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23 - Evolution of Modern Medicine by Sir William Osler · Evolution of Modern Medicine

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Speaker 1: Section twenty two of the Evolution of Modern Medicine. This
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Speaker 1: is a LibriVox recording. All LibriVox recordings are in the
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Speaker 1: public domain. For more information, too, volunteer, please visit LibriVox
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Speaker 1: dot org. The Evolution of Modern Medicine by Sir William Osler,
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Speaker 1: Section twenty two, Chapter five, The Rise and Development of
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Speaker 1: modern Medicine, Part one. The middle of the seventeenth century
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Speaker 1: saw the profession thus far on its way. Certain objective
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Speaker 1: features of disease were known, the art of careful observation
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Speaker 1: had been cultivated, Many empirical remedies had been discovered, The
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Speaker 1: coarser structure of man's body had been well worked out,
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Speaker 1: and a good beginning had been made in the knowledge
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Speaker 1: of how the machinery worked. Nothing more, what disease really was,
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Speaker 1: where it was, how it was caused, had not even
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Speaker 1: begun to be discussed intelligently in empirical discovery of the
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Speaker 1: first importance marks the middle of the century. The story
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Speaker 1: of Chincona is of special interest, as it was the
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Speaker 1: first great specific in disease to be discovered. In sixteen
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Speaker 1: thirty eight, the wife of the Viceroy of Peru, the
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Speaker 1: Countess of Kincona, lay sick of an intermittent fever in
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Speaker 1: the Palace of Lima. A friend of her husbands, who
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Speaker 1: had become acquainted with the virtues in fever of the
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Speaker 1: bark of a certain tree, sent a parcel of it
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Speaker 1: to the Viceroy, and the remedy administered by her physician,
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Speaker 1: Don Juan del Vego, rapidly effected a cure. In sixteen forty,
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Speaker 1: the countess returned to Spain, bringing with her a supply
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Speaker 1: of quina barque, which thus became known in Europe as
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Speaker 1: the Countess's powder Polvis Commetisse. A little later her doctor followed,
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Speaker 1: bringing additional quantities. Later in the century, the Jesuit fathers
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Speaker 1: sent parcels of the barque to Rome, whence it was
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Speaker 1: distributed to the priests of the community and used for
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Speaker 1: the cure of aagu, hence the name of Jesuits bark.
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Speaker 1: Its value was early recognized by Sindiham and by Locke.
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Speaker 1: At first, there was a great deal of opposition, and
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Speaker 1: the Protestants did not like it because of its introduction
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Speaker 1: by the Jesuits. The famous quack Robert Talbor sold the
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Speaker 1: secret of preparing quiquina to Louis the fourteenth in sixteen
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Speaker 1: seventy nine for two thousand Louis de or, a pension
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Speaker 1: and a title. That the profession was divided in opinion
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Speaker 1: on the subject was probably due to sophistication, or to
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Speaker 1: the importation of other and inert barks. It was well
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Speaker 1: into the eighteenth century before its virtues were universally acknowledged.
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Speaker 1: The tree itself was not described until seventeen thirty eight,
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Speaker 1: and Linnaeus established the genus Chintona in honor of the countess.
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Speaker 1: A step in advance followed the objective study of the
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Speaker 1: changes wrought in the body by disease. To a few
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Speaker 1: of these the anatomists had already called attention. The Salius
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Speaker 1: always keen, in his description of aberrations from the normal,
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Speaker 1: was one of the first to describe internal aneurism. The
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Speaker 1: truth is even the best of men at little or
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Speaker 1: no appreciation of the importance of the study of these changes.
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Speaker 1: Sidaham scoffs at the value of post mortems. Again, we
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Speaker 1: have to go back to Italy for the beginning of
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Speaker 1: these studies, this time to Florence, in the glorious days
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Speaker 1: of Lorenzo the Magnificent, The pioneer now is not a professor,
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Speaker 1: but a general practitioner Antonio Binevienni, of whom we know
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Speaker 1: very little, save that he was a friend of Masilio
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Speaker 1: Ficino and of Angelo Poliziano, and that he practiced in
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Speaker 1: Florence during the last third of the fifteenth century, dying
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Speaker 1: in fifteen oh two. Through associations with the scholars of
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Speaker 1: the day, he had become a student of Greeks medicine.
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Speaker 1: And he was not only a shrewd and accurate observer
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Speaker 1: of nature, but a bold and successful practitioner. He had
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Speaker 1: formed the good habit of making brief notes of his
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Speaker 1: more important cases, and after his death these were found
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Speaker 1: by his brother Jerome and published in fifteen o seven.
