The Age of Renovation (continued).—The Eighteenth Century; General Considerations. Foundation of Learned Societies, etc. The Royal College of Surgeons, 1800; the Josephinum, 1785.—The Nineteenth Century. Realistic Reaction Against Previous Idealism. Influence of Comte, of Claude Bernard, and of Charles Darwin, 1809-1882. Influence Exerted by Other Sciences.—Theory of Excitement: Roeschlaub.—Stimolo and Contrast imolo: Rasori, 1762-1837.—Homoeopathy: Hahnemann, 1753-1843.—Isop-athy, Electrohomoeopathy of Mattei.—Cranioscopy, or Phrenology: Gall and Spurzheim.—The Physiological Theory: Broussais, 1772-1838.—Paris Pathological School: Cruveilhier, 1791-1873. Andral, 1797-1876. Louis, 17871872. Magendie, 1783-1855. Trousseau, 1801-1866. Claude Bernard, 1813-1878.—British Medicine: Bell and Hall, Travers, 1783-1858.—Germany, School of Natural Philosophy: Johannes MÜller, 1801-1858.—School of Natural History: SchÔnlein, 1763-1874.—New Vienna School: Rokitansky, 1804-1878. Skoda, 1805-1881.

That the eighteenth century, up to its close, was the golden age of medicine, is due to the prevalence during that period of a strong idealistic undertone, as a result of which any learned occupation caused the scholar to be held in higher esteem than is the case even to-day. Medicine was then regarded as a conscientious vocation and not as a mere business or trade; indeed, general scientific knowledge more widely prevailed among the better class of the profession, and there was much less of that one-sided, narrow education that obtains to-day. The profession, moreover, was not overcrowded; physicians were neither too few nor too numerous, consequently their social position was higher. Again, the relations between doctor and patient were more intimate, most practitioners being of the type described as "family physicians," and those possessed of the doctorate degree ranked among the gentry rather than as artisans. They were, for the most part, fully devoted to their calling; moreover, the State took greater care to protect the people, so that it became dangerous for strolling vagabonds and imposters to attempt to trifle with human life and excite the vulgar to the prejudice of scientific knowledge.

The pursuit of anatomical studies was now facilitated, despite the fact that students were frequently compelled to take long journeys in order to obtain the "material" therefor. In the early part of the century so great was the lack of dissecting material that the great Haller while in Paris was compelled to purloin his cadavers, and ultimately, on discovery of this fact, to fly for his life; Hoffmann was only able to make twenty dissections during twenty-four years; even in the middle of the century there was only one dissection annually in Halle; up to 1712 there had been only three dissections in a score of years—though now subjects can be had there in abundance at a ridiculously low figure; cadavers were extremely scarce in Vienna as late as 1765; and for a long time the only places in London where the study of anatomy could be legally pursued were the College of Physicians and the College of Surgeons, and the trouble that hampered John Hunter in this direction is historical. The crime of "Burking" became known in Hunter's day. Murder was committed, and the victim sold for purposes of dissection—for at this time, as "body-snatching" was a necessity, those that purchased cadavers asked few questions, and the fees paid were, of course, high.

The first clinical institution in Austria was organized in Vienna, in 1754, by Van Swieten, though there was an "ambulatory clinic" (out-patient department) in Prague nine years before. During the century, however, hospitals were everywhere in bad condition. In the HÔtel-Dieu, at Paris, several patients—even as many as six—were sometimes put in the same bed; the convalescent and the dying found themselves thus associated; in Vienna the Allgemeines Krankenhaus was composed of seventeen hospitals that subsequently were amalgamated into one. In London numerous hospitals were founded, and as the medical staff of each became eminent they attracted numerous pupils; but later it became necessary to relieve the hospital wards, and private institutions for instruction were established by popular teachers, the most celebrated being the "Windmill Street School of Anatomy," founded by William Hunter about 1770, and the private school of Sir William Blizzard, which, established in 1780, developed, five years later, into the London Hospital Medical School.

While few, if any, of the lectures were compulsory, particularly in the natural sciences, even more attention than now was bestowed upon the accessory branches; botany, chemistry, and natural history were the recreation of many students and physicians. Pupils enjoyed the privilege of studying what they pleased—as they do practically to-day in the Portuguese University of Coimbra,—and professors exercised to the utmost their individuality in teaching. In Spain natural sciences found no admission, and even so late as 1770 no instruction in these branches was given, as they were regarded as dangerous to the purity of the faith; mineralogy for mining purposes was an exception, for even the most faithful Catholic needs money.

