The Project Gutenberg eBook of Makers of Modern Medicine
    
This ebook is for the use of anyone anywhere in the United States and
most other parts of the world at no cost and with almost no restrictions
whatsoever. You may copy it, give it away or re-use it under the terms
of the Project Gutenberg License included with this ebook or online
at www.gutenberg.org. If you are not located in the United States,
you will have to check the laws of the country where you are located
before using this eBook.

Title: Makers of Modern Medicine

Author: James J. Walsh

Release date: March 3, 2011 [eBook #35477]
                Most recently updated: January 7, 2021

Language: English

Credits: Produced by Don Kostuch


*** START OF THE PROJECT GUTENBERG EBOOK MAKERS OF MODERN MEDICINE ***




Produced by Don Kostuch






[Transcriber's notes]
  This is derived from a copy on the Internet Archive:
  http://www.archive.org/details/cu31924012267013

  Page numbers in this book are indicated by numbers enclosed in curly
  braces, e.g. {99}. They have been located where page breaks occurred
  in the original book.

  Obvious spelling errors have been corrected but "inventive" and
  inconsistent spelling is left unchanged.

  Extended quotations and citations are indented.

  Footnotes have been renumbered to avoid ambiguity, and relocated
  to the end of the enclosing paragraph.

  There are several occurrences of square brackets used by the author.
  They do not begin with "Transcriber's note", "Footnote", or
  "Illustration".
[End Transcriber's notes]






_By the Same author_.

  Catholic Churchmen in Science. Cloth,
  gilt top, with portraits. The Dolphin
  Press, Philadelphia, 1906. $1.00, _net_.

  History of the Medical Society of the
  State of New York (appearing serially
  in _New York State Journal of Medicine_,
  beginning February, 1906).


_In Press_.

  The Thirteenth the Greatest of Centuries.


_In Preparation_.

  The Popes in Medical History.


_In Collaboration_.

  Essays in Pastoral Medicine. O'Malley
  and Walsh. Longmans, Green & Co.,
  New York, 1906. $2.50, _net_.



[Illustration: PASTEUR]




MAKERS of Modern Medicine


BY

JAMES J. WALSH, M.D., Ph.D., LL.D.

ACTING DEAN AND PROFESSOR OF THE HISTORY OF MEDICINE AND OF NERVOUS
DISEASES, FORDHAM UNIVERSITY MEDICAL SCHOOL, AND ADJUNCT PROFESSOR
OF MEDICINE AT THE NEW YORK POLYCLINIC SCHOOL FOR GRADUATES
IN MEDICINE; PROFESSOR OF PHYSIOLOGICAL PSYCHOLOGY
AT ST. FRANCIS XAVIER'S COLLEGE
IN NEW YORK.



FORDHAM UNIVERSITY PRESS

NEW YORK

1907



COPYRIGHT, 1907,

FORDHAM UNIVERSITY PRESS,

NEW YORK.



TO



DR. WILLIAM OSLER

WHO EXEMPLIFIES FOR THIS GENERATION THE FINEST QUALITIES OF
THESE MAKERS OF OUR MODERN MEDICINE, THIS VOLUME IS
WITH HIS KIND PERMISSION DEDICATED AS A
SLIGHT TOKEN OF THE ADMIRATION
OF A DISTANT DISCIPLE.



"If in some things I dissent from others, whose wit, industry,
diligence and judgment I look up at and admire, let me not therefore
hear presently of ingratitude and rashness. For I thank those that
have taught me, and will ever; but yet dare not think the scope of
their labor and inquiry was to envy their posterity what they also
could add and find out. If I err, pardon me. I do not desire to be
equal with those that went before; but to have my reasons examined
with theirs, and so much faith to be given them, or me, as those shall
evict. I am neither author or fautor of any sect. I will have no man
addict himself to me; but if I have anything right, defend it as
Truth's, not mine, save as it conduceth to a common good. It profits
not me to have any man fence or fight for me, to follow or take my
part. Stand for truth, and 'tis enough."


{vii}

PREFACE.


The present volume is published at the solicitation of many friends
who have read the articles contained in it as they appeared at various
times in magazines and who deemed that they were worth preservation in
a more permanent form. The only possible claim for its filling a want
lies in the fact that it presents these workers in medicine not only
as scientists but also and especially as men, in relation to their
environment, social, religious and educational. I have to thank the
editors of the _Messenger, Donahoe's Magazine, The Catholic World_ and
the _Records of the American Catholic Historical Society_, for
permission to reprint the articles which appeared in their
periodicals.

The opening chapter, The Making of Medicine, is an abstract from the
introductory lecture of the course in the history of medicine at the
Fordham University Medical School, New York. Much of the material for
the article on the Irish School of Medicine was gathered for a lecture
before the Historical Club of Johns Hopkins University and the
District Medical Society of the District of Columbia. The sketch of
the life of Dr. Jenner has not hitherto been published. All of the
other articles have been considerably lengthened and revised.

There are other makers of modern medicine who deserve a place beside
those mentioned here, but as the material had reached the amount that
would make a good-sized volume it {viii} was thought better to proceed
with the publication of the first series of sketches, which will be
followed by others if conditions conspire to encourage any further
additions to our not very copious English medical biography. A
subsequent volume will contain sketches of the lives of old-time
makers of medicine in the fifteenth, sixteenth and seventeenth
centuries, the men who laid the firm foundations of our medical
science of the present day.

I have to thank my friend of many years and brother alumnus of Fordham
University, Dr. Austin O'Malley, of Philadelphia, for reading the
proofs and for suggestions while the book was going through the press.



{9}

CONTENTS.


                                                         PAGE

The Making of Medicine                                    11

Morgagni, Father of Pathology                             27

Auenbrugger, Inventor of Percussion                       53

Jenner, Discoverer of Vaccination                         87

Galvani, Founder of Animal Electricity                   113

Laennec, Father of Physical Diagnosis                    133

The Irish School of Medicine--Graves, Stokes, Corrigan   165

Müller, Father of German Medicine                        215

Schwann, Founder of the Cell Doctrine                    251

Claude Bernard, Discoverer in Physiology                 269

Pasteur, Father of Preventive Medicine                   291

O'Dwyer, Inventor of Intubation                          323

{10}

{11}

THE MAKING OF MEDICINE

{12}

  Without History a man's soul is purblind, seeing only the things
  which almost touch his eyes.
    --Fuller, _Holy and Profane State_, 1641.

{13}

THE MAKING OF MEDICINE.

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 {14} 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.

{15}

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
{16} 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 {17} 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 {18} 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. {19} 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
{20} 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 {21}
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 {22} 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 {23} 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 {24} 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 {25} 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.


{26}

{27}

MORGAGNI, THE FATHER OF PATHOLOGY


{28}

  Let us then blush, in this so ample and so wonderful field of nature
  (where performance still exceeds what is promised), to credit other
  men's traditions only, and thence come uncertain problems to spin
  out thorny and captious questions. Nature herselfe must be our
  adviser; the path she chalks must be our walk; for so while we
  confer with our own eies, and take our rise from meaner things to
  higher, we shall at length be received into her closet-secrets.

    --Preface to _Anatomical Exercitations concerning the Generation
    of Living Creatures_, 1653. William Harvey.


{29}

MORGAGNI, THE FATHER OF PATHOLOGY.

  "VIR INGENII, MEMORIAE, STUDII, INCOMPARABILIS."
    --HALLER.


In 1894, when the International Medical Congress met at Rome, Prof.
Virchow of Berlin, the greatest living pathologist at the time, was
asked to deliver the principal address. He chose as his subject John
Baptist Morgagni, the distinguished Italian physician and original
investigator of the eighteenth century, whom he hailed as the Father
of Pathology. No medical scientist of the nineteenth century was in a
better position than Virchow to judge who had been the founder of the
science for which he himself did so much. Virchow besides, through
long and faithful study of the history of medicine, knew well whereof
he spoke. In pathology especially modern medicine has made its sure
advances, so that Morgagni's ground-breaking work may well be
considered the beginning of the most recent epoch in medical science.
As a matter of fact, medicine lost much of its obscurity by losing all
its vagueness when Morgagni's methods came into general use.

As a medical student scarcely twenty years of age, he revolutionized
medical observation by studying his fatal cases with a comparative
investigation of their clinical symptoms and the postmortem findings.
This had been done before, but mainly with the idea of finding out the
cause of death and the principal reasons for the illness which {30}
preceded. Morgagni's investigations in pathology consisted in tracing
side by side all the clinical symptoms to their causes as far as that
might be possible. This looks so simple now as to be quite obvious, as
all great discoveries are both simple and obvious once they have been
made; but it takes a genius to make them, since their very nearness
causes them to be overlooked by the ordinary observer so prone to seek
something strange and different from the common.

How much Morgagni's studies from this new viewpoint of the
investigation of all the symptoms of disease has meant for modern
medicine, may be best appreciated by a quotation from an address
delivered before the Glasgow Pathological and Clinical Society in
1864, by Professor Gairdner, who thus tersely describes the character
of the distinguished Italian pathologist's work:

  "In investigating the seats of disease, Morgagni is not content to
  record the coincidence of a lesion in an organ with the symptoms
  apparently due to disordered function in that organ.

  "For the first time almost in medical inquiry, he insists on
  examining every organ, as well as the one suspected to be chiefly
  implicated; not only so, he marshals with the utmost care, from his
  own experience and that of his predecessors, all the instances in
  which the symptoms have existed apart from the lesion, or the lesion
  apart from the symptoms. He discusses each of these incidents with
  severe exactness in the interest of truth, and only after an
  exhaustive investigation will he allow the inference either that the
  organ referred to is or is not the seat of the disease.

  "And in like manner in dealing with causes: a group of symptoms may
  be caused by certain organic changes--it may be even probable that
  it is so--but, according to Morgagni's method, we must first inquire
  into all the lesions of {31} organs which occur in connection with
  such symptoms; in the second place, we must know if such lesions
  ever occur without the symptoms; and again if such symptoms can be
  attributed in any cases to other causes in the absence of such
  lesions."

During over sixty years of a long life Morgagni continued to follow
out the idea that he had developed as a boy, and his works contain the
first definite account of pathological lesions and clinical
manifestations that attracted attention.

As a proof of the striking difference between the value of observation
and theory in medicine, it may be said that many hundreds of volumes
containing the most elaborate medical theories were published during
the eighteenth century, and that practically none of these is ever
read now, except for curiosity's sake by some seeker after the quaint
and distant in medicine, while Morgagni's books still contain a
precious fund of information, to which pathologists at least, and not
a few clinicians, turn often with interest and come away always with
profit. They are not infrequently quoted from, and, as we shall see,
have been highly appreciated by some of the best medical authorities
of the present and the immediately preceding generations.

To the modern thinker, accustomed to look rather to the northern
nations or to France for great advances in science, it may prove
somewhat of a surprise to have an Italian thus put forward as the
founder of modern medicine, and especially of the most scientific
department of it. Those who are familiar with the history of medicine
since the revival of civilization after the Dark Ages will realize
what a prominent place Italy has always held in the development of
medical science. The first great Christian medical school was founded
at Salerno, not far from Naples, in the tenth century. The first
regular practical teaching of anatomy by means of {32} dissections of
human bodies and demonstrations on the cadaver was done at Bologna by
Mondino at the beginning of the fourteenth century. The great Father
of Modern Anatomy, Vesalius, was a Belgian, but he did all the work
for his epoch-making book, the _De Fabrica Humani Corporis_, at the
Universities of North Italy, especially at Padua, Bologna and Pisa,
during the first half of the sixteenth century. Every student of
medicine in those times who was desirous to secure wider opportunities
for medical education went down into Italy, and on the rosters of the
Italian medical schools of the sixteenth century are to be found the
names of most of the men who in all the countries of Europe became
famous for their medical attainments.

Morgagni only forms a final link in the chain of great Italian medical
scientists, connecting medieval with modern medicine. From the time of
Vesalius to that of Morgagni there was never a period when Italy did
not possess the leading medical investigator of Europe. We need only
mention such names as those of Fallopius, who added so much to our
knowledge of abdominal anatomy; Eustachius, to whom we owe many
important details of the anatomy of the head; Spigelius, whose name is
forever associated with the liver, and Malpighi, to whom the whole
round of the biological sciences allied most closely to medicine owes
more than perhaps to any other single investigator, to show the
complete justification for this claim. As a matter of fact, every
encouragement to the progress of medicine was extended both by the
secular and the ecclesiastical authorities in Italy during these
centuries, and the Italian peninsula was from the beginning of the
sixteenth to the end of the eighteenth centuries the mecca for ardent
medical students desirous of exhausting the medical knowledge of their
time, quite as Germany has been in our day.

{33}

John Baptist Morgagni was born on February 25, 1682. His birthplace
was Forli in Romagna. It was the capital of a little papal state,
lying at the foot of the Apennines to the southeast of Bologna. The
modern American traveler is likely to know something about it, because
it is one of the principal stopping places on the road from Bologna to
Rimini, for at least the feminine portion of any travelling party will
want to make a pilgrimage to the home of Dante's poor Francesca and to
the scene of the heroic exploits of Catarina Sforza, the great woman
of the Renaissance, to whom in all honor, and without any tinge of the
discredit it has since come to convey, was given the proud title of
the Virago of Forli. The little town is noted for the beauty of its
situation, and well deserves a visit for itself, for it contains a
famous palace built after designs made by Michael Angelo. The town had
decreased in importance and population at the end of the seventeenth
century, when Morgagni was born there, but it was favorably known for
the high standard of cultivation among its inhabitants, possessed a
good library, a number of schools and a well-known college.

Like many another great man, Morgagni seems to have been especially
fortunate in his mother. He was left an orphan at a very early age.
His mother, however, whose maiden name was Maria Tornieli, not only
bore her loss bravely, but devoted her life and talents to the
education of her gifted son. She seems to have been a woman of
uncommon good sense and remarkable understanding. Morgagni often spoke
of her during the course of his life, and attributed much of his
success to the training he had received from her. It is the custom
sometimes to think that women have come to exert great cultural
influence only in these latter days. Nothing could be more untrue. All
through history are abundant traces of women exerting the {34} highest
intellectual influences in their own sphere, and the North Italians in
their era of highest cultural development seem to have been happier in
nothing more than their recognition of the possibilities that lay in
providing educational facilities for women.

These times and this part of Italy are famous in history for some of
the opportunities afforded women in the matter of higher education. It
has been suggested that it is perhaps to the liberal culture of the
mothers we owe the fact that this part of Italy furnished for one
hundred and fifty years about this time the greatest men in science of
the time. It is well known that women occasionally held professorships
at the University of Bologna, not far from Morgagni's birthplace. The
general culture of the women of this section was very high. Modern
masculine historians have even been ungenerous enough to point out
that Bologna was famous for two things--the opportunities provided for
the higher education of women and the extensive manufacture of various
forms of prepared food, the best known of which, the classical Bologna
sausage, has come down as a precious heritage to hurried housekeepers
in our own time.

After an excellent preliminary education at Forli, always under the
careful supervision and enlightened encouragement of his mother,
Morgagni, as might have been expected from the place of his birth,
went to the neighboring university town of Bologna for his higher
studies. Bologna was at this time at the very acme of its reputation
as the greatest of existent medical schools. The science of anatomy
had been especially developed here as the result of important
investigations and discoveries made by some of the greatest men in the
history of medical science. Mondino had, very early in the fourteenth
century, recreated the modern science of anatomy as we know it. He was
the first to realize the importance {35} and urge the necessity for
the dissection of human bodies, if any real lasting progress in human
anatomy was to be made. Medical teaching before this time had been
largely by lectures and disputations upon the work of Aristotle,
Hippocrates and Galen, but actual observation on human tissues and
organs now replaced the older method. Bologna became a papal city in
1512, and it is especially after this date that, under the fostering
care of the Popes, the University of Bologna became the centre of
medical teaching for the whole world for several centuries.

As the result of actual observation and patient study instead of idle
theorizing there came a large number of great discoveries in anatomy.
From Mondino to Morgagni there is a continuous series of great men in
connection with the University of Bologna such as no other institution
can show. About midway between the first and last came the great
Vesalius, who taught at Bologna as well as at Padua and Pisa, and
whose work on anatomy was to be a treasure for anatomists of all
countries for many generations. It was while teaching at Bologna that
Vesalius made the famous series of dissections which formed the
subjects of the illustrations for his great work on anatomy. Titian,
the celebrated Venetian artist, who had come down from Venice in order
to study anatomy for artistic purposes at the famous school of anatomy
and under the supervision of its great teachers, is said to have
executed the plates for the book. The work remains a worthy monument
of the two great masters in their respective professions whose
collaboration created it.

During the century before Morgagni's entrance into the University of
Bologna, the distinguished English physician Harvey, who was to lay
the foundation of modern physiology by the discovery of the
circulation of the blood, was attracted to Bologna because of the
opportunities it presented for {36} advanced work in the studies in
which he was so much interested. While repeating some of the
dissecting work that Vesalius had done Harvey was led to suspect the
existence of the circulation and had his thoughts directed in the
channel which finally led to his masterly exposition of the subject.
In a word, here at Bologna the study of the physical side of life, so
important a characteristic of latter-day science, became a distinct
and recognized branch of science. As Professor Benjamin Ward
Richardson said, in his sketch of the life of Morgagni, "Since that
time there has been no decline in interest in these studies and
medicine has been developed in a manner as daring in project as it has
been useful in application."

Bologna was, at the time, certainly an excellent place for Morgagni.
He went there as an inquiring youth of fifteen and began his medical
studies at once. He became a student of two of the most celebrated
professors of the time--Albertini, a leader in his day, though since
more or less forgotten, and Valsalva, whose investigations into the
anatomy of the ear assure him a permanent place in the science of
anatomy for all time. When Morgagni went to the university, Valsalva
was at the zenith of his brilliant career as an anatomist. He was in
the midst of his great work on the organ of hearing. This extremely
intricate piece of human mechanism had never been understood before
his time, and the working out of its details proved a time-taking but
intensely interesting investigation.

It was not long before the genial insight of Valsalva picked out
Morgagni as a person excellently fitted to assist him in his
dissecting work. Morgagni had not only an enthusiasm for the work, but
had, what is much more precious under the circumstances, untiring
patience and industry and unswerving perseverance. These were the
qualities that were {37} afterward to prove the foundation of his
reputation. His genius consisted certainly in the faculty for hard
work, and his special talent was an infinite capacity for taking
pains. Nearly all of the dissections which Valsalva required for his
demonstrations during lecture hours, or for the illustrations of his
books, are said to have been made by Morgagni under the master's
personal supervision.

After four years of this precious training and study at the
university, Morgagni took his degree as Doctor of Medicine and of
Philosophy. The late Benjamin Ward Richardson, one of the great
English medical men of the end of the nineteenth century, says that
this is a happy combination of qualifications which might, with great
advantage, be required of the graduate in the present day, when so
much of medicine and so little of philosophy is demanded of the
student, to the manifest detriment of both departments of knowledge.

Some idea of the estimation in which Morgagni was held at this time
may be gathered from the fact that, though scarcely more than
twenty-one years of age, he was sometimes allowed to assume Valsalva's
lecture obligations during the master's absence. After graduation he
spent some time at the university doing special work in connection
with the science of anatomy, in which he was so much interested, and
as an assistant professor and tutor. Bologna at this time enjoyed as
wide a European reputation as at any period of its history. Students
from all countries in Europe flocked here, especially to make their
legal and medical studies. Among the medical students Morgagni was
always a moving spirit, a leader in the phases of thought in many
lines that were occupying students' minds at the time.

He was the founder and director of a society of young professors and
maturer students, whose object was the discussion of scientific
subjects of many kinds. The standard of the {38} new society was
personal investigation and observation as a means of arriving at
scientific truth. The principal maxim that guided their discussions
seems to have been that nothing was to be accepted on authority,
merely because it was authority. In the physical sciences thought had
been frequently cramped to fit the old theories inherited from Galen
and Pliny and Aristotle and Hippocrates. A quotation from one of these
classic authors on a point at issue was supposed to throw light on any
difficulty that might be the subject of discussion.

Morgagni's society was called the Academia Inquietorum--"The Academy
of the Restless"--the idea of the curious name being that the members
were not satisfied to rest peacefully in the knowledge to be gleaned
from the older authors, but preferred to get at science for themselves
by direct observation and planned experiment. Morgagni's idea in
founding the society seems to have been premature. The fate of the
Academy of the Restless is involved in some obscurity, but biographers
seem to hint that it failed of its purpose. Neither the university nor
the times were yet ready for such freedom of thought as this. Even in
our own day such a scheme would be considered radical and chimerical.
The discouragement met with finally led to the abandonment of the
meetings, and Morgagni gave up his attempt to inspire others with his
own industry and enthusiasm for original investigation in the physical
sciences.

For some years after this he seems to have been absent from Bologna.
His time was spent especially at the medical schools of the great
universities of Pisa and of Padua. Students who wished to make some
special branch of medicine such as physiology, or anatomy, or the,
then as yet scarcely known, science of pathology, their prime object
in life, had to visit various universities in order to find
opportunity and {39} suggestion for study. Morgagni devoted himself so
faithfully to his work that his eyesight failed him for a time and
very probably his general health also. For some years he returned to
his native town to recuperate. Here he took up the active practice of
medicine. As so often happens, this period of rest after years of
study proved especially broadening in its influence upon Morgagni.
After his rest his contemporaries begin to realize his great
possibilities as a scientist.

His first publication was a series of notes on anatomy. These were
published in the form of collected essays, with the title _Adversaria
Anatomica_. The title has a pugnacious sound, but Morgagni did not
indulge in controversy and _adversaria_ is only the Latin name for
note-books. The first articles thus collected were really
communications made by Morgagni to the "Academy of the Restless"
during his presidency of that body. This opened his career as a
writer, and it is interesting to note that his last book was to be
published some sixty-three years later--a period of fecund authorship
almost unprecedented.

As the result of the reputation gained by this work he was offered a
teaching position at the University of Padua and later was transferred
to the chair of the second professorship of anatomy. After a few years
he succeeded to the first professorship of anatomy at the university,
at that time the most important post in the medical school. This gave
him, at the age of about thirty-five, one of the greatest university
professorships in the world. Opportunities for research were now amply
provided. He was in a position where his communications would be
received with due attention and his reputation was secure.

A university professorship in those days was a position of more
importance than even in our own, and Morgagni was {40} especially
favored in the fact that it had come early in life, so as to enable
him to round out his career. His work was eminently congenial to him,
and the labor it involved was that which constituted for Morgagni the
highest form of recreation. He made many friends among professors and
students. The lectures which Morgagni delivered to the university
became so popular that his lecture-room was overcrowded and new
quarters had to be provided. Many foreign students were attracted to
the university by his wide-spread reputation as a great and suggestive
teacher. These students came in great numbers especially from the
northern countries of Europe. At one time there were over a thousand
German students at the University of Padua, and when they organized
into a guild for mutual help and social purposes, Morgagni was chosen
by them to act as their patron.

Here at the University of Padua Morgagni was to found the new science
of pathological anatomy. Normal anatomy had received its development
at the hands of the other great masters in the schools of North Italy.
To Morgagni was to be given to describe the changes which take place
in organs as the result of disease. Needless to say, this is the most
important practical branch of modern medical science. The symptoms of
disease mean very little unless we know just what organs are affected
and what changes have taken place. Morgagni's work on _The Seats and
Causes of Disease_ contains the foundation of modern pathology. Modern
advances might seem to put it out of date, but the acuity of its
author's observations and the truth of his investigations make it an
enduring classic.

Of this work of Morgagni's, Professor Benjamin Ward Richardson, said:
"To this day no medical scholar can help being delighted and
instructed by the study of this wonderful book. To move into it from
the midst of a body {41} of current medical literature, is like
passing from the periodical flux of current general literature to the
perusal of a Shakespearean drama, the _Pilgrim's Progress_, or
_Paradise Lost_. It is a transition from the mediocrity of incessant
repetition of well-known truths told in long and hackneyed terms, back
to descriptions derived direct from nature and fresh from her
treasury. It matters not where the book is opened, it is always good
and instructive reading, full of suggestion and rich in original
narrative."

Some of Morgagni's work in clinical medicine and in pathology, as
detailed in these volumes, remains of perennial interest and is often
referred to. Many an after-time discovery, proclaimed loudly by its
author, will be found, at times only in embryo but often enough in
entirety, in its pages. There are frequent surprises to the reader in
the anticipation of what are supposedly much later thoughts in
medicine. Some of these passages of more general interest I venture to
present here.

It was Morgagni who first realized that minute connections between
parts of the nervous system might very easily provide the basis for
symptoms quite distant from the site of actual disease. He gives, for
instance, a detailed account of a curiously interesting case in which
the patient, a man somewhat beyond middle life, was annoyed on a
number of occasions by violent sneezing. These attacks of sneezing
became more and more frequent and finally were accompanied by
difficulty of breathing and a sense of pressure over the chest. These
symptoms became more and more marked, until finally, during an
especially violent attack of sneezing, the man suddenly died.

Up to this time anatomists generally had declared that there was no
direct nervous connection between the mucous membrane of the nose and
the diaphragm. Sneezing is {42} due to a violent contraction of the
diaphragm and is almost invariably caused by the presence of an
irritant in the nose. This is, in fact, nature's method of getting rid
of irritant material on the sensitive nasal mucous membranes by an
explosive expulsion of air through the nose. This expulsion of air is
brought about by a convulsive contraction of the diaphragm. It had
always been supposed that the sneezing was due to irritation
transmitted through the brain to the diaphragm.

Morgagni, in discussing the reason why the diaphragm should be excited
into sympathetic reaction by the presence of an irritant in the nose,
pointed out a fact that had been forgotten or the significance of
which had not been appreciated. The membrane of the nose concerned in
smell is supplied by the first pair of cranial nerves, the so-called
olfactory nerves. Between this olfactory nerve and the nerve which
supplies the diaphragm, the phrenic nerve, which is a cervical and not
a cranial nerve, that is to say, comes from the central nervous system
through the spinal cord in the neck and not directly from the brain,
the older anatomists declared there was no connection. Morgagni
pointed out that the mucous membrane of the nose is partly supplied
also from the fifth pair of cranial nerves. From the fifth nerve,
small branches of connection with the cervical nerves, as low even as
the intercostal nerves, had been traced by Meckel. This shows the
possibility of a nervous reflex; that is, of a communication of nerve
impulses without the necessity for the intervention of the central
nervous system.

This was the first direct tracing of distant reflex nervous action in
human physiology. The problem of nervous reflexes was to remain
obscure for more than a century later, until light was thrown upon it
by the investigation of the French physiologist, Claude Bernard. Here,
however, was {43} the pregnant suggestion of the explanation of the
seeming mystery. In subsequent cases Morgagni looked for the
confirmation of his theory in this matter and found it. He pointed out
that there was a relationship between the abdominal viscera and the
olfactory mucous membrane of the nose. In one of his cases an
epileptic seizure was always accompanied by a sense of discomfort in
the upper abdominal region and a fetid odor. This odor was entirely
subjective; that is, though extremely annoying to the patient it could
not be noticed by any one else, even though the patient was close at
hand and exhaled his breath at the moment of the observation.

This would seem to point to the fact that Morgagni suspected there
were other connections between the special senses and important organs
besides those which had been discovered by anatomists up to that time.
As a matter of fact the so-called sympathetic nervous system does
place all the organs of special sense in direct connection with the
other important organs of the body. Morgagni's suspicions were to be
confirmed by the discoveries made in this sympathetic system during
the succeeding century.

Morgagni first of all seems to have realized what was the mechanism by
which alcohol injures the human system. He pointed out that the
excitation of the heart due to the action of alcohol was reflected in
an overdistention of the arteries. This overdistention gradually led
to degenerations in the arterial walls. The loss of elasticity thus
induced brought on a disturbance of the circulation in the important
organs of the body, and so gave rise to symptoms of wide-spread
interference with organic functions.

Morgagni's studies in aneurism, that is, in the dilatation of
bloodvessels, show how thoroughly he understood the mechanism of the
formation of this serious pathological {44} condition. He pointed out
that the first noticeable disease change that occurs is a degeneration
of the inner coat of the artery. This leads to the formation of
furrows on the inner wall of the vessels and finally brings on
weakness of the middle coat of the artery. He realized that the
progress of these arterial changes is due to a large extent to blood
pressure within the arteries. He felt, too, that blood pressure could
be kept from being dangerously high by strict attention to diet
limitation. If aneurisms are discovered in early stages the patient's
life may well be prolonged by these simple measures. This idea
contains the germ of the Tufnell treatment, which has been the most
successful therapeutic measure for the treatment of aneurism in the
nineteenth century.

The Italian anatomist's acumen led him to appreciate better than ever
before in medical history the influence of the mind on the
circulation. He pointed out that emotions have a powerful influence on
the circulatory system in all its parts. How much the peripheral
bloodvessels are affected can be seen in the tendency to blushing
during certain forms of excitement, involving shame or embarrassment;
on the contrary, pallor in anger, or indignation, or fright. He
pointed out, too, that the heart is affected by such emotions and is
sometimes strenuously excited and sometimes very much retarded.
Morgagni understood that the influence of such emotions in especially
excitable individuals leads to wear and tear on the bloodvessels and
so to a shortening of lives. He thought of some aneurisms, even those
affecting the large bloodvessels, might be caused by sudden intense
emotions, and especially by violent efforts to suppress or conceal
emotions. We know now, however, that these pathological conditions are
due to human passions, but quite other than those which Morgagni had
in mind.

It is interesting to note that comparative {45} pathology--that is,
the study of the diseases of animals as illustrating corresponding
conditions in human beings--had already attracted the attention of the
Bolognese school of medicine. Albertini, who had been a professor of
Morgagni's, pointed out that aneurisms are rarely found in animals,
because brutes were not subject to emotions as are human beings.
Morgagni made still further observations in this line to confirm his
own conclusions in the matter. For a time in his earlier life he
devoted himself to the study of fishes, because they seemed to promise
to throw light on certain problems in human anatomy and pathology.

How closely he studied pathological changes in tissues can be gathered
from the fact that his observations led him to point out that aneurism
of the aorta occurs most frequently at that part of the curvature of
the aorta against which blood is constantly projected by the heart.
The realization of the importance of this mechanical factor in the
production of aneurism is one of the first successful results of
carefully applied observation and knowledge of physical laws in the
causation of changes in the tissues as opposed to elaborate theories
with very little foundation in fact.

Variations in the pulse attracted his attention, and he was among the
first to point out that the occurrence of flatulency is liable to
cause disturbance of the heart's action and to bring on noticeable
cardiac palpitation in the absence of any organic affection of the
heart itself. Morgagni also pointed out that intermittence of the
pulse may be due to nervous conditions. He showed that severe mental
shock or trying emotions may cause irregularity of the heart's action
and pulse intermittency. Some of his observations in this matter show
an intuition with regard to the nerve supply of the heart that is
quite beyond the anatomy of his time, and seems to indicate that he
suspected the existence and {46} function of the sympathetic system
and also the existence of a special nerve supply to the small
arteries.

Perhaps Morgagni's most penetrating evidence of insight in pathology
and its relations to clinical medicine is with regard to tuberculosis.
Over a century and a half ago he insisted on its contagiousness. He
refused to make autopsies on patients who had died of tuberculosis,
and his position in the matter was undoubtedly of the greatest service
in directing the attention of his contemporaries, and especially those
closely in contact with him, to the important question of intimate
association with tuberculous patients as a potent factor in the
acquirement of the disease, more potent even than heredity which then
occupied all men's minds on this subject.

It might be deemed that this advanced position of Morgagni was due
rather to intuitive abhorrence of the disease than to the conviction
of actual observation, and that his conclusions were the result more
of prejudice than of real knowledge. Any such opinion, however, is
absolutely contradicted by the fact that he knew and understood better
than any one of his generation the pathology of consumption. He
pointed out at a time when any chronic affection of the lungs was
liable to be considered consumption that there are a number of forms
of chronic bronchitis that are not due to pthisis pulmonalis, but to
other slow-running conditions within the lungs.

He anticipated very completely the present position of surgery with
regard to the treatment of cancer. He advised the operative removal of
these malignant tumors whenever possible. As Benjamin Ward Richardson
points out, this advice was given evidently not with the idea that the
disease could be always thus completely cured, but because early
operation gave speediest relief of annoying {47} symptoms and assured
the greatest prolongation of life. Many other methods of removal of
cancerous growths were suggested in Morgagni's time, as in our own,
and many false promises made and false hopes raised by their
advocates. He pointed out that the quickest, the safest, the surest
and in the end, for the patient, the easiest method of removal is by
the knife in the hands of the bold and skilful surgeon. After a
century and a half of vauntedly great advance, especially in surgery,
we are practically in the same position as when Morgagni's advice was
penned, and his opinion remains practically as valuable to-day as
then.

In another important point of medicine Morgagni seems to have
anticipated the opinion of our own time. It was the custom to practise
venesection very freely. On one or two occasions in his own lifetime
Morgagni fell ill and venesection was recommended. His biographer says
that he constantly refused this method of treatment, adding very
naively, "and he who had often cured others by venesection would never
allow this remedy to be used upon himself because, as I believe, he
had a natural abhorrence to it."

It was an index of thoroughgoing independence of thought in those days
to stand out, even for personal reasons, against the overwhelming
tradition in favor of blood-letting. But Morgagni had well-grounded
doubts as to the remedial efficacy of abstraction of blood, and at
least avoided it in his own case.

Besides his skill in practical and theoretic medicine, Morgagni was a
man of cultivated taste in art, and he was conversant not only with
the literature of his own language, but also of French, Latin and
Greek. He was always welcomed in the literary circles of the cities of
Northern Italy, and counted among his friends many of the great
writers of the time. His success in winning the friendship of rulers
was especially {48} noteworthy, and had not a little influence for the
advantage of education and science. The patricians of Venice were
proud to consider him as a personal friend, and to the Venetian Senate
he owed his professorship at Padua. The King of Sardinia, Emanuel III,
looked upon him as an intimate acquaintance. All the Popes, five in
number, of the second half of his life were on terms of personal
intimacy with him, and his advice was asked on many important
questions with regard to educational matters in his own day.

Some of these Popes are among the most influential pontiffs that ever
occupied the Roman See. The great Benedict XIV, himself a native of
Bologna and an intimate friend of the scientist, in his classic work
"De Beatificatione Servorum Dei" mentions Morgagni in terms of special
commendation. His scarcely less famous successor, Clement XIII, had
often consulted Morgagni professionally at Padua before his elevation
to the See of Rome. After his election as Pope he assures Morgagni of
his continued esteem and friendship, and asks him to consider the
Vatican always open to him on his visits to Rome. In an extant letter
Clement praises his wisdom, his culture, his courtesy, his charity to
God and men, and holds him up as an example to others, since with all
his good qualities he had not aroused the enmity or envy of those
around him.

Morgagni's life must have been in many ways ideally happy. Rewards for
his scientific success began early in life, even before his
professorship, and continued all during his long career. The Royal
Society of England elected him a fellow in 1724; the Academy of
Sciences of Paris made him a member in 1731. In 1735 the Imperial
Academy of St. Petersburg conferred a like honor upon him. In 1754 the
Academy of Berlin elected him to honorary membership.

His English biographer, Dr. William Cook, says quaintly {49} that all
the learned and great who came into his neighborhood did not depart
without a visit to Morgagni. He was in correspondence with most of the
great men of his time, and the terms of intimate relationship that
this correspondence reveals are the best evidence of the estimation in
which Morgagni was held, especially by the prominent scientists of his
time. Among them were such men as Ruysch, Boerhaave, Sir Richard Mead,
Haller and Meckel. This wide acquaintanceship of itself was a great
distinction at a time when the means of communication were so much
more limited than at present.

It is gratifying to think that Morgagni must have been enviably
content in his private life, though, as usually happens when this is
the case, very little is said explicitly on this subject. His untiring
labor deserved the compensation of a loving domestic circle. During
his retirement at Forli, after his graduation from the university and
when, from overwork, his health failed him for a time, he married the
descendant of a noble family of the town, Paola Vergieri by name, a
companion for him who, biographers declare, could not have been
surpassed in judgment or in affection. They had a family of fifteen
children, eight of whom survived their father though he lived to the
ripe age of eighty-seven years. There were three sons, one of whom
died in childhood; another became a Jesuit and taught in the famous
Jesuit school at Bologna whose magnificent building has now become the
municipal museum, the Accademia delle Belle Arte. The third followed
his father's profession, married and settled in Bologna, but died
before his father, who assumed the care of his grandchildren. All
Morgagni's daughters who grew up to womanhood, eight in number, became
nuns in various religious orders.

The spirit of science had not disturbed the development {50} of a
homely simple faith in the family. The great Father of Pathology, far
from being disturbed by the unselfish self-sacrifice of so many of his
children, bore it not only with equanimity but even rejoiced at it.
His relations to his children were ever most tender. After the
suppression of the Jesuits, his son, who had been a member of the
order, worked at science with his father at the University of Bologna
and not without distinction.

The estimation in which Morgagni was held by his contemporaries can be
judged from the fact that twice when invading armies had entered the
Emilia and laid siege to Bologna, their commanders, as in old Greek
history did the Grecian generals with regard to Pindar and Archimedes,
gave strict orders that special care was to be taken that no harm come
to Morgagni, and that his work was not to be hampered. Having lived
his long life amidst the reverent respect of all who knew him, he died
full of day and honors.

Succeeding generations have not been backward in acknowledging
Morgagni's merits. I have already spoken of Virchow's tribute to his
greatness. The Italians have long considered him as one of their most
brilliant names in medicine. One of the best known of the
representative Italian medical journals is _Il Morgagni_, published at
Milan. To its pages the foreigner seeking to know the progress of
Italian medicine turns almost as the first resort. _Il Morgagni_ was
founded some fifty years ago, and continues to uphold its reputation
as one of the world-known medical periodicals.

The great medical scientist whose work was to prove the foundation of
modern pathology, and thus be the source of more blessings to mankind
than ever even he dreamed of, remained in the midst of the reverence
and gratitude of his generation, one of those beautifully simple
characters whom all the world delights to honor. As a teacher he was
the {51} idol of his students. No great scientist who came to Italy
felt that his journey had been quite complete unless he had had the
privilege of an interview with Morgagni. This friend of Popes and of
many of the European rulers was the happy father of a houseful of
members of religious orders, and considered himself blest that so many
of them had chosen the better part. He was himself all during his long
life the ardent seeker after truth, who did well the work that came to
his hand and followed his conscience in sincere simplicity of heart
and reaped his personal reward in the peace that is beyond
understanding to those who have not the gift of faith to appreciate
the things that are beyond the domain of sense.

{52}

{53}

AUENBRUGGER, THE INVENTOR OF PHYSICAL DIAGNOSIS

{54}

  While medicine is your vocation, or calling, see to it that you have
  also an avocation--some intellectual pastime which may serve to keep
  you in touch with the world of art, of science, or of letters. Begin
  at once the cultivation of some interest other than the purely
  professional. The difficulty is in a selection and the choice will
  be different according to your tastes and training.
    --Osler, _Aequanimitas and other Addresses_.

{55}


AUENBRUGGER,

THE INVENTOR OF PHYSICAL DIAGNOSIS.

At the present time the most interesting development in medicine is
the gradual reduction of the death rate from tuberculosis. This is
entirely due to the fact that the disease can now be recognized very
early in its course, and that, as a consequence, the treatment may be
begun before serious damage has been inflicted on the lungs. Under the
circumstances, the disease formerly supposed incurable has become
according to all the best modern authorities one of the most tractable
of infectious diseases. In their recent lectures in Philadelphia,
before the Phipps Institute for the Prevention and Cure of
Consumption, such distinguished medical authorities as Dr. Trudeau, of
Saranac; Professor Osler, of Johns Hopkins, and Professor G. Simms
Woodhead, of Cambridge, England, insist on the absolute curability of
tuberculosis when it is taken in time. Professor Woodhead particularly
asserts that there has been entirely too much pessimism in this
matter, even among physicians.

This present confidence with regard to the successful treatment of
pulmonary consumption is due to the fact that the diagnosis can be
made early. The glory of this early recognition depends entirely on
two men--Auenbrugger, of Vienna, and Laennec, of Paris. To
Auenbrugger, whose work was done nearly half a century before that of
Laennec, must be given the credit of having first approached the
problem of differentiating diseases of the lungs from one {56} another
by methods which were so objectively practical that every practitioner
of medicine could, after having become expert in their employment, use
them with absolute confidence in his diagnosis.

Modern medical science and practice acknowledges very gratefully its
deep obligations to what is known as the Vienna school of medicine. It
is not a little surprising to find that it was the practical side of
medicine particularly which was developed at Vienna, since the
inhabitants of the Austrian capital, while supposed to have artistic
tastes far above the average, are usually considered to be among the
most impractical people in Europe. For over one hundred and fifty
years, however, the medical department of the University of Vienna has
always ranked among the first in the world. Many of the Viennese
professors of medicine have been acknowledged as the greatest teachers
of their time. Beginning with Van Swieten and De Haen during the
second half of the eighteenth century, the medical department of the
University of Vienna has scarcely ever been without at least one of
the leading lights of medicine in Europe. Wunderlich, Rokitansky and
Skoda were, in the middle of the nineteenth century, the greatest
medical men of their time. Hebra, Billroth and Nothnagel worthily
continued the tradition of medical greatness in the Austrian capital.
Even at the present time, notwithstanding the great advance in
medicine and medical teaching that has come over all Europe, it is
generally conceded that the best place in the world to study clinical
medicine--that is, to study illness at the bedside of the patient--is
the famous Allgemeines Krankenhaus, the General Hospital of Vienna.

The clinical teaching of medicine developed much later in the history
of medical education than might naturally have been expected. There is
a tradition of bedside instruction {57} in medicine in old Grecian
times at the various shrines of AEsculapius, but this is not well
authenticated. Early in the sixteenth century came the modern birth of
clinical medical instruction at St. Francis's Hospital, in Padua, in
connection with the University there, which in every line did so much
for modern medicine. The first clinic that attracted widespread
attention, however, did not come until Boerhaave's time, at the end of
the seventeenth and the beginning of the eighteenth century. The
bedside instruction in medicine by this distinguished master drew
hosts of students to the hitherto comparatively unimportant University
of Leyden, in Holland. Two rulers--just the two who, to modern minds,
would perhaps appear least likely to do so--at once recognized the
immense practical value of this innovation in medical teaching and
immediately set about securing its benefits for their people. Pope
Benedict XIII and the Empress of Austria put themselves in
communication with Boerhaave, and the Pope was the first to avail
himself of the advice in the matter which the great Dutch master gave.
The Roman clinic became, in the first half of the eighteenth century,
under the direction of the distinguished Lancisi, one of the best
known in Europe.

The Austrian Empress, Maria Theresa, interested in everything that
could prove to be for the benefit of her people, invited the
distinguished pupil of Boerhaave, Van Swieten, to become her family
physician, and encouraged him in the foundation of a clinical medical
school at Vienna. Van Swieten soon came to occupy a very prominent
place at Court. When he was invited from Holland, on the
recommendation of the sister of the Empress, there was no heir to the
Austrian crown, though one had been anxiously looked for for several
years. Heirs to the number of sixteen in all blessed the imperial
family in the next twenty-five years, {58} and Van Swieten became the
confidential adviser of the reigning monarchs in polity as well as in
medicine. Accordingly, when he suggested the invitation of De Haen,
who had also been a pupil of Boerhaave, the suggestion was promptly
accepted, and the Leyden colleagues became the founders of the Old
Vienna School of Medicine, as it is called. They established the
tradition of bedside teaching, of actual practical experience in the
treatment of patients, and of the collection of detailed information
of every feature of cases that could possibly be helpful for
diagnosis. They also established the custom of demonstrations on
pathological material with confrontation of the diagnostic conclusions
during life and the findings of the postmortem examination in fatal
cases, which, down to our own day, makes Vienna an ideal place for
serious post-graduate work in clinical medicine.

It was not long after the establishment of the clinic on these broad
lines at Vienna before the first important fruit of the new teaching
method was to be gathered. Curiously enough, however, this initial
advance in practical medicine did not come from one of the
distinguished heads of the clinic, but from a comparatively young man
of no previous reputation. The greatest discovery ever made at Vienna
is due to Auenbrugger, an unassuming practitioner of medicine, who
came from the Austrian province of Styria, or, as it is called in
German, the Steiermark, about the middle of the eighteenth century. He
was the son of a small hotel keeper of Gratz, and, after making his
medical studies in Vienna, he remained at the capital for some years,
doing hospital work.

While thus engaged, the young Styrian, who attracted very little
attention except for his affability, and who made no pretension to
special knowledge or genius in observation, {59} laid the first stone
in the structure of modern exact diagnosis of pulmonary disease, and
cleared up many of the obscurities in which all affections of the
chest had been shrouded before his time. Having accomplished this
noteworthy achievement before he was forty years of age, Auenbrugger
then quietly settled down to be an ordinary medical practitioner in
the Austrian capital, with a special reputation for his knowledge of
chest diseases, and for kindly ways that gave him as much interest in
his poor patients as in those that could afford to pay handsomely for
his services.

Leopold Auenbrugger, afterward Edler von Auenbrug--a term about
equivalent to the English "Knight of Auenbrug"--who thus stands at the
head of modern medical diagnosis, was born on the 19th of November,
1722, at Gratz, in Lower Austria. His early education was received at
Gratz, and it seems to have been of rather a comprehensive character,
for Auenbrugger, later in life, was a member of the elegant literary
circles in Vienna and a welcome friend at the tables of cultured and
distinguished fellow-townsmen. It will be recalled, by those who
remember German literature, that at this time Vienna was the centre of
culture in Germany, attracting many literary men--as, for instance,
the two Schlegels--from other parts of Germany.

Auenbrugger's father was of the lower middle class, the proprietor of
the Gasthaus Zum Schwarzen Mohren, in one of the suburbs of the city
of Gratz, but also the owner of another hotel in the city itself, so
that he was able, by making some sacrifices, to afford his son a
university and medical education in Vienna. The family were not in
very affluent circumstances, however, and in this Auenbrugger was in
the same condition as many other of the distinguished medical men who
have made important original discoveries. Volta, Laennec, Johann
Mueller, Helmholtz, Pasteur and {60} Virchow were all the sons of
comparatively poor parents, and had to eke out their university
education by doing teaching work as soon as they were considered
capable.

Auenbrugger's studies in medicine were pursued under the well-known
Baron Van Swieten. Van Swieten was, as has been said, one of the most
distinguished of Boerhaave's pupils, and devoted most of his life to
writing a set of commentaries on Boerhaave's aphorisms and editing his
master's work. Van Swieten's greatest ambition was to make the
Austrian capital the home of the great clinical school of medicine and
a pilgrimage at least as attractive for physicians seeking to study
practical medicine at the bedside as had been his own alma mater at
Leyden. He was of so great administrative ability that Maria Theresa
made him one of her state counsellors.

With all the influence of the government behind him, then, it is not
surprising that Van Swieten succeeded in his very laudable project of
establishing a great medical school at Vienna.

It was fortunate that Auenbrugger made his medical studies under such
good auspices. We have no details of his student life nor of his
success in his examinations. Even as a student his engagement of
marriage to Marianna von Priesterberg was announced. The formal
marriage ceremony took place in 1754, when Auenbrugger was about
thirty-two years of age. His wife seems to have had a dowry, and this
enabled Auenbrugger to begin his medical career in Vienna. Some years
before this, as a young graduate physician, he had accepted the
position of resident medical attendant at the Spanish military
hospital of the Holy Trinity in Vienna. This hospital was large and
important and provided manifold opportunities for clinical study. Its
wards were frequently drawn on by the {61} clinical department of the
University of Vienna for cases to be demonstrated before the students.


This fact was sufficient to make Auenbrugger's position of great
educative value for him. Mistakes in diagnosis would be apt to be
discovered, since the interesting cases were reviewed by some of the
best physicians of the time in Europe. His position carried with it no
salary beyond his maintenance, but proved well worth the time he gave
it, since it developed in him habits of careful investigation. Just
ten years after he began his work at this hospital he published the
little book called "Inventum Novum," or new discovery, on which his
reputation depends. It was written in Latin, and its full title ran:
"A New Discovery that Enables the Physician, from the Percussion of
the Human Thorax, to Detect the Diseases Hidden within the Chest."

Altogether his little manual probably does not contain much more than
ten thousand words. It is perhaps two or three times as long as
thousands of medical articles published every year in our modern
medical journals. It contains, however, one of the most important
discoveries in the whole history of medicine. One of the best
diagnosticians of the nineteenth century, Skoda, the distinguished
head of the Vienna school of sixty years ago, calls the discovery that
Auenbrugger outlined so unpretentiously "the beginning of modern
diagnosis," and hailed Auenbrugger himself as the founder of the new
science of diagnosis that was to prove so fruitful of good in the
prevention of human suffering.

It is interesting to compare Auenbrugger's little book with Van
Swieten's commentaries on Boerhaave's works, which were published in
some eight huge volumes. Van Swieten's successor, De Haen, an equally
illustrious contemporary of Auenbrugger, published about the same time
some eighteen volumes on the science of medicine. Neither {62} of
these works is ever consulted now, except by some enthusiastic student
of the history of medicine, who wishes to clear up a point in medical
historical development; but Auenbrugger's unpretending monograph is,
and will ever remain, a classic. Practically nothing has been needed
to complete the clinical usefulness of his discovery. Like Laennec,
whose work was done just half a century later, he had the genius to
realize what the possibilities and the limitations of his discovery
are, and he completed it in all its details before giving it to the
public.

Auenbrugger's discovery consisted in recognizing that diseases of the
chest can be distinguished from one another and their varying
character differentiated by the sounds elicited when the chest is
tapped with the finger. To this tapping he gave the technical name,
since become classic in medicine, of percussion. Wherever there is air
in the chest, that is all over the healthy lungs, the sound elicited
by percussion resembles that given out by a drum over which a thick
woolen cloth has been placed. Over the heart, where there is no air,
the sound given out, when the chest is percussed, corresponds very
nearly to the sound produced when the thigh is tapped. The sound
elicited by percussion of the thigh Auenbrugger took as the standard
of dulness and applied to it the term Schenkel-ton, or thigh sound.

When the lungs become consolidated because of an inflammatory process
such as pneumonia or tuberculosis, then the percussion note over the
consolidated area resembles the sound over the leg or that found over
the heart. As a rule the heart is somewhat covered by the lungs, and
the sound produced by percussion over it is not quite as dull as that
over the solid muscular structures of the legs. Whenever fluid finds
its way into the thorax, as in pleurisy, then the sound produced on
percussion is very dull.

{63}

Auenbrugger further showed that by means of the sound thus obtained he
could demonstrate the size of the heart under varying conditions, and
so determine whether it is larger than normal or not. This gave the
first inkling as to the discernment of hypertrophy and dilatation of
the heart, and was the first step in the modern differential diagnosis
of heart diseases. He showed, moreover, that he could, by percussion,
outline very exactly the extent to which a consolidation of the lung
has taken place, or the height to which an effusion into the pleural
cavity reaches. These conclusions and demonstrations require not only
the greatest care but the most deliberate confirmation of every detail
by comparison of the diagnosis during life with the condition found
after death in fatal cases.

Auenbrugger seems to have spared neither time nor labor in this work
of confirmation. He made a number of experiments upon dead bodies,
injecting fluid into the pleural cavity and then demonstrating by
percussion the line of demarcation that indicated the level of the
fluid within the chest, as well as the pulmonary conditions that
developed because of its presence. In the study of pneumonia and
tuberculosis particularly, Auenbrugger spent many hours of patient
investigation during his ten years of hospital service. He succeeded
not only in demonstrating the presence of consolidation, but also the
existence of cavities in the lungs and their size and general
character.

Vienna was an ideal place for the development of Auenbrugger's ideas
of confirmation. At this time, it must have been one of the most
unhealthy places in Europe as regards pulmonary diseases. The city was
surrounded by walls that occupied the ground now taken up by the
magnificent Ring Strasse and the inhabitants were packed into
extremely narrow quarters, The modern municipal sanitary {64}
conscience is lax enough in our own day, but at that time it had not
been awakened to the slightest sense of duty toward the citizens.
Narrow, wandering streets lined by high buildings that made an attaché
of the British Legation of Vienna speak of the houses of the city,
scarcely more than fifty years ago, as "well-like," were the universal
rule.

It must be remembered that the present magnificent Austrian capital,
containing, perhaps, the handsomest single street and some of the
finest buildings in the world, is entirely a creation of the last
half-century. The old city had every cause to be unsanitary. Situated
in the valley of the Danube, liable in the spring-time to serious
floodings from the capricious, mighty river, which has been brought
under control only in recent years at great expense; in an exposed
situation, which makes it a veritable temple of the winds during the
autumn and winter; it is not surprising that tuberculosis should have
been very frequent. Even with all its improvements in recent years,
sanitary, hygienic, municipal and domiciliary, Vienna has at the
present time one of the highest death rates from tuberculosis in
Europe. In Auenbrugger's time there must have been practically
unlimited opportunity for the study of pulmonary diseases of all
kinds.

How well the brilliant young medical observer took advantage of the
opportunities thus afforded him can be judged very well from the
passages of his book that refer to chronic pulmonary diseases. He
divides the chronic diseases of the thorax in which abnormal
percussion sounds are heard into two classes. In the first place, he
places those in which the thoracic organs are rendered less capable of
resisting disease and become actually affected, because of insidious
influences, such as hereditary conditions, depressing circumstances,
poverty and poor nutrition. Without really calling it tuberculosis, it
is evident that in this group pulmonary {65} consumption is included.
The second class consists of affections in which the thoracic organs
become diseased from definite, easily recognizable causes. Such are
disturbances of the general health in pulmonary affections that follow
thoracic disease not completely recovered from. By these diseases
Auenbrugger evidently intends cases of pneumonia or other affections
of the lungs, or trauma and the like, which are followed by
tuberculous processes.

With regard to cavities in the lungs, Auenbrugger was able not only to
demonstrate their presence and to show by autopsy records that his
localization and determination of their approximate form and size were
correct, but he also understood the method of their formation and
explains the reasons for certain varieties of cavities that occur. He
speaks of two classes of cavity formations. From one kind there is an
ichorous discharge; from the other variety the evacuations are
purulent. Cavities with non-purulent secretions are situated only in
the lung. Abscesses of various kinds--that is, cavities with purulent
secretions--may occur in any part, or in any of the organs of the
thorax. The lung cavities are usually due to the breaking down of what
he calls crude tubercles. Both kinds of cavities may either be closed
or have an opening into the bronchi.

Auenbrugger showed very well how to distinguish, by percussion,
cavities of various kinds, and set it down as a principle, that before
the evacuation of the contents of the cavity percussion over it gave a
distinctly dull note, resembling that obtained when the thigh is
percussed, while after evacuation, as by copious expectoration, a
distinctly resonant note occurred. It is clear from his discussion of
the symptoms noted in cavities (at least in the opinion of Dr.
Merbach, who wrote a sketch of Auenbrugger's life for the
Jahresbericht der Gesellschaft für Natur und Heilkunde in Dresden,
{66} in 1861), that Auenbrugger was very near the discovery of
auscultation in his study of pulmonary cavities. Auenbrugger says that
when a cavity has been located by means of percussion, if the hand be
laid over the place beneath which it lies and the patient is asked to
cough, the fremitus produced by the pus in the cavity can be felt as
it moves under the coughing impulse. This is what we now know as
palpation. If instead of using his hand Auenbrugger had applied his
ear to the chest, auscultation would have been discovered nearly half
a century before Laennec began his work upon the subject. Perhaps
Merbach, who was himself a native of Styria and a professor at the
University of Gratz, was for patriotic motives more ready than others
might be to give Auenbrugger credit for practically discovering
auscultation.

Auenbrugger's and Laennec's observations were made on exactly the same
sort of clinical material. They were both studying advanced cases of
tuberculosis in the hospitals of a great city. Laennec's work was
actually not anticipated in the slightest degree however. How
Auenbrugger could have made the careful examinations of the chest that
he did in thoracic diseases without acquiring some knowledge of the
value of the further application of the sense of hearing, which
Laennec was to employ so fruitfully in the diagnosis of affections of
the lungs and heart, seems to us almost impossible to understand.
Discoveries once made, however, always seem so obvious that the wonder
is they were not made long before. It takes genius to cross the line
into the realm of the hitherto unknown, and the contemporary
generation usually occupies itself mainly with making little of the
new discovery. Even genius very rarely makes more than one original
observation in a lifetime, and it would be too much to expect more
from Auenbrugger.

{67}

The preface to Auenbrugger's little book is a model of concise
directness typical of the man and his ways. As the modest introduction
to a work that will ever be a classic in medicine it seems to deserve
a place here:

  "I present to you, kind reader, a new sign for the detection of
  diseases of the chest, which I have discovered. It consists in the
  percussion of the human thorax and the determination of the internal
  condition of this cavity by the varying resonance of the sounds thus
  produced. My discoveries in this subject are not committed to paper
  because of an itch for writing, nor an inordinate desire for
  theorizing. Seven years of observation have put the subject in order
  and have clarified it for myself and now I feel that it should be
  published.

  "I foresee very well that I shall encounter no little opposition to
  my views and I put my invention before the public with that
  anticipation. I realize, however, that envy and blame and even
  hatred and calumny have never failed to come to men who have
  illuminated art or science by discoveries or have added to their
  perfection. I expect to have to submit to this danger myself, but I
  think that no one will be able to call any of my observations to
  account. I have written only what I have myself learned by personal
  observation over and over again, and what my senses have taught me
  during long hours of toil. I have never permitted myself to add or
  subtract anything from my observations because of the seductions of
  preconceived theory.

  "I would not wish, however, that any one should think that this
  method of diagnosis, which I suggest, has been developed to its
  utmost perfection. I confess with all candor that there are defects
  in the system which conscientious observation will, I hope, amend
  with time. It is possible that there are even other important truths
  for the recognition {68} of disease still hidden from this method of
  diagnosis. Some of these may prove of great usefulness for the
  differentiation, prognosis and cure of diseases of the chest.

  "This was the reason why in my personal experience, after I had
  succeeded in finding the signs in the chest and proceeded further to
  the investigation of their causes so far as my own observation could
  help me, I have always afterward had recourse to the commentaries of
  the illustrious Baron Van Swieten, since I have considered that
  whatever can be desired by an observant man is sure to be found in
  his work. I have thus been able to spare you a long disquisition. I
  have found in his work a sure basis of knowledge on which my slight
  superstructure may be raised up to view.

  "I do not doubt, however, that I have accomplished a work which will
  earn the gratitude of all true devotees of the art of medicine,
  since I have succeeded in making clear certain things which shed not
  a little light on our knowledge of the obscure diseases of the
  chest, a subject hitherto very imperfectly understood.

  "I have omitted many things that seem doubtful because they are as
  yet not sufficiently elaborated. I shall endeavor, however,
  faithfully to devote myself to [literally to sweat over] the further
  development of these points. Finally, it has not been my effort to
  write in any elegant diction. I have chosen a style in which I may
  be thoroughly understood.

  _Vale;_
  "December 31, 1760."


