the evolution of modern medicine(现代医药的演变)-第49章
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THE EVOLUTION OF MODERN MEDICINE
have reports of post…mortem examinations made specifically with a view
to finding out the exact cause of death。 Among the 111 cases； there are
post…mortem records of cases of gallstones； abscess of the mesentery；
thrombosis of the mesenteric veins； several cases of heart disease； senile
gangrene and one of cor villosum。 From no other book do we get so good
an idea of a practitioner's experience at this period； the notes are plain and
straightforward； and singularly free from all theoretical and therapeutic
vagaries。 He gives several remarkable instances of faith healing。
＇2＇ De abditis nonnullis ac mirandis morborum et sanationum causis。
8th； Florence； Gandhi； 1507。
＇3＇ Possibly it was only a case of angina Ludovici； or retro…pharyngeal
abscess。
To know accurately the anatomical changes that take place in disease
is of importance both for diagnosis and for treatment。 The man who
created the science； who taught us to think anatomically of disease； was
Morgagni； whose 〃De sedibus et causis morborum per anatomen
indagatis〃＇4＇ is one of the great books in our literature。 During the
seventeenth century； the practice of making post…mortem examinations
had extended greatly； and in the 〃Sepulchretum anatomicum〃 of Bonetus
（1679）； these scattered fragments are collected。＇5＇ But the work of
Morgagni is of a different type； for in it are the clinical and anatomical
observations of an able physician during a long and active life。 The work
had an interesting origin。 A young friend interested in science and in
medicine was fond of discoursing with Morgagni about his preceptors；
particularly Valsalva and Albertini； and sometimes the young man inquired
about Morgagni's own observations and thoughts。 Yielding to a strong
wish； Morgagni consented to write his young friend familiar letters
describing his experiences。 I am sorry that Morgagni does not mention the
name of the man to whom we are so much indebted； and who； he states；
was so pleased with the letters that he continually solicited him to send
more and more 〃till he drew me on so far as the seventieth； 。 。 。 when I
begged them of him in order to revise their contents； he did not return
them； till he had made me solemnly promise； that I would not abridge any
part thereof〃 （Preface）。
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THE EVOLUTION OF MODERN MEDICINE
＇4＇ Venice； 1761。
＇5＇ Boerhaave remarked that if a man wished to deserve or get a
medical degree from ONE medical author let it be this。 （James Atkinson：
Medical Bibliography； 1834； 268。）
Born in 1682； Morgagni studied at Bologna under Valsalva and
Albertini。 In 1711； he was elected professor of medicine at Padua。 He
published numerous anatomical observations and several smaller works of
less importance。 The great work which has made his name immortal in the
profession； appeared in his eightieth year； and represents the accumulated
experience of a long life。 Though written in the form of letters； the work is
arranged systematically and has an index of exceptional value。 From no
section does one get a better idea of the character and scope of the work
than from that relating to the heart and arteriesaffections of the
pericardium； diseases of the valves； ulceration； rupture； dilation and
hypertrophy and affections of the aorta are very fully described。 The
section on aneurysm of the aorta remains one of the best ever written。 It is
not the anatomical observations alone that make the work of unusual value；
but the combination of clinical with anatomical records。 What could be
more correct than this account of angina pectorisprobably the first in the
literature？ 〃A lady forty…two years of age； who for a long time； had been a
valetudinarian； and within the same period； on using pretty quick exercise
of body； she was subject to attacks of violent anguish in the upper part of
the chest on the left side； accompanied with a difficulty of breathing； and
numbness of the left arm； but these paroxysms soon subsided when she
ceased from exertion。 In these circumstances； but with cheerfulness of
mind； she undertook a journey from Venice； purposing to travel along the
continent； when she was seized with a paroxysm； and died on the spot。 I
examined the body on the following day。。。。 The aorta was considerably
dilated at its curvature； and； in places； through its whole tract； the inner
surface was unequal and ossified。 These appearances were propagated into
the arteria innominata。 The aortic valves were indurated。。。。〃 He remarks；
〃The delay of blood in the aorta； in the heart； in the pulmonary vessels；
and in the vena cave； would occasion the symptoms of which the woman
complained during life； namely； the violent uneasiness； the difficulty of
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breathing； and the numbness of the arm。〃＇6＇
＇6＇ Cooke's Morgagni； Vol。 1； pp。 417…418。 I cannot too warmly
commend to young clinicians the reading of Morgagni。 English editions
are availableAlexander's three…volume translation of 1769 and Cooke's
Abridgement （London； 1822）； of which there was an American edition
published in Boston in 1824。
Morgagni's life had as much influence as his work。 In close
correspondence with the leading men of the day； with the young and rising
teachers and workers； his methods must have been a great inspiration； and
he came just at the right time。 The profession was literally ravaged by
theories； schools and systemsiatromechanics； iatrochemistry； humoralism；
the animism of Stahl； the vitalistic doctrines of Van Helmont and his
followers and into this metaphysical confusion Morgagni came like an
old Greek with his clear observation； sensible thinking and ripe
scholarship。 Sprengel well remarks that 〃it is hard to say whether one
should admire most his rare dexterity and quickness in dissection； his
unimpeachable love of truth and justice in his estimation of the work of
others； his extensive scholarship and rich classical style or his downright
common sense and manly speech。〃
Upon this solid foundation the morbid anatomy of modern clinical
medicine was built。 Many of Morgagni's contemporaries did not fully
appreciate the change that was in progress； and the value of the new
method of correlating the clinical symptoms and the morbid appearances。
After all； it was only the extension of the Hippocratic method of careful
observation the study of facts from which reasonable conclusions could
be drawn。 In every generation there had been men of this typeI dare say
many more than we realizemen of the Benivieni character； thoroughly
practical； clear…headed physicians。 A model of this sort arose in England in
the middle of the seventeenth century； Thomas Sydenham （1624…1689）；
