Fielding H. (Fielding Hudson) Garrison.

An introduction to the history of medicine, with medical chronology, bibliographic data and test questions online

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botanical works were William Roxburgh's "Plants of the Coromandel CJoast
(1795-1819) and "Flora Indica" (1820-24), Nathaniel Wallich's "Tentamen
Florae Nepalensis'* (1824-26) and "Plantce Asiatics Rariores" (1830-32),
Robert Wight's "Icones Pkntarum Indise Orientalis," six volumes witii
over 2000 plates (1838-53), WiUiam Griffith's "Icones Plantarum Asiati-
corum" (1847-51), and Thomson and Hooker's "Flora Indica" (1855).
Important original monographs on tropical diseases were John Peter Wade
on fever and dysentery (1791-93), John MacPherson's "Annals of Cholera"
(1839), Edward Hare on the treatment of remittent fever and dysentery
(1847), N. C. MacNamara's "History of Asiatic Cholera" (1876) and the
oridnal investigations of Hehry Vandyke Carter (1831-97) on mycetoma
(1874), leprosy, and elephantiasis (1874) and spirillosis (1882), and of
Leonard Rogers on Indian fevers (1897-1908). Beri-beri had already been
described in the seventeenth century by Bontius (1642) and Tulp (1652),
but the treatise of John Grant Malcolmson (1835) will always be accounted
the classical source of recent knowl^ge of the disease. Some of the Indian
surgeons, who left the service early, attained distinction in other fields of
activity, notably Murchison, Esdaile, Playfair, whose midwifery passed
through nine editions (1876-98), Ireland, memorable for his writings on insan-
ity, and Edward John Waring (1819-91), who compiled the first official



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360 HISTORY OF MEDICINE

Indian pharmacopoeia (1868), a bilingual work on Bazar Medicinee (I860),
also a Haller-like "Bibliotheca Therapeutica " (1878), and afterwwxl cUd
good service in public hygiene.

Charles Murchison (1830-79), bom in Jamaica of Scotch par-
entage, entered the Bengal army in 1853, and published a treatise
on the climate and diseases of Burmah in 1855. Returning to
England, he became a prominent physician at the London Fever
Hospital (1856-70) and St. Thomas's Hospital (1871-79), in con-
nection with his wonderful special knowledge of fevers; and, in
1873, he was presented with a testimonial by the residents of West
London for tracing an epidemic of typhoid to a polluted milk
supply. He was noted for his solid accuracy, promptitude and
decision in diagnosis, and although he opposed the bacterial
theory of infection, his "Treatise on the Continued Fevers of
Great Britain" (1862) is as important a work for England as
Drake's Diseases of the Mississippi Valley is for the United States.
Murchison translated Frerichs' book on diseases of the liver in
1861 and wrote a number of important monographs on the same
subject himself. Like his famous brother, he was an able geologist.

The name of Esdaile, of the Indian Medical Service, is prom-
inently associated with the history of hypnotism, particularly
of hypnotic anesthesia in surgical operations. After the time
of Mesmer, hypnotism was only a peg for arrant charlatanry.
The great pioneer of scientific hypnosis was James Braid (1795-
1861), a surgeon of Fifeshire, Scotland, who settled in Man-
chester and became attracted to the subject of animal magnetism
about 1841. Braid at first believed that the phenomena produced
by professional mesmerists were due to "collusion and illusion";
but he soon became convinced, upon experimentation, that there
can be a genuine self-induced sleep brought about by a fixed stare
at a bright inanimate object (Braidism). The importance of
Braid's work is that he proved that the mesmeric influence is
entirely subjective or personal, and that no fluid or other influence
passes from the operator to the patient. This subjective trance
he called neurohypnotism or hypnosis (1842), and his important
treatise on the subject was entitled Neuryjmology, or the Rationale
of Nervous Sleep (1843). Braid's ideas met with violent opposi-
tion, especially from the professional mesmerists, who wished to
keep their exhibits upon a miraculous basis, but his ideas were
taken up by Azam, Broca, Charcot, Li^beault, Bemheim, and be-
came the true starting-point of the French school.^ Hypnotism
was first used in surgical operations by John EUiotson (1791-1868),
a professor of practice in the University of London and president



* Wilhelm Preyer translated Braid's complete works into (}erman in 1882.



