RESEARCH IN MEDICINE 561 



logical anatomy clinical classification was impossible, and without 

 physiology and the methods of the physiologist, clinical interpretation 

 was difficult. The influence of pathological anatomy on clinical medi- 

 cine was felt first in England through Baillie (1761-1823), a pupil of 

 Hunter; in France, after Bichat, through Louis, Andral and Laennec; 

 in Germany through Schonlein and Eomberg ; and in America through 

 the pupils of Louis. The discovery of the diseased conditions with 

 which we associate the names of Bright, Pott, Addison, Graves, Stokes 

 and Hodgkins came at this time, as also Marshall Hall's discrimination 

 of diseases of the spinal cord and Bayle's study of tuberculosis of the 

 lung. It was the period when the best members of the profession 

 endeavored to give to the study of symptoms the same precision as 

 characterized anatomical observation and to combine the results of this 

 method with the revelations of pathological anatomy. It was this 

 method that culminated in Louis's so-called " numerical or statistical 

 method," the method of basing conclusions on large groups of records 

 rather than on isolated observations, and which, in this country, through 

 the work of two of Louis's students, Gerhard and Stille, led to the 

 differentiation of typhoid fever from typhus fever, with which it had 

 been confounded. 



But of equal importance was the second influence which was at 

 work, that of improved methods of diagnosis of diseases of the heart 

 and lungs, the methods of percussion and auscultation. Percussion 

 was first used by Auenbrugger, in 1761, but was treated with contempt 

 and ridicule until 1808 when his pamphlet was translated into French 

 by Corvisart, who proclaimed the value of the method and obtained for 

 it universal recognition. Shortly after, in 1819, came Lgennec's work 

 on the use of the stethoscope in auscultation, and Skoda in 1839 did 

 much to extend the use of both percussion and auscultation. 



This phase of medicine, the development of instruments and means 

 of studying diseases of the internal organs and the organs of the special 

 senses — the history of the stethoscope, the ophthalmoscope, the laryngo- 

 scope, and like instruments — is a most fascinating subject and one 

 worthy of extended treatment, but it must suffice here to state that the 

 new methods of direct exploration brought about a complete revolution 

 in the knowledge of disease and had " more influence on the develop- 

 ment of modern medicine than all the ' systems ' evolved by the most 

 brilliant intellects of the eighteenth century." (Payne.) 



Exact clinical observation, the study of pathological anatomy and 

 the increasing use of instruments and methods tending to accuracy in 

 diagnosis were, therefore, the characteristic features of the early nine- 

 teenth century school of medicine. Both medicine and surgery were 



douloureux; of prison and camp fevers by Pringle, of epidemic fevers by Hus- 

 ham; of diseases of the skin by Willan, of angina pectoris by Heberden, and of 

 gastric ulcer by Baillie. 