Auenbrugger's own realization of the importance of his work and of its
significant value for medicine kept him faithfully investigating his
chosen subject, though he seems to have met with very little
encouragement from members of {69} the medical profession near him. It
is extremely difficult to understand how his practical observations
and thoroughly conservative claim failed to attract more attention
than they did from really great physicians who were deeply interested
in the progress of medicine. At least two distinguished writers on
medicine, Van Swieten and De Haen, compiled treatises on medical
subjects that included the consideration of diseases of the chest
within a few years after Auenbrugger's _Inventum Novum_ appeared, and
yet neither of them devotes any space to the question of percussion
nor hints at its possible value.

Van Swieten's work consisted of commentaries upon the aphorisms of
Boerhaave. The Vienna professor did not, however, limit himself to the
consideration of the aphorisms alone, but made his work also a
compendium of his own clinical experiences with acute and chronic
diseases. As a matter of fact his commentaries on the aphorisms are
each a monograph on some special disease. The two last volumes of this
commentary appear after the publication of Auenbrugger's book on
percussion, one volume being published in 1772, the other in 1774.

The first of these articles contains a long article on pulmonary
consumption, and the other an almost equally long chapter on pleurisy
with effusion. In neither of the volumes, however, is there any
mention of percussion, or of Auenbrugger's work, though if Van Swieten
had given any serious attention to the subject, he must have become
convinced how valuable Auenbrugger's invention was in the diagnosis of
these conditions.

This omission is all the more surprising as Auenbrugger was a pupil of
Van Swieten's and practically dedicated his _Inventum Novum_ to his
master. He mentions Van Swieten's work several times in his little
book. Auenbrugger's {70} investigations were not unknown to Van
Swieten then, and the only conclusion to be drawn from his neglect to
mention Auenbrugger's methods is that he deliberately omitted
reference to them because of his failure to recognize the value of the
discovery. This constitutes one of the most serious blots on Van
Swieten's medical career. He was succeeded as the head of the clinic
in Vienna by De Haen, who also came from Leyden and brought with him
the methods of Boerhaave's clinical school. As the time during which
Auenbrugger was making his valuable observations at the Spanish
military hospital coincides with the years when De Haen was professor
of clinical medicine, and when he was frequently indebted to his
colleague of the Spanish hospital for his cases for demonstration, it
is impossible to conceive that Auenbrugger or his work should have
remained unknown to the distinguished head of the clinic.

There is not a single mention, however, to be found anywhere in De
Haen's voluminous writings of Auenbrugger or his work. De Haen's
principal work is his _Ratio Medendi_ (_System of Medicine_),
published at Vienna during the years from 1757 to 1779. It consists of
eighteen volumes, in which all the important forms of disease as well
as the rarer types of affections that came to the clinic are
thoroughly discussed. De Haen treated of pneumonia, of consumption, of
pleurisy with effusion, which he calls dropsy of the chest, but never
suggests the use of percussion. On the contrary, he complains in a
number of places how very obscure and difficult of diagnosis are
thoracic diseases and especially dropsy of the chest, pleuritic and
pericardial exudates, and insists on the ease with which errors of
diagnosis may be made in these subjects. He failed completely to
recognize how much light had just been thrown on this subject by
Auenbrugger's work, and how much easier the differential {71}
diagnoses of these conditions were to be as the result of systematic
percussion.

Some of the commentaries on Auenbrugger's work are not entirely
depreciative, however. In Ludwig's _Commentaria de Rebus in Scientia
Naturali et Medicina Gestis_ for the year 1762, published at Leipzig,
there is an excellent notice of Auenbrugger's work within a year after
its appearance. It is not known who the reviewer was, but he calls
Auenbrugger's discovery "a torch that was designed to illumine the
darkness in which diseases of the thorax had up to this time lain
concealed." A brilliant future was prophesied for the new method of
examination. It is evident that the writer not only thoroughly
comprehended Auenbrugger's work, but had himself applied the
percussion method for purposes of diagnosis.

This is almost the only favorable and reasonably intelligent review of
Auenbrugger's work to be found in the medical journals of the time. In
the new Medical Library, issued by Rudolph Vogel, Professor of
Medicine in Göttingen, published in six volumes in 1766, there is a
short mention of Auenbrugger's book and his new discovery. This
reference is, however, an extremely curious affair. The good professor
completely failed to understand in what the new discovery really
consists. It is clear that he had never read Auenbrugger's book. He
seems to have heard of the subject from some medical friend, and to
have obtained an entirely wrong notion. He talks of Auenbrugger's new
diagnostic method as if it were an imitation of Hippocrates's
succussion method of recognizing the presence of fluid in the chest by
shaking the patient till the liquid gave the characteristic splash.

Other medical writers of the time perhaps, as the result of reading
Professor Vogel's book, made the same mistake {72} in their
appreciation of Auenbrugger's work. Vogel himself insisted that
Auenbrugger did wrong to claim any originality for his invention,
since it had been used so long before by Hippocrates. He adds that
what is original with Auenbrugger is of very little value, the older
ideas being the only ones worth while considering with regard to the
application of this so-called new method of diagnosis. Vogel was an
authority in medicine at the time and other commentators took the key
note from him in this matter, and in many parts of Germany it was
generally accepted that Auenbrugger's method of percussion was only an
elaborated method of the so-called succussion of Hippocrates.

Under these circumstances it is perhaps not surprising that
Auenbrugger's work attracted very little attention in the
German-speaking countries. In Vienna itself, as we have already said,
Van Swieten and De Haen failed utterly to recognize its value. Outside
of Vienna their example was naturally followed, for the Vienna school
was considered authoritative, and surely, if any one, the professors
of the University of Vienna might be expected to know whether
Auenbrugger's new discovery was really of any value or not.

It is interesting to compare Auenbrugger's state of mind, with regard
to the neglect of his discovery, with Laennec's remark in the preface
of his book. Laennec said: "For our generation is not inquisitive as
to what is being accomplished by its own sons. Claims of new
discoveries made by contemporaries are apt for the most part to be met
by smiles and mocking remarks. It is always easier to condemn than to
test by actual experience." Auenbrugger seems to have suffered from
more than the neglect of which Laennec complains. When he speaks of
envy and calumny in no uncertain terms, the only conclusion possible
is that his representations as to his discoveries must have been set
{73} down as pretensions that his contemporaries considered
unjustified by what they knew of his work.

It is interesting also to note that both men found their prospects of
reward, not in the good will of their contemporaries, nor even the
prospect of fame, but in the hope that their work would be useful in
lessening the sum of human suffering. Laennec said: "It suffices for
me if I can only feel sure that this method will commend itself to a
few worthy and learned men who will make it of use to many patients. I
shall consider it ample, yea more than sufficient reward for my labor,
if it should prove the means by which a single human being is snatched
from untimely death."

Laennec's words are almost an echo fifty years afterward of
Auenbrugger's expressions, just quoted: "I console myself," he said,
"with the thought that I have accomplished a work which will earn the
gratitude of all true devotees of the art of medicine, since I have
succeeded in making clear many things which shed not a little light on
the chapter of the obscure diseases of the chest, in which our
knowledge has hitherto been so very incomplete."

As a rule it may be said that medical observers whose genius leads
them to step across the narrow line that separates the known from the
unknown are likely to lack the appreciation of their own generation.
Long before Auenbrugger or Laennec, Harvey, the discoverer of the
circulation of the blood, said to friends that he did not expect any
one of his generation to accept the new doctrine, and it is well known
that the great medical men of the time did not accept it. Harvey is
not an isolated example, and even in our own time real medical
progress sometimes waits for years for recognition, while
well-advertised pretended advances are occupying the centre of the
stage. Auenbrugger's discovery made its impress, however, and was
never entirely lost to sight. Even {74} before his death there was the
consoling prospect of its meeting with adequate attention.

De Haen's successor in Vienna, Maximilian Stoll, treated Auenbrugger's
work very differently from his predecessors, and was the first to
introduce it practically into clinical medical training. Stoll did not
hesitate in his clinic, on the strength of what was discovered by
means of percussion, to attempt the evacuation of fluid from the
pleural cavity on a number of occasions. It can be easily understood
that with their lack of knowledge of the necessity for thorough
cleanliness in the surgical sense, such an operation might readily be
followed by discouragingly fatal results. This actually happened in
Stoll's own experience. He does not, however, seem to have abandoned
his practice of tapping the chest because of this. He insisted to his
students that Auenbrugger more than anyone else had experience in
removing fluid, and especially purulent collections, from the chest,
and he recommended the practice to them. He added that medicine owed
as much to Auenbrugger for his rational method of treating effusions
into the pleural cavity, whether of pus or serum, as for his
diagnostic sign by which the presence of the fluid could surely be
recognized.

Some of Stoll's pupils took up the work of commending Auenbrugger's
method, and a little book written by one of them, Eyerel, came into
the hands of the distinguished French physician, Corvisart. Eyerel did
not hesitate to say, in his treatise on empyema, that the practice of
percussion of the thorax, a diagnostic method introduced by the very
distinguished Vienna physician, Auenbrugger, had been of great help to
them in the study of this disease.

Once the great French professor of medicine, Corvisart, took it up,
the new method of diagnosis was destined to have an immediate and
world-wide vogue. Corvisart was not {75} only a power in medicine
because of his faculty of observation and his thorough appreciation of
the work of others, but he was the court physician of the first
Napoleon, and this gave any ideas that he favored many adventitious
chances for publicity. Napoleon's well-known faculty for selecting men
for special positions whose genius was calculated to be of service to
him was never less at fault than when he violated most of the court
medical traditions in Paris and chose Corvisart for the imperial
physician. Corvisart's selection was the result of Napoleon's
appreciation of his new method of diagnosis, namely, that of
percussion, in chest diseases.

The Emperor himself was suffering from a persistent cold and was told
that Corvisart, instead of following the traditional method of feeling
the pulse, looking very wisely at the tongue and then gazing learnedly
into space, conducted an actual examination of the chest and sounded
it carefully all over, in order to determine where abnormal conditions
might exist. This struck Napoleon as a very practical and possibly
valuable feature of diagnosis. Accordingly Corvisart was summoned to
give his professional opinion. After the consultation he was made the
Emperor's private physician. When Corvisart took up the subject of
percussion of the chest, it was practically unknown in Europe outside
of Vienna. Even in the city of its origin, as we have seen, it was not
well appreciated. Auenbrugger's little book had fallen into oblivion.
Corvisart obtained his hint as to the possible value of percussion
from Stoll's and Eyerel's appreciative remarks with regard to it. The
Frenchman used the method to some extent and, realizing its value,
resolved to call the attention of his countrymen and the medical world
to this very helpful aid in diagnosis. It was at this time that he
came upon Auenbrugger's original monograph. Instead then of writing
himself on the subject, he translated {76} Auenbrugger's little book
into French and made a commentary on it.

Corvisart was Laennec's patron in medicine, his favorite teacher, and
the man to whom the great French physician owed much of his early
inspiration. It is no little merit in Corvisart's career thus to have
been the connecting link between the men who did most for the
practical science of medicine, and especially for the important but
obscure chapter of diseases of the chest. He did not attempt at all to
claim for himself any of the merit that he felt should rightfully go
to Auenbrugger, and while his own observations and writings
established percussion upon a firm basis and extended its knowledge,
he shares the immortality of his discoverer, and comes down to us in
medical history as an example of the reward of having rendered
faithfully what was due, where it was due. It has been the custom to
praise Corvisart for his justice toward Auenbrugger. Mere justice
seems scarcely a worthy reason for praise of a great man, yet the
history of medicine is so full of failures on the part of subsequent
observers to acknowledge priority of discovery, that perhaps the
praise does not seem quite as futile as it otherwise would.

It is not surprising then that Corvisart's pupil Laennec should have
appreciated very thoroughly the value of Auenbrugger's discovery. In
the preface of his book on Mediate Auscultation, Laennec bewails the
fact that men are generally neglectful of discoveries made in their
own time, and fail to give them the attention they deserve. He
attributes this neglect rather to the well-known carelessness of men
than to any deliberate failure to recognize the merit of contemporary
work. He says:

  "Lack of attention is an extremely common failing of all men. What
  it takes years and hard labor to acquire, is not {77} infrequently
  passed over without notice. Auenbrugger's method, published some
  fifty years ago, though capable of being learned in a few days, and
  without difficulty, and of being put into practice without the use
  of any instruments, although snatched from oblivion by my
  illustrious preceptor, Professor Corvisart, and made clearer than it
  had been left even by the author himself, is not as yet in ordinary
  use among physicians. Even the wonderful invention of the
  illustrious Jenner, though received with so much praise, and with
  regard to whose efficaciousness numberless confirmatory observations
  have been made, is already somewhat less prominent in the minds of
  men than it should be, or at least it would be, only for the fact
  that the governments of many countries, provinces and cities, the
  foresight of the clergy, of the authorities of all kinds, and the
  advice of the best physicians have exerted all their influence to
  keep it at public expense constantly in practice."

After about ten years of service at the Spanish military hospital,
Auenbrugger resigned his position there and took up private practice.
In this he was eminently successful, being, as might be expected,
especially in demand for cases involving affections of the thorax. His
practice appears to have been to a great extent among the better class
of people, but he seems never to have neglected the poorer patients
whom he had come to know during his hospital experience. There are
traditions in Vienna of his unfailing willingness to assist the poor
and even to put himself to considerable inconvenience in order to be
of service to them.

Tradition tells that he was very conscientious in the pursuit of his
vocation as a physician, and among the family relics there is
preserved a small lantern which he kept always by his bedside, to
light him on his visits to the sick when called out at night. It must
not be forgotten that city streets {78} were not regularly lighted at
the end of the eighteenth century, and night calls even in city work
must have been a source of great annoyance and discomfort. There is a
family tradition, too, that the night bell at his house was connected
directly with Auenbrugger's room, so that the others of the household
might not be disturbed when night callers came for him. Every
tradition points to him as a man among men in his unselfish readiness
to save others trouble, and do all the good in his power.

Auenbrugger was, according to well-grounded traditions, especially
admirable in his relations toward other members of the medical
profession. This may not seem a very significant sign of amiability to
those outside the profession, but it is well recognized that even
great physicians have not always been known to get on well with
brother practitioners. Auenbrugger has, besides, the pleasant
reputation of having been of great material assistance to a number of
needy medical students during the time of their university careers,
and to have frequently lent a helping hand to young practitioners in
the city, who probably found it quite as discouraging, beginning
practice in those days, as any of their young confreres of this
generation find it at the present time.

To physicians and medical students when ill, Auenbrugger was almost
unceasing in attention. Two or three physicians of the generation
immediately after his attributed to his unselfish care and devotion to
them their recovery from what would otherwise have been mortal
illnesses. In this way Auenbrugger seems to have been a man whom
everyone who came to know him, even slightly, learned to love and
respect. His relations to his family and relatives were always of the
most happy, kind character, and family traditions show that his
fatherly care was befittingly returned to him in his old age. The
number of his friends was very great, {79} and he counted among them
some of the most distinguished inhabitants of the Austrian capital.

Notwithstanding his devotion to his practice, Auenbrugger did not
cease to make observations that occasionally he considered worthy of
being committed to paper. He was especially careful in the study of
his cases, and left fully written records of over 400 important cases
that he had studied very faithfully. His attention seems to have been
attracted particularly to certain mental diseases. This work was done
half a century before even the first beginnings of the modern
classifications of mental diseases were attempted. He wrote a short
article with regard to mania and its treatment, and a longer article
on melancholia. How well he recognized the essential feature of this
latter affection and the main symptom that must be guarded against,
can be gathered very well from the title of his paper, which he called
"The Still Madness, or the Impulse to Self-Murder."

It is about the time that he was engaged in the study of melancholia,
perhaps as a contrast to sadder things, that he wrote a comic opera,
of which we shall have more to say presently. His description of the
conditions that he saw during an epidemic of dysentery that occurred
in Vienna show how exact and careful a clinical observer he could be,
and that the demands of his practice did not absorb all his attention
to the detriment of his faculty for observation. He seems himself to
have suffered from a severe attack of typhus fever which raged
epidemically in Vienna in 1798.

Auenbrugger had a wide circle of interests beyond the subject of
medicine. There is a family tradition that he had a magnificent
library. He seems with true Viennese spirit to have been a great
devotee of the opera, and to have had an especial liking for music. He
wrote the text, {80} score, and libretto of a comic opera with the
title, "The Chimney Sweep." This operetta evidently enjoyed more than
a _succes d'estime_, and further writing in this line was confidently
expected from him by his friends. There is even a story to the effect
that the Empress Maria Theresa, of whom he was an intimate friend, and
who made use, it is said, of his counsel in political matters more
than once, asked him why he did not follow up his first success in
operatic writing. His blunt reply shows how intimate must have been
his relations with the great empress. He said he had things much
better with which to occupy himself than the writing of comic operas.

Seeing that he was so favored at court, it is not surprising to find
the family tradition that Auenbrugger was associated with many of the
most prominent persons in the Austrian capital during his lifetime. He
was a special friend of and spent a great deal of time with the famous
philosopher, Werner. As he grew older he delighted especially in
music, and spent many hours at the house of Baron Zois, where many of
the distinguished European musicians were to be found and where famous
matinee concerts were given every Sunday from twelve to two. The day
and the time may seem strange to foreigners, but Vienna still has
concerts at this time on Sunday, and after the Viennese have gone to
Mass in the morning they think that they could not occupy themselves
better than with listening to good music in the middle of the day.

Toward the end of his life, Auenbrugger lived during the summer time
in the suburb of Rossau and cultivated a little garden, taking the
greatest pleasure in spending his time at this simple occupation. It
is a source of satisfaction to find that though Auenbrugger's medical
work failed during his life to attract the attention it deserved, he
had his reward, {81} for his patient investigations in earlier life,
in a peaceful and contented ending to a career that had been so worthy
of what was best in the man. He lived to celebrate his golden wedding
in 1804 and was especially happy in the almost constant companionship
of the good wife who had proved so faithful a helpmate during her long
life. After her death, which took place the year following the
celebration of their jubilee, his vitality and his contentment with
life seemed to abandon him. He was a changed man and kept himself for
the most part to his room. He went to bed very early and did not care
to see anyone but his near relatives. His last illness was the result
of a cold, and his advanced age, eighty-seven, left him little
resistive vitality. He retained his consciousness until the very end,
and said the day before his death that the next day would be his last.


Shortly before noon of the day of his death he looked at the clock in
his room and said that when the hands would point to two o'clock he
would be no more. His prophecy came true.

Vienna has never had the reputation of honoring its great geniuses
during their lifetime, unless they happened to belong to the higher
nobility. The exclusiveness of court society at the capital made
itself felt in all circles, and the consequence was that genius sprung
from the lower orders was almost sure not to receive its due share of
attention. The comparative neglect of Auenbrugger does not seem so bad
when we recall the case of Mozart. Music has always been one of the
special fads of the Austrian and the Viennese pride themselves on
their appreciation of it. Mozart, however, perhaps the greatest
musical genius that ever lived, received some attention during his
life, but passed away almost unnoticed at the early age of
thirty-five, was buried in a common trench with the poor people of the
city, and now Vienna cannot {82} find his resting place. There is a
magnificent monument to him, but his bones lie with his own people
forever.

Outside the circle of his personal friends Auenbrugger did not receive
much attention, so that even the year of his death was until recently
more or less uncertain and the resting place of his remains continues
to be unknown. The present generation of medical men has done more to
afford the due meed of praise to Auenbrugger than any preceding
generation. The interest in tuberculosis particularly has led medical
men to appreciate all the significance of Auenbrugger's work, and the
practical importance of his discovery for the early recognition and
consequently for the cure of the disease. The appreciation of
Auenbrugger in our time has been so flattering as quite to make up for
previous neglect. His name has been linked with that of Laennec as the
great discoverers of physical diagnosis in chest diseases.

At the opening of his address as President of the American
Climatological Association, some five years ago, Dr. Edward O. Otis,
of Boston, said:

  "It is quite improbable, I think, that we should be here to-day, or,
  indeed, have an existence as a society largely devoted to the
  consideration of diseases of the chest, were it not for the methods
  of thoracic examination which Auenbrugger and Laennec have given us
  in their discoveries of percussion and auscultation. Without these
  two precious methods of investigation we could scarcely have arrived
  at any degree of precision or certainty in thoracic pathology and
  might have been not unlike the old physicians and surgeons, 'who
  would swear,' as Morgagni says, 'that there was fluid in the chest
  when in reality there was not a single drachm, or perform
  paracentesis of the thorax upon a duke for an empyema which did not
  exist.'"

His tribute is only an echo of many others not less {83} appreciative
of Auenbrugger's important original work than have been expressed by
modern medical men of all nations. The simple old German practitioner,
who had the annoyance of seeing his discovery neglected by his
contemporaries for so many years, has at last come into his own. There
is scarcely an important medical meeting held anywhere in the world in
which diseases of the chest are discussed without a mention of
Auenbrugger's name. This is not surprising in Germany, but is quite as
true of France, and England, and America. As Dr. Otis said, in closing
the address from which we have just quoted:

  "Although we possess but meagre and fragmentary records of
  Auenbrugger's life, there is yet enough to enable us to fill in the
  lines and gain a distinct idea of his personality and character.
  With some persons one does not need to be acquainted with much of
  the detail of their lives in order to know what manner of men they
  are; a few characteristic illustrations here and there in their
  career redeem the spirit and motives of their lives, and show the
  kind of men just as they are, quite as well and clearly as an
  extended and continuous biographical narrative. Always
  enthusiastically devoted to the study of disease, Auenbrugger
  escaped the not infrequent misfortune of the student, a loss of
  sympathy with one's kind. His love for his fellow-men, for suffering
  humanity, for struggling students in his own profession, kept pace
  with his love for medical study. He never sacrificed the man for the
  scientist, nor did he lose his interest for other things in life, as
  happens sometimes with men intensely devoted to one pursuit. A man
  of original powers, as some one has truly remarked, can never be
  confined within the limits of a single field of activity.

  "He was interested in music, philosophy and the drama, and well
  illustrates what Dr. Da Costa has so happily styled {84} 'the
  scholar in medicine.' With dignity, sympathy, enthusiasm in his
  profession, even to the last; ever seeking to improve and add to his
  art; modest, like most great men; never refusing to give what is
  best to suffering humanity, he richly lived out his long life. As we
  teach our students percussion, as a matter of just recognition and
  due honor let us tell them something of the life of the discoverer,
  and at least his name, which I fear but few, who avail themselves of
  the result of his long and arduous labors, know."

Auenbrugger's German biographer, Professor Clar, of Gratz, says of his
early life that from his parents he received an excellent early
training, especially edifying because of the exemplary Christian
family life he saw about him, the piety of his father and mother, and
of the other members of the family. The baptismal register of the
parish church at Gratz is one of the important documents in his life
history, for there is some dispute as to the exact date of his birth,
as there is also with regard to his death. In 1798 he suffered from a
severe attack of typhus fever, which at the time was epidemic in
Vienna, and some of his biographers report his death in this year as a
consequence of it. His descendants, however, have shown, by the burial
register of the parish church in Vienna, that his death did not take
place until May 17, 1807; from this church, of which he had been for
half a century a faithful member, he was buried.

Few of the lives of the great discoverers in medicine have in them
more of encouragement for the busy practitioner of medicine than that
of Auenbrugger. He began his medical career by a series of practical
observations that stamped him for all time as one of the great
geniuses. When his discoveries failed to meet with the acceptance they
deserved, he was not disturbed, and, above all, he did not insist on
acrid controversy. He took up the practice of medicine and {85}
demonstrated how much his discovery could help in the diagnosis of the
obscure chapter of the diseases of the chest. In the mean time he went
on his way placidly doing the good that he found to do, taking care of
his poor patients and faithfully tending brother-physicians who
happened to be ill. He found an avocation to fill the moments spent
apart from his vocation, and added to the pleasure of humanity by his
work in music. All the time he remained a simple, faithful believer in
the relation of Providence to man, and considered that somehow the
inexplicable things of this life would find an explanation in the
hereafter. He was probably the best-liked member of the profession in
Vienna during his lifetime, and the profession of his native town are
very proud to recall the example that he sets physicians generally in
all the ethical qualities that make a physician's life not only
successful in the material sense, but also in inspiration for those
around him to do their duty rather than seek the fulfilment of merely
selfish aims.

{86}

{87}

EDWARD JENNER, THE DISCOVERER OF VACCINATION

{88}

  "It helps a man immensely to be a bit of a hero worshipper, and the
  stories of the lives of the masters of medicine do much to stimulate
  our ambition and rouse our sympathies. If the life and work of such
  men as Bichat and Laennec will not stir the blood of a young man and
  make him feel proud of France and of Frenchmen, he must be a dull
  and muddy-mettled rascal. In reading the life of Hunter, of Jenner,
  who thinks of the nationality which is merged and lost in our
  interest in the man and in his work! In the halcyon days of the
  Renaissance there was no nationalism in medicine, but a fine
  catholic spirit made great leaders like Vesalius, Eustachius,
  Stenson and others at home in every country in Europe."
    --Osler, _Aequanimitas and other Essays_.


{89}

EDWARD JENNER, THE DISCOVERER OF VACCINATION.

A very striking life in its lessons for the serious student of medical
problems is that of Edward Jenner, who first demonstrated to the world
that a simple attack of mild, never fatal, cowpox, deliberately
acquired, might serve as a protective agent against the deadly
smallpox, which before that time raged so violently all over the
civilized world. His successful solution of this problem has probably
saved more lives and suffering than any other single accomplishment in
the whole history of medicine. While this fact is apparently not
generally appreciated, Jenner's discovery did not come by mere chance,
but was the result of his genius for original investigation, which led
him to make many other valuable observations covering nearly the whole
range of medicine; nor indeed was his activity limited to medicine
alone, but extended itself to many of the allied sciences, and even to
scientific departments quite beyond the domain of medicine.

In medicine we owe to Jenner the first hint of the possible connection
between rheumatism and heart disease. He pointed out, at a discussion
in a little English medical society, how often affections of the heart
occurred in those who had suffered from previous attacks of
rheumatism. He was among the first, perhaps the very first, to hint at
the pathological basis of angina pectoris. While Heberden's name is
usually connected with this discovery, there seems good reason to
think that already Jenner had independently noted and called attention
to the frequency with which {90} degenerative affections of the
arteries within the heart muscle itself were to be found where during
life heart-pang had been a prominent and annoying symptom.

Besides these important advances in medicine made by him, and his
great discovery of the identity of cowpox and smallpox, Dr. Jenner was
an interesting observer of phenomena in all the biological sciences,
and in geology and palaeontology. He was a great friend of Dr. John
Hunter, who frequently suggested to him the making of such experiments
and observations as were more likely to succeed in the country than in
the city, and one cannot help but be struck with the determination
evinced all his life to take nothing on authority, but to test
everything by actual observation, and above all not to theorize where
he did not have the actual data necessary for assured conclusions; and
even where he thought he had them, his wonderful faculty for waiting
until they had properly matured, and their true significance had
become evident, stamped him for all time as a model for scientific
investigators.

Undoubtedly Jenner's greatest work was that of determining the value
of vaccination. His patient investigation of this subject, the
thorough conservatism with which he guarded himself from publishing
his conclusions until he had tested them in every way, the absence of
that haste to rush into print so characteristic of most present-day
medical investigators, and which is the cause of so much
disappointment in modern medicine, all distinguished this country
physician as one of the greatest investigating geniuses that medicine
has produced. His life is a mirror for the medical student and the
investigating practitioner of medicine. His discovery was so complete
when he finally announced it that but very little has been added to it
since. His invention came from his mind as Minerva from the brain {91}
of Jove fully armed for the conflict that was sure to come. In this
Jenner resembled very much Laennec and the other investigating
geniuses in medicine. As a matter of fact only one improvement has
been made in the preparation of vaccine material since Jenner's time,
and that is the incorporation of glycerin in very recent years, which
gradually destroys any micro-organisms that may be present, leaving
the vaccine virus itself unimpaired in its efficacy, though without
the possibility of inflicting those secondary infections which for so
long cast a shadow on vaccination.

Dr. Edward Jenner was the third son of an Anglican clergyman, his
mother being the daughter of a clergyman who had been at one time
prebend in the cathedral of Bristol. The family held considerable
property in Gloucestershire. He received his early education at
Wotton-under-Edge and later at Cirencester, the old Roman town in
Gloucestershire. While he acquired a good working knowledge of the
classics, from his earliest years he was interested in natural
history. Before he was nine he made a collection of the nests of the
dormouse. The hours that other boys spent at play he devoted to
searching for fossils or other interesting natural curiosities.

After his preliminary education had been finished he was apprenticed
to Mr. Ludlow, an eminent surgeon at Bristol, and after two years here
he went to London, where he had the privilege of residing as a
favorite pupil in the family of John Hunter for two years. At this
time Jenner was in his twenty-first year, John Hunter in his
forty-second. Hunter was not then a public lecturer, but he had been
for two years surgeon to St. George's Hospital, and for nearly five
years had been engaged in studying the habits and structure of animals
in a menagerie and laboratory which he had established at Brompton.
The inspiration of Hunter's original {92} genius meant much for young
Jenner. He learned not only to respect the teacher but to love the
man. In Hunter's unquenchable desire for knowledge and love of truth
there was something very congenial to the spirit of Jenner, who was
himself, above all things, an inquirer.

After completing his two years of work with Hunter he still remained
intimately associated with him by letter. Though later in life
Jenner's correspondence became very voluminous, these letters from
Hunter were always very carefully preserved in a special cover, and
they serve to show how stimulating to the young man must have been
Hunter's virile enthusiasm for truth as it could be deduced by
observation and experiment.

It was to Hunter that Jenner once wrote that he had heard it said in
Gloucestershire that the dairy workers who suffered from a certain
disease caught from the udders of cows and called cowpox were
protected thereafter from attacks of smallpox. He added that this
tradition interested him very much and that he intended to think about
it. "Don't think," wrote Hunter to him, in return; "make observations,
investigate for yourself the truth of the tradition." Jenner did so,
and the result is now known to all.

These letters from Hunter contained many other interesting
suggestions. For instance, it was under Hunter's direction that Jenner
succeeded in finding out that in hibernating animals the temperature
is very much reduced and the respirations are very slow, while the
rate and force of the pulse are often so much diminished as to be
scarcely more than noticeable at the extremities. Between Hunter and
Jenner it had already been discovered that the sap in trees will not
freeze at temperatures much lower than that at which the same fluid
freezes when withdrawn from the tree, and the same thing seemed to be
true with regard to {93} the blood of hibernating animals. He learned
that notwithstanding the low temperature to which it is reduced the
animals are not affected particularly by the cold, though their store
of fat is consumed and they awake very hungry in the spring-time.

Besides hibernation Jenner also investigated the habits of the cuckoo,
that crux of the biologist which insists on foisting its eggs upon
other birds and allowing its orphan young to be brought up in alien
nests, while the real young of the deceived foster-parents are often
pushed out of their nests by this burly intruder which grows so fast
and strong. It is needless to say, this subject interested John Hunter
very much and there are a number of letters which passed between them
on the subject.

It must not be supposed, however, that young Jenner was entirely
occupied with his scientific work to the exclusion of social life and
recreation. He was one of the best-known men of the county, and was
looked upon as a genial companion from whom might be expected on
almost any occasion pleasant jests and epigrams, not too biting, with
regard to friends and acquaintances. Some of these have been preserved
and we quote several of them as indicative of his special vein of
humor.


  ON THE DEATH OF A MISER.

    "Tom at last has laid by his old niggardly forms,
    And now gives good dinners; to whom pray?--the worms."


  ON LORD BERKELEY'S HUNTSMAN, WHO DIED IN THE CHASE.

    "Determined much higher to hoist up his name,
     Than Nimrod the hunter, in annals of fame,
    'Hark forward!' cried Charles, and gallantly whirled
     His high-mettled steed o'er the gates of the world."


{94}

  DEATH AND MR. PEACH.
  A Short Dialogue. N. B.--Mr. P. died in April.

    "P.--Awhile forbear thy horrid gripe,
      Do pray, dread Sir! remember
    Peaches are never fairly ripe
      'Till August or September."

    "D.--To gratify my longing taste,
       And make thy flavour fine,
     I had thee in a hot-house placed,
       And moistened well with wine."
    "Mr. Peach had shortened his life by the too free use of the bottle."


We have said that Dr. Jenner's supreme accomplishment in science was
the working out of the vaccination problem to a great humane
conclusion. His discovery was no mere accident, nor chance
confirmation of a medical tradition. He devoted himself for many years
to the study of cowpox, as he had the opportunity to see it, and it is
what we know of this investigation, his patience and care in
eliminating all the factors of error, that stamped Jenner as a medical
scientist worthy of honor. When he began practice in Berkeley, he made
many inquiries among his professional brethren, with regard to their
opinion of the protecting power of cowpox, but most of them had either
paid no attention to such reports, or shook their heads at once, and
said they were at most popular traditions, due merely to coincidences
and unsupported by any credible evidence. In the face of this, Jenner
began to follow John Hunter's advice to investigate. The first careful
investigation dates from about 1775, and it took him more than five
years to clear away the difficulties surrounding the solution of the
question, in which he was interested.

As Pasteur found in the next century, when investigating the silkworm
disease, Jenner soon learned that there was {95} more than one disease
called cowpox, and that the confusion consequent upon the existence of
at least two specific diseases and a number of skin affections of the
hands of various kinds, which existed among dairy workers, made the
recognition of the protective power of true cowpox extremely
difficult. After he had differentiated genuine cowpox, however, there
was no difficulty in tracing its apparent protective power. He soon
found, however, that the protection was not afforded unless the cowpox
had been communicated at a particular stage of the disease. In other
words, after the true vaccinia has run its course, secondary
affections of the skin of the cows usually take place, and if dairy
workers became infected from these lesions, then no protection against
smallpox is afforded them. Another important observation that Jenner
made at this time was that the disease known as grease in horses is
the same affection as cowpox, and that both of these diseases are
smallpox as modified by the organism in which they develop. It may be
said at once that this opinion so difficult to arrive at, more than a
century ago, when so little was known of comparative pathology, is
held at the present day, and was confirmed by the last series of
investigations made under the auspices of the Jenner Society, in
England.

One difficulty that confronted Jenner in his researches was the fact
that cowpox was scarce in his part of the country, and he had no
opportunity of making inoculations with the disease in a proper stage,
so as to put his suspicions to an absolute test. He collected much
information, however, and stimulated others to the making of
observations, so that when his discovery was announced the mind of the
medical profession was more ready to receive it. In 1788 he carried a
carefully made drawing of a case of cowpox as it occurred on the hands
of a Gloucester milkmaid to London, and {96} showed it to a number of
medical men, whose opinions he wished to obtain. Among these was Sir
Edward Holme, who agreed that there was a distinct similarity between
it and certain stages of smallpox and considered that the question of
a connection between the two diseases was an interesting and curious
subject. He did not share any of Jenner's views, however, with regard
to the practical importance of his discovery in this matter, and gave
little encouragement to the idea that a possible prophylactic for
smallpox might be discovered.

Something of Jenner's enthusiasm for experiment may be gathered from
the fact that he did not hesitate even to inject various materials
related to cowpox into the arm of his own children. We know Mrs.
Jenner to have been a very wonderful woman, quite as deeply interested
as the doctor himself in securing the great benefit to humanity that
would result from the demonstration that cowpox protected against
smallpox, but it is a little bit difficult for us in these days to
understand how her mother-heart could have permitted some of the
experiments which Dr. Jenner's biographer, Dr. Baron, describes.
[Footnote 1]

  [Footnote  1: The life of Edward Jenner, M.D., F.R.S., Physician
  Extraordinary to His Majesty Geo. IV, Foreign Associate of the
  National Institute of France, &c. &c. &c. With illustrations of his
  doctrines, and selections from his Correspondence by John Baron,
  M.D., F.R.S., Late Senior Physician to the General Infirmary,
  Consulting Physician to the Lunatic Asylum at Gloucester, and Fellow
  of the Royal Medical and Chirurgical Society of London. In two
  Volumes. London: Henry Colburn, 1838.]


The subject is indeed so surprising that I prefer to quote
the passage with regard to these experiments directly from
Dr. Baron:

  "In November, 1789, he inoculated his eldest son Edward, who was
  then about one year and a half old, with swine-pox matter. The
  progress of the disease seemed similar to that which arises from the
  insertion of true smallpox matter when {97} the disease is very
  slight. He sickened on the eighth day: a few pustules appeared; they
  were late and slow in their progress, and small. Variolous matter
  (this would mean material from a smallpox patient calculated to give
  that disease) was carefully inserted into his arms at five or six
  different periods, subsequently without the slightest inflammation
  being excited in the part.

  "On Thursday, April 7th, 1791, variolous matter was again inserted
  by two small incisions through the cutis, [beneath the skin]. Then
  the following notes of observed conditions day after day are made:
  9th, Evidently inflamed. 10th, An efflorescence of the size of a
  shilling spread round the inferior wound. 11th, The incision assumed
  a kind of erysipelatous elevation: the efflorescence much increased.
  12th, These appearances much advanced. 13th, A vesicle, containing a
  brownish fluid, and transparent, about the size of a large split-pea
  on the superior incision, the inferior about twice as big; the
  surrounding parts affected with erysipelas. The erysipelas extended
  to the shoulder, and then pretty quickly went off. The child showed
  no signs of indisposition the whole time."

  "March, 1792. E. Jenner was again inoculated: the matter was taken
  from a child that caught the disease in the natural way, and had it
  pretty full. It was inserted fresh from the pustule. The same
  evening an inflammation appeared round the incision, which, at the
  end of twenty hours, increased to the diameter of a sixpence, and
  some fluid had already been collected on the lips of the scratch,
  which the child had rubbed off."

It was not for five years after this time, however, that Jenner was
able to make his crucial experiments in the matter. On the 14th of
May, 1796 (the date is still recalled as Vaccination Day in Germany,
especially in Berlin), vaccine {98} matter was taken from the hand of
a dairy maid, Sarah Nelmes, and inserted by two superficial incisions
in the arms of James Phipps, a healthy boy of about eight years of
age. The boy went through an attack of cowpox in a regularly
satisfactory manner. After this, however, it was necessary to
determine whether he was protected from smallpox. After waiting two
months Jenner inoculated him with variolous material. The result of
this experiment can best be learned from the following letter written
to his friend Gardner:

  "Dear Gardner:

  "As I promised to let you know how I proceeded in my inquiry into
  the nature of that singular disease the Cow Pox, and being fully
  satisfied how much you feel interested in its success, you will be
  gratified in hearing that I have at length accomplished what I have
  been so long waiting for, the passing of the Vaccine Virus from one
  human being to another by the ordinary mode of inoculation.

  "A boy of the name of Phipps was inoculated in the arm from a
  pustule on the hand of a young woman who was infected by her
  master's cows. Having never seen the disease but in its casual way
  before; that is, when communicated from the cow to the hand of the
  milker, I was astonished at the close resemblance of the pustules,
  in some of their stages, to the variolous pustules. But now listen
  to the most delightful part of my story. The boy has since been
  inoculated for the smallpox which, as I ventured to predict,
  produced no effect. I shall now pursue my experiments with redoubled
  ardour.

  "Believe me yours, very sincerely,
                      "Edward Jenner.
  "Berkeley, July 19, 1796."


{99}

Notwithstanding the complete success of this experiment, Jenner did
not rush into print with it. Two years later, at the end of June,
1798, his "Inquiry into the Causes and Effects of the Variolae
Vaccinae" was published. In the mean time Jenner had succeeded in
demonstrating the protective quality against smallpox of vaccination,
contracted either casually or by direct inoculation, in some
twenty-three cases. Sixteen of these had occurred accidentally in the
course of occupations connected with cows and horses; the rest were
done under Jenner's directions. Among the persons inoculated was
Jenner's own little second son, Robert Fitts Harding Jenner, an infant
eleven months old. Jenner demonstrated conclusively that the cowpox
protects the human constitution from the infection of smallpox.

After Dr. Jenner had made his tests he prepared a pamphlet for
publication. Before publishing, however, he thought it better to make
a visit to London, so that he might have the opportunity to introduce
the subject personally to friends, and demonstrate the truth of his
assertion to them. He remained in London for nearly three months
without being able to find any one who would submit to vaccination.
The medical profession generally took very little interest in the
subject and seemed to consider him sadly visionary. Under the
circumstances it is not surprising that Jenner went back to
Gloucestershire, and his country practice, rather disappointed. It
happened, however, that soon after his return home, a distinguished
London surgeon named Cline resolved to make a trial of the vaccine
material which Jenner had left with his friends. The surgeon's purpose
in using it, however, was not altogether to test its efficacy as a
prophylactic against smallpox, but with the notion that the
counterirritation thus obtained might be useful in a case which he had
under treatment. Those {100} were the days when the seton and the
issue were still in common use, and counterirritation was considered
one of the most important remedial measures at the command of the
surgeon.

The patient was a child suffering from a form of chronic hip-joint
disease that at this distance of time, and with rather incomplete
descriptions, seems to have been the ordinary tuberculosis of the hip.
The vaccine material was inoculated over the joint and, surprising
though it may appear now, the vaccine vesicle ran rather a normal
course and healed kindly. The little patient was afterward inoculated
with smallpox and found to be incapable of acquiring that disease.
This case attracted considerable attention. It is not, however, a
matter for congratulation as regards the openness of mind of the
medical men of the period to find that this was the only sort of a
case that was considered suitable for such an experiment. It is very
easy to understand that in a child in a run-down condition the vaccine
material might very well have provoked a rather serious local
reaction. In a way, the fate of vaccination hung in the balance and
good luck was in its favor. Mr. Cline, however, after this, became a
strong advocate of vaccination, and brought it very decidedly before
the London physicians. There was still a feeling of opposition, as
indeed there always is against any novelty in medicine, but this
gradually disappeared, to give place to a suspension of judgment,
until more accurate and detailed information could be obtained from
further observations and tests.

It was not long before the opposition to the practice of vaccination
took definite form. One of the best-known London physicians of the
time, Dr. Ingenhouz, became the leader of a strong faction of the
medical profession of London, who not only would have nothing to do
with vaccination, {101} but proclaimed openly that it was a dangerous
innovation, absolutely unjustifiable, and communicated a disease
without protecting against any other. On the other hand, there were
overzealous advocates of vaccination, who insisted on its value but
did not know how to recognize the true cowpox from other lesions
sometimes confounded with it, nor the exact stage of the disease in
which the vaccine material obtained would prove effectively
protective. A number of these used vaccine material so contaminated by
secondary infections of one kind or another that no wonder serious
sores were reported as a result.

Physicians who have for many years known how difficult it is to bring
certain people to a recognition of the benefits that have been
conferred on modern civilization by vaccination, will appreciate how
many difficulties and prejudices and misunderstandings Jenner himself
must have encountered during the original introduction of vaccination.
Some of the supposed objections to vaccination wear a very modern air,
and come from physicians whose only purpose apparently is to bring out
the truth, and yet who are evidently led to the drawing of conclusions
much wider than their premises by the fact that they know they will
have an attentive audience among the anti-vaccinationists at least.

A fair example of one of these old-time objections against vaccination
may be found in the following passage from a letter by Dr. Jenner
written to Mr. Moore. Corresponding objections have been made in much
more modern times, and the passage will arouse the sympathetic
amusement of present-day physicians:

  "You probably may not have seen a pamphlet lately published by Dr.
  Watt of Glasgow, as there is nothing in its title that develops its
  purport or evil tendency: 'An Inquiry into the Relative Mortality of
  the Principal Diseases of {102} Children,' &c. The measles, it
  seems, have been extremely fatal in the city of Glasgow for the last
  four or five years among children, and during this period
  vaccination was practised almost universally. Previously to this,
  the measles was considered as a mild disease. Hence Dr. Watt infers
  that the smallpox is a kind of preparative for the measles,
  rendering the disease more mild. In short, he says, or seems to say,
  that we have gained nothing by the introduction of the cow-pox; for
  that the measles and small-pox have now changed places with regard
  to their fatal tendency. Is not this very shocking? Here is a new
  and unexpected twig shot forth for the sinking anti-vaccinist to
  cling to. But mark me--should this absurdity of Mr. Watt take
  possession of the minds of the people, I am already prepared with
  the means of destroying its effects, having instituted an inquiry
  through this populous town and the circumjacent villages, where, on
  the smallest computation, 20,000 children must have been vaccinated
  in the course of the last twelve years by myself and others. Now it
  appears that, during this period, there has been no such occurrence
  as a fatal epidemic of measles. You would greatly oblige me in
  making this communication to the Board, with my respectful
  compliments."

Fortunately only a few colleagues were so illogical, and an excellent
idea of how much Jenner's discovery was appreciated by his
contemporaries may be obtained from the number of honors, diplomas,
addresses and communications from public bodies and distinguished
individuals which he received. A chronological list of these may be
found at the end of Dr. Baron's Life of Jenner. Among them may be
noted the diploma of LL.D. from the Senate of Harvard University,
Cambridge, Mass., under the presidency of Dr. Willard; also the
Diploma of Doctor in Medicine, honoris {103} causa, which Jenner
especially appreciated, as he says in one of his letters, because he
understood that the University conferred this degree in this way only
once or twice in a century. There is a diploma as Fellow of the
American Society of Arts and Sciences in Massachusetts, as well as a
Diploma as a member of the American Philosophical Society at
Philadelphia. The diploma from Boston bears the signature of John
Adams as president, that from Philadelphia the signature of Thomas
Jefferson. Most of the prominent medical and scientific societies of
Europe had elected him a member or had sent him some special token of
recognition.

One of these documents, expressive of the gratitude of the senders for
the great benefit his work had conferred upon the human race, which
Jenner valued the highest, was an address from the Five Indian Nations
which, with a Wampum Belt, was delivered to him on November 8, 1807.
In reply to this Dr. Jenner wrote to the American agent through whom
the insignia had been forwarded:

  "Sir:

  "Your kindness in delivering to the Five Nations of Indians my
  Treatise on vaccination, and in transmitting to me their reply,
  demands my warmest thanks.

  "I beg you to make known to the Five Nations the sincere
  gratification which I feel at finding that the practice of
  vaccination has been so universally received among their tribes, and
  proved so beneficial to them; at the same time, be pleased to assure
  them of the great thankfulness with which I received the belt and
  string of Wampum, with which they condescended to honour me, and of
  the high estimation in which I shall for ever hold it. May the
  active benevolence which their chiefs have displayed in preserving
  the lives of {104} their people be crowned with the success it
  deserves; and may that destructive pestilence, the smallpox, be no
  more known among them.

  "You also, Sir, are entitled to the most grateful acknowledgments,
  not only from me, but from every friend of humanity, for the
  philanthropic manner in which you originally introduced the vaccine
  among these tribes of Indians.

  "I have the honor to remain, &c,
                        "E. Jenner."

The general trend of American appreciation for Dr. Jenner's work, at
least among the intelligent classes, may be gathered from the
following letter sent to Dr. Jenner by Thomas Jefferson while he was
president, May 14, 1806:

  "Monticello, Virginia, May 14, 1806.

  "Sir:

  "I have received the copy of the evidence at large respecting the
  discovery of the vaccine inoculation, which you have been pleased to
  send me, and for which I return you my thanks. Having been among the
  early converts in this part of the globe to its efficacy, I took an
  early part in recommending it to my countrymen. I avail myself of
  this occasion to render you my portion of the tribute of gratitude
  due to you from the whole human family. Medicine has never before
  produced any single improvement of such utility. Harvey's discovery
  of the circulation of the blood was a beautiful addition to our
  knowledge of the human economy; but on a review of the practice of
  medicine before and since that epoch, I do not see any great
  amelioration which has been derived from that discovery. You have
  erased from the calender of human afflictions one of its greatest.
  Yours is the comfortable reflection that mankind can never forget
  that you have lived; future nations will know by history only that
  the {105} loathsome small-pox has existed, and by you has been
  extirpated. Accept the most fervent wishes for your health and
  happiness, and assurances of the greatest respect and consideration.


  "Th. Jefferson."

Almost more interesting than the story of Jenner, the experimental
scientist, the true harbinger of modern experimental medicine, the
founder of experimental pathology, and the discoverer of the pregnant
idea which was to mean so much for nineteenth century medicine in the
hands of Pasteur and his successors, is the story of Jenner the man,
the husband, the friend, and the physician of the poor. In spite of
his intense preoccupation in his experimental work and the amount of
time it must have required to make his observations, he found
opportunities to care for the poor and to interest himself in all
their concerns as well as their health. He made many firm friends
among people of his own social status and generally was considered a
most amiable, as well as a liberal, and humanitarian man. He was
deeply religious, and, as we shall allow his earliest biographer Dr.
Baron to tell, was not ashamed to exhibit his religious feelings by
word and deed when the proper occasion presented itself. This part of
his life deserves to be studied as carefully and remembered as
faithfully as that in which he made his discoveries, since it is the
complement that shows the character of the man in its entirety.

Jenner's personal character may be very well understood from a
paragraph of his biographer, who had been his bosom friend for many
years. He says:

  "But Dr. Jenner was not only humble in all that concerned this, the
  greatest incident of his life (the successful discovery of
  vaccination); he continued so after success had crowned {106} his
  labors, and after applause greater than most men can bear had been
  bestowed upon him. This most estimable quality was visible at all
  times; but it was particularly conspicuous when he was living in
  familiar intercourse with the inhabitants of his native village. If
  the reader could in imagination accompany me with him to the
  dwellings of the poor, and see him kindly and heartily inquiring
  into their wants, and entering into all the little details of their
  domestic economy; or if he could have witnessed him listening with
  perfect patience and good humor to the history of their maladies, he
  would have seen an engaging instance of untiring benevolence. He
  never was unwilling to receive any one, however unseasonable the
  time may have been. Such were his habits, even to the latest period
  of his life. I scarcely know any part of his character that was more
  worthy of imitation and unqualified respect than that to which I have
  alluded. I have never seen any person in any station of life in whom
  it was equally manifest; and when it is remembered that he was well
  'stricken in years;' that he had been a most indefatigable and
  successful laborer in the cause of humanity; and that he might have
  sought for a season of repose, and the uncontrolled disposal of his
  own time, the sacrifices which he made are the more to be valued. In
  the active and unostentatious exercise of kindness and charity he
  spent his days; and he seemed ever to feel that he was one of those
  'qui se natos ad homines juvandos, tutandos, conservandos
  arbitrantur,' who consider themselves born to help, protect, and
  cherish their fellow men.

  "His kindness and condescension to the poor was equalled by his most
  considerate respect and regard to the feelings and character of the
  humblest of his professional brethren. I have often been struck with
  the total absence of everything that could bear the semblance of
  loftiness of demeanor. {107} Few men were more entitled to deliver
  their sentiments in a confident or authoritative tone; but his whole
  deportment was opposed to everything of that description, and he did
  not hesitate to seek knowledge from persons in all respects his
  inferiors. All his younger brethren who have ever had the happiness
  to meet him in practice, must have been deeply impressed with this
  part of his character."

Many a member of the medical profession who is not a genius will find
an excuse for allowing disorder about his rooms from the example which
is said to have been set by Jenner. He was interested in nearly every
branch of science and specimens from many departments were constantly
around him. He himself, it is said, had the key to the apparent
confusion. Most of the others who allow themselves to drift into
careless habits in the same direction insist that they too have the
key. Some of their friends, however, are inclined to doubt it. It is
curiously interesting under these circumstances to have Jenner's
biographer tell of the confused state of affairs that existed in his
room and yet his defence of it. Perhaps in this matter it is well to
remember what Augustin Birrell says at the end of his essay on
Carlisle:

  "Don't let us quarrel with genius; we have none of it ourselves and
  the worst of it is we cannot get along without it."

  "The objects of his studies generally lay scattered around him; and,
  as he used often to say himself, seemingly in chaotic confusion.
  Fossils, and other specimens of natural history, anatomical
  preparations, books, papers, letters--all presented themselves in
  strange disorder; but every article bore the impress of the genius
  that presided there. The fossils were marked by small pieces of
  paper pasted on them, having their names and the places where they
  were found inscribed in his own plain and distinct handwriting.
  {108} His materials for thought and conversation were thus
  constantly before him; and a visitor, on entering his apartment,
  would find in abundance traces of all his private occupations. He
  seemed to have no secrets of any kind; and, notwithstanding a long
  experience with the world, he acted to the last as if all mankind
  were as trustworthy and free from selfishness as himself. He had a
  working head, being never idle, and accumulated a great store of
  original observations. These treasures he imparted most generously
  and liberally. Indeed his chief pleasure seemed to be in pouring out
  the ample riches of his mind to everyone who enjoyed his
  acquaintance. He had often reason to lament this undoubted
  confidence; but such ungrateful returns neither chilled his ardor
  nor ruffled his temper."

It is interesting to note what was Jenner's opinion with regard to two
subjects that are very much discussed at the present time. These are
the questions of religious training in education, and the advisability
of making nature study a part of the course for children. Jenner
considered that no education could possibly be complete which did not
include both of these subjects. Religious training he deemed
absolutely indispensable. Nature study he advised for somewhat
different reasons from those for which it is now urged. He thought
there was a depth of interest in the study of the objects of nature
that could scarcely fail to lessen the burden of education for the
child, but the main reason for its study to his mind was that children
intent on the wonders of nature could scarcely help but realize the
power of the Creator and, learning to admire Him more and more, be
thus drawn to respect His laws, to acknowledge His supremacy and to
devote themselves to bringing about the fulfilment of His will in this
world to the fullest extent in their power.

{109}

Jenner's religious opinions and beliefs must be left to the expression
of the biographer already mentioned, who gives them very fully. He
says:

  "One of the most remarkable features in Jenner's character, when
  treating of questions of a moral or scientific nature, was a devout
  expression of his consciousness of the omnipresence of the Deity. He
  believed that this great truth was too much overlooked in our
  systems of education; that it ought to be constantly impressed upon
  the youthful heart, and that the obligations which it implied, as
  well as the inward truth and purity which it required, should be
  rendered more familiar to all. Mrs. Jenner was constantly occupied
  in teaching these lessons to the poor around her, in schools which
  she established for the purpose of affording a scriptural education.
  He, building upon this foundation, wished to add instruction of a
  more practical description, deduced from their daily experience, and
  illustrated by a reference to those works of wisdom and beauty which
  the universe supplies. He always contended that some aid of of this
  kind was necessary to impress completely upon the character of the
  lower ranks those maxims which they derived from their teachers. He
  had other views, too, in recommending such a plan; he thought that
  the lot of the poor might be ameliorated, and many sources of
  amusement and information laid open to them which they are at
  present deprived of; that the flowers of the field and the wonders
  of the animal creation might supply them with subjects of useful
  knowledge and pious meditation."

His wife, as is often, though unfortunately not always, the case,
seems to have had that precious uplifting influence over him which
served continually as an incentive to higher things and kept him from
the sterile materialism which an exclusive absorption in scientific
studies, with lack of the {110} exercise of faith and of association
with human suffering, seems to bring to many men. Dr. Baron says on
this point:

  "I remember, when discussing with him certain questions touching the
  conditions of man in this life, and dwelling upon his hopes, his
  fears, his pains, and his joys, and coming to the conclusions which
  merely human reason discloses to us; and when dwelling on the
  deformity of the heart, our blindness, our ignorance, the evils
  connected with our physical structures, our crimes, our calamities,
  and our unfathomable capacity both for suffering and for
  enjoyment; he observed, Mrs. Jenner can explain all these things:
  they cause no difficulties to her."

Toward the end of his life Jenner's feelings with regard to the
importance of a confident other worldliness as the only fitting
explanation for the mysteries of this, became emphasized. To quote his
biographer once more:

  "As he approached nearer to his own end, his conversations with
  myself were generally more or less tinged with such views as occur
  to the serious mind when contemplating the handiwork of the Creator.
  In all the confusion and disorder which appears in the physical
  world, and in all the anomalies and errors which deface the moral,
  he saw convincing demonstration that He who formed all things out of
  nothing still wields and guides the machinery of his mighty creation."


Jenner's feelings with regard to the relative importance of medical
and religious ministrations may be very well appreciated from an
expression of his on the occasion when he was being presented to a
distinguished nobleman by the famous missionary, Roland Hill. The
Reverend Mr. Hill said: "Allow me to present your Lordship my friend,
Dr. Jenner, who has been the means of saving more lives than any other
man." "Ah," responded Jenner, "were I like {111} you I could save
souls." In his sketch of Jenner's life in "The Disciples of
AEsculapius," Sir Benjamin Ward Richardson considers that this
incident shows a lack of appreciation of the dignity of the medical
profession and a humility rather difficult to understand. Anyone who
will place himself in Jenner's position of fervent belief that the one
thing necessary is the salvation of souls will not fail to recognize,
however, his sincerity or fail to appreciate its true significance.

After all, Jenner was so deeply impressed with the importance of other
worldly things and the comparative insignificance of this that he
found it even a little difficult to understand why men should not see
the direct action of the Creator and all His providence in even some
of the minutest details of life. Once he said, "I do not marvel that
men are grateful to me, but I am surprised that they do not feel
grateful to God for making me a medium of good."

Few men who have accomplished so much have felt so little vainglory
over it as Jenner. There was not a jot or tittle of what is so rightly
called conceit in him. He well deserves a place beside such beautiful
characters as Morgagni, Auenbrugger, Laennec and Pasteur, whose work
was done for others, not for themselves, and after all the most
striking definition of a saint is one who thinks first of others and
only second of himself.


{112}

{113}

GALVANI, FOUNDER OF ANIMAL ELECTRICITY


{114}

  The world that I regard is myself; it is the Microcosm of my own
  frame that I cast mine eye on; for the other, I use it but like my
  Globe, and turn it round sometimes for my recreation. Men that look
  upon my outside, perusing only my condition and Fortunes, do err in
  my Altitude; for I am above Atlas his shoulders. The earth is a
  point not only in respect of the Heaven above us, but of that
  heavenly and celestial part within us; that mass of Flesh that
  circumscribes me, limits not my mind; that surface that tells the
  Heavens it hath an end, cannot persuade me I have any: I take my
  circle to be above three hundred and sixty; though the number of the
  Arc do measure my body, it comprehendeth not my mind; whilst I study
  to find how I am a Microcosm, or little World, I find myself
  something more than the great one. There is surely a piece of
  Divinity in us, something that was before the Elements, and owes no
  homage unto the Sun.
    --Sir Thos. Browne, M.D.


{115}

GALVANI, FOUNDER OF ANIMAL ELECTRICITY.

It is often thought and only too often stated that the impetus to the
rise of our modern science which came during the last half of the
eighteenth century was due to the spirit of the French Revolution,
making itself felt long before the actual declaration of the rights of
man, by the French Encyclopedists. It is the custom to conclude that
the spirit of liberty which was abroad infected the minds of the
rising generation to such an extent that they cast off the fetters of
old traditional modes of thinking, refused to accept supposed truths
on the strength of tradition or on authority as before, tested
knowledge for themselves, and as a consequence made true progress in
the sciences. Something doubtless there is in this, and yet a careful
investigation of the lives of the men to whom especially the
beginnings of the biological sciences are due, will show that not only
were they men with the deepest respect for authority, the greatest
reverence for old modes of thinking, but also they were typical
representatives of the developing influence of methods of education
which are sometimes unfortunately deemed to be narrowing in the
extreme.

