212 INTERNAL MEDICINE 



had already begun. Even as these words were written Lavoisier, 

 too soon to fall a victim to the premature explosion of the forces 

 of pent-up freedom, was in the midst of his great work. In 1796 

 came the introduction of vaccination by Jenner, and but a few 

 years later, Bichat with his wonderful genius, took up the thread 

 dropped by Morgagni and placed anatomy and physiology, normal 

 and pathological, on a basis of accurate observation and experi- 

 ment. Hand in hand with the introduction of exact methods of 

 anatomical and physiological observation, Auenbrugger, in 1761, 

 had demonstrated in his Inventum Novum, a method of physical 

 investigation which, for the first time, enabled the physician to 

 determine changes in size, shape, and consistency of the thoracic 

 organs. At first unnoticed by the world, this important discovery 

 was destined to gain a sudden general recognition in the early days 

 of the nineteenth century. With the spread of knowledge of the 

 gross pathological changes in disease which followed the inspira- 

 tion of Bichat, the work of Auenbrugger, expounded by Corvisart, 

 became a common possession of the medical world, and, less than 

 ten years later, Laennec, by the introduction of mediate auscul- 

 tation, opened possibilities for accurate physical diagnosis such as 

 had not been dreamed of in the ages which had gone before. 



With the great school of French observers which followed Laen- 

 nec, Andral, Chomel, Louis, Bouillaud, and Trousseau, with Skoda 

 and Schonlein in Germany and Addison and Bright and Stokes 

 in England, the exact association of clinical pictures with local 

 anatomical changes made great advances. Typhus and typhoid 

 fevers were distinguished; the relation between albuminuria and 

 renal disease was demonstrated; the association of endocarditis 

 with acute rheumatism was discovered; the corner-stone of our 

 knowledge of cerebral localization was laid. Clinical diagnosis was 

 becoming more than a conjectural art. 



In the mean time physiology was making great strides. Majendie, 

 Bell, Johannes Muller, Beaumont and finally Claude Bernard, and 

 a host of their followers, were shedding light upon many obscure 

 corners of our knowledge of the vital functions. In the hands of 

 Muller the microscope began to open up new fields of study which 

 were destined in a few years through the cultivation of the genius 

 of a Virchow and a Max Schultze to bear a noble harvest. The "great 

 reform in medicine" which followed the introduction of the cellular 

 pathology laid solid foundations for much which is most vital in 

 our anatomical and physiological and pathological knowledge of 

 to-day, and the correlation of these observations with the results 

 of accurately recorded clinical studies, the application of the micro- 

 scope to the study of the urine, the sputa, the blood, to patho- 

 logical neoplasms, to exudates and transudates, soon brought new 



