a history of science-4-第40章

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ost　startling　distinctness。

The　possibility　of　associating　the　varying　chest　sounds　with　diseased　conditions　of　the　organs　within　appealed　to　the　fertile　mind　of　Laennec　as　opening　new　vistas　in　therapeutics；　which　he　determined　to　enter　to　the　fullest　extent　practicable。　His　connection　with　the　hospitals　of　Paris　gave　him　full　opportunity　in　this　direction；　and　his　labors　of　the　next　few　years　served　not　merely　to　establish　the　value　of　the　new　method　as　an　aid　to　diagnosis；　but　laid　the　foundation　also　for　the　science　of　morbid　anatomy。　　In　1819　Laennec　published　the　results　of　his　labors　in　a　work　called　Traite　d'Auscultation　Mediate；＇2＇　a　work　which　forms　one　of　the　landmarks　of　scientific　medicine。　By　mediate　auscultation　is　meant；　of　course；　the　interrogation　of　the　chest　with　the　aid　of　the　little　instrument　already　referred　to；　an　instrument　which　its　originator　thought　hardly　worth　naming　until　various　barbarous　appellations　were　applied　to　it　by　others；　after　which　Laennec　decided　to　call　it　the　stethoscope；　a　name　which　it　has　ever　since　retained。

In　subsequent　years　the　form　of　the　stethoscope；　as　usually　employed；　was　modified　and　its　value　augmented　by　a　binauricular　attachment；　and　in　very　recent　years　a　further　improvement　has　been　made　through　application　of　the　principle　of　the　telephone；　but　the　essentials　of　auscultation　with　the　stethoscope　were　established　in　much　detail　by　Laennec；　and　the　honor　must　always　be　his　of　thus　taking　one　of　the　longest　single　steps　by　which　practical　medicine　has　in　our　century　acquired　the　right　to　be　considered　a　rational　science。　Laennec's　efforts　cost　him　his　life；　for　he　died　in　1826　of　a　lung　disease　acquired　in　the　course　of　his　hospital　practice；　but　even　before　this　his　fame　was　universal；　and　the　value　of　his　method　had　been　recognized　all　over　the　world。　　Not　long　after；　in　1828；　yet　another　French　physician；　Piorry；　perfected　the　method　of　percussion　by　introducing　the　custom　of　tapping；　not　the　chest　directly；　but　the　finger　or　a　small　metal　or　hard…rubber　plate　held　against　the　chest…mediate　percussion；　in　short。　　This　perfected　the　methods　of　physical　diagnosis　of　diseases　of　the　chest　in　all　essentials；　and　from　that　day　till　this　percussion　and　auscultation　have　held　an　unquestioned　place　in　the　regular　armamentarium　of　the　physician。

Coupled　with　the　new　method　of　physical　diagnosis　in　the　effort　to　substitute　knowledge　for　guess…work　came　the　studies　of　the　experimental　physiologistsin　particular；　Marshall　Hall　in　England　and　Francois　Magendie　in　France；　and　the　joint　efforts　of　these　various　workers　led　presently　to　the　abandonment　of　those　severe　and　often　irrational　depletive　methodsblood…letting　and　the　likethat　had　previously　dominated　medical　practice。　To　this　end　also　the　〃statistical　method；〃　introduced　by　Louis　and　his　followers；　largely　contributed；　and　by　the　close　of　the　first　third　of　our　century　the　idea　was　gaining　ground　that　the　province　of　therapeutics　is　to　aid　nature　in　combating　disease；　and　that　this　may　often　be　accomplished　better　by　simple　means　than　by　the　heroic　measures　hitherto　thought　necessary。　　In　a　word；　scientific　empiricism　was　beginning　to　gain　a　hearing　in　medicine　as　against　the　metaphysical　preconceptions　of　the　earlier　generations。


PARASITIC　DISEASES

I　have　just　adverted　to　the　fact　that　Napoleon　Bonaparte；　as　First　Consul　and　as　Emperor；　was　the　victim　of　a　malady　which　caused　him　to　seek　the　advice　of　the　most　distinguished　physicians　of　Paris。　　It　is　a　little　shocking　to　modern　sensibilities　to　read　that　these　physicians；　except　Corvisart；　diagnosed　the　distinguished　patient's　malady　as　〃gale　repercutee〃that　is　to　say；　in　idiomatic　English；　the　itch　〃struck　in。〃　It　is　hardly　necessary　to　say　that　no　physician　of　today　would　make　so　inconsiderate　a　diagnosis　in　the　case　of　a　royal　patient。　If　by　any　chance　a　distinguished　patient　were　afflicted　with　the　itch；　the　sagacious　physician　would　carefully　hide　the　fact　behind　circumlocutions　and　proceed　to　eradicate　the　disease　with　all　despatch。　　That　the　physicians　of　Napoleon　did　otherwise　is　evidence　that　at　the　beginning　of　the　century　the　disease　in　question　enjoyed　a　very　different　status。　　At　that　time　itch；　instead　of　being　a　most　plebeian　malady；　was；　so　to　say；　a　court　disease。　It　enjoyed　a　circulation；　in　high　circles　and　in　low；　that　modern　therapeutics　has　quite　denied　it；　and　the　physicians　of　the　time　gave　it　a　fictitious　added　importance　by　ascribing　to　its　influence　the　existence　of　almost　any　obscure　malady　that　came　under　their　observation。　Long　after　Napoleon's　time　gale　continued　to　hold　this　proud　distinction。　For　example；　the　imaginative　Dr。　Hahnemann　did　not　hesitate　to　affirm；　as　a　positive　maxim；　that　three…fourths　of　all　the　ills　that　flesh　is　heir　to　were　in　reality　nothing　but　various　forms　of　〃gale　repercutee。〃

