Читать книгу Makers of Modern Medicine - James Joseph Walsh - Страница 2

Our generation, in this no more self-concentrated than many another, has prided itself so much on the progress it has achieved in science that it has in its interest in the insistent present rather neglected the claims of the history of science. There has been the feeling that our contemporaries and immediate predecessors have accomplished so much as to put us far beyond the past and its workers, so that it would seem almost a waste of time to rehearse the crude notions with which they occupied themselves. In no one of the sciences is this truer than in medicine. Yet it seems likely that no more chastening influence on the zeal for the novel in science, which so often has led this generation astray, could possibly be exerted than that which will surely follow from adequate knowledge of scientific history. In medicine there is no doubt at all that an intimate acquaintance with the work of the great medical men of the past would save many a useless investigation into problems that have already been thoroughly investigated, or at least would help modern workers to begin at a place much farther on in their researches than is often the custom.

There are other reasons why the knowledge of the history of medicine cannot but prove of great service to the present generation. We are entering upon a time when original research as the main business of selected lives, in contra-distinction to the few hours a day or even a week that the medical practitioners of a few generations ago could steal from their busy lives, is becoming more and more the rule. A consideration then of the methods by which advances in medicine were made in the past, of the character of the men to whom we owe the ground-breaking discoveries, of the way in which such discoveries were accepted or rather rejected by contemporaries, for rejection was almost the rule, will serve as a mirror for reflections that will surely be helpful in this day of great institutions of research. It must not be forgotten, however, that only too often in the past it is in the large institutions that routine work has been done, while the occasional genius has sprung up in circumstances that seemed quite unlikely to be the fostering mother of originality, and there has taken for the world the precious step into the unknown which represents a new departure in medical science.

Prof. Osier's declaration that the world's best work was mainly done by young men was not well received, but no one knew better than he that this is the most salient fact in the history of medical progress. There is practically not a single great discovery in medicine that was not made by a young man under thirty-five. As a rule, indeed, the new departures in medicine came from men who were well under thirty, some of them in fact only at the beginning of their third decade of life. Morgagni's great germinal idea, which made him the father of modern pathology, came to him when he was a student scarcely more than twenty. He then began to take notes on all the morbid appearances that he found in bodies, recognizing very clearly that he must trace out not only the main cause of the disease, but also the subsidiary pathological factors that were at work in the production of the various symptoms of the special case as he had studied it clinically. This idea is so obvious now as to seem impossible to be missed; yet scarcely a century ago it constituted the foundation-stone of modern pathology.

Auenbrugger, who laid the foundation of modern physical diagnosis by his observations upon percussion, began the work when he was under twenty-five, at the Spanish Hospital in Vienna, and carried it out to a completely successful issue absolutely without any encouragement from the great masters of the Vienna school. As a matter of fact, they rather pooh-poohed the idea that this foolish drumming, as one of them is said to have termed it, could ever amount to anything in enabling physicians to recognize pathological conditions within the chest. For twenty-five years after the publication of his little book, Auenbrugger's discovery attracted no attention. Laennec, who followed Auenbrugger in the development of physical diagnosis, set himself the much harder problem of constructing a system of auscultation when he was in his early twenties, studied the subject for twelve years and then published the book on it when he was as yet scarcely thirty-five. He accomplished the revolution in medicine that is due to him, though he was never strong and died at the early age of forty-six.

These are only striking examples which show what the young man has accomplished. The same thing was true in other countries. Corrigan wrote his famous essay on the "Permanent Patency of the Aortic Valve" when he was only twenty-nine years of age, and the work for it had been done during the preceding three years, at a hospital in which there were beds for only six medical patients. Trousseau declared this the greatest medical work, from a clinical standpoint, that had ever been accomplished, and hailed young Corrigan as one of the masters of clinical medicine. He maintained that disease of the aortic valve should receive the name Corrigan's disease. Stokes, Corrigan's contemporary and friend in Dublin, wrote his little book on the stethoscope when he was not yet twenty-one, and at a time when the distinguished clinicians of the day were all asking if these young men expected the old physicians to carry this toy about with them and use it for any serious purpose. Graves, also of the Irish school of medicine, made some of the clinical observations on which his reputation is founded, including a short description of characteristic cases of the affection that still bears his name, when he was well under thirty-five.