At the universities medical students were not permitted to go out without their scholastic cloaks,—a regulation that still obtains in Spain. That the number of students has enormously multiplied may be seen from the fact that the little University of Giessen, with scarcely any medical school at all, has always more students than had Halle in the days of the famous Hoffmann. In the middle of the last century WÜrzburg had at one time but three medical students, while to-day it has in the neighborhood of five hundred. Even then it was complained that, on account of the number of students, there was an educated proletariat arising, and in 1791 it was proposed, in Austria, that the rush for study should be repressed.

Among the Continental students the revels and bad behavior of past centuries were not to any great extent corrected; fights and debauchery were very common, and all sorts of orgies and bacchanals prevailed. The professors were, in large measure, independent of the State, and a single individual often represented a number of branches now taught by special chairs. When indisposed to lecture, they simply posted upon the blackboard: "Hodie non legitur," and this was the end of the matter. In 1777 Vienna had one hundred and forty-seven medical teachers, and in Germany there were two to every thirty-nine students. That in the last century one man often accomplished more than a great number of average teachers do to-day is amply demonstrated by the lives of Boerhaave, Haller, and others. Then, too, the Latin tongue was generally employed for purposes of instruction, though surgeons, for the most part, lectured in the vernacular; Cullen, in 1770, was the first in Great Britain to deliver purely medical lectures in English; and as the clergy gradually retired from the ranks of the profession, Latin more and more fell into disuse. Strange to say, as the clerical influence waned, the Jews began to enter medicine, the movement beginning about 1791, in France, under the promulgation of "civil equality" ideas; previously the Hebrews had been an almost universally suppressed people, and in Berlin were permitted to enter and leave the city by only one gate, and were forbidden to learn or write pure German, in consequence whereof their dialect was an Hebraic-Teutonic jargon, that even to-day prevails in some portions of western Europe. Educated Jews were few in number, since attendance upon universities was ordinarily denied them, although long before they had been admitted at Salamanca, Toledo, Salernum, and Montpellier. In Austria the prohibition was not removed until 1789, and even then, so bitter was the prejudice against the Semitic race, the clergy vigorously protested. It was the same clerical body that, in 1667, protested with the greatest vehemence against allowing Hebrew physicians to pass through the gates of Wurtemburg without paying toll, declaring that it was "better to die with Christ than be cured by Jews, who were aided by the devil."

Professors were often attached to the courts of their various sovereigns, and at one time the French court possessed a faculty of forty-eight physicians, surgeons, and apothecaries, the first two physicians being required to attend every morning when the king arose; hence originated the titles, still known in Germany, of "Hofrath" and "Geheimrath."

Medical fees, as a rule, were very small, though there were exceptional instances in which enormous sums were bestowed: Joseph II, of Austria, gave Guerin, who was summoned from Paris in consultation, an honorarium of 171,000 marks and made him a baronet. Taking all things into consideration, the income of the average practitioner in the eighteenth century would be in the neighborhood of $1000, which, however, was equivalent to three times that amount to-day. Fothergill, whose highest income in a single year was $25,000, bequeathed to the poor of London $1,000,000; Sir Astley Cooper had a yearly income of from $75,000 to $100,000, but it may be remembered that his practice during the first year netted him just $26, and that it was four years later before his income reached the sum of $500.

The physician of the last century was, at least, on occasions of moment, very different from other men, and to be recognized by his dress. A cap was placed upon his head when he graduated, in recognition of the fact that physicians at an earlier period belonged to the learned or clerical profession; and in later life he wore a purplish or scarlet cloak (to distinguish him from lawyers, whose professional color was yellow, and from theologians, who then, as now, sported the sombre black). The regulation full-dress costume of the English physician of the last century demanded a well-powdered wig, silk coat, knee breeches with stockings, buckled shoes, lace ruffles, cap, and goldheaded cane, to which, in cold weather, was added a muff—to preserve his delicacy of touch.