We have already studied the life of Morgagni, the great Father of
Modern Pathology, to find that he least of all, in his generation, was
affected by any of the liberalizing tendencies that are supposed to
have led up to the freedom of the human mind and the consequent
successful broadening of human science. We shall see that there were
many others who did their work at the end of the eighteenth century of
whom this same thing can be said, and no more {116} striking examples
of this can be found than the lives of two great Italians, Volta and
Galvani, to whom the modern world has paid the tribute of
acknowledging them as founders in electricity by taking their names to
express important basic distinctions in the science.

It was not in Italy alone, however, that this adhesion of great
scientific minds to the old orthodox teachings of Christianity
constituted a notable characteristic of the history of eighteenth
century science. Everywhere the same thing was true. Cavendish, Sir
Humphrey Davy and Faraday, the great English scientists, to whom so
much of progress in electricity and in physics is due, were very
similar in this respect to their Italian colleagues. Oersted the Dane
belongs in the same category. In France such distinguished names as
Lamarck, the great founder of modern biology and the first to broach
the theory of evolution; Haüy, the father of crystallography; Laplace,
and many others might be mentioned. The lives of the men who were
contemporary workers in medicine as sketched in the present volume
will show this same thing to be true also in their cases.

A glance at the life of Aloysius Galvani will illustrate how little
the spirit of the revolution had to do with the rise of electricity
and the first discussions of its relations to life. He was born at
Bologna, September 9, 1737. A number of his immediate relatives had
been distinguished as clergymen. The early years of Galvani's life
were spent in association with religious, and as a youth he wished to
become a member of a religious order whose special function it was to
assist the dying at their last hour. His father, however, was opposed
to his entrance into religion, and so Galvani devoted himself to
medicine at the University of Bologna, and at length became a
professor of anatomy in his Alma Mater. Professor Galeazzi, who was at
the time {117} one of the most distinguished professors in anatomy in
Italy, was very much attracted to young Galvani and became his friend
and patron in his student days. Galvani became a member of Galeazzi's
household, and finally having fallen in love with one of his
daughters, won her father's consent to their early marriage. The
happiness in life that he thus prepared for himself became one of the
often quoted exemplars of domestic felicity in Bologna, where
Galvani's life was passed.

Medici, in his panegyric of Galvani, which we shall have occasion to
quote from more than once, gives a very pretty story of the doctor's
wooing and marriage with Lucia Galeazzi, which we prefer to repeat in
the naive simplicity with which it is related by the Italian
panegyrist.

Galvani had been seriously thinking of matrimony for some time and
had, it seems (strange as that might be considered in a rising young
scientist in our day), even prayed for counsel in the matter. One of
his favorite saints was St. Francis of Sales, the Archbishop of
Geneva, the gentleman saint as he has been called, for whose charming
personal character Galvani had a very devout admiration. One day while
praying in one of the churches of Bologna before a statue of St.
Francis of Sales he looked up after some moments of abstraction to
find a young woman's face between him and the altar. The face proved
to be that of Lucia. Galvani looked upon it as a sign from heaven of
approval of some of his wishes, and applied for the hand of the fair
Lucia. Anyone who has seen the offerings at the shrine of St. Anthony
of Padua, not so far from Bologna, and has realized that the good
patron of things lost seems also to be a special subject of recourse
in cases of lost hearts among the northern Italians even at the
present day, will realize that probably the story as told is the
simple truth without any tincture of romance.

{118}

Galvani began original work of a high order very early in his medical
career. His graduation thesis with regard to bones, treating specially
their formation and development, attracted no little attention and is
especially noteworthy because of the breadth of view in it, for it
touches on the various questions relative to bones from the standpoint
of physics and chemistry as well as medicine and surgery. It was
sufficient to obtain for its author the place of lecturer in anatomy
in the University of Bologna, besides the post of director of the
teaching of anatomy in the Institute of Sciences, a subsidiary
institution. From the very beginning his course was popular. Galvani
was an easy, interesting talker, and he was one of the first who
introduced experimental demonstrations into his lectures.

At this time the science of comparative anatomy was just beginning to
attract widespread attention. John Hunter in London was doing a great
work in this line which has placed him in the front rank of
contributors to biology and collectors of important facts in all the
sciences allied to anatomy and physiology. Galvani took up this work
with enthusiasm and began the study particularly of birds. These
animals, the farthest removed from man of the beings that have warm
blood, present by that very fact many interesting contrasts and
analogies, which furnish important suggestions for the explanation of
difficult problems in human anatomy and physiology.

His experimental work in comparative anatomy, strange as it might
appear and apparently not to be expected, led him into the domain of
electricity through the observation of certain phenomena of animal
electricity and the effect of electrical current on animals.

Like so many other great discoveries in science, his first and most
important observations in electrical phenomena {119} were results of
an accident. Of course, it is easy to talk of accidents in these
cases. The fall of the apple for Newton, Laennec's observation of the
little boys tapping on a log in the courtyard of the Louvre, from
which he got his idea for the invention of the stethoscope, were
apparently merest accidents. Without the inventive scientific genius
ready to take advantage of them, however, these accidents would not
have been raised to the higher planes of important incidents in
history. They would have meant nothing. The phenomena had probably
occurred under men's eyes hundreds of times before, but there was no
great mind ready to receive the seeds of thought it suggested and go
on to follow out the conclusions so obviously indicated. Galvani's
observation of the twitching of the muscles of the frog under the
influence of electricity may be called one of the happy accidents of
scientific development, but it was Galvani's own genius that made the
accident happy.

There are two stories told as to the method of the first observation
in this matter. Both of them make his wife an important factor in the
discovery. According to the more popular form of the history, Galvani
was engaged in preparing some frog's legs as a special dainty for his
wife, who was ill and who liked this delicacy very much. He thought so
much of her that he was doing this himself in the hope that she would
be thus more readily tempted to eat them. While so engaged he exposed
the large nerve of the animals' hind legs and at the same time split
the skin covering the muscles. In doing this he touched the
nerve-muscle preparation, as this has come to be called, with the
scalpel and little forceps simultaneously, with the result that
twitchings occurred. While seeking for the cause of these twitchings
the idea of animal electricity came to him.

The other form of the story of his original discovery is not {120}
less interesting and is perhaps a little more authentic. One evening
he was engaged in his laboratory in making some experiments while some
friends and his wife were present. By chance some frogs, the hind legs
of which had been stripped of skin, were placed upon the table not far
from an apparatus for the generation of frictional electricity. They
were not in contact with this apparatus at any point, however, though
they were not far distant from the conductor. While the apparatus was
being used to produce a series of sparks, a laboratory assistant,
without thinking of any possible results, touched with the point of a
scalpel the sciatic nerves of one of the animals. Just as soon as he
did this all the muscles of this limb went into convulsive movement.
It was Galvani's wife who noticed what had happened and who had the
assistant use the scalpel once more with the same result.

She was herself a woman of well-developed intellect, and her
association with her father and husband made her well acquainted with
the anatomy and physiology of the day. She realized that what had
occurred was quite out of the ordinary. Accordingly, she called the
attention of her husband to the phenomena, and is even said to have
suggested their possible connection with the presence and action of
the electric apparatus. Husband and wife then together, by means of a
series of observations, determined that whenever the apparatus was not
in use the phenomenon of the conclusive movements of the frog's legs
did not take place, notwithstanding irritation by the scalpel.
Whenever the electric apparatus was working, however, then the
phenomenon in question always took place. According to either form of
the story it is clear that Madame Galvani had an important part in the
discovery, and Galvani himself, far from making little of what she had
accomplished, was always {121} glad to attribute his discovery, or at
least the suggestive hint that led up to it, to his wife.

After these first discoveries on the influence of artificial
electricity, nothing seemed more interesting than to investigate
whether ordinary atmospheric electricity as manifested in lightning
would produce the same effects on muscular movements. In this matter
Galvani showed much courage as an inventive genius. He dared to place
an atmospheric conductor on the highest point of his house and to this
conductor he attached a wire, which ran down to his laboratory. During
a storm he suspended on this metallic circuit by means of their
sciatic nerves frogs' legs and the legs of other animals prepared for
the purpose. To the feet of the animals he attached another wire
sufficiently long to reach down to the bottom of a well, thus
completing a current to the ground.

All the phenomena took place exactly as if with artificial
electricity. Whenever lightning flashed from the clouds the limbs of
the animals experimented with underwent violent contractions, which
were noticeable before the noise of the thunder, and were, so to say,
the signal for it. These contractions took place, although there were
no conductors from the muscles, and although the nerve conductors were
not isolated. The muscular contractions were greater in proportion
than the intensity of the lightning and the proximity of the storm.
The phenomena were manifest whether the animal was in the open air or
if, for greater convenience, it was enclosed in a room, or even in a
vessel. The muscular contractions could even be noticed despite the
fact that the nerves were separated somewhat from their conductor,
especially whenever the lightning was violent. The sparks would leap
over a small gap almost as in the case of artificial electricity, the
muscular contraction of the animal {122} being proportioned to the
energy and the nearness of the sparks.

It is almost needless to say, these experiments upon the frog were not
accomplished in a few days or a few weeks. Galvani had his duties as
Professor of Anatomy to attend to, besides the obligations imposed
upon him as a busy practitioner of medicine and surgery. At that time
it was not nearly so much the custom as it is at present, to use frogs
for experiments, with the idea that conclusions might be obtained of
value for the biological sciences generally, and especially for
medicine. There has always been an undercurrent of feeling that such
experiments are more or less a beating of the air. Galvani found
opposition not only to his views with regard to animal electricity as
enunciated after experimental demonstration, but also met with no
little ridicule because of the supposed waste of time at occupations
that could not be expected to lead to any practical results. It was
the custom among scientific men to laugh somewhat scornfully at his
patient persistence in studying out every detail of electrical action
on the frog, and one of the supposedly prominent scientists of the
time even dubbed him the frog dancing master. This did not, however,
deter Galvani from his work, though some of the bitter things must
have proved cutting enough, and might have discouraged a smaller man,
less confident of the scientific value of the work that he was doing.

There were even phases of physical science quite apart from physiology
or animal electricity, which he was able to illustrate by his
experiments. He called special attention, for instance, to the fact
that the lightning does not excite a single contraction of the muscle
as is the case with a spark of artificial electricity, but that there
are a series of muscular contractions succeeding one another rapidly
in diminishing {123} energy and somewhat corresponding to the
reiterated reports of thunder. This was Galvani's expression for the
dying away of the electrical influence upon the muscle. He had thus
evidently reached a hint of the pendulum-like swing with which
electrical equilibrium is restored after its violent disturbance
immediately following the lightning stroke. He noted, moreover, that
for the production of muscular contractions the absolute appearance of
lightning was not indispensable. Muscular twitchings were noted
whenever the heavens were overclouded by a storm, or whenever clouds
charged with electricity were passed above the conductor.

These experiments were made upon living frogs, as well as upon the
separated legs, and in both cases the results obtained were very
similar to those observed on the employment of some form of artificial
electricity. In some of these observations, Galvani was anticipating
ideas that became current truth in electrical science only many years
after his time. In his observations upon the effects of lightning, he
was forestalling Franklin's works to a certain extent. Both of these
great scientists, however, had been anticipated by a clergyman in
Austria; whose work attracted very little attention, however, because
he was not in touch with the scientific bodies of the day. The
demonstration of the identity of ordinary terrestrial artificial
electricity and the lightning was in the air, as it were, and many
workers, as is usually the case with any great discovery, came very
close to it, and deserve at least a portion of the credit for it.

It is almost needless to say, many of these experiments with lightning
thus conducted by Galvani were not without an element of serious
personal danger. Not long after this time a Russian savant, Richman by
name, while repeating Franklin's experiments with the kite, was struck
dead by the charge received from his apparatus. Galvani, however,
{124} devoted himself only in passing to the physical problems
involved, and kept always in view the physiological aspects of the
problem of animal electricity; and, accordingly, made a series of most
interesting observations on the ray fish or torpedo, as it is
sometimes called, the fish which gives electrical shocks. His idea was
to demonstrate that the shocks felt when this animal is touched are
really due to sparks of electricity similar to those which can be
obtained by artificial means. This had never been determined, and
Galvani succeeded in showing the presence of sparks exactly as if the
animal were one of the apparatuses by which the sparks of frictional
electricity are developed. At this time this seemed surprising enough.
Galvani also endeavored to demonstrate that the electricity in the
electric torpedo differed only in degree, but not in quality, from
certain electric manifestations that he had noted in the bodies of
other animals, especially the frog. His idea always was to show the
existence of a natural animal electricity, by means of which some of
the complex mechanism of life was accomplished. He seems to have had
some notion of the theory that has been suggested often enough since,
and is not yet entirely disproved, that there is some very close
relationship between nerve impulses and the electric current. In this,
of course, he was far ahead of his time, and utterly unable to make
absolute demonstration, because of the lack of proper apparatus.

The most interesting quality of Galvani's scientific career is the
thoroughly experimental character of all his researches into natural
phenomena. Few men have known so well how to vary their experiments so
as to bring out new details of scientific knowledge. His experimental
skill was of the highest order, and it is to this that we owe the
development in his hands of the nascent science of electricity to a
point {125} where it became easy to continue its natural evolution.
Galvani's work furnished the necessary stimulus to Volta, and then the
real foundation of modern electricity was laid.

Almost more interesting than Galvani the scientist, however, is
Galvani the man. As one of his biographers said of him, he joined to
the most eminent intellectual genius a group of very precious
qualities of the heart. Utterly unselfish in his relationship to
others, he was known to be extremely sympathetic and had a large
number of friends. His friends, too, he bound to him by even more than
the proverbial hoops of steel, so that when they passed out of life
they left him unconsolable. While it was very hard to get him to take
part in social functions at which numbers of people were gathered, he
was by no means a recluse, and liked to be in the company of a few
friends. He seemed to care very little for the renown that his
discoveries gave him, and refused, as far as possible, to be made the
object of public congratulations and testimonials.

His relations with his patients--for during all of his long career he
continued to practise, especially surgery and obstetrics--were of the
friendliest character. While his distinction as a professor at the
university gave him many opportunities for practice among the rich, he
was always ready and willing to help the poor, and, indeed, seemed to
feel more at home among poor patients than in the society of the
wealthy and noble. Even towards the end of his life, when the loss of
many friends, and especially his wife, made him retire within himself
much more than before, he continued to exercise his professional skill
for the benefit of the poor, though he often refused to take cases
that might have proved sources of considerable gain to him. Early in
life, when he was very busy between his professional work and his
practice, he remarked more than once, on refusing {126} to take the
cases of wealthy patients, that they had the money with which to
obtain other physicians, while the poor did not, and he would prefer
to keep some time for his services for them.

Toward the end of his life Galvani was not a little perturbed by the
course of events around him and by the sweeping away of faith in old
beliefs, consequent upon the French Revolution and the philosophic
movement that had led up to it. Seeing around him, too, the abuses to
which this supposed liberty and assertion of the rights of man led, it
used to be a favorite expression of Galvani that "A little philosophy
led men away from God, but a good deal of it led them back to Him
again." Especially did he consider this true with regard to younger
men, whose lack of wisdom in the difficult phases of life made them
think their philosophy of things was complete, until sad experience
had taught them the necessity for lifting men's minds above any mere
religion of humanity, any mere stoic resignation to the inevitable, if
what was best in them was to be brought out.

A very interesting phase of the Italian university life of that time
is revealed in two important incidents of Galvani's university career.
One of his professors, one, by the way, for whom he seems to have had
a great deal of respect, and to whose lectures he devoted much
attention, was Laura Caterina Maria Bassi, the distinguished woman
professor of philosophy at the University of Bologna, about the middle
of the eighteenth century. It is doubtless to her teaching that
Galvani owes some of his thoroughgoing conservatism in philosophic
speculation, a conservatism that was of great service to him later on
in life, in the midst of the ultra-radical principles which became
fashionable just before and during the French Revolution. Madame Bassi
seems to have had her influence on him for good not only during his
student {127} career, but also later in life, for she was the wife of
a prominent physician in Bologna, and Galvani was often in social
contact with her during his years of connection with the university.

As might, perhaps, be expected, seeing that his own happy domestic
life showed him that an educated woman might be the centre of
intellectual influence, Galvani seems to have had no spirit of
opposition to even the highest education for women. This is very well
illustrated by the first formal lecture in his course on anatomy at
the university, which had for its subject the models for the teaching
of anatomy that had been made by Madame Manzolini. In the early part
of the eighteenth century Madame Manzolini had been the professor of
anatomy at the University of Bologna, and in order to make the
teaching of this difficult subject easier and more definite she
modelled with great care and delicate attention to every detail, so
that they imitated actual dissections of the human body very closely,
a set of wax figures which replaced the human body for demonstration
purposes at least at the beginning of the anatomical course.

Galvani, in taking up the work of lecturer on anatomy, appreciated how
much such a set of models would help in making the introduction to
anatomical study easy, yet at the same time without detracting from
its exactness, and, accordingly, introduced his students to Madame
Manzolini's set of models in his very first lecture. At the time there
were those connected with the teaching of anatomy who considered the
use of these models as rather an effeminate proceeding. Galvani's lack
of prejudice in the matter shows the readiness of the man to accept
the best wherever he found it without regard to persons or feelings.

He was one of the most popular professors that the University of
Bologna has ever had. He was not in the ordinary {128} sense of the
word an orator, but he was a born teacher. The source of the
enthusiasm which he aroused in his hearers was undoubtedly his own
love for teaching and the power it gave him to express even intricate
problems in simple, straightforward language. More than any of his
predecessors he understood that experiments and demonstrations must be
the real groundwork of the teaching of science. Accordingly, very few
of his lectures were given without the aid of these material helps to
attract attention. Besides he was known to be one who delighted to
answer questions and was perfectly frank about the limitations of his
knowledge whenever there was no real answer to be given to a question
that had been proposed. Though an original discoverer of the first
rank, he was extremely modest, particularly when talking about the
details of his discoveries, or subjects relating to them.

The most striking proof of the thorough conscientiousness with which
he faced the duties of life is to be found in his conduct after the
establishment of the so-called Cis-Alpine Republic in Italy. This was
a government established merely by force of arms without the consent
of the people and a plain usurpation of the rights of the previous
government. He considered himself bound in duty to the authority under
which he had lived all his previous life and to which he had sworn
fealty. When the University of Bologna was reorganized under the new
government the first requirement of all those who were made professors
was that they should take the oath of allegiance to the new
government. This he refused to do. His motives can be readily
understood, and though practically all the other professors of the
university had taken the oath he did not consider that this freed him
from his conscientious obligations in the matter.

Accordingly, he was dropped from the roll of professors {129} and
deprived of the never very large salary which he had obtained from
this chair. On this sum he had practically depended for his existence
and he soon began to suffer from want. While he had been a successful
practitioner of medicine, especially of surgery, he had always been
very liberal and had spent large sums of money in demonstrations for
his lectures and personal experimentation and in materials for the
museums of the university. He began to suffer from actual want and
friends had to come to his assistance. He refused, however, to give up
his scruples in the matter and accept the professorship which was
still open for him. Finally, at the end of two years, influence was
brought to bear on the new government and Galvani was allowed to
accept his chair in the university without taking the oath of
allegiance. This tribute came too late, however, and within a short
time after his restoration to his professorship he died.

That his action in this matter was very properly appreciated by his
contemporaries, and that the moral influence of his example was not
lost, can be realized from the expressions used by Alibert, the
Secretary-general of the Medical Society of Emulation, in the
historical address on Galvani which he delivered before that society
in 1801:

  "Galvani constantly refused to take the civil oath demanded by the
  decrees of the Cis-Alpine Republic. Who can blame him for having
  followed the voice of his conscience, that sacred, interior voice,
  which alone prescribes the duties of man and which has preceded all
  human laws? Who could not praise him for having sacrificed with such
  exemplary resignation all the emoluments of his professorship rather
  than violate the solemn engagements made under religious sanction?"

In the same panegyric there is a very curiously interesting passage
with regard to Galvani's habit of frequently closing his {130}
lectures by calling attention to the complexity yet the purposefulness
of natural things and the inevitable conclusion that they must have
been created with a definite purpose by a Supreme Being possessed of
intelligence. At the time that Alibert wrote his memoir it was the
fashion to consider, at least in France, that Christianity was a thing
of the past, and that while theism might remain, that would be all
that could be expected to survive the crumbling effect of the
emancipation of man.

He says: "We have seen already what was Galvani's zeal and his love
for the religion which he professed. We may add that in his public
demonstration he never finished his lectures without exhorting his
pupils to a renewal of their faith by leading them always back to the
idea of the eternal Providence which develops, preserves and causes
life to flow among so many different kinds of things. I write now," he
continues, "in the age of reason, of tolerance and of light. Must I
then defend Galvani in the eyes of posterity for one of the most
beautiful sentiments that can spring from the nature of man? No, and
they are but little initiated in the saner mechanism of philosophy who
refused to recognize the truths established on evidence so strong and
so authentic. _Breves haustus in philosophiâ ad atheismum ducunt,
longiores autem reducunt ad deum_, small draughts of philosophy lead
to atheism, but longer draughts bring one back to God"--(which may
perhaps be better translated by Pope's well-known lines, "A little
learning (in philosophy) is a dangerous thing; drink deep or touch not
the Pierian spring").

Galvani has been honored by his fellow-citizens of Bologna as one of
their greatest townsmen and by the university as one of her worthiest
sons. In 1804 a medal was struck in his honor, on the reverse of
which, surrounding a figure of the {131} genius of science, were the
two legends: _"Mors mihi vita"_ "Death is life or me," and _"Spiritus
intus alit,"_ "The spirit works within," which were favorite
expressions of the great scientist while living and are lively symbols
of the spirit which animated him. In 1814 a monument was erected to
him in the courtyard of the University of Bologna. It is surmounted by
his bust, made by the most distinguished Bolognian sculptor of the
time, De Maria. On the pedestal there are two figures in bas-relief
executed by the same sculptor, which represent religion and
philosophy, the inspiring geniuses of Galvani's life.

Before he died, he asked, as had Dante, whose work was his favorite
reading, to be buried in the humble habit of a member of the Third
Order of St. Francis. He is said to have valued his fellowship with
the sons of the "poor little man of Assisi" more than the many
honorary fellowships of various kinds which had been conferred upon
him by the scientific societies all over Europe.


{132}

{133}

LAENNEC, MARTYR TO SCIENCE


{134}

  The knowledge which a man can use is the only real knowledge, the
  only knowledge which has life and growth in it and converts itself
  into practical power. The rest hangs like dust about the brain, or
  dries like rain-drops off the stones.
    --Froude.


{135}

LAENNEC, MARTYR TO SCIENCE.

On August 13, 1826, there died at Quimper in Brittany at the early age
of forty-five, one of the greatest physicians of all time. His name,
René Theodore Laennec, was destined to be forever associated with one
of the most fruitful advances in medicine that has ever been made, and
one which practically introduced the modern era of scientific
diagnosis. At the present time the most interesting phase of medical
development is concerned with the early recognition and the prevention
of tuberculosis. To Laennec more than to any other is due all the data
which enable the physician of the twentieth century to make the
diagnosis of tuberculosis with assurance, and to treat it with more
confidence than before, and so prevent its spread as far as that is
possible.

The history of pulmonary consumption in its most modern phase is
centred around the names of three men, Laennec, Villemin, and Koch. To
Laennec will forever belong the honor of having fixed definitely the
clinical picture of the disease, and of having separated it by means
of auscultation and his pathological studies from all similar
affections of the lungs. Villemin showed that it was an infectious
disease, absolutely specific in character, and capable of transmission
by inoculation from man to the animal. To Koch the world owes the
knowledge of the exact cause of the disease and consequently of the
practical method for preventing its spread. The isolation of the
bacillus of tuberculosis is the great triumph of the end of the
nineteenth century, as the separation of the disease from all others
by Laennec was the triumph of the beginning of that century. There is
{136} still room for a fourth name in the list, that of the man who
will discover a specific remedy for the disease. It is to be hoped
that his coming will not be long delayed.

The estimation in which Laennec was held by the most distinguished
among his contemporaries, may be very well appreciated from the
opinions expressed with regard to him and his work by the best-known
Irish and English clinical observers of the period. Dr. William
Stokes, who was himself, as we shall see, one of the most important
contributors to our clinical knowledge of diseases of the heart and
lungs in the nineteenth century, said with regard to the great French
clinician whom he considered his master:

  "Time has shown that the introduction of auscultation and its
  subsidiary physical signs has been one of the greatest boons ever
  conferred by the genius of man on the world.

  "A new era in medicine has been marked by a new science, depending
  on the immutable laws of physical phenomena, and, like the
  discoveries founded on such a basis, simple in its application and
  easily understood--a gift of science to a favored son; one by which
  the ear is converted into the eye, the hidden recesses of visceral
  disease open to view; a new guide to the treatment, and a new help
  to the ready detection, prevention and cure of the most widely
  spread diseases which affect mankind."

Dr. Addison, who is best known by the disease which since his original
description has been called by his name, was no less enthusiastic in
praise of Laennec's work. He said:

  "Were I to affirm that Laennec contributed more toward the
  advancement of the medical art than any other single individual,
  either of ancient or of modern times, I should probably be advancing
  a proposition which, in the estimation of many, is neither
  extravagant nor unjust. His work, {137} _De l'Auscultation Mediate_,
  will ever remain a monument of genius, industry, modesty and truth.
  It is a work in perusing which every succeeding page only tends to
  increase our admiration of the man, to captivate our attention, and
  to command our confidence. We are led insensibly to the bedside of
  his patients; we are startled by the originality of his system; we
  can hardly persuade ourselves that any means so simple can
  accomplish so much, can overcome and reduce to order the chaotic
  confusion of thoracic pathology; and hesitate not in the end to
  acknowledge our unqualified wonder at the triumphant confirmation of
  all he professed to accomplish."

These tributes to Laennec, however, from men who were his
contemporaries across the channel, have been more than equalled by
distinguished physicians on both sides of the Atlantic at the end of
the nineteenth and the beginning of the twentieth century. While we
might hesitate to accept the opinions of those who had been so close
to him at the beginning of the new era of physical diagnosis, there
can be no doubt now, after the lapse of three-quarters of a century,
of what Laennec's influence really was, and the tributes of the
twentieth century place him among the few great geniuses to whom
scientific medicine owes its most important advance.

At the annual meeting of the State Medical Society of New York held in
Albany at the end of January, 1903, the president of the society,
Doctor Henry L. Elsner, of Syracuse, in his annual address devoted
some paragraphs to a panegyric of Laennec. He wished to call attention
to what had been accomplished for scientific medicine at the beginning
of the last century by a simple observant practitioner. In the course
of his references to Laennec and his work he said:

  "It is by no means to be considered an accident that, {138} among
  the greatest advances in medicine made during the century just
  closed, the introduction of pathological anatomy and auscultation
  into the practice of medicine at the bedside were both effected by
  the same clear mind, Laennec. He is one of the greatest physicians
  of all time."

He then quoted the opinion of a distinguished English clinician,
Professor T. Clifford Allbutt, who is well known, especially for his
knowledge of the history of medicine. Professor Allbutt is the Regius
Professor of Physic (a term about equivalent to our practice of
medicine) of Cambridge University, England, and was invited to this
country some years ago as the representative of English medicine to
deliver the Lane lectures in San Francisco. During his stay in this
country he delivered a lecture at Johns Hopkins University on
"Medicine in the Nineteenth Century," in which he said, "Laennec gives
me the impression of being one of the greatest physicians in history;
one who deserves to stand by the side of Hippocrates and Galen, Harvey
and Sydenham. Without the advances of pathology Laennec's work could
not have been done; it was a revelation of the anatomy of the internal
organs during the life of the patient."

René Theodore Hyacinthe Laennec, who is thus conceded by twentieth
century medicine a place among the world's greatest medical
discoverers, was born February 17, 1781, at Quimper in Bretagne, that
rocky province at the north of France which has been the sturdy
nursing mother of so many pure Celtic Frenchmen who have so mightily
influenced the thought not only of their own country but of all the
world. The names of such Bretons as Renan and Lamennais have a
universal reputation and the province was even more distinguished for
its scientists.

There was published [Footnote 2] a few years ago in France a detailed
{139} history of Breton physicians. This work sketches the lives of
the physicians of Breton birth from the sixteenth to the twentieth
century. Only those of the nineteenth century concern us, but the list
even for this single century includes such distinguished names as
Broussais, whose ideas in physiology dominated medicine for nearly
the whole of the first half of the nineteenth century; Jobert, the
famous French surgeon whose reputation was world-wide; Alphonse
Guerin, another distinguished surgeon, whose work in the protection of
wounds in some respects anticipated that of Lister; Chassaignac, to
whose inventive genius surgery owes new means of preventing hemorrhage
and purulent infection, and who introduced the great principle of
surgical drainage; finally Maisonneuve, almost a contemporary, whose
name is a household word to the surgeons of the present generation;
without mentioning for the moment the subject of this sketch, Laennec,
the greatest of them all. Six greater men never came from one province
in the same limited space of time.

  [Footnote 2: Les Médecins Bretons par Dr. Jules Roger. Paris, J. B.
  Baillière, 1900.]

Bretagne, "the land of granite covered with oaks" as the Bretons love
to call it, may well be proud of its illustrious sons in the century
just past. Taken altogether they form a striking example of how much
the world owes to the children of the countryside who, born far from
the hurrying bustle of city life, do not have their energies sapped
before the proper time for their display comes. These Bretagne
physicians, illustrious discoverers and ever faithful workers, are at
the same time a generous tribute to the influence of the simple,
honest sincerity of well-meaning parents whose religious faith was the
well-spring of humble, model lives that formed a striking example for
their descendants. The foundations of many a great reputation were
laid in the simple village homes, far from the turmoil and the
excitement of the fuller {140} life of great cities. The Bretons are
but further examples of the fact that for genuine success in life the
most precious preparation is residence in the country in childhood and
adolescent years. The country districts of Normandy, the province
lying just next to Bretagne, have furnished even more than their share
of the Paris successes of the century, and have seen the Norman
country boys the leaders of thought at the capital.

Laennec's father was a man of culture and intelligence, who, though a
lawyer, devoted himself more to literature than his case books. His
poetry is said to recall one of his better known compatriots,
Deforges-Maillard. Laennec was but six years old when his mother died.
His father seems to have felt himself too much preoccupied with his
own work to assume the education of his son, and so the boy Laennec
was placed under the guardianship of his grand-uncle, the Abbé
Laennec, and lived with him for some years in the parish house at
Elliant.

A relative writing of Laennec after his death says that the boy had
the good fortune to be thus happily started on his path in life by a
hand that was at once firm and sure. The training given him at this
time was calculated to initiate him in the best possible way into
those habits of application that made it possible for him to make
great discoveries in after life. The boy was delicate besides, and the
house of the good old rector-uncle was an excellent place for him,
because of its large and airy rooms and the thoroughly hygienic
condition in which it was kept. Household hygiene was not as common in
those days as in our own and child mortality was higher, but the
delicate boy thrived under the favorable conditions.

Besides the parish house was situated in the midst of a beautiful
country. The perfectly regular and rather serious {141} life of the
place was singularly well adapted to develop gradually and with due
progression the precious faculties of a young, active mind and
observant intelligence. This development was accomplished besides
without any excitement or worry and without any of the violent
contrasts or precocious disillusions of city life.

The boy passed some four or five years with his grand-uncle the priest
and then went to finish his studies with a brother of his father, Dr.
Laennec, a physician who has left a deservedly honored name. At this
time Dr. Laennec was a member of the Faculty of Medicine at the
University of Nantes. The growing lad seems to have been wonderfully
successful in his studies, and a number of prizes gained at school
show how deeply he was interested in his work. During this time he
learned English and German and became really ready to begin the study
of the higher sciences. Besides working at his academic studies,
Laennec paid some attention to his uncle in his professional work, and
by careful observation laid the foundation of his medical studies. His
character as an observer, rather than a student of books, showed
itself very early. He devoted himself to the clinical investigation of
cases in the military hospital and was especially interested in the
study of anatomy.

In 1800, at the age of nineteen, he went to Paris. It was typical of
the man and his careful, thoroughness all through life that the first
impulse when he found himself free to work for himself, was to try to
make up for what he considered defects in his elementary studies. It
must not be forgotten that the ten years of Laennec's life, from his
tenth to his twentieth year, came in the stormy time of the French
Revolution, and that school regularity was very much disturbed. His
first care then was to take up the study of Latin again. He learned to
read and write the language with elegance and {142} purity. Later on,
occasionally, he delivered his clinical lectures, especially when
foreigners were present, in Latin. We shall have the occasion to see
before the end of this article, with what easy grace he learned to use
it from some passages of the preface of his book written in that
language.

He did not allow his accessory studies, however, to interfere with his
application to his professional work. He was one of those rare men who
knew how to rest his mind by turning it from one occupation to
another. When scarcely more than a year in Paris, Laennec secured the
two first prizes for medicine and surgery in the medical department of
the University of Paris. In 1804 he wrote two medical theses, one of
them in Latin, the other in French. The subject of both was
Hippocrates, the great Greek father of medicine, whom Laennec admired
very much and whose method of clinical observation was to prove the
key-note of the success of Laennec's own medical career.

At this time the Paris school of medicine had two great rival
teachers. One of them was Corvisart, who endeavored to keep up the
traditions of Hippocrates and taught especially the necessity for
careful observation of disease. The other was Pinel, famous in our
time mainly for having stricken the manacles from the insane in the
asylums of Paris, but who was known to his contemporaries as a great
exponent of what may be called "Philosophic Medicine." Corvisart
taught principally practical medicine at the bedside; Pinel mainly the
theory of medicine by the analysis of diseased conditions and their
probable origin.

Needless to say, Laennec's sympathies were all with Corvisart. He
became a favorite pupil of this great master, who did so much for
scientific medicine by introducing the method of percussion, invented
nearly half a century before by Auenbrugger, but forgotten and
neglected, so that it {143} would surely have been lost but for the
distinguished Frenchman's rehabilitation of its practice. Corvisart
was a man of great influence. He had caught Napoleon's eye. The great
Emperor of the French had the knack for choosing men worthy of the
confidence he wished to place in them. His unerring judgment in this
matter led him to select Corvisart as his personal physician at a
moment when his selection was of the greatest service to practical
medicine, for no one was doing better scientific work at the time, and
this quasi-court position at once gave Corvisart's ideas a vogue they
would not otherwise have had.

Corvisart's most notable characteristic was a sympathetic
encouragement of the work of others, especially in what concerned
actual bedside observation. Laennec was at once put in most favorable
circumstances, then, for his favorite occupation of studying the
actualities of disease on the living patient and at the autopsy. For
nearly ten years he devoted himself almost exclusively to the care and
study of hospital patients. In 1812 he was made physician to the
Beaujon Hospital, Paris. Four years later he was transferred to the
Necker Hospital, where he was destined to bring his great researches
to a successful issue. To the Necker Hospital, before long, students
from all over the world flocked to his clinical lectures, to keep
themselves in touch with the great discoveries the youthful master was
making. In spite of rather delicate health Laennec fulfilled his
duties of physician and professor with scrupulous exactitude and with
a self-sacrificing devotion that was, unfortunately, to prove
detrimental to his health before very long.

One of his contemporaries says of him:

  "Laennec was almost an ideal teacher. He talked very easily and his
  lesson was always arranged with logical method, clearness and
  simplicity. He disdained utterly {144} all the artifices of oratory.
  He knew, however, how to give his lectures a charm of their own. It
  was as if he were holding a conversation with those who heard him
  and they were interested every moment of the time that he talked, so
  full were his lectures of practical instruction."

Another of his contemporaries says, naïvely: "At the end of the lesson
we did not applaud, because it was not the custom. Very few, however,
who heard him once, failed to promise themselves the pleasure of
assisting at others of his lectures."

The work on which Laennec's fame depended and the discovery with which
his name, in the words of our great American diagnostician, Austin
Flint, the elder, will live to the end of time was concerned with the
practice of auscultation. This is the method of listening to the
sounds produced in the chest when air is inspired and expired in
health and disease, and also to the sound produced by the heart and
its valves in health and disease. Nearly two centuries ago, in 1705,
an old medical writer quoted by Walshe, in his "Treatise on the
Disease of the Lungs and Heart" said very quaintly but very shrewdly:
"Who knows but that one may discover the works performed in the
several offices and shops of a man's body by the sounds they make and
thereby discover what instrument or engine is out of order!"

It was just this that Laennec did. He solved the riddle of the sounds
within the human workshop, to continue the quaint old figure, and
pointed out which were the results of health and which of disease. Not
only this, but he showed the difference between the sounds produced in
health and disease by those different engines, the lungs and the
heart. The way in which he was led to devote his attention originally
to the subject of auscultation is described by Laennec himself with a
simplicity and directness so charmingly characteristic {145} of the
man, of his thoroughly Christian modesty, of his solicitude for even
the slightest susceptibility of others and of his prompt inventive
readiness, that none of his biographers has been able to resist the
temptation to quote his own words with regard to the interesting
incident, and so we feel that we must give them here.

He says:

  "In 1816 I was consulted by a young person who was laboring under
  the general symptoms of a diseased heart. In her case percussion and
  the application of the hand (what modern doctors call palpation)
  were of little service because of a considerable degree of
  stoutness. The other method, that namely of listening to the sounds
  within the chest by the direct application of the ear to the chest
  wall, being rendered inadmissible by the age and sex of the patient,
  I happened to recollect a simple and well-known fact in acoustics
  and fancied it might be turned to some use on the present occasion.
  The fact I allude to is the great distinctness with which we hear
  the scratch of a pin at one end of a piece of wood on applying our
  ear to the other.

  "Immediately on the occurrence of this idea I rolled a quire of
  paper into a kind of cylinder and applied one end of it to the
  region of the heart and the other to my ear. I was not a little
  surprised and pleased to find that I could thereby perceive the
  action of the heart in a manner much more clear and distinct than I
  had ever been able to do by the immediate application of the ear.

  "From this moment I imagined that the circumstance might furnish
  means for enabling us to ascertain the character not only of the
  action of the heart, but of every species of sound produced by the
  motion of all the thoracic viscera, and consequently for the
  exploration of the respiration, the voice, the _râles_ and perhaps
  even the fluctuation of fluid effused in the pleura or pericardium.
  With this conviction I forthwith {146} commenced at the Necker
  Hospital a series of observations from which I have been able to
  deduce a set of new signs of the diseases of the chest. These are
  for the most part certain, simple and prominent, and calculated
  perhaps, to render the diagnosis of the diseases of the lungs, heart
  and pleura as decided and circumstantial as the indications
  furnished to the surgeons by the finger or sound, in the complaints
  wherein these are of use."

This is the unassuming way in which Laennec announces his great
discovery. He did not in modern fashion immediately cry "Eureka!" and
announce the far-reaching importance of his method of diagnosis. For
two years he devoted himself to the patient study of the application
of his method and the appreciation of its possibilities and its
limitations. Then he presented a simple memoir to the French Academy
of Sciences on the subject. A committee of three, then distinguished
members of the Academy, Doctors Portal, Pelletan and Percy were named
to investigate the new discovery.

It is rather interesting to notice, though almost needless to say,
that the names of these men would be now absolutely unremembered in
medical history but for the fortuitous circumstance that made them
Laennec's investigators. Such is too often the ephemeralness of
contemporary reputation. Fortunately for the committee, they reported
favorably upon Laennec's discoveries. It is not always true of new and
really great advances in medicine that they are received with proper
appreciation upon their first announcement. Even Harvey said of his
discovery of the circulation of the blood that he expected no one of
any reputation in his own generation to accept it. It is not very
surprising to find then in the matter of the Laennec investigators
that there is a cautious reserve in their report, showing that they
were not too ready {147} to commit themselves to a decided opinion on
the importance of the new discovery, nor to any irretrievable
commendation.

The important part of the discovery was supposed to consist in the use
of the wooden cylinder which Laennec came to employ instead of the
roll of paper originally used. This wooden cylinder, now familiar to
us under the excellent name invented for it by Laennec himself is the
modern single stethoscope. This instrument is of great service. The
really important part of Laennec's work, however, was not the
invention of the stethoscope, but the exact observation of the changes
of the breath sounds that could be noted with it in various forms of
chest diseases.

Laennec succeeded in pointing out how each one of the various diseases
of the heart and lungs might be recognized from every other. Before
his time, most of the diseases of the lungs, if accompanied with any
tendency to fever particularly, were called lung fever. He showed the
difference between bronchitis and pneumonia, pneumonia and pleurisy,
and the various forms of tuberculosis and even the rarer pathological
conditions of the lung, such as cancer, or the more familiar
conditions usually not associated with fever, emphysema, and some of
the forms of retraction.

With regard to heart disease, it was before Laennec's discovery almost
a sealed chapter in practical medicine. It was known that people died
from heart disease often and, not infrequently, without much warning.
The possibility that heart conditions could be separated one from
another, and that some of them could be proved to be comparatively
harmless, some of them liable to cause lingering illness, while others
were surely associated with the probability of sudden fatal
termination, was scarcely dreamed of. It is to Laennec's introduction
of auscultation that modern medicine owes all its exacter knowledge of
heart lesions and their {148} significance. He himself did not solve
all the mysteries of sound here as he did in the lungs; indeed, he
made some mistakes that render him more sympathetic because they bring
him down to the level of our humanity. He did make important
discoveries with regard to heart disease, and his method of diagnosis
during his own life was, in the hands of the Irish school of medicine,
to prove the key to the problems of disease he failed to unlock.

Almost at once Laennec's method of auscultation attracted widespread
attention. From Germany, from Italy, from England, even from the
United States, in those days when our medical men had so few
opportunities to go abroad, medical students and physicians went to
Paris to study the method under the direction of the master himself
and to learn from him his admirable technique of auscultation. Those
who came found that the main thing to be seen was the patient
observation given to every case and Laennec's admirably complete
examination of each condition. The services to diagnosis rendered by
the method were worthy of the enthusiasm it aroused. Only the work of
Pasteur has attracted corresponding attention during the nineteenth
century. Physicians practice auscultation so much as a matter of
course now that it is hard to understand what an extreme novelty it
was in 1820, and how much it added to the confidence of practitioners
in their diagnosis of chest diseases.

Bouilland said, with an enthusiasm that does not go beyond literal
truth, "A sense was lacking in medicine and I would say, if I dared,
that Laennec the creator, by a sort of divine delegation of a new
sense, supplied the long-felt want. The sense which medicine lacked
was hearing. Sight and touch had already been developed in the service
of medical diagnosis. Hearing was more important than the other two
senses, and in giving it to scientific medicine Laennec disclosed a
new {149} world of knowledge destined to complete the rising science
of diagnosis."

Henri Roger said: "Laennec in placing his ear on the chest of his
patient heard for the first time in the history of human disease the
cry of suffering organs. First of all, he learned to know the
variations in their cries and the expressive modulations of the
air-carrying tubes and the orifices of the heart that indicate the
points where all is not well. He was the first to understand and to
make others realize the significance of this pathological language,
which, until then, had been misunderstood or, rather, scarcely
listened to. Henceforth, the practitioner of medicine, endowed with
one sense more than before and with his power of investigation
materially increased, could read for himself the alterations hidden in
the depths of the organism. His ear opened to the mind a new world in
medical science."

The freely expressed opinions of distinguished German, English and
American physicians show that these enthusiastic praises from his
French compatriots are well deserved by Laennec for the beautifully
simple, yet wonderfully fecund method that he placed before the
medical profession in all its completeness.

The first employment of the stethoscope by rolling up sheets of paper
is of itself a sign of his readiness of invention. He made his own
stethoscopes by hand and liked to spend his leisure time fashioning
them carefully and even ornately. One of the stethoscopes certainly
used by him and probably made by himself is to be seen at the Museum
of the College of Physicians of Philadelphia.

After three years of study and patient investigation of the use of
auscultation in pulmonary and cardiac diagnosis, Laennec wrote his
book on the subject. This is an immortal work--a true classic in its
complete treatment of the subject. {150} We have had thousands of
books written on the subject since Laennec's time, and yet no
physician could do better at the present moment than study Laennec's
two comparatively small volumes to learn the art of physical
diagnosis.

It is a characteristic of genius to give a completeness to work that
endows it with an enduring independent vitality. Almost innumerable
disciples follow in the footsteps of a teacher, and each thinks that
he adds something to the fulness of the revelation made by the master.
At the end of a century the fourth generation finds that scarcely
anything has been added and that the master's work alone stands out,
not merely as the great central fact of the new theory or doctrine,
but as the absolute vital entity to which the other supposed
discoveries are only adventitious and not entirely indispensable
accessories.

Dr. Austin Flint, the elder, admittedly one of the greatest
diagnosticians in pulmonary and heart diseases that we have ever had
in America, said on this subject: "Suffice it to say here that,
although during the forty years that have elapsed since the
publication of Laennec's works the application of physical exploration
has been considerably extended and rendered more complete in many of
its details, the fundamental truths presented by the discoverer of
auscultation not only remain as a basis of the new science, but for a
large portion of the existing superstructure. Let the student become
familiar with all that is now known on this subject, and he will then
read the writings of Laennec with amazement that there remained so
little to be altered or added."

Laennec's unremitting devotion to his hospital work finally impaired
his health. He was never robust and strangers who came to Paris and
saw him for the first time wondered that he should be able to stand
the labor he required of himself. The portraits of him give a good
impression of {151} his ascetic delicacy; they convey besides a
certain wistfulness, the look of one close to human suffering, and
unable to do all that he would wish to relieve it. Long before his
discovery of the mysteries of auscultation, he had accomplished
results that of themselves, and without his subsequent master
discovery, would have given him an enduring name in medical
literature. Laennec's genius enabled him to make a really great
discovery, but Laennec's talent, the principal part of which was an
inexhaustible faculty for untiring labor, an infinite capacity for
taking pains with all that he did, enabled him to make a number of
smaller discoveries any one of which would have given a great
reputation to a lesser man.

Some idea of the amount of work that he did in preparing himself for
the observations that were to result in his discovery may be gathered
from details of his earlier career. During the first three years of
his attendance at La Charité Hospital in Paris he drew up a minute
history of nearly four hundred cases of disease. As early as 1805 he
read a paper on hydatid cysts. These cysts were formerly thought to be
hollow tumors formed within the tissues themselves somewhat as other
cystic tumors are formed. Laennec showed conclusively that their
origin was entirely due to certain worms that had become parasites in
human beings. The cysts instead of being tumors were really one stage
of the worm's existence, and had an organization and an independent
existence of their own. He gave an exact description of them and even
showed that there were several types of the parasite, and described
the different changes that various forms produced in the human
tissues. This study of the hydatid parasites remains a remarkable
contribution to medicine down even to our own day.

During these early years Laennec devoted himself particularly to the
study of pathology. Like all the men who {152} have made great
discoveries in medicine he understood that all true medical advance
must be founded on actual observation of the changes caused by disease
in the tissues, and that this knowledge can only be obtained in the
autopsy room. For years he devoted himself to the faithful study of
the tissues of patients dead from various forms of disease. He wrote
as the result of this work a treatise on peritonitis that was a
distinct advance over anything known before his time and which, in the
words of Benjamin Ward Richardson, "as a pathological study was
shrewdly in anticipation of the later work of one who became his most
formidable rival, the famous Broussais."

From the peritoneum his attention was attracted to the liver. As early
as 1804 he wrote a description of the membranes of the liver.
Pathological changes in the liver continued to occupy his attention
for some time, and it is to him we owe the name cirrhosis of the
liver, as a term for the changes which are produced by alcohol in this
gland. Alcoholic cirrhosis is often spoken of as Laennec's cirrhosis
of the liver, and he was the first to point out the significance of
the changes in the organ, their etiology and the reason for the
symptoms that usually accompany this condition. This work alone would
have been sufficient to have made Laennec's name a permanent fixture
in medical literature.

During the early years of Laennec's career at Paris, the French
Anatomical Society was founded and Laennec became a prominent member
of it. Corvisart, who was the moving spirit in the society, was at
this time--the early years of the nineteenth century--doing his great
teaching at the medical school of the University of Paris. He was
Laennec's master, and was at the height of his glory. It was a
constant source of surprise to his students to note how well the
master's diagnosis agreed with postmortem findings. This is, after
{153} all, the only true criterion of scientific diagnosis. It is not
surprising that the strict application of this practical method of
control of medical theory soon gave rise to a series of distinct
advances in medical knowledge of the greatest importance.

Discussions of cases were frequent and Laennec took a prominent part
in them. His knowledge of medicine was broadening in this great field
of practice, and he was chosen as one of the contributors to the
_Dictionnaire des Sciences Médicales_. His articles for this work
contained much original matter of great value and suggestive views of
notable importance. Laennec was the first to give a description of
carcinoma encephaloides and certain especially malignant forms of
cancers. He showed the distinction between pigmented spots of
benignant character and those that were due to malignant disease.

"After all, however," says Benjamin Ward Richardson, "the grand
reputation of Laennec must rest on his one immortal work. It is not
too much to say that any man of good intelligence could have written
the other memoirs. No one less than Laennec could have written the
'Treatise on Mediate Auscultation and the Use of the Stethoscope.' The
true student of medicine, who never wears out, reads this original
work of Laennec once in two years at least, so long as he is in
practice and takes a living interest in the subject of which it
treats. It ranks equally with the original works of Vesalius, Harvey
and Bichat and as a section of medical literature is quite equal to
any section of Hippocrates." [Footnote 3]

  [Footnote 3: The full title of this work of Laennec's is "De
  l'auscultation médiate ou traité du diagnostic des maladies des
  poumons et du coeur par R. T. H. Laennec." Its modest motto is the
  Greek sentence: [Greek Text], (The most important part of an art is
  to be able to observe properly.) The book was published in Paris by
  J. A. Brosson et J. S. Chandé, rue Pierre-Sarrazin, No. 9, 1819.]


{154}

Some quotations from the Latin preface to the book will serve to show
that Laennec appreciated the value of the discovery he had made for
the diagnosis of chest diseases, yet that he did not expect it to be
taken up enthusiastically at once, and in his modest way he adds that
he shall be satisfied if it should serve to save but one human being
from suffering and death. [Footnote 4]

  [Footnote 4: "Imo neminem hanc methodum expertum deinceps cum
  Baglivio dicturum esse spero: O quantum difficile est diagnoscere
  morbos pulmonum."

  "Nostra enim _aetas incuriosa_ quoque _suorum_ (the italics are
  Laennec's own); et si quid novi ab homine coaevo in medio ponitur,
  risu ut plurimum ineptisque cavillationibus excipiunt; quippe
  facilius est aspernari quam experiri."

  "Hoc mihi satis est quod bonis doctisque viris nonnullis acceptam
  aegrotisque multis utilem, hanc methodum fore confidere possim;
  hominem unum ereptum orco dulce dignumque meae atque etiam majoris
  operae pretium praemium fore existimem."

  "I may say that no one who has made himself expert with this method
  will after this have occasion to say with Baglivi, Oh! how difficult
  it is to diagnose disease of the lungs."

  "For our generation is not inquisitive as to what is being
  accomplished by its sons. Claims of new discoveries made by
  contemporaries are likely for the most part to be met by smiles and
  mocking remarks. It is always easier to condemn than to test by
  actual experience."

  "It suffices for me if I can only feel sure that this method will
  commend itself to a few worthy and learned men who will make it of
  use to many patients. I shall consider it ample, yea, more than
  sufficient reward for my labor, if it should prove the means by
  which a single human being is snatched from untimely death."]


Unfortunately, as we have said, Laennec's untiring devotion for nearly
twenty years to medical investigation caused his health to give way.
It is painful to think that in the full tide of the success of his
great labors, when the value of his work was only just beginning to be
properly appreciated and when he had attained a position which would
satisfy even lofty ambitions, his nerves gave way and he had many
{155} of the typical melancholic symptoms that disturb the modern
neurasthenic. Fortunately, his habits of life, always extremely
abstemious, and his liking for outdoor sports had been a safeguard for
him. He retired to the country and for nearly two years spent most of
his time in the open air.

It was not long before surcease from intellectual labor and indulgence
in field sport restored him to health and to activity. He foresaw,
however, that to go back to the city and to his scientific work would
almost surely lead to another breakdown. One of his biographers states
that it was the great regard which he had for his family and the
powerful influence of his religious principles which alone had
sufficient weight to make him leave his retreat in the country. After
an absence of two years, he returned to Paris and once more took up
his hospital duties.

Soon after his return he received the appointment of physician to the
Duchesse de Berri. One of the main objections to this position in
Laennec's mind seems to have been the necessity for occasionally
wearing court dress with a sword and regalia. Ordinarily he went
dressed very plainly, and it was noted that, when men of much less
authority and much less practice used their own carriages, he usually
took a hired cab. His position at court gave him enough influence to
bring about the proper recognition of his merit as a teacher. At this
time his lectures on auscultation, though he held no regular
professorship, were crowded by students from all nations. The year
after his return to Paris he was appointed Professor of Medicine in
the College of France, and afterward of clinical medicine at the
Hospital La Charité where he had made his own studies as a medical
student.

About this time he was offered a position of importance as a member of
the Royal Council of Public Instruction. This he refused, however,
because it would deprive him of {156} some of the precious time that
he wished to devote to the further investigation of important subjects
in clinical medicine and especially to the elaboration of his method
of auscultation.

One of the most striking features of Laennec's character was his
absolute placidity and lack of personal ambition. His life was passed
in the most complete calm. He devoted himself to his work, and had the
supreme joy of duty accomplished, seeming to look for no other
enjoyment in life. Those who knew him best said that they had never
seen him angry or even impatient. In the midst of his discussion with
Broussais, it might have been expected that there would occasionally
have been some flashes of impatience, for the great protagonist of
medical theory was a man of satiric character, and his supposedly
scientific discussion was stained by some very bitter personalities.
In spite of all Broussais' sarcasm, Laennec remained absolutely
unmoved. Occasionally his friends saw a smile at some of Broussais'
emphatic asseverations, but Laennec simply continued at his work, and
looked straight ahead, convinced that what he was doing was for the
cause of truth, and the truth would finally prevail.

He was known for the kindness of his disposition, and his readiness to
help his friends whenever it was possible. He was never known to
injure anyone, and a certain quiet elevation of spirit preserved him
from all conceit. One of his most intimate Breton friends, Kergaradec,
said, "I have never heard Laennec express by a single word, or even by
the slightest insinuation, anything that might seem to indicate pride
in what he had accomplished or that might provoke a listener to say
something in praise of him." The friends he made were bound to him
with hoops of steel. They were not many, for he had not the time to
waste on many friends. He was too devoted to his work, and too {157}
deeply interested in the great problem whose solution he foresaw meant
so much for the good of humanity, to have much time for anything but
his studies and his patients.

With regard to Laennec's personal character, his most recent
biographer Dr. Henri Saintignon, has said: [Footnote 5]

      [Footnote 5: Laennec, Sa vie et son oeuvre. Par Dr. Henri
      Saintignon. Paris, J. B. Baillière et Fils, 1904.]

  "I have shown in the course of this life just what was the character
  of Laennec and his intellectual and moral qualities, so that it will
  not be necessary for me to dwell at length on this subject, in
  concluding. His great piety, which had never been abandoned from his
  earliest infancy, was his main guide during all his life. Without
  ostentation, yet without any weakness, absolutely ignoring human
  respect, he obeyed with utter simplicity the prescriptions of his
  faith. While he did not conceal his convictions when during the
  first empire they might have proved a source of lessened esteem, or
  positive prejudice, he made no noise about them when under the
  Restoration they might have proved the means of advancement and of
  fortune. He had not in the slightest degree what is so often
  objected to, in devoted persons, namely, the love of making
  proselytes. The words of Prof. Desgenettes might very well have been
  applied to him: as he did not believe himself to have any mission to
  lead others to his opinions, he limited himself to preaching by
  example. The reproach of being rabidly clerical or propagandist,
  which was urged against him, when he first became a member of the
  faculty of medicine, was absolutely unjustified. Laennec never
  occupied himself with politics nor with religion in public. As a
  physician he devoted himself exclusively to his profession,
  receiving at his clinic all those who desired to follow his
  teaching, whatever might be their opinions or their beliefs."

{158}

It was not long, however, before Laennec's many labors in Paris began
to tell on his health once more. His practice after his return to
health and his attachment to the court became large and lucrative. It
is characteristic of the man and his ways that he frequently refused,
owing to lack of time, to go to see wealthy patients, from whom he
would have received large fees, but it is said that he never refused
to go to see a poor patient. His hospital patients always received the
most solicitous attention, and his time was almost entirely at their
disposal. It was not long before Laennec himself, who had taught
modern physicians so much about the diagnosis of pulmonary diseases,
began evidently to suffer from pulmonary disease himself. There seems
no doubt now that almost constant association with tuberculous
patients in an overworked subject inclined naturally to be of
underweight, and therefore especially susceptible, led to the
contraction of the disease.

After about four years in Paris, a dry, hard cough developed
insidiously, gradually increased in annoyance, and finally grew so
serious as to demand a return once more to his native Bretagne. He
lost flesh, became subject to intermittent attacks of fever and
suffered from some pleuritic and pulmonic pains. For some time after
his return to his native air he improved. He was treated by the usual
method employed at the time whenever fever accompanied any ailment.
Venesection was the main part of what was then called the
antiphlogistic treatment. It is needless to say he did not improve. He
was suffering from exhausting disease and the treatment became really
an accessory to further exhaustion.

At last there could be no longer any doubt that the end was
approaching. The old curé of the village came often to visit him, and
brought him all the consolations of religion. {159} With his sincere
Christian faith and firm conviction, it was not hard for Laennec to
find the moral force and the calm necessary to secure an easy death.
Finally one day, on August 13th, his wife saw him take off his fingers
one after another the rings he wore, and place them softly upon the
table. When she asked him why he did so, he replied, "It will not be
long now before someone else would have to do this service for me, and
I do not wish that they should have the trouble." Even in death he was
thinking of others rather than of himself, and he was calmly facing
the inevitable, thoroughly prepared for it. Two hours afterward, at
five o'clock in the afternoon, without there having been at any time
the slightest loss of consciousness, Laennec passed away.

How faithfully his family had watched over him, and how simple was the
feeling of Christian confidence in all of them, may very well be
gathered from the letter of his cousin Ambrose to Laennec's brother
Meriadec in Paris.

  "My dear Meriadec:--Poor Renè is no more. His life was passed in the
  midst of labor and of benevolence. While he had all the virtues of
  the true Christian, and a wisdom far beyond what was usually granted
  to men, they have not sufficed to obtain for him the grace of a
  longer life. Somehow it was ordained that this glory and ornament of
  our family was not to remain with us. What a sad reflection it is on
  our restless eagerness in this life, and on the vanity of our hopes,
  that a genius like this must perish just when it was about to
  receive the fruit of its labors! He leaves to us a name, a name
  difficult to sustain and the example of virtues that it will not be
  easy to imitate. Let us hope that he will watch over us in the
  future as he has done in the past, and that he will still continue
  to aid us after his death. Although I have been prepared for this
  sad event, I could not suspect how much grief I was to experience in
  losing my {160} second master, my friend from earliest infancy, and
  him whom I had become accustomed to consider as my eldest brother. I
  must confess that for some years now we have all had to pay dear for
  the short intervals of happiness that it has pleased heaven to
  accord to us."