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Speaker 1: This book has a rare value as the record of
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Speaker 1: the experience of an unusually intelligent practitioner of the period.
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Speaker 1: There are, in all one hundred and eleven observations, most
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Speaker 1: of them commendably brief. The only one of any length
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Speaker 1: deals with the new Morbus Galicus, of which in the
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Speaker 1: short period between its appearance and Benaviani's death he had
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Speaker 1: seen enough to leave a very accurate description, and is
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Speaker 1: interesting to note that even in those early days mercury
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Speaker 1: was employed for its cure. The surgical cases are of
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Speaker 1: exceptional interest, and number thirty eight refers to a case
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Speaker 1: of angina for which he performed a successful operation. This
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Speaker 1: is supposed to have been a tracheotomy, and if so,
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Speaker 1: it is the first in the fourteenth centuries that had
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Speaker 1: elapsed since the days of Antelius. There are other important
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Speaker 1: cases which show that he was a dexterous and fearless surgeon.
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Speaker 1: But the special interest of the work for us is that,
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Speaker 1: for the first time in modern literature we have reports
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Speaker 1: of post mortem examinations made specifically with a view to
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Speaker 1: finding out the exact cause of death. Among the one
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Speaker 1: hundred and eleven cases, there are post mortem records of
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Speaker 1: cases of gallstones, abscesses of the mesentery, thrombosis of the
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Speaker 1: mesenteric veins, several cases of heart disease, senile gangrene, and
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Speaker 1: one of corvulosum. From no other book do we get
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Speaker 1: so good an idea of a practitioner's experience at this period.
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Speaker 1: The notes are plain and straightforward and singularly free from
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Speaker 1: all theoretical and therapeutic vagaries. He gives several remarkable instances
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Speaker 1: of faith healing. To know accurately the anatomical changes that
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Speaker 1: take place in disease is of importance both for diagnosis
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Speaker 1: and for treatment. The man who created the science, who
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Speaker 1: taught us to think anatomically of disease, was Morgani, whose
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Speaker 1: Decidibus at causis moriborum per anatomin indiagadis is one of
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Speaker 1: the great books in our literature. During the seventeenth century,
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Speaker 1: the practice of making post mortem examinations had extended greatly,
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Speaker 1: and in the Subultritum Anatomicum of Bonetas sixteen seventy nine,
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Speaker 1: these scattered fragments are collected. But the work of Morgani
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Speaker 1: is of a different type, for in it are the
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Speaker 1: clinical and anatomical observations of an able physician during a
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Speaker 1: long and active life. The work had an interesting origin.
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Speaker 1: A young friend, interested in science and in medicine, was
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Speaker 1: fond of discoursing with Morgani about his preceptors, particularly Volsava
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Speaker 1: and Albertini, and sometimes the young man inquired about Morgani's
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Speaker 1: own observations and thoughts. Yielding to a strong wish, Morgani
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Speaker 1: consented to write his young friend familiar letters describing his experiences.
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Speaker 1: I am sorry that Mrgani does not mention the name
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Speaker 1: of the man to whom we are so much indebted,
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Speaker 1: and who he states, was so pleased with the letters
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Speaker 1: that he continually solicited him to send more and more,
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Speaker 1: till he drew me on so far as the seventieth.
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Speaker 1: When I begged them of him in order to revise
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Speaker 1: their contents, he did not return them till he had
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Speaker 1: made me solemnly promise that I would not abridge any
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Speaker 1: part thereof. Born in sixteen eighty two, Brgani studied at
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Speaker 1: Bologna under Vasava and Albertini. In seventeen eleven he was
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Speaker 1: elected professor of medicine at Padua. He published numerous anatomical
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Speaker 1: observations and several smaller works of less importance. The great work,
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Speaker 1: which has made his name immortal in the profession, appeared
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Speaker 1: in his eightieth year, and represents the accumulated experience of
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Speaker 1: a long life. Though written in the form of letters,
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Speaker 1: the work is arranged systematically and has an index of
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Speaker 1: exceptional value. From no section does one get a better
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Speaker 1: idea of a character and scope of the work than
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Speaker 1: from that relating to the heart and arteries. Affections of
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Speaker 1: the pericardium, diseases of the valves, ulceration, rupture, dilation and hypertrophy,
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Speaker 1: and affections of the order are all fully described. The
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Speaker 1: section on aneurysm of the aorder remains one of the
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Speaker 1: best ever written. It is not the anatomical observations alone
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Speaker 1: that make the work of unusual value, but the combination
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Speaker 1: of clinical and anatomical records. What could be more correct
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Speaker 1: than this account of angina pectorus, probably the first in
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Speaker 1: the literature. A lady forty two years of age, who
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Speaker 1: for a long time had been a valetudinarian, and within
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Speaker 1: the same period on using pretty quick exercise of body,
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Speaker 1: she was subject to attacks of violent anguish and the
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Speaker 1: upper part of the chest on the left side, accompanied
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Speaker 1: with a difficulty of breathing and numbness of the left arm.