Further examples might well be cited, but they will be met with in the course of this book. The history of most of the sciences is like medicine in this respect, and it is to young men that the great ground-breaking ideas come. How true this is in biology can be noted even from the lives of the physician-biologists that are included in this volume. Theodore Schwann, the father of the cell doctrine, did all the work for which he deserves the name of founder of modern biology when he was scarcely more than thirty. Part of the best of it was accomplished before he was twenty-five. Claude Bernard had shown the precious metal of his originality before he was far on in his twenties. Pasteur, the most original genius of them all, began his work when he was scarcely more than a boy, and though every five years of a long life was filled with original observations of the most precious kind, his genius had received the bent which it was to follow from the successful accomplishment of observations during his third and fourth decades.

In these modern days, when the education of the young man for medicine is not supposed to be finished until he is nearly thirty, it is easy to understand that perhaps the precious years in which originality might manifest itself are already past before he gets out of the swaddling clothes of enforced instruction from others. As has been very well said, it is possible to smother whatever of the investigating spirit and original initiative there may be in a young man by attempting to teach him too much of what the present generation knows. Unfortunately, it happens only too often even in this wise generation of ours that it is not so much the ignorance of mankind that makes them ridiculous as the knowing so many things that are not so. The number of things that the young man has to learn and that are taught him, often with the assurance that they are almost gospel truth in medicine, and yet that he finds before he has been long out of school or indeed sometimes before he leaves school, to be at best opinions, is entirely too great. The saving grace for the correction of this constantly recurring fault in education is undoubtedly a knowledge of the development of medicine in the past and a recognition of the fact that the accepted truth of any one generation proves after all often enough to be only apparent.

After the false impression that it is to older men we owe progress in medicine, perhaps the most universally accepted apparent truth is that the investigating spirit is communicable, and that the pupils of a great master may be expected to carry on his work and add almost as much as he has done to the great body of medical knowledge during the generation immediately following his work. It would naturally be expected, for instance, that Morgagni having laid the foundations of modern pathology and connected pathological observation with clinical observation the great development in modern diagnosis would have come down in Italy. This was not true, however. The next great step connecting bedside observations with postmortem appearances was made by Auenbrugger in Vienna in distant Austria. Auenbrugger's work having been successfully accomplished it might reasonably be supposed that he himself or some of those who had seen his successful diagnosis of thoracic conditions by percussion would take the next step and discover auscultation. This, however, did not happen in Germany, but in France. It is true that Laennec's work was done under the influence of Corvisart, who revived Auenbrugger's work and gave it to the world once more, and that in a way, therefore, Laennec may be considered an indirect pupil of Auenbrugger; but the fact stands that the two discoveries of percussion and auscultation were made at an interval of nearly fifty years and at a distance of more than a thousand miles from each other.

On the other hand, Laennec having solved the wonderful mystery of the significance of the sounds within the chest as far as they concern pulmonary diseases might have been expected to do as much also for heart disease. Even genius, however, is able it seems to take only one step into the unknown. Auenbrugger did not discover auscultation, though it apparently lay so near at hand. Laennec did not solve the riddle of heart murmurs, though for most of us they do not present any more difficulty than the wonderfully successful recognition of the significance of râles of various kinds in which Laennec never failed. The problem of heart diagnosis was to be solved by Corrigan and the Irish school of medicine hundreds of miles away, though they were doing their work about the same time that Laennec was making his observations in Paris. Curiously enough just during the same decade Richard Bright, in England, was studying out the problem of kidney disease, and, as a young man, teaching the world nearly as much about it as it has ever learned, though, in the seventy-five years that have passed since, so much of investigation has been devoted to the subject.

No one nation can claim the palm of superiority in the matter of original investigation. The spirit of genius breathes where it will, and unfortunately it is incommunicable. Students may think they absorb all that the master has to give them, and that they are ready to go on with his work where he left it. They do actually seem to their own generation to make distinct progress in medicine. When the situation is analyzed fifty or a hundred years afterward, however, it is found that only the master's work counts, and that much of what seems to be advance was only a skirmishing here and there along the lines laid down by him, but without any material progress for true science.