Laennec's burial took place in the cemetery of Ploare. The attendance
at the funeral was very large. Practically the entire population of
the countryside came to mourn for the benefactor that they loved so
much. He had made friends even among the simplest of the country
people and knew most of them by name. After his return to the country,
he had improved somewhat in appearance, and the neighbors had been
very glad to express their feelings of gratitude for his apparent
improvement in health. Undoubtedly not a little of this state of
better spirits was due to the fact that he liked Brittany and the
peasants of the neighborhood so well, and always felt so much at home
among them.

He was mild and agreeable in his manners, and of a quiet and even
temper. His conversation was lively and full of quiet humor, and his
friends often said that they never came away from a conversation with
him without having learned something. Toward the end of his life, when
his great reputation caused him to be honored by medical men from all
over the world, and when his reputation made him the lion of the hour,
he lost none of his natural affability and kindness of heart. He was
remarkable, especially, for his great kindness and courtesy to
foreigners, and he is said to have taken special care to make himself
understood by English-speaking medical visitors.

It must be confessed that he was somewhat less popular with his
contemporaries who did not belong to his immediate circle of friends
and students. One of the reasons for this was his genius, which no
generation seems ready to {161} acknowledge in any of its members.
Another reason was his continued misunderstanding with Broussais.
Broussais was the medical theorist of the hour, and medical theories
have always been popular, while medical observation has had to wait
for due recognition. There were undoubtedly good points in Broussais'
theories that Laennec failed to appreciate. This is the only blot on a
perfect career, taking it all in all, whether as man or as physician.
It can easily be understood with what impatience Laennec, entirely
devoted himself to observation, would take up the study of what he
considered mere theory, and it is easy to forgive him his lack of
appreciation.

Benjamin Ward Richardson says: "It was a common saying regarding
Laennec by his compeers that, while he was without a rival in
diagnosis, he was not a good practitioner; which means that he was not
a good practitioner, according to their ideas of practice, heroic and
fearful. To us, Laennec would now be a practitioner very heroic; so
much so, that I doubt if any medical man living would, for the life of
him, take some of his prescriptions. But in his own time, when so
little was known of the great system of natural cure, he would be
easily out of court. It was amply sufficient against him that he had a
glimmering of the truth as to the existence of a considerable run of
cases of organic disease, for which the so-called practice of remedial
cure by drugs, bloodlettings and other heroic plans, could do no good
but was likely to do grievous harm." We are reminded of Morgagni's
refusal to permit bloodletting in his own case, though he practised it
himself on others. Like Laennec, Morgagni seems to have doubted the
efficacy of bloodletting at a time when unfortunately all medical men
were agreed that it was the sovereign remedy.

If Laennec was not popular with his immediate {162} contemporaries,
succeeding generations have more than made up for the seeming neglect.
Less than twenty-five years after his death, Austin Flint, here in
America, hailed him as one of the five or six greatest medical men of
all times. Forty years after his death, Professor Chauffard, himself
one of the distinguished medical men of the nineteenth century, said:

  "Without exaggeration we can call the glory which has come to French
  medicine because of the great discovery of auscultation a national
  honor. It must be conceded that for a long time before Laennec, the
  great man of medicine, those to whom medical science owed its
  ground-breaking work did not belong to France. Harvey, Haller and
  Morgagni had made the investigations on which are founded the
  circulation of the blood, experimental physiology, and pathological
  anatomy, in other lands than ours. It almost seemed that we were
  lacking in the fecund possibilities of daring and successful
  initiative. Auscultation, however, as it came to us perfect from the
  hands of Laennec, has given us a striking revenge for any objections
  foreigners might make to our apathy. This discovery has rendered the
  scientific medicine of the world our tributary for all time. It was an
  immortal creation, and its effects will never fail to be felt. More
  than this, it will never be merely an historical reminiscence,
  because of the fact that it guided men aright, but it will in its
  actuality remain as an aid and diagnostic auxiliary. Auscultation
  will not disappear but with medical science itself, and with this
  stage of our civilization which guides, directs and enlightens it."

Laennec was known for his simple Bretagne faith, for his humble piety,
and for uniformly consistent devotion to the Catholic Church, of which
he was so faithful a member. His charity was well known, and while his
purse was very ready to assist the needy, he did not hesitate to give
to the {163} poor what was so much more precious to him, and it may be
said to the world also, than money--his time. After his death, and
only then, the extent of his charity became known.

Dr. Austin Flint said of him: "Laennec's life affords an instance
among many others disproving the vulgar error that the pursuits of
science are unfavorable to religious faith. He lived and died a firm
believer in the truths of Christianity. He was a truly moral and a
sincerely religious man."

Of his death, his contemporary, Bayle, who is one of his biographers,
and who had been his friend from early youth, said:

"His death was that of a true Christian, supported by the hope of a
better life, prepared by the constant practice of virtue; he saw his
end approach with composure and resignation. His religious principles,
imbibed with his earliest knowledge, were strengthened by the
conviction of his maturer reason. He took no pains to conceal his
religious sentiments when they were disadvantageous to his worldly
interests, and he made no display of them when their avowal might have
contributed to favor and advancement." Surely in these few lines is
sketched a picture of ideal Christian manhood. There are those who
think it wonderful to find it in a man of genius as great as Laennec.
It should not be surprising, however, for surely genius can bow in
acknowledgment to its Creator.

Shortly after the death of Pasteur it was well said that two of the
greatest medical scientists of the nineteenth century have given to
the physicians of France a magnificent, encouraging and comforting
example. It is almost needless to say these two were Laennec and
Pasteur, and their example is not for France alone, but for the whole
medical world. They were living nineteenth century answers to the
advocates of free thought, who would say that religious belief and
{164} especially Catholic faith make men sterile in the realm of
scientific thought.

No better ending to this sketch of Laennec's life seems possible than
the conclusion of Dr. Flint's address to his students in New Orleans,
already so often quoted from. It has about it the ring of the true
metal of sincere Christian manhood and unselfish devotion to a
humanitarian profession:

  "The career of the distinguished man whose biography has been our
  theme on this occasion is preeminently worthy of admiration. In his
  character were beautifully blended the finest intellectual and moral
  qualities of our nature. With mental powers of the highest order
  were combined simplicity, modesty, purity and disinterestedness in
  such measure that we feel he was a man to be loved not less than
  admired. His zeal and industry in scientific pursuits were based on
  the love of truth for its own sake and a desire to be useful to his
  fellow-men. To these motives to exertion much of his success is to
  be attributed. Mere intellectual ability and acquirements do not
  qualify either to make or to appreciate important scientific
  discoveries. The mind must rise above the obstructions of self-love,
  jealousy and selfish aims. Hence it is that most of those who have
  attained to true eminence in the various paths of scientific
  research have been distinguished for excellencies of the heart as
  well as of the head. The example of Laennec is worthy of our
  imitation. His superior natural gifts we can only admire, but we can
  imitate the industry without which his genius would have been
  fruitless. Let us show our reverence to the memory of Laennec by
  endeavoring to follow humbly in his footsteps." _Quod faustum
  vertat!_


{165}

THE IRISH SCHOOL OF MEDICINE


{166}


  There are men and classes of men that stand above the common herd:
  the soldier, the sailor, and the shepherd not infrequently; the
  artist rarely; rarelier still, the clergyman; the physician almost
  as a rule. He is the flower (such as it is) of our civilization; and
  when that stage of man is done with, and only to be marvelled at in
  history, he will be thought to have shared as little as any in the
  defects of the period, and most notably exhibited the virtues of the
  race.
    --Robert Louis Stevenson, Preface to _Underwoods_.


  The physician who is not also a scholar may be a more or less
  successful practitioner, but his influence will be confined, his
  methods mechanical and his interests narrow. The doctor, the lawyer
  and the minister of religion can do but inferior work, unless to a
  knowledge of their several sciences they bring the insight, the wide
  outlook, and the confidence which nothing but intimate acquaintance
  with the best that has been thought and said can confer. The more
  accomplished the specialist, the greater the need of the control
  which philosophic culture gives.
    --Bishop Spalding.

{167}

THE IRISH SCHOOL OF MEDICINE. [Footnote 6]

Robert Graves, M.D.

  [Footnote 6: For much of the material embodied in this series I am
  indebted to Sir Charles Cameron, the Historian of the Royal College
  of Surgeons in Ireland, whose courtesy to me while on a visit to
  Dublin in 1904 is one of the precious memories I shall always
  cherish. At the same time Sir Christopher Nixon and Sir John Moore,
  for letters of introduction to whom I was indebted to Prof. Osier,
  not only gave me valuable suggestions, but demonstrated how kind is
  the Celtic nature at its best.]


It has been always generally recognized that a very important portion
of what is called English literature is really due to the native
genius of the English-speaking writers of Irish birth and parentage,
whose Celtic qualities of mind and heart have proved the sources of
some of the most significant developments in the language of their
adoption. What a large lacuna would be created in English literature
by the removal from it of the work of such men as Dean Swift,
Goldsmith, Burke, Sheridan, and Moore! It is not so generally known,
however, that if the work of the distinguished Irish physicians and
surgeons of the last century were to be blotted out of English medical
literature there would be left quite as striking and as wide a gap. It
is, indeed, to what is known as the Dublin School of Medicine, for
medical schools have very properly been named usually after the cities
rather than the countries in which they were situated, that we owe not
a little of our modern progress in practical medicine, and especially
the advance in the clinical teaching of the medical sciences. Now that
the Gaelic movement is calling attention more than ever before to
things Irish, it {168} Seems only proper that this feature of the
national life should be given its due prominence and that the great
members of the Irish School of Medicine should not be without honor in
their own and other English-speaking countries.

There are three great names in the history of Irish medicine
recognized by all the world as well deserving of enduring fame. These
three names are Robert James Graves, William Stokes, and Dominic
Corrigan. Graves' name is indelibly attached to the disease known as
exophthalmic goitre, which he described and separated from other
affections before anyone else had realized its individuality. William
Stokes was, perhaps, the best authority on diseases of the heart and
lungs in his time. His name will be preserved in the designation of
the peculiar form of breathing which occurs in certain comatose
conditions and has received the name Cheyne-Stokes respiration, in
honor of the men who first called attention to it. Corrigan was in his
time one of the greatest authorities on the heart, and especially on
the pulse. His name is preserved in the term Corrigan pulse, which is
applied to a peculiar condition that occurs very characteristically in
disease of the aortic valves of the heart.

The lives of these men deserve to be better known, for they can
scarcely fail to be an inspiration to others to do work of a high
order in medicine--work that will represent not alone present success
and emolument but will stand for medical progress for all time.

Dr. Robert Graves was the youngest son of the Rev. Richard Graves,
D.D., Senior Fellow of Trinity College and Regius Professor of
Divinity in the University of Dublin, and of Elizabeth, daughter of
James Drought, also a fellow of Trinity College, whose family had been
long settled in King's County. His father, as a tribute to his
distinguished learning, was later promoted to the deanery of Armagh.
There {169} were two other sons in the family, Richard and Hercules.
All three of the boys passed through Trinity College with high honors
and, in fact, established a record there that has since been
unequalled, for at the degree examinations of three successive years
the gold medal in classics and in science, then the highest
distinctions attainable by students of Trinity, was conferred upon one
of the brothers.

Dr. Graves received his degree of Bachelor of Medicine at the
University of Dublin in 1818. After this he studied for some time in
London, and then spent three years on the continent, at Berlin,
Göttingen, Vienna and Copenhagen, as well as in Paris and certain
Italian schools, finally studying also for some months in Edinburgh
before his return to Dublin. As Dr. Stokes very well says: "In this
large and truly liberal education, which embraced the training of the
school, the university and the world, we can discover in part the
foundations of his subsequent eminence. He did not content himself, as
is so commonly the case, with commending--to use his own words--'the
life of a practitioner without practice,' but he made himself intimate
with the recent discoveries and modes of thinking in every great
school of medicine, whether abroad or at home, and formed friendships
with the leading physiologists and physicians of Europe, with many of
whom he kept up a correspondence during his life."

An interesting incident in his travels serves to illustrate very well
his facility for the acquisition of languages. Once while on a
pedestrian journey in Austria he neglected to carry his passport, and
was arrested as a spy. He was thrown into prison and for a time his
condition seemed serious enough. He insisted that he was a British
subject, but his assertions in this matter were immediately repudiated
by the Austrian authorities in the little town, who insisted that no
{170} Englishman could possibly speak German as well as he did. He was
kept in prison for some ten days until authentic information could be
obtained with regard to him, and, during this time, such was the state
of the prison that he suffered many privations. Later in life this
gave him a sympathy with the prisoners of Ireland and led to his
making suggestions for the amelioration of their condition.

Like practically all the great medical men who have proved to be
original workers, Graves' interest was not confined alone to medicine.
During his sojourn in Italy he became acquainted with Turner, the
celebrated English landscape painter, and was his companion in many
journeys. Graves himself was possessed of no mean artistic powers, as
his friend Stokes tells us, and his sketches are characterized by
natural vigor and truth. His thorough appreciation of his companion,
however, and the breadth of his sympathy and admiration for the great
painter of nature can perhaps best be understood from some candid
expressions of his with regard to their work in common: "I used to
work away," he said, "for an hour or more and put down as well as I
could every object in the scene before me, copying form and color as
faithfully as was possible in the time. When our work was done and we
compared drawings the difference was strange. I assure you there was
not a single stroke in Turner's drawing that I could see like nature,
not a line nor an object, and yet my work was worthless in comparison
with his. The whole glory of the scene was there."

After wandering for some three years in Europe, Graves returned to
Dublin and at once took a leading position in his profession as well
as in society. He came back at a very fortunate period for him. In
1807, Dr. Cheyne, who had been educated in Edinburgh, made the first
step toward the foundation of a new school of medical observation, by
the {171} publication of the first volume of the Dublin Hospital
Reports. Dr. Stokes says that the best proof of the value of these
reports is that they appear to have given the tone to the subsequent
labors of the Irish school which inherited their practical nature and
truthfulness. Within a year after Graves' return he appeared as one of
the founders of the new school of medicine in Park Street, and was
also elected physician to the Meath Hospital, where he commenced to
put into effect that system of clinical observation and instruction
which has done so much to establish the lasting reputation of the
Dublin School of Medicine.

For the next thirty years Graves' life is full of the teaching and the
practice of medicine. He was noted for his tenderness toward the poor,
but the rich soon came to appreciate his skill. Nothing ever made him
neglect his poor patients. Meantime he left his mark on every subject
that he handled in medicine. Fevers, nervous diseases of many kinds
besides that named after him, tuberculosis, and other forms of
pulmonary disease, were all illuminated by his practical genius in a
way that has made them clear for succeeding generations in medicine.

With regard to fevers especially Graves' work will count for all time,
because he set their treatment on so practical a basis. The trained
nurse is quite a modern acquisition, yet seventy-five years ago Dr.
Graves insisted that the services of a properly qualified nurse in
severe, continued fever are inestimable. He emphasized the necessity
for moral management in fever, and friends and relatives are seldom
capable of discharging this office. "If they chance to discover from
the physician's remarks or questions the weak points of the patient's
case they generally contrive to let him know them in some way or
another. If the patient is restless, for instance, the ill-judged
anxiety of his friends {172} will most certainly keep him from
sleeping. If he happens to take an opiate and they are aware of the
nature of his medicine they will surely inform him of it in some way
or another, though it may be only by a hint and his anxiety for sleep
conjoined with their disturbing inquiries prevents its due operation."


We are apt to think that the modern aphorism, nursing (meaning trained
care) is more important than medicine in the treatment of fever, is
the result of observations in our own day. Dr. Graves, however, felt
very deeply that the most important element in the treatment is the
conservation of the patient's strength with the preservation of his
morale, and this can be best accomplished when the patient is
constantly under the care of an experienced nurse, noting every
symptom and averting every possible source of worry and every form of
exhaustion of energy.

With regard to fever treatment, however, Graves' name is immortal in
medicine because of his insistence on the doctrine that fever patients
must be fed. A century ago the presence of fever was supposed
definitely to indicate that the patient should have no food. Any
contribution to his nutrition was supposed to feed the fever rather
than the patient. Graves pointed out, however, that at the end of a
long-continued fever the most serious condition is the emaciation and
weakness of the patient. He insisted that, appetite or no appetite,
fever patients should be fed regularly. The result was at once
noteworthy. Only the very hardy individuals had recovered before this;
now even weaker patients had a good chance for life. The mortality
from fever fell very strikingly, and in his time Dublin was overrun
with typhoid and typhus fever and the saving of life produced by the
new method of treatment was very considerable. Graves himself, when he
saw how much he had accomplished by his {173} new doctrine, said that
he wanted no better epitaph on his tombstone than the words, "He fed
fevers."

Some of Dr. Graves' very particular hints with regard to treatment of
fever show how careful he was in clinical observation. He deprecates
the allowance of very much fluid for patients, since their thirst
cannot be assuaged in that way, and the amount of liquid taken may be
harmful by causing depression. He suggests, therefore, the use of
acidulated water made by means of a little currant jelly or raspberry
vinegar, given in small portions and at regular intervals. Much better
than plain water he considers water to which some light bitter has
been added, such as cascarilla. Small quantities of this will appease
the morbid thirst of fever more effectually and for a much longer
period than large draughts of water.

Even more interesting in these modern times, however, than Graves'
attitude toward the treatment of fever is the position he took with
regard to the habits of life that were best for the consumptive. At
that time tuberculosis of the lungs was considered to be an
inflammatory disease requiring the patient to be in the house most of
the time, carefully protected from cold, and during any rise of
temperature to be kept in warm rooms, without any special
encouragement to take food. Graves and Stokes changed all that, and
for the time completely revolutionized the principles of treatment for
this serious ailment. Alas! their work, notwithstanding the good
results shown in a certain number of cases, failed to attract
widespread attention, and not until our own time did the principles
that they laid down as the rational basis of successful therapeutics
for tuberculosis come to be generally adopted.

Graves insisted that his patients when suffering from beginning
tuberculosis should not be confined to the house, {174} but on the
contrary should be out of doors most of the time. He emphasized what
he called the taking of exercise, but in such a way that he agrees
much more than might be thought with modern ideas on this subject.
Now, it is insisted that tuberculous patients must not overtire
themselves by taking exercise, though they must be in the open air a
large part of the time. Graves explains the exercise that he would
like to have them take by saying that they should spend four or five
hours every day riding in a carriage, or, as he seems to prefer, in an
open jaunting-car. And that they should spend at least as much time
sitting outside in quiet.

Besides this the most important element in treatment he considers to
be the encouragement of the appetite--as might be expected from the
man who first fed fevers. His directions in this matter are very
explicit, and he suggests various methods by which patients can be
tempted to eat more and more food, and emphasizes the use of cereals
and of milk and eggs as likely to be of most service in helping these
patients to gain in weight and strength so as to be able to resist the
further advance of the disease. This, it may be said in passing, is
just the ideal treatment for the consumptive at the present time.

Others of Graves' opinions in regard to tuberculosis are in general
surprisingly modern. He insists, for instance, that the main causes of
the disease are overcrowding in towns, the long hours of hard work in
factories, and abuse of alcohol. He thought that the population of
country places, though fed no better as a rule than in the city, do
not develop the disease so frequently because of their opportunity for
fresh air. He placed very little confidence in the opinion that cold
has anything to do with tuberculosis, though he disputed Laennec's
dictum that bronchitis was never the beginning of tuberculosis. Graves
advises his students not to try to {175} protect their throats by
means of mufflers, for this will only render them more liable to cold.
His advice is rather to harden themselves against cold. For this he
suggests the use of water plentifully on the chest and throat, to be
employed not too cold during the winter time, unless one is used to
it. He also suggests the use of vinegar and alcohol as hardening
fluids. They should be applied freely, and in his experience were
effective.

Another interesting anticipation of modern methods was with regard to
child feeding in summer diarrhoea. It is often thought that only in
recent years, with the development of the science of bacteriology, the
danger of continuing milk feeding when infants are already ill in the
summer has come to be recognized. Milk is now known to be an excellent
culture medium for various forms of bacteria, that is, it is a
substance on which microbes grow plentifully, and it is often used in
the laboratory to raise microbes. Dr. Graves, however, without any
knowledge of modern bacteriology, but from clinical observation alone,
pointed out that the only way to avoid summer diarrhoea is to stop all
milk feeding.

"Let the infant," he says, "abstain from milk in any shape for
twenty-four hours, sometimes for the space of two or even three days.
It is incredible how small a portion of milk, even in the most diluted
state, will keep up this disease, acting like a species of poison on
the intestinal mucous surface."

Here, of course, was scientific intuition running far beyond medical
knowledge, and pointing out a serious danger and the best means of
avoiding it. There is scarcely a subject touched upon in Dr. Graves'
clinical lectures, however, which is not illuminated in this way by
precious sidelights, many of which unfortunately were obscured by
medical {176} theories, and conclusions founded on them without due
experience.

We have already said that his careful clinical observations led him to
separate the type of disease which has since come to be known as
Graves' disease from a number of other forms of nervous disturbances
of the heart rhythm. There is at least one other class of disease
usually considered to be much more modern, the type of affection known
as Raynaud's disease, or a tendency to spontaneous stoppage of the
circulation in the extremities, and also the other type now known as
Weir Mitchell's disease, or erythromelalgia, in which there is
suffused redness and pain in the extremities, examples of which Graves
picked out from his hospital service and described in such a way that
it is easy to recognize them even at this distance of time. His two
volumes of clinical lectures on the practice of medicine are much more
than an index of the medical teaching of his time. They contain
anticipations of many a supposed after-discovery, besides an immense
amount of very practical observations made at the bedside, and
valuable hints for treatment, the result of his personal experience.

One of the best proofs of the greatness of the work accomplished by
Graves is to be found in the tribute to his character, and what he
achieved, by Professor Trousseau, who was at the time the acknowledged
leader of the clinicians of Europe. He said:

  "For many years I have spoken of Graves in my clinical lectures; I
  recommend the perusal of his work; I entreat those of my pupils who
  understand English to consider it as their breviary; I say and
  repeat that, of all the practical works published in our time, I am
  acquainted with none more useful, more intellectual; and I have
  always regretted that the clinical lectures of the great Dublin
  practitioner have not been translated into our language."

{177}

A little later in the same lecture he said:

  "And nevertheless, when he inculcated the necessity of giving
  nourishment in long-continued fevers, the Dublin physician,
  single-handed, assailed an opinion which appeared to be justified by
  the practice of all ages; for low diet was then regarded as an
  indispensable condition in the treatment of fevers. Had he rendered
  no other services than that of completely reversing the medical
  practice upon this point, Graves would, by that act alone, have
  acquired an indefeasible claim to our gratitude."

His tribute closes with the following very striking passage:

  "I freely confess that I had some difficulty in accepting,
  notwithstanding the imposing authority of Graves, what he states of
  the influence of certain remedies, such as mercurials, essence of
  turpentine, spirituous preparations, nitrate of silver, etc.; but
  the Dublin professor speaks with so much conviction that I ventured
  to follow his precepts, and I must say that my early trials very
  soon encouraged me to adopt unreservedly what I at first accepted
  only with misgivings. There is not a day that I do not in my
  practice employ some of the modes of treatment which Graves excels
  in describing with the minuteness of the true practitioner, and not
  a day that I do not, from the bottom of my heart, thank the Dublin
  physician for the information he has given me.

  "Graves is, in my acceptation of the term, a perfect clinical
  teacher. An attentive observer, a profound philosopher, an ingenious
  artist, an able therapeutist, he commends to our admiration the art
  whose domain he enlarges, and the practice which he renders more
  useful and more fertile."

After this tribute from one who was himself one of the greatest
medical teachers of his generation, it will be very interesting to
find how much Graves anticipated nearly three-quarters of a century
ago the principles of the bedside {178} teaching of medicine which
have come to be acknowledged as the only sure basis of a genuine,
practical medical education. For him the only possible way to learn
medicine practically was to study it at the bedside, and he insisted
over and over again that while the theoretical sciences allied to
medicine were eminently fascinating, they were of little actual value
in teaching the student how to solve the all-important problem of
treating patients. In his address before the Dublin Medico-Chirurgical
Society, an association of students in connection with the Dublin
hospitals, he said in 1836:

  "Many causes contribute to prevent students from attaining what
  after all should be the great object of their wishes--practical
  knowledge. The different sciences to which you are required to turn
  your attention successively possess so many fascinations that you
  may attach to some an undue degree of importance; but be assured of
  this, that however accurate be your knowledge of anatomy, healthy
  and morbid, however skilful you may be in the chemical theories and
  manipulations, however extensively you may have mastered the
  necessary properties of botany, however well you are acquainted with
  the nature and properties of drugs--be assured, I say, that you have
  acquired all this knowledge in vain unless you have diligently
  studied symptoms at the bedside of the patient and have observed the
  consequences and causes of disease in the dead room. In fact, in
  whatever other pursuits you may employ your afternoon hours, the
  morning should always be dedicated with earnestness to the hospital;
  from its wards all appearance of levity and inattention must be
  banished, for your neglect of the opportunities there presented for
  observation loads you with a serious amount of responsibility, I had
  almost said of guilt. It is no light thing to have life entrusted
  into your hands; we are all liable to err, we all commit mistakes;
  {179} the rules of our art are not invariably precise and certain;
  but they only are guilty who have not used every opportunity of
  acquiring practical knowledge; he is doubly guilty who, conscious of
  his neglect, embarks in practice and commences with the decision and
  boldness true experience alone can confer."

At a comparatively early age Graves realized more than most men that
medicine is an art and not a science, and that each individual case
presents problems that have to be studied out for themselves and for
which no general principles of diagnosis, prognosis or therapeutics
serve. He appreciated that there was no royal road to medical wisdom,
in the sense of a scientific shortcut by means of which manifestations
of disease and their indications for treatment might be grouped
together and easily learned. Nor, may we add, has any such road been
found since. Each physician must train himself by patient, repeated
observation, and without this discipline and training there can be no
real success. Accordingly he said to his students in Dublin:

  "The chief object of medical science is to relieve suffering and to
  save life: you must, therefore, anxiously watch the action of
  remedies and, by constantly noting down the effects of treatment,
  learn to appreciate its merits and apply it when required. Nor is
  this an easy task; some indeed have vainly imagined that the method
  of treating or curing disease could be compressed within the limits
  of a few short directions made easily deducible from some general
  principles and easily applicable in any particular case; but it is
  not so. Gentlemen, we have as yet discovered no such general
  principles to serve as guides. This discovery presupposes a
  knowledge of the laws and relations of the vital powers far beyond
  what we now possess: no, we must toil onward by a much more {180}
  laborious and circuitous route and must commence by making ourselves
  thoroughly masters of a vast number of individual cases, assisted by
  the observations and the writings of practical men; we may afterward
  proceed to arrange our knowledge, to classify it so as to render it
  more available; analogy and induction are here our only or at least
  our most valuable guides, and they will seldom fail to instruct us
  how to act when properly consulted."

While recognizing all the difficulties of medical practice and the
essential individualization of all its problems, Dr. Graves had little
or no patience with the skeptic who thought that medicine could
accomplish but little for the cure of many ailments. He said once
before the Medico-Chirurgical Society:

  "Many, indeed, aiming at acquiring the character of medical
  skeptics, think they exhibit proofs of superior discrimination when
  they, with apparent candor, make the confession that the more they
  see the less confidence they have in the resources of medicine. This
  confession should be interpreted not as a reproof of our art, but as
  a testimony of the want of skill of the would-be philosophical
  asserter of so false a proposition. No, God be praised, our
  predecessors have not toiled in vain; the anxious experience of ages
  has not been recorded to no purpose; our art is in truth boundless
  in resources and, when applied with ability, most successful. There
  are, indeed, some acute and many chronic diseases which baffle our
  powers of diagnosis, and defy our modes of treatment; such appear to
  be, however, not numerous when compared with the great mass of cases
  capable of cure or alleviation. The medical skeptic, however acute
  his powers of reasoning may be, and however he may labor to render
  plain subjects obscure and direct facts ambiguous, can never rob the
  good practitioner of the {181} pure, the inward joy he feels when
  conscious that he has snatched a patient from the jaws of death."

Knowing that such were his ideas with regard to the practice of
medicine, it is all the more interesting to review the system of
teaching that Graves considered most likely to produce genuine
practitioners of medicine. Those who have been mainly concerned with
the reform of medical education here in America in recent years can
scarcely fail to be struck with the appropriateness of Graves' ideas
on this subject nearly a century ago. When a very young man he did not
hesitate to express his deprecation of the conventional and artificial
methods of medical instruction in his own time, and he anticipated
what is best in the methods that have gradually come into vogue at the
end of the nineteenth and the beginning of the twentieth centuries.
His views will always remain a suggestive storehouse of thought for
those who have the higher medical education at heart.

In his introductory lecture at the opening of the Medical course at
the Meath Hospital in Dublin in 1821, he declared very definitely what
he considered to be the principal aim of the medical student:

  "Students should aim not at seeing many diseases every day; no,
  their object should be constantly to study a few cases with
  diligence and attention; they should anxiously cultivate the habit
  of making accurate observations. This cannot be done at once; this
  habit can be only gradually acquired. It is never the result of
  ability alone; it never fails to reward the labors of patient
  industry. You should also endeavor to render your observations not
  only accurate but complete. You should follow when it is possible
  every case from its commencement to its termination; for the latter
  often affords the best explanation of previous symptoms and the best
  commentary on the treatment."

{182}

Graves was inculcating in principle what Corrigan and himself and
Stokes were to exemplify so thoroughly in practice in the next few
years. Before the end of the decade in which this address was
delivered at the Meath Hospital, Corrigan at the little Jervis Street
Hospital, where there were only beds for six medical patients
altogether, was to make his great discoveries with regard to aortic
disease, and to lay the sound basis of the diagnosis of affections of
the heart for all time. There are many passages in this address of
Graves that might well serve for warnings to the present day and
generation as regards methods of medical education which do not
include sufficient practical teaching. He said, for instance:

  "The chief objection to our present mode of teaching is that,
  however well inclined the student may be, he is never obliged to
  exercise his own judgment in distinguishing diseases and has no
  opportunity of trying his skill in their cure, and consequently at
  the end of his studies he is perhaps well grounded in the accessory
  sciences--is a perfect medical logician--able to arrange the names
  of diseases in their classes, orders and different subdivisions; he
  may be master of the most difficult theories of modern
  physiologists; he may have heard, seen and, if a member of the
  medical society, he may also have talked a great deal; but at the
  end of all this preparation what is he when he becomes a full
  doctor?--a practitioner who has never practised!"

These words have quite as suggestive applications to most phases of
our modern education as they had to that of Graves' time. There are
other passages that bear so significant a meaning in this regard that
one can scarcely refrain from quoting:

  "Our present method of instruction is indeed very useful and nothing
  better can be devised for a beginner; but for {183} the more
  advanced student it is by no means sufficient, nor is it calculated
  to give him practical experience, without which all other
  acquirements are of no avail. I say it does not give him experience,
  because he has at no time been charged with the responsibility of
  investigating a case for himself, and by himself; because at no time
  has he been called on to make a diagnosis, unassisted by others; and
  above all because he has never been obliged to act upon that diagnosis
  and prescribe the method of treatment. If those who had been thus
  educated, and who had been made doctors upon so slender a
  foundation, were to confess the truth, we should be presented with a
  picture calculated to excite dismay if not a stronger feeling. How
  many doubts and distracting anxieties attend such a man at his first
  patient's bedside. If the disease be acute and life in imminent
  danger, and if he shrink under this sudden and unusual load of
  responsibility, he gains little credit for professional ability. If,
  on the contrary, inexperienced as he is, he assumes that decision of
  judgment, that energy of practice which experience alone can confer,
  is it not probable that the result will be still more disastrous?"

Graves' last days and the circumstances of his death and burial are
given by Professor Stokes, his great personal friend, and himself one
of the most distinguished physicians of his time. We quote the
concluding paragraph of Professor Stokes' biographical notice:

  "It was in the autumn of 1852, he being then in his fifty-seventh
  year, that the symptoms of the malady which was to prove fatal first
  showed themselves. In the following February he began to succumb to
  the disease. Although at times his sufferings were great, yet he had
  many intervals of freedom from pain. And he then showed all his old
  cheerfulness and energy. To the very last he continued to {184} take
  pleasure in hearing of any advance of knowledge that tended to
  ameliorate the condition of man, or to throw light on his relations
  to a future state. In this latter point of view, the discoveries of
  Layard greatly interested him, as illustrative of the Sacred
  History; and thus he was permitted to fill up the intervals of his
  sufferings, even to the last; for his mental faculties never failed
  or flagged,--a mercy for which he often expressed a fervent
  gratitude; and so he was providentially enabled to review the past,
  and to form a calm and deliberate judgment on the religious
  convictions of his earlier years. And once the truthfulness of these
  were ascertained, he adhered to them with that earnestness which
  characterized all his decisions.

  "It was after the attainment of this state of patient expectation
  that one who was dear to him expressed a prayerful wish for his
  recovery. 'Do not ask for that,' he replied; 'it might prove a fatal
  trial.'

  "His mind having become thus satisfied he made few remarks on these
  subjects, except in reply to the inquiries of others. Thus, when
  referred to the prophetic illustration of purifying and redeeming
  love, 'A fountain shall be opened for sin and for uncleanness,'
  'No,' he said, 'not a fountain, but an ocean.'

  "On the day before his death he desired (a second time) to partake
  of the Holy Communion, with his family. When some explanations were
  commenced, he answered, 'I know all that; I do not regard this as a
  charm, but I wish to die under the banner of Christ.' Feeling
  himself sinking, he asked for prayer, and a petition was offered
  suitable to his condition; but he seemed to long for something more
  and, when questioned, replied, 'I want some prayer that I know, some
  of the prayers of my youth, some of my father's prayers.' The Litany
  was commenced, he immediately took up the {185} well-known words,
  and when the speaker's voice faltered he continued them alone, and
  distinctly, to the end of the strain, 'Whom thou hast redeemed with
  thy most precious blood.'

  "On the twentieth day of March, 1853, and without renewed suffering,
  he ceased to breathe.

  "His tomb is in the cemetery of Mount Jerome. It bears the following
  inscription dictated by himself:

         "ROBERT JAMES GRAVES,
  Son of Richard Graves, Prof. of Divinity,
                  Who,
   After a Protracted and Painful Disease,
       Died in the Love of God, and
                In the
         Faith of Jesus Christ."



William Stokes.

Very closely associated with the name of Robert Graves in all that
made the Irish School of Medicine influential for good, about the
beginning of the second quarter of the nineteenth century, is that of
William Stokes. Stokes' work on Diseases of the Chest and, later in
life, his treatise on Diseases of the Heart and Aorta stamp him as one
of the great physicians of all time. His name is assured of
immortality in medicine, because with that of the well-known Scotch
physician, Cheyne, who came to Dublin late in the second decade of the
nineteenth century, it is associated in the term most commonly used
for a form of breathing, having special diagnostic and prognostic
significance in certain serious diseases, and which is known as
Cheyne-Stokes respiration. Even more interesting, however, than Stokes
the physician, is, as we shall see, Stokes the man, and all that he
stood for in his generation in Dublin, during a long life.

{186}

William Stokes was of a family that had long been distinguished in
Dublin for scholarship. While his ancestors came originally from
England, five generations occupied more or less prominent positions in
the public life of Ireland, and they had lived in Dublin for more than
one hundred and fifty years before Stokes began to be prominent in
Irish medicine. His father, Whitley Stokes, had been a scholar and
Senior Fellow of Trinity College, and was prominent in the scientific,
political, and literary circles of the Irish capital at the end of the
eighteenth and the beginning of the nineteenth century. He had been a
member of the United Irishmen, but fearing that the revolutionary
principles that were being propagated would only bring about an
ineffectual rebellion, he separated himself from them, though years
after when the United Irishmen came under the ban of the English
government his previous connection with them cost him suspension from
the fellowship. Later on, however, Whitley Stokes became the Regius
Professor of the Practice of Medicine at Trinity College, a chair
which he held until succeeded in the early forties of the nineteenth
century by his son, William, the subject of this sketch. Something of
the character of the man can be judged from the fact that though he
was a distinguished physician and interested in every branch of
science, taking an active part in the foundation of Trinity College
Botanical Gardens, and being one of the founders of the Zoological
Garden in Phoenix Park, he was also the author of a prize essay in
reply to Tom Paine's Age of Reason, which was then attracting so much
attention.

Our William Stokes was the second son of Whitley Stokes, and was born
in Dublin in 1804. Like many another distinguished investigator in
science, he was not looked upon as a bright student as a boy, and
indeed could be prevailed upon to interest himself only very slightly
in what is usually {187} considered to be the absolutely necessary
fundamental work in education. He had a great love for poetry and
romance, which indeed he carried with him all his life. The Scottish
Border Ballads were his favorite reading, and he spent days in
committing them to memory. Almost needless to say his apparent
indolence and disinclination to any steady, methodical system of study
were, as his son, the late Sir William Stokes, records in his
biography of his father, sources of real concern to his parents, and
caused his mother specially much anxious thought. One day while
reading his favorite author, Sir Walter Scott, he fell asleep--to be
awakened shortly after by some warm drops falling on his face. He
started up to find his mother bending over him. It was her tears that
had awakened him. Stung with remorse at having been the cause of so
much sorrow to the mother whom he loved very dearly, his nature
underwent an immediate and salutary change, and the dreamy, indolent
boy became thereafter the ardent and enthusiastic student.

Stokes amply made up for any neglect of study there might have been in
his boyhood days as soon as he entered upon the medical course to
which he felt called. Here he came to be looked upon as one of the
most ardent and painstaking of students.

His preliminary medical studies were begun in Dublin at the Meath
Hospital. Chemistry he learned in the laboratory of Trinity College
and anatomy in the Royal College of Surgeons. After spending several
years thus he went to Glasgow, where for two years more he was
occupied mainly at chemistry in the laboratory of Professor Thompson.
Like most of the young Irishmen of his time, he next proceeded to
Edinburgh in order to complete his education in clinical medicine and,
if possible, obtain his medical degree from that famous institution.
It was at Edinburgh, under the magnetic {188} influence of that great
teacher, Allison, that Stokes began to develop the rare powers of
original observation which at an early age placed him in the front
rank of the best medical men of the time.

It is interesting to note that before he left Edinburgh he published
his first medical work, a treatise on the use of the stethoscope,
which was undoubtedly the means of bringing that instrument--and with
it Laennec's fruitful system of physical diagnosis by means of
auscultation--to the general notice of the English-speaking medical
profession. Even after all that has been written on the subject, it
remains a very valuable little book. It was dedicated to the famous
Cullen, who had already published a series of cases which had been
illustrated by the use of the stethoscope, and to whom Stokes probably
owed the idea of the need for a formal little treatise on the subject.
It is typical of the slow adoption of medical novelties even when they
are of great importance that more than ten years afterward, old-time,
though distinguished, physicians not infrequently made fun of Stokes
for spending so much time in the study of cases with the stethoscope,
since in their opinion it was little more than a toy. This was done in
no bitter, carping spirit, but with the most friendly complacency and
condescension. Stokes, however, intensely practical in his way,
realized the value of the instrument, and as the result of his
teaching it soon began to be more generally used; thus introducing
into English-speaking medical circles that exact knowledge of diseases
of the chest which can only be obtained by means of this little
instrument and the methods of auscultation which are associated with
it.

Immediately after graduation, Stokes settled down in his native city
to practise. In 1826, when Stokes was only twenty-two, Dublin was
visited by one of those epidemics of typhus fever which were so common
in the first half of the {189} nineteenth century, and which consisted
evidently, at least to a great degree, of what we now call typhoid
fever, but intermixed with many cases of the real, dread typhus. The
mortality in such epidemics, as we have reason to know from statistics
here in New York, was always over twenty-five per cent, and often
reached far above fifty per cent. The manner of contagion was unknown,
only it was very well understood that those much in contact with the
patients were likely to contract the disease. Among the poorer classes
in Dublin the fever raged with virulence, but young Stokes devoted
himself to the care of patients to an extent that severely taxed his
physical powers of endurance. He devoted himself especially to the
poorer classes. He did not contract the fever during the height of the
epidemic in 1826, but he did in 1827, when it recurred, but
fortunately he suffered in the mild form.

An epidemic of another disease, Asiatic cholera, the danger from which
has been almost entirely removed by the progress of scientific
medicine in modern times, followed not long after. It showed itself in
Dublin, when Stokes was about twenty-five. He it was who recognized
the first case of the disease, and sounded the note of warning that
probably saved many lives by calling attention to the danger that was
just beginning. Once more he devoted himself to the care of the
patients, and, as with regard to typhus fever, wrote an account of his
experiences, which is in itself a valuable medical document that shows
the powers of observation of the young medical man.

Stokes spent himself in labor for the poor, and his deep interest in
their welfare led him to sacrifice much time in order to organize
medical charities for his unfortunate countrymen during the sad years
of that awful fifth decade of the nineteenth century. His interest in
this matter of {190} organization led him also to realize how much
might be accomplished by public hygiene and efficient government
sanitation. He recognized too how much would be accomplished along
these lines if men were given proper training to make them specialists
in these subjects. To Stokes then, almost more than to any other man,
is due the development of public sanitation as a special science, and
its organization for the proper safeguarding of public hygiene.

His efforts, especially with regard to the physicians of Ireland, who
so nobly sacrificed, not unfrequently at the expense of other
practice, their time, health, and often even their lives, in order to
aid their stricken countrymen, form one of the best monuments to his
tender sympathy and his goodness of heart as a man. His testimony
before the Parliamentary Committee was at this time of the utmost
value in securing due recognition of their services.

In 1843, when the Medical Charities Bill was brought forward, Stokes
and Cusack united in the effort to procure for these devoted men an
amelioration of the conditions under which they labored. They repaired
to London to give evidence on the subject before the House of Commons.
Both these friends had had to deplore the loss of many of their
dearest and most promising pupils, who, after a short experience of
country practice, had fallen victims to fever contracted in the
discharge of their duties. They pleaded that in all justice the
remuneration for attendance on fever hospitals and dispensaries should
be fixed at a liberal scale, and that some provision ought to be made
for the widows and children of gentlemen who had lost their lives in
the public service. They collected statistics which proved that during
a period of twenty-five years the mortality of the medical
practitioners of Ireland was twenty-four per cent., while in most
instances the cause of death was typhus fever. They {191} showed that,
on the authority of Inspector-General Marshall, the comparative
mortality of combatant officers in the army was less than half that,
amounting to only ten and a quarter per cent. It was little to be
wondered at that William Stokes should say, in answer to the
chairman's question regarding the existence of any special risk to the
medical officer in Ireland: "Such a number of my pupils have been cut
off by typhus fever as to make me feel very uneasy when any of them
take a dispensary office in Ireland. I look upon it almost as going
into battle." Again he observes: "The medical practitioners in Ireland
are placed in a position very different from and far more serious than
that of their brethren in Great Britain. . . . . The Irish physician
is often exposed to contagion in its most concentrated force when
himself under the influence of cold, wet, fatigue, and hunger, as he
labors among the poor, passing from hovel to hovel in wild and
thinly-populated but extensive districts. He has often to ride for
many hours in the worst weather, and at night, enduring great fatigue,
while himself a prey to mental as well as physical suffering; for if
we add to such labor the injurious influence which the knowledge of
danger must have on the system of a man feeling that he is struck down
by the disease under which he has seen so many sink, and tortured by
the thought of leaving a young family unprovided for, we can
understand how it happens that the country is so often deprived by
death of so many of its best educated and most devoted servants."

Perhaps the most interesting phases of Stokes' purely medical work
during the first part of his career is his treatment of the subject of
consumption. When not quite thirty-three he wrote a treatise on the
diagnosis and treatment of diseases of the chest. His familiarity with
the work of Graves and of Auenbrugger gave him command of all the
{192} modern methods of physical diagnosis, so that he was able to
study tuberculosis to the best possible advantage and with the least
possible chance of too favorable judgment with regard to its cure.
Notwithstanding the accuracy of his knowledge, however, he insisted
that the disease was curable, and that the important point with regard
to it was the recognition of it as early as possible, in order that
the patient might be given the best chance for life.

At that time most physicians considered tuberculosis to be an
hereditary disease, without any idea of its being possibly contagious.
Acceptance of heredity seemed to set the stamp of inevitable fatality
on the heads of victims of the disease. To announce the curability of
tuberculosis then was to run counter to all the medical traditions of
the time, and Stokes in doing so must have had in support of his
teaching many observations of patients who had been cured
notwithstanding the fact that they were assured sufferers from this
supposedly fatal disease. We know that Stokes was surely correct in
his judgment in this matter, and realize too that his method of
treatment, which included abundant feeding and long hours each day in
the outdoor air, comprised the best elements of the modern treatment
of tuberculosis.

Perhaps one of the most striking anticipations of what is apt to be
considered quite modern in medicine is Dr. Stokes' descriptions of the
methods by which he considers certain forms of heart weakness,
especially that incident to incipient fatty disease, should be
treated. His directions are almost exactly those which have made the
names of the Schott Brothers known throughout the world during the
last twenty-five years. To have anticipated our modern views with
regard to tuberculosis, its curability, and the best methods of
treatment shows how thoroughly Stokes had studied his cases of
consumption. That the same man {193} should also have been able to
work out the details of treatment for heart weakness is a triumph that
indicates better than anything else perhaps the genius of the
physician not only in the observation of disease, but above all in
that more important part of medicine--the proper application of
therapeutic principles.

Stokes observes, "In the present state of our knowledge the adoption
of the following principles in the management of a case of incipient
fatty disease seems justifiable:

  "We must train the patient gradually but steadily to the giving up
  of all luxurious habits. He must adopt early hours, and pursue a
  system of graduated muscular exercises; and it will often happen
  that, after perseverance in this system, the patient will be enabled
  to take an amount of exercise with pleasure and advantage which at
  first was totally impossible owing to the difficulty of breathing
  which followed exertion. The treatment by muscular exercise is
  obviously more proper in younger persons than in those advanced in
  life. The symptoms of debility of the heart are often removable by a
  regulated course of gymnastics or by pedestrian exercise, even in
  mountainous countries, such as Switzerland, or the Highlands of
  Scotland or of Ireland. We may often observe in such persons the
  occurrence of what is commonly known as 'getting the second wind;'
  that is to say, during the first period of the day the patient
  suffers from dyspnoea and palpitation to an extreme degree, but by
  persevering, without overexertion, or after a short rest, he can
  finish his day's work and even ascend high mountains with facility.
  In those advanced in life, however, as has been remarked, the
  frequent complications with atheromatous disease of the aorta and
  affections of the liver and lungs must make us more cautious in
  recommending the course now specified."

{194}

If any proof of Stokes' ability as an observer and a teacher were
needed it would be readily found in his original description of the
form of respiratory disturbance since known as Cheyne-Stokes
respiration. The passage is besides a model of succinct completeness
of description that would well deserve to be in the commonplace book
of physicians who write, for so many of them need to imitate his
conciseness and clarity. It is to be found in his book _Diseases of
the Heart and the Aorta_, p 336.

  "A form of respiratory distress, peculiar to this affection (fatty
  degeneration of the heart), consisting of a period of apparently
  perfect apnoea, succeeded by feeble and short inspirations, which
  gradually increase in strength and depth until the respiratory act
  is carried to the highest pitch of which it seems capable, when the
  respirations, pursuing a descendant scale, regularly diminished
  until the commencement of another apnoeal period. During the height
  of the paroxysm the vesicular murmur becomes intensely puerile."

It is curiously interesting to find that a favorite subject of
discussion in the Irish medical societies of nearly fifty years ago
was a topic which is still frequently on the tapis in medical society
meetings. In one of his public addresses Dr. Stokes bewailed the fact
that medicine did not have its proper place in the estimation of the
people and was not able to assert its dignity as a profession in its
proper sphere. He discussed also the remedies for this state of
affairs, and as he was a man of eminently broad views, of very large
experience, and of sane, conservative judgment, they are worth while
pondering at the beginning of the twentieth century, for the practical
problems of professional life which he sets forth are still with us.
It is for this reason that it has seemed worth while to give a rather
lengthy quotation that would adequately represent his conclusions in
the matter.

{195}

  "Is it by public agitation and remonstrances addressed to deaf or
  unwilling ears that these medical abuses are to be corrected? Is it
  by the demand for class legislation? or is it, by the efforts of one
  and all, to place medicine in the hierarchy of the sciences--in the
  vanguard of human progress; eliminating every influence that can
  lower it, every day more and more developing the professional
  principle, while we foster all things that relate to its moral,
  literary, and scientific character? When this becomes our rule of
  action, then begins the real reform of all those things at which we
  fret and chafe. Then will medicine have its due weight in the
  councils of the country. There is no royal road to this
  consummation. On the one hand, the liberal education of the public
  must advance, and the introduction of the physical sciences in the
  arts courses of the universities must give the death-blow to
  empiricism; and, on the other, education of ourselves must extend
  its foundations, and we should trust far less to the special than to
  the general training of the mind. When medicine is in a position to
  command respect, be sure that its reward will be proportionally
  increased and its status elevated. In the history of the human race,
  three objects of man's solicitude may be indicated: first, his
  future state; next, his worldly interests; and lastly, his health.
  And so the professions which deal with these considerations have
  been relatively placed: first, that of divinity; next, that of law
  or government; and, as man loves gold more than life, the last is
  medicine. But, with the progress of society, a juster balance will
  obtain, conditionally that we work in the right direction, and make
  ourselves worthy to take a share in its government, not by coercive
  curricula of education; not by overloaded examinations in special
  knowledge, which are, in comparison to a large mental training,
  almost valueless; but by seeing to the moral and religious {196}
  cultivation, and the general intellectual advancement of the
  student."

From this, it is to be feared that Dr. Stokes would have very little
sympathy with the specializing trend of modern medical education.
Certain it is that not thus were the medical giants of the old days
developed; but the times have changed; perhaps we should change with
them, only the danger of the change must be ever kept in mind so as to
avert, if possible, its most serious consequences at the first
warning.

While Stokes felt deeply for the Irish people, and the sad conditions
under which they were laboring, unfortunately, like many another
educated Irishman, he had very little active sympathy in any of the
movements for their relief. He was a man in early middle life when
O'Connell's agitation began, but he had no part in the movement. Later
on, when his personal friend, Isaac Butt, was engaged in his great
political work for Ireland, Stokes tried to dissuade him from it,
feeling that the arousing of the people to a realization of their
rights only led to a tighter riveting of their chains. Better judgment
has prevailed and now practically all classes are united in the Gaelic
movement, making it harder to understand Stokes' position, yet his is
a case for sympathy rather than blame. His heart was touched, but his
head could not see a happy issue for his countrymen, and so he
preferred to have them endure in patience rather than suffer further
ills through coercive measures.

Dr. Stokes realized, however, all the iniquity of the union of the
Irish and English parliaments, and a favorite story of his was told
with regard to one of the members of the Irish Parliament who sold
themselves to England. This member, finding that he was unnoticed in
the distribution of rewards after the passage of the Union, though
eighteen of his {197} fellow-members were raised to the peerage,
waited on the Secretary of State and in an injured tone complained of
having been neglected. The Secretary answered in the blandest manner:
"The government, sir, is most anxious to do all it can to assist those
who supported it. What is the object of your ambition?"

"Make me aqual to the rest of the blackguards," was the prompt reply
of this conscientious legislator.

Stokes used to add: "History does not tell if his quite reasonable
request was granted."

In the midst of Stokes' sympathy for his compatriots there was always
a counter-current of reactionary feeling, as if he feared the Celtic
enthusiasm for reform would overstep the mark and bring evils in its
train, even worse than the good it might entail. The following letter
to a friend, as representing one phase of this feeling on the part of
a true-hearted Irishman, seems worth reproducing, because it suggests
thoughts with regard to the present movement which warn of possible
dangers from the commercial spirit that must be avoided at all
hazards, if Irishmen are to retain the influence their idealism has
ever given them in whatever part of the world they might be:

  "October 27, 1836.--You will be sorry to hear that I have been for
  two days down to Connemara, to see poor Macnamara. He is dying. Oh,
  what a tragedy it will be! We expect him up to town this week. I
  never saw the glorious Lough Corrib look so beautiful. I was
  entertained by Miss Blake; she is a perfect specimen of the old
  Irish aristocracy. Tall, distinguished, elegantly formed, with dark
  hair and exquisitely fair complexion; she looked, as she stood in
  her tapestried hall, a lady of romance; her youth, her mourning
  dress, her classic head, and the symbols of her loved religion all
  combined to form a picture not easily to be forgotten. {198} The
  castle, grey and worn, stands on a green platform over the clear and
  rapid river through which the whole waters of Lough Mask and Lough
  Corrib rush to the sea. It reverses Byron's simile, 'All green and
  wildly fresh without,' etc., etc. You will say I am raving; but in
  truth a little time will level these ancient castles, and their
  highborn and honorable inhabitants and the feelings which their
  communion creates, and then 'utility' will have its reign, and
  'common sense,' laughing at the past and the beautiful, will build
  factories with the remains of history, make money, and die."

Dr. Stokes' interest in Irish historical matters can be best judged
from the fact that toward the close of his life, when he was extremely
busy with his practice and medical work of all kinds, he took the time
to write a life of his friend, George Petrie, the distinguished Irish
antiquary. It will be recalled by those who are interested in Irish
antiquities that Petrie's work eminently deserved this tribute, and
that Stokes' life is worthy of Petrie's merit. Dr. Stokes' daughter
Margaret, as the result of association with Petrie and her father's
interest in Irish antiquities, became a deep student of the same
subject and wrote a little volume, _Early Christian Art in Ireland_,
which has come to be the standard handbook on this subject for those
who want sure and definite information, yet are not specializing in
antiquities.

On March 17, 1874, as a recognition of his interest in Irish
antiquities, Stokes was nominated to the presidency of the Royal Irish
Academy. "It was a new departure for the members of that society,"
says Stokes' biographer, "which is mainly representative of literature
and abstract science, to choose a physician as their head, but it was
felt that the time had now come when medicine had obtained, owing to
the labors of Stokes and others, such a position in {199} the
estimation of literary and scientific men that the election of the
Regius Professor of that art in Trinity College (to the presidency of
the Royal Irish Academy) would be welcomed by the majority." Certainly
no member of the medical profession could have been found more
deserving of the tribute because of all that he had done for Irish
medicine, and besides his broad, sympathetic, liberal interest in
Irish antiquities eminently fitted him for this honorable position.

When Stokes' death was announced at the beginning of January, 1878,
the medical world thought that it had lost one of its most
representative men. For some years before his death many honors had
come, all unsought, to this worthy protagonist of Irish medicine. He
had been made a member of the Prussian order of Merit, and an honorary
Fellow of many scientific societies on the Continent. He had received
the rare distinction of the degree of LL.D. from Cambridge, and had
been similarly honored by many other universities. Perhaps the honor
that Stokes himself would have appreciated most came after his death,
when the country people who had learned to know and love him asked to
be allowed to carry his remains from Carrig Breac to the church of St.
Fintan--the "grassy churchyard grave," where he was to be laid beside
his beloved wife and children. They laid him in the same grave and
beneath the same stone with her who was the beloved companion of his
life, and on whose tomb he had engraved these words:

  "When the ear heard her, then it blessed her;
     When the eye saw her it rejoiced;
   When the poor and suffering came unto her
     They were comforted."

Surely a union like theirs was not destined to be but passing.

{200}

Stokes' beautiful domestic affection was but another index of one of
the most beautifully rounded types of man that ever lived. The
affective side of his being, profoundly tender, deeply sympathetic,
thoughtful always of others first, and humanely devoted to the poor
and the helpless above all others, was typical of the best side of the
Irish character. For this even more than for all he did for practical
medicine (yet the absence of his work would make a large lacuna in
nineteenth century medical progress) the race may well be proud of
him. His example still lives to animate his professional brethren, one
of whom (Sir John Moore) said of him: "Those who have seen Dr. Stokes
at the bedside of the sick know how gentle, how refined, how kindly
was his bearing toward the patient. Amid all the ardor of clinical
observation and research he never for one moment forgot the sufferer
before him--no thoughtless word from his lips, no rough or unkind
action ever ruffled the calm confidence reposed in him by those who
sought his skill and care. In many eloquent lectures delivered in the
Meath Hospital he inculcated those Christian lessons of charity and
thoughtfulness; and so by precept and example he strove to teach the
duties of a true and God-fearing physician."





Dominic Corrigan.

The third of the great trio of the founders of the Irish School of
Medicine is Sir Dominic John Corrigan, whose name will be forever
associated with the form of pulse which occurs in aortic heart
disease. It was his supreme merit to have been the first to describe
in all its details this type of heart disease, and the distinguished
French clinician, Trousseau, declared that aortic regurgitation should
be called Corrigan's Disease. At this time Trousseau was deservedly
{201} looked up to as the leading spirit among the clinicians of
Europe. He was never tired of commending to his students Corrigan's
acute clinical observations, and insisted that it was work of this
kind which assured real progress in medicine. Trousseau's suggestion
as to nomenclature was not adopted in its entirety, but Corrigan's
pulse is well-known all over the medical world, and there is no doubt
now that it will continue for many generations to confer deserved
honor on the man who first appreciated its full significance though he
was not the first to recognize it--and indeed it could scarcely escape
notice--but who showed just what diagnostic conclusions might be
reached from it.

Corrigan's career should prove a stimulating example to the young
physician just taking up that real post-graduate work in medicine
which comes after he has received his degree, finished, perhaps, his
hospital work, and is beginning his practice. Corrigan was only
twenty-seven when he began the series of observations on which was
founded his paper on aortic heart disease, which was published when he
was about thirty. In this matter of youthful accomplishment, Corrigan
is not alone among his distinguished Irish contemporaries. Stokes, it
will be remembered, wrote his little book on the stethoscope when he
was only twenty-one and had made some very important observations on
disease of the chest before he had reached the age of thirty. Graves
had showed very clearly the sound metal of his intelligence before he
was twenty-five, and had described the cases of the nervous disease
which have since come to be called after his name, Graves' disease,
before his fourth decade had run more than a year or two. In fact
these young men accomplished so much by their careful observation and
dependence on their own resources that the medical writer of the
modern times is tempted to wonder if perhaps that most precious {202}
quality of the human mind in the young adult, its originality, is not
obscured by the amount of information that it is expected to absorb
before it is tempted to do any thinking for itself.

There is another remarkable feature of Corrigan's achievement, in the
recognition and description of this form of heart disease. At the time
he was the physician to a hospital which had only room for six medical
patients. This appointment to the little Jervis Street Hospital in
Dublin had been secured only after competition, and Corrigan had to
pay for the privilege of being the attending physician. This he could
ill afford to do at the time, and so he resolved, as he told a friend,
to make all his opportunities for the study of patients count to the
greatest possible extent. He did not visit his hospital merely to see
patients, but to study the cases carefully. His success is only
another example of the necessity for seeing much, and not many things,
if there is to be any real progress. In our day, physicians scarcely
consider that they have any hospital experience unless they are the
attending physicians to several hospitals, seeing at least one hundred
patients a week. The result is that patients do not receive the
skilled care they should, and that advance in medicine suffers because
of the wasted opportunities for clinical observations while a busy
attending physician rushes through a ward and the resident physician
has only time for the routine work that enables him to keep just
sufficiently in touch with the progress of his cases to satisfy the
hurrying chief.