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Speaker 1: But these paroxysms soon subsided when she seized from exertion.
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Speaker 1: In these circumstances, but with cheerfulness of mind, she undertook
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Speaker 1: a journey from Venice, proposing to travel along the continent.
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Speaker 1: When she was seized with a paroxysm and died on
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Speaker 1: the spot. I examined the body on the following day.
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Speaker 1: The aorda was considerably dilated at its curvature, and in
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Speaker 1: places through its whole tract. The inner surface was unequal
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Speaker 1: and ossified. These appearances were propagated into the arteria inominata,
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Speaker 1: the aortic valves were indurated. He remarks, the delay of
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Speaker 1: blood in the aorda, in the heart, in the pulmonary vessels,
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Speaker 1: and in the vinakeeva would occasion the symptoms of which
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Speaker 1: the woman complained during life, namely the violent uneasiness, the
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Speaker 1: difficulty of breathing, and the numbness of the arm. Borgani's
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Speaker 1: life had as much influence as his work in close
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Speaker 1: correspondence with the leading men of the day, with the
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Speaker 1: young and rising teachers and workers. His methods must have
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Speaker 1: been a great inspiration, and he came just at the
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Speaker 1: right time. The profession was literally ravaged by theories, schools
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Speaker 1: and systems, iatrau mechanics, iatro chemistry, new moralism, the animism
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Speaker 1: of Stahle, the vitalistic doctrines of van Helmont and his followers,
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Speaker 1: and into this metaphysical confusion Organi came like an old Greek,
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Speaker 1: with his clear observation, sensible thinking, and ripe scholarship. Sprangel
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Speaker 1: Well remarks that it is hard to say whether one
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Speaker 1: should admire most his rare dexterity and quickness in dissection,
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Speaker 1: his unimpeachable love of truth and justice, in his estimation
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Speaker 1: of the work of others, his extensive scholarship and his
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Speaker 1: rich classical style, or his downright common sense and manly speech.
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Speaker 1: Upon this solid foundation, the morbid anatomy of modern clinical
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Speaker 1: medicine was built. Many of Morgani's contemporaries did not fully
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Speaker 1: appreciate the change that was in progress and the value
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Speaker 1: of the new method of correlating the clinical symptoms and
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Speaker 1: the morbid appearances. After all, it was only the extension
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Speaker 1: of the Hippocratic method of careful observation, the study of
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Speaker 1: facts from which reasonable conclusions could be drawn. In every
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Speaker 1: generation there has been men of this type, I dare
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Speaker 1: say many more than we realize men of the Benavienni
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Speaker 1: care character, thoroughly practical, clear headed physicians. A model of
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Speaker 1: this sort arose in England in the middle of the
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Speaker 1: seventeenth century Thomas Sydenham sixteen twenty four to sixteen eighty nine,
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Speaker 1: who took men back to Hippocrates, just as Harvey had
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Speaker 1: led them. Back to Galen Sydenham broke with authority and
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Speaker 1: went to nature. It is extraordinary how he could have
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Speaker 1: been so emancipated from dogmas and theories of all sorts.