Surgeons were still strictly separated from physicians, even in education; nor were they esteemed as equal in rank, until the French Revolution brought about the doctrine of civil equality; perhaps this is one reason why this branch of the medical art made less conspicuous progress until recent times. The change was brought about, in France, by the abolition of eighteen universities and fifteen colleges of medicine, the Royal Society of Medicine (founded in 1776), and the Academy of Surgery (founded in 1731); but by this abolition charlatanism acquired such speedy control that the arrangement was soon abandoned. Thus it came about that surgical instruction was given in special institutions or in the universities, and the conditions of instruction finally improved. When the College of St. Come was abolished in 1753 the SociÉtÉ de Chirurgie, founded in 1731, became the AcadÉmie de Chirurgie; and, when the French Academy was formed in 1795, the AcadÉmie was merged into its medical department. The École Pratique, where Desault and Chopart taught, was established in 1750 for the practical education of surgeons. In England the Royal College of Surgeons was not incorporated until 1800. In Austria, in 1785, the Josephinum was opened by Joseph II, who also erected permanent military hospitals in Prague, BrÜnn, Milan, Mantua, Pesth, OlmÜtz, etc.; he also created the "Joseph's Akademie" in order to educate military surgeons and thus overcome the defects of army surgery; the Josephinum unquestionably exerted great influence in elevating the social and military position of army surgeons and attained historical importance after Brambilla compelled the recognition of surgeons as social equals of other members of the medical profession. As the result of these improvements, the various armies of Europe were soon furnished with better medical officers. Prior to this, too, the field hospitals had been as badly mismanaged as their civil prototypes, and the substitution, in 1793, of movable hospitals, as suggested at the close of the sixteenth century by Henry IV, of France, was scarcely an improvement. The whole system suffered from perpetuation of the dual and distinct functions of the physician and the surgeon, to destroy which was a part of the design of the Josephinum. How unpleasant was the position of the army surgeon up to this date may be inferred from the fact that in 1758 one was subjected to corporeal punishment at the command of his colonel, and that a general upon his death-bed could leave orders that fifty blows be given each of his medical staff in case the post-mortem disproved the diagnosis.

In Austria, at the beginning of the Seven Years' War, all military surgeons of the Protestant faith were compelled to become Catholics or leave the service. The condition of the wounded soldiers was as deplorable as can well be imagined; but upon this subject I cannot dwell.

The tendency of the nineteenth century seems to be a continuation, and, perhaps, in some respects, an exaggeration, of the condition obtaining in France during the previous century; in other words, the world has become practically an enormous school of pathological anatomy and diagnosis,—a school inaugurated by Bichat, as representing so-called scientific or exact medicine. Philosophically this has been a century of reaction against the idealism of the preceding age; it places the individual, rather than the idea, in the foregound. The mutual influence of medicine, philosophy, and the natural sciences is less conspicuous now than formerly. Recent philosophers who have exercised the greatest influence are: Schelling, who held to the equality of the real and the ideal; Hegel, whose supreme principle was absolute reason, of which religion was regarded as a representation; Hartmann, whose philosophy of the "unconscious" depends largely upon the results of natural sciences, embraces Darwinism, and is, in many respects, an extension and completion of Schopenhauer's pessimism and doctrine of the soul. But one who has exercised still more influence upon our profession is Comte, whose positivism contrasted strongly with the idealism and atheism of Schelling, and who required only this of philosophy,—namely, that it should work out the general ideas and results of other sciences; his most important follower was Claude Bernard, and upon these two the whole exact school of France is based. But the most influential philosophic doctrines of this or any other century have been those emanating from Charles Darwin, Herbert Spencer, Ernst Haeckel, Alfred Wallace, and their contemporaries and followers. Darwin (1809-1882) was the grandson of Erasmus Darwin, already mentioned, and his Variation of Animals and Plants Under Domes-tication, Origin of Species, and Descent of Man have found a place in all modern languages. The system known by his name is the pure science of nature, is founded upon scientific investigation, and by its merits alone has found almost universal acceptance; it has been added to and further elucidated by the efforts of Haeckel and Spencer.

When it is declared that medicine of the present is influenced by no system, it is speedily found, on critical analysis, that this is an error. It necessarily follows the realistic and materialistic as readily as it did the teachings and doctrines of natural philosophy; and, in consequence, "medical thought," so called, is just as one-sided to-day as at any time in the history of the art. The watchword of to-day, natural specific tendency, veils, but does not take away, its philosophic principles, and so our ridicule of earlier medical systems is quite unjustifiable. A modern historian aptly remarks that the medicine of the present "embraces nothing but a theorem of investigation by the senses."