Before publishing his classic paper on the _Permanent Patency of the
Aortic Valves_, on which his reputation as a wonderful clinical
observer in medicine rests, Corrigan had called attention to some
mistakes in the classification of heart murmurs as made by Laennec in
Paris. At this time Laennec was considered to be the best authority in
Europe {203} on diseases within the thorax. As regards diseases of the
lungs, he well deserved the reputation. To him the medical world owes
all that it knows about diseases of the chest, as far as these can be
detected by means of the ear. His young contemporary in Ireland,
however, was able to show that in diseases of the heart some of the
ideas acquired in long years of study of the lungs were leading
Laennec into false conclusions as regards the significance of murmurs
of the heart. Even genius does not succeed in doing more than one
thing well, and especially in the matter of taking a second step into
the unknown. While the distinguished Frenchman might have been thought
just the one to complete the work he began so well on the heart, and
while his experience with the lungs might have been expected to help
him in the recognition of the significance of heart murmur, this did
not prove to be the case. The privilege of solving the mystery of
heart diseases was to be left for his Irish contemporaries, one of the
most successful of whom in this matter was Corrigan.

Anyone who wishes to see how little subsequent study has added to our
knowledge of aortic disease should read Corrigan's original paper on
this subject. He describes all the varying forms of affections of the
aortic valve, with their various clinical manifestations. His paper is
illustrated by a set of plates that would still be valuable for
demonstrative purposes, and which serve to show how painstaking were
his pathological studies. He illustrated experimentally his ideas of
how the murmurs and thrills occur by means of an apparatus consisting
of rubber tubes through which water might be allowed to flow under
pressure, and varying calibre. Some of his conclusions, derived from
experimental observations, will not stand the test of our modern
knowledge, but they are very suggestive. Perhaps the best idea of the
clinical {204} value of Corrigan's observations can be given by a
quotation from his original paper, in which he discusses the
interesting and difficult question of the relationship between
aneurism of the aorta and inadequacy of the aortic valve. He said:

  "The two diseases, aneurism of the aorta and inadequacy of the
  valves, may, however, be combined. Aneurism of the ascending aorta
  may, by extending to the mouth of this vessel, dilate it so that the
  valves are unable to meet, and there is then a combination of the
  two diseases; there is aneurism and there is permanent patency of
  the aortic opening. The first cases that came under my observations
  presenting the signs of inadequacy of the aortic valves were cases
  in which the valves were rendered useless in this way, namely, by
  the mouth of the aorta sharing in the aneurismal dilatation. These
  cases led me into an error; for, meeting the signs of permanent
  patency of the aortic orifice in conjunction with aneurism, I
  erroneously attributed to the aneurism the signs which arose from
  the permanent patency. Aneurism of the aorta of itself does not
  produce the signs arising from permanent patency of the mouth of the
  aorta. It can only produce them in the way already described, by
  involving in the dilatation the mouth of the aorta; and hence, when
  in conjunction with an aneurismal tumor of the arteria innominata or
  aorta, there are found visible pulsation, _bruit de soufflet_, and
  _frémissement_ in the ascending aorta, and the trunks arising from
  it, we may be certain that, in addition to the aneurism, there is a
  defect in the aortic valves, or that the aneurism has extended
  downward, involving the mouth of the aorta. On the other hand, if
  these signs be absent, the valves are sound and the mouth of the
  aorta is not included in the disease. The propriety of performing
  Mr. Wardrop's or indeed the common operation for aneurism about the
  neck might depend on the information {205} thus obtained of the
  state of the aortic valves. To perform either in a case where the
  aneurismal dilatation was so extensive as to involve the mouth of
  the aorta, or where the aortic valves were diseased, would only
  bring the surgical treatment of the disease into unmerited
  discredit."

Another very distinct contribution of Corrigan to the medicine of his
time was his insistence on the distinction that exists between typhoid
and typhus fever. This is one of the most interesting features of his
little book on the _Nature and Treatment of Fever_. With our present
knowledge, it seems hard to understand that these two fevers should
have been so long confounded, but as a matter of fact it was not until
the middle of the nineteenth century that the distinction between them
was recognized even by the most acute observers. In this matter the
French and Americans anticipated most of the rest of the world, though
Corrigan's teaching in the matter had been correct for many years
before others in the British Isles came to the true position.

It was his work among the poor particularly that enabled Corrigan to
recognize the differences between these two diseases. He came to have
one of the largest practices that any practitioner in Dublin, or for
that matter in any city of the world, has ever enjoyed, if enjoyment
it can be called. His office used to be crowded with patients who
would occupy all his time if he allowed them to do so. In order to
secure opportunities for his other work, for his lectures, for his
hospital visitation, and for his pathological investigation, he had a
back entrance to his house through which he could steal out--even
though there were many patients waiting for him--when he felt that it
was time for him to fill another engagement.

Late in life, after his return from Parliament when he took up his
practice again, it was only a very short time {206} before the same
state of affairs developed once more. It almost seemed as though every
sick Irishman and Irish woman wanted to have the opinion of Dr.
Corrigan. He had also a large consultant practice, though he was known
for being a very different man from the ordinary type of the medical
consultant. As one of his younger colleagues said, "he never wore the
supreme air of a consultant." He was always simple and easy in his
manner, was always congenial and ready to listen to what had developed
and had been found in the case before consultation with him, and had
none of that superciliousness that was supposed to characterize the
true high-grade consultant physician in the British Isles a half a
century ago.

Within a few years after his essay on aortic heart disease, Corrigan
published a paper on chronic pneumonia or, as he called it, cirrhosis
of the lungs. Corrigan's successful achievements in medicine depended
mainly on the fact that he studied the pathological anatomy of fatal
cases with the greatest care. He had detected that in certain cases of
chronic pneumonia the process seemed to be quite different from
tuberculosis. Observations made postmortem showed that his clinical
observations were justified by the differences observed in the organ.
As a result he formulated his opinions on the subject. He called
particular attention to the fact that what he found corresponded very
closely with the pathological process which had been observed by
Laennec in the liver, and to which the French medical pathologist had
given the name of cirrhosis. It would seem as though the pathology of
the time was so crude that Corrigan must surely fall into serious
errors in his account of what he saw. Twenty years later, Virchow was
to revolutionize pathology by the publication of his "Cellular
Pathology." Notwithstanding the progress made since his time, {207}
however, Corrigan's description of the condition of the lungs that he
noted and of the pathological process observed is so true that even to
the present day this paper remains of distinct value in medicine and
represents the beginning of correct ideas on the subject.

After Corrigan's death in 1881 the London _Lancet_ said: "In the light
of recent pathology Corrigan's speculations on cirrhosis of the lungs
are more meritorious than ever and continue to be regarded as in the
main sound. They anticipated by forty years much of the present
pathology." Needless to say it is only a genius of a very high order
that is thus capable of rising above the limitations of environment,
and in spite of the defective knowledge of his times observing
correctly and drawing proper conclusions, though all the usual
accepted principles would seem to be sure to lead him from the truth.
The principal lesions of chronic pneumonia, after having been the
subject of much disputation, with conclusions now one way and now
another in the intervening years, are at the present time recognized
as being essentially due to the pathological processes Corrigan
originally pointed out.

The man who thus made a permanent place for himself in the history of
medicine was the son of a poor shopkeeper in one of the outlying
districts of Dublin. His early education was obtained at Maynooth
College, which had at that time a department for the training of youth
for secular vocations, though it has since become an exclusively
clerical institution. It is needless to say he acquired an excellent
knowledge of the classics, of which he made abundant use later in
life, and of which he was always very proud. The physician in
attendance at Maynooth in his time took quite a liking to him, and it
was the result of his suggestion that Corrigan took up medicine as his
profession. For a time {208} he was under the tutelage of this Doctor
O'Kelley, who seems to have been a very intelligent man, and a rather
painstaking clinical observer. Most of his medical studies were made
in Dublin and he attended the practice at Sir Patrick Dun's Hospital.
It was the fashion at this time, however, for Irish students of
medicine to finish their medical education at Edinburgh, whenever
possible, and Corrigan spent several years there, receiving his degree
of Doctor in Medicine in 1825.

He had attracted considerable attention in Edinburgh for his acute
powers of observation, and received an appointment to the Meath Street
Dispensary shortly after his return. From the service here he was
appointed to the Jervis Street Hospital. He had to pay, however, for
the privilege of being attending physician here, and this, as he said,
made him more careful in endeavoring to secure all the advantages
possible from his service.

After his publication of the article on "The Permanent Patency of the
Mouth of the Aorta," or "Inadequacy of the Aortic Valves," he at once
became recognized as one of the best clinicians in the city. This
article appeared, in April, 1832, in the _Edinburgh Medical and
Surgical Journal_, at a time when, as has been said, its author was
not yet thirty years of age. As soon as he began his work at the
Jervis Street Hospital, he gave a course of lectures, and as he was an
excellent talker and a good demonstrator, he at once attracted a large
class. In 1834 he joined Hargrave's School, in Digges Street, Dublin,
as lecturer on the practice of medicine, and continued to hold the
position for more than ten years. His success as a lecturer attracted
many students from the other medical schools. Corrigan's class was
often three times as large as that of other medical lecturers in the
city. It not infrequently happened that as a result of his {209}
popularity the medical class was two or even three times as large as
the surgical and anatomical classes at the same institution. This was
very unusual, for Dublin was famous for its anatomical instruction,
and there were often five times as many pupils enrolled in the anatomy
classes as in the medical classes.

It was not long before honors began to be showered upon Corrigan. When
he was about forty the diploma of the London College of Surgeons was
conferred upon him, and, as according to the by-laws of the
institution the diploma can only be conferred after examination,
Corrigan's examination was made to consist of the reading of the
thesis, "Inadequacy of the Aortic Valves," before the faculty and the
other members of the college. In 1849 the University of Dublin
conferred upon him the degree of M.D., _honoris causa_.

There was only one setback in Corrigan's medical career in Dublin.
When first proposed for honorary fellowship in the Irish College of
Physicians, he was rejected. The reason was entirely apart from
medical matters. Corrigan was the most active member of the Irish
Board of Health, which had charge of the famine cases in Ireland,
during the awful years between 1845 and 1850. This Board proposed to
allow about five shillings per day to physicians who would be sent to
the country to attend famine fever cases. It is easy to understand
that this remuneration was considered inadequate and the Board's
decision in the matter raised a storm of protest. Graves wrote very
bitterly with regard to it, and blamed Corrigan for any part he might
have had in it. The result was that for some time Dr. Corrigan was the
most popularly hated physician in the medical profession of Dublin.

Corrigan made, up for any lack of tact he might have had {210} in this
matter, however, before long, and in 1855 he obtained the license of
the college. Two years later he was elected a Fellow. Before another
two years had passed he was elected President of the College, and had
the unprecedented honor of being re-elected four years in succession.
The college further made up for its offense by having a statue of Dr.
Corrigan, by the famous Irish sculptor Foley, made for its hall while
he was still alive.

His own self-sacrificing work during the famine fever years was well
known. After he had achieved nearly every distinction that his brother
physicians could confer upon him, he was created a baronet. It was
understood that this distinction was mainly meant as a reward for his
services during the famine, though also for the time which he had so
unstintedly given to the improvement of national education in Ireland,
in the capacity of a Commissioner of Education.

Not long after his creation as a baronet, Sir Dominic stood, in
Dublin, for a seat in Parliament in the Liberal interests. At first he
was unsuccessful. In 1869, however, he was returned as one of the
members of the government and sat in Parliament for five years. As he
was a very eloquent speaker, it was thought that he would produce a
very distinct impression in Parliament. His type of eloquence,
however, did not prove to have any special influence in the cold
British House of Commons, though Sir Dominic was always looked upon as
one of the men to be counted on whenever there was under consideration
legislation that affected Irish interests.

He was defeated for re-election in 1874, but it is rather to his
credit than otherwise, since he had been approached by the vintners of
Dublin, who were at that time all-powerful in municipal politics, and
offered the membership, provided he would agree not to actively
support the Sunday Closing {211} Bill, which was to come up at the
next session of Parliament. Such an agreement Sir Dominic absolutely
refused to consider as consistent with his legislative honor, and the
result was the close of his Parliamentary career.

His years in Parliament, however, did not separate him from his
interests either in medicine or in general science. He continued to be
especially interested in zoology and made liberal contributions to the
Dublin Zoological Garden. His residence at Dalkey, the grounds of
which ran down to a rocky coast line, enabled him to obtain many
specimens for his aquarium, and these were often transferred to the
Dublin Zoological Gardens, for which he was one of the most active
collectors. It was his custom during his Parliamentary career, though
he was more than seventy, to leave London on Friday night and reach
Dublin about eight o'clock on Saturday morning. From the station he
went directly to the Zoological Gardens and took part in the pleasant
breakfast which the Council of Officers of the Zoological Society,
with some invited guests, had there every Saturday morning. He was
noted for his humor, and his presence at these breakfasts was always
appreciated, because in spite of his advancing years he was sure to
add to the pleasure of the occasion.

His friends feared that his Parliamentary career might prove a serious
drawback to his health at his time of life, and their fears were not
without foundation. He suffered severely from gout, which left its
marks upon his feet and made it very difficult for him to walk for a
time, and maimed him for all his after-life. Though a man who had
worked very hard all his life and who, at the age of seventy,
practically took up another career, that of politics, Sir Dominic
lived to be nearly eighty years of age; thus illustrating the old
aphorism that "it is not work but worry that kills," and {212}
furnishing another example of the fact that great men are great also
in their superabundant vitality, and are able to spend their lives in
the hardest kind of work, yet, barring accident, live on to an age
beyond even that which is considered the average term of human
existence.

Few men have had happier lives than Corrigan, if the high esteem of
contemporaries can ever confer happiness. There was no honor in the
gift of his Dublin professional brethren or of scientific bodies in
which he was interested which was not conferred upon him. He was the
president of the Royal Zoological Society, the president of the Dublin
Pathological Society, of which he was one of the founders, and the
first president of the Dublin Pharmaceutical Society. When not yet
fifty years of age he was made physician in ordinary to the Queen in
Ireland, and had the unapproached record of five elections to the
presidency of the King and Queen's College of Physicians in
Dublin--more than enough to make up for the one serious setback in his
medical career, his black-balling by the college only a few years
before. Foreign medical societies invited him to honorary membership
and foreign universities conferred many degrees on him.

It is easy to understand then that his death was followed by tributes
of the loftiest character to his professional work, to his standing as
an influential member of the community and as a man of the highest
intelligence and thoroughly conservative patriotism. The London
_Lancet_ said in its obituary: "By the death of Sir Dominic Corrigan,
the medical profession loses one of its most conspicuous members, the
University at Edinburgh one of its most illustrious graduates, and the
Irish race one of its finest specimens. Though a perfect Irishman, Sir
Dominic was as much at home in London, and though a sincere Catholic
in religion, he had {213} too much humor and too much humanity in his
constitution to be a bigot. It were well for Ireland if all her public
men displayed so much moderation, sense, and good humor as Sir Dominic
habitually displayed in dealing with difficult and delicate
questions."

About the same time the _British Medical Journal_ said, after calling
attention to the distinguished contemporaries with whom Corrigan had
been associated, that he was "_haud minimus inter magnos_--not the
least among the great ones." "Indeed," his biographer added, "in
originality of conception which, confirmed by later and independent
observation, is the true test of genius, in a correct appreciation of
the operation of natural laws, in producing and modifying the
phenomena of disease, in a rare aptitude for testing his hypotheses by
actual experience, and in a forcible exposition of them, he probably
had no equal among his contemporaries."

In the midst of all his honors and political influence, including
association with the highest English officials in Ireland, Sir Dominic
Corrigan had remained a consistent and faithful Catholic. Educated at
Maynooth as a boy, he was proud to remain the physician to the college
during many of the busiest years of his life when he must have often
found it very difficult to spare the time to fulfil the duties
attached to the position. He was the consultant physician till the end
of his life. He is not even yet, after a quarter of a century,
forgotten by the poor of Dublin, who recall his kindly help in
affliction and his generous aid often given in ways that would be
arranged with studied care so as not to hurt delicate Irish
susceptibilities.

The Irish School of Medicine has in Graves and Stokes and Corrigan a
greater group of contemporaries than has been given to any other
nation at one time. If we were to eliminate from nineteenth century
medicine all the {214} inspiration derived from their work there would
be much of value lacking from the history of medical progress. These
men were deeply imbued with the professional side of their work as
physicians, and were not, in any sense of the word, money-makers.
Another very interesting phase in all their careers is that no one of
them occupied himself exclusively with medical studies. All of them
had hobbies followed faithfully and successfully together with
medicine, and all of them were deeply interested in the uplifting of
the medical profession, especially in securing the rights of its
members and saving poor sick people from exploitation by quacks and
charlatans. All of them gave of their time, their most precious
possession, for the political and social interests of their
fellow-men, and felt in so doing that they were only accomplishing
their duty in helping their generation to solve the problem that lay
immediately before it.


{215}

JOHANN MÜLLER, FATHER OF GERMAN MEDICINE


{216}

  I say, then, that the personal influence of the teacher is able in
  some sort to dispense with an academical system, but that system
  cannot in any way dispense with personal influence. With influence
  there is life, without it there is none; if influence is deprived of
  its due position, it will not by those means be got rid of, it will
  only break out irregularly, dangerously. An academical system
  without the personal influence of teachers upon pupils is an Arctic
  winter; it will create an ice-bound, petrified, cast-iron
  university, and nothing else.
    --Newman, _Idea of a University_.


{217}

JOHANN MÜLLER, FATHER OF GERMAN MEDICINE

Germany has come to occupy so large a place in progressive medicine
during the last half-century that it is rather hard to conceive of a
time when the Teutonic race was not the head and front of modern
medical progress. The leadership that had existed in Italy for over
five centuries only passed to Germany at the beginning of the
nineteenth century. The first great leader in German medical thought
was Johann Müller, and to the wonderful group of students that
gathered around him German medicine owes the initiative which
gradually forced it into the prominent place it still holds in the
world of medicine. The great institutions of learning that have since
come in Germany did not exist with anything like their modern
systematic arrangement when Müller began his work. It was the
marvellous influence of the man as a teacher, and not the scientific
aids afforded by institutional methods, that brought forth the great
generation of teachers which followed immediately on Müller's
footsteps. Nowhere more than in the life of Müller can it be
recognized with absolute certainty that the system and the institution
count for little in education, as compared to the man and his methods.


The keynote of Müller's career, even more than what he did for
biology, and for all the biological sciences related to medicine, is
the wonderful conservatism of thought which characterizes his
scientific conclusions, while at the same time he began the
application of the experimental methods {218} to medicine as they had
never been applied before. At a time when physiologists, because of
Woehler's recent discoveries of the possibility of the artificial
manufacture of urea, might easily have been led to the thought that
life counted for little in the scheme of the universe, Müller
continued to teach consistently that vital energy may direct chemical
or physical forces, but must not be confounded with them. It looked as
if in the development of the chemistry of the carbon compounds, all of
which are the result of life action, that materialistic views must be
expected to prevail. Müller insisted, however, that life ever remains
the guiding principle which rules and coordinates all the physical and
chemical forces at play, within living organisms; and that the vital
principle is entirely independent of these forces so closely attached
to matter.

All Müller's disciples, and they were the representative biological
scientists in Germany during the nineteenth century, followed closely
in his footsteps in this matter, and the result was a conservatism of
thought in biology in Germany that is the more surprising when we
realize how much German philosophers in their systems emphasized the
necessity for absolute independence from all previous systems of
philosophical speculation. It is so much more interesting, then, to
find what was the method of education that made of Johann Müller so
conservative a thinker, while not injuring his genius for experimental
observations. The influences that were at work in his earlier years
were evidently those that made him subsequently the bulwark against
materialistic tendencies in biology, and yet did not impair his
originality. His early education was obtained under influences that
are usually considered to be distinctly harmful to independence of
thought, and yet they seemed to have helped him to the fulfilment of
his destiny, as a great thinker and investigator. {219} Müller is
undoubtedly one of the very great men of modern science, and is the
recognized founder of the system and methods of investigation which
have given German medicine its present prominence and prestige.

In recent years there have been many tributes to Müller, because as
Virchow's teacher it was considered that some of the praise for the
work done by Virchow must naturally reflect on the man to whom the
great German pathologist acknowledged that he owed so much of his
inspiration and his training in methods of investigation. Virchow's
death too very naturally led to the recall of what had been
accomplished in German medicine during the nineteenth century, and for
much of this Johann Müller must be considered as at least indirectly
responsible, since to him so many of the great German medical
scientists owed their early training. These men, all of them, did not
hesitate to attribute the progress of German medicine to the methods
introduced by Müller. At the beginning of the twentieth century
something of the estimation in which he was held in a land far distant
from the German Fatherland may be gathered from the following tribute
paid to him in a recent meeting of the Medical Society of the State of
New York by Dr. C. A. L. Read, of Cincinnati, former President of the
American Medical Association. In the midst of his panegyric of Virchow
Dr. Read described in some detail the medical faculty of Berlin at the
time when Virchow was beginning his work as a student at that
University. He said:

  "In the faculty there were Dieffenbach, the foremost surgeon of his
  day; Schoenlein, the great physician who had come from Zurich the
  same year to join, not only the teaching body, but to act as a
  reporting counsellor for the ministry and to serve as
  physician-in-ordinary to the King; Froriep, who was in charge of the
  Pathological Institute; Caspar, who {220} was also medical
  counsellor, with a seat in the special deputation for medical
  affairs in the ministry; but towering above them all was the
  intellectual figure of Johann Müller, the Professor of Physiology.
  He was an original genius with daring, actually engaged in winnowing
  the wheat of demonstrated truth from the prevailing chaff of
  egoistic opinion which divorced physical science from speculative
  philosophy. Prompted by the inspiration which he had derived in turn
  from Bichat and the French school, the Professor of Physiology was
  busily retesting in the laboratory truths previously elaborated by
  Haller, Whytt, Spalanzani, Cullen, Prochaska, John Hunter, the
  Bells, Magendie, Berzelius and Bichat himself."

This is the tribute to Johann Müller, nearly fifty years after his
death. That of Virchow, at his obsequies in Berlin, is even more
enthusiastic. Virchow, then at the age of thirty-seven, at the height
of his powers, already acknowledged the greatest of living
pathologists, just recalled to Berlin to become Professor of Pathology
in the University which he had left more or less in disgrace because
of his political opinions, could not say too much of the teacher whom
he respected and honored so highly and whose inspiration he felt stood
for so much in his own career.

He said:

  "My feeble powers have been invoked to honor this great man whom we
  all, representatives of the great medical family, teachers and
  taught, practitioners and investigators, mutually lament and whose
  memory is still so vividly with us. Neither cares by day nor labors
  by night can efface from our mind the sorrow which we feel for his
  loss. If the will made the deed, how gladly would I attempt the
  hopeless task of proper appreciation. Few have been privileged, like
  myself, to have this great master beside them in every stage of
  development. It was his hand which guided {221} my first steps as a
  medical student. His words proclaimed my doctorate and from that
  spot, whence now his cold image looks down upon us, his kindly eyes
  beamed warmly upon me, as I delivered my first public lecture as
  Privat-Docent under his deanship. And, in after years, I was the one
  out of the large number of his pupils who, by his own choice, was
  selected to sit beside him within the narrow circle of the faculty.

  "But how can one tongue adequately praise a man who presided over
  the whole domain of the science of natural life; or how can one
  tongue depict the master mind, which extended the limits of his
  great kingdom until it became too large for his own undivided
  government? Is it possible in a few short minutes to sketch the
  history of a conqueror who, in restless campaigns, through more than
  one generation, only made use of each new victory as a standpoint
  whereon he might set his feet and boldly look out for fresh
  triumphs?

  "Yet such is the task to which we are called. We have to inquire
  what it was that raised Müller to so high a place in the estimation
  of his contemporaries; by what magic it was that envy became dumb
  before him, and by what mysterious means he contrived to enchain to
  himself the hearts of beginners and to keep them captive through
  many long years? Some have said--and not without reason--that there
  was something supernatural about Müller, that his whole appearance
  bore the stamp of the uncommon. That this commanding influence did
  not wholly depend on his extraordinary original endowments is
  certain, from what we know of the history of his mental greatness."

Virchow's tribute could not well be more enthusiastic or more ample.
His appreciation has been the standard for all other medical opinions
of the man. How much Müller is honored at the present time in Germany
can be best {222} appreciated from the number of times that his name
is mentioned with respect and often with laudation in the proceedings
of German medical societies. Scarcely a meeting passes in which more
than once Johann Müller is not referred to as the founder of the
scientific method in medicine which has given Germany her present
position in the very forefront of medical scientific progress. It is a
common expression, said half in jest it is true, but surely more than
half in earnest, that the proceedings of no medical society would be
really successful within the bounds of the German fatherland unless
they were hallowed by an invocation of the great name of Johann
Müller, the revered patron of modern German medicine. This is no
witticism by exaggeration, after the American fashion, but a sincere
Teutonic expression of feeling that occupies German medical minds with
regard to the man who founded the most progressive school of modern
medicine, and in doing so brought honor to his native country.

Johann Müller was born at Coblentz, on July 14, 1801. About six months
before, the Emperor of Austria by the treaty of Luneville, signed
February 9, 1801, ceded to the French Republic all the Austrian
possessions on the left bank of the Rhine. The electors of Treves, who
were archbishops and reigning princes and who had resided for
centuries at Coblentz, by this treaty disappeared forever from the
list of German rulers. When Johann Müller was born, French prefects of
the Departments of the Rhine and Moselle took up their residence in
the old town which had been, since the beginning of the French
Revolution, a favorite dwelling place for the French nobility driven
from their homes by fear of persecution.

Müller's father was a shoemaker and lived in a small house in the
street of the Jesuits, so called because the fathers had had a school
in it for many years. Johann was {223} not destined to receive his
education from the Jesuits, however, for the order had been suppressed
nearly thirty years before his birth, and did not re-establish itself
in the Rhineland for many years afterward. The circumstances of the
Müller family were not such as to encourage hopes of a broad
education, though his father seems to have taken every possible means
to secure as much school training as could be obtained for his son.
The early death of his father promised to deprive Müller of whatever
advantages might have accrued from family sacrifices, but his mother
was one of these wonderful women who somehow succeed in raising their
families well and affording their children an education in spite of
untoward circumstances.

Johann was the eldest of five children, with two sisters. He was very
proud himself of the fact, that while he took from his father a large,
strong, healthy frame and a dignified carriage, he had his mother's
skill for putting things in order, her constancy of enterprise and her
tireless faculty for hard work. After his father's death, his mother's
energy and good sense enabled her to carry on the business established
by the elder Müller by means of assistants, and as Coblentz was the
centre of a district that during the Napoleonic wars was constantly
overrun with soldiery, the shoemaking trade was profitable.

Johann seems to have learned the trade, but his mother succeeded in
enabling him to begin his education seriously at the age of eleven or
twelve. About this time, Joseph Görres, who was afterward the great
leader of Catholic thought in Germany, and after whom is named the
famous Görres Gesellschaft which stands for so much in German Catholic
life and progress, was a professor in the Sekunden Schule, or
secondary school, in Coblentz, and had recently published treatises on
natural philosophy with special {224} reference to physiology. Müller
entered this school in 1810 and Görres did not resign his
professorship until 1814, when owing to the publication of a political
work he was obliged to flee from the country. It is not known how much
influence Görres exercised over young Müller, but some at least of his
precious love for the natural sciences, which even in his student days
led to the making of natural collections of various kinds, seems to
have been imbibed under the influence of the philosopher physiologist.
The touching of the orbits of the two men, who were destined, more
than any of their fellow-citizens of Coblentz, to influence Germany's
future, must always remain an interesting consideration in the lives
of both.

Johann's parents were, as might have been expected, down in the old
Catholic Rhineland in the capital of the spiritual principality of
Treves, faithful members of the Roman Catholic Church. Very early in
life, Johann conceived the wish to become a priest. His mother,
rejoiced at her son's idea, was ready to make every possible sacrifice
to secure his education. It was with the intention of education for
the priesthood, then, that Johann entered the Sekunden Schule, an old
college of the Jesuits, in which Jesuit tradition and methods of
education still survived, and in which some of the old Jesuit pupils
seem still to have held positions even during Müller's time as a
student (1810 to 1817).

It would appear probable that because of the traditions of Jesuit
teachings that held over at the school in Coblentz, and perhaps, too,
because of the presence of some of the old masters and teachers
trained by them, Müller knew the ancient languages so well. He made
his own translations of Plato and Aristotle, and consulted the latter
especially always in the original and had a lifelong reverence for the
great Greek philosophic naturalist's work, Latin he used {225} so well
as to speak it readily, and practice in the disputations of the
University at Bonn made the language still more familiar to him. It
was said that he wrote Latin better than German. After the fall of
Napoleon the Prussian government took up the reorganization of the
schools in this part of the Rhineland, and Müller became more
interested in scientific studies. At this time he became devoted to
mathematics, which he studied under the old pupil of Pestalozzi,
Professor Leutzinger, to whom Müller, in the sketch of his life
prefixed to his thesis at the university, expressed the feeling that
he owed a special debt of gratitude.

During his school days Müller became a collector, as we have said, of
natural objects. He was especially interested in butterflies for a
time, and collected all the species in the country around. He had a
curious dislike for spiders which remained with him all his life. He
was able to overcome this, however, and made important studies of that
insect's eyes, and of its changing expressions under the influence of
fear or when about to fall upon its prey.

His feeling with regard to the insect is an index of a certain
feminine quality of mind that had a characteristic expression in later
life in his dislike for vivisection. He could not bring himself to the
conclusion that animals must be sacrificed in the midst of horrible
pain unless there was some very definite scientific point to be
determined, and unless every precaution was taken to avoid inflicting
needless suffering. Even then he preferred that others should do this
work and more than once took occasion to point out the fallacy of
physiological observations founded on animal experimentation under
such anomalous circumstances, and insisted that very frequently the
results gave conclusions only by analogy and not by any strict logic
of animal similarity or absolute physiological nexus.

{226}

In a sketch of Müller's life, by Professor Brücke, of Vienna, himself
one of the most distinguished physiologists of the nineteenth century,
to whom the University of Vienna has paid the tribute of a marble bust
and tablet in its courtyard, the great Austrian physiologist sums up
very well the reasons for Müller's fame. Professor Brücke's tribute
may be found in the _Medical Times and Gazette_, of London, July 17,
1858. "If we inquire," he says, "what were the circumstances to which
Müller, independently of his high intellectual endowment, his gigantic
power for work, the energy and massiveness of his character, and his
active and vigorous bodily constitution, owed the commanding position
he incontestably held among men of science in our day, we must admit
that before all things this was due to the breadth and depth of the
foundations upon which his intellectual cultivation had been built."
Professor Brücke then dilates on the variety of scientific interests
which occupied Müller's earlier years and the thoroughness with which
he accomplished everything that he set himself to.

A very curious reflection on our modern methods of education, and
especially the tendency to specialization and the formation of
specialists from their very early years, is to be found in Brücke's
account of the extent and variety of Müller's studies in all lines.
Far from considering that these diverse intellectual interests
hindered the development of his genius, he seems to consider that they
rather aided in the evolution of that largeness of mind characteristic
of the great genius. He says:

"In his schooldays Müller's attention was directed to subjects of
study far beyond the mere medical curriculum, for we find him
attending the lectures of celebrated professors on poetry and
rhetoric, on the German language and literature, on Shakespeare and
Dante." As a matter of {227} fact, Brücke seems to have understood
that no one is so little likely to make scientific discoveries as he
whose mind has been directed without diversion along the narrow lines
of a specialty in science. Constantly trained to see only what lies in
the sphere of this short-sighted interest, the mind never raises
itself to a view beyond the horizon of the already known.

The old classical training, supposed to be so useless in this
matter-of-fact, practical age, trained the minds of the men who have
given us all the great discoveries in science. The evolution of
intellectual power consequent upon the serious study of many things
proved an aid rather than a hindrance to future original work. Not one
of these great scientific investigators had at the beginning any hint
of the work that he was to do. It seems almost an accident that their
researches should have been conducted along certain lines which led to
important discoveries. What was needed for them was not special
training, but that mental development which puts them on a plane of
high thinking above the already known, to look for progress in
science.

Müller continued for many years to entertain the idea of eventually
becoming a priest. At about the age of sixteen, however, he became
deeply interested in Goethe's work, and was especially attracted by
the great poet's studies of scientific subjects. About this time he
became interested in the collection of plants and animals and took up
seriously the study of physiology. Lavater's work was, at that time,
still sufficiently recent to have little of the novelty worn off, for
young students, at least. At the age of eighteen Müller went to Bonn
and, when about to begin his university career, hesitated as to
whether he should study theology or not. His natural liking for nature
study, however, finally caused him to decide in favor of a scientific
career, and he began the study of medicine.

{228}

He took up his medical studies with the greatest enthusiasm. Under the
special guidance of Mayer, who besides being his teacher was a
personal friend, he applied himself zealously to the study of anatomy.
One of his expressions in his early student days that has often been
repeated, but which Müller took the greatest care in later life to
correct and deny as a lasting impression, was the famous "Whatever
cannot be demonstrated by the scalpel, does not exist." The professor
of physiology at the time at Bonn was the famous Fredrich Nasse,
especially known for the wonderful attractiveness of his lessons and
his power of arousing enthusiasm in others, and it is not surprising
that Müller, naturally so enthusiastic in scientific studies, should
have acquired a liking for the study that he never afterward lost.

During Müller's second year of medical study the University of Bonn
announced its first prize, which was to be given for an investigation
of the subject of respiration in the foetus. Although Müller was only
in his first year as a medical student at the time, he grappled with
the difficult subject and devoted all his spare time to arranging
experiments for the demonstration and investigation of doubtful
points. He received the prize, and Virchow, surely a good judge in the
matter, says that this work of his student days is distinguished alike
by the extent of its learning and by the number and boldness of the
experiments detailed. At the moment of his graduation, the young
doctor, in his twenty-first year, was already a marked man. From this
time on everything that he did attracted attention and had a ready
audience.

Müller's mind was constantly occupied after this time with the
arranging of experiments to demonstrate natural principles. How far he
carried this habit of experimenting can be understood from some of the
habits of control over {229} his muscles which he had acquired by
continual practice and intense attention. He had thorough control over
the muscles of his ears and used often to amuse his fellow-students by
their movements. The anterior and posterior muscular portions of this
occipito-frontalis muscle were able readily to move his scalp and
produce curious disturbances in his hair. These habits of muscular
control many people have acquired. Other acquisitions of Müller's are,
however, much rarer. He could, at will, contract or dilate his pupils,
having secured control over his iris by practice before a mirror, and
he could use the little muscles that connect the bones within the ear,
the hammer, anvil and stirrup, so as to make them produce an audible
click at will.

His habits of experimentation on one occasion at least placed him in a
rather ridiculous position. While making his military service, it
happened one day that when the command "Order arms" was given, Müller
amused himself by inserting one finger after another into the muzzle
of his firelock. At last his middle finger got fairly wedged into the
weapon. When the order attention was given, Müller could not withdraw
his finger. His predicament at once attracted notice, and he was
ordered to the front to be reprimanded by the major, to the no small
amusement of his comrades, who laughed heartily at his ridiculous
predicament. He was sent to his quarters in disgrace and the
regimental surgeon had no little trouble in liberating the thickly
swollen finger.

While everything thus seemed to promise a life of experimentation,
Müller's imagination had a powerful hold on him, and he gave himself
up for some time to certain mystical theoretical questions and
problems of introspection which, for a time, threatened to take him
away from his real calling of an experimental physiologist.
Fortunately for Müller, as we shall see, though at the moment he
doubtless {230} thought it a serious misfortune, these excursions into
a too introspective psychology were followed by nervous troubles, what
we could now call neurasthenia, and he was consequently led back to
the study of external nature.

Just after Müller's promotion to the doctorate in medicine, the
Rhenish universities came once more under the authority of the
Prussian government, and Berlin became a Mecca for students, who
looked upon it in a way as the mother university. After his graduation
at Bonn, then, Müller was attracted to Berlin, and came especially
under the influence of Rudolphi, who recognized his talents and gave
him special opportunities for original investigation. Rudolphi's
private library and his collection were placed at the command of this
young original worker, who had already proved his power of
investigation and his capacity for following a subject to its ultimate
conclusions, even though those were not yet extrinsically known. While
at Berlin, too, Müller came under the influence of the younger Meckel,
whom he learned to respect very much. After Meckel's death the
_Archives of Physiology_, previously edited by Meckel, fell into
Müller's hands, who successfully continued it for many years.

At Müller's departure from Berlin he was presented by Rudolphi with an
English microscope, as a testimonial of the old professor's
appreciation of the young man's labors while under his observation. As
Müller's pecuniary resources were very limited, this must have been an
especially acceptable gift, since it enabled him to continue his
researches in embryology, and it was not long before these began to
bear fruit. At Bonn, to which Müller returned, he set up as a
Privat-Docent in the University, and for several years eked out by
teaching the allowance his mother could give him, and even by the
practice of medicine.

Bonn, at this time, had a population of perhaps 30,000, {231} and had
some eighteen regular practitioners of medicine. It is easy to
understand, then, that Müller's practice did not add materially to his
pecuniary resources. It was not long before he gave up the practice of
medicine entirely, led to the step by the sad death of a friend, who,
while under his care, suffered from perforation of the intestines,
followed by peritonitis. Notwithstanding the rather precarious state
of his finances, at the age of twenty-six, Müller married Anna Zeiler,
the daughter of a landholder in the Rhineland, not far from Bonn. He
had previously dedicated to her a poem, in which he promised her, in
lieu of more material advantages as a marriage settlement, an immortal
name. The young man seems to have felt something of the genius that
was in him, but, then, so have others, and their presages have not
always been confirmed by the issue. Shortly before and after his
marriage, he applied himself so hard to his investigations of many
kinds that within a few months he broke down. The government allowed
him a furlough, and for several months he wandered with his bride
along the Rhine, in what has been described by a biographer as a
"one-horse shay," and came back to his work renewed in mind and body.

As a matter of fact, Müller's breakdown was what would be called at
the present time a neurasthenic attack, induced by overwork and too
great introspection. He had been experimenting upon himself in many
apparently harmless ways, but by methods which often cause serious
trouble. It was not an unusual thing for him to fast, in order to note
the physiological effect on his mind and senses of the absence of
proper nutrition. He would often lie awake for hours at night in the
darkness, experimenting upon himself and noting the phenomena induced,
especially in his sight, by the total absence of light. He devoted
himself, too, to the investigation of the curiosities of second sight;
those interesting {232} reminders of things seen long ago, though
without producing much impression, and which recur at unexpected
moments, to make us think that we are seeing again when we are really
only unconsciously remembering. He used to exercise a good deal the
faculty of bringing up objects into his vision with all the physical
peculiarities of actual sight. In this his master was Goethe, who had
written extensively on this subject in treating of the phenomena of
vision, and who was able himself to recall to his imagination with
great vividness the many shades of colors of objects with the sensory
satisfaction of actual vision. Müller had this imaginative power only
for the reds.

It is not surprising that a young man, engaged too exclusively at this
sort of investigation, should have impaired his nervous equilibrium to
some degree, and made symptoms, otherwise unimportant, appear to him
as the index of serious illness. For a time Müller despaired of ever
being himself again. When he had regained his health, however, he
realized what had been the essential cause of his nervous condition;
and so he never went back to his introspective observations,
considering their results somewhat in the nature of a series of
illusions.

After this, Müller devoted himself for ten years strictly to his
physiological investigations. The best knowledge of what Müller
accomplished for scientific medicine, during these early years, can be
obtained from Virchow's summation of the discoveries of this period
made shortly after his great teacher's death.

Virchow says:

  "It was Müller who introduced to the knowledge of physiologists and
  physicians the doctrine of reflex actions, which had been already
  indicated by Prochaska, and simultaneously discovered by Marshall
  Hall and himself. Just before this Müller succeeded in showing an
  {233} easy mode of performing experiments on the anterior and
  posterior roots of the spinal nerve in corroboration of Bell's
  teaching of their diverse functions. Thus he had the privilege of
  establishing for all time two of the greatest practical discoveries
  of the physiology of the nervous system.

  "Next to the nerves the blood became the subject of his researches
  and he not only naturalized in German medicine the accurate
  knowledge of the fibrin and blood-corpuscles, which Hewson had
  cultivated with such fertility in English literature, but he also
  managed by simple experiment to demonstrate the peculiar composition
  of the vital fluid. The discernment of right methods of
  investigation lay ever open to his clear and cultivated intellect,
  and he knew well that there were cases in which the scalpel and
  experiments could not determine a question, and where the truth was
  only to be elicited by means of chemical agents and physical
  instruments. It was thus he discovered the peculiar gelatinous
  substance found in cartilage, called chondrin; thus he proved the
  existence of lymphatic hearts in the amphibia, and thus that he
  determined not only the organs but all the laws which are concerned
  in the production of the human voice.

  "The special researches of the Bonn epoch are those of the minute
  structure and anatomy of the glands. They put an end to the
  controversy which had existed so long between adherents of Malpighi
  and Ruysch, concerning the sacculated extremities of the glandular
  follicles, and obtained for us a correct knowledge of these
  important organs throughout the whole animal kingdom. Perhaps his
  most important work is that of the Ducts of Müller, the structures
  (named after him) which form so important a part of the
  genito-urinary system in the embryo."

Practically all this had been accomplished before he was {234} quite
thirty-two years of age. In the autumn of 1832, Rudolphi, the
professor of physiology at Berlin, died. As Virchow says, candidates
sprung up on every side, and some who were the least qualified
considered themselves best fitted for the position. Müller took an
unusual step which illustrated his decision in character, though in
any other it would have seemed an evidence of conceit. He declared, in
an open letter, laid before the Minister of Prussia, that his claims
were superior to those of any other living physiologist, except John
Frederick Meckel. So powerful was the impression produced upon the
minister by this letter that he immediately appointed Müller to the
vacant chair.

Not long after his appointment to the chair of physiology at the
University of Berlin Müller completed the well-known "Hand-book of
Physiology," which established his reputation. The book is sometimes
spoken of as an experimental physiology, but this is not correct.
Müller was no more a mere experimentalist than Haller, and he,
himself, heartily detested the tendency which experimental physiology
had assumed in France, especially under the influence of Magendie.
Part of Müller's aversion to experimental physiology was aesthetic. He
could not bear the idea of inflicting so much pain as many of his
colleagues inflicted without a thought. In his panegyric of Rudolphi,
Müller says: "Rudolphi looked upon physiological experiments as having
no relation to anatomical accuracy, and it is no wonder that this
admirable man, who had at every opportunity expressed his abhorrence
of vivisection, took up a hostile position against all hypotheses and
conclusions insufficiently established upon physiological
experiments." Müller adds: "We could not have failed to share his
righteous indignation, had we seen how many physiologists were using
every effort to reduce physiology to an experimental science by the
live dissection and agonies {235} of innumerable animals, undertaken
without any definite plan, and yielding often only insignificant and
imperfect results."

Müller shared these views of Rudolphi with regard to vivisection. The
uncertainty of the conclusions, the amount of suffering inflicted, and
the indefiniteness of the conditions of experiment, so that the
conclusions could not have any very great weight, or any special
accuracy of information, made him consider such experiments, unless
very carefully conducted by trained investigators, as largely a waste
of time and infliction of unnecessary pain and a leading astray of
physiological advance because of the uncertainty involved.

The qualities in Müller's "Hand-book of Physiology," which gave it its
greatest value, are the thorough review of all of the physiological
literature of the world which it contains, and the greatest number of
original observations it details as the basis of the principles
enunciated. Müller himself said, in the preface to his "Hand-book": "I
need scarcely remark that it is the duty of a scholar to make himself
acquainted with the progress of science among all nations; and this is
now possible and, moreover, quite indispensable in these days of
progress. A purely German, French, or English school of medical
science is barbarism; and in Germany we would consider the idea of an
isolated English or French system of natural history, physiology or
medicine just as barbarous as the notion of Prussian, Bavarian, or
Austrian medicine or physiology."

How valuable the book was as the corner-stone of modern German
medicine, may best be judged from Virchow's opinion of it. He says in
his panegyric of Müller:

  "There are two qualities in his 'Hand-book of Physiology' which have
  particularly enhanced my estimation of its value--its strictly
  philosophical method and its completeness {236} in facts. Since the
  time of Haller no one has so thoroughly mastered the entire
  literature of natural history or collected in all directions so many
  original experiences, and no one has been at the same time familiar
  with medical practice, as well as with the remotest provinces of
  zoology. It has been well said that while Haller often, in doubtful
  questions, espoused a side which must eventually be forced to
  succumb, Müller always had the luck (if we may call that luck which
  was preceded by so much intelligent activity), sooner or later, to
  discern the opinion that was sure, eventually, of the victory. He
  was wonderfully fitted for the office of critic by his comprehensive
  knowledge. He knew how to discriminate the healthy from the unsound,
  the essential or real from the adventitious or accidental. And, in
  surveying the whole series of forms--often widely different--among
  which a well-determined plan of nature seemed to be realized, he
  knew the changes which not infrequently altered considerably the
  arrangement and composition of the substances within these forms. In
  Müller, as a physiologist, it is not the genius of the discoverer,
  nor the ground-breaking nature of his observations we admire, but
  rather the methodical exactness of investigation in calculating
  judgment, the confident tranquility and the perfect consummation of
  his knowledge."

In a word, Müller owed the success of his career to the perfect poise
of his intellect and the admirable critical faculty that guided him in
the thorny path of knowledge at a time when there were so few
landmarks of real scientific significance to show the investigator
what the probable course and progress of real science must be. It was
for this reason that, as Virchow has said, the reform of newer views
became embodied in him, and in spite of the almost monastical
retirement of the scholar, the influence of the method introduced by
Müller was not limited to physiology, but continues to {237} spread
beyond that science in ever-widening circles into the domain of all
the biological sciences.

Virchow concludes: "Müller vanquished mysticism and phantasms in the
organic kingdom and he was most distinctly opposed to every dangerous
tendency, whether it was pursued under the pretext of physiology or
belief, or merely in accordance with conjectures. Müller did not
discover, but he firmly established the exact method of investigating
natural sciences: Hence, he did not found a school in the sense of
dogmas--for he taught none, but only in the sense of methods. The
school of natural science which Müller created knew no community of
doctrine, but only of facts and still more of methods."

He did not confine himself in his studies, however, to the physiology
and pathology, nor even to the anatomy and embryology of man. After
1840 he devoted himself to the study of invertebrates and investigated
the starfish and the pentacrinites. While engaged in his work on the
invertebrates he found that the fossil remains of animals had not been
carefully explored, so for a time he devoted himself to paleontology.
While his salary as professor was ample for his own support, it was
not what would be called generous at the present time, yet Müller
became so devoted to his science that he paid certain of the workmen
to be on the lookout for fossil remains for him in the quarries of the
Eifel. He became deeply interested, too, in life in the sea and made
his vacations times of specially hard work, investigating the
conditions of low life among marine organisms. He passed from one
class of life to another. From sea-urchins and starfish to infusoria
and polycystina, whose varieties he was himself the first to recognize
and describe.

Müller was one of the first to point out that certain of the lower
animals could propagate similar and dissimilar {238} generations, that
is, reproduce by alternate generations. He studied and demonstrated
especially the metamorphoses in the echinodermata, and his broad
vision and careful observation in this new and surprising scientific
field cleared up many things that had been mysteries before.

In paleontology Müller worked with our own Agassiz, then a young man,
or perhaps it should rather be said that Agassiz worked with Müller. A
paper, for whose compilation they made a series of observations
together, appeared at Neufchatel, in 1834. It was a note on the
vertebrae of living and fossil dog fishes. At this time Müller was
interested in fossil fishes of many kinds and wrote several articles
in later years on this subject. Toward the end of Müller's life he
studied especially the polycystina, certain of the radiolaria, and
some of the many chambered specimens, fossil and living, that were
attracting much attention at that time. As a matter of fact he went
the day before his death to the zoological museum of Professor Peters
in Berlin, in order to obtain some polythalamacea.

How open to advance in science and how ready to encourage the work of
others Müller was, may be gathered from his attitude to parasites as
the cause of disease, when these began to be discovered. After
Professor Schoenlien's discovery of the parasite of favus, Müller
became interested in it, confirmed Schoenlein's observations and added
something to our knowledge of it. About this time, also, he discovered
the psorosperm as a parasite of animals and possibly of man, and
devoted considerable attention to it. His work was afterward greatly
extended by one of his pupils, Lieberkühn, whose researches with
regard to these minute organisms attracted the attention of the
medical world.

It is not a little surprising how many of the investigations that
afterward were to give fame to Virchow were initiated {239} by his
great teacher, Müller. It was Müller whose study of tumors led Virchow
to devote himself to this subject and give us the best pathological
work on it that has ever been written. Virchow himself notes with
regret that Müller turned aside from pathology and never finished the
promised work which was to have contained his theory of the origin of
tumors. Another work in which Virchow followed in Müller's footsteps
was the development of craniometry and, in general, the scientific
investigations of skulls. Müller had interested himself very much in
microcephalic skulls and Virchow assisted him in the investigations of
them. Many years afterward Virchow established the science of
craniology in the department of anthropology, and succeeded in
throwing not a little light on the origins of races by his discoveries
in this matter.

After Schoenlien's discovery of the parasite of favus, Müller became
interested in the parasitology of human beings, and with Retzius, the
famous Swedish anatomist, investigated certain molds which occur in
the respiratory passages of birds. They succeeded in demonstrating
that these vegetable parasitic growths were a form of Aspergillus.
Their studies in the white owl particularly called general attention
to the possibility of such molds occurring as parasites of animals.
Later on, Virchow showed that these same molds occur occasionally in
the respiratory passages of men. Virchow found them in three bodies at
autopsy, all of them being run down individuals, two of them old
subjects, and all sufferers from chronic bronchitis. Usually, when the
parasites were found, there was a distinct tendency to very low
resistive vitality in the tissues, sometimes proceeding even to the
extent of beginning pulmonary gangrene. In reviewing the subject
Virchow [Footnote 7] said that the light thrown {240} upon it by the
investigations of Müller and Retzius was of the greatest possible
assistance in enabling him to identify the parasite when he found it
in human subjects.

  [Footnote 7: Virchow's Archiv, Bd. ix.]

The number of positive facts which Müller brought to light in the most
diverse departments of science is almost beyond calculation, and yet
it is astonishing how seldom the slightest error, or even an
incomplete observation, can be found in his work. On the other hand,
it has happened, over and over again, that when the correctness of his
observations in the beginning seemed according to other investigators
to be dubious, they have come eventually to be acknowledged as
representing the truth. As a rule, he went over every set of
observations three times. During the second series he wrote about
them. He always repeated the experiments on which his observations
were founded while his material was going through the press. His
manuscripts were a mass of corrections; notwithstanding this, his
proof sheets were the despair of the printers.

Müller accomplished all this only by the most careful husbanding of
his time. He knew how to make use even of the ends of hours and brief
intervals which others waste without a thought about them. He used to
call these periods of short duration between the duties "the gold-dust
of time," and said that he did not wish to lose a particle of it. In
the quarter of an hour between two lectures it was not an unusual
thing to find that he took up some dissection at which he was engaged,
or continued his work sketching the observations that he had been
making during the previous day.

How thorough was Müller's work in everything that he devoted himself
to can be gathered from certain excursions into pathology, which was,
after all, only a side issue in his work, and to which he gave very
little serious attention. Müller's assistant in the Museum of Berlin,
and one of his {241} favorite pupils, Schwann, made a series of what
Virchow calls comprehensive and magnificent investigations on the cell
structures of the animal tissues, on which progress in pathology so
essentially depends. Müller followed up these discoveries, and, to
quote Virchow once more, he was in this matter the authority of
authorities; for the medical world owes to him practically all its
knowledge of tumors. Müller first demonstrated the harmony which
existed between the pathological and the embryonic development of
tumors.

This physiological observation is of the highest importance. It came
at a time when tumors were considered to have nothing of the
physiological about them, but to be entirely manifestations of morbid
processes foreign to all natural functions of the body. Müller's
observation of the identity of the pathological and the embryonic
development of tumors is really the key to the whole doctrine of
morbid formations. Virchow assures us that Müller's labors gave the
strongest impulse to the employment of the microscope in pathological
investigations. Undoubtedly this was his most important contribution
to scientific medicine. With this he laid the foundation of the
explanations of tumors--a work that his great pupil was destined to
carry on. Some of Müller's work in this line, his study of
enchondromata for instance, Virchow confesses to have been part of the
inspiration that led to his own later work. Müller was occupied,
however, with too many things to devote himself to the study of
pathology in the way that would have been necessary to make great
discoveries in the science. He promised that he would sometime settle
down to make a classification of tumors, and that the principle of
such a classification would not be based either on their fineness of
structure or on their chemical composition, but that their
physiological nature and tendency to grow must be taken into account.
When he died, however, he {242} left behind him nothing unfinished
except the long-expected conclusion of his book on tumors.

Müller's most important work in physiology, and his most far-reaching
influence on the biological sciences, which were just then beginning
their modern development, came from his assertion of vital force as a
thing entirely different from and absolutely independent of the
physical or chemical forces which it directs and makes use of. Vital
force for Müller was the ultimate cause and supreme ruler of vital
phenomena, so that all the energies of an organism follow a definite
plan. It was for him the complete explanation of all the physical
manifestations of life. It disappears in death without producing any
corresponding effect. Without losing anything of itself it hands over
in multiplication or reproduction a force equal to itself to the new
being that is born from it. This vital force that is thus handed over
need not necessarily manifest itself at once, but may lie dormant for
a long time to be awakened to manifestations of life by the
concurrence of proper conditions in its environment.

In a word, Müller appreciated fully the mystery of life, faced the
problem of it directly, stated it in unequivocal terms, and by so
doing saved the rising science of biology from wandering off into
speculations which were seductive enough at that time, but which would
have proved vain and wasteful of time and investigative energy.
Müller's influence on his students was sufficient in this matter to
set the seal of vitalism, as it is called, on most of the biological
work done in Germany about the middle of the century, and it was a
recurrence to his observations and his methods which led the reaction
to vitalistic theories that characterized the concluding years of the
nineteenth century.

With regard to the significance of Müller's work, Professor Du
Bois-Reymond, himself a pupil of Müller, in his memorial {243} address
delivered before the Royal Academy of Sciences of Berlin in 1859,
[Footnote 8] says: "It has been objected by those who insist on the
greatness of Müller's reputation that he himself made no discovery
that can be said to be of the first rank. Müller's fame is great
enough for us to allow that there is something true in this objection.
He accomplished more in developing the ideas of others than in
original research of his own. That he did not make any great discovery
is, however, rather due to the fact that he came at a time when great
discoveries were no longer lying around loose as they had been in the
preceding century, waiting to be made, as it were; and what he
accomplished was of more value than one or two single discoveries of
primary importance. He made the original ideas of other men so clear
that they were at once accepted by all the medical and scientific
world. In this way he furthered the progress of medicine better than
any devotion, however successful, to one single feature could possibly
have accomplished.

  [Footnote 8: Gedächtnissrede auf Johannes Müller, von Emil Du
  Bois-Reymond, Berlin, Buckdruckerei der Königlichen Akademie der
  Wissenschaften (Dummler), 1860.]

"Müller made mistakes, but then who ever fails to make mistakes in the
face of nature? As a rule, however, he hit the nail on the head. There
are many suggestive thoughts from him that the investigators of later
times have proved to be true. He suggested, for instance, that there
must necessarily be some connection between the ganglionic bodies and
the nerve stems. He suggested, also, that there must be a special
nerve system for the intestinal tract. Later discoveries in physiology
have established both of these thoughts and have shown that Müller had
so entered into the spirit of nature and her processes as to be able
to think her thoughts. There is no doubt that there are suggestions in
{244} his writings, especially those of the later years of his life,
which will give a series of triumphal substantiations of the same
kind."

Du Bois-Reymond's final judgment is of special interest, because it
tries to point out the comparative place that will be occupied by
three great men in the biological sciences of a century ago:

  "Haller and Müller must be considered as giants of earlier days,
  though when future generations compare them with Cuvier they will
  occupy somewhat of the position that Galileo and Newton hold in
  comparison to La Place and Gauss, or Lavoisier in comparison to
  Berzelius. The first of these men had the opportunity to do great
  things while it was yet possible to do them, and left to their
  successors only the possibility of developing their thoughts."
  [Footnote 9]

    [Footnote 9: Some idea of the estimation in which Müller was held
    by his contemporaries, German and foreign, may be gathered from
    the number of scientific bodies of which he was a member. He was
    an associate in practically every serious scientific body in
    Germany. He was, besides, foreign member of the scientific
    academies at Stockholm, Munich, Brussels, Amsterdam; the
    scientific societies of Göttingen, London, Edinburgh, Copenhagen;
    foreign honorary member of the Academy of Sciences of Vienna;
    corresponding member of the Academies of St. Petersburg, Turin,
    Bologna, Paris and Messina; of the Society for Science at Upsala,
    of the Mecklenburg Naturalist Society of Rostock, of the
    Senkenberg Institute of Frankfort-on-Main, of the Academy of
    Natural Sciences of Philadelphia, of the Society of the Museum of
    Natural History at Strasbourg, of the Naturalists' Association of
    Dutch East India; member of the Holland Society of Sciences,
    Haarlem; of the Naturalist Society of Frieburg in Breisgau, Halle,
    Dantzig and Mainz; of the American Philosophical Society of
    Philadelphia, of the Society of Biology of Paris; honorary member
    of the Cambridge Philosophical Society, of the Natural Science
    Union of Hamburg, and the Natural Science Association of the
    Prussian Rheinland and Westphalia, of the American Academy of Arts
    and Sciences in Boston, of the Ethnological Society of London, of
    the Microscopic Association of Giessan, member of the Society for
    Science and Medicine at Heidelburg, of the Naturalists' Society at
    Dresden; corresponding member of the Scientific and Medical
    Association of Erlangen and Moscow; member of the Academy of
    Medicine of Paris; honorary member of the Academy of Medicine of
    Prague and of Dorpat, of the Medico-Chirurgical Academies of Wilna
    and of St. Petersburg, of the Medical Society of Guy's Hospital in
    London, of the Medical Society of Edinburgh and of the Hunterian
    Society of the same city, and of the Medico-Chirurgical Societies
    of London and of Zurich, of the Medical Societies of Budapest, of
    Lisbon, of Algiers and Constantinople; corresponding member of the
    Medico-Chirurgical Academy of Turin and of the Medical Society of
    Vienna.

    Even this long list does not include all his various honorary and
    active memberships in scientific and medical societies. He was,
    besides, the laureate, that is, a prize winner, of the Medical
    Faculty of the University of Bonn, of the Sömmering Prize of the
    Senkenberg Institution, of the Copley Medal of the Royal Society
    of London, of the Culver Prize Monthyon of the same institution,
    as well as laureate of the Academy of Sciences of Vienna for
    Experimental Physiology. He had been honored by the King of
    Prussia by the conferment of the knighthood of the Order of the
    Red Eagle, by the King of Sweden by the Royal Swedish Order of the
    North Star, by the King of Bavaria by the Royal Bavarian
    Maximilian Order, and by the King of Sardinia by a knighthood in
    the Order of SS. Mauritius and Lazarus.]