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Speaker 1: He laid down the fundamental proposition and acted upon it
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Speaker 1: that all disease could be described as natural history. To
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Speaker 1: do him justice, we must remember, as doctor John Brown says,
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Speaker 1: in the midst of what a mass of errors and
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Speaker 1: prejudices of theories actively mischievous. He was placed at a
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Speaker 1: time when the mania of hypothesis was at its height,
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Speaker 1: and when the practical part of his art was overrun
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Speaker 1: and stultified by vile and silly nos Hore Subsivier, Volume one,
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Speaker 1: fourth Edition, Edinburgh, eighteen eighty two, page forty. Listen to
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Speaker 1: what he says upon the method of the study of
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Speaker 1: medicine In writing. Therefore, such a natural history of diseases,
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Speaker 1: every merely philosophical hypothesis should be set aside, and the
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Speaker 1: manifest and natural phenomena, however minute, should be noted with
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Speaker 1: the utmost exactness. The usefulness of this procedure cannot be overrated,
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Speaker 1: as compared with the subtle inquiries and trifling notions of
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Speaker 1: modern writers. For can there be a shorter, or indeed
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Speaker 1: any other way of coming at the morbific causes or
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Speaker 1: discovering the curative indications then by a certain perception of
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Speaker 1: the peculiar symptoms. By these steps and helps, it was
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Speaker 1: that the father of physique, the great Hippocrates, came to
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Speaker 1: excel his theory, being no more than an exact description
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Speaker 1: or view of nature, that nature alone often terminates diseases
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Speaker 1: and work secure with a few simple medicines, and often
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Speaker 1: enough with no medicines at all. Towards the end of
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Speaker 1: the century, many great clinical teachers arose, of whom perhaps
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Speaker 1: the most famous was Borhave, often spoke of as the
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Speaker 1: Dutch Hippocrates, who inspired a group of distinguished students. I
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Speaker 1: have already referred to the fact that Franciscus Silvius at
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Speaker 1: Leiden was the first among the moderns to organize systematic
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Speaker 1: clinical teaching under Borhave. This was so developed that to
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Speaker 1: this Dutch university students flocked from all parts of Europe.
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Speaker 1: After teaching botany and chemistry, Borhav succeeded to the chair
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Speaker 1: of Physique in seventeen fourteen with an unusually wide general training,
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Speaker 1: a profound knowledge of the chemistry of the day, and
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Speaker 1: in accurate acquaintance with all aspects of the history of
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Speaker 1: the profession. He had a strongly objective attitude of mind
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Speaker 1: towards disease, Following closely the methods of Hippocrates and Sydenham.
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Speaker 1: He adopted no special system, but study disease as one
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Speaker 1: of the phenomena of nature. His clinical lectures, held bi weekly,
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Speaker 1: became exceedingly popular and were made attract of not less
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Speaker 1: by the accuracy and care with which these cases were
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Speaker 1: studied than by the freedom from fanciful doctrines and the
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Speaker 1: frank honesty of the man. He was much greater than
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Speaker 1: his published work would indicate, and, as is the case
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Speaker 1: with many teachers of the first rank, his greatest contributions
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Speaker 1: were his pupils. No other teacher of modern times has
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Speaker 1: had such a following. Among his favorite pupils may be
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Speaker 1: mentioned Holler, the physiologist, and Van Sweden and Dehan, the
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Speaker 1: founders of the Vienna School. In Italy, too, there were
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Speaker 1: men who caught the new spirit and appreciated the value
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Speaker 1: of combining morbid anatomy with clinical medicine. Lancsi, one of
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Speaker 1: the early students of disease of the Heart, left an
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Speaker 1: excellent monograph on the subject, and was the first to
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Speaker 1: call special attention to the association of syphilis with cardiovascular disease.
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Speaker 1: A younger contemporary of his, at Rome by Glevi, was
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Speaker 1: unceasing in his call to the profession to return to
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Speaker 1: hippocratic methods, to stop reading philosophical theories, and to give
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Speaker 1: up what he calls the fatal itch to make systems.
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Speaker 1: The lid In methods of instruction were carried far and
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Speaker 1: wide throughout Europe, into Edinburgh by John Rutherford, who began
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Speaker 1: to teach at the Royal Infirmary in seventeen forty seven,
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Speaker 1: and was followed by Wit and by Culin, into England
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Speaker 1: by William Saunders of Guy's Hospital. Unfortunately, the great majority
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Speaker 1: of clinicians could not get away from the theoretical conceptions
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Speaker 1: of disease, and Cullen's theory of spasm, and atuny sized
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Speaker 1: a profound influence on practice, particularly in this country, where
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Speaker 1: it had the warm advocacy of Benjamin Rush. Even more
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Speaker 1: widespread became the theories of a pupil of Cullen's, John Brown,
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Speaker 1: who regarded excitability as the fundamental property of all living creatures.