Discoveries in botany, the result of better knowledge of natural history and more accurate habits of study, have influenced modern progress not a little; have led to better classification and broader knowledge. The natural system of de Candolle (1778-1841) of Geneva, and of Endlicher, of Vienna, called into existence the so-called natural historical school of medicine; the researches into plant-cells by Schleiden and Baumgartner, and the almost contemporaneous discovery of animal cells by Schwann became, in course of time, the origin of recent cellular pathology; then came microscopic botany, and the influence of the lower fungi in the production of fermentation and putrefaction.

Similarly too, the laws of physics have been shown to have an inseparable connection with anatomy and physiology, and their study has become a most important aid in the experimental researches of to-day; through Helmholz they brought in the ophthalmoscope; thermal electricity, for the discovery of which medicine is indebted to Seebeck; a better knowledge of optics, thanks to Fraunhofer, who was equally expert in electricity; spectrum analysis, invented by Kirchhoff; and the varied efforts of Faraday, Graham Bell, Thomas Alva Edison, and Daguerre, the latter better known for his invention of photography. Finally, medicine is immeasurably indebted to Tyndall and Huxley for their teaching of the correlation and conservation of energy.

Chemistry also has performed its share, and, as applied to physiology, is a discovery almost wholly within the present century. The new nomenclature serves a practical purpose in that it is now possible to portray chemical combinations and isomerism in a graphic, and at least, semi-comprehensive way. Among the chemists may be specially mentioned Bertholet, whose laws are as well known as they are succinct; Humboldt; Berzelius; Dumas; Chevreuil, who recently died at the age of almost one hundred years; Magendie; Orfila, the toxicologist; Gmelin, eminent in physiological chemistry; Rose, perfecter of organic analysis; Wohler, who first made organic alkaloids; Bunsen; Sir Humphry Davy; Marsh; Faraday; Graham; Young, who first showed the industrial value of coal; and Gay-Lussac.

Upon medicine, zoology also, with comparative anatomy and physiology, has had a wonderful influence; here may be noted the names of Cuvier, Oken, Bilharz, Brehm, Wagner, Leuckart, Richard Owen, William Carpenter, and last, but by no means least, Thomas Huxley.

But perhaps the most significant feature of the age has been the wonderful development of scientific associations and the publication of medical and scientific literature. Whether these have yet reached their climax is perhaps an open question, but the consequent widening circle of readers, as well as of writers, seems to imply that there will be for a long time to come no lack of activity in this direction. In the United States more than in any other country medical societies and associations innumerable have sprung up, and to such a degree that (in the eastern States at least) there are few counties that cannot boast of a medical organization.

During the present century foreign universities have decreased in number, partly owing to consolidations and partly by surrender of charters; for instance, the old University of Ingolstadt was united with that of Landshut, and in 1827 was removed to Munich; in 1816 the University of Wurtemburg was united with that of Halle; the University of Bonn was abolished in 1792, but revived in 1818. A few new universities, like that of ZÜrich, have been founded. In the quaint old town of Prague the old German university was, in 1883, divided, and there now exist in that city two universities side by side, in one of which German is spoken, in the other Bohemian.

It will thus be seen that the nineteenth century is essentially an era of modern science, with whose dawn was sounded the death-knell of the "demon of disease" and his twin brother "visitation." In 1801 the first experiment in steam-navigation took place upon the Thames. In 1807 the slave-trade in England was abolished by Parliament. The theological part has entirely faded out of medicine; and the era of accurate scientific experimentation which long since dawned, is now, so far as we can see, at its height, since it is difficult to conceive of much improvement upon its methods under existing conditions, or of greater enthusiasm than has been already manifested.

Now, regarding some of the systems and theories of this age. The systems of the past have been more or less long-lived,—as, for instance, those of Dogmatism and of Galen,—while as we come closer to the present they become more ephemeral. Those of the early part of the present century took root in the soil of the eighteenth,—for instance, the so-called theory of excitement of Roeschlaub (1768-1835), which endeavored to mold into one the Brunonian errors and the fancies of Schelling. According to it, life depends upon irritability, but is inherent in the organism as an independent feature; so it recognizes both irritability and solidism, while Brown considered the former alone, adding, as an after-thought, a chemical or qualitative potency (oxygen), in order to account for alterations of quality. Roeschlaub inclined first toward natural philosophy, then, owing to an inherent theological and polemical bias (he was originally intended for the church), to mysticism and theosophy; finally, with a courage almost unexampled, he upset all his former teachings by admitting he was mistaken. To him was opposed Hufeland, who wrote on the Lengthening of Life, was noted for a warm and benevolent heart, and possessed no small penetration, as is evidenced by his aphorism, "Successful treatment requires one-third science and two-thirds 'savoir faire.'"