{245}

It is as a teacher that Müller did his best work. He was not by nature
a good talker and never said much, but he was very direct; and, as he
spoke from the largest possible and most progressive knowledge of the
subject, his lectures were always interesting to serious students.
There seems to be a more or less general agreement that for the mass
of his students he was uninteresting because likely to be above their
heads. For the talented members of his class, however, he was an ideal
teacher--always suggestive, always to the point, and eminently
complete. Du Bois-Reymond says that he never was confused, never
repeated himself, and never contradicted himself.

He was able to illustrate his lectures by sketches on the board in a
way that enabled students to follow every step of {246} even a
complex, embryological developmental process. He could trace, step by
step, with the chalk, every stage of evolution in the organism and
bring it clearly before his students. To a narrow circle of the best
men within his class he became a personal friend, whose inspiration
led them on to the deepest original researches. Among his students
were some of the men who made German medicine and German science known
all over the world in the last fifty years. Chief among them may be
mentioned Virchow, Helmholtz, Du Bois-Reymond, Schwann, Lieberkuhn,
the discoverer of the follicles in the intestines; Max Schultze, whose
work in histology and physiology are well known; Claparede, Remak,
Guido, Wagener, Lachmann and Reichert.

What he demanded of his students above all was that they should learn
to help themselves. He set them tasks, gave them suggestions, directed
their work, corrected their errors, but he wanted them to do work for
themselves. His very presence was an inspiration. Both Virchow and Du
Bois-Reymond speak of the power of his eye. Du Bois-Reymond says that
there was in him an almost demoniac magic, and that students looked to
him as the soldiers of the first Napoleon did when the great Emperor's
words were in their ears--"Soldiers, the Emperor has his eye on you."
Du Bois-Reymond adds that, consciously or unconsciously, every student
felt the winning influence of his great personality. With all this he
knew how to unbend, especially with favorite students, and many a joke
from him found its way around the laboratory even during working
hours. He was not one to stand on his dignity, and Virchow tells of
him that even when nearly fifty he was known to race with a student
down the corridor from one class-room door to another. He took up
skating at the age of forty-five, and though he had not many friends
and was too entirely devoted to his work to make {247} many
acquaintances, it was always a source of pleasure to young men to be
allowed to associate with him, and many eagerly sought the privilege.

How impressive a figure Müller made in his character of teacher can be
gathered best, perhaps, from a note added to Virchow's panegyric
during its progress through the press, in which the pupil tells his
impressions of the master:

  "I must confess that Müller, in his lectures and in his manner,
  reminded me of a Catholic priest, which might be accounted for by
  the impressions of his early childhood. When as the dean of the
  Faculty he mounted the _cathedra superior_, dressed in his official
  robes, and pronounced the Latin formulary of the proclamation of the
  doctors of medicine, with short, broken and contracted words; when
  he began his ordinary lectures in almost murmured syllables; or,
  when with religious earnestness he was discussing any of the
  abstruse questions of physiology, his tone and manner, his gestures
  and looks, all betrayed the traditional training of the Catholic
  priest."

Virchow adds, "Müller himself was what he styled one of his greatest
predecessors--perpetually a priest of nature. The religion which he
served attached his pupils to him as it were by a sacred bond; and the
earnest, priest-like manner of his speech and gestures completed the
feeling of veneration with which everyone regarded him."

In the recently issued life of von Helmholtz, the great German
physicist, his biographer makes it very clear how much Helmholtz
thought of Müller, one of the earliest teachers. [Footnote 10]
Helmholtz, Brücke, and Du Bois-Reymond were warm personal friends
(college chums we would call them in America), and all fervent
admirers of their greatest {248} master, who showed them, as Helmholtz
says, "how thoughts arise in the brains of independent thinkers." A
half-century later, in his recollections of the time, he said: "He who
has come in contact with one or more men of the first rank has his
mental intellectual standard for all time broadened, and such contact
is the most interesting thing that life can hold." Curiously enough,
one of the most interesting things in Helmholtz's recollections is
that, despite the fact that the poverty of his parents made it
advisable for him to get through his medical studies as soon as
possible, Müller persuaded him to take another year's medical work
before going up for his graduation. This was mainly for the purpose of
having his pupil complete an essay in physiology on which he was
engaged. Müller offered him the use of his own laboratory and all his
instruments for this purpose. His judgment was justified by
Helmholtz's wonderful work on the conservation of energy made within a
few years after his graduation.

  [Footnote 10: Herman von Helmholtz, von Leo Koenigsberger. Bd. 2,
  Braunschweig, Friedrich Viewig und Sohn, 1902-3]

Müller's death was sudden, though not entirely unexpected. He had been
ailing for many months and had resolved to give up his lectureship. He
had made most of his preparations for settling up his affairs, and had
even sent for his son, who was practising medicine at Cologne, to come
up to see him. He made a special engagement for a consultation with
his physician for a certain morning, and having gone to bed in
reasonably good spirits, in fact, feeling better than he had for a
long while, was found dead in the morning. Some time before he had
made his will forbidding an autopsy, and so the exact cause of death
will never be known, though it is rather easy to surmise that it was
due to apoplexy, as arteriosclerosis--that is, degeneration of
arteries--had been noticeable in Müller for some years, and his
temporal artery particularly had become hard and tortuous.

Müller was buried with all the rites of the Church, and as {249} in
Germany the ecclesiastical authorities are very strict in this matter,
there can be no doubt that the great physiologist had been a faithful
Catholic. He was known for his edifying attendance at Mass on all the
Sundays of the year. Many years afterward, in the midst of the
Kulturkampf in the early seventies, a monument was erected to him in
his native Coblentz, and the occasion of its unveiling was taken by
the Catholic Rhineland for a celebration in honor of their great
scientist.

For a time, in his younger years, Müller appears to have been not all
unaffected by the materialistic tendencies so rife in the science of
the time. His early anatomical investigations seem to have clouded
somewhat his faith in things spiritual. One of the expressions
attributed to him before his twenty-fifth year is that nothing exists
in the human being which cannot be discovered by the scalpel. It was
not long, however, before Müller repudiated this expression and came
back to a realization of the importance of the immaterial. Another
expression attributed to him, "Nemo psychologus, nisi physiologus,"
"No one can be a psychologist, unless he is a physiologist," has been
often repeated as if Müller meant it in an entirely materialist sense.
As a matter of fact, however, it is intended to convey only the idea
that no one can really exhaust the science of psychology unless he
knows the physiology of the brain, the organ which the mind uses in
its functions in this life. The expression is really the foundation of
the modern physiological psychology, which is by no means necessarily
materialistic in its tendency, and has become a favorite subject of
study even with those who appreciate thoroughly the importance of the
immaterial side of psychology.

Müller seems never to have gotten so far away from the Church as that
other great physiologist of the succeeding generation in France,
Claude Bernard, who for many years allowed himself to be swamped by
the wave of materialism {250} so likely to seem irresistible to a
scientist engaged in physiological researches. But, even Claude
Bernard came back to the Church before the end, and, under the
guidance of the great Dominican, Père Didon, reached the realization
that the only peace in the midst of the mysterious problem of life and
the question of a hereafter is to be found in a submissive faith of
the doctrines of Christianity.

Many years ago, when Virchow took it upon himself to say harsh words
in public of Catholic scholarship, and to put forward the hampering
influence of the Church on intellectual development as a reason for
not allowing Catholics to have any weight in educational matters, the
organ of the Catholics of Germany, _Germania_, reminded him that his
own teacher, the great Johann Müller, the acknowledged father of
modern German medicine, and the founder of the fecund scientific
method to which so many discoveries in the biological and medical
sciences are due, had been brought up and educated a Catholic, had
lived all the years of his productive scholarship and fruitful
investigation in her bosom, and had died as an acknowledged son of the
great mother Church.

Müller is certainly one of the great names of nineteenth century
science. When many another that seems now as well, or perhaps even
better known, shall have been lost, his will endure, for his original
researches represent the primal step in the great movement that has
made possible the advances in nineteenth century medicine. He was
honored by his contemporaries, venerated by the men of science who
succeeded him; he has been enshrined in a niche for himself by
posterity, and his name will remain as that of one of the great
geniuses to whose inventive faculty the world owes some of those steps
across the borderland into the hitherto unknown which seem so obvious
once made, yet require a master mind to make and mean so much for
human progress.


{251}

THEODORE SCHWANN, FATHER OF THE CELL DOCTRINE


{252}

  My message is chiefly to you, Students of Medicine, since
  with the ideals entertained now your future is
  indissolubly bound. The choice lies open, the paths are
  plain before you. Always seek your own interests, make of
  a high and sacred calling a sordid business, regard your
  fellow-creatures as so many tools of trade, and, if your
  heart's desire is for riches, they may be yours; but you
  will have bartered away the birthright of a noble
  heritage, traduced the physician's well-deserved title of
  the Friend of Man, and falsified the best traditions of an
  ancient and honorable Guild. On the other hand, I have
  tried to indicate some of the ideals which you may
  reasonably cherish. No matter though they are paradoxical
  in comparison with the ordinary conditions in which you
  work, they will have, if encouraged, an ennobling
  influence, even if it be for you only to say with Rabbi
  Ben Ezra, "What I aspired to be and was not, comforts me."
  And though this course does not necessarily bring position
  or renown, consistently followed it will at any rate give
  to your youth an exhilarating zeal and a cheerfulness
  which will enable you to surmount all obstacles--to your
  maturity a serene judgment of men and things, and that
  broad charity without which all else is naught--to your
  old age that greatest of blessings, peace of mind, a
  realization, maybe, of the prayer of Socrates for the
  beauty in the inward soul and for unity of the outer and
  the inner man; perhaps, of the promise of St. Bernard,
  "Pax sine crimine, pax sine turbine, pax sine rixa."
    --Osler, _Teacher and Student, Aequanimitas_.

{253}

THEODORE SCHWANN, FATHER OF THE CELL DOCTRINE.

It is one of the curious features of history that genuine worth of
human accomplishment is almost in inverse ratio to the popularity it
obtains in the generation in which it is produced. Supremely great
work is rarely appreciated at anything like its proper value, by
contemporaries. This principle is true apparently in all fields of
human endeavor. In literature and in art it is a commonplace. But
also, surprising though it may be, in science and in social betterment
the rule holds a prominent place. It is nearly always the sign of only
passing merit when any work secures the plaudits of its own
generation. Brilliant theories are often immediately hailed with
universal acclaim, while ground-breaking observations that are really
great discoveries are apt to be neglected. The really new discovery is
so novel that men cannot appreciate it at once. It is so different
from their ordinary modes of thinking that they cannot place it
properly. Its complete significance fails them.

This has been true for our nineteenth century biology almost more
strikingly than for any other department of knowledge. Our many
avenues of publicity instead of heralding abroad the great
observations as soon as they have been made, in order to enable others
to continue the work that the master mind has begun, have been only
too constantly crowded with new opinions, novel theories, taking
hypotheses, all attracting attention that they did not deserve. Men
like Theodore Schwann, the father of the cell doctrine, are not apt to
be so well known as the suggestor of some {254} striking bit of
theory. Even the great biologists, such as Darwin himself, are known
rather for their insubstantial theories than for their substantial
additions to biological knowledge by patient observation and genial
penetration into the secrets of nature. It is perhaps a warning to the
modern physician who realizes this state of affairs, not to take the
popular theories even in his own branch of biology as the current coin
of truth. Theories pass, but observations endure. Auenbrugger's new
method of tapping the chest in order to elicit its varying sounds
looked even more childish than Galvani's acceptance of the position of
dancing master to a frog, but their observations thus made continued
the germs of undying truth.

While the name and the life of Theodore Schwann are but little known
by the general public, his work is very thoroughly appreciated by
those who have made special studies in biology, and few men in the
progress of that science are considered to hold as high a place as
that assigned to him. A study of the life of Schwann will serve to
show not only that he eminently deserves this honor which has come to
him, but will also bring into evidence the fact that his career
deserves to be better known popularly, because it illustrates very
well the typical mode of life in which great scientists are nurtured
and the methods of investigation by which great discoveries are made.

Of the men who have made the biology of the nineteenth century there
are three whose names stand out with special prominence. They are
noted not for their controversial writing on mooted points, but for
ground-breaking, original work of the highest scientific import. Their
discoveries will preserve their memories for posterity long after the
names of many of those to whom the glare of controversial publicity
lent an ephemeral brightness for their own {255} generation shall have
been forgotten. They are: Theodore Schwann, the anatomist, to whom
modern biology owes its foundation by the establishment of the cell
theory; Claude Bernard, the physiologist, to whom we are indebted for
the great biological ideas of nervous inhibition and internal
glandular secretion; finally Louis Pasteur, the
chemist-bacteriologist, to whom is due the refutation of the
annihilatory abiologic doctrine of spontaneous generation, and the
discoveries that have revolutionized modern medicine and promise to
accomplish as great a revolution in modern manufactures and
industries.

It has often been said that the Catholic Church is opposed to
scientific advance. It has especially been insisted that in what
concerns biological science the Church's attitude has been distinctly
discouraging. Recently the definite assertion has been made that no
original thinker in science could continue in his profession of faith.
Now, it so happens that all three of these men were born in the bosom
of the Catholic Church, and were educated from their earliest years to
maturity under her watchful care. Schwann and Pasteur remained in the
midst of their great scientific triumphs her faithful sons. For years
Bernard withdrew from all his old religious associations and became
indifferent to the spiritual side of life, but before the end he came
back to the knees of the Mother whose fostering care meant so much to
him in early life.

Theodore Schwann, the first to formulate the cell doctrine, to
promulgate the teaching that all living tissues, whether plant or
animal, are composed of a number of minute elements which under all
circumstances are biologically equivalent--is the father of modern
biology. Cells had been seen and recognized as such before, but their
significance was first pointed out by him. His cell theory has now
become the {256} cell doctrine, the teaching of all the schools of
biology. The generalization that forms the basis of the doctrine was
the result of some of the most accurate and careful observation that
has ever been made. The work was done when the mechanical helps to the
analysis of tissues were in the most primitive condition. The
microscope had just been introduced into general laboratory work. The
microtome, the instrument by which tissues are cut into thin sections
suitable for microscopic examination, and to which almost more than to
the microscope itself we owe our detailed knowledge of the intimate
constitution of tissues, was as yet unthought of. Despite these
drawbacks Schwann's work was done with a completeness that leaves very
little to be desired. He published, when not yet thirty, the story of
his comparative investigation of the cellular constitution of plants
and animals, and there is very little that can be added, even in our
day, to make its scientific demonstration any clearer than it was. It
was typical of the man that, heedless of disputatious controversy over
details of his work, he should go calmly on to complete it, and then
give it to the world in all its convincing fulness. The same trait
crops out with regard to other subjects. His was one of the great
scientific minds of the century, always immersed in a philosophic calm
befitting the important problems he had in hand. His life is ideal in
its utter devotion to science, and to the teaching of science, while
no duty that could round it out and make it humanly complete for
himself or others was despised or neglected.

Theodore Schwann was the fourth of a family of thirteen children, born
in the little German town of Reuss, not far from Cologne. He received
his college education in the Jesuit Gymnasium of Cologne, and passed
thence to the University of Bonn. The lower Rhineland is largely {257}
Catholic, and to this day, though Bonn has become the fashionable
exclusive German university to which the Kaiser and many of the scions
of the great German families go for their higher education, the
faculty of theology at the university remains Catholic. Schwann
devoted some time here to the study of theology, but he came under the
influence of Johann Müller, was allowed to assist in some of his
experiments on the functions of the spinal nerves of frogs, and this
seems to have determined him to a medical career.

After two years spent in medicine at Würzburg, another great Catholic
university of Southern Germany, we find Schwann at the University of
Berlin, once more working with Johann Müller, who had been invited
from Bonn to fill the distinguished Rudolphi's place in the chair of
anatomy at the rising Prussian university. Müller was one of those
wonderful men--they turn up, unfortunately, all too rarely--who,
though not great discoverers themselves, have the invaluable faculty
of inspiring students with an enthusiasm for original observation
which leads to the most brilliantly successful researches. A great
teacher, in the proper sense of the word, he was not. In his public
lectures and his ordinary lessons he was often arid and uninteresting,
insisting too much on unrelieved details, "the dry bones of science."
He seems to have failed almost completely in conveying the usual
scientific information of his course with the air of novelty that
attracts the average student. The true teaching faculties are not
given to many. Müller had a precious quality all his own that has
proved much more valuable for science than the most enlightened
pedagogy.

To the chosen few among his students who were drawn into close
intimacy with him and permitted to share his personal scientific
labors, Müller proved a source of most precious incentive--a
suggestive master, the inspiration of {258} whose investigating spirit
was to be with them throughout life. To no one, except perhaps to
Socrates of yore, has it been given to have sit at his feet as pupils
so many men who were to leave their marks upon the developing thought
of a great era in human progress. Beside Schwann, there studied with
Müller, during these years at Berlin, Henle the anatomist, Brücke the
physiologist, Virchow the pathologist, Helmholtz the physicist, Du
Bois-Reymond the physiologist, Claparède, Reichert, Lachmann,
Troschel, Lieberkühn and Remak. All these names are writ large in the
scientific history of the century. It is a remarkable group of men,
and of them Schwann, with the possible exception of Helmholtz, will be
remembered the best by posterity; certainly none of them would not
have cheerfully resigned his hopes of scientific renown for any work
of his own to have made the discovery which, as an enthusiastic
biographer said, set the crown of immortality on a young, unwrinkled
forehead.

Schwann's thesis for his doctorate at Berlin showed the calibre of the
man, and demonstrated his thorough fitness for success as an
experimental scientist. The question whether the growing embryo in the
ordinary hen's egg consumes oxygen or not had been in dispute for some
time. It was well known that an air-chamber existed in the egg even at
the earliest stages of embryonic life. It was understood that the
mature chick just before its egress from the egg must have air, and
the porosity of the egg-shell was sufficient to permit its entrance.
Whether at the beginning of embryonic life within the egg, however,
oxygen was necessary, remained somewhat in doubt. It had been
demonstrated that the gas existing in the air-chamber of an egg became
changed in composition during the progress of development. From being
slightly richer in oxygen than ordinary atmospheric air at the
beginning of embryonic growth, {259} containing 24 to 25 parts of
oxygen per 100, it became modified during comparatively early
development so as to contain not more than 17 parts of oxygen per 100
and some 7 parts of carbon dioxide. This change of composition was, at
least, very suggestive of the alteration that would take place during
respiration. It was pointed out, however, that the argument founded on
these observations was drawn only from analogy, and was by no means a
scientific demonstration of the fact that the embryo not only consumed
air during its growth, but actually needed oxygen for the continuance
of its vital processes.

It was suggested that the change of composition in the air within the
egg might be due not to any essential vital functions, but to chance
alterations brought on by decomposition in the unstable organic
material so abundantly present in the substance of the egg. Schwann
settled the question definitely by a set of ingenious experiments. He
exposed eggs for various periods to the action of other gases besides
air, and also placed them in the vacuum chamber of an air-pump. When
not in contact with the air the eggs developed for some hours if the
temperature was favorable, and then development ceased. If after
twenty-four hours' exposure to an atmosphere of hydrogen eggs were
allowed free contact with the air, development began once more at the
point at which it had ceased. After thirty hours of exposure to
hydrogen, however, or to the vacuum, all life in the egg was
destroyed, and it failed to develop no matter how favorable the
conditions in which it was afterward placed. The completeness with
which the points in dispute in this problem were demonstrated is
typical of all Schwann's work. His conclusions always went farther
than the solution of the problem he set out to solve, and were always
supported by simple but effective experiments, often ingeniously
planned, {260} always carried out with a mechanical completeness that
made them strikingly demonstrative.

One of Schwann's brothers had been a worker in metal, and Schwann
himself had always shown a great interest in mechanical appliances.
This hobby stood him in good stead in those days when laboratories did
not contain all the intricate scientific apparatus and the facilities
for experimentation so common now, with their workshop and skilled
mechanics for the execution of designs. Many another worker in the
biological sciences of that time owes his reputation to a similar
mechanical skill. Experiments were impossible unless the investigator
had the mechanical ingenuity to plan and the personal handiness to
work out the details of appliances that might be necessary for
experiments. It is told of Schwann that when Daguerre's discoveries in
photography were announced, such was his interest in the new invention
that he made a trip to Paris especially to learn the details of the
method. Some daguerreotypes made by him according to the original
directions of the inventor himself are still preserved by his family.

Schwann's investigation of the respiration of the embryo in hens' eggs
led to further studies of the embryo itself, and to the discovery that
it was made up of cells. Later came the resolution of other tissues
into cells. When, after his graduation as doctor in medicine, the post
of assistant in anatomy at Berlin fell vacant, it was offered by
Johann Müller to Schwann. The position did not carry much emolument
with it. The salary was ten German thalers--_i.e._, about $7.50 per
month--a pittance even in those days when the purchasing power of
money was ever so much greater than now. His duties took up most of
his time. The work was congenial, however, and Schwann remained here
for five years. As Henle has said in his biographical sketch of {261}
Schwann, in the _Archiv f. mikroskopische Anatomie_, just after his
death in 1882: "Those were great days. The microscope had just been
brought to such a state of perfection that it was available for
accurate scientific observations. The mechanics of its manufacture had
besides just been simplified to such a degree that its cost was not
beyond the means of the enthusiastic student even of limited means.
Any day a bit of animal tissue, shaved off with a scalpel or picked to
pieces with a pair of needles or the finger-nails, might lead to
important ground-breaking discoveries." For at that time almost
everything as to the intimate composition of tissues was unknown.
Discoveries were lying around loose, so to speak, waiting to be made.
Schwann was not idle. The precious years at Berlin saw the discovery
that many other tissues were composed of cells. The nuclei of the
striped and unstriped muscles were found, and while the cellular
character of these tissues was not demonstrated, their secret was more
than suspected and hints provided for other workers that led very
shortly to Kölliker's and Henle's discovery of muscle cells.

Besides his interest in histology, the branch of anatomy which treats
of the intimate constitution of tissues, Schwann was working also at
certain general biological questions, and at some knotty problems of
physiology. Not long after his installation as an assistant at Berlin,
from observations on fermenting and decomposing organic liquids, he
came to a conclusion that was far in advance of the science of his
day. He announced definitely _infusoria non oriuntur generatione
aequivoca_--the infusoria do not originate by spontaneous generation.
Under the term infusoria, at that time, were included all the minute
organisms; so that Schwann's announcement was a definite rejection of
the doctrine of spontaneous generation over thirty years before
Pasteur's demonstrations finally settled the question. Schwann was
never a {262} controversialist. He took no part in the sometimes
bitter discussions that took place on the subject, but having stated
his views and the observations that had led up to them he did not ask
for the immediate acceptance of his conclusions. He continued his work
on other subjects, confident that truth would prevail in the end. When
the congratulations poured in on Pasteur for having utterly subverted
the doctrine of spontaneous generation, the great French scientist
generously referred the pioneer work on this subject to Schwann, and
sent felicitations to that effect when Schwann was celebrating the
jubilee anniversary of his professoriate.

While studying ferments and fermentations Schwann became interested in
certain functions of the human body that carry with them many
reminders of the biological processes which are at work in producing
the various alcohols and acids of fermentation. The changes that occur
in the contents of the human stomach during the preparation of food
for absorption had long been a subject of the greatest interest to
physiologists. It had been studied too much, however, from the merely
chemical side. The necessity for the presence of an acid in the
stomach contents in order that digestion should go on led to the
conclusion that the acid was the most important constituent of the
gastric juice. By means of the scrapings of the stomachs of various
animals Schwann succeeded in preparing an artificial gastric juice,
and showed just how the action of the gastric secretions brought about
the solution of the contents of the stomach. He isolated pepsin, and
demonstrated that it resembled very closely in its action the
substances known as ferments. He even hinted that digestion, instead
of being a chemical was a biological process. Any such explanation as
this was scouted by the chemists of the day, headed by Liebig. Most of
the physiological functions within the human body were {263} then
triumphantly claimed as examples of the working of chemical laws.

Of the contradiction of his conclusions Schwann took practically no
notice, but went faithfully on with his work. He could not be lured
into controversy. For nearly five years he continued his work at the
University of Berlin, receiving only the pittance that has been
mentioned--less than ten dollars per month. Only the purest love of
science for its own sake, and the satisfaction of his own enthusiastic
spirit of investigation kept him at work. There was but little
prospect of advancement at the University of Berlin itself. Schwann
was one of the lowest in rank of the assistants; the professor was
only just beyond the prime of life; and before Schwann on the list for
promotion was at least one man, Henle, who had already done
distinguished work. Germany had the good fortune to have all during
the nineteenth century young men who, unmindful of present emolument,
had been satisfied with the scantest wages for their support, provided
the positions they occupied gave them opportunities for original work.
Even at the present day young medical men are glad to accept what they
consider the honor of the position of assistant to the professor and
director of the clinic, and to remain in it for from five to ten
years, sometimes even more, though the salary attached to it is only
from $250 to $400 per year. They well know that if their original
investigations into various medical questions are successful, advance
in university rank is assured. Their promotion seldom comes from the
institution where they have done their work, unless it should be one
of the smaller universities; but the invitation to a chair at a
university will come sooner or later for meritorious research.

Schwann's invitation came from Louvain. His work on cells had
attracted a great deal of attention. In the midst {264} of the
rationalism and infidelity then so common among scientific men Schwann
was known as a faithful, sincere Catholic. When the great Catholic
University of Louvain, then, looked around for a professor of anatomy,
he appeared to be the most suitable person. Henle, who had very little
sympathy for Schwann's religious views, speaks most kindly of him as a
man and a comrade. Schwann seems to have endeared himself to the
"difficult" Prussians, as he did to those around him all his life. For
the dominant note in the sketches of him by those who knew him
personally is that of heartiest friendship, joined with enthusiastic
admiration for his simple sincerity and unselfish devotion to his
friends and to science.

A little incident that has been preserved for us by Henle shows how
much his young contemporaries appreciated even at that early date,
long before the full significance of the cell theory could be
realized, the aspect of Schwann's work which was to make him immortal.
At a little farewell dinner given him by his co-workers in various
laboratories of the University of Berlin the feature of the occasion
was a punning poem, by the toast-master, on the words Louvain and
cells.

In German Louvain is Löwen, which also means lion; that is, it is the
dative case of the name of the lion. Reference is made to the fact
that as Samson found honeycomb (in German, bee-cells) in the lion, so
now Louvain--_i.e._, in German, Löwen, the lion--finds a champion in
the man of the cells. As Samson's riddle was suggested by finding the
bee-cells, so will the new professor at Louvain solve the riddles of
science by the demonstration of cells. The youthful jesting seer
prophesied better than he knew. Schwann's first completed work at
Louvain was the _Microscopical Researches into the Accordance in
Structure and Growth of Plants and Animals._ [Footnote 11] {265} The
theory it advanced was to prove the most potent element thus far
introduced into biological science to help in the solution of the
difficult problems that constantly occur in the study of the various
forms of life.

  [Footnote 11: Mikroskopische Untersuchung über die Uebereinstimmung
  in der Structur und dem Wachsthum der Thiere und Pflanzen, 1839.]

At Louvain, Schwann remained for about ten years. The period is marked
by a continuance of his fruitful investigation of cell-life, of the
physiological biology of ferments and fermentation, and of the allied
subject of digestion in animals. His researches in Berlin on this
interesting and important subject, which was practically a complete
mystery at that time, had been mainly concerned with the gastric
juice. He now began the study of various secretions which aid
intestinal digestion. He proved that bile, which used to be considered
an excretion, was really an important digestive secretion. He was not
able to demonstrate the function of bile as completely as he had done
for the gastric juice. The problem of intestinal digestion is much
more complicated than that of stomach digestion, and involves a number
of factors for which allowance has to be made if the value of any one
of them is to be accurately determined. Even in our own day all of the
physiological problems in the functions of biliary secretion are not
solved. The greatest step was the demonstration that bile is a thing
whose presence in the intestines is to be encouraged, not because, as
Horace said, mental trouble was imminent unless one were purged of
black bile in the springtime, but because its presence insures the
proper preparation of food, and neutralizes in the intestinal tract
certain poisonous substances that if absorbed would prove sources of
irritation to all higher tissues.

His work on bile practically closes Schwann's career as an
investigator. The seven years between twenty and {266} twenty-seven
were so full of discovery that there seemed to be great promise for
his mature years. Had Schwann died at thirty his biographies would
have surely contained lengthy comments on the great discoveries that
would undoubtedly have rewarded his efforts in the prime of his
powers. Schwann's seeming inactivity has been a fruitful cause for
conjecture. The fact of the matter is, however, that original work of
a high order is accomplished mainly during the time when activity of
the imagination is at its height. There are very few cases in which
this acme of inventive effort has lasted more than ten years.

Besides this there were certain more material factors that hindered
original work. Schwann was a German, yet had to give his lectures at
Louvain in French. For several years most of his efforts were devoted
to acquiring facility in the language of his adopted country. Then
Schwann was not such a teacher as Müller, but the true pedagogue who
took seriously to heart the duty of teaching all his students. To do
this meant, in the rapidly advancing science of that day, unceasing
toil on the part of a conscientious professor. For it was a time of
great discoveries succeeding one another with almost incredible
rapidity. For ten years Schwann faithfully devoted himself to his
teaching duties in the anatomical course at Louvain. He then accepted
the chair of comparative anatomy and physiology at Liège, where he
continued to lecture for thirty years. As the result of his stay at
Louvain there has always been special attention given to biological
studies at that university. At the present time there is published
there a very well and favorably known biological journal, _La
Cellule_, through which many important contributions from the
professors and students of the university find their way before the
public.

During his stay at Liège Schwann was formally invited, {267} on three
different occasions, to return to his German Father-land to become
professor at some of her great universities. Professorial chairs in
anatomy or physiology at Würzburg, at Giessen, and at Breslau, were
offered him between 1850 and 1860. He refused them, however, to
continue his work in Belgium. He found his adopted countrymen
eminently sympathetic. It seems clear that he felt more at home in the
midst of the profoundly Catholic sentiment that pervaded the Belgian
universities, and which was in such marked contrast to the
rationalistic spirit characteristic of the German universities at that
time. Schwann was penetrated with a lively sense of the deepest
religious feeling, which is noticeable all through his life. His
attitude in this matter greatly impressed his scientific
contemporaries. His sense of duty in matters spiritual was only
equalled by his affectionate regard for his relatives. His vacations
were invariably spent with his parents while they were alive, and
later with his brothers and sisters in the neighborhood of Cologne. It
was while making a Christmas visit to them that he suffered the fatal
stroke which carried him away.

Toward the end of his career Schwann was invited to be a member of a
commission to investigate the case of Louise Lateau. It will be
remembered that the report of recurring bleedings from stigmata in
this case attracted a great deal of attention, not only among
Catholics, but among all classes throughout the world. After careful
observation Schwann refused to concur in the report that the bleedings
were manifestly miraculous. At first it was announced that he had
declared them evidently beyond the domain of natural causes, but this
report he took occasion to correct immediately. The circumstance led
to the publication of some harsh words in the religious press, but
with his usual moderation Schwann refused to enter into any
discussion, and so the affair ended. {268} His thoroughly conservative
attitude in the matter, and his application of the strictest
scientific criteria to the case, prevented formal expression of
approval on the part of those in authority. While such an opinion
would have carried only personal weight with it, it might easily have
been made a cause for unfortunate aspersions upon the Church.

The most marked feature of Schwann's career is the unfailing
friendships that linked him to those with whom he was associated. At
Louvain, and later at Liège, he was the personal friend of most of his
students, while at Berlin he made friendships with some of the great
men in German medicine which endured to the end of his life. When the
celebration of his fortieth anniversary came around, the hearty
tributes from all over Europe showed in what lofty reverence the
kindly old man was held, who had sacrificed some of his chances for
greater scientific fame in order to be a teacher of others, and a
living exponent of the fact that the frame of mind which leads to
great scientific discovery and that which bows humbly to religious
truth, far from being hopelessly and essentially opposed to each
other, may be peacefully united in the same person in their highest
expression.


{269}


CLAUDE BERNARD, PHYSIOLOGIST


{270}

  The experienced eye, the power of perceiving minute differences and
  fine analogies which discriminate or unite the objects of science,
  and the readiness of comparing new phenomena with others already
  treasured up in the mind--these are accomplishments which no rules
  can teach and no precepts put us in possession of. This is a portion
  of knowledge which every man must acquire for himself; nobody can
  leave as an inheritance to his successor. It seems, indeed, as if
  nature had, in this instance, admitted an exception to the will by
  which she has ordained the perpetual accumulation of knowledge among
  civilized men, and had destined a considerable portion of science
  continually to grow up and perish with individuals.
    --Dr. John Brown, _Edward Forbes, Spare Hours_.


{271}

CLAUDE BERNARD, THE PHYSIOLOGIST.

With the recent development of post-graduate education the Collège de
France has become a favorite shrine of pilgrimage for educators who
visit Paris. It represents the oldest educational institution
deliberately founded with the idea of combining teaching with
investigation. The professors were not bound to teach definite
doctrines, literary or scientific, but to give rather the results of
recent investigations and personal meditation on great scientific and
philosophic problems. The college was not meant, in a word, so much
for students as for specialists. It was intended not to convey a
definite body of knowledge on any subject, but rather to round out the
knowledge acquired in the regular course at the University of Paris,
and to dwell particularly on recent lines of advance in special
subjects in a manner that would encourage original investigation.

In a word, the Collège de France was the first modern post-graduate
school. We have learned in recent years how important are
post-graduate departments for their influence on the regular work of a
university. Unless original investigation of a high order is
constantly done at a university, it is inevitable that the regular
course will cease to be up to date. Modern educators are coming to
realize very forcibly this quality of a successful teaching
institution. Hence the interest that will surely continue to grow in
the Collège de France, its foundation, its history, its teachers, and
its methods.

To the great majority of those who come to pay their respects at this
shrine of original investigation, it will prove a {272} distinct
surprise to find the centre of the court of the Collège de France
occupied by a statue of Claude Bernard. Bernard is not well known, and
is still less appreciated out of scientific circles. By many it is
forgotten that the original free school, the _Collège de trois
langues_, in which Hebrew, Greek, and Latin were the only chairs, has
extended its scope, and that in our day the natural sciences represent
the most fertile field of its achievements. The absolute freedom of
opinion guaranteed to professors originally, and which constituted the
principal reason for an educational institution apart from the
University of Paris and its trammels, has proved a precious heritage
to later generations. Science has flourished vigorously, and the
memorial to its representative cultivator at the college in this
century has deservedly been given the place of honor in its court.

To the initiate, however, for whom, in medicine and physiology and
general biology, his work is still an inspiration, many points of
interest around the college will have all their attraction from
associations with Claude Bernard's career. His neglect by the popular
mind is more than compensated for by the fervent admiration of all
those who are occupied with investigations along the lines he
followed. For in him they recognize a master mind such as is given to
a branch of science not more than once in a century; the veritable
possessor of a magician's wand, who knows how to disclose the hidden
veins of precious ore, the exploitation of which will prove a source
of riches to so many faithful followers. For these the dark little
laboratory of the college in which Bernard made so many of his
ground-breaking discoveries will be in the nature of a shrine to which
one comes with grateful memories of the _genius loci_ that was. The
apartment across the street at No. 40 Rue des Ecoles, where Bernard
lived for years, will be the term of many a pilgrimage. Scientists
{273} from all over the world will wander from here out to the
laboratory in the Jardin des Plantes, where Bernard's work was done in
his later years, and where the fundamental problems of life--plant and
animal--usurped the attention that had at first been devoted
exclusively to human physiology and its allied sciences.

Claude Bernard is another and a striking illustration of the
historical tradition that great men usually come from the country, and
not infrequently from poor parents. He was born in 1813, at St.
Julien, not far from Lyons, almost in the centre of France. His father
owned a small farm in the Beaujolais wine district. The little estate
came later into Bernard's hands, and when he could afford the time he
spent his summers there. When the air is clear the white summits of
the Alps can be seen, and they make a pleasing contrast to the plains
along the Saone and the hill-sides of the immediate neighborhood, all
covered with vineyards. The physiologist, who enjoyed nature very
much, speaks enthusiastically of his "little verdant summer nest."

He was educated at the Jesuit school of Villefranche. It will be
recalled that Theodore Schwann was also a student of the Jesuits. In
these days, when Jesuit educational training is impugned, the facts
are worth noting. It is claimed especially that the old-fashioned
training by means of the classics is narrowing. The old method of a
definitely prescribed course of study for every student is said to
hamper development. Slavish devotion to old pedagogic methods, it is
urged, cannot but shackle and destroy initiative. The subordinate
place of the sciences in this scheme of education is said to hinder
progress in the sciences later in life, to leave the powers of
observation undeveloped until too late, and to distract the mind of
the student too much from the practical side of life. Here are two men
whose lives are {274} an open contradiction to all the allegations of
the opponents of the old Jesuit system of training. Needless to say
that they are but two of many.

Bernard pursued the course with the Jesuits at the Collège de
Villefranche as far as it went. After this we find him at Lyons, at
first pursuing studies in philosophy in preparation for his
baccalaureate degree, evidently with the idea of eventually entering
the university. Family reasons, mainly financial, compelled him to
give up his studies, and for nearly two years he was an assistant in a
pharmacy in Lyons. Here he developed a skepticism with regard to the
effect of the drugs he compounded that led later in life to his
important studies on the physiological action of remedies.

The science of therapeutics was at that time in a most inchoate stage.
Very little was known of the exact action of drugs. Exaggerated claims
were made for many, but mainly on uncertain clinical experience. The
modern, patent medicine was as yet unknown, but something not unlike
it had become popular among the patrons of the Lyons pharmacy. One
remedy was in constant demand by city patrons and by country people,
who came from long distances especially to procure it. It was known as
_la thériaque_--"the cure"--I suppose from some fancied connection
with the root of the word therapeutics.

This remedy, according to the old women of the neighborhood and the
countryside, was a panacea for every ill that flesh is heir to, and a
few others besides (_pro morbis omnibus cognitis et quibusdam aliis_).
The composition of this wonder-worker was even more interesting than
its universal curative efficacy. Whenever a drug spoiled from too long
keeping, or an error in its manufacture made it unavailable for the
purpose for which it was originally intended, or whenever an
involuntary mistake in compounding occurred, the {275} assistants in
the pharmacy were directed not to throw the drugs away, but to reserve
them for "la thériaque." "Mettez vous cela de côté pour la thériaque"
(put that aside for "la thériaque") was a standing order in the shop.
From a remedy of such varied ingredients the most wonderful effects
could be expected and were secured. An unexpected action of the
remedy, however, was that produced on Bernard's mind. This influence
was later to lead to the healing of numberless ills in the system of
therapeutics, and to bring about the establishment of the sciences of
experimental pharmacology and physiology.

Bernard developed literary ambitions while at work in the pharmacy. He
spent many of his free evenings at the theatre, and wrote a musical
comedy, "The Rose of the Rhone," which was acted with some success. He
worked at a prose drama, and, thinking the possibilities of life too
narrow in Lyons, he resolved to go to Paris. With his play in his
pocket, and a letter of introduction to the distinguished critic, St.
Marc Girardin, he reached the capital. Bernard's drama, "Arthur de
Bretagne," was published after his death, and shows that its author
possessed literary talent of a high order. This must have been evident
to Girardin, to whom it was given to read; but he very wisely advised
its author to eschew literature, at least for a time, until he was
able to make his living by some other means. Girardin advised Bernard
to take up the study of medicine, for which his work in pharmacy had
already prepared him somewhat.

Bernard, having once made up his mind to pursue medicine, threw
himself, as was his wont, enthusiastically into the study of it. The
utmost frugality was necessary in order to enable him to live on the
scant income that could be allowed him from home. He lived with a
fellow-student in a garret in the Quartier Latin. Their one room was
study and {276} sleeping room, and even, on occasion, kitchen. When a
"box" came from home, utensils were borrowed from the laboratory for
whatever cooking was necessary.

Bernard was especially interested in anatomy, and soon made himself
known by the perfection of his dissections. Physiology attracted him
not for what was known in the science, but for the many problems as
yet unsolved. His was above all a mind not prone to accept scientific
teaching on the _ipse dixit_ of a professor. Except in the
dissecting-room, his work attracted no attention. He was not looked
upon as a brilliant student, and yet all the while he was
unconsciously preparing himself thoroughly for his life-work. Later on
his dissecting skill was to be a most helpful acquisition. Bernard's
first promising opening came unexpectedly. The nicety with which he
did certain dissecting work in preparation for one of Magendie's
lessons attracted the attention of the professor, at that time the
greatest living experimental physiologist. Magendie, in his bluff,
characteristic way, without asking further about him, called out one
day: "I say, you there, I take you as my _preparateur_ at the Collège
de France."

This position was gladly accepted by Bernard, for it provided him with
an income sufficient to support himself. The work was congenial. His
duty was to prepare the specimens and make ready the demonstrations
for Magendie's lectures. His career as a physiologist dates from this
appointment. He had to give some private lessons, and do what is
called "coaching," or "tutoring," to eke out his slender income, but
in the main his time after this was entirely devoted to investigation
and experiment.

His first investigation concerned stomach digestion. It was important
mainly because it directed his mind to digestive questions. In these
he was to make his great discoveries. {277} His first independent
investigation concerned the differences to be found in the digestive
apparatuses and functions of the carnivora and herbivora--that is, of
the meat and plant-eating animals. The differences in the natural
habits of these two classes of animals had long been noted. While the
meat-eaters invariably bolt their food, the plant-eaters chew theirs
very carefully. Many of these latter, like the cow, are
ruminants--that is, they bring up their food to chew it over again at
their leisure. The instinct that makes them do this is most precious.
Their food is mainly composed of starch, in the digestion of which the
saliva takes a large part. The thorough mixture of the food with
saliva, then, is an extremely important matter. Human beings, who are
both herbivorous and carnivorous, must learn to masticate thoroughly
at least the starch-containing portions of the food. Bernard's first
researches concerned the nerves that supplied the salivary glands, and
which consequently influence the flow of saliva. Curiously enough, the
conclusions of his first experiments were erroneous. The topic led
him, however, into the general subject of the influence of nerves upon
glandular secretion, a problem that he was destined to illustrate in
many ways.

After the salivary glands the most important structure for the
digestion of starches in the animal economy is the pancreas. It was
early evident, however, that the pancreatic secretion effected more
than the conversion merely of starch into sugar. Its most important
rôle, that of influencing the digestion and absorption of fats, was
only recognized as the result of a classical observation of Bernard's
upon the rabbit. He noticed that fat introduced into the digestive
tract of a rabbit undergoes no change until it has advanced a
considerable distance beyond the stomach. When fat is introduced into
the dog's digestive apparatus a marked change {278} begins in it
almost as soon as it leaves the stomach. At first this seemed very
mysterious. Observations were made over and over again, always with
the same result. There was evidently some important distinction
between the intestines of the two animals. Careful investigation
showed that the difference between the behavior of the fat in the
rabbit and the dog was due to the presence or absence of the
pancreatic fluid from the intestinal contents. In the dog the
pancreatic duct which carries the secretion of the gland to the
intestine empties into the intestine just beyond the stomach. In the
rabbit the duct and its secretion empty into the intestine only some
eight to ten inches below the intestinal orifice of the stomach. It is
just beyond where the pancreatic duct reaches the intestine in both
animals that the digestion of fat begins. This observation solved the
seeming mystery of fat digestion, and at the same time made clear the
importance of the pancreatic secretion in the general work of
digestion.

Bernard's attention was directed by this first observation to the
other properties of the pancreatic fluid. He soon demonstrated by
experiment, not only that it split up fats into fatty acids and
glycerin, and so made their absorption possible, but that it had a
powerful action upon proteids--that is, upon the albuminous portions
of the food, and also upon the starches and sugars. Up to this time
the principal role in digestion had been assigned to the stomach and
the gastric juice. After Bernard's observations it was evident that
the action of the stomach was mainly preliminary to intestinal
digestion, and that the chief work in the preparation of food for
absorption into the system was really accomplished by the secretion of
the pancreas. It took some years to make all this clear. Much of the
advance in our knowledge of the effect of pancreatic juice upon
proteids--that is, upon meat and other albuminous materials--is due to
Kühne, a pupil {279} of Bernard; but not only did the inspiration for
the pupil's work come from the master, but the important fundamental
principle of pancreatic proteolysis--_i.e._, the solution of proteids
by pancreatic secretion--was clearly laid down in Bernard's original
publications on the subject. Only in our own day has come the greatest
confirmation of the notion then first introduced into physiology, of
the surpassing importance of intestinal digestion. The removal of the
whole stomach for malignant disease is now undertaken without any
fears as to the ultimate result on the patient's general nutrition.
The operation has been done many times, and the surgeon's confidence
that the intestines would compensate, as far as digestion of food was
concerned, for the absent stomach has been amply justified. Patients
who survived the operation have all gained in weight, and some of them
have enjoyed better health than for years before the removal of their
stomachs.

From his studies of the pancreas, Bernard, whose mind was always of a
very practical bent, was very naturally led to the study of that
puzzling disease, diabetes. The question of how sugar was absorbed
into the system was an interesting one even at that time. It was not
realized, as it is now, that saccharine material was a most valuable
food-stuff. Its use in the world's great armies of recent years has
brought sugar very prominently before the medical profession of
to-day. The bone and sinew for hard fighting and exhausting marches
would not seem to be derivable from the favorite dainty of the child,
which has besides fallen into such disrepute as a health disturber;
yet tons upon tons of sweets are now shipped to fighting armies, and
are distributed in their rations when especially hard work is required
of them. Bernard did not quite realize that he was attacking, in the
question of the digestion and consumption of sugar in the system, one
of the {280} most important problems of nutrition, especially as far
as regards the production of heat.

Sugar is a substance that dissolves easily and in considerable
quantity in water. When in solution it easily passes through an animal
membrane by osmosis, and so the question of its absorption seemed
simple enough. The disease diabetes showed, however, that sugar might
exist very plentifully in the blood and yet the nutrition of an
individual suffer very much for the lack of it. Something else beside
its mere presence in the system was necessary to secure its
consumption by the tissues. Bernard thought that the liver was active
in the consumption of sugar, and that disease of this organ caused
diabetes. He therefore secured some of the blood going to the liver of
a living animal and some of the blood that was just leaving it. To his
surprise the blood leaving the liver contained more sugar than that
entering it. After assuring himself that his observations were
correct, he tried his experiments in different ways. He found that
even in the blood leaving the liver of an animal that had been fed
only on substances containing no sugar, sugar could be demonstrated.
Even in a fasting animal the liver itself and the blood leaving it
showed the presence of a form of sugar. The only possible conclusion
from this was that the liver was capable of manufacturing this form of
sugar out of non-sugar-containing material, or even from the blood of
a fasting animal.

This was the first time in physiology that the idea of an internal
secretion was advanced. Glands within the body that gave off a
secretion always possessed a duct by which this secretion was
conducted to where it was to produce its effect. The idea that glands
exist which pour their secretion directly into the blood-stream had
not occurred.

This branch of physiology has developed wonderfully since {281}
Bernard's discovery. The chapter of the functions of the ductless
glands is one of the most interesting and most practical in modern
medicine. The spleen, the thyroid, the suprarenal glands have taken on
a new significance. Mysteries of disease have been solved, and, most
wonderful of all, we have learned that many of the substances derived
from these glands, when not present in the human body, may be
effectually supplied by corresponding substances from animals, with
results upon suffering human beings that are little short of
marvellous. To mention but one example: the stunted, idiotic child
that, because of congenital absence of the thyroid gland, formerly
grew up to be a repellent, weak-minded man or woman, can now in a few
short months be made the peer of most of its kind. All the modern
tissue-therapy, with its hopeful outlook, is due to Bernard's
far-reaching conclusions from his experiments upon sugar digestion and
absorption.

His studies on sugar logically led Bernard to the investigation of
heat production and heat regulation in the human body. Glycogen, the
sugary substance produced by the liver, occurs abundantly in all the
muscles of the body, and it was evident that muscular movement leads
to its consumption and the consequent production of heat. Sugar is a
carbon-containing substance, and its combustion always produces
energy. The question of heat regulation was a much more complicated
problem. Heat is always being produced in the human body and always
being given off. Very different amounts of heat are required to keep
up the temperature of the human body in the winter and summer seasons.
Near the pole or at the equator man's temperature in health is always
the same. To secure this identity of temperature some very delicately
balanced mechanism is required. Without the most nicely adjusted
equilibrium of heat production and dissemination human tissues would
soon freeze up at a {282} temperature of 70° below zero, or the
albumin of the body fluids and muscular tissue coagulate at a
temperature above 110° F.

While engaged in the investigation of this interesting problem Claude
Bernard found that the cutting of the sympathetic nerves in the neck
of a rabbit was followed by increased heat on the side of the head
supplied by the nerve, and that this increased heat coincided with
heightened sensibility and greater blood-supply in the parts affected.
Here was an important factor in heat regulation laid bare. It was
evident that the sympathetic nerve trunk supplied filaments to the
small arteries, and that when these nerves no longer acted, as after
the cutting of the nerve trunk, these arteries were no longer
controlled by the nervous system and became dilated. The presence of
more blood than usual in the tissues and its slower flow gave occasion
to more chemical changes in the part than before, and consequently to
the production of more heat.

These vasomotor nerves, as they have been called, because they preside
over the dilatation and contraction of the walls of the bloodvessels
(vasa) of the body, are now known to play an important rôle in every
function. When food enters the stomach, it is dilatation of the
gastric arteries, brought on by the reflex irritation of the presence
of food, that causes the secretion of the gastric juices necessary for
digestion. It is the disturbance of this delicate nervous mechanism
that gives rise to the many forms of nervous dyspepsia so common in
our day. It is its disturbance also that makes digestion so imperfect
at moments of intense emotion, or that makes severe mental or bodily
exertion after the taking of food extremely inadvisable. The vasomotor
nerves, however, control much more than heat processes and digestion.
The familiar blushing is an example of it, and blushes may occur {283}
in any organ. Excitement paralyzes the efforts of some individuals,
but renders others especially acute. It is probable that the
regulation of the blood-supply to the brain has much to do with this.
While one student always does well in an oral examination, another, as
well gifted, may always do poorly. Just as there are those who cannot
control the vasomotor nerves of the face, and blush furiously with
almost no provocation, so there are brain-blushers in whom the rush of
blood interferes with proper intellection. On the other hand, there
are those, and they are not always unaware of it, in whom the slight
disturbance of the facial vasomotor mechanism only gives rise to a
pleasing heightened color, and in the same way the increased
blood-supply to the brain only gives them more intellectual acumen.

These two discoveries by Bernard--the formation of sugar by the liver
and the nervous vasomotor mechanism--are, in their far-reaching
application and their precious suggestiveness for other investigators,
the most significant advances in physiology of the nineteenth century.
They are directly due to a great imaginative faculty informing a most
fertile inquiring spirit. Bernard was very different from his master,
Magendie, in his applications of the experimental method. Magendie's
researches were made more or less at random in the great undiscovered
regions of physiology. He made his experiments as so many questions of
nature. He cared not what the answer might be. He seldom had an
inkling beforehand where his experiments might carry him. As he said
himself, he was a rag-picker by the dust-heap of science, hoping to
glean where others had missed treasures, and not knowing what his
stick might turn up next. Bernard's experiments were always made with
a definite idea as to what he sought. Not infrequently his
pre-conceived theory proved to be a mistake. It is of the very {284}
genius of the man that he was able to recognize such errors, and that
he did not attempt to divert the results of experiments so as to
bolster up what looked like eminently rational theories. The
imaginative faculty that had come so near perverting him to literature
was a precious source of inspiration and initiative in his scientific
work. It was not followed as an infallible guide, however, but only as
a suggestive director of the course investigation should take.

Besides the important discoveries made by Bernard there are two minor
investigations, successfully accomplished, that deserve a passing
word. To Claude Bernard we owe the use of curare in physiological
experimentation. Curare is an Indian arrow poison which absolutely
prevents all muscular movement. If artificial respiration is kept up,
however, the animal lives on indefinitely, and no motion will disturb
the progress of the most delicate experiment. In Bernard's time it was
thought that the drug did not affect the sensory nervous system at
all, and that as a consequence, though absolutely immobile, the animal
might be suffering the most excruciating pain. We now know that the
sensory system is also affected, and that the animal in these
experiments suffers little if at all.

Bernard's investigation of the effect of carbonic oxide gas will
probably be of more practical benefit to this generation and the next
than it was to his. Like most of Bernard's discoveries, this one threw
great light on important questions in physiology quite apart from the
subject under investigation. Carbonic oxide is the gas produced by
incomplete combustion of coal. The blue flames on the surface of a
coal fire when coal is freshly added are mainly composed of this gas
in combustion. From burning charcoal it is given off in considerable
quantities. The gas is extremely poisonous. Unlike carbon dioxide,
which does harm by shutting off the supply {285} of oxygen, carbonic
oxide is actively poisonous. After death the blood of its victims,
instead of being of a dark reddish-blue, is of a bright pinkish-red.
Bernard's study of the change that had taken place in the blood showed
that the hemoglobin of the red blood-cells had united with the
carbonic oxide present in the lungs to form a stable compound. The
usual interchange of oxygen and carbon dioxide in the tissues could
not take place. The combinations formed between oxygen and carbon
dioxide and the hemoglobin of the blood readily submit to exchanges of
their gaseous elements, and so respiratory processes are kept up.

Before Bernard's discovery it was thought that the respiratory oxygen
was mostly carried dissolved in the blood-plasma--that is, in the
watery part of the blood--or at least that its combination was a
physical rather than a chemical process. This idea was overthrown by
the discovery that the carbonic oxide combination with hemoglobin was
very permanent. The rôle of the red blood-cell in internal respiration
took on a new importance because of the discovery, and the
comprehension of anaemic states of the system became much easier.

About the middle of his career Bernard suffered from a succession of
attacks of a mysterious malady that we now recognize to have been
appendicitis. Once at least his life was despaired of, and recurring
attacks made life miserable. After a year of enforced rest on the old
farm of his boyhood, now become his own, he seems to have recovered
more or less completely. His health, however, was never so robust as
before. Toward the end of his life he lived alone. His wife and
daughters were separated from him, and one of the daughters devoted
her time and means to suffering animals in order to make up, as she
proclaimed, for all her father's cruelty.

{286}

Bernard lived almost directly opposite to the Collège de France, in a
small apartment in the rue des Ecoles. An old family servant took care
of him, and his life was one of uttermost simplicity, devoted only to
science. Once at court, in 1869, Napoleon III insisted on knowing,
after an hour's conversation with him, what he could do for him.
Bernard asked only for new facilities for his experimental work, and
new apparatus and space for his laboratory.

Honors came to him, but left him modest as before. He was elected a
member of the French Academy--one of the forty immortals. Only five
times in the history of the Academy has the honor of membership been
conferred upon a medical man. Before Bernard, Flourens, the father of
brain physiology, had occupied a _fauteuil_, while Cabanis and Vicq
d'Azyr are two other names of medical immortals.

Bernard was elected to the 24th _fauteuil_, which had been occupied by
Flourens, and according to custom had to pronounce his predecessor's
panegyric. The conclusion of his address was the expression: "There is
no longer a line of demarcation between physiology and psychology."
Physiology had become the all-ruler for Bernard in human function, and
he drifted into what would have been simple materialism only for the
saving grace of his own utter sanity, his active imagination, and the
unconscious influence of early training. During his most successful
years of scientific investigation, wrapped up in his experiments and
their suggestions, Bernard was drawn far away from the spiritual side
of things. This partial view of man and nature could not endure,
however. In an article on Bernard in the _Revue des Questions
scientifiques_ for April, 1880, Father G. Hahn, S. J., says of him: "A
man of such uprightness of character could not be allowed to persist
to the end in this restless skepticism. His mental condition was
really a kind of vertigo caused by the {287} depths of nature that he
saw all around him. At the threshold of eternity he came back to his
true self and his good sense triumphed. The great physiologist died a
true Christian."

Bernard was one of the great thinkers of an age whose progress in
science will stamp it as one of the most successful periods of advance
in human thought. He accomplished much, but much more he seemed to
have divined. He seldom gave out the slightest hint of the tendencies
of his mind, or of his expectations of discovery in matters of
science, until fully satisfied that his theoretic considerations were
justified and confirmed by observation and experiment. In one thing,
however, he allowed favored friends to share some of his
anticipations, and the notes published after his death show that he
was on the very point of another great discovery in biology which has
since been made. He was a firm friend of Pasteur's, and had ably
seconded the great chemist-biologist's efforts to disprove spontaneous
generation. Bernard's demonstration that air passed through a tube
heated red hot might be suffered with impunity to come in contact with
any sort of organic material, yet would never cause the development of
germ life, was an important link in the proof that if life were
carefully destroyed, no life, however microscopic in character, would
develop unless the seeds of previously existent life were somehow
brought in contact with the organic matter.

With regard to fermentation, too, Bernard was for many years in close
accord with Pasteur, who taught that fermentation was the result of
the chemical activity of living cells, the ferments. Toward the end of
his life Bernard came to the view, however, that the action of
ferments was really due to the presence in them of chemically active
substances called diastases. These substances are of varied chemical
{288} composition, but each one has a constant formula. Their presence
in a fermentescible solution is sufficient of itself, even in the
absence of living cells, to bring about fermentation. It has since
been shown that after this substance is removed from ferment-cells by
pressure, and the liquid carefully filtered so that absolutely no
cells remain, fermentation will yet take place.

This does not disprove the necessity for life to produce the diastases
originally, though it advances science a step beyond the theory that
it is the actual vital interchange of nutritious substances within the
ferment-cell that causes fermentation. With each step of advance in
biological science the mystery of life and its processes deepens.

No one has done more to bring out the depths there are in vital
function than Bernard. His early training was of the type that is,
according to many prominent educators of our day, least calculated to
develop originality of view, or capacity for initiating new lines of
thought. Our pedagogic Solons would claim that the narrow orthodoxy
that wrapped itself around his developmental years must surely stifle
the precious genius for investigation that was in him. It is due, on
the contrary, very probably to the thorough conservatism of his early
training and the rounded fulness of the mental development acquired
under the old system of classical education, that we have to chronicle
of Bernard none of the errors by exaggeration of personal bias that
are so common among even great scientific men. Few successful men have
ever owed less to luck or to favoring circumstances in life. He was in
the best sense a self-made man, and he owed his success to a large
liberality of mind that enabled him to grasp things in their true
proportions. With an imaginative faculty that constantly outstripped
his experimental observations he was singularly free from prejudgment
and was able to {289} control his theories by what he found, never
allowing them to warp his powers of observation. Bernard is without
doubt the greatest example of the century that a fully rounded
youthful training is much more favorable to successful investigation
than the early specialization which is falsely supposed to foster it.


{290}

{291}

PASTEUR, FATHER OF PREVENTIVE MEDICINE

{292}

  More than two hundred and fifty years ago, Descartes, the most
  original mind of the modern age, who, more than any other thinker,
  has determined the course both of speculative and of scientific
  inquiry, declared that if any great improvement in the condition of
  mankind was to be brought about, medicine would provide the means,
  and what he foresaw we see.
     --Bishop Spalding.

{293}

PASTEUR, FATHER OF PREVENTIVE MEDICINE.


