The forerunners of this school were Bichat and Pinel, and its proper founders were Corvisart, Dupuytren, and Laënnec. There was also Bayle, who was first to apply the ear to the thorax in disease of the heart, and thus became the predecessor of Laënnec and Chomel. He was the godfather of typhoid fever, and from being a famous clinician became later a great pathologist. The most celebrated adherent of the method, however, was Cruveilhier (1791-1873), professor first in Montpellier and then in Paris, who revived the Anatomical Society founded by Bichat, and wrote his first essays as the result of Dupuytren's advice; finally, there came from his pen the famous treatise on Pathological Anatomy, with its magnificent plates,—a work begun in 1830 and not fully completed until 1864. Like Morgagni, he associated general and pathological anatomy with bedside observations; also established a class of inflammations to which belong gangrene and atony, and a certain class of neuroses and fevers, and endeavored to investigate the different steps in the development of lesions, not simply their final products. His teachings concerning pyæmia and phlebitis, which had been first studied by John Hunter, excited great attention, and he even came to the one-sided conclusion that "phlebitis rules the whole of pathology." He was the first to observe that its suppurative form does not occur primarily, but is secondary to coagulation of the blood.
The ablest representative of this school, and one who, perhaps, more than any other man, made Paris a Mecca to which foreigners made their pilgrimages, was Andral (1797-1876),—the son of a physician and the most noted and indefatigable investigator and thinker of his time. Between 1823 and 1840 were published the five volumes of his Medical Clinic, which made him famous. He taught, in opposition to Broussais, the existence of primary diseases of the blood, the so-called dyscrasiæ; made physiology subservient to pathology; was the creator of the chemistry of the blood; and in therapeutics was wedded to emetics and cathartics, ascribing little importance to abstraction of blood.
The first man to apply the Numerical Method to pathology, and who brought about the downfall of Broussais, was Louis (1787-1872), who had studied in Russia, but came to Paris while still a young man. He expressed his principle in the following words: "As often as I have formed an a priori idea and had afterward opportunity to prove the facts, I have invariably found that my idea was false. In pathology as well as in therapeutics numerical analysis is a useful practice. By numbers only can be obtained the frequency of conditions or this or that symptom; by a definite enumeration alone is it possible to utilize the special relations of age, sex, constitution of our patients, to settle that this or that symptom occurs so often in one hundred or one thousand cases." This system he applied to etiology, symptomatology, prognosis, therapeutics, and pathological anatomy. He discarded blisters and condemned large bleedings, but fell into other errors, carrying his numerical method to an unjustifiable extreme.
Next to Andral and Louis should be mentioned Magendie (1783-1855), Professor of General Pathology in the College de France, and physician to the Hôtel-Dieu, who was a representative of the new French medicine, and introduced experiments into both pathology and physiology; he was the pioneer in experimental pharmacodynamics, which occupies itself largely with alkalies, a large number of which he introduced into practice. He was a solid humoralist in pathology, a most accurate diagnostician, but (it is charged) "was too simple in therapeutics"! As a result of his intravenous injections of putrefactive material, he had the terms "pyæmia," "icliorrhæmia," and "metastasis" introduced into pathology.
Trousseau (1801-1866), of Tours, also became professor in the Paris Faculty, and rendered especial service in his studies of croup and the employment therefor of tracheotomy, though his chief fame rests upon his merit as a clinical teacher and the publication of clinical lectures which are still models in every way of accurate, forcible teaching.
Claude Bernard (1813-1878) became the successor of Magendie, and even more famous as an experimenter in pathology, physiology, and anatomy. Originally a poet, he finally turned to medicine and science, and in 1869 became a member of the French Academy.
One of the results of the French fondness for pathological anatomy was an outgrowth, unfortunate in some respects, of specialism, which made its appearance early and spread to other countries, particularly to Germany, so that to-day there is scarcely an organ in the body which has not only its special student, but its special representative in medicine. It would be of interest to go over some of the various organs and count those who have become most renowned in the study of their diseases, but that is beyond the scope of this volume.
As Baas says, England, after her excessive participation in the iatrochemistrv and iatromechanics of the seventeenth century, with a devotion that extended far into the eighteenth, seemed then to lose all confidence in systems and schools of medicine, inasmuch as since that time no system or so-called school has gained in Great Britain any large or permanent band of followers; even Brunonianism did not succeed in this respect. This form of conservatism is a characteristic of the British race. But while schools have not risen, individuals have formulated hypotheses or doctrines that at least attracted attention, if not followers. For instance, John Mason Goode (1764-1827) formulated an intricate nosological arrangement in his long-popular text-book entitled The Study of Medicine, and also arranged a classification of diseases now almost forgotten.
In 1816 Sir Charles Bell (1774-1842) made the memorable discovery that the posterior roots of the spinal nerves preside over sensation, and the anterior over motion; and this attracted anew the attention of English physicians to the nervous system, and was rewarded by the later discovery of reflex action or reflex phenomena, communicated to the Royal Society in 1863 by Marshall Hall. Both discoveries were important, and both were duly rewarded by yet others.
Benjamin Travers (1783-1858) seems to have been greatly influenced by the first of these discoveries, and led thereby to pay special attention to what he termed "constitutional irritation"; his studies on this subject are often quoted to-day, and are well worthy of perusal; he understood by this term a process (in strong contrast with inflammation) which subsides without hyperæmia and without plastic exudate, but which, on the other hand, may occasion liquid products and result in neoplasms.