectation of it. It is curious that both of these men, one of them a German and the other a Frenchman, one of them a rather stolid Styrian, the other of the lively Celtic nature of the Bretons, should in turn have realized, at a distance of a thousand miles and more than half a century from one another, just what the attitude of the men of science was to be toward their discoveries, even though those are of a kind that were eventually to be hailed as among the most important steps in medical progress ever made. Certain words of Laennec's preface are an echo of Auenbrugger's expressions. He said:
"For our generation is not inquisitive as to what is being accomplished by its sons. Claims of new discoveries made by contemporaries are likely, for the most part, to be met by smiles and mocking remarks. It is always easier to condemn than to test by actual experience."
Many people are accustomed to think that, after the spirit that came into the world with the French Revolution, men were less prone to listen to authority or cling to old-fashioned notions, and that liberalism of mind is to be found written large on many pages of nineteenth century scientific history. One of the great scientists of the first part of the last century was Dr. Thomas Young, to whom we owe so much with regard to the theory of light waves and the existence of the ether to carry them. Men absolutely refused to listen to this idea at all at the beginning, though now it is the [{405}] groundwork of most of our thinking and of nearly all of our mathematical demonstrations with regard to the movement of light. They not only refused, however, but they expressed their scorn of the man who invented such a cumbrous theory. Dr. George M. Gould, in one of the volumes of his Biographic Clinics, has told the story of Dr. Young's career, and I prefer to present it in his words rather than my own.
"A practicing physician, Young, as early as 1801, hit upon the true theory of the luminiferous ether, and of light and color, which nearly a century before had been discovered by Robert Hooke. But his scientific contemporaries would not see it, and to avoid persecution and deprivation of practice, Dr. Young was compelled to publish his grand discoveries and papers anonymously. Published finally by the Royal Society (one can imagine the editor's smile of superior wisdom over such trash), they were as utterly ignored as were those of Mitchell, Thompson and Martin as to eyestrain, two or three generations later. Arago finally championed Dr. Young's theory in the French Academy, but the leaders, LaPlace, Poissin, Biot, etc., denounced and conquered, and not until 1823 would the Academy allow the publication of Fresnel's papers on the subject; in about twenty-five years the silencers were themselves silenced. But Young had been silenced too; his disgust was so great that he resigned from the Royal Society, and devoted himself to his poor medical practice and to deciphering Egyptian hieroglyphics." (In which, by the way, as might be expected I suppose, he made a distinguished name for himself.)
Many another important medical discoverer in the nineteenth century found the truth of Auenbrugger's and Laennec's expressions, and met the fate of Jenner and Young. Next to vaccination for small-pox, probably the most important advance in nineteenth century medicine was the discovery of the cause of puerperal fever, and the consequent diminution of the death-rate from that very fatal disease. At one time in the nineteenth century, it was much more dangerous for a woman to have a child in a lying-in hospital in Europe than to go through an attack of typhoid fever. The death-rate was at least 10 per cent. When it was [{406}] reduced to five per cent, the hospital authorities felt quite self-complacent about it. Shortly after the beginning of the second quarter of the nineteenth century, there began to come glimmerings of the real cause of the affection. It was not due to something from within the patient, but was caused by a materies morbi introduced from without. Usually the physician in attendance was responsible for the introduction of it. He came to these patients after contact with septic cases of various kinds improperly cleansed. The consequence was that he infected them, and puerperal fever was contracted.
It would seem as though the medical profession would be very ready and willing to test any such simple explanation of the origin of a serious disease, and if possible secure its diminution. On the contrary, the old men proved to be so wedded to the notion that the physician could not possibly be the cause of this serious condition, that they were very bitter in their denunciation of those who tried to introduce the new idea. One distinguished old professor of midwifery declared very superciliously that, of course, it was a very charming thing for a young poet to insist on the notion that these serious diseases were not associated necessarily with the beautiful function of maternity itself, but were extraneous factors quite apart from it; but there was no doubt, he declared, that the affection came from within, all the same, and that the youthful poet's idea was only a pleasant fiction. The poet in the case was Dr. Oliver Wendell Holmes, and, needless to say now, though he was laboring under the heinous crime of being a young man, and did indulge in occasional poetry, he was entirely in the right, and the distinguished old professor entirely in the wrong. No little denunciation was heaped upon the devoted head of Holmes, however, for his strenuous humanitarian work with regard to this subject. It cost Holmes some of his medical friends and not a little practice for some time. Even in America, then the land of the free, there was a strong conservatism that made the introduction of new ideas a very difficult and almost a dangerous thing.
The man who worked out the same idea to a practical [{407}] effect in Europe met with even more determined opposition than did our own Dr. Holmes. I refer, of course, to Semmelweiss, who, while teaching obstetrics in Vienna, realized that it was the students and doctors engaged in pathological work at the same time that they were taking out their courses in obstetrics, who caused the havoc among the patients in his (obstetrical) department in the hospital. The death-rate in the hands of these obstetrical attendants, who came directly to the lying-in department from their work in pathology, was sometimes as high as one in five. Semmelweiss insisted that this state of affairs must cease, and that while the students were doing the pathological work they must not be allowed to attend obstetrical cases. This at once raised a storm of opposition in the university. Poor Semmelweiss lost his position as a consequence of it. In the midst of the rancorous discussion that followed, Semmelweiss lost his reason also for a time, and had to be cared for in an insane asylum. It is well recognized that his beneficent discovery was for him the cause of many years of unhappiness.
Nor must it be thought that it is only with regard to medical discoveries that such opposition--bitter, personal, rancorous and persecutory--can be aroused. While it might be thought that the great minds in the ordinary natural sciences would have no reason for the personal element which more or less necessarily enters into medical discussion because men had been applying for gain the notions that now are proved to be incorrect, and their reputations have been made on such applications, to think that all was placid and quiet in the physical sciences would be a serious mistake. Long ago Virgil asked in a famous line, "Is it possible that there can be such great wrath in divine minds?"--"tantaene animae celestibus irae"--and we might be tempted to ask, can there be such foolish intolerance on the part of scientific teachers? but the answer would be the same in each case. Virgil found that the gods were very human in this respect, and anyone who knows the history of science knows the scientists are like the pagan dieties, when their conservative spirit is aroused, and when they are up in arms, as they fondly think, to protect their beloved science from foolish innovators.