the evolution of modern medicine(现代医药的演变)-第50章
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the middle of the seventeenth century； Thomas Sydenham （1624…1689）；
who took men back to Hippocrates； just as Harvey had led them back to
Galen。 Sydenham broke with authority and went to nature。 It is
extraordinary how he could have been so emancipated from dogmas and
theories of all sorts。 He laid down the fundamental proposition； and acted
upon it； that 〃all disease could be described as natural history。〃 To do him
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justice we must remember； as Dr。 John Brown says； 〃in the midst of what
a mass of errors and prejudices； of theories actively mischievous； he was
placed； at a time when the mania of hypothesis was at its height； and when
the practical part of his art was overrun and stultified by vile and silly
nostrums〃 （〃Horae Subsecivae；〃 Vol。 I； 4th ed。； Edinburgh； 1882； p。 40）。
Listen to what he says upon the method of the study of medicine： 〃In
writing therefore； such a natural history of diseases； every merely
philosophical hypothesis should be set aside； and the manifest and natural
phenomena； however minute； should be noted with the utmost exactness。
The usefulness of this procedure cannot be easily overrated； as compared
with the subtle inquiries and trifling notions of modern writers； for can
there be a shorter； or indeed any other way of coming at the morbific
causes； or discovering the curative indications than by a certain perception
of the peculiar symptoms？ By these steps and helps it was that the father
of physic； the great Hippocrates； came to excel； his theory being no more
than an exact description or view of nature。 He found that nature alone
often terminates diseases； and works a cure with a few simple medicines；
and often enough with no medicines at all。〃
Towards the end of the century many great clinical teachers arose； of
whom perhaps the most famous was Boerhaave； often spoken of as the
Dutch Hippocrates； who inspired a group of distinguished students。 I have
already referred to the fact that Franciscus Sylvius at Leyden was the first
among the moderns to organize systematic clinical teaching。 Under
Boerhaave； this was so developed that to this Dutch university students
flocked from all parts of Europe。 After teaching botany and chemistry；
Boerhaave succeeded to the chair of physic in 1714。 With an unusually
wide general training； a profound knowledge of the chemistry of the day
and an accurate acquaintance with all aspects of the history of the
profession； he had a strongly objective attitude of mind towards disease；
following closely the methods of Hippocrates and Sydenham。 He adopted
no special system； but studied disease as one of the phenomena of nature。
His clinical lectures； held bi…weekly； became exceedingly popular and
were made attractive not less by the accuracy and care with which the
cases were studied than by the freedom from fanciful doctrines and the
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frank honesty of the man。 He was much greater than his published work
would indicate； and； as is the case with many teachers of the first rank； his
greatest contributions were his pupils。 No other teacher of modern times
has had such a following。 Among his favorite pupils may be mentioned
Haller； the physiologist； and van Swieten and de Haen； the founders of the
Vienna school。
In Italy； too； there were men who caught the new spirit； and
appreciated the value of combining morbid anatomy with clinical
medicine。 Lancisi； one of the early students of disease of the heart； left an
excellent monograph on the subject； and was the first to call special
attention to the association of syphilis with cardio…vascular disease。 A
younger contemporary of his at Rome； Baglivi； was unceasing in his call
to the profession to return to Hippocratic methods； to stop reading
philosophical theories and to give up what he calls the 〃fatal itch〃 to make
systems。
The Leyden methods of instruction were carried far and wide
throughout Europe； into Edinburgh by John Rutherford； who began to
teach at the Royal Infirmary in 1747； and was followed by Whytt and by
Cullen； into England by William Saunders of Guy's Hospital。
Unfortunately the great majority of clinicians could not get away from the
theoretical conceptions of disease； and Cullen's theory of spasm and atony
exercised a profound influence on practice； particularly in this country；
where it had the warm advocacy of Benjamin Rush。 Even more
widespread became the theories of a pupil of Cullen's； John Brown； who
regarded excitability as the fundamental property of all living creatures：
too much of this excitability produced what were known as sthenic
maladies； too little； asthenic； on which principles practice was plain
enough。 Few systems of medicine have ever stirred such bitter controversy；
particularly on the Continent； and in Charles Creighton's account of
Brown＇7＇ we read that as late as 1802 the University of Gottingen was so
convulsed by controversies as to the merits of the Brunonian system that
contending factions of students in enormous numbers； not unaided by the
professors； met in combat in the streets on two consecutive days and had
to be dispersed by a troop of Hanoverian horse。
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＇7＇ Dictionary of National Biography； London； 1886； VII； 14…17。
But the man who combined the qualities of Vesalius； Harvey and
Morgagni in an extraordinary personality was John Hunter。 He was； in the
first place； a naturalist to whom pathological processes were only a small
part of a stupendous whole； governed by law； which； however； could never
be understood until the facts had been accumulated； tabulated and
systematized。 By his example； by his prodigious industry； and by his
suggestive experiments he led men again into the old paths of Aristotle；
Galen and Harvey。 He made all thinking physicians naturalists； and he lent
a dignity to the study of organic life； and re…established a close union
between medicine and the natural sciences。 Both in Britain and Greater
Britain； he laid the foundation of the great collections and museums；
particularly those connected with the medical schools。 The Wistar…Horner
and the Warren Museums in this country originated with men greatly
influenced by Hunter。 He was； moreover； the intellectual father of that
interesting group of men on this side of the Atlantic who； while practising
as physicians； devoted much time and labor to the study of natural history；
such men as Benjamin Smith Barton； David Hossack； Jacob Bigelow；
Richard Harlan； John D。 Godman； Samuel George Morton； John Collins
Warren； Samuel L。 Mitchill and J。 Ailken Meigs。 He g