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MODERN PERIOD 361

of the Royal Medical and Chirurgical Society, who, in 1843, pub-
lished a pamphlet describing "Niimerous Cases of Surgical
Operations Without Pain in the Mesmeric State." Dispute
about this led to his resignation from his various offices. A far
more impressive record was made by James Esdaile (1808-59),
of Montrose, Scotland, who, in 1846, began to try hypnotism
in operating on Hindu convicts. He performed over 100 such
operations with success, having been put to a severe test by the
Deputy Governor of Bengal, and eventually had a record of
261 painless operations with a mortality of 5.5 per cent., which he
described in his book, "Mesmerism in India" (1846). On return-
ing to Scotland, Esdaile found that, except in disease, the self-
contained Europeans differed from the impressionable, neurotic
Hindus in not being specially susceptible to the hypnotic trance.
German medicine, in the first half of the nineteenth century,
labored under the disadvantage of being split up into schools.
Exhausted by the Napoleonic wars, and existing mainly as a set
of petty principalities, with only a vague racial and political
solidarity, the Grerman people had to endure a long period of brutal
miUtary regime, as a natural sequel of the previous struggle against
foreign invasion. In consequence, the best minds of the time
were driven into various idealistic modes of thought, a fermenta-
tion which came to a head in the Revolution of 1848. During this
period of idealism, the gods of their worship were Schelling and
Hegel; and clinical medicine was dominated by the fanciful reveries
of the Nature-Philosophy School, of which Schelling himself was,
indeed, the founder. Its principal, spirit was the Bavarian
naturtdist, Lorenz Oken (1779-1851), editor of the journal '*Isis"
and a foimder of the first German Congress of Naturalists and
Physicians (1822), in whom great originality of thought went
hand in hand with much ineptitude. He accepted and expanded
Goethe's vertebrate theory of the skull (in 1806), regarded the flesh
as a conglomeration of infusoria (cells), and glorified the male
element in nature to the extent of declaring that "Ideally every
child should be a boy. " Other members of the school, such as DoU-
inger, Gorres, Treviranus and Steff ens, drifted into a maze of incom-
prehensible jargon and fanciful distinctions as to the real and the
ideal, identity, imponderables, polarities, irritability, metamor-
phosis, and the like. Hard upon the Nature-Philosophy School
followed the Natural History School, which aimed to name and
classify diseases after a rigid system, as in botany or zoology.
This was succeeded by the rational or physiologic teaching of
Roser and WunderUch, Henle and Pfeufer, the forerunners of the
scientific movement of German medicine, which was headed by the
pupils of its prime mover, Johannes Mtiller. Apart from these,



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362 HISTORY OF MEDICINE

many strayed into such devious by-paths as Phrenology, Homoeop-
athy, Rademacherism, Baunscheidtism, Hydropathy, Odic Force,
Animal Magnetism, and other narrow and exclusive ways of
conceiving the facts of medicine. The tendency of all these hole-
and-corner schools was toward wholesale contempt for the scien-
tific achievements of men like Bichat and Magendie, Laennec
and Louis, or the practical sense of such clinical workers as Bright,
Stokes or Graves; and this tendency reached the limit of exaggera-
tion in the doctrines of the New Vienna School, as stated by Skoda,
Hamemijk and Dietl. Skoda said that while we can diagnose
and describe disease, we dare not expect by any means to cure it.
Dietl, in an oft-quoted utterance of 1851, announced that a
physician must be judged, not by the success of his treatment but
by the extent of his knowledge: "As long as medicine is art, it
will not be science. As long as there are successful physicians
there will be no scientific physicians. " These ingenious paradoxes,
which amounted virtually to a plea of impotence, made up the
" therapeutic nihilism '' of the New Vienna School. The Revolution
of 1848 dissipated the silly doctrines of the Nature-Philosophy
School into space, but the New Vienna School died hard, and
Rokitansky had to be overthrown by Virchow, and Semmelweis
had to sacrifice his life in proving his thesis before German medi-
cine could finally emerge from the Happy Valley of speculation to
gain the tableland of reality.^