Stimolo and contrastimolo were titles applied to a theory advanced by Rasori (1762-1837), of Milan, that combined Methodism with Brunonism; by Baas it is characterized as a "genuine blot upon the human heart beyond any other of the various systems." Long centuries of experience and the conclusions of great and venerable minds may go for naught, as Rasori abundantly demonstrated. The theories of Brown were then taught as his own to his classes in Pavia, showing he was not above plagiarism; his stimolo corresponded to the sthenic diathesis devised by Brown, while his system consisted of an endeavor to make a diagnosis by watching the effects of drugs. Bleeding was held to be the best measure; if it did the patient good, the sthenic diathesis was assumed; if it made him worse, the asthenic was certain. He gave enormous doses of powerful drugs—sixty grains of gamboge, and from two to three ounces of saltpeter in a single day. Is it strange that homoeopathy or any other heterodox system sprang up in the midst of such measures? It is an old saying that there is no folly which will not secure a following; and, strange to say, Rasori had a numerous and an eminent one.

As just intimated, Homoeopathy was the natural reaction against such heroic measures; in the rebound the other extreme was reached, even to practical therapeutic nihilism. Now, instead of venesection and drastic medication, came the theories expounded by Hahnemann (1753-1843), which denied disease, admitting only symptoms. This apostle of homoeopathy was the son of a porcelain-painter in Meissen; he studied in Leipzig and in Vienna, and later practiced in various cities, including Dresden and Leipzig. "Similia similibus curantur" was not original with him, as it long before had been formulated by Hippocrates, and later by Paracelsus. Of the life and labors of Hahnemann, much might be told; but this is not the time or place to go into the subject.

Original

An offshoot of homoeopathy, which demands only the harshest criticism, is Isopathy,—perhaps the filthiest theory ever invented,—according to which like is to be cured by like, and to such an extent that small-pox is to be treated by variolous pus, tape-worm by the ingestion of the proglottides, etc.

Another of the rankest of fraudulent outgrowths is the so-called Electrohomceopathic system of Count Mattei, who prates of "red," "blue" and "green" electricity,—a theory that, in spite of its utter idiocy, has attracted a considerable following and earned a fortune for its chief promoter.

Another of the vagaries of the earlier portion of the present century, and that still survives, in a weak way, is Cranioscopy, or Phrenology. Gall expounded his doctrines at Vienna as early as 1796, but, being expelled, went to Germany, where he was joined by Spurzheim, who, though much more of a student and scientist, accepted the doctrine of the former with enthusiasm; and it was chiefly due to the efforts of Spurzheim that phrenology was introduced into England, and later (1832) into America. Gall assumed to locate twenty-seven different organs alongside of each other in the brain, and held that external markings on the skull were guides to the development of the various parts. Every neophyte in anatomy knows how little foundation there is for such a doctrine, but for a time it attracted great attention, and there are to-day certain men and women who make their living out of this imposition.

The Physiological Theory of Medicine was originated by Broussais (1772-1838), and combined the views of Pinel and Bichat with the "sympathetic" view of Hoffmann, the "concealed inflammation" of Stoll, and the theory of inflammation held by Marcus. Broussais had been a pupil of Bichat. In 1814 he began hospital teaching, and in 1831 was made professor. Personally very vain, quick-tempered, even belligerent, as a therapeutist he was a man of routine. He was, perhaps, best known shortly before his death, when delivering lectures on phrenology. According to him, life depends upon external irritation, produced by heat, which excites new chemical processes, while these in turn stimulate regeneration, assimilation, as well as contractility, and sensibility. When the functions supported by heat cease, death ensues. Health depends upon moderate action of external irritants; disease, upon either their weakness or their extraordinary strength. He saw nothing ontological about disease. In therapeutics he admitted the healing power of Nature, but regarded the physician not as a minister, but as a lord of Nature. Febrile and inflammatory diseases were all treated by the withdrawal of nourishment, carried to the extreme. His most powerful antiphlogistic treatment consisted in the application of leeches to the abdomen, and to robust individuals he applied from thirty to fifty at once It is not, then, to be wondered at that, in consequence of his so-called "hirudinomania," leeches became very scarce In the year 1833 forty-one million five hundred thousand leeches were imported into France, while in 1824 one-twentieth of this number sufficed to supply the demand. Even in cases of worms, the abdominal integument had to pay its blood-tribute, particularly if enteritis prevailed. He only allowed a spare diet of mucilaginous and acid drinks. In mercurial France and Italy he gained numerous followers, but they were few and far between in practical, hard-headed Germany and England. His best follower was Bouillaud (1797-1881), who adopted the symptomatic nature of fever and the sanguinary therapeutics of his master, but used the lancet more than the leech. As the homoeopaths regard Hahnemann, so Bouillaud looked up to Broussais as the Messiah of medicine and science, which, as Baas says were "already greatly overstocked with Messiahs."