Louis Pasteur is the most striking figure in nineteenth century
science. In biology, in chemistry, in physics, in medicine and
surgery, and in the important practical subjects of fermentation,
spontaneous generation and sanitation, he has left landmarks that
represent great advances in science and starting-points for new
explorations into the as yet unmapped domain of scientific knowledge.
His was a typically scientific mind. His intuitions were marvellous in
their prophetic accuracy, yet were surpassed by his wonderful faculty
for evolving methods of experimental demonstrations of his theories.
His work has changed the whole aspect of biology and medicine, and
especially the precious branches of it that refer to the cure and
treatment of disease.

To such a man our generation owes a fitting monument. It has been
given him. He was modest in life with the sincere modesty of the true
man of science, who knows in the midst of great discoveries that he is
only on the edge of truth, who realizes that "abyss calls to abyss" in
the world of knowledge that lies beyond his grasp. Pasteur's monument,
very appropriately for a man of his practical bent, is no idle
ornamental memorial. It is a great institution for the perpetual
prosecution of his favorite studies and for the care of patients
suffering from the diseases to whose investigation the best part of
his life was devoted.

In this Institut Pasteur repose his ashes. They find a suitable
resting-place in a beautiful chapel. Situate just below the main
entrance a little lower than the ground floor, {294} of the institute
proper, this chapel seems to form the main part of the foundation of
the building. It is symbolic of the life of the man in whose honor it
was erected. He who said, "The more I know the more nearly does my
faith approach that of the Breton peasant. Could I but know it all my
faith would doubtless equal even that of the Breton peasant woman." On
a firm foundation of imperturbable faith this greatest scientific
genius of the century raised up an edifice of acquisitions to science
such as it had never before been given to man to make.

Above the entrance of this chapel-tomb, and immediately beneath the
words "Here lies Pasteur," is very fittingly placed his famous
confession of faith:

  "Happy the man who bears within him a divinity, an ideal of beauty
  and obeys it; an ideal of art, an ideal of science, an ideal of
  country, an ideal of the virtues of the Gospel." [Footnote 12]

    [Footnote 12: Heureux celui qui porte en soi un dieu, un idéal de
    beauté et qui lui obéit; idéal de l'art, idéal de la science,
    idéal de la patrie, idéal des vertus de l'Evangile.]

When we turn to the panegyric of Littré in which the words occur we
find two further sentences worth noting here: "These are the living
springs of great thoughts and great actions. Everything grows clear in
the reflections from the infinite." [Footnote 13]

    [Footnote 13: Ce sont les sources vives des grandes pensées et des
    grandes actions. Toutes s'éclairent des reflets de l'infini.]

These words are all the more striking from the circumstances in which
they were uttered. When a vacant chair (_fauteuil_) in the French
academy is filled by the election of a new member of the Forty
Immortals, the incoming academician must give the panegyric of his
predecessor in the same chair. Pasteur was elected to the fauteuil
that had been occupied by Littré. Littré, who by forty years of
unceasing toil made a greater dictionary of the French language than
{295} the Academy has made in the nearly two hundred years devoted to
the task, was the greatest living positivist of his day. He and
Pasteur had been on terms of the greatest intimacy. Pasteur's
appreciation of his dead friend is at once sincere and hearty, but
also just and impartial. Littré had been a model of the human virtues.
Suffering had touched him deeply and found him ever ready with
compassionate response. His fellow-man had been the subject of his
deepest thoughts, though his relationship to other men appealed to him
only because of the bonds of human brotherhood. Pasteur called him a
"laic" saint. For many of us it is a source of genuine consolation and
seems a compensation for the human virtues exercised during a long
life that the great positivist died the happy death of a Christian
confident in the future life and its rewards.

But Pasteur himself rises above the merely positive. The spiritual
side of things appeals to him and other-worldliness steps in to
strengthen the merely human motives that meant so much for Littré.
Higher motives dominate the life and actions of Pasteur himself. In
the midst of his panegyric of the great positivist the greatest
scientist of his age makes his confession of faith in the things that
are above and beyond the domain of the senses--his ideals and his God.


There is said to exist a constant, unappeasable warfare between
science and religion. Perhaps it does exist, but surely only in the
narrow minds of the lesser lights. In no century has science developed
as in the one that has just closed. Faraday the great scientific mind
of the beginning of the century, said, at one of his lectures before
the Royal Academy of Sciences of England, when the century was
scarcely a decade old: "I do not name God here because I am lecturing
on experimental science. But the notion of respect for God comes to my
mind by ways as sure as those {296} which lead us to physical truth."
At the end of the century the monument of a great man of science is a
chapel with an altar on which the sacrifice of Him that died for men
is commemorated on Pasteur anniversaries.

The walls of the chapel are inscribed with the scientific triumphs of
the master whose ashes repose here. It is a striking catalogue. Each
heading represents a great step forward in science:

  1848, Molecular Dissymmetry.
  1857, Fermentations.
  1862, So-called Spontaneous Generation.
  1863, Studies in Wine.
  1865, Diseases of Silk Worms.
  1871, Studies in Beer.
  1877, Virulent Microbic Diseases.
  1880, Vaccinating Viruses.
  1885, Prophylaxis of Rabies.

Apparently these various subjects are widely separated from one
another. It might seem that Pasteur was an erratic genius. As a matter
of fact, each successive subject follows its predecessor by a rigid
logic. Pasteur's life-work can be best studied by a consideration of
these various topics and an appreciation of the advance made in each
one.

Pasteur was first of all and always a chemist! He was interested in
chemistry from his early years. In the decade from 1840 to 1850
organic chemistry--or as we prefer to call it now, the chemistry of
the carbon compounds--was just opening up. Great discoveries were
possible as they were not before or since. Pasteur, with a devotion to
experimental work that amounted to a passion, was a pupil at the Ecole
Normale, in Paris. Bruited about he heard all the suggestive questions
that were insoluble problems even to the great men around him. He was
especially interested in the burning {297} question of the day, the
internal constitution of molecules and the arrangement of atoms in
substances which, though they are composed of exactly the same
constituents, exhibit very different physical and chemical qualities.
The subject is, almost needless to say, a basic problem in chemistry
and remains to our own day the most attractive of scientific
mysteries.

Mitscherlich, one of the greatest chemists of the time, had just
announced that certain salts--the tartrates and paratartrates of soda
and ammonia--"had the same chemical composition, the same crystalline
form, the same angles in the crystalline condition, the same specific
weight, the same double refraction and, consequently, the same
inclination of the optic axes. Notwithstanding all these points of
similarity, if the tartrate is dissolved in water it causes the plane
of polarized light to rotate while the paratartrate exerts no such
action." Pasteur could not believe that all the chemical and physical
qualities of two substances could be identical and their action to
polarized light be so different. Mitscherlich was known, however, as
an extremely careful observer. For several years Pasteur revolved all
the possibilities in Mitscherlich's observations and, finally, came to
the conclusion that there perhaps existed in the paratartrates, as
prepared by Mitscherlich, two different groups of crystals, the
members of one of which turned the plane of polarization to the right,
the other to the left. These two effects neutralized each other and
apparently the paratartrates have no influence on the polarized beam
of light.

Pasteur found that the paratartrates were composed of crystals that
were dissymmetrical--that is, whose image reflected in a mirror cannot
be superposed on the crystal itself. This idea Pasteur makes clear by
reference to the mirrored image of a hand. The image of the right hand
as {298} seen in a mirror is a left hand. It cannot be superposed on
the hand of which it is the reflection any more than the left hand can
be superposed on the right and have corresponding parts occupy
corresponding places. Pasteur found that the paratartrates were not
only dissymmetrical, but that they possessed two forms of dissymmetry.
The mirrored image of some of the crystals could be superposed on
certain of the other crystals just as the mirror image of the right
hand can be superposed on the actual left hand. He concluded that if
he separated these two groups from each other he would have two very
different substances, and so the mystery propounded by Mitscherlich
would be solved.

With Pasteur to conceive an idea was to think out its experimental
demonstration. He manufactured the paratartrates according to the
directions given by Mitscherlich, and then proceeded to sort the two
varieties of crystals by hand. It was slow, patient work, and for
hours Pasteur strove feverishly on alone in the laboratory. At length,
the crystals were ready for solution and examination as to their
effect upon polarized light. If Pasteur's idea as to the dissymmetry
of crystals were confirmed, a great scientific advance was assured.
Tremblingly the young enthusiast adjusted his polariscope. He tells
the story himself of his first hesitant glance. But hesitation was
changed to triumph. His prevision was correct. There were two forms of
crystals with different effects on polarized light in Mitscherlich's
supposed simple substance. Pasteur could not stay to put his
instrument away. The air of the laboratory had become oppressive to
him. Drunk with the wine of discovery, as a French biographer remarks,
he rushed into the open air and almost staggered into the arms of a
friend who was passing. "Ah," he said, "I have just made a great
discovery. Come to the Luxembourg garden and I will tell you all about
{299} it." It was characteristic of the man all through life to have
no doubt of the true significance of his work. He was sure of each
step in the demonstration and his conclusions were beyond doubt.

Pasteur's discovery made a profound sensation. The French Academy of
Sciences at once proceeded to its investigation. Among the members who
were intensely interested, some bore names that now belong to
universal science--Arago, Biot, Dumas, De Senarmont. Pasteur told
long years afterward of Biot's emotion when the facts were visibly
demonstrated to him. Greatly moved, the distinguished old man took the
young man's arm and, trembling, said: "My dear child, I have loved
science so well that this makes my heart beat." How deeply these men
were bound up in their work! How richly they were rewarded for their
devotion to science! There were giants in those days.

Pasteur's discovery was much more than a new fact in chemistry and
physics. It was the foundation-stone that was to support the new
science of stereochemistry--the study of the physiochemical
arrangement of atoms within the molecule--that took its rise a few
years later. Much more, it was a great landmark in biology. Pasteur
pointed out that all mineral substances--that is, all the natural
products not due to living energy--have a superposable image and are,
therefore, not dissymmetrical. All the products of vegetable and
animal life are dissymmetrical. All these latter substances turn the
plane of polarization. This is the great fundamental distinction
between organic and inorganic substances--the only one that has
endured thus far in the advance of science. Dissymmetry probably
represents some essential manifestation of vital force. Often there
seem to be exceptions to this law; but careful analysis of the
conditions of the problem shows that they are not real.

{300}

An apparent contradiction, for instance, to this law of demarcation
between artificial products and the results of animal and vegetable
life is presented by the existence in living creatures of substances
like oxalic acid, formic acid, urea, uric acid, creatine, creatinin,
and the like. None of these substances, however, has any effect on
polarized light or shows any dissymmetry in the form of its crystals.
These substances, it must be remembered, are the result of secondary
action. Their formation is evidently governed by the laws which
determine the composition of the artificial products of our
laboratory, or of the mineral kingdom properly so called. In living
beings they are the results of excretion rather than substances
essential to life. The essential fundamental components of vegetables
and animals are always found to possess the power of acting on
polarized light. Such substances as cellulose, fecula, albumin,
fibrin, and the like, never fail to have this power. This is
sufficient to establish their internal dissymmetry, even when, through
the absence of characteristic crystallization, they fail to manifest
this dissymmetry outwardly.

It would scarcely be possible to indicate a more profound distinction
between the respective products of living and of mineral nature than
the existence of the dissymmetry among living beings and its absence
in all merely dead matter. It is strange that not one of the thousands
of artificial products of the laboratory, the number of which is each
day growing greater and greater, should manifest either the power of
turning the plane of polarization or non-superposable dissymmetry.
Natural dissymmetrical substances--gum, sugar, tartaric and malic
acids, quinine, strychnine, essence of turpentine, and the like--may
be and are employed in forming new compounds which remain
dissymmetrical though they are artificially prepared. It is evident,
however, that all these new {301} products only inherit the original
dissymmetry of the substances from which they are derived. When
chemical action becomes more profound--that is, becomes absolutely
analytic or loosening of the original bonds imposed by nature--all
dissymmetry disappears. It never afterward reappears in any of these
successive ulterior products.

"What can be the causes of so great a difference?" We quote from
Pasteur's life by his son-in-law: "Pasteur often expressed to me the
conviction," says M. Radot, "that it must be attributed to the
circumstance that the molecular forces which operate in the mineral
kingdom and which are brought into play every day in our laboratory
are forces of the symmetrical order; while the forces which are
present and active at the moment when the grain sprouts, when the egg
develops, and when under the influence of the sun the green matter of
the leaves decomposes the carbonic acid of the air and utilizes in
diverse ways the carbon of this acid, the hydrogen of the water and
the oxygen of these two products are of the dissymmetrical order,
probably depending on some of the grand dissymmetrical cosmic
phenomena of our universe."

For the first few years after this discovery Pasteur endeavored by
every possible means to secure experimental modifications of some of
these phenomena of dissymmetry. He hoped thus to learn more fully
their true nature. Magnetic influences especially would, he hoped,
enable him to pierce, at least to some degree, this fundamental
mystery of nature. While acting as professor at Strasburg, he procured
powerful magnets with the view of comparing the actions of their poles
and, if possible, of introducing by their aid among the forms of
crystals a manifestation of dissymmetry. At Lille, where he was for
several years dean of the scientific faculty, he contrived a piece of
clockwork intended {302} to keep a plant in continual rotary motion,
first in one direction and then in the other. "All this was crude," he
says himself, "but further than this I had proposed with the view of
influencing the vegetation of certain plants to invert, by means of a
heliostat and a reflecting mirror, the motion of the solar rays which
should strike them from the birth of their earliest shoots. In this
direction there was more to be hoped for."

He did not have time, however, to follow out these ingenious
experiments. He became involved, as we shall see, in labors more than
sufficient to take up all his time and all his energy. These labors
were of great practical importance for France. Pasteur always
insisted, however, that great discoveries will yet be made in
following out this order of ideas, and that there is in this subject
magnificent opportunity for young men possessed of the genius of
discovery and the power of persistent work.

When, only a few years ago, Professor Duclaux, Pasteur's successor as
the head of the Pasteur Institute, and himself one of the greatest
living authorities on biological chemistry, wrote the story of the
mind of the master, [Footnote 14] he said, of this subject of
dissymmetry: "A living cell appears to us, then, as a laboratory of
dissymmetrical forces, a bit of dissymmetrical protoplasm acting under
the influence of the sun--that is to say, under the influence of
exterior dissymmetrical forces. It presides over actions of very
different kinds. It can manufacture, in its turn, new dissymmetrical
substances which add to or take away from its energy. It can, for
instance, utilize one of the elements of a paratartrate without
touching another. It can manufacture crystalline sugar at one moment
and consume it at another, laying by stores for itself to-day using
them up to-morrow. In a word, the living cell {303} presents a
marvellous plasticity, which exerts itself without the slightest
disturbance by minimal deviations of forces due to dissymmetrical
influence. Ah, if spontaneous generation were only possible! If we
could only create living matter, raise up in the midst of inactive
mineral material a living cell, then it would be easy for us to
understand something more of vital manifestations and to comprehend
better the mystery of dissymmetry."

  [Footnote 14: L'Histoire d'un esprit, par M. Duclaux, Paris, 1896.]

But spontaneous generation is as far off as ever. Pasteur's
discoveries in dissymmetry have brought us closer than ever before to
the mystery of life. Scientists still hope, but it is with ever-waning
confidence, that they may pluck out the heart of the mystery.
Pasteur's own thoughts with regard to dissymmetry rose above even the
lofty heights of mere earthly biology. He saw in it the great force
that links the universe together. On one occasion, at the Academy of
Sciences, he expressed himself as follows:

  "The universe is a dissymmetrical whole. I am inclined to think that
  life, as manifested to us, must be a function of the dissymmetry of
  the universe or of the consequences that follow in its train. The
  universe is dissymmetrical; for, placing before a mirror the group
  of bodies which compose the solar system with their proper movement,
  we obtain in the mirror an image not superposable on the reality.
  Even the motion of solar light is dissymmetrical. A luminous ray
  never strikes in a straight line. Terrestrial magnetism, the
  opposition which exists between the north and the south poles of a
  magnet, the opposition presented to us by positive and negative
  electricity, are all the resultants of dissymmetrical actions and
  motions."

This raising of his thoughts far above the sordid realities he is
concerned with into the realms of suggestive theory is typical of
Pasteur. His was a true creative mind--poetic {304} in its highest
sense. The imagination properly controlled is of as great value to the
scientist as to the poet. Pasteur's theories were ever pregnant with
truth to be. All his life he kept this question of dissymmetry before
his mind and hoped to get back to work at it. But opportunity failed.
Other and more practical work was destined to occupy the busy
half-century of investigation that followed.

Most of Pasteur's work, after this first thrilling discovery and its
possible significance, is very well known. His meditations on the
distinction between material derived from living and non-living
sources led him to investigate certain processes called
fermentations--before his time considered merely chemical. It is well
known that if a dilute solution of sugar be exposed to the air
anywhere in the world it will ferment--that is, certain changes will
take place in the liquid, some gas will escape from its surface and
alcohol will be formed. There are changes that take place in other
organic substances--milk, meat solutions, butter, etc.--that resemble
quite closely alcoholic fermentations, though the end-product of the
process is not alcohol. Pasteur showed that all these supposed
chemical changes are really due to the presence of minute living
cells, called ferments. During the growth of these cells they split up
the substances contained in the material in which they occur, using
parts of them for their nutrition. He proved this very clearly for the
lactic acid and butyric acid fermentations. Milk was supposed to
become sour and butter rancid because they are unstable organic
compounds, liable to change in the presence of the oxygen of the air.
These changes were now shown to be due to minute living things that
grow in the milk and the butter.

When Pasteur offered the same explanation of the origin of vinegar he
found a strenuous opponent in Liebig, the great chemist. Liebig
admitted the existence of specific substances, {305} called ferments,
but said that they were nitrogenous compounds in unstable equilibrium
as regards their composition, and with a marked tendency to undergo
alteration when exposed to the air or free oxygen. These alterations,
once begun, affect also the liquids in which the ferments are
contained--milk, blood, sugar solutions and the like. Theodore Schwann
had shown the existence of certain yeast-like bodies in fermenting
liquids, but these were considered to be effects, not causes, of the
fermentation, and even Schwann, himself, believed that they originated
in the liquids in which they were found. It remained for Pasteur to
demonstrate, as he did by a brilliant series of ingenious and
conclusive experiments, that ferments are living cells, that they
never originate except from previous cells of the same species, and
that no fermentation takes place unless they are present.

The changes that take place in organic liquids when exposed to the air
and the frequent development in such liquids of moving bodies
evidently possessed of life constituted, before Pasteur's time, the
principal reason for believing that life might originate from some
special combination of chemical forces, and without the necessity for
preceding life of the same species as its efficient cause. The new
explanation of fermentation greatly weakened the position of those who
believed in spontaneous generation--that is, the origin of life from
dead matter under certain specially favorable circumstances. Pasteur
proceeded to show, by rigid demonstration, that if all life were
destroyed in organic substances, living beings never originated in
them unless living seeds from the air gained access to them. After a
meat solution has been thoroughly boiled nothing living develops in
it, even though the air is allowed free access, if the air admitted
has been previously filtered through cotton, He showed that even the
{306} bending of the neck of the tube into the shape of an "S," so as
to prevent the entrance of dust particles, suffices to protect the
most changeable organic material from the growth of micro-organisms in
it. His teaching was not accepted at once. Details of his experiments
were impugned. Apparently complete counter-demonstrations were made,
but Pasteur knew how, by his marvellous intuition, to detect the
fallacy of supposed demonstration, and to invent new crucial tests of
the proof of biological succession.

These studies in minute life and in fermentation led him almost
naturally to the study of disease. Two centuries before, Robert Boyle,
of whom his notorious descendant the great bullster, Sir Boyle Roche,
had said that he was the father of chemistry and the brother of the
Earl of Cork, made use of an expression wonderfully prophetic in its
accurate penetration of the future. "He that thoroughly understands
the nature of ferments and fermentations," said Boyle, "shall probably
be much better able than he that ignores them to give a fair account
of divers phenomena of certain diseases (as well fevers as others)
which will perhaps be never properly understood without an insight
into the doctrine of fermentations." The marvel is that the very first
man who understood the nature of fermentation proved to be the one
destined to unlock the mystery of contagious disease and its origin.

Pasteur's first investigations in the field of disease concerned a
mysterious malady that affected the silkworm and was ruining the silk
industry of France. This disease was first noted seriously about 1850.
When a colony of silkworms had been attacked it was useless to try to
do anything with them. The only resource for the silk farmers was to
get the eggs of an unaffected race of worms from some distant country.
These became infected after several generations, {307} and untainted
eggs had to be brought from a distance once more. Soon the silkworm
plague invaded most of the silk-growing countries of Europe. In 1864,
only the races of silkworms in China and Japan were surely not
infected. Great suffering had been entailed on many departments of
France by the failure of the silk industry. The most careful
investigation failed to reveal any method of combating the disease.
Acute observers had been at work and some very suggestive observations
on the affected worms had been made, but the solution of the problem
of the prevention of the disease seemed as far off as ever. In 1863
the French minister of agriculture formally agreed to pay 500,000
francs (about $100,000) to an Italian investigator who claimed to have
found a remedy for the disease, if his remedy proved efficient. The
offer was to no purpose. In 1865 the weight of cocoons of silk had
fallen to 4,000,000 kilos. It had formerly been nearly 30,000,000
kilos. This involved a yearly loss of 100,000,000 francs (about
$20,000,000).

Pasteur showed that the failure of the silkworm was not due to one
disease, but to two diseases--pebrine and flacherie. These diseases
are communicated to the eggs of the worms, so that the young begin
life handicapped by the maladies. The crawling of the worms over
leaves and stems makes these liable to communicate the diseases. The
prevention of the diseases is accomplished by procuring absolutely
healthy eggs and then never letting them come in contact with anything
that may have been touched by diseased worms. If, at the egg-laying
period, worms show any signs of disease their eggs are to be rejected.
These simple suggestions were the result of rigid experimental
demonstration of the spread of the diseases from worm to worm,
including the demonstration of the microbic causes of the two
diseases. These precautions proved effective, {308} but their
introduction met with opposition. The strain of the work and the worry
of controversy brought Pasteur to the brink of the grave by a
paralytic stroke. From this he never entirely recovered and was always
afterward somewhat lame. After the severest symptoms had passed off he
was given the opportunity to make a crucial test of preventing the
silkworm diseases at the villa of the French Prince Imperial. The
products obtained from the silkworms on the estate had, for years, not
sufficed to pay for the fresh supplies of eggs obtained from a
distance. Pasteur was given full charge of the silk industry on the
estate. The sale of the cocoons at the end of the year gave a net
profit of 26,000,000 francs (over $5,000,000). This decisive
demonstration effectually ended all opposition.

His attention was next naturally directed to the diseases of animals
and human beings. His studies in fermentations and in silkworm
diseases had taught him the use of the microscope for such
investigations. Splenic fever--known also as anthrax--a disease that
attacks most species of domestic animals and may also prove fatal to
man, was the first to yield the secret of its origin. The cause proved
to be a bacterium--that is, a small, rod-shaped plant. This was but
the first of a series of similar discoveries, until now the science of
bacteriology has become one of the most important branches of
knowledge. Pasteur's investigations included much more, however, than
the mere discovery of the germ of the disease. He showed that a series
of diseases which passed under different names in different animals
were all due to the same cause. Further, he discovered one of the
methods of distributing the disease. When the carcasses of animals
that have died from the disease are not buried deeply below the
surface of the ground, animals grazing above may become infected with
the disease. {309} The germs of the disease can be shown to occur in
the grass above the graves. It is carried to the surface in the bodies
of earth-worms. This important observation was the first hint of the
methods of disease distribution by some living intermediary. Modern
medicine has come to understand that these biological distributing
agents are far more important than the fabled transmission through the
air.

Pasteur overturned the notion of spontaneous generation of life. Then
his work eradicated the idea of the spontaneous generation of disease.
It opened up a new era by showing that the origin of many diseases is
not due to changes in the atmosphere nor to some morbid productivity
of soil or water under favoring circumstances, but to minute living
organisms whose multiplication is encouraged by the conditions that
were supposed to produce disease. Finally, came the precious
suggestion that living things always convey and distribute disease;
man to man, for epidemics travel not with the velocity of the wind but
only as fast as the means of communication between distant points;
animal to man, as is well known, for many diseases now; and, lastly,
insects, worms and the like were also shown to be real carriers of
disease.

In investigating chicken cholera Pasteur discovered another great
basic principle in the knowledge of disease, especially of its
treatment. After considerable difficulty he succeeded in finding the
germ of this disease which was causing great losses in the poultry
industry of France and other European countries. This germ was
cultivated for a number of generations on artificial media and never
failed to produce the disease when fowls had been inoculated. During
the course of his studies in the malady Pasteur was called away to a
distant part of France in connection with his investigation of
anthrax. He was away from his laboratory for several months. When he
returned he inoculated {310} some fowls with the cultures of chicken
cholera which he had left behind. To his surprise and annoyance the
inoculations failed to produce the typical symptoms of the disease.
The fowls suffered from some slight symptoms and then recovered. When
he left his laboratory inoculations had been invariably fatal. It took
considerable time and trouble to procure fresh cultures of the
chicken-cholera microbe. Meantime, the fowls which had been only
slightly affected by the old cultures were carefully preserved. When
these birds were inoculated with the fresh virulent cultures they
failed to take the disease. Other fowls promptly died, exhibiting all
the characteristic symptoms of chicken cholera. Those that had
suffered from the mild form of the disease produced by the old
cultures were protected from further attacks of the disease.

One of the great mysteries of medicine, the varying virulence of
disease, had been thus solved by what seemed an accident. There are no
accidents in the lives of great investigators. There are surprises,
but genius knows how to reconcile their occurrence with the principles
they are working out. Pasteur understood at once the wonderful utility
there might be in this discovery for the protection of men and animals
from disease. He proceeded to practical applications of the new theory
by providing old cultures for the inoculation of fowls in districts
where chicken cholera produced serious ravages. Then, working on the
same lines as for chicken cholera, he proceeded to elaborate vaccine
material for anthrax.

Vaccine was the name deliberately selected for the inoculating
substance in order to honor the genius of the English physician
Jenner, who had discovered the power of vaccination to protect from
smallpox. The weakening of the germs of anthrax, so as to produce only
a mild form of the disease, was a much more intricate problem than for
chicken cholera, {311} because the anthrax bacillus does not weaken
with age, but enters a resting or spore stage, resembling the seed
stage in large plants. After a patient series of investigations
Pasteur accomplished his object by some ingenious methods that served
to show, perhaps better than any other details of his career, how
thoroughly practical was his inventive genius.

Unfortunately the absorption in his work proved too much for his
health. He was seized by a series of apoplectic attacks which for a
time threatened to put an end to his invaluable career. When he did
begin to recover his health one of the most serious problems in his
regard was to keep him from hindering his convalescence by a return to
his old-time absorption in the important problems of the cure and the
prevention of disease, at which he had been so happily engaged. The
keynote of Pasteur's life was to prevent human suffering as far as
possible, and any time not given to this important duty seemed to him
to be utterly wasted. With regard to this unfortunate break in
Pasteur's work Dr. Christian Herter, in his address on the "Influence
of Pasteur in Medical Science," delivered before the Medical Society
of Johns Hopkins University, [Footnote 15] has an interesting passage,
in which he discusses the significance of the master's work up to this
time, and the interest that his illness awakened among all the
distinguished medical scientists of Europe at the time:

    [Footnote 15: New York: Dodd, Mead & Co., 1904.]

  "It is likely that excessive work and mental stress in some degree
  contributed to the onset of the series of paralytic seizures which
  in October, 1868, threatened the life of Louis Pasteur. During the
  critical period of his illness, many of the most distinguished
  scientific men of France vied with each other to share with Mme.
  Pasteur the privilege of nursing the man they loved so well and of
  rescuing the life {312} that had already placed science and a nation
  under enduring obligation through discoveries which were either of
  the greatest practical utility or appeared susceptible of almost
  unlimited development. Had Pasteur died in 1868, he would have left
  a name immortal in the annals of science. Others would in some
  degree have developed his ideas. Already inspired by the researches
  on fermentation, Lister would have continued to develop those
  life-saving surgical methods which will forever be associated with
  his name. But we may well question whether investigations in biology
  and medicine would not have been for a time at least conducted along
  less fruitful paths. Who shall say how soon the great principle of
  experimental immunity to pathogenic bacteria, the central jewel in
  the diadem of Pasteur's achievements, would have been brought to
  light?"

When Pasteur recovered sufficiently to resume work, it was soon clear
to apprehensive friends that he had no intention of leaving his ideas
to be worked out by other men. The miseries of the Franco-Prussian War
deeply affected him, and could not fail to inhibit his productiveness,
but after a time the unquenchable love for experimental research was
once more ascendant and there began a new epoch, the epoch of great
discoveries relating to the origin and cure or prevention of the
infectious diseases of man and the domestic animals. As in the case of
Ignatius Loyola, it seems as if the lamp of the genius shone with a
larger and more luminous flame after the onset of bodily infirmity in
defiance of the physical mechanism which is too often permitted to
master the will.

After his illness Pasteur devoted himself even more than before to the
study of the various biological problems connected with human
diseases. There was one exception to this, in his series of studies on
beer, undertaken shortly after {313} the Franco-Prussian War. Pasteur
was an ardent patriot, so much so, indeed, that after the war he sent
back to the German government certain decorations and diplomas that
had been conferred upon him. He thought that his country had been
overreached by a scheming, political statesman, bent on the
aggrandizement of the kingdom of Prussia. To the end of his life this
feeling of hostility never entirely vanished. It was his hope, then,
that by improving the character of French beer it might not only be
made more wholesome in the best sense of the word, but also that the
French brewing industry might be made a serious rival of its German
competitors. Pasteur's discoveries are the most important for the
brewing industry that have ever been made. The Germans proved,
however, even more capable of taking advantage of them than his French
compatriots.

After this Pasteur devoted himself without further interruption to the
study of the microbic diseases of man. His greatest practical triumph
was undoubtedly with regard to hydrophobia, or, as it is more properly
called, rabies. The mystery of the disease was most illusive. Pasteur
could not succeed in finding the germ of the disease. Even down to our
own day it has not been satisfactorily demonstrated. In spite of this
lack of an important element of knowledge, which might be supposed
absolutely essential for the successful therapeutics of rabies from a
biological standpoint, Pasteur succeeded in producing material that
would protect those bitten by rabid dogs from developing the affection.


Long and bitter was the opposition to the introduction of his method
of treatment. The greatest living German bacteriologist said that it
was idle to provide "remedies of which we know nothing for diseases of
which we know less." The reference was to the failure to find the germ
of the disease and the claim, nevertheless, of having discovered {314}
a cure. Wherever the Pasteur treatment for rabies was introduced,
however, the number of deaths following the bites of mad animals fell
off. In Russia, where the mad wolves of the Steppes so often inflict
fatal bites, the power of the new treatment was soon recognized. In
Hungary its value was appreciated without delay. Then the British
government, after a most careful investigation, introduced it into the
Indian army. Then Austria took it up officially. At the International
Medical Congress at Moscow, in 1897, Americans, who expressed doubts
as to the efficiency of the Pasteur treatment for rabies, were laughed
at by the medical representatives of nations who have the most
opportunities for studying the disease. Shortly after the Moscow
congress the German government officially announced its intention of
treating all persons bitten by rabid animals by the Pasteur method. A
Pasteur institute for the treatment was opened in connection with the
University of Berlin. With this the last serious opposition
disappeared. The Germans are now enthusiastic advocates of the value
of the Pasteur treatment. The statistics of the Berlin Pasteur
Institute are pointed to as demonstrating beyond doubt the possession
of power to cope with one of the most fatal diseases man is liable to.
Alas, that this should not have come during the master's lifetime! It
would have been the happiest moment of Pasteur's life to have had his
ideas triumphant in Germany. Unlike the generality of great men,
however, Pasteur enjoyed the meed of almost unstinted appreciation
during life.

Geniuses are often said to be neglected by their contemporaries. The
expression is exemplified much less frequently in our own time than
formerly. The rapid diffusion of ideas, and the consequent control and
confirmation of scientific claims by many minds, enable the present
generation to recognize merit before its possessor has starved. {315}
Pasteur's career was certainly an exemplification of the fact that
true genius, though it may meet with opposition, will be well
rewarded. The son of the poor tanner of Dole, by the mere force of his
intellectual energy, lifted himself to the level of earth's great
ones. His funeral obsequies were a pageant in which French officialdom
felt itself honored to take part. The President of the French
Republic, the members of both houses of the legislative department,
the officials of the city of Paris, the members of the faculty of the
university, of the French Academy, and of the various scientific
societies of the French capital, gathered to honor their mighty dead.
Never has it been given to anyone without family prestige or political
or ecclesiastical influence to have a great world-capital and a great
nation accord such glorious obsequies, while all the world extended
its sympathy and added paeans of praise.

Nor was it only at the moment of death that the expression of sincere
respect and merited honor was paid. When there was question of
erecting a Pasteur institute, in which the master's great work could
be carried on more effectually, contributions poured in from every
part of France and from all over the civilized world. Two of the
world's greatest hereditary rulers made it a point to visit the humble
laboratory of the great scientist whenever they came to Paris.
Alexander II, the Czar of the Russians, was the intimate friend of the
tanner's son, who became the world's benefactor. Dom Pedro II, the
late Emperor of Brazil was another royal visitor to Pasteur. In the
library of the _Institut Pasteur_ at Paris, the busts of these two and
of two other great friends of his, scarcely less in worldly importance
and greater in their beneficence, keep watch above the ashes of the
dead scientist. They are Baroness Hirsch, the world benefactress, and
Baron Albert Rothschild, the head of the French branch of the great
banking family.

{316}

All united in honoring the marvellous genius whose work has proved of
such practical utility for mankind, and whose discoveries are as yet
only beginning their career of pregnant suggestiveness to scientific
men. His genius has brought the great ones of earth to his level or
raised him to theirs. His own thought on the equality of man is a
confession of the faith that was in him. It was expressed in his
discourse of reception into the French Academy in the midst of the
panegyric on Littré, from which we quoted at the beginning of this
sketch: "Where are the true sources of human dignity, of liberty and
of modern democracy, if not in the infinite, before which all men are
equal? The notion of the infinite finds everywhere its inevitable
expression. By it the supernatural is at the bottom of every heart."

Pasteur, the man, is, however, if possible, even more interesting than
Pasteur, the greatest of living scientists. In the midst of all his
work and his wonderful success, amid the plaudits of the world,
Pasteur remained one of the simplest of men and the kindest of friends
to those who knew him. Dr. Roux's expression is well known: "The work
of Pasteur is admirable; it shows his genius; but one must have lived
on terms of intimacy with him in order to know all the goodness of his
heart." He was kindness personified, and those who think of him as a
cruel vivisector and encourager of experiments upon animals that cause
suffering, belie him and his humanity very much. He would never permit
animals to be used in experiments without an anesthetic, and even then
only when he deemed that use absolutely necessary for the furtherance
of projects that promised great benefit to humanity. Nothing was
harder for him to do than to walk the hospitals and see human
suffering when he was studying the causes of disease in human beings.
Even the slight pain inflicted during the {317} injections for
hydrophobia was a source of great discomfort to him, and his anxiety
with regard to these patients was one of the main causes of the
breakdown in health that shortened his life.

One of the most beautiful things about Pasteur's personal life is the
relation to his family, and especially to his children, and their
union in religious simplicity. On the occasion of the death of his
father, whom Pasteur loved very deeply and for whom he had instilled
the deepest affection into the hearts of his children, he wrote to his
daughter, whose first communion was to occur on that day. His letter
is that of a man deeply affectionate, sincerely religious, and
eminently trustful of the future that faith alone points out. His
letter runs:

  "He died, my dear Cecelia, the day of your first communion. Those
  are two memories which will, I hope, never leave your heart, my dear
  child. I had a presentiment of his death when I asked you to pray
  particularly on that morning for your grandfather at Arbois. Your
  prayers will surely be very agreeable to God at such a time, and who
  knows if grandpa himself did not know of them and did not rejoice with
  our little Jeanne [a daughter who had died the year before] over the
  pious sentiments of Cecelia?"

It is not surprising, then, to find many other expressions of
Pasteur's extreme interest in spiritual things, though they might have
been little expected from a man so deeply immersed in scientific
investigations as he was. After all, it must not be forgotten that his
discoveries, by solving the mystery that surrounds the origin of
disease, cleared some of the ways of Providence of that inscrutable
character which is supposed in shallow minds to constitute the
greatest part of their impressiveness. With epidemics explained, not
as dispensations of Divine Providence, but as representing the
sanction of nature for the violation of natural laws, one of the {318}
reasons for which mankind worshipped the Deity seemed to be gone. The
man who had done most to make clear these mysterious processes of
nature was, however, himself far from thinking that materialism offers
any adequate explanation of the mysteries of life, or of the relations
of man to man, and of man to his Creator. Impatient at the pretensions
of such pseudoscientists, Pasteur once said: "Posterity will one day
laugh at the sublime foolishness of the modern materialistic
philosophy. The more I study nature, the more I stand amazed at the
work of the Creator. I pray while I am engaged at my work in the
laboratory."

For Pasteur, death had no mysteries. He had written to his father,
once, on the death of his little daughter Jeanne: "I can only think at
this moment of my poor little one so good, so full of life, so happy
in living, and whom this fatal year, now drawing to a close, has
snatched from us. After a very short time she would have been for her
mother and for me, for all of us, a friend, a companion, a helpmate.
But I ask your pardon, dear father, for recalling to you such sad
memories. She is happy. Let us think of those who remain, and let us
try to prevent for them, as far as lies in our power, the bitternesses
of life." So, when it came to the hour of his own death, Pasteur faced
it with the simple confidence of a sincere Christian, and the
undoubting faith of a lifelong son of the Church. For many hours he
remained motionless, one of his hands resting in that of Madame
Pasteur, while the other held a crucifix. His last conscious glance
was for his lifelong companion, his last conscious act a pressure of
the image of his Redeemer. Thus, surrounded by his family and
disciples in a room of almost monastic simplicity, on Saturday,
September 28, 1895, about five in the afternoon, passed peacefully
away the greatest of the nineteenth century scientists.

{319}

Almost needless to say, the life of a man like Pasteur contains the
most wonderful lessons for the young scientists of the twentieth
century. Few men have lived their lives so unselfishly, and with so
much preoccupation for the good that they might accomplish, as he did.
To have remained in the midst of it all simple, earnest and faithful
to duty, without self-seeking, is a triumph worthy of recording, and
makes a career well deserving of emulation. When Pasteur made his
discoveries with regard to fermentation the Empress of the French
asked to be shown just what his investigations had demonstrated.
Pasteur went to Court for the purpose, and after the Emperor and
Empress had been shown the ferment cells, and expressed their
interest, Eugenie said: "Now, you will develop this discovery
industrially, will you not?" Pasteur replied. "Ah, no, that will be
left for others. It does not seem to me that it would be worthy of a
French scientist to allow himself to be diverted to the industrial
applications of his discoveries, even though it might prove eminently
lucrative for him." As a matter of fact, had Pasteur allowed himself
to be allured into the foundation of an immense manufactory
constructed and directed on the great principles which he had
discovered, there seems no doubt that this would have been a wonderful
money-making scheme. Certain it is that the capital for such an
adventure would have been readily available. Had Pasteur yielded to
the solicitations made him he might have died worth many millions,
instead of the very modest competency which came to him in the
ordinary course of his scientific labors. The money might have seemed
a temptation for the sake of his children, but the world would have
lost all the great discoveries with regard to human diseases. It is
not unlikely that these would have been made even without Pasteur,
There is no doubt, however, that their discovery {320} would have been
very much delayed and that as a consequence almost untold human
suffering that has been prevented would have occurred. It must never
be forgotten that such men as Lister and Koch derived their most
fertile suggestions from the discoveries made by Pasteur.

Pasteur's life may very well be held up, then, as a model to the
present and future generations of what the highest ideals of a
scientific career can be. Dr. Christian Herter, in the discourse
already quoted from, has stated this so well and at the same time has
joined with it so felicitously a quotation from Pasteur's advice to
young men, that we can find no better way in which to close this
consideration of Pasteur's career than by quoting him once more:

  "To have fought the long battle of life with unwavering constancy to
  the loftiest ideals of conduct, toiling incessantly without a
  thought of selfish gain; to have remained unspoiled by success and
  unembittered by opposition and adversity; to have won from nature
  some of her most precious and covert secrets, turning them to use
  for the mitigation of human suffering;--these are proofs of rare
  qualities of heart and mind. Such full success in life did Louis
  Pasteur attain, and from the consciousness of good achieved his
  noble nature found full reward for all his labors.

  "Of the children whom nature has endowed with splendid gifts there
  are few whose lives have affected so profoundly and so beneficently
  the fate of their fellows, few who have earned in equal degree the
  gratitude and reverence of all civilized men. Although not many can
  hope to enrich science with new principles, all of us may gain from
  Pasteur's life the inspiration to cultivate the best that is in us.
  Let us keep living in our memories the inspiring words which the
  master spoke on the seventieth anniversary of his birthday:

    "'Young men, young men, devote yourselves to those sure {321} and
    powerful methods, of which we as yet know only the first secrets.
    And I say to all of you, whatever may be your career, never permit
    yourselves to be overcome by degrading and unfruitful skepticism.
    Neither permit the hours of sadness which come upon a nation to
    discourage you. Live in the serene peace of your laboratories and
    your libraries. First, ask yourselves, What have I done for my
    education? Then, as you advance in life, What have I done for my
    country? So that some day that supreme happiness may come to you,
    the consciousness of having contributed in some manner to the
    progress and welfare of humanity. But, whether our efforts in life
    meet with success or failure, let us be able to say, when we near
    the great goal, 'I have done what I could.'"


{322}

{323}

JOSEPH O'DWYER, THE INVENTOR OF INTUBATION

{324}

  I have hope and wish that the nobler sort of physicians will advance
  their thoughts, and not employ their time wholly in the sordidness
  of cures; neither be honored for necessity only; but that they will
  become coadjutors and instruments in prolonging and renewing the
  life of man.
      --Bacon


{325}

JOSEPH O'DWYER, THE INVENTOR OF INTUBATION.


At the beginning of the nineteenth century a young medical
practitioner, working faithfully in the wards of his hospital in
Paris, pitying especially the patients who suffered from pulmonary
disease, and realizing how hopeless was their treatment, since medical
science knew so little of the real nature of the ailment from which
they suffered, invented the stethoscope and established the principles
on which modern physical diagnosis is based in a method so complete
that after the lapse of three-quarters of a century very little has
been added to what was then discovered. This genius was the famed
Laennec, of whom we have written in a preceding chapter, who was wont
to spend his days walking the wards of the Necker Hospital in Paris,
caring more for his poor patients than for the nobility and members of
the wealthy classes, who willingly would have taken advantage of his
clinical knowledge so conscientiously gained. Laennec made possible
progress in medicine that places him among the five or six greatest
medical men of all times.

At the end of the nineteenth century a man of about Laennec's age was
touched with pity for the sufferings of the poor children whom he saw
dying from suffocation because of the ravages of laryngeal diphtheria.
Nothing could be done for them except, perhaps, to benumb their senses
by means of narcotics, while nurse and medical man stood idly by
suffering excruciatingly themselves while their little patients bore
all the lingering, awful pains of death by asphyxiation. {326} For
years Joseph O'Dwyer labored at the problem of relieving these little
patients, and finally achieved similar success to Laennec with his
stethoscope. The modern doctor, moreover, was quite as patient in his
work of research as Laennec, and though his discovery had not so wide
an application as the latter's it was accomplished through the same
tireless, persevering labor, and through the same instinct of genius
that finally led to the culminating invention which no one has been
able to improve, and which has made its inventor's name a familiar
word to medical men over the world. American medicine has no more
shining light than the name of Joseph O'Dwyer, and the record of his
simple, sincere, straightforward life, faithful during his successful
career to the simple religious principles imbibed in the bosom of an
old-fashioned Catholic family, who, during a long career, thought
little of self and mainly of the possibilities for good presented by
his profession, cannot but prove one of the standard biographies in
this country's medical history.

Dr. Joseph O'Dwyer, the inventor of intubation, was born in 1841, in
Cleveland, Ohio. Shortly after his birth his parents, who were only
moderately well to do, moved to Canada, so that O'Dwyer's boyhood was
passed not far from London, Ontario. There he received his early
education, and there also, as was the custom in those days, he began
his medical studies by becoming a student in the office of a Dr.
Anderson. After two years of apprenticeship, he came to New York and
attended lectures in the New York College of Physicians and Surgeons,
where he was graduated in 1866, at the age of twenty-five. Immediately
after graduation he obtained the first place in the competitive
examination for resident physician and sanitary superintendent of the
Charity or City Hospital of New York City, on Blackwell's Island.
Shortly after his appointment {327} an epidemic of cholera broke out
in the workhouse (under his charge), and Dr. O'Dwyer nobly devoted
himself to the care of the patients. While engaged in this work he
contracted the disease himself, but fortunately recovered completely
without suffering from any of its usual after-effects.

When, not long subsequently, another epidemic of cholera occurred in
New York, and a number of cases of the disease were transferred to
Hart's Island and there quarantined, volunteers for their medical
attendance were asked from among the members of the medical staff of
the Charity Hospital. Dr. O'Dwyer was one of the first to come forward
and offer his services. Again he contracted the disease, but recovered
from it as completely as from typhus. Years afterward he described to
a friend his feelings as he lay in one of the hospital tents, the only
accommodation that could be provided for him owing to the crowded
condition of the wards. His attack was rather severe and yet left him
his consciousness, while as he lay expecting death at almost any
moment, the thought (as he was wont to relate) sometimes came to him
that it was perhaps foolish of him to have volunteered in so dangerous
a service. This thought was always put away, however, and he assured
his friend that at no time had he ever regretted his exposure to the
disease in the cause of suffering humanity. The risks that usually
come with professional obligations (it appeared to him) are not to be
avoided at the cost of the consciousness of a duty refused.

During his service at the Charity Hospital, Dr. O'Dwyer endeared
himself to all those with whom he came in contact. In examination for
the position of resident on the Island he had passed first, and during
his service there it was generally conceded that he towered above his
companions in his efficiency and attention to duty. Some of {328}
those who were residents with him afterward made names that are
distinguished in the history of the practice of medicine in New York
City, yet all of them were ever ready to acknowledge that O'Dwyer had
been a leader among them in the service. With a very practical turn of
mind, he united the capacity for patient work that enabled him to
master difficulties, while his devotion to his profession gave him a
deep interest in every department of medicine. The foundation of his
future success as a practitioner of medicine was laid in these
fruitful years of hard work among the poor charity patients of New
York City, for whose welfare, as is evident from what we have said, he
was ready to make any sacrifice.

After about two years of service on Blackwell's Island, Dr. O'Dwyer,
who had attracted no little attention by his faithful fulfilment of
duty, was appointed examiner of patients--applicants for admission to
the hospitals under the control of the City Board of Charities and
Correction. He therefore resigned his position on the Island, and in
partnership with Dr. Warren Schoonover opened an office on Second
Avenue, between Fifty-seventh and Fifty-eighth Streets. With his
colleague, he devoted himself especially to obstetrical practice, in
which he had great success, delivering in one year, it is said, over
three thousand patients.

In 1872 Dr. O'Dwyer was appointed to the staff of the New York
Foundling Asylum, in connection with which his real life-work was to
be accomplished. While there Doctors Reynolds and J. Lewis Smith were
his colleagues, and all three of them have added no little distinction
to American medicine by the careful observations made at that asylum.

At this time one of the most fearful scourges that could afflict a
foundling asylum or children's hospital was an epidemic of diphtheria.
Those who pretend not to believe {329} in the efficacy of the
antitoxin treatment of diphtheria should listen to the account given
by some of the Sisters, who for long years were in service in the New
York Foundling Asylum, of the fear that came over them when it was
announced that diphtheria had entered the wards in their charge. It
was always certain beyond doubt that this disease would spread very
extensively, and, in spite of all precautions and the enforcement of
whatever quarantine was possible, the mortality rate would be very
high. Usually forty or fifty per cent, of those who were attacked by
diphtheria would perish from the disease, nor was it easy to foresee
the end of any epidemic.

In not a few cases death took place from that most excruciating of all
fatal terminations--asphyxia. The false membrane, characteristic of
diphtheria, would form, in a certain proportion of cases, in the
larynx and upper part of the trachea of the little patient, the
inflammatory swelling that accompanied it further decreasing the
naturally small lumen of the child's undeveloped air passages.
Gradually dyspnoea would set in, the dreaded croup begin to be heard,
and difficulty of breathing developed at times to such a degree that
the little one would use every effort to secure breath, the aeration
of the blood growing less and less, and cyanosis--that is, an intense
blueness of the face and hands--becoming evident, till finally the
child died slowly in all the agonies of asphyxiation, while doctor and
nurse stood sadly by, absolutely powerless to do anything to relieve
the heart-rending symptoms.

About the middle of the nineteenth century tracheotomy--that is, the
surgical opening of the trachea, or wind-pipe, below the larynx, for
the purpose of admitting air to the lungs through such artificial
opening--had been introduced by Trousseau, of Paris. In many cases
this afforded relief; {330} at least the little patients did not die
the awful death by asphyxiation, though not many recovered from the
diphtheria or the results of the operation. O'Dwyer himself, when
asked what had led him to think of intubating the larynx, said that he
had been aroused to experimentation in this direction by the complete
failure of tracheotomy during the years from 1873 to 1880 at the New
York Foundling Asylum.

In 1880, Dr. O'Dwyer began to devise some method of providing a
channel for the passage of air and secretions through the larynx. He
knew that tracheotomy, as a serious, bloody operation, always is put
off until the condition of the patient is quite alarming, if not
hopeless, and that some device for holding the larynx open, if not too
difficult of application, would surely prove life-saving in a great
many cases. His first thought was that the introduction of a wire
spring within the larynx might serve to hold the inflamed sides apart.
He realized, however, that the edema and false membrane would force
their way around the wires, and so gradually occlude the throat
passage in spite of the presence of the spring.

His next thought was a small bivalve speculum, that is to say, two
portions of tubes cut longitudinally and fastened together in such a
way that the ends could be forced apart. Such instruments are used
very commonly for the examination of various cavities in the human
body. The laryngeal spring, or speculum, was more successful than the
wire, but it had one of the faults of the wire spring. Into the slit
between the two portions of the speculum the inflamed mucous membrane
was apt to force itself, so that before long difficulty of breathing
would recur. Besides, if the spring which kept the blades of the
speculum apart were weak, the instrument would fail of its purpose in
{331} keeping the mucous membrane apart, while, if it were strong, the
pressure of the blades would cause ulceration.

Notwithstanding its faults, however, the bivalve laryngeal speculum
accomplished somewhat of the purpose intended. In one case it kept a
child alive until the dangerous period of the disease was passed, and
thus was the means of saving the first little patient suffering from
membranous croup in the thirteen years that the Foundling Asylum had
been in existence. Dr. O'Dwyer continued to experiment with the
speculum for some time, but finally gave it up and began to study the
detailed anatomy of the human larynx. These studies included not only
the normal larynx, but also its conditions under the influence of
various pathological lesions. Finally (as one of Dr. O'Dwyer's
assistants at that time says), he appeared one day in the autopsy-room
with a tube. This tube was a little longer than the speculum that
before had been in use. It was somewhat flattened laterally, and had a
collar at its upper end. This tube was very soon to prove of practical
value.

In the first case in which it was employed it was a failure, inasmuch
as the patient died from the progress of the diphtheria, though the
notes of the case show that after the introduction of the tube the
dyspnoea was relieved and the child breathed with comparative ease for
the sixteen hours that elapsed before death took place. To any one who
knows the harrowing agony of death from asphyxiation, and who
appreciates the fact that this form of death was now to be definitely
done away with, the triumph of this first introduction of the tube
will be at once clear. Dr. O'Dwyer himself was very much encouraged.
The relief afforded the patient was for him a great personal
satisfaction, since one of the severest trials to his sensitive nature
in the midst of his professional work had always {332} been to have to
stand helplessly by while these little patients suffered.

The fact that this tube had been retained for sixteen hours
demonstrated definitely that the larynx would tolerate a foreign body
of this kind without any of the severe spasmodic reflexes that might
ordinarily be expected under such circumstances, while the fact that
the tube had not been coughed up showed definitely that the inventor
was working along the proper lines for the solution of his
life-problem. The second case in which the tube was employed resulted
in recovery, and Dr. O'Dwyer's more than a dozen years of labor and
thought were rewarded by not only relief of symptoms, but the complete
recovery of the patient without any serious complications and without
any annoying sequelae.

As the first case (alluded to above) is now a landmark in the history
of medicine, the details relating to it seem worth giving. The little
patient was a girl of about four years of age, who on the fifth or
sixth day of a severe laryngeal diphtheria developed symptoms of
laryngeal stenosis, with great dyspnoea. Hitherto the only hope would
have been tracheotomy, but Dr. O'Dwyer introduced one of his tubes.
The little patient was very much frightened and, as might be expected,
in an intensely irritable condition because of the difficulty of
breathing. She absolutely refused to permit any manipulations, and it
was only with great difficulty that he finally succeeded in
introducing the tube. After its introduction the little one shut her
teeth tightly upon the metallic shield which the doctor wore on his
finger for his protection, and he was absolutely unable to withdraw it
from her mouth. It was only after chloroform had been given to her to
the extent of partial anesthesia, with consequent relaxation of
muscles, that he succeeded in freeing himself.

This proved to Dr. O'Dwyer the need of another {333} instrument (to be
employed in the introduction of tubes)--an apparatus by which the
mouth could be kept widely open so as to allow of manipulation without
undue interference by the patient. For this purpose he contrived the
mouth-gag--a very useful little instrument that has been found of
service in many other surgical procedures about the mouth besides
intubation.

His first tubes, however, were not without serious defects. For
instance, in order to permit of the extraction of the tube afterward,
there was a small slit in the side of the tube, into which the
extractor hooked. Into this slit the swollen and edematous mucous
membrane was apt to force its way, and (as can readily be understood)
in the removal of the tube considerable laceration in the tissues
usually was inflicted. Accordingly the tubes subsequently made were
without this slit. Moreover, the first tubes that were employed were
not quite long enough, a defect which led to their being rather
frequently coughed up. This inconvenience was not wholly obviated even
by the lengthening of them.

O'Dwyer continued his studies, and finally hit upon the idea of
putting a second shoulder on the tubes. This, it was hoped, would fit
below the vocal cords, and with the cords in between the two shoulders
the tubes would surely be retained. This improved tube was actually
retained, but the drawback to its adoption (as shown in practice)
proved to be that it was retained too tightly. When the time for its
removal came it was almost impossible to get it out. It was evident
then that some other model of tube would have to be constructed in
order to make the process of intubation entirely practical, and thus
do away with certain dangers.

One of O'Dwyer's assistants at this time at the Foundling Asylum tells
of the amount of time the doctor gave to the {334} study of the
problem involved in these difficulties and of his ultimate success
therein. Putty was moulded in various ways on tubes, which were
inserted in specimen larynxes, and plaster casts were taken, with the
idea of determining just the form of tube which would so exactly fit
the average normal larynx as to be retained without undue pressure,
yet at the same time keep the false membrane from occluding the
respiratory passages and furnish as much breathing space as possible.
Finally Dr. O'Dwyer decided that the best form of tube for all
purposes would be one with a collar, or sort of flaring lip at the
top, which was to rest on the vocal cord, with, moreover, a
spindle-shaped enlargement of the middle portion of the tube, which
lay below the vocal cords, fitting more or less closely to the shape
of the trachea. To avoid the pressure and ulceration at the base of
the epiglottis--a very sensitive and tender portion of the laryngeal
tissues--a backward curve was given to the upper portion of the tube.
On the other hand, the lower end, which rests within the cricoid ring
and which was likely to be forced against the mucous membrane of the
trachea occasionally, was somewhat thickened to avoid the friction and
leverage that might be exerted if there were any free-play allowed. At
the same time the lower end of the tube was thoroughly rounded off.

Thus Dr. O'Dwyer, realizing all the difficulties of this new method of
treatment, solved them, as experience proved that the tubes could be
made of still smaller calibre than had been hitherto supposed and yet
be efficient in relieving respiratory dyspnoea. Experience also proved
that the metal tubes at first used had a number of serious
disadvantages. They were heavier than those which could be made of
hard rubber in the same size and shape, while the metal tubes besides
had a tendency to encourage the deposition and {335} incrustation on
their surfaces of calcium salts. These incrustations, roughening the
surface of the tube, increased its tendency to produce pressure
ulceration, as well as added to the difficulty of its removal, and
consequently to the liability of producing laceration of tissues after
convalescence had been established. Accordingly tubes were made of
hard rubber, which could be allowed to remain in the larynx almost for
an indefinite period without any inconvenience. While at first
intubation was looked upon as a merely temporary expedient, clinical
experience showed that sometimes in neurotic patients it was necessary
to let the tube remain in the throat for several weeks or even months.


Dr. O'Dwyer's originality in the invention of intubation has sometimes
been doubted. The idea of some such instrumental procedure as he
finally perfected seems to have occurred to practitioners of medicine
a number of times in medical history. No one reduced the idea to
practice in any successful degree. O'Dwyer's invention was not some
chance hit of good fortune in lighting on a brilliant idea, but the
result of years of patient investigation and shaping of means to ends.
Often failure seemed inevitable, but he continued to experiment until
he forced the hand of the goddess of invention to be favorable to him.
The history of intubation is interesting mainly because it brings out
clearly O'Dwyer's success where others had failed.

The evolution of intubation forms, moreover, a very interesting
chapter in the story of medicine. It is curious to learn that the
Greeks of the classical period, and very probably for a long time
before, knew something of the possibility of putting a tube into the
larynx in cases of stenoses or contractions which threatened to
prevent breathing. It is clear that they thus secured patency of the
air-passages after these had become occluded. Hippocrates mentions
{336} canalization of the air-passages, and suggests that in
inflammatory croup with difficulty of respiration, canulas should be
carried into the throat along the jaws so that air could be drawn into
the lungs. This is probably diphtheria, the first mention of the
disease in medical literature, though it is usually said to have been
first described in Spain at the beginning of the nineteenth century.
There is evidence, too, in Greek medical history that these directions
were followed by many practising physicians of those early times.
Considering that intubation of the larynx is usually thought to be a
very modern treatment, this tradition in Greek medical history serves
to show how transitory may be the effect of real progress in applied
science. After a time the Asclepiades, and some centuries later
Paulinus of AEginetus, rejected the teaching of Hippocrates in this
matter, while the latter suggested even the employment of bronchotomy.


After this episodic existence among the Greeks, there is no mention of
anything like intubation of the larynx until about the beginning of
the nineteenth century. In 1801, Desault, a French surgeon, while
attempting to feed a patient suffering with a stricture of the
oesophagus through a tube passed down the throat, inadvertently
allowed the tube to pass into the larynx. This brought on a severe fit
of coughing, but after a time the tube was tolerated and an attempt
was made to feed the patient through it, with the production (as can
be readily imagined) of a very severe spasmodic laryngeal attack.
Desault realized the probable position of the tube then, and, taking a
practical hint from this accident, suggested that possibly tubes could
be passed down into the lungs even through a spasmodically contracted
or infiltrated larynx, with the consequent assurance of free ingress
of air. As these cases were otherwise extremely {337} hopeless, it was
not long before he found the opportunity to put his hypothesis to the
test, and in some half a dozen cases he succeeded in lengthening
patient's lives and making them more comfortable for some hours at
least.