This same peculiarity is manifest, also, not only in the history of sciences allied to medicine, but in that of all the physical sciences. A very striking example is to be found in the story of the rise of electrical science, which took place almost at the same period as that which saw the rise of clinical medicine. Origins in electricity date from Franklin's work here in America and Galvani and Volta's observations in Italy. It might quite naturally have been expected that the further progress of electrical science would come in either of these countries. The next great discoveries, however, were separated by long distances and a considerable interval of time. After Volta came the demonstration by Oersted, in Denmark, of the identity of magnetism with electricity. It was not in Denmark, however, that the problems connected with this principle were worked out, but by Ampere in France. In the mean time, Cavendish and Faraday, working quite independently of their Continental colleagues, were making significant strides in electricity in England.

When the problem of the resistance to the passage of electricity in a conductor was to be studied, another nation supplied the man for the opportunity. Ohm had never been in contact with any of these great contemporaries and did his work entirely by himself. It is a curious confirmation of what we have stated with regard to the young man in medicine and the making of great discoveries that practically all these founders in electricity were under thirty-five when their best original work was accomplished.

From a series of biographies of great medical discoverers, certain salient traits stand out so as to attract attention even from the cursory reader. The essence of significant work in medicine consists of observation, not theory. It has always been the custom to theorize much and unfortunately to observe but little. Long ago John Ruskin said that the hardest thing in the world for a man to do is to see something and to tell it simply as he saw it. Certainly this has been true in medicine. The men who have had eyes, and have used them, have impressed their names upon the history of progressive scientific advance. The theorists have never contributed anything worth while to the body of medical truth.

While this is readily acknowledged by every generation, with regard to the past, it is curious to note how different is the appreciation of each generation for the theorist as opposed to the observer. Medical theorists have always been honored by their contemporaries unless their theories were utterly outlandish, and even then they have had many disciples, and have seldom been without honor and never, with sorrow for the foolishness of men be it said, without emolument. The observer, however, has but rarely been in favor with his contemporaries. Not infrequently the observation that he made appeared to be so obvious that his fellows could not think that it represented a great truth. As a consequence they have usually derided him for attempting to make them see a significance in his observation that they could not think was there. Huxley once stated the phases through which a new scientific truth ordinarily passes. At first it is said to be trivial and insignificant, then as it attracts more attention it is declared to be in contradiction with hitherto known truth. Finally it is declared to be after all only in other terms what the world has always believed in the matter. Certainly through these stages all the great discoveries in medicine have gone. So true is this, that if what seems to be a new truth in medicine is accepted at once, and willingly, there is more than a suspicion that it is not really a new discovery but only a modification of something hitherto well known.

All the great discoverers in medicine have practically without exception met, if not with opposition, surely with neglect of their work. We smile complacently now at the generation that considered the stethoscope a toy, and asked derisively if they should be expected to carry it about with them. The next generation, however, having grown accustomed to the stethoscope, refused quite as inconsequentially to have anything to do with the thermometer. They refused to carry these glass things around with them in order to test the fever that patients might have, since they claimed they were able to accomplish this purpose quite as well by means of their educated touch. The generation of medical men is not yet passed who refused to credit the thought that the diagnosis of diphtheria would ever be made only by the microscope and culture methods, and who considered that they could tell very well what was diphtheria, and what not, from the appearance of the throat.

Of course similar opposition was the fate meted out to every distinguished scientific discoverer, and so I suppose medical men cannot complain. His contemporaries said of Galvani that he had made of himself a dancing master for frogs, because he continued his observations on the legs of these animals in order to solve the problems of animal electricity. Pasteur's demonstration that there was no such thing as spontaneous generation, served at first only to bring down on his devoted head the aspersions of most of the distinguished scientific men in Europe. When that genius, the physician Robert Mayer, discovered the conservation of energy as the result of his acute observation, that blood drawn by venesection in the tropics was redder than that drawn in colder climates, he found that scientific circles were not only not ready to accept his demonstration, but that he was looked upon as a visionary, somewhat as one who thought that he had solved the problem of squaring the circle or the endless puzzle of perpetual motion.

Fortunately these men have as a rule had a physical and mental force that enabled them to go on in spite of the opposition or derision of their contemporaries. It is rather a curious fact that most of the great medical discoverers were born in the country and were as a rule the sons of rather poor parents. Many of them were so situated that they had to begin to make their own livelihood to some extent at least at the beginning of their third decade of life. Far from proving a hindrance to their original work, this necessity seems rather to have been one of the sources of inspiration that spurred them on to successful efforts in their investigations.