The first to break away from the jargon of the Nature-Phil-
osophy School was Johann Lucas Schonlein (1793-1864), of Bam-
berg, the founder of the so-called Natural History School, the am-
bition of which was, as we have said, to study medicine as descrip-
tive botany and zoology are studied. Schonlein, his pupil, Carl
Canstatt, and Conrad Heinrich Fuchs, all of them inspired by
de Candolle's classification of plants, proceeded to make arbitrary
classifications of disease, based, in each case, upon a very hazy
fundamentum divisionis, not unlike those of Boissier de Sauvages
in the eighteenth century. Schonlein, in particular, indulged
in such whimsies as forcing gangrene of the uterus into the class
"neurophlogoses'' and cholera into the catarrhs. The real merits
of Schonlein, however, are of a different order. In his clinic at
the Charity, in Berlin, he was the first to lecture on medicine in
German instead of Latin (1840), and was the founder of modem
clinical teaching in Germany, introducing examinations of the
blood and urine, chemical analysis, auscultation, percussion and



^ For a brilliant and effective exposition of the intellectual follies of this
period see Dr. A. Jacobi's account of his student days in Germany, in New
York Med. Jour., 1901, Ixxui, 617-623.



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MODERN PERIOD 363

microscopical investigations. He wrote little, his only contribu-
tions of importance being his description of peliosis rheumatica
(Schonlein's disease) in 1837/ his discovery of the parasitic cause
of favus (achorion Schonleinii) in 1839,^ and his proposal of the
terms "typhus abdominalis" and "typhus exanthematicus" to
differentiate the latter diseases (1839). Schonlein was a man of
pecuUar character. During his later years in Berlin, he often
affected the eccentricities of a recluse, denying himself to patients
when it suited his whim, and otherwise treating them with the
"godlike coarseness" of demeanor {goUlicke Grobheity which
was then the vogue. His scientific abilities have been ably set
forth in the well-known eulogy of Virchow (1865),^ but he seemed,
alike to the delicate perception of
Fanny Hensel and the plain common
sense of Augustin Prichard, something
of a boor.

Schonlein's pupil, Carl Friedrich
Canstatt (1807-50), of Ratisbon, wrote
a sterling text-book on practice, abso-
lutely free from metaphysical dogma,
which, says Jacobi,^ was the "Bible of
German medicine'' imtil it was super-
seded by Niemeyer, as the latter was,
in due course, by Striimpell.

The scientific movement in modem
German medicine was started and kept
in pace mainly through the medium

of four important {periodicals which Johann Lucas Schonlein

stood out for exact investigation and ex- (1793-1864).

erted great influence upon the younger

spirits in the speculative period, viz., Miiller's Archiv fur Anatomie,
Physiologie und wissenschaftliche Medicin (1834) , Henle and Pf euf er's
ZeUschriftfur rationelle Medicin (1841-69), Roser and Wunderlich's
Archiv fiir physiologische HeiUcunde (1842-59), and Virchow's
Archiv fur pathologische Anatomie (1847-1913). Of these able
editors, Mliller, Henle, and Virchow were the leaders in Germany



^SchSnlein: Allg. u. spec. Path. u. Therap., Herisau, 1837, ii, 1848.

•MuUer's'Arch., Berlin, 1839, 82, 1 pi.

•The Homeric phrase occurs for the first time in Friedrich Schlegers
celebrated romance of "Lucinde." Virchow gives one (perhaps apocryphal)
instance of Schonlein's rudeness. The latter was once consulted by an elderly
ph^cian, who, disconcerted by his brusque manner, pointed to his gray
murs. Schdnlein retorted: Atich die Esel sind grau!

* Virchow: Ged&chtnissrede auf Lucas Sch5nlein, Berlin, 1865.

