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.

THE MAKING OF MEDICINE

Without History a man's soul is purblind, seeing only the things which almost touch his eyes.

--Fuller, Holy and Profane State, 1641.

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 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.

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 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 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 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