CLIMAX CLINICAL MEDICINE. 



269 



phy, vol. v. lx>ok Ixxv.) : " Assuming this explana- 

 tion as sufficient for South America anil Mexico, we 

 sliall add, with regard to North America, that it scarce- 

 ly extends any distance into die orrid zone, but, on 

 the contrary, stretches, in all probability, very far 

 into the frigid zone, and, unless the revived hope of a 

 north-west passage be confirmed, may, perhaps, reach 

 and surroand the pole itself. Accordingly, the co- 

 lum of frozen air attached to this continent is no where 

 counterbalanced by a column of equatorial air. From 

 this results an extension of the polar climate to the 

 very confines of the tropics ; and hence winter and 

 summer struggle for the ascendency, and the seasons 

 change with astonishing rapidity. From all this, how- 

 ever, New Albion and New California are happily ex- 

 empt ; for, being placed beyond the reach of freezing 

 winds, they enjoy a temperature analogous to their la- 

 titude. (For further information, see Malte-Brun's 

 Universal Geography, book xvii. and the article IVind.} 



CLIMAX (from the Greek xX<V$, a ladder or 

 stairs) and ANTICLIMAX are rhetorical figures ; in the 

 former of which the ideas rise in degree ; in the lat- 

 ter, they sink. Climax was also the name of several 

 mountains one in Arabia Felix ; another in Pisidia ; 

 another in Phoenicia; also of a castle inGalatia; 

 also of a place in Peloponnesus, and another in Libya. 



CLINGSTONE. See Peach. 



CLINICAL MEDICINE (from the Greek xXm>,a 

 bed) teaches us to investigate, at the bedside of the 

 sick, the true nature ot the disease in the phenomena 

 presented ; to note their course and termination ; and 

 to study the effects of the various modes of treatment 

 to which they are subjected. From this mode of' 

 study we learn the character of individual cases ; 

 theoretical study being competent to make us ac- 

 quainted with species only. Clinical medicine de- 

 mands, therefore, careful observation. It is, in fact, 

 synonymous with experience. What advances would 

 medicine have made, and from how many errors 

 would it have been saved, if public instruction had 

 always followed this natural course, so that pupils 

 had received none but correct impressions and dis- 

 tinct conceptions of the phenomena of disease, and 

 had attained a practical knowledge of the applica- 

 tion of those rules and precepts, which dogmatical 

 instruction always leaves indefinite ! We are unac- 

 quainted with the method of clinical instruction in 

 medicine, which was followed by the Asclepiades, 

 but we cannot help admiring the results of it as ex- 

 hibited to us in the writings of Hippocrates, who 

 augmented the stores of experience inherited from 

 them, by following in their steps. After his time, 

 medicine ceased to be the property of particular fa- 

 milies, and the path of experience, by which it had 

 been rendered so valuable, was soon deserted. The 

 slow progress of anatomy, and physiology, the con- 

 stant study of the philosophy of Aristotle, and end- 

 less disputes respecting the nature of man, of diseases 

 and of remedies, occupied all the attention of physi- 

 cians ; and the wise method of observing and describ- 

 ing the diseases themselves fell into disuse. Hos- 

 pitals, at their origin, served rather as means of dis- 

 playing the benevolence of the early Christians than 

 of perfecting the study of medicine. The school of 

 Alexandria was so celebrated, according to Ammi- 

 anus Marcellinus, that a careful attendance upon its 

 lessons entitled the student to pursue the practice of 

 medicine. Another old and very thriving, although 

 less known institution, wfis situated at Nisapour, in 

 Persia ; and hospitals, even before the flourishing 

 period of the Arabians, to whom the happy idea is 

 commonly ascribed, were united with these medical 

 institutions. The last school, founded by the em- 

 peror Aurelian, and superintended by Greek physi- 

 cians, spread the doctrines of Hippocrates through all 



the East. It was supported for several centuries, and 

 in it, without doubt, Rhazes, Ali-Abbas, Avicenna, 

 and the other celebrated Arabian physicians, were 

 instructed. At the same time, the celebrated John 

 Mesue, of Damascus, was at the head of the hospital 

 of Bagdad. Of the mode of instruction pursued 

 there, we know nothing ; but we are inclined to form 

 no very elevated opinion of the systems of an age 

 which was devoted to all the dreams of Arabian poly- 

 pharmacy. In truth, medicine shared the fete of all 

 the other natural sciences in those barbarous ages. 

 Men were little disposed to acquire, slowly and cau- 

 tiously, the knowledge of disease, at the bedside of 

 the sick, in the manner of the Greek physicians. It 

 appears probable, that the foundation of universities 

 led to a renewed attention to the study of medical 

 science ; and we find, accordingly, that in Spain, 

 even under the dominion of the Arabians, there were 

 schools and hospitals for the instruction of young 

 physicians at Seville, Toledo, and Cordova. But, 

 even then, clinical studies were almost wholly ne- 

 glected. Instead of studying the history of diseases, 

 the pupils occupied their time with the most unprofit- 

 able pursuits. Not much more advantageous were 

 the journeys which were made for the same objects 

 to Italy and France, in the eleventh and twelfth cen- 

 turies. The schools of Paris and Montpellier were 

 those principally resorted to ; but in these, the in- 

 struction consisted simply in lectures and endless 

 commentaries upon the most obscure subjects ; and, 

 even at the close of the fifteenth century, when the 

 works of the Greek physicians began to be printed, 

 men were still busied with verbal explanations and 

 disputes. Two centuries elapsed before physicians 

 returned to clinical studies and instructions. Among 

 the renovators of this mode of studying medicine 

 may be named, in Holland, William von Straten, 

 Otho Heurnius, and the celebrated Sylvius, about the 

 middle of the seventeenth century ; and it is said 

 that clinical instruction was given, at the same pe- 

 riod, in the schools of Hamburg, Vienna, and Stras- 

 br.rg. Even Boerhaave, who succeeded Sylvius as 

 clinical instructor at Leyden, in 1714, has left us no 

 journals of daily observation of disease, but only aca- 

 demic discourses upon the general principles of me- 

 dicine. The influence of this celebrated school was 

 first perceived at Edinburgh, and afterwards at Vien- 

 na, two schools which, in celebrity for clinical in- 

 struction, soon eclipsed their common mother, the 

 school of Leyden. Cullen, one of the most celebrat- 

 ed teachers of practical medicine at Edinburgh, was 

 too fond of fine-spun theories upon the condition of 

 the diseased structures of the body, and the proxi- 

 mate causes of disease, ever to follow a uniform me- 

 thod in his lectures, and to adopt the entire history 

 of disease, as observed at the bedside, as the basis of 

 his system. From the account of what was effected 

 in clinical medicine in Italy, Germany, and France, 

 in the course of the 18th century, we may discover 

 both the constantly increasing attention to this de- 

 partment of knowledge, and the difficulties with 

 which such institutions are obliged to contend. The 

 Vienna school, by means of the labours of Van 

 Swieten, De Haen, and, still more, of Stoll and ot 

 Franck, became a model of clinical study, since public 

 lectures were given in the hospitals, and the sim- 

 plicity of G recian medicine successfully inculcated. 

 The practice and study of medicine in the hospitals 

 in France, was only an indirect mode of gaining 

 public confidence, till the period of the general re- 

 vival of science, and the erection of the French Ecoie 

 de Sante. In that for the first time, clinical instruc- 

 tion was expressly commanded. At the present day, 

 every good school has its establishment for clinical 

 medicine connected with it ; that is, an hospital, in 