Desault's suggestion was followed by similarly directed experiments on
the part of Chaussier, Ducasse and Patissier. All these came during
the first quarter of the century in France, while, in 1813, Finaz of
Seyssel, a student of the University of Paris, in writing his
graduation thesis for the faculty of medicine, suggested the use of a
gum-elastic tube that should be passed down into the larynx in order
to allow the passage of air in spasmodic and other obstructive
conditions. In 1820, Patissier suggested that some such remedy as this
should be employed for edema of the glottis. This affection, which is
apt to be rapidly fatal, is a closing of the chink of the glottis, or
_rima glottidis_, as it is called, which occurs very rapidly as the
result of inflammatory conditions, especially in patients who are
suffering from some kidney affection.

There was no doubt in the mind of practitioners generally of the
necessity in many cases for some such expedient as the intubation of
the larynx, but there was a very generally accepted notion that the
mucous membrane of the larynx was entirely too sensitive to permit of
a tube remaining for any considerable length of time in contact with
the vocal cords and the very sensitive mucous membrane of the
epiglottis. Meantime many precious lives were lost. Our own Washington
was a sufferer, perhaps, from inflammatory edema of the larynx,
complicated by a kidney trouble, though this was thirty years before
Bright's work, and (as a matter of course) we have no definite data in
the matter; or, as seems not unlikely, he suffered from a severe
attack of laryngeal diphtheria, and, after hours of intense dyspnoea,
{338} suffocated while his physicians stood hopelessly by, unable to
do anything for him.

There are many other names in the history of attempts at intubation
during the first half of the century, two of the most important of
which are Liston and John Watson, who, as the result of chance
observations in cases in which feeding-tubes were inadvertently passed
into the larynx, came to the thought that the larynx might tolerate a
tube much better than had been previously imagined. About the middle
of the nineteenth century there was no little discussion with regard
to the possibility of applying remedies within the larynx after the
insertion of a tube, and a large number of medical articles appeared
thereon. Diefenbach, the great German surgeon, interested himself in
this matter particularly, and protected his left index-finger by a
shield that acted also as mouth-gag in inserting the tubes. This
technique was afterward to be made use of by O'Dwyer.

The first great step in intubation, as we know it at the present time,
however, came from Bouchut, who suggested the use of a tube about the
size of a thimble meant to be inserted into the larynx. At the upper
part of this tube there were a pair of rings, between which the vocal
cords were supposed to rest and hold it in place. Bouchut operated in
seven cases with his tube, but five of his patients died, while two of
them recovered only after tracheotomy had been performed. Bouchut
succeeded, however, in showing that the larynx would tolerate a tube,
though he made exaggerated claims for his method, while the very
imperfect instruments he employed foredoomed his inventions to
failure. It happened, moreover, that the time was unpropitious.
Trousseau had not long before re-invented tracheotomy, and had
employed it with considerable success in cases of croup. Under
Trousseau's influence, a committee of the Academy of {339} Medicine of
Paris declared Bouchut's method unphysiological and impracticable.
Moeller, of Koenigsberg, tried to reintegrate Bouchut's method with
certain ameliorations, but failed. The field of intubation--and a very
discouraging one it seems, strewn as it was with failures made by many
excellent workers--was left for O'Dwyer to exploit. How thoroughly he
worked out his methods can best be appreciated from the fact that no
improvement of importance has come since he presented to the medical
profession the intubation system as he had elaborated it some fifteen
years ago.

How thoroughly Dr. O'Dwyer realized all the difficulties attached to
the practice of intubation may be gathered from some of his articles
on details of the treatment of patients necessary in order to make
intubation a success. One of the great difficulties in the matter was
the liability, when a tube was in place, for food and drink to find
their way, during the process of swallowing, into contact with
sensitive tissues of the larynx. To overcome this difficulty, Dr.
O'Dwyer made many modifications of the upper part of the tube.
Accordingly he made many wax models of the larynx, and studied the
function of the epiglottis and its method of covering the larynx in
order to facilitate the complete protection of the laryngeal tissues
during the process of swallowing. Finally, he succeeded in making a
tube that enables most patients to learn how to swallow without much
difficulty.

In the mean time O'Dwyer was full of practical suggestions with regard
to the management of these cases. His clinical experience showed him
that it was better to teach the patients to swallow rapidly and then
cough up any material that might find its way into the larynx rather
than to take small sips with a spasm of coughing after each sip. He
showed that, notwithstanding the apparently great danger {340} of
portions of food being carried past the larynx into the trachea, and
so to the lungs, there was not nearly so much risk in this matter as
had been anticipated. The almost inevitable occurrence of pneumonia
was supposed to be one of the serious objections to the use of the
intubation methods. Careful pathological investigations, however, soon
showed that pneumonia developed much less frequently than had been
expected, and, as a rule, when it did develop, it was due to an
extension of the diphtheritic processes from the throat rather than to
any infection by material that, because of the presence of the tube,
had been inadvertently allowed to find its way into the respiratory
tract.

However, O'Dwyer's work was not done without considerable opposition.
Bouchut's original invention of tubes for the larynx had failed to
attract attention because of its condemnation by the Academy of
Medicine of Paris, under the influence of Trousseau. When O'Dwyer's
tubes were first suggested, then, there were not lacking critics, who
said at once that his method was not new, that it had been fairly
tried already and found wanting, and that it was hopeless to expect
that any intubation method would succeed, since the larynx would not
tolerate such a foreign body. There are always those who are sure, on
_a priori_ grounds, that a new invention cannot succeed because it
infringes on certain well-known physical laws that make it impossible.
Similarly there were a number of experienced clinicians who were sure
that O'Dwyer's reported results could not be as represented.

It was not only from members of the medical profession that O'Dwyer
met with discouragement. His work at the Foundling Asylum was carried
on in spite of many difficulties and disappointments. His first
contrivances for keeping the larynx open in spite of the inflammatory
swelling were all failures, and, as owing to unfamiliarity
considerable {341} difficulty was experienced in the insertion of the
various mechanical appliances, he seemed to be adding to the torture
of his little patients. Many of the attendants at the hospital became
discouraged and almost dreaded to see any attempt made to save the
children. From one of the sisters attached to that institution O'Dwyer
received the greatest possible encouragement. Sister Rosalie had often
been known to weep at the death of her little charges, orphans though
they were, and, though death frequently seemed a welcome relief from
suffering, she hoped against hope that something would be accomplished
to make deaths by asphyxiation rarer; so that even in the face of
repeated failure she was ever ready to encourage O'Dwyer in further
attempts in the accomplishment of his humane purpose. Not a little of
his ultimate success is due to her sympathy and the enthusiastic faith
inspired by her motherly love for the little homeless waifs who had
come to occupy places in her heart.

At the beginning, some of the specialists in children's diseases gave
the new method a trial, yet without obtaining satisfactory results.
Professor Jacobi, our most distinguished specialist in that field in
America, to whom the German government offered the chair of pediatrics
at the University of Berlin, contended, in writing his article on
diphtheria for Pepper's _System of Medicine_, that intubation could
not be expected to accomplish all that was claimed for it. It was not
long, however, before Jacobi realized his mistake in this matter and
handsomely made up for it. While he was president of the Academy of
Medicine, in opening a discussion on intubation before the academy, in
1886, he said that O'Dwyer's work deserved all possible praise, and
that his untiring devotion to the subject, in silent patience until he
had brought it to perfection, was a model {342} that might well be
held up for the emulation of American physicians, commonly only too
prone to announce discoveries even before they were made.

Besides the application of O'Dwyer's tubes in acute diseases affecting
the larynx and causing difficulty of breathing, the method of
intubation has proved of special service in the treatment of stenotic
diseases of the larynx. There are certain diseases in which deep
ulcerations of the vocal cords, and of the laryngeal structures in
their neighborhood, are followed by persistent contraction. This
contraction may extend so as to cause serious narrowing of the chink
of the glottis, producing difficulty of breathing, and an intense
breath-hunger that usually causes excruciating agony. Such patients
formerly were objects of very special pity, but unfortunately very
little could be done for them. Since the introduction of O'Dwyer's
tubes, the lot of these patients has been made not only more
tolerable, but, in course of time, even actual cures have been
obtained, the tendency to contraction in the scar-tissue in the larynx
being eventually overcome, with consequent relief of all the symptoms.


Dr. O'Dwyer himself tells the story of the first patient thus treated.
It was a woman, about forty years of age, the innocent victim of a
dissolute husband, who came suffering with labored, stridulous
breathing. The morning of the previous day she had visited a prominent
laryngologist of New York City, who advised her to have tracheotomy
done before the sun went down. A colleague suggested that she should
go to Dr. O'Dwyer to see if he could not give her relief by means of
his process of intubation. The stricture in the larynx had resulted
after the healing of frequently repeated ulcerations. The tissue all
around the site of the old ulcers was densely cicatricial, with a very
marked tendency to contract. The aperture through which the breathing
{343} had to be done was just sufficient to admit air enough to allow
the patient to continue on her feet, but it was becoming ever
narrower, while her discomfort was very marked. The stenosis had been
coming on for two years, and was slowly progressive in spite of every
form of treatment then known to the medical profession.

At this time there was no such thing as intubation tubes suited for
adults. Dr. O'Dwyer, therefore, had a set made, using as models casts
taken from a series of various-sized bodies, and furnishing directions
to the instrument-maker from careful measurements of adult larynxes.
The tubes were made in various sizes for different-sized people, but
none of them was small enough to be of service in this case, and even
the largest of the tubes that had been made for children could be
inserted only after the use of considerable force. This tube was
inserted and allowed to remain for several days and then the next
larger size was introduced. As considerable irritation had been set up
by the previous tube, however, an interval of several days' rest was
allowed. At the end of about eighteen days, breathing had become quite
comfortable and the patient was allowed to return to her home in a
suburban town. In two months and a half, however, all her symptoms had
returned.

Another course of dilatation was then undertaken, and the patient was
instructed to return thereafter every week for some time, until the
tendency to contraction had been overcome. After a time, the intervals
between dilatations were increased to a month, and then to six weeks,
without any return of the dyspnoea. It is characteristic of O'Dwyer's
very conservative view of things to find his prognosis of this case as
given to the "Laryngological Section" of the Ninth International
Medical Congress. He said:

  "It is now one year and nine months since I began the {344}
  dilatation of this patient's larynx, and there is scarcely any doubt
  that it will be necessary to continue it during the rest of her
  life."

Later, however, we find the report:

  "The cicatricial tissue in the larynx (as reported by the doctor)
  lost its tendency to contract, and the patient has remained now for
  over five years free from any return of the stenosis."

This last sentence is from Dr. O'Dwyer's note of the case, when by
special invitation he discussed the subject at the annual meeting of
the British Medical Association, held at Bristol, England, in July,
1894.

Interesting as is the career of Dr. O'Dwyer as an investigator and
discoverer in medicine, his character as a man is still more worthy of
attention. For nearly thirty-five years he was a member of the staff
of the New York Foundling Asylum; during which time he endeared
himself to sisters and nurses, to his brother-physicians on the staff
and to his little patients. He was eminently conscientious in the
fulfilment of his duty, and had a tender sympathy that made him feel
every slightest pain of his child-patients almost as personal.

One very stormy evening, in the closing years of his life, after his
more than twenty years' service as a member of the asylum staff, a
little child fell ill and he was sent for. Though not well himself,
the doctor came out into the night and the storm to attend the little
patient. As he was leaving the hospital, long after midnight, one of
the sisters, who had been longest in the hospital and who knew him
very well, said to him:

"But Doctor, why did you come out on such an awful night? The house
physician might have gotten on very well without you until morning,
even though the little one was much worse than usual."

{345}

"Ah, sister," he said, "it was a child suffering, and I couldn't stay
home and think that perhaps there was something I might suggest that
would relieve that suffering even a little during the night."

It was this beautifully tender sympathy that urged him on against many
discouragements to continue his investigations with regard to the
possibility of intubation, and finally led him to his brilliant and
perfected discovery. Yet it is even more interesting to find that
after all these years of labor, just as soon as antitoxin was
introduced, and it became clear that a new and great advance in
therapeutics had probably been made, O'Dwyer immediately took up the
new remedy in order to test fully its possibilities. If antitoxin were
to prove the success that was claimed for it abroad, if cases of
diphtheria were to recover under its influence as they apparently had
done in France and Germany, then the role of intubation would soon be
a very small one and O'Dwyer's years of patient investigation would go
for very little. Such considerations, however, had no weight with him,
and it may be said that during his superintendency at the New York
Foundling Asylum antitoxin had for the first time a full, unrestricted
opportunity given it to demonstrate its power for good.

Notwithstanding discouragements of many kinds, the test of the
efficacy of diphtheria serum was persevered in when others with more
apparent reason for interest in it became disheartened and were ready
to give it up, if not even actually deprecating its use. The medical
profession understands very well now how unfavorable were the
conditions under which diphtheria antitoxin was used at first. The
original experiments had been made in the laboratory with small
animals, and the amount of antitoxin necessary to produce good effects
in human beings was not well understood. As {346} a distinguished
authority in children's diseases, who is himself a great advocate of
the efficacy of antitoxin, once said: "It can practically be admitted
that when first antitoxin was introduced its use was scarcely more
than expectant treatment." That is to say, so little of antitoxic
power was contained in the serum injected at first that the children
were practically only kept from other and more exhausting forms of
treatment, while the physicians awaited the results with nature as the
only really active therapeutic agent.

After all, it must not be forgotten that the first doses of antitoxin
contained at most 50 to 100 antitoxin units, as we now measure serum
efficacy for the treatment of diphtheria. At the present time no one
would think of using less than five hundred units as a beginning dose,
and those who obtain the best results begin with 1000 to 1500, or in
severe cases with 2000 to 3000 units of antitoxic strength. It is
almost providential that, notwithstanding this failure to understand
the serum properly, the verdict of the profession did not go so
generally against antitoxin as to condemn its use hopelessly. It is
owing to O'Dwyer and a few other sympathetic souls, who "hoped almost
against hope," that finally experience succeeded in demonstrating the
true value of diphtheria antitoxin.

There was another difficulty, however, in the way of the adoption of
antitoxin that had to be overcome, one that proved no little source of
discouragement to many of those who were testing the remedy. The
original diphtheria serum employed was not concentrated; so when a
sufficient amount of antitoxic units to neutralize the toxins of the
disease under treatment was employed, a large quantity of serum had to
be injected. Experience shows that the injection of any foreign blood
serum into an animal is followed by a certain amount of haemolysis, or
blood destruction, and by {347} certain cutaneous manifestations, such
as urticaria, erythemata, the familiar hives-like eruption and red
itchy spots, which prove a great source of annoyance. In very
susceptible cases the injection of even a small amount of foreign
serum is followed by some fever, by restlessness, and red and swollen
joints. In the early days of the employment of diphtheria antitoxin,
all of these complications were noted in many cases. They were
sufficient to make many who were interested in the demonstration of
the value of antitoxin so disappointed and discouraged that they gave
up the task. Not so, however, with O'Dwyer, who continued its use, and
encouraged others by his example so that in spite of these objections
antitoxin obtained a firm foothold.

Dr. O'Dwyer's conduct, with regard to the continued use of antitoxin
under the discouraging conditions we have sketched, stamps him as a
great member of his humanitarian profession, whose only purpose was
the relief of suffering and the cure of disease, without any thought,
moreover, of self-glorification. The use of antitoxin has made the
necessity for intubation occur much less frequently than before, and
thus has undone some of the good contemplated by Dr. O'Dwyer, but has
accomplished it in a way which he eminently approved and helped on as
far as lay in his power, even at the time when others were doubtful,
not without good reasons, as to the results that were being obtained
from the use of antitoxin.

Perhaps the best index of the sincere simplicity and frank goodness of
O'Dwyer's character is to be found in his relations to the religious
community of which he had been so long a medical attendant. In the
words of one of their superiors, he was looked upon by the sisters at
the Foundling Asylum as the father of the house, who had, as might be
expected, the confidence and trust of every member of the {348}
community. His relations to Sister Irene, the famed superior of the
asylum, became those almost of brother to sister. Sister Irene (as is
well known), though a woman who accomplished some of the best
philanthropic work that, at least, our generation has known, was
always in delicate health. For several years before his death, Dr.
O'Dwyer scarcely ever let an evening go by without coming to see her
personally. He, better than anyone else, realized how much she had
done for the Foundling Asylum, and how much her wonderful influence
was still accomplishing in making the extension of that work possible.


There is, of course, another side to this story of Dr. O'Dwyer's
solicitude for Sister Irene that deserves to be noticed. Few women
have ever accomplished work of the extent and character that Sister
Irene succeeded in doing with so little friction. In the parlor of the
Foundling Asylum there is an engrossed scroll--a tribute to her memory
from the medical board of the Asylum--which shows how well she was
appreciated. As a bit of hospital history it deserves a place here,
especially as there seems no doubt that O'Dwyer's mutual relations to
the sisters and to the medical staff were of a kind that helped
wonderfully in securing the frictionless co-operation that meant so
much for the institution. The memorial scroll reads as follows:

  "Tribute to the memory of Sister Irene--to the Sister Superior who
  secured friends and funds for the building of the first and largest
  foundling hospital in America.

  "To the sweet-souled woman--the friend of the foundling and fallen;
  to the best friend any medical board ever had, this tribute is
  presented with their sympathies to the Reverend Mother and the
  Sisterhood of the Sisters of Charity by the Medical Board of the New
  York Foundling Hospital."

While an extremely modest man himself, and one of very {349} few
words, Dr. O'Dwyer delighted in teaching others anything he felt that
he knew well himself. His conduct with regard to the teaching of
intubation was especially admirable. He was ready to show any
serious-minded physician just how the operation was accomplished, and
many a young doctor obtained precious training in the exercise of the
rather difficult manipulation involved in placing a tube in a child's
larynx from the hands of O'Dwyer himself. He never lost patience with
the awkward ones and never seemed to consider that too many calls were
made on his time. He might easily have made money on the operation or
the instruments, but deemed such considerations unworthy of his
professional dignity. Personally he was a very reticent man, but, as a
number of friends have said of him, "he made every word count;" and
those who knew him best justly appreciated the expression of an
opinion from him, since it was always sure to be the fruit of mature
consideration and the result of personal clinical experience, usually
extending over long periods.

The opinion held of Dr. O'Dwyer by his colleagues in the
profession--and, be it well understood, there is no more searching
appreciation of practical methods and theoretical opinions than that
obtained by brother-physicians--is the best possible tribute to his
greatness as an investigator, his honorableness as a practitioner, and
his distinction as a man. We quote the summing up of his character
given by Dr. Northrup, who had been his colleague for a score of years
at the New York Foundling Asylum, and whose paper on the subject was
read before the New York Academy of Medicine shortly after O'Dwyer's
death:

"What the world knows of O'Dwyer," said Dr. Northrup, "is his genius
as an inventor, his achievement in adding a great operation to the
equipment of the profession, and thus {350} making the most
conspicuous real contribution to medical progress within the last
fifty years. This the world knows and has acknowledged. To us there is
another and a pleasant duty to testify, that with this genius there
was all that goes to make a man. His home life, his religious life,
his civic life, his professional relations with both colleague and
patient, his hospital relations, were such as befit a high-principled
man. As highly as we esteem him as an inventor and genius and
practitioner of wide knowledge, as much as we valued his superior
medical judgment, we would write upon the monument of his
achievements, 'O'Dwyer the Man.'"

In a previous passage of his address before the Academy, Dr. Northrup
had said:

  "If I were asked what most contributed to Dr. O'Dwyer's medical
  excellence I would say his habit of thinking and his good logic. He
  had a good medical mind, an excellent medical judgment. Above all,
  that quality of intellect which allows a man to grow after the age
  of forty. To the New York Foundling Asylum, with which Dr. O'Dwyer
  was connected for twenty-five years, he was everything; to the
  maternity service he was the expert obstetrician; in intubation he
  was the inventor and teacher; in the general medical service he was
  the constant consulting mind, whose opinion in times of difficulties
  and in the midst of puzzling clinical problems every one voluntarily
  sought. To the Sisters of Charity he was physician and friend,
  consulted with regard to every important concern of the house,
  whether medical or not. All adored him."

Dr. O'Dwyer's domestic life was most happy. He had married, very
suitably, a woman of bright disposition, who was a foil to his own
soberer and more melancholy ways, and the relations between husband
and wife growing tenderer with the progress of years, their home-life
became the model {351} of an ideal Christian family. When he lost her
through death, more than half of his life seemed to have gone, and he
never quite recovered from the blow. The circumstances of her death
added to his sense of loss, as it must have increased his appreciation
of her worth. She died a martyr to what she considered her duty as a
Christian mother. During the course of a pregnancy she was taken with
what is known as pernicious vomiting, an affection that is likely to
prove fatal unless the irritated uterus should be relieved of its
burden--a means that neither she nor her husband would consent to
adopt. Her death thus was the result.

During the years after the death of the doctor's wife, intimate
friends found out what an effort of Christian fortitude it was for him
to keep up his spirits and his work. Though he was one of the busiest
of professional men, in very active practice, not a week passed but he
found time to go to her grave and put flowers thereon. Just after her
death he was as a man stricken by some dazing mental affection. Yet
his sense of duty was so great that on his return from her funeral,
being informed that a little child suffering from diphtheria needed
his services for the performance of intubation, he at once made haste
to comply with the untimely demand on him, and had given the little
patient relief within the quarter of an hour after he had alighted
from the funeral carriage.

Personally, Dr. O'Dwyer was of cold exterior, nor had he many close
friends. Those who knew him well understood that beneath the layer of
ice there was a warm, considerate, tender heart for those whom he
admitted to the penetralia of his intimacy. On the other hand, few men
have ever had friends more devoted than were O'Dwyer's. He was,
however, of an extremely sensitive disposition. His conclusions in
medicine had always been worked out with {352} the greatest care, and
were the results of personal observations. To have them criticised
then by those who had much less experience, or who had never thought
along the same lines, was always intolerable to him, and generally
kept him out of medical discussions. Those who knew him best realized
that his opinions were of the greatest value, nor ever failed to
contain a germ of original thought, the result of his personal
experience. After his long years of work at intubation, many of his
medical brethren refused at first to accept his new method of
treatment, claiming that it did not reduce the mortality, even though
it did for a moment relieve the sufferings of the patient. This
position was a source of the keenest disappointment and depression to
O'Dwyer.

After the method of treatment by intubation had been for some time
before the medical profession of the country, a thorough discussion of
it was held at one of the meetings of the Academy of Medicine of New
York. Authorities in children's diseases from several of the large
Eastern cities were invited to be present to give their opinions of
intubation. Most of them were agreed that O'Dwyer's invention was of
very little service. It was not a novelty in the history of medicine
to have a really great and helpful discovery thus at first rejected by
those who were later to be its ardent advocates. To O'Dwyer, however,
who was present and took part in the discussion, the criticism of his
method of treatment was a source of veritable torment. He did not show
at the meeting how deeply wounded was his spirit, but for three days
afterward he practically shut himself up in his room and refused to
see anyone.

Naturally he was of a rather melancholic tendency, prone to dwell on
the sadder side of things, and was constantly interested in sad
stories and songs. He liked sad music, {353} and usually refused to
listen to the livelier airs that others, especially of his race, were
apt to find so refreshing. Something of this sterner side of his
character entered into all his relations with others, and even with
his own family. Though deeply affectionate, he very seldom permitted
them to see and appreciate that fact. He was rather apt to be stern
than otherwise, fearful lest his affection should in any way spoil
them. To the very young children, in whose regard he did not consider
this objection to hold, he was almost demonstratively affectionate,
and those who knew his love for little children appreciated the
sacrifice he made in denying himself demonstrations of affection to
his own.

With all his sadness there was, as might be expected from his racial
descent, a vein of dry humor, not infrequently manifest, though only
to very near friends. He appreciated a good story, though the
slightest tendency to vulgarity was extremely displeasing to him. He
is said to be the originator of the humorous expression that has since
been used often enough. While one day calling at a friend's house, in
the absence of the friend, the servant asked him to leave his name,
but was met with the reply (from the doctor) that "he preferred not
to, as he thought he might have use for it before he got home."

The religious side of O'Dwyer's character is intensely interesting,
because it represents a successful professional man--the maker of an
important discovery in medicine; a logical, scientific thinker, whose
opinion was valued by all his professional brethren--as one of the
simplest of believers, tenderly pious and faithful. The sexton of the
church near which he lived tells (since his death) of frequently
seeing him steal in during the day to say his prayers at the foot of
the altar. He was one of the most faithful attendants at the
communions and retreats of the Xavier Alumni Sodality {354} of New
York City, of which he was an enthusiastic member. His deep piety can,
perhaps, be best appreciated from a characteristic incident, which
illustrates his faith in prayer--his confidence in Providence. He had
asked for something with regard to one of his children over and over
again, and finally thought that his prayer had been heard. Later on he
had reason to regret the fact that his wish had been granted, and to a
friend, to whom he told the circumstances, he said:

  "All that we can do is to say with resignation, 'Thy will be done,'
  and then we shall be sure that whatever happens will be for the
  best."

The story of O'Dwyer's death serves to illustrate some of the weaker
points of modern medicine. During the nearly ten years after his
wife's death he had never been quite the same man, but had succeeded
in doing a large amount of work and had continued to care for a very
large practice. In December, 1897, he began to develop some anomalous
symptoms, pointing to a serious pathological condition within the
skull. He seemed to have had what are known as "Ménière's symptoms,"
that is, a tendency to vertigo, some ringing in the ears and other
unpleasant feelings. Toward the end of that month some hemiplegia, or
at least some weakness of one side of his body, developed. He was
rather neglectful of his personal health, as most physicians are, and
until this time had paid very little attention to his symptoms. Most
of the prominent New York consultants and nervous specialists were
called in, but there was a marked disaccord as to the cause of the
symptoms.

After some days in bed, comatose symptoms began to manifest
themselves, and on January the seventh following, after having been
lethargic for some days, Dr. O'Dwyer died. The _antemortem_ diagnosis
of his case was dubious, lying amid the possibilities of tubercular
meningitis, {355} secondary infection after otitis media, and
secondary infection from some external cause. During the previous
December, O'Dwyer had been treating a patient with carbuncle, and
developed himself a small carbuncle on his chin. By some it is thought
that infectious material from this lesion had been carried by emissary
veins or their accompanying lymphatics to the inside of the skull,
affecting the meninges, and perhaps portions of the brain-substance
itself.

The _postmortem_ examination did not entirely clear up the doubts of
diagnosis. The lateral sinus was found thrombosed, while there were
some suspicious signs in the middle ear, but no distinct inflammatory
condition. Just how the infection took place, then, is not clear, but
O'Dwyer's condition of lowered resistive vitality was evidently at
fault, to an important degree, in permitting infection to take place
and in not throwing it off afterward.

At the time of his death he was about fifty-seven years of age. He had
reached the maturity of his powers, and with the consciousness of
having accomplished one good work was ready for further original
investigations in practical medicine. A thought that had occupied him
very much toward the end of his life was the possibility of a
mechanical method of treating pneumonia. He had made a series of
experiments on the lungs, and many clinical observations with regard
to the possibility of producing over-inflation by mechanical measures.
He confided to one of his physician friends, who had been closest to
him during life, that he hoped thus to secure a method of treating
pneumonia successfully. This, after all, is the most serious problem
in present-day medicine. Our death-rate from pneumonia is at least as
high now as it was a century ago. O'Dwyer started from the observation
that those suffering from emphysema seldom develop true pneumonia. And
he hoped {356} to prevent the progress of the disease, or to abort it
in its inception, by producing artificial emphysema for the time
being. Had he lived, it seems not unlikely that we would have had
further original work of a high order from him.

Though of Irish descent, Dr. O'Dwyer illustrated very well the
expression that was used of the English nobility who went to Ireland
in Elizabeth's time, and who are said to have become "more Irish than
the Irish themselves." O'Dwyer became an American of the Americans. He
believed in meeting Americans on their own ground, cultivating their
acquaintance, and making them realize the worth of new citizens of the
republic by showing them how sincere was the patriotism of their
recently admitted compatriots.

Dr. O'Dwyer was in everything the model of a Christian gentleman, and
an exemplary member of the great humanitarian profession whose
charitable opportunities he knew how to find and take advantage of at
every turn in life. The American medical profession has never had a
more worthy model of all that can be expected from physicians in their
philanthropic duties toward suffering humanity, nor a better exemplar
of what Christian manhood means in the widest sense of that expressive
term. With an inventive genius of a high order, that gave him a
prominent place in a great generation and that has stamped his name on
the roll of medical fame for all time, there were united the simple
faith, the earnest purpose, the clear-sighted judgment and the feeling
kindness--those supreme qualities of head and heart that will always
secure for him a prominent place in the small group of great medical
men.


{357}

INDEX.

  Allbutt, 138
  Allison, 188
  Alternate generation, 238
  America to Jenner, 102
  Ampere, 19
  Aneurism, 43
  Aneurism of aorta, 45, 203
  Angelo Michel, 33
  Angina pectoris, 89
  Animal electricity, 119
  Antivaccination, 100
  Aortic aneurism, 45, 203
  Aortic valves, 202
  Appendicitis, 285
  Arago, 299
  Archimedes, 50
  Asiatic cholera, 189
  Aspergillus, 239
  Atmospheric electricity, 121
  Attending physician, 202
  Auenbrugger
    and Laennec, 66-72
    beneficence, 78;
    cases, 79;
    neglect, 69-73;
    preface, 67
  Auscultation, mediate, 145
  Avocation, 54

B

  Bacon, 324
  Baron, Dr., 96
  Bassi, Laura 126
  Bayle, 163
  Bedside instruction, 57
  Bell, 233
  Bernard
    statue, 272;
    honors, 286;
    musical comedy, 275;
    poverty, 273-275;
    succeeds Flourens, 286
  Benedict XIII, 48
  Benedict XIV, 48
  Berzelius, 244
  Bichat, 153
  Biological succession 306
  Biot, 299
  Birrell Augustine, 107
  Blushing, 283
  Boerhaave, 49
  Bologna, 35-37
  Bologna sausage, 34
  Bonn, 231
  Bouillaud, 148
  Bouchut, intubation, 338
  Boyle, Robt., 306
  Breadth of education, 226
  Breton
    peasant's faith, 294;
    peasant woman, 294
  Bribery and union, 197
  Brittany, 138
  Bronchitis, chronic, 46
  Broussais, 139-152
  Brown, Dr. Jno., 270
  Browne, Sir Thos., 114
  Bruecke, 226
  Butt, Isaac, 196
  Butyric acid, 304

C

  Cabanis, 286
  Cameron, Sir Chas., 167
  Cancer, removal, 46
  Carbonic oxide 284
  Carlyle, 107
  Carriers of disease, 309
  Caspar, 219
  Catarina Sforza, 33
  Cavendish, 19
  Cavities, 65
  Cell doctrine, 255, 261-264
  Cellulose, 300
  Charité, La, 152
  Chassaignac, 131
  Chauffard, 164
  Chaussier's tubes, 337
                                     {358}
  Chauvinism, 235
  Chemistry, organic, 296
  Cheyne, 170
  Cheyne-Stokes, 168, 185, 194
  Chicken cholera, 309
  Cholera, epidemic, 327
  Cirrhosis, 152
  Cirrhosis of lungs, 206
  Cisalpine republic, 128
  Classical training, 227, 288
  Claude Bernard, 42
  Clement XIII, 48
  Cline, Dr., 99
  Clinical teaching, 57, 178
  Collège de France, 271
  Common sense and the beautiful, 198
  Comparative pathology, 45
  Confidence in medicines, 180
  Conservatism, 288
  Consumption
    and alcohol, 174;
    and city life, 174;
    curable, 192;
    outdoor life, 193
  Contagion of tuberculosis, 46
  Contemporary popularity, 253
  Cook, Dr. Win, 48
  Corrigan
    and Sunday closing, 210;
    as a consultant, 206;
    as a teacher, 208;
    disease, 15, 200;
    honors, 209;
    member of parliament, 214;
    physician in ordinary, 212;
    pulse, 168;
    practice, 201, 205
  Corvisart, 74, 142
  Cowpox, 94
  Croup, 329
  Cuckoo, 93
  Cullen, 188
  Curare, 284

D

  Da Costa, 83
  Daguerre, 260
  Dalkey, 211
  Dante, 131
  Danube capricious, 64
  Darwin, 254
  Dean Swift, 167
  De Haen, 58;
    writings, 69
  De Maria, 131
  Desault, 336;
    tubes, 337
  Desgenettes, 157
  Diabetes, 279
  Diastases, 287
  Dictionnaire des sciences méd., 153
  Dieffenbach, 219
  Digestion, 278;
    and emotion, 282
  Dignity of medicine, 194
  Diphtheria fatality, 329;
    antitoxin, 345
  Discoveries rejected, 14
  Discovery in distans, 18;
    wine of, 298
  Dissymmetrical forces, 301
  Dissymmetry and universe, 302, 303
  Distinction, living and non-living, 300
  Doctor of medicine and philosophy, 37
  Do not think, investigate, 92
  Dom Pedro II, 315
  Dublin Zoological Garden, 211
  Du Bois-Reymond, 242
  Duchesse de Berri, 155
  Duclaux, 302
  Ductless glands, 281
  Ducts of Müller, 233
  Dust and life, 306
  Dyspepsia, nervous, 282

E

  Earth worms, carriers of disease, 309
  Edinburgh, 208
  Education,
    classical, 288;
    rounded, 289
  Eggs and oxygen, 258
  Electricity,
    animal, 119;
    atmospheric, 121
  Elsner, Dr. Henry L., 137
  Emanuel III, 48
  Emphysema and pneumonia, 355
  Empress Eugenie, 319
  Encyclopedists, 115
  Eustachius, 32
  Eyerel, 74

F

  Fallopius, 32
  Faraday, 19
  Fat digestion, 277
  Father Morgagni, S. J., 50
  Father of German medicine, 217
  Father of pathology, 29
  Fatty heart, 192
                                       {359}
  Fermentations, 304;
    and disease, 306
  Ferments, 287
  Fever, nature and treatment, 205
  Flacherie, 307
  Flint, 144, 150, 166
  Flourens, 286
  Foolishness of materialism, 318
  Forli, 33
  Foundling Asylum (N. Y.), 328
  Franco-Prussian War, 312
  Franklin, 19;
    anticipated, 123
  French Revolution, 115;
    Academy of Physicians, 286
  Frog dancing-master, 122
  Froriep, 219
  Froude, 134

G

  Gaelic movement, 167
  Gairdner, 30
  Galeazzi, 116
  Galen, 35
  Galileo, 244
  Galvani, 19;
    Mme., 117, 120;
    dancing frogs, 21;
    the physician, 125;
    medal, 130
  Gases and eggs, 259
  German
    students at Padua, 40;
    decorations returned, 313;
    rabies, 313, 314
  Girardin, St. Marc, 275
  Glycogen, 281
  Goerres, 223
  Goethe, 227
  Gold dust of time, 240
  Graves
    family, 169;
    as a traveler, 169;
    fed fevers, 172;
    perfect teacher, 177;
    remedies, 177;
    last moments, 185
  Grease in horses, 95
  Guerin, 131

H

  Hahn, S. J., 286
  Haller, 29;
    and Müller, 244
  Harvey, 28, 35, 104
  Haüy, 116
  Heart percussion, 63
  Heat
    production, 281;
    regulation, 282
  Heberden, 89
  Heliostat and growth, 302
  Helmholtz, 247
  Henle, 200
  Herter, Dr. Christian, 311, 320
  Hibernation, 92
  Hippocrates, 35, 142, 336;
    succussion, 72
  Hirsch, Baroness, 315
  History, 12
  Holme, Sir Edw., 95
  Hunter, 90, 120
  Huxley, 20
  Hydatids, 151

I

  Ideals, 294;
    in life, 320
  Il Morgagni, 50
  Imagination, 284
  Indians, American, and Jenner, 103
  Infinite and supernatural, 316
  Institutions and men, 217
  Internal secretion, 280
  Intubation
    experiments, 330;
    first, 332;
    for chronic ills, 342;
    history, 335;
    improvement, 333;
    studies, 334;
    tubes, 331
  Inventum novum, 61
  Investigating spirit, 16
  Irene, Sister, 348
  Irish
    aristocracy, 197;
    College of Physicians, 210
  Italy's
    leadership in medicine, 31;
    medical schools, 32

J

  Jacobi, 341
  Jardin des Plantes, 273
  Jefferson, 104
  Jenner, 77;
    and Indians, 103;
    epigrams, 93;
    honors conferred, 102;
    Hunter, 91;
    Mrs. Jenner, 109;
    Jenner's patience, 91;
    personality, 105;
    son inoculated, 93
  Jesuit education, 224-273

K

  Koch, 135
  Kühne, 278
  Kulturkampf, 249
                                        {360}
L

  La Cellule, 266
  Laennec's
    character, 156;
    in practice, 161;
    preface, 154
  Laic, saint, 295
  Lamarck, 116
  Lamennais, 138
  Lancet on Corrigan, 207, 212
  Lancisi, 57
  Laplace, 116
  Lavater, 227
  Lavoisier, 244
  Layard, 184
  Lieberkühn, 238
  Liebig, 262, 304
  Liège, 266
  Limitations of genius, 203
  Lister, 312
  Liston, 338
  Littré, 294
  Liver sugar, 280
  Lough Corrib, 197
  Louise Lateau, 267
  Louvain, 264
  Ludwig, 71

M

  Magendie, 276, 283
  Maisonneuve, 139
  Malpighi, 32, 233
  Manzolini, Mme., 127
  Maria Theresa, 23, 80
  Mayer, 22
  Maynooth, 207, 212
  Mead, Sir Richard, 49
  Meckel, 42
  Meckel's Archiv, 230
  Medical
    charities bill, 190;
    education, 181;
    progress, 19
  Medicine
    an art, 178;
    and the public, 195;
    faith, 24;
    in Italy, 31
  Ménière's symptoms, 354
  Merbach, 65
  Microcosm, 114
  Microtome, 256
  Milk in diarrhea, 175
  Mitscherlich, 297
  Molecular forces, 301
  Mondino, 32, 34
  Moore, Sir Jno., 167, 200
  Morgagni
    daughters nuns, 49;
    basic idea, 14;
    literary light, 23;
    long life, 31;
    method, 30;
    popularity, 48
  Mouth-gag, 333
  Mozart, 81
  Müller,
    a priest of nature, 247;
    as a teacher, 245, 257;
    and Aristotle, 224;
    education, 218;
    discoveries, 232;
    distinctions, 244;
    ducts, 233;
    father, 222;
    handbook, 234;
    introspection, 231;
    methods, 237;
    monument, 249;
    mother, 223;
    muscular control, 229;
    panegyric, 220;
    personality, 246;
    students, 246;
    translates plate, 224;
    vivisection, 225, 235
  Muscle sugar, 281

N

  Napoleon III, 286;
    judgment, 75, 143
  Nasse, 228
  Nature, study, 108
  Necker hospital, 143
  Nervous reflex, 42
  Newman, 216
  Newton, 244
  Normandy, 140
  Northrup, 349;
    O'Dwyer's personality, 350
  Not many patients, 181
  Nurses, trained, 171

O

  Observation, 181
  O'Connell, 196
  O'Dwyer
    Americanism, 356;
    birth, boyhood, 326;
    careful prognosis, 343;
    cholera volunteer, 327;
    clinical experience, 339;
    devotion to duty, 344;
    discouragements, 340;
    domestic life, 353;
    feeling for children, 345;
    originality, 335;
    patient work, 328, 339;
    resignation, 354;
    sensitiveness, 352
  Oersted, 19, 116
  Ohm, 19
  Olfactory nerve, 42
                                       {361}
  Opposition
    to vaccination, 101;
    to science, 22
  Organotherapy, 281
  Original research, 13
  Origins in electricity, 19
  Osler, 14, 252
  Otis, Dr. Edw. O., 82

P

  Padua, 1000 German students, 40
  Paine's Age of Reason, 186
  Pancreas, 277
  Paradise Lost, 41
  Parasites, 238
  Paratartrates, 297
  Pasteur,
    advice to young men, 321;
    and money, 319;
    chemist, 296;
    faith, 294;
    ideals, 295;
    illness, 311;
    last moments, 318;
    letters, 317;
    monument, 293;
    obsequies, 315;
    prayer in laboratory, 318;
    tenderness, 317
  Pathology, comparative, 45
  Pebrine, 307
  Pepsin, 262
  Percussion, 62
  Petrie, 198
  Pharmacy, old-time, 274
  Phila. College of Physicians, 144
  Philosophy, a little, 126
  Phipps Institute, 55
  Physiology and Psychology, 286
  Pilgrim's Progress, 41
  Pindar, 50
  Pinel, 142
  Pneumonia, 355
  Polarization, 299
  Poor patients, 214;
    Corrigan, 213;
    Galvani, 125;
    Graves, 171;
    Laennec, 156;
    Stokes, 190
  Positivism, 295
  Practical teaching, 183
  Psychologus physiologus, 249
  Pulse, intermittence, 45

R

  Rabies, 313, 314
  Radot, M., 301
  Ragpicker of science, 283
  Ratio medendi, 70
  Ray-fish, 124
  Read, Dr. C. A. L., 219
  Red blood cell, 285
  Religion
    and science, 255;
    and medicine, 24
  Religious training, 108
  Removal of stomach, 279
  Respiration, 285
  Retzius, 239
  Rheumatism and the heart, 89
  Richardson, Benj. Ward, 36, 40, 153
  Richman, 123
  Roger, 149
  Rosalie, Sister, 341
  Rothschild, 315
  Roux, 316
  Royal Irish Academy, 198
  Rudolphi, 230, 234
  Ruskin, 20
  Ruysch, 49, 233

S

  Saintignon, Life of Laennec, 157
  Salivary nerves, 277
  Sap temperatures, 92
  Schenkelton, 62
  Schlegels, August and Friedrich, 59
  Schoenlein, 219, 238
  Scholar in medicine, 84
  Schott treatment anticipated, 193
  Schwann
    and professorships, 267;
    devotion to science, 256;
    friendships, 268;
    handiness, 260;
    scientific work, 265
  Science and religion, 24, 255
  Scott, Sir Walter, 187
  Seats and causes of disease, 40
  Sense, a new, 148
  Silkworm
    diseases, 306,
    industry, 307
  Sisters Irene and Rosalie, 341, 348
  Skepticism, medical, 180
  Skoda, 61
  Sources of democracy, 316
  Spalding, 166, 292
  Spanish hospital, Vienna, 60
  Specialization, 289
  Spigelius, 32
  Splenic fever, 308
                                                {362}
  Spontaneous generation, 262, 287, 309;
    of disease, 263
  Spores, 311
  Stereochemistry, 299
  Stethoscope, 147;
    a toy, 16
  St. Francis of Assisi, 131
  St. Francis of Sales, 117
  Still madness, 79
  Stokes, 136, 186;
    character, 200;
    distinctions, 199;
    Margaret, 198;
    Sir Wm. Jr., 198;
    wife, 199
  Stoll, 74
  Sugar absorption, 279
  Sydenham, 138
  Sympathetic nerves, 43, 282

T

  Tartrates, 297
  The chimney sweep, 80
  Theorists, 20
  Theory and observation, 20
  Theriaque, 274
  Thompson, 187
  Tissue-therapy, 281
  Titian, 35
  Torpedo fish, 124
  Tracheotomy, 329;
    failure, 330
  Trousseau, 15, 176, 200, 238
  Trudeau, 55
  Truth in medicine, 17
  Tuberculosis, 173, 192
  Tufnell treatment anticipated, 44
  Turner, 170
  Typhoid and typhus, 188, 205

U

  United Irishmen, 186
  Unselfish devotion, 25
  Uric acid, 300
  Utility and ideals, 198

V

  Vaccination and measles, 102;
    day, 97;
    first successful, 98
  Valsalva, 36
  Van Swieten, 58, 60;
    writings, 69
  Vasomotor nerves, 282
  Venesection, 47, 158
  Venetian patricians, 48
  Vesalius, 32, 35
  Vicq d'Azyr, 286
  Vienna
    school, 15, 56;
    general hospital, 56
  Villemin, 135
  Virago of Forli, 33
  Virchow, 29, 206, 219, 220;
    Virchow and Müller, 239
  Vital force, 218, 242, 288, 299
  Vogel, 71
  Volta, 19

W

  Walshe, 144
  Wardrop's operation, 204
  Washington, 337
  Watson, Jno., 338
  Werner, 80
  Woehler, 218
  Women at Italian Universities, 126, 127
  Woodhead, G. Sims, 55

Y

  Young Germany, 263
  Young men
    discoverers, 14, 15, 16;
    in biology, 16;
    electricity, 19;
    in medicine, 201

Z

  Zois, Baron, 80
  Zoological Society, 211






End of Project Gutenberg's Makers of Modern Medicine, by James J. Walsh



*** END OF THE PROJECT GUTENBERG EBOOK MAKERS OF MODERN MEDICINE ***


    

Updated editions will replace the previous one—the old editions will
be renamed.

Creating the works from print editions not protected by U.S. copyright
law means that no one owns a United States copyright in these works,
so the Foundation (and you!) can copy and distribute it in the United
States without permission and without paying copyright
royalties. Special rules, set forth in the General Terms of Use part
of this license, apply to copying and distributing Project
Gutenberg™ electronic works to protect the PROJECT GUTENBERG™
concept and trademark. Project Gutenberg is a registered trademark,
and may not be used if you charge for an eBook, except by following
the terms of the trademark license, including paying royalties for use
of the Project Gutenberg trademark. If you do not charge anything for
copies of this eBook, complying with the trademark license is very
easy. You may use this eBook for nearly any purpose such as creation
of derivative works, reports, performances and research. Project
Gutenberg eBooks may be modified and printed and given away—you may
do practically ANYTHING in the United States with eBooks not protected
by U.S. copyright law. Redistribution is subject to the trademark
license, especially commercial redistribution.


START: FULL LICENSE

THE FULL PROJECT GUTENBERG LICENSE

PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK

To protect the Project Gutenberg™ mission of promoting the free
distribution of electronic works, by using or distributing this work
(or any other work associated in any way with the phrase “Project
Gutenberg”), you agree to comply with all the terms of the Full
Project Gutenberg™ License available with this file or online at
www.gutenberg.org/license.

Section 1. General Terms of Use and Redistributing Project Gutenberg™
electronic works

1.A. By reading or using any part of this Project Gutenberg™
electronic work, you indicate that you have read, understand, agree to
and accept all the terms of this license and intellectual property
(trademark/copyright) agreement. If you do not agree to abide by all
the terms of this agreement, you must cease using and return or
destroy all copies of Project Gutenberg™ electronic works in your
possession. If you paid a fee for obtaining a copy of or access to a
Project Gutenberg™ electronic work and you do not agree to be bound
by the terms of this agreement, you may obtain a refund from the person
or entity to whom you paid the fee as set forth in paragraph 1.E.8.

1.B. “Project Gutenberg” is a registered trademark. It may only be
used on or associated in any way with an electronic work by people who
agree to be bound by the terms of this agreement. There are a few
things that you can do with most Project Gutenberg™ electronic works
even without complying with the full terms of this agreement. See
paragraph 1.C below. There are a lot of things you can do with Project
Gutenberg™ electronic works if you follow the terms of this
agreement and help preserve free future access to Project Gutenberg™
electronic works. See paragraph 1.E below.

1.C. The Project Gutenberg Literary Archive Foundation (“the
Foundation” or PGLAF), owns a compilation copyright in the collection
of Project Gutenberg™ electronic works. Nearly all the individual
works in the collection are in the public domain in the United
States. If an individual work is unprotected by copyright law in the
United States and you are located in the United States, we do not
claim a right to prevent you from copying, distributing, performing,
displaying or creating derivative works based on the work as long as
all references to Project Gutenberg are removed. Of course, we hope
that you will support the Project Gutenberg™ mission of promoting
free access to electronic works by freely sharing Project Gutenberg™
works in compliance with the terms of this agreement for keeping the
Project Gutenberg™ name associated with the work. You can easily
comply with the terms of this agreement by keeping this work in the
same format with its attached full Project Gutenberg™ License when
you share it without charge with others.

1.D. The copyright laws of the place where you are located also govern
what you can do with this work. Copyright laws in most countries are
in a constant state of change. If you are outside the United States,
check the laws of your country in addition to the terms of this
agreement before downloading, copying, displaying, performing,
distributing or creating derivative works based on this work or any
other Project Gutenberg™ work. The Foundation makes no
representations concerning the copyright status of any work in any
country other than the United States.

1.E. Unless you have removed all references to Project Gutenberg:

1.E.1. The following sentence, with active links to, or other
immediate access to, the full Project Gutenberg™ License must appear
prominently whenever any copy of a Project Gutenberg™ work (any work
on which the phrase “Project Gutenberg” appears, or with which the
phrase “Project Gutenberg” is associated) is accessed, displayed,
performed, viewed, copied or distributed:

    This eBook is for the use of anyone anywhere in the United States and most
    other parts of the world at no cost and with almost no restrictions
    whatsoever. You may copy it, give it away or re-use it under the terms
    of the Project Gutenberg License included with this eBook or online
    at www.gutenberg.org. If you
    are not located in the United States, you will have to check the laws
    of the country where you are located before using this eBook.
  
1.E.2. If an individual Project Gutenberg™ electronic work is
derived from texts not protected by U.S. copyright law (does not
contain a notice indicating that it is posted with permission of the
copyright holder), the work can be copied and distributed to anyone in
the United States without paying any fees or charges. If you are
redistributing or providing access to a work with the phrase “Project
Gutenberg” associated with or appearing on the work, you must comply
either with the requirements of paragraphs 1.E.1 through 1.E.7 or
obtain permission for the use of the work and the Project Gutenberg™
trademark as set forth in paragraphs 1.E.8 or 1.E.9.

1.E.3. If an individual Project Gutenberg™ electronic work is posted
with the permission of the copyright holder, your use and distribution
must comply with both paragraphs 1.E.1 through 1.E.7 and any
additional terms imposed by the copyright holder. Additional terms
will be linked to the Project Gutenberg™ License for all works
posted with the permission of the copyright holder found at the
beginning of this work.

1.E.4. Do not unlink or detach or remove the full Project Gutenberg™
License terms from this work, or any files containing a part of this
work or any other work associated with Project Gutenberg™.

1.E.5. Do not copy, display, perform, distribute or redistribute this
electronic work, or any part of this electronic work, without
prominently displaying the sentence set forth in paragraph 1.E.1 with
active links or immediate access to the full terms of the Project
Gutenberg™ License.

1.E.6. You may convert to and distribute this work in any binary,
compressed, marked up, nonproprietary or proprietary form, including
any word processing or hypertext form. However, if you provide access
to or distribute copies of a Project Gutenberg™ work in a format
other than “Plain Vanilla ASCII” or other format used in the official
version posted on the official Project Gutenberg™ website
(www.gutenberg.org), you must, at no additional cost, fee or expense
to the user, provide a copy, a means of exporting a copy, or a means
of obtaining a copy upon request, of the work in its original “Plain
Vanilla ASCII” or other form. Any alternate format must include the
full Project Gutenberg™ License as specified in paragraph 1.E.1.

1.E.7. Do not charge a fee for access to, viewing, displaying,
performing, copying or distributing any Project Gutenberg™ works
unless you comply with paragraph 1.E.8 or 1.E.9.

1.E.8. You may charge a reasonable fee for copies of or providing
access to or distributing Project Gutenberg™ electronic works
provided that:

    • You pay a royalty fee of 20% of the gross profits you derive from
        the use of Project Gutenberg™ works calculated using the method
        you already use to calculate your applicable taxes. The fee is owed
        to the owner of the Project Gutenberg™ trademark, but he has
        agreed to donate royalties under this paragraph to the Project
        Gutenberg Literary Archive Foundation. Royalty payments must be paid
        within 60 days following each date on which you prepare (or are
        legally required to prepare) your periodic tax returns. Royalty
        payments should be clearly marked as such and sent to the Project
        Gutenberg Literary Archive Foundation at the address specified in
        Section 4, “Information about donations to the Project Gutenberg
        Literary Archive Foundation.”
    
    • You provide a full refund of any money paid by a user who notifies
        you in writing (or by e-mail) within 30 days of receipt that s/he
        does not agree to the terms of the full Project Gutenberg™
        License. You must require such a user to return or destroy all
        copies of the works possessed in a physical medium and discontinue
        all use of and all access to other copies of Project Gutenberg™
        works.
    
    • You provide, in accordance with paragraph 1.F.3, a full refund of
        any money paid for a work or a replacement copy, if a defect in the
        electronic work is discovered and reported to you within 90 days of
        receipt of the work.
    
    • You comply with all other terms of this agreement for free
        distribution of Project Gutenberg™ works.
    

1.E.9. If you wish to charge a fee or distribute a Project
Gutenberg™ electronic work or group of works on different terms than
are set forth in this agreement, you must obtain permission in writing
from the Project Gutenberg Literary Archive Foundation, the manager of
the Project Gutenberg™ trademark. Contact the Foundation as set
forth in Section 3 below.

1.F.

1.F.1. Project Gutenberg volunteers and employees expend considerable
effort to identify, do copyright research on, transcribe and proofread
works not protected by U.S. copyright law in creating the Project
Gutenberg™ collection. Despite these efforts, Project Gutenberg™
electronic works, and the medium on which they may be stored, may
contain “Defects,” such as, but not limited to, incomplete, inaccurate
or corrupt data, transcription errors, a copyright or other
intellectual property infringement, a defective or damaged disk or
other medium, a computer virus, or computer codes that damage or
cannot be read by your equipment.

1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the “Right
of Replacement or Refund” described in paragraph 1.F.3, the Project
Gutenberg Literary Archive Foundation, the owner of the Project
Gutenberg™ trademark, and any other party distributing a Project
Gutenberg™ electronic work under this agreement, disclaim all
liability to you for damages, costs and expenses, including legal
fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT
LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE
PROVIDED IN PARAGRAPH 1.F.3. YOU AGREE THAT THE FOUNDATION, THE
TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE
LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR
INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH
DAMAGE.

1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a
defect in this electronic work within 90 days of receiving it, you can
receive a refund of the money (if any) you paid for it by sending a
written explanation to the person you received the work from. If you
received the work on a physical medium, you must return the medium
with your written explanation. The person or entity that provided you
with the defective work may elect to provide a replacement copy in
lieu of a refund. If you received the work electronically, the person
or entity providing it to you may choose to give you a second
opportunity to receive the work electronically in lieu of a refund. If
the second copy is also defective, you may demand a refund in writing
without further opportunities to fix the problem.

1.F.4. Except for the limited right of replacement or refund set forth
in paragraph 1.F.3, this work is provided to you ‘AS-IS’, WITH NO
OTHER WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT
LIMITED TO WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PURPOSE.

1.F.5. Some states do not allow disclaimers of certain implied
warranties or the exclusion or limitation of certain types of
damages. If any disclaimer or limitation set forth in this agreement
violates the law of the state applicable to this agreement, the
agreement shall be interpreted to make the maximum disclaimer or
limitation permitted by the applicable state law. The invalidity or
unenforceability of any provision of this agreement shall not void the
remaining provisions.

1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the
trademark owner, any agent or employee of the Foundation, anyone
providing copies of Project Gutenberg™ electronic works in
accordance with this agreement, and any volunteers associated with the
production, promotion and distribution of Project Gutenberg™
electronic works, harmless from all liability, costs and expenses,
including legal fees, that arise directly or indirectly from any of
the following which you do or cause to occur: (a) distribution of this
or any Project Gutenberg™ work, (b) alteration, modification, or
additions or deletions to any Project Gutenberg™ work, and (c) any
Defect you cause.

Section 2. Information about the Mission of Project Gutenberg™

Project Gutenberg™ is synonymous with the free distribution of
electronic works in formats readable by the widest variety of
computers including obsolete, old, middle-aged and new computers. It
exists because of the efforts of hundreds of volunteers and donations
from people in all walks of life.

Volunteers and financial support to provide volunteers with the
assistance they need are critical to reaching Project Gutenberg™’s
goals and ensuring that the Project Gutenberg™ collection will
remain freely available for generations to come. In 2001, the Project
Gutenberg Literary Archive Foundation was created to provide a secure
and permanent future for Project Gutenberg™ and future
generations. To learn more about the Project Gutenberg Literary
Archive Foundation and how your efforts and donations can help, see
Sections 3 and 4 and the Foundation information page at www.gutenberg.org.

Section 3. Information about the Project Gutenberg Literary Archive Foundation

The Project Gutenberg Literary Archive Foundation is a non-profit
501(c)(3) educational corporation organized under the laws of the
state of Mississippi and granted tax exempt status by the Internal
Revenue Service. The Foundation’s EIN or federal tax identification
number is 64-6221541. Contributions to the Project Gutenberg Literary
Archive Foundation are tax deductible to the full extent permitted by
U.S. federal laws and your state’s laws.

The Foundation’s business office is located at 809 North 1500 West,
Salt Lake City, UT 84116, (801) 596-1887. Email contact links and up
to date contact information can be found at the Foundation’s website
and official page at www.gutenberg.org/contact

Section 4. Information about Donations to the Project Gutenberg
Literary Archive Foundation

Project Gutenberg™ depends upon and cannot survive without widespread
public support and donations to carry out its mission of
increasing the number of public domain and licensed works that can be
freely distributed in machine-readable form accessible by the widest
array of equipment including outdated equipment. Many small donations
($1 to $5,000) are particularly important to maintaining tax exempt
status with the IRS.

The Foundation is committed to complying with the laws regulating
charities and charitable donations in all 50 states of the United
States. Compliance requirements are not uniform and it takes a
considerable effort, much paperwork and many fees to meet and keep up
with these requirements. We do not solicit donations in locations
where we have not received written confirmation of compliance. To SEND
DONATIONS or determine the status of compliance for any particular state
visit www.gutenberg.org/donate.

While we cannot and do not solicit contributions from states where we
have not met the solicitation requirements, we know of no prohibition
against accepting unsolicited donations from donors in such states who
approach us with offers to donate.

International donations are gratefully accepted, but we cannot make
any statements concerning tax treatment of donations received from
outside the United States. U.S. laws alone swamp our small staff.

Please check the Project Gutenberg web pages for current donation
methods and addresses. Donations are accepted in a number of other
ways including checks, online payments and credit card donations. To
donate, please visit: www.gutenberg.org/donate.

Section 5. General Information About Project Gutenberg™ electronic works

Professor Michael S. Hart was the originator of the Project
Gutenberg™ concept of a library of electronic works that could be
freely shared with anyone. For forty years, he produced and
distributed Project Gutenberg™ eBooks with only a loose network of
volunteer support.

Project Gutenberg™ eBooks are often created from several printed
editions, all of which are confirmed as not protected by copyright in
the U.S. unless a copyright notice is included. Thus, we do not
necessarily keep eBooks in compliance with any particular paper
edition.

Most people start at our website which has the main PG search
facility: www.gutenberg.org.

This website includes information about Project Gutenberg™,
including how to make donations to the Project Gutenberg Literary
Archive Foundation, how to help produce our new eBooks, and how to
subscribe to our email newsletter to hear about new eBooks.