»Jacobi: Op. ci<., p. 622.



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364 HISTORY OF MEDICINE

of comparative, histologic and pathologic anatomy respectively,
and Muller, in particular, was the greatest German physiologist
of his time. Wunderiich was perhaps the most original clinician.
Carl Reinhold August Wunderiich (1815-77), of Wtirttemberg,
graduated at Tubingen in 1837 and taught medicine there until
1850, when he succeeded to Oppolzer's chair at Leipzig (1850-77).
He wrote a good treatise on practice (1858) and an excellent history
of medicine (1859), but his masterpiece is undoubtedly his treatise
on the relations of animal heat in disease (1868),* which is the very
foundation of our present clinical thermometry. About 1850,

Clausius, Helmholtz, and Sir
WiUiam Thomson had worked
out the mathematical relations
of the laws governing heat-
transformations, and, in 1849,
Thomson (Lord Kelvin) had
established his '^absolute scale
of temperature, " without
which no thermometers could
be reliable. Upon this hint,
Wunderiich made many careful
observations of temperature in
disease, tabulating his results,
and, after the true significance
of the thermal changes in the
body were better imderstood,



Carl R. A. Wunderiich (1815-1877). thermometry became a recog-
(By kind permission of Frau Geheimrat nized feature m clmical diag-
Franz Hofmann-Wunderlich, Leipzig.) nosis, and new studies were

made of fever and other path-
ologic problems in which the idea of temperature is involved.
Before the time of Clausius, heat (caloric) was still regarded by
many as a material substance, an idea which threw back the prog-
ress of medicine as much as did its parent and forerunner, the
phlogiston theory of Stahl.^ By utilizing the advanced thermo-
dynamic knowledge of his time, Wunderiich made his book a
permanent scientific classic.



* Wunderiich: Das Verbal ten der Eigenwarme in Krankheiten, Leipzig,
1868.

* It is now charitably 8upp)osed that when Stahl and his followers main-
tained that if a body undergoes combustion, it gives off something (becomes
*'dephlogisticated"), they were clumsily groping in the direction of Camot's

Erinciple that "Heat cannot flow from a colaer to a warmer body." Even as
kte as 1865, we find such an able engineer as the hard-headed Rankine still
believing that heat is an indestructible substance.



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MODERN PERIOD 365

Josef Skoda (1805-81), of Pilsen, Bohemia, was the leading
clinician of the New Vienna School and the exponent of its thera-
peutic nihilism. He was the first medical teacher in Vienna to
lecture in German (1847), and taught nearly all his Ufe in the
Allgemeines Krankenhaus. His principal contribution to medicine
is his treatise on percussion and auscultation (1839),^ in which he
attempts to classify the different sounds in the chest by categories,
ranged according to musical pitch and tonality, and alternating
from full to hollow, clear to dull, tympanitic to muffled, high to
deep. Skoda's resonance, the drum-like sound heard in pneu-



Josef Skoda (1805-1881).

monia and pericardial effusion, is a permanent part of modem
diagnosis. Although little was known of the physics of sound in
Skoda's time, his acoustic refinements were, in some respects, an
improvement upon the loose descriptive terms used by the French
clinicians of the period, so wittily exemplified in the "Stethoscope
Song" of Dr. Holmes:

"The bruit de rdpe and the bruit de scie
And the bruit de diable are all combined;
How happy Bouillaud would be,
If he a case like this could find."



* Skoda: Abhandlung tiber Perkussion und Auskultation, Vienna, 1839.



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366 HISTORY OF MEDICINE

None the less, such an effective expression as Laennec's
"segophony" still means a great deal to the ear of the modem
practitioner. In recent times, Skoda's work has found further
elaboration in the complicated instruments with Helmholtz
resonators which some clinicians use to analyze the sounds of the
chest for teaching purposes. Skoda was a whimsical, top-heavy
old bachelor, who, as Baas relates, put up with queer clothes all
his life for fear of offending his tailor (a personal friend), yet once
sued a clergyman to obtain payment of a fee.^ He looked upon
his patients as objects of investigation merely, and, when it came to

treatment, said, with a shrug:
Achy das ist ja aUes eins! This
set a bad example. A diag-
nosis confirmed by a post-
mortem came to be a sort of
shibboleth in Vienna, and snap-
diagnoses (SchneU-Diagnosen)
the fashion, even among prac-
titioners who could not have
differentiated the pitch and
tonality of a heart-sound from
a band of music.

