November 25, 1904.] 



SCIENCE. 



707 



Reaumur and Black and Haller and Spal- 

 lanzani and Hunter and Priestley and La- 

 voisier had lived. Morgagni, sweeping 

 aside the dogmatism of the old schools, had 

 demonstrated the local changes in many 

 diseases and had opened the way for the 

 objective pathological anatomy of Bichat. 

 In the field of practical medicine such men 

 as Sydenham and Morton and Torti and 

 Lancisi practised and taught much which 

 holds good to-day. Boerhaave had intro- 

 duced clinical instruction. Cullen and 

 Cheyne and Huxham and Pringle and 

 Heberden and Van Swieten and De Haen 

 were all in many ways true and faithful 

 students; yet methods and doctrines that 

 were often strangely fantastic still held 

 general sway — such, for instance, as the 

 Brunonian system. A perusal of the 

 writings of Stoll, one of the wisest prac- 

 titioners of his day, can not fail to impress 

 one with the meagreness of the basis of 

 anatomy and physiology, normal and path- 

 ological, on which medicine rested, the 

 almost entire lack of diagnostic methods, 

 the absence of a rational therapy— how 

 much of the conjectiiral, how little of the 

 scientifically exact there was in medicine. 



Diagnosis, based largely upon gross clin- 

 ical conceptions, was necessarily vague and 

 uncertain. 



Prophylaxis, in the absence of any cer- 

 tain knowledge of the causes and manner 

 of origin of disease, was devoid of any 

 sound basis. 



Treatment was almost wholly empirical, 

 and, where it was not empirical, it was fre- 

 quently based upon some theoretical system 

 so arbitrary and dogmatic that the unfor- 

 tunate sufferer was too often stimulated or 

 purged, fed or bled, as he fell into the 

 hands of a Brown or a Broussais rather 

 than according to the nature of his malady. 



In the Dictionaire de 1 'Academic fran- 

 qaise for 1789, a year which marks the end 

 of an era in the world at large, one finds 



the following definition: "Medecine. s. f. 

 L'art qui enseigne les moyens de conserver 

 la sante & de guerir les maladies (La 

 medecine est un Art conjectural * * *)." 

 Medicine, a conjectural art ! Such was the 

 estimate placed upon our profession by the 

 French Academy a little over one hundred 

 years ago. 



But the seeds of a new life had been 

 sown and the germination had already be- 

 gun. 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, nor- 

 mal and pathological, on a basis of accurate 

 observation and experiment. Hand in 

 hand with the introduction of exact meth- 

 ods of anatomical and physiological ob- 

 servation, Auenbrugger in 1761 had dem- 

 onstrated in his 'Inventum Novum' a 

 method of physical investigation which, for 

 the first time, enabled the physician to 

 determine changes in size, shape and con- 

 sistency of the thoracic organs. At first 

 unnoticed by the world, this important dis- 

 covery was destined to gain a sudden gen- 

 eral recognition in the early days of the 

 nineteenth century. With the spread of 

 knowledge of the gross pathological changes 

 in disease which followed the inspiration of 

 Bichat, the work of Auenbrugger, ex- 

 pounded by Corvisart, became a common 

 possession of the medical world, and less 

 than ten years later, Laennee, by the intro- 

 duction of mediate auscultation, 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 ob- 

 servers which followed Laennee, Andral, 

 Chomel, Louis, Bouillaud and Trousseau, 