Contemporaneous with the school of Broussais, and its antagonist in all respects, was the Paris School of Pathological Anatomy and Diagnosis, which has given tone to all medical art. It made it the duty of the physician to search for changes in the human body, to investigate the local products of disease, and assigned to medicine the duty of removing these products. The tendency of its teaching was to treat the patient rather as a living cadaver than as a sentient being endowed with vital forces, and the charge which Asclepiades once falsely made against Hippocrates was revived upon new grounds. Kratzmann wrote some years ago: "In France every one experiments on the sick, less to attain the best method of cure than to enrich science with an interesting discovery and to advance the accuracy of diagnosis by some new physical sign." The seductiveness of this system promoted still more onesidedness, which finally almost attained the belief that the science of medicine really originated in the Anatomical School of Paris.

The forerunners of this school were Bichat and Pinel, and its proper founders were Corvisart, Dupuytren, and LaËnnec. There was also Bayle, who was first to apply the ear to the thorax in disease of the heart, and thus became the predecessor of LaËnnec and Chomel. He was the godfather of typhoid fever, and from being a famous clinician became later a great pathologist. The most celebrated adherent of the method, however, was Cruveilhier (1791-1873), professor first in Montpellier and then in Paris, who revived the Anatomical Society founded by Bichat, and wrote his first essays as the result of Dupuytren's advice; finally, there came from his pen the famous treatise on Pathological Anatomy, with its magnificent plates,—a work begun in 1830 and not fully completed until 1864. Like Morgagni, he associated general and pathological anatomy with bedside observations; also established a class of inflammations to which belong gangrene and atony, and a certain class of neuroses and fevers, and endeavored to investigate the different steps in the development of lesions, not simply their final products. His teachings concerning pyÆmia and phlebitis, which had been first studied by John Hunter, excited great attention, and he even came to the one-sided conclusion that "phlebitis rules the whole of pathology." He was the first to observe that its suppurative form does not occur primarily, but is secondary to coagulation of the blood.

The ablest representative of this school, and one who, perhaps, more than any other man, made Paris a Mecca to which foreigners made their pilgrimages, was Andral (1797-1876),—the son of a physician and the most noted and indefatigable investigator and thinker of his time. Between 1823 and 1840 were published the five volumes of his Medical Clinic, which made him famous. He taught, in opposition to Broussais, the existence of primary diseases of the blood, the so-called dyscrasiÆ; made physiology subservient to pathology; was the creator of the chemistry of the blood; and in therapeutics was wedded to emetics and cathartics, ascribing little importance to abstraction of blood.

The first man to apply the Numerical Method to pathology, and who brought about the downfall of Broussais, was Louis (1787-1872), who had studied in Russia, but came to Paris while still a young man. He expressed his principle in the following words: "As often as I have formed an a priori idea and had afterward opportunity to prove the facts, I have invariably found that my idea was false. In pathology as well as in therapeutics numerical analysis is a useful practice. By numbers only can be obtained the frequency of conditions or this or that symptom; by a definite enumeration alone is it possible to utilize the special relations of age, sex, constitution of our patients, to settle that this or that symptom occurs so often in one hundred or one thousand cases." This system he applied to etiology, symptomatology, prognosis, therapeutics, and pathological anatomy. He discarded blisters and condemned large bleedings, but fell into other errors, carrying his numerical method to an unjustifiable extreme.

Next to Andral and Louis should be mentioned Magendie (1783-1855), Professor of General Pathology in the College de France, and physician to the HÔtel-Dieu, who was a representative of the new French medicine, and introduced experiments into both pathology and physiology; he was the pioneer in experimental pharmacodynamics, which occupies itself largely with alkalies, a large number of which he introduced into practice. He was a solid humoralist in pathology, a most accurate diagnostician, but (it is charged) "was too simple in therapeutics"! As a result of his intravenous injections of putrefactive material, he had the terms "pyÆmia," "icliorrhÆmia," and "metastasis" introduced into pathology.