CarlRokitansky (1804-78),
Skoda's colleague, was also a
Bohemian, but a man of dif-
ferent type, genial and unas-
suming, where Skoda was prag-
matic and pedantic; a graceful
and witty writer, where Skoda
was dry and dull. His Viennese
Carl Rokitansky (1804r-1878). bonhomie is sensed in his jest

about his four sons, two of
whom were physicians, the other two singers: Die Einen heilen, die
A nderen heulen. Rokitansky did an enormous amount of pathologic
work, and, it is said, had the disposal of between 1500 and 1800
cadavers annually. He made over 30,000 postmortems in his life.
He was the first to detect bacteria in the lesions of malignant endo-
carditis, and'to differentiate between lobar and lobular pneumonia,
as also between Bright^s disease and "Speckniere" (Virchow's amy-
loid degeneration of the kidney). He left a classic account of the
pathologic appearances in acute yellow atrophy of the liver,
giving the disease its present name (1843); descrilbed and defined
the bronchitic and pulmonary complications of typhoid as broncho-



1 Baas: Op. cit., foot-note to p. 954.



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MODERN PERIOD 367

typhus and pneumotyphus; and completed Laennec's picture of
emphysema of the lungs by describing the microscopic appearances
of the same. In obstetrics and orthopedics, he is memorable as
the first to describe the spondylolisthetic deformities (1839).^
The value of the first edition of Rokitansky's treatise on pathologi-
cal anatomy (1842-46)* was seriously impaired by his doctrine of
"erases" and "stases/' in which chemical states of substance
were actually conceived of as being susceptible to "disease,"
and which was mercilessly chaffed out of existence by Virchow
(1846).^ The latter intimated that Rokitansky was in reality
an adherent of the Natural History School, since he employed a
bizarre terminology to describe things of which he had no ken,
his chemical hypotheses of tissue changes being susceptible of a
simpler and more purely mechanical explanation, wMle his at-
tempt to revamp the ancient drivel about solidism and hmnoralism
was a monstrous anachronism (ein ungeheurer AnachronismiLs).
Virchow knew more chemistry than Rokitansky, but he cordially
admitted that in picturing what was actually before him on the
postmortem table his jolly Viennese rival was the ablest descrip-
tive pathologist of his time. It is said that when the latter read
Virchow's criticism, he could never bring himself to look at his
unfortunate first edition again. Rokitansky's finest productions
are unquestionably his monograph on diseases of the arteries
(1852),* illustrated with 23 folio plates; and his great memoir on
defects in the septum of the heart (1875),^ the result of fourteen
years' labor, giving his transposition theory of the deviation of
the aortic septmn. These works have been the subject of deep
study by modem pathologists, in connection with the English
classic of Thomas Bevill Peacock (1812-82) on malformations
of the human heart (1866).

Johannes von Oppolzer (1808-71), also a Bohemian, was a
clear-headed, extremely competent practitioner who steered clear
of all haphazard theorizing, and, as professor at Leipzig, did
much to popularize the Viennese innovations in Germany. He
was noted for his quickness in offhand diagnosis. Hamemijk
of Prague and Dietl of Cracow were the extremists in therapeutic



^Rokitansky: Med. Jahrb. des osterreichischen Staates, Vienna, 1839,
xix, 41; 195.

' Rokitansky: Handbuch der pathologischen Anatomie, Vienna, 1842-46.

' Virchow: Kritik des Rokitansky'schen Handbuchs der pathologischen
Anatomie. Med.-Ztg. (Verein f. Heilk. in Preussen), Berlin, 1846, xv, Lit. Bei-
lage, Nos. 49, 50, pp. 237, 243.