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Speaker 1: Too much of this excitability produced what were known as
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Speaker 1: sthenic maladies, too little aesthetic on which principles practice was
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Speaker 1: plain enough. Few systems of medicine have ever stirred such
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Speaker 1: bitter controversy, particularly on the continent, and in Charles Crichton's
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Speaker 1: account of Brown, we read that as late as eighteen
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Speaker 1: o two the University of Gottingen was so convulsed by
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Speaker 1: controversies as to the merits of the Brunonian system that
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Speaker 1: contending factions of students in enormous numbers, not unaided by
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Speaker 1: the professors, met in combat in the streets on two
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Speaker 1: consecutive days and had to be dispersed by a troop
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Speaker 1: of Hanoverian horse. But the man who combined the qualities
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Speaker 1: of Visalius, Harvey and Morgani in an extraordinary personality was
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Speaker 1: John Hunter. He was, in the first place, a naturalist,
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Speaker 1: to whom pathological processes were only a small part of
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Speaker 1: a stupendous whole governed by law, which however, could not
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Speaker 1: be understood until the facts had been accumulated, tabulated, and systematized.
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Speaker 1: By his example, by his prodigious industry, and by his
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Speaker 1: suggestive experiments, he led men again into the old paths
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Speaker 1: of Aristotle, Galen and Harvey. He made all thinking physicians naturalists,
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Speaker 1: and he lent a dignity to the study of organic life,
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Speaker 1: and re established a close union between medicine and the
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Speaker 1: natural sciences, both in Britain and Great Britain. He laid
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Speaker 1: the foundation of the great collections and museums, particularly those
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Speaker 1: connected with the medical schools. The Wistar, Horner and the
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Speaker 1: Warren museums in this country originated with men greatly influenced
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Speaker 1: by Hunter. He was moreover the intellectual father of that
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Speaker 1: interesting group of men on this side of the Atlantic, who,
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Speaker 1: while practicing as physicians, devoted much time in labor to
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Speaker 1: the study of natural history, such men as Benjamin Smith, Barton,
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Speaker 1: David Hassack, Jacob Bigelow, Richard Harlan, John D. Godman, Samuel
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Speaker 1: George Morton, John Collins, Warren, Samuel L. Mitchell, and j
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Speaker 1: Elkin Miggs. He gave an immense impetus in Great Britain
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Speaker 1: to the study of morbid anatomy, and his nephew, Matthew
19:44
Speaker 1: Bailey published the first important book on the subject in
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Speaker 1: the English language. Before the eighteenth century closed practical medicine
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Speaker 1: had made great advance. Smallpox, though not one of the
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Speaker 1: great scourges like plague or cholera, was a prevalent and
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Speaker 1: much dreaded disease, and in civilized countries few reached adult
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Speaker 1: life without an attack. Edward Jenner, a practitioner in Gloucestershire
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Speaker 1: and the pupil to whom John Hunter gave the famous
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Speaker 1: advice don't think try, had noticed that milkmaids who had
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Speaker 1: been infected with cowpox from the utter of the cow
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Speaker 1: were insusceptible to smallpox. I show you here the hand
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Speaker 1: of Sarah Elms with cow pox, seventeen ninety six. Notwithstanding
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Speaker 1: the resemblance which the postural thus excited on the boy's
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Speaker 1: arm bore to variolus inoculation. Yet as the indisposition attending
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Speaker 1: it was barely perceptible, I could scarcely persuade myself the
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Speaker 1: patient was secure from the smallpox. However, on his being
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Speaker 1: inoculated some months afterward, it proved that he was secure.
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Speaker 1: The results of his experiments were published in a famous
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Speaker 1: small quarto volume in seventeen ninety eight. From this date
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Speaker 1: smallpox has been under control. Thanks to Jenner, not a
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Speaker 1: single person in this audience is pock marked. One hundred
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Speaker 1: and twenty five years ago, the faces of more than
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Speaker 1: half of you would have been scarred. We now know
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Speaker 1: the principle upon which protection is secured and active acquired
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Speaker 1: immunity follows upon an attack of a disease of a
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Speaker 1: similar nature. Smallpox and cowpox are closely allied, and the
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Speaker 1: substances formed in the blood by the one are resistant
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Speaker 1: to the virus of the other. I cannot see how
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Speaker 1: any reasonable person can oppose vaccination or decry its benefits.
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Speaker 1: I show you the mortality figures of the Prussian Army
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Speaker 1: and of the German Empire. A comparison with the statistics
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Speaker 1: of the armies of other European countries in which revaccination
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Speaker 1: is not so thoroughly carried out is most convincing of
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Speaker 1: its efficacy. End of Part one, end of Section twenty two.