Trousseau (1801-1866), of Tours, also became professor in the Paris Faculty, and rendered especial service in his studies of croup and the employment therefor of tracheotomy, though his chief fame rests upon his merit as a clinical teacher and the publication of clinical lectures which are still models in every way of accurate, forcible teaching.

Claude Bernard (1813-1878) became the successor of Magendie, and even more famous as an experimenter in pathology, physiology, and anatomy. Originally a poet, he finally turned to medicine and science, and in 1869 became a member of the French Academy.

One of the results of the French fondness for pathological anatomy was an outgrowth, unfortunate in some respects, of specialism, which made its appearance early and spread to other countries, particularly to Germany, so that to-day there is scarcely an organ in the body which has not only its special student, but its special representative in medicine. It would be of interest to go over some of the various organs and count those who have become most renowned in the study of their diseases, but that is beyond the scope of this volume.

As Baas says, England, after her excessive participation in the iatrochemistrv and iatromechanics of the seventeenth century, with a devotion that extended far into the eighteenth, seemed then to lose all confidence in systems and schools of medicine, inasmuch as since that time no system or so-called school has gained in Great Britain any large or permanent band of followers; even Brunonianism did not succeed in this respect. This form of conservatism is a characteristic of the British race. But while schools have not risen, individuals have formulated hypotheses or doctrines that at least attracted attention, if not followers. For instance, John Mason Goode (1764-1827) formulated an intricate nosological arrangement in his long-popular text-book entitled The Study of Medicine, and also arranged a classification of diseases now almost forgotten.

In 1816 Sir Charles Bell (1774-1842) made the memorable discovery that the posterior roots of the spinal nerves preside over sensation, and the anterior over motion; and this attracted anew the attention of English physicians to the nervous system, and was rewarded by the later discovery of reflex action or reflex phenomena, communicated to the Royal Society in 1863 by Marshall Hall. Both discoveries were important, and both were duly rewarded by yet others.

Benjamin Travers (1783-1858) seems to have been greatly influenced by the first of these discoveries, and led thereby to pay special attention to what he termed "constitutional irritation"; his studies on this subject are often quoted to-day, and are well worthy of perusal; he understood by this term a process (in strong contrast with inflammation) which subsides without hyperÆmia and without plastic exudate, but which, on the other hand, may occasion liquid products and result in neoplasms.

Contemporaries of Travers were: Abram Colles; John Cheyne (1777-1830), of Dublin, who wrote on Diseases of Children and described "Cheyne-Stokes respiration." William Stokes (1804-1878), also of Dublin, who distinguished himself in 1857 by a great work, entitled A Treatise on the Diagnosis and Treatment of Diseases of the Chest; Robert Graves (1797-1853), Professor of Medicine in the King's and Queen's College, Dublin, who published clinical lectures of his own, besides many clinical reports in connection with Stokes. Graves was one of the first to oppose the "absolute diet" of the earlier physicians in the management of febrile maladies, and requested that his epitaph should have but one line—"He fed fevers!"

"The School of Natural Philosophy" was the title applied to a system which, in Germany, ran parallel with that of Broussais, being the legitimate outcome of the medical philosophy of the eighteenth century which had originated there, and also a revival of opposition thereto on the side of realism. It led into speculative extremes, which finally sobered down, because of the meaningless scholastic phrases often introduced, and thus broke a path for the subsequent enthusiasm in behalf of French positivism in medicine. Those who constituted this school were, for the most part, men of importance, but were followed by a number of imbecile representatives. Use was made of the abstract doctrine of the philosophy of identity and the imponderables, such as electricity, mechanical forces, and magnetism, contrasted with which were the dimensions of matter and certain qualities, like sensibility, irritability, etc. Perhaps the greatest influence of this teaching was in the department of embryology and physiology, where Johannes MÜller displayed his remarkable activity. Among the most distinguished representatives of the natural-philosophy school was Oken (1779-1851), of Bavaria, who subsequently taught in Munich, Jena, and ZÜrich, and published a large work on natural history, which did much for the popularization of this science; he explained that the skull is made up from a series of vertebrÆ; also discovered the Wolffian bodies, and was such a power in his way that Agassiz characterized him not only as "a master in the art of teaching," but as "a courageous and ruling spirit." Others of this school were: von Walther (1782-1849), eminent as a surgeon; Dollinger (1770-1841), of Bamberg, the distinguished leader of the Old Catholics; Reil and Procliaska, anatomists; Troxler and Schelling, philosophers and anatomists; Treviranus, the microscopist; Malfatti, Kilian, Spindler; Schmidt, of Vienna; and others too numerous to mention.