Most of them were what would be called handy men, in the sense that they could use their hands to work out their ideas mechanically. This was typically true of Galvani, who had to construct his own first electrical instruments, and of Laennec, who took pride in making his own stethoscopes. So many of them made by his own hands are still extant, that a number of museums have the opportunity to hold specimens of his handiwork. Auenbrugger and Johann Müller and Pasteur are further examples of this same handiness. Claude Bernard exhibited this quality very early in life and continued to exercise it all during his career.

Nor was their ingenuity limited to material things. Many of them were interested in literary and artistic work of various kinds. Morgagni was considered a literary light in his generation. Auenbrugger composed a musical comedy which had a distinct success, even in music loving Vienna. The Empress Maria Theresa said that she supposed he would now continue to write musical comedies; but Auenbrugger replied, with more candor than gallantry, that he had something better to do. Claude Bernard composed a play that shows distinct evidence of literary talent. It seems fortunate indeed that he was diverted from his original intention of following literature as a career, and took up medicine. Many of the others, as, for instance, Graves and Stokes, were excellent judges of art, critics of real knowledge and genuine appreciation; and indeed it may be said that none of them was ever so absorbed in his vocation of medicine as not to have much more than a passing interest in some of the great phases of intellectual activity quite apart from his professional work, or from scientific knowledge: an avocation to which he turned for the only true recreation of mind there is–a change of work.

This seems all the more worth while calling attention to in our strenuous age, because it is sometimes considered a mistake for a physician to show that he is interested in intellectual pursuits of any kind apart from his professional work. It is supposed that no one is capable of dividing his attention in this way and yet do justice to his profession and his patients. As a matter of fact it has well been said that no really great physician has ever been a narrow specialist in the sense that he knew only medicine well; there was always at least one other department of intellectual attainment with which he had made himself so familiar as to be an authority in it. It is not the lopsided who make great athletes, and it is not the one-sided man who succeeds in doing really great work. Practically all the great physicians have had favorite hobbies to which they have turned for relaxation, for surely no one understands better than physicians that recreation consists not in that impossibility, the doing of nothing, but in resting the mind by doing something quite different from what it has been engaged at before.

There is another phase of the lives of these great men of medicine that is so different from what is ordinarily thought to be the rule with physicians, that it seems worth while emphasizing at the end of this introduction. All these great discoverers have been men of constructive imagination, men who might have been distinguished litterateurs very probably, had they applied themselves in that field. All of them have had too much imagination to be materialists, that is, to consider that they could know nothing except what they learned from the matter with which their studies were taken up. All these great discoverers in medicine have been simple, sincere, faithful believers, ready to express their trust in an overruling Providence, and in a hereafter that they knew only by faith, it is true, but which was for that reason none the less distinctly recognized. While it is usually considered that medicine leads men's minds away from orthodox thinking in the great matter of the relationship of the creature to the Creator, all these men have been not only ready to acknowledge their personal obligations to Him, but have furnished exemplary models of what the recognition of such obligations can make of human lives.

There is an old proverb that runs Ubi tres medici ibi duo athei, –where there are three physicians there are at least two atheists. This has made many a heartache for fond mothers when they found their sons had determined on becoming physicians. If the present series of sketches is to be taken as any argument, however, it is only the small minds among physicians who become atheists. They are not able to see their way clearly from the material they work in to the higher things that prove a source of strength and consolation to the great minds while they are busy making medicine for their own and subsequent generations. Certainly no more thoroughly representative group of the makers of nineteenth century clinical medicine could have been selected than those whose sketches are here given. They are from all the nations who have contributed materially to modern medical advance, yet all of them were deeply religious men. There is another and equally important point with regard to them. It is their relations to their fellows. Without exception they were men beloved by those around them for their unselfish devotion not only to science, but also to their brother men. In the midst of their occupations the thought that has been the profoundest consolation for all of them without exception has been that they were accomplishing something by which their fellow-men would be saved suffering and by which human life would be made more happy. A study of their careers cannot fail to show the young physician the ideals he must cherish if he would have real and not apparent success and happiness in life.