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A GENERAL SURVEY OF GERMAN MEDICINE AT THE END OF THE EIGHTEENTH CENTURY

Among those who read the present chapter there may be some who will express surprise at the gloomy character of the picture which I draw of the state of medical affairs in Germany at the period of time now under consideration. In answer to this implied criticism I would state that I am in no degree responsible for the unpleasant impression conveyed by the picture, as I have simply reproduced, without the slightest exaggeration, the account which such excellent authorities as August Hirsch, of Berlin, and George Korn, of Munich, give in their published writings. Furthermore, I have not hesitated to quote, wherever I could do so without obscuring the clarity of my account, the actual statements of these authors. However gloomy, therefore, the picture here presented may appear, this unattractive characteristic must be attributed to the actual condition of medical affairs in Germany during the period named.

At the end of the eighteenth century and at the beginning of the nineteenth culture entered upon an entirely new phase of development in all parts of the civilized world; more quickly in certain parts than in others because the seeds of such development had already begun there to take root. In this work of development John Locke, the English philosopher, was a conspicuous leader. His philosophy formed the starting-point of the new development of the natural sciences, first in France and afterward in Germany and other European countries. Voltaire was the first among the French philosophers to advocate the teachings of Locke in opposition to those of Descartes (i.e., realistic rather than as the result of a priori reasoning). Condillac, another great French philosopher (1715–1780), also expressed himself as approving the views set forth by Voltaire,—that is, in favor of Locke’s philosophy. Diderot and others among the encyclopaedists sanctioned the same teachings. As Hirsch expresses it:—

These ideas broke like a thunderstorm over the thinking classes of France and spread rapidly to the other countries; the French Revolution cleared the atmosphere in all the different walks of life; it cast off the fetters of feudalism or at least materially loosened their hold; it greatly increased tolerance of religious beliefs and placed limits upon superstition.

At this period of time Germany was still living under deplorable conditions. The after-effects of the Thirty Years’ War still lingered. Those Germans who wished to lay some claim to culture were obliged to think, speak and write in French. The great mass of the people, however, were still bound hand and foot under the dominion of their spiritual and state tyrants. The learned classes still cultivated a barbaric Latin in their university lectures and in their writings. They considered it beneath their dignity to cultivate their own tongue. In the schools and universities the teaching had reached a decidedly low ebb. “The humanistic spirit” had vanished; the teaching was directed to the acquisition of the science of bread-winning. The Roman Catholic Church at this time was entirely in the hands of the Jesuits; the Protestant Church was no longer guided by the high ideals of its founder. A hollow dogmatism had put a stop to all further search for the truth; the one important thing was orthodoxy. There had developed a Protestant hierarchy that exerted as stupefying an influence upon the great mass of the people as did the Jesuits in the Roman Catholic Church. Superstition and charlatanry permeated the medical profession. These superstitious beliefs found lodgment in the minds of even such otherwise great physicians as Friedrich Hoffmann, Georg Ernst Stahl and Anton de Haen, one of Boerhaave’s distinguished pupils and a celebrated clinical teacher.

After the lapse of a few years—that is, in 1842—there was founded a new German periodical, the Archiv für Physiologische Heilkunde, under the management of Wunderlich and Roser. According to the Prospectus it was to be devoted to physiological medicine, or—to be more precise—to the cultivation of physiological methods in the treatment of disease. The introductory article in the first number of this new periodical bore the title: “The Defects of German Medicine as Taught to-day and the Importance of Giving it a Decidedly Scientific Tendency.” From the convincing style in which the article is written there can be no mistake, says Petersen, in ascribing its authorship to Karl August Wunderlich (1815–1877), a member of the Tübingen Faculty of Medicine. The following brief extracts from this article will suffice to give the reader a fair idea of this writer’s views on the subject of which he treats:—

We are establishing to-day an organ which is intended to promote the interests of physiological medicine. Henceforth it should be the aim of all enlightened minds to place pathology upon a physiological basis.^[9] Nothing of a dogmatic character may be tolerated in these pages; every law here promulgated must be accompanied by proofs showing that it is justified; all the facts, observations and experiments that have led to its acceptance as a law must form a part of the account. Although for a long time past the necessity of following the course here outlined has been appreciated and has been unostentatiously adopted by all good observers, nevertheless, it is believed that the time has now come when this important fundamental truth should be announced loudly and in no uncertain terms, and should be defended again and again with untiring energy, until it shall have received universal acceptance.... People are already beginning to make a distinction between the doctrines taught in the books and those which are derived from a direct observation of what takes place in nature.... But this scepticism is only too often based upon mere assumptions and consequently fails to produce any useful results.... We believe that the time has at last arrived when this sort of scepticism should be organized into something like a system, and that intelligent criticism should persevere in testing the correctness of those observations which have been cited as actual facts and as the bases upon which the hitherto prevailing medical theories, so it is claimed, deserve to receive acceptance.

We further believe that to-day is the time when an attempt should be made to construct, out of the clinical materials that are now in our possession and that have been brought together with great care and without bias, a positive science, a science which in the course of time cannot fail to lead to sound therapeutic methods. This is what we mean by the expression “Physiological Medicine.”

Up to this point in his article Wunderlich says nothing to which any of my readers are likely to object. Quite the contrary; the first impression which the text makes is something like this: At last Wunderlich has discovered a road by following which closely one may eventually develop a really scientific practical medicine. But, when one reaches the end of the article, one can scarcely fail to experience no small degree of disappointment on finding that it does not furnish the slightest evidence of the manner in which the author’s seemingly admirable scheme is to be realized; nor—as we are assured by Petersen—is any further enlightenment upon this subject to be found in any of the succeeding volumes, either in the seven which were published under the joint editorship of Wunderlich and Roser, or in those which were issued after Wilhelm Griesinger had been accepted as an associate in the management of the Archiv. The old evil which carried Broussais as it were by storm into the dictatorship of medical thinking and of medical practice in France was here being reëstablished in Germany. Men seemed to find it impossible to go on patiently collecting facts; they could not resist the temptation to build theories first. So far at least as the treatment of disease is concerned, we are forced to admit that the collecting of any large body of facts is well-nigh an impossibility. Only after the lapse of very many years would it be possible to realize the desirable results which Wunderlich had in mind.

BOOK III

THE VIENNA SCHOOL OF MEDICINE