All　of　which　goes　to　show　how　easy　it　may　be　for　a　masked　pretender　to　impose　on　credulous　humanity；　for　nothing　is　more　clearly　established　in　modern　knowledge　than　the　fact　that　〃gale　repercutee〃　was　simply　a　name　to　hide　a　profound　ignorance；　no　such　disease　exists　or　ever　did　exist。　　Gale　itself　is　a　sufficiently　tangible　reality；　to　be　sure；　but　it　is　a　purely　local　disease　of　the　skin；　due　to　a　perfectly　definite　cause；　and　the　dire　internal　conditions　formerly　ascribed　to　it　have　really　no　causal　connection　with　it　whatever。　This　definite　cause；　as　every　one　nowadays　knows；　is　nothing　more　or　less　than　a　microscopic　insect　which　has　found　lodgment　on　the　skin；　and　has　burrowed　and　made　itself　at　home　there。　Kill　that　insect　and　the　disease　is　no　more；　hence　it　has　come　to　be　an　axiom　with　the　modern　physician　that　the　itch　is　one　of　the　three　or　four　diseases　that　he　positively　is　able　to　cure；　and　that　very　speedily。　　But　it　was　far　otherwise　with　the　physicians　of　the　first　third　of　our　century；　because　to　them　the　cause　of　the　disease　was　an　absolute　mystery。

It　is　true　that　here　and　there　a　physician　had　claimed　to　find　an　insect　lodged　in　the　skin　of　a　sufferer　from　itch；　and　two　or　three　times　the　claim　had　been　made　that　this　was　the　cause　of　the　malady；　but　such　views　were　quite　ignored　by　the　general　profession；　and　in　1833　it　was　stated　in　an　authoritative　medical　treatise　that　the　〃cause　of　gale　is　absolutely　unknown。〃　　But　even　at　this　time；　as　it　curiously　happened；　there　were　certain　ignorant　laymen　who　had　attained　to　a　bit　of　medical　knowledge　that　was　withheld　from　the　inner　circles　of　the　profession。　As　the　peasantry　of　England　before　Jenner　had　known　of　the　curative　value　of　cow…pox　over　small…pox；　so　the　peasant　women　of　Poland　had　learned　that　the　annoying　skin　disease　from　which　they　suffered　was　caused　by　an　almost　invisible　insect；　and；　furthermore；　had　acquired　the　trick　of　dislodging　the　pestiferous　little　creature　with　the　point　of　a　needle。　　From　them　a　youth　of　the　country；　F。　Renucci　by　name；　learned　the　open　secret。　He　conveyed　it　to　Paris　when　he　went　there　to　study　medicine；　and　in　1834　demonstrated　it　to　his　master　Alibert。　　This　physician；　at　first　sceptical；　soon　was　convinced；　and　gave　out　the　discovery　to　the　medical　world　with　an　authority　that　led　to　early　acceptance。

Now　the　importance　of　all　this；　in　the　present　connection；　is　not　at　all　that　it　gave　the　clew　to　the　method　of　cure　of　a　single　disease。　What　makes　the　discovery　epochal　is　the　fact　that　it　dropped　a　brand…new　idea　into　the　medical　ranksan　idea　destined；　in　the　long…run；　to　prove　itself　a　veritable　bombthe　idea；　namely；　that　a　minute　and　quite　unsuspected　animal　parasite　may　be　the　cause　of　a　well…known；　widely　prevalent；　and　important　human　disease。　Of　course　the　full　force　of　this　idea　could　only　be　appreciated　in　the　light　of　later　knowledge；　but　even　at　the　time　of　its　coming　it　sufficed　to　give　a　great　impetus　to　that　new　medical　knowledge；　based　on　microscopical　studies；　which　had　but　recently　been　made　accessible　by　the　inventions　of　the　lens…makers。　The　new　knowledge　clarified　one　very　turbid　medical　pool　and　pointed　the　way　to　the　clarification　of　many　others。

Almost　at　the　same　time　that　the　Polish　medical　student　was　demonstrating　the　itch　mite　in　Paris；　it　chanced；　curiously　enough；　that　anot