As a successor to the School of Natural Philosophy came the School of Natural History (1831-1850). which made important concessions to realism; its most prominent members were from South Germany. This school was based partially upon the philosophy of Nature, and expired almost suddenly. One of its most eminent exponents was Krukenberg, whose therapeutic creed was that "Physicians should be filled with pious reverence toward Nature; the organism is a whole, and must be contemplated in this sense; medical art is, undoubtedly, capable of decisive action, but let us not mistake that in many cases its activity is quite superfluous, in very many null and inadequate, and in many injurious." This school was the expression of the turn medicine was compelled to take in order to escape the after-effects of the one-sided, ideal, systematizing tendency of the eighteenth century (whose final outcome was natural philosophy), and to square itself with the realism and positivism of the nineteenth.

Schonlein (1763-1874), of Bamberg, outlined a system that taught pathological and anatomical revelations as concrete expressions of the independent entity disease, whose relation to the organism is as that of a parasite sojourning temporarily in it; he also constructed a classification of diseases, something after the manner of the botanical classification of de Candolle. One of his best-known pupils was Canstadt (1807-1850), whose Jahresbericht has preserved his name. Siebert, of Jena, famous as a diagnostician, and Haeser, the medical historian, belonged to this school.

An offshoot of the French school of pathological anatomy and diagnosis was the so-called New Vienna School, which aided the French system in obtaining high recognition in German medicine, and gained its first influence from the labors of WÜnderlich (1815-1857); next to whom should be mentioned Baron von Rokitansky (1804-1878),—a Bohemian,—one of the most famous men in modern times, and who exercised a profound influence, even in foreign countries,—particularly in Italy and Russia. Von Rokitansky worked for a long time in miserable quarters in Vienna, but finally a magnificent building was specially erected for him. He was loaded with honors, and took his seat in the Austrian House of Deputies. Two sons are well known in medicine to-day, and two more have achieved reputation as singers,—a circumstance which the father embodied in the bon mot that "two of his sons howled and two of them healed." He transplanted into Vienna the tendency of the earliest pathologico-anatomical school, which captivated all by its novelty and interest, and in the post-mortem room and the clinical-lecture room he converted medicine in Germany to the realism of the nineteenth century. He was, indeed, the Van Swieten of his time in his influence upon educational affairs. His works are distinguished by simplicity, clearness, and logical order. He performed more than thirty thousand autopsies; for fourteen years he studied the defects of the septum of the heart and the comparative anatomy of the uterus and genito-urinary organs, yet paid little attention to the microscope or to applied medicine. He was a pathologist, pure and simple.

A friend and co-laborer,—Skoda (1803-1881),—also a Bohemian, was little, if any, less famous. In 1839 he gave to the world his famous work on Auscultation and Percussion; in 1847 became professor at Prague, and was the first man to lecture in German. In spite of his bachelor peculiarities, his taciturnity, and his heedlessness, he was very popular, and left a fortune,—quite in contrast to Rokitansky, who died poor. His scientific merit was based upon the fact that he overthrew the specific and pathognomonic arrangement of sounds, as taught by the French, and substituted therefor a category, based upon the physical constitution and shape of organs and tissues. He endeavored to develop a strictly scientific system of physics out of the empirical French doctrine of physical signs, and in his work on Physical Diagnosis he displayed an independent spirit, though as one who had received his impulse from France. He was the first in Germany to insist upon the merits of Avenbrugger, and was the leading diagnostician of his time of the new Vienna school. Skoda was the first for whom was created, in Vienna, a specialty after the French model,—that is, a special division for patients suffering from thoracic diseases. Great as he was, we must yet lay it up against him that through his influence,—first in Vienna and afterward throughout Germany,—practical medicine degenerated into simple diagnosis, and that, by his observations on the natural course of disease, undisturbed by therapeutics, he became the founder and exponent of expectant or nihilistic therapeutics,—the harbinger of a very cheerless period in the history of medicine.