model of clinical teaching, and indeed served as such to the most
popular teacher of the Paris school in the middle of this century,
Trousseau. William Stokes (1804–1878) was especially known for
his works on diseases of the chest and of the heart, and for his
clinical teaching.
German Medicine from 1800 to 1840.—Of the other countries of Europe, it is now only necessary to mention Germany. Here the chief home of positive medicine was still for a long time Vienna, where the “new Vienna school” continued and surpassed the glory of the old. Joseph Skoda (1805–1881) extended, and in some respects corrected, the art of auscultation as left by Laennec. Karl Rokitansky (1804–1878), by his colossal labours, placed the science of morbid anatomy on a permanent basis, and enriched it by numerous discoveries of detail. Most of the ardent cultivators of this science in Germany in the next generation were his pupils. In the other German schools, though some great names might be found, as Moritz Heinrich Romberg (1795–1873), the founder of the modern era in the study of nervous diseases, the general spirit was scholastic and the result barren till the teaching of one man, whom the modern German physicians generally regard as the regenerator of scientific medicine in their country, made itself felt. Johann Lucas Schönlein (1793–1864) was first professor at Würzburg, afterwards at Zürich, and for twenty years at Berlin (from 1839–1859). Schönlein’s positive contributions to medical science were not large; but he made in 1839 one discovery, apparently small, but in reality most suggestive, namely, that the contagious disease of the head called favus is produced by the growth in the hair of a parasitic fungus. In this may be found the germ of the startling modern discoveries in parasitic diseases. His systematic doctrines founded the so-called “natural history school”; but his real merit was that of the founder or introducer of a method. In the words of H. Häser: “Schönlein has the incontestable merit of having been the first to establish in Germany the exact method of the French and the English, and to impregnate this method with the vivifying spirit of German research.” (J. F. P.)
Modern Progress.—In recent times the positive bent of modern knowledge and methods in other spheres of science and thought, and especially in biology, has influenced medicine profoundly. Minuter accuracy of observation was inculcated by the labours and teaching of the great anatomists of the 17th century; and, for modern times, experimental physiology was instituted by Harvey, anatomy having done little to interpret life in its dynamic aspects. For medicine in England Harvey did what William Gilbert did for physics and Robert Boyle for chemistry: he insisted upon direct interrogation of natural processes, and thereby annihilated the ascendancy of mere authority, which, while nations were in the making, was an essential principle in the welding together of heterogeneous and turbulent peoples. The degradation of medicine between Galen and Harvey, if in part it consisted in the blind following of the authority of the former physician, was primarily due to other causes; and its new development was not due to the discovery of the experimental method alone: social and political causes also are concerned in the advance even of the exact sciences. Among such contributory causes is the more familiar intercourse of settled nations which we enjoy in our own day; the ideas of one nation rapidly permeate neighbouring nations, and by the means of printed books penetrate into remoter provinces and into distant lands. Hence the description of the advance of medicine in western Europe and America may for the latest stage be taken as a whole, without that separate treatment, nation by nation, which in the history of earlier times was necessary. Italy lost the leading place she had taken in the new development of science. The several influences of modern Germany, France and America became of the first importance to English medicine; but these tides, instead of pursuing their courses as independent streams, have become confluent. The work of Theodor Schwann (1810–1882), Johannes Müller (1809–1875), Rudolph Virchow and Karl Ludwig (1816–1895) in Germany, of R. T. H. Laennec and Claude Bernard in France, was accepted in England, as that of Matthew Baillie, Charles Bell, Bright, Graves and others of the British school, quickly made itself felt abroad.
The character of modern medicine cannot be summed in a word, as, with more or less aptness, that of some previous periods may be. Modern medicine, like modern science, is as boldly speculative as it has been in any age, and yet it is as observant as in any naturalistic period; its success lies in the addition to these Experimental Method recognized. qualities of the method of verification; the fault of previous times being not the activity of the speculative faculty, without which no science can be fertile, but the lack of methodical reference of all and sundry propositions, and parts of propositions, to the test of experiment. In no department is the experimental method more continually justified than in that of the natural history of disease, which at first sight would seem to have a certain independence of it and a somewhat exclusive value of its own. Hippocrates had no opportunity of verification by necropsy, and Sydenham ignored pathology; yet the clinical features of many but recently described diseases, such, for example, as that named after Graves, and myxoedema, both associated with perversions of the thyroid gland, lay as open to the eye of physicians in the past as to our own. Again, to the naturalist the symptoms of tabes dorsalis were distinctive enough, had he noted them. No aid to the trained eye was necessary for such observations, and for many other such; yet, if we take Sir Thomas Watson (1792–1882) as a modern Sydenham, we may find in his lectures no suspicion that there may be a palsy of muscular co-ordination apart from deprivation of strength. Indeed, it does not seem to have occurred to any one to compare the muscular strength in the various kinds of paraplegia. Thus it was, partly because the habit of acceptance of authority, waning but far from extirpated, dictated to the clinical observer what he should see; partly because the eye of the clinical observer lacked that special training which the habit and influence of experimental verification alone can give, that physicians, even acute and practised physicians, failed to see many and many a symptomatic series which went through its evolutions conspicuously enough, and needed for its appreciation no unknown aids or methods of research, nor any further advances of pathology. We see now that the practice of the experimental method endows with a new vision both the experimenter himself and, through his influence, those who are associated with him in medical science, even if these be not themselves actually engaged in experiment; a new discipline is imposed upon old faculties, as is seen as well in other sciences as in those on which medicine more directly depends. And it is not only the perceptions of eye or ear which tell, but also the association of concepts behind these adits of the mind. It was the concepts derived from the experimental methods of Harvey, Lavoisier, Liebig, Claude Bernard, Helmholtz, Darwin, Pasteur, Lister and others which, directly or indirectly, trained the eyes of clinicians to observe more closely and accurately; and not of clinicians only, but also of pathologists, such as Matthew Baillie, Cruveilhier, Rokitansky, Bright, Virchow—to name but a few of those who, with (as must be admitted) new facilities for necropsies, began to pile upon us discoveries in morbid anatomy and histology. If at first in the 18th century, and in the earlier 19th, the discoveries in this branch of medical knowledge had a certain isolation, due perhaps to the prepossessions of the school of Sydenham, they soon became the property of the physician, and were brought into co-ordination with the clinical phenomena of disease. The great Morgagni, the founder of morbid anatomy, himself set the example of carrying on this study parallel with clinical observation; and always insisted that the clinical story of the case should be brought side by side with the revelations of the necropsy. In pathology, indeed, Virchow’s (1821–1902) influence in the transfiguration of this branch of science may almost be compared to that of Darwin and Pasteur in their respective domains. In the last quarter of the 19th century the conception grew clearer that morbid anatomy for the most part demonstrates