* Rokitansky: Ueber einige der wichtigsten Krankheiten der Arterien,
Denkschr. d. k. Akad. d. Wissensch., Vienna, 1852, iv, 1-72.

• Die Defekte der Scheidewande des Herzens, Vienna, 1875.



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368 HISTORY OF MEDICINB

nihilism, and the latter is now remembered only by the painful
symptoms in floating kidney (DietFs crises), attributable to a
Idnk in the ureters or renal vessels, which he described in 1864.

Perhaps the most brilliant name of the New Vienna School,
after Skoda's and Rokitansky's, was that of Ferdinand von Hebra
(1816-80), of Briinn in Moravia, a pupil of both these masters, and
the founder of the histologic school of dermatology, the second
phase in its modem development. Hebra's classification of skin
diseases (1845)^ was based upon their pathological anatomy, and
while complicated and artificial, lacking the simplicity of Willan's,
it opened out new lines of investigation, in which his pupils, Kaposi,
Nemnann and Pick, played a prominent part. Hebra regarded
most cutaneous disorders as purely local, and, from this viewpoint,

devised many effective modes of
treatment. Yet, as a champion
of nihilistic therapy, he is said to
have followed Skoda in feigning
treatment in some cases in order
to demonstrate to his own satis-
faction that they could get well
of themselves. Hebra revived the
use of mercurials in syphilis and
gave the classical accounts of lichen
exsudativus ruber (1857)^ and ec-
zema marginatmn( 1860).^ He also
did much to clear up obscure points
in classification and nomenclature,
and was the first to describe impet-
igo herpetiformis (1872),* although
the final account of the latter dis-
Ferdinand von Hebra (1816^1880). ^^^ ^^ completed by his son-in-

law, Kaposi, in 1887.^ Hebra's
clinic was one of the most popular in Vienna, on accoimt of his genial,
offhand style of lecturing, and his keen, often sarcastic, humor.

The greatest single achievement of the New Vienna School was
the determination of the true cause and prophylaxis of puerperal
fever. In the eighteenth century, Charles White, of Manchester,

1 F. von Hebra: Versuch einer auf pathologischer Anatomie gegrttndeten
Eintheilung der Hautkrankheiten. Ztschr. d. k. k. Gesellsch. d. Aerzte zu
Wien, 1845, i, 34; 142, 211.

* Allg. Wien. med. Ztg., 1857, ii, 95.

» Handb. d. spec. Path. u. Therap. (Virchow), 1860, iii, 31, 1. Abth., pp.
361-363.

* Wien. med. Wochenschr., 1872, xxii, 1197-1201.

* Kaposi: Vrtljschr. f. Dermat., Vienna, 1887, xiv, 273-296, 5 pi.



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MODERN PERIOD 369

E]ngland, had enlarged upon the advantages of scrupulous cleanli-
ness in these cases, and on February 13, 1843, Oliver Wendell
Holmes (1815-94) read to the Boston Society for Medical Improve-
ment his paper On the Contagiousness of Puerperal Fever,^ in which
he announced that women in child-bed should never be attended
by physicians who have been conducting postmortem sections or
cases of puerperal fever; that the latter disease may be conveyed
in this manner from patient to patient, even from a case of
erysipelas; and that washing the hands in calcium chloride and
changing the clothes after leav-
ing a puerperal fever case was
held to be a preventive meas-
ure. Holmes's essay stirred up
violent opposition on the part
of the Philadelphia obstetri-
cians, Hodge and Meigs, and,
in 1855, he returned to the
charge in his monograph on
'* Puerperal Fever as a Pri-
vate Pestilence," in which
he reiterated his views and
stated that one "Senderein"
had lessened the mortality of
puerperal fever by disinfecting
the hands with chloride of lime
and the nail-brush. This Sen-
derein was Ignaz Philipp Sem-



Online LibraryFielding H. (Fielding Hudson) GarrisonAn introduction to the history of medicine, with medical chronology, bibliographic data and test questions → online text (page 38 of 84)