VIII. NINETEENTH-CENTURY MEDICINE

PHYSICAL DIAGNOSIS

Although Napoleon Bonaparte, First Consul, was not lacking in self-appreciation, he probably did not realize that in selecting a physician for his own needs he was markedly influencing the progress of medical science as a whole. Yet so strangely are cause and effect adjusted in human affairs that this simple act of the First Consul had that very unexpected effect. For the man chosen was the envoy of a new method in medical practice, and the fame which came to him through being physician to the First Consul, and subsequently to the Emperor, enabled him to promulgate the method in a way otherwise impracticable. Hence the indirect but telling value to medical science of Napoleon's selection.

The physician in question was Jean Nicolas de Corvisart. His novel method was nothing more startling than the now-familiar procedure of tapping the chest of a patient to elicit sounds indicative of diseased tissues within. Every one has seen this done commonly enough in our day, but at the beginning of the century Corvisart, and perhaps some of his pupils, were probably the only physicians in the world who resorted to this simple and useful procedure. Hence Napoleon's surprise when, on calling in Corvisart, after becoming somewhat dissatisfied with his other physicians Pinel and Portal, his physical condition was interrogated in this strange manner. With characteristic shrewdness Bonaparte saw the utility of the method, and the physician who thus attempted to substitute scientific method for guess-work in the diagnosis of disease at once found favor in his eyes and was installed as his regular medical adviser.

For fifteen years before this Corvisart had practised percussion, as the chest-tapping method is called, without succeeding in convincing the profession of its value. The method itself, it should be added, had not originated with Corvisart, nor did the French physician for a moment claim it as his own. The true originator of the practice was the German physician Avenbrugger, who published a book about it as early as 1761. This book had even been translated into French, then the language of international communication everywhere, by Roziere de la Chassagne, of Montpellier, in 1770; but no one other than Corvisart appears to have paid any attention to either original or translation. It was far otherwise, however, when Corvisart translated Avenbrugger's work anew, with important additions of his own, in 1808.

"I know very well how little reputation is allotted to translator and commentators," writes Corvisart, "and I might easily have elevated myself to the rank of an author if I had elaborated anew the doctrine of Avenbrugger and published an independent work on percussion. In this way, however, I should have sacrificed the name of Avenbrugger to my own vanity, a thing which I am unwilling to do. It is he, and the beautiful invention which of right belongs to him, that I desire to recall to life."[1]

By this time a reaction had set in against the metaphysical methods in medicine that had previously been so alluring; the scientific spirit of the time was making itself felt in medical practice; and this, combined with Corvisart's fame, brought the method of percussion into immediate and well-deserved popularity. Thus was laid the foundation for the method of so-called physical diagnosis, which is one of the corner-stones of modern medicine.

The method of physical diagnosis as practised in our day was by no means completed, however, with the work of Corvisart. Percussion alone tells much less than half the story that may be elicited from the organs of the chest by proper interrogation. The remainder of the story can only be learned by applying the ear itself to the chest, directly or indirectly. Simple as this seems, no one thought of practising it for some years after Corvisart had shown the value of percussion.

Then, in 1815, another Paris physician, Rene Theophile Hyacinthe Laennec, discovered, almost by accident, that the sound of the heart-beat could be heard surprisingly through a cylinder of paper held to the ear and against the patient's chest. Acting on the hint thus received, Laennec substituted a hollow cylinder of wood for the paper, and found himself provided with an instrument through which not merely heart sounds but murmurs of the lungs in respiration could be heard with almost startling distinctness.

The possibility of associating the varying chest sounds with diseased conditions of the organs within appealed to the fertile mind of Laennec as opening new vistas in therapeutics, which he determined to enter to the fullest extent practicable. His connection with the hospitals of Paris gave him full opportunity in this direction, and his labors of the next few years served not merely to establish the value of the new method as an aid to diagnosis, but laid the foundation also for the science of morbid anatomy. In 1819 Laennec published the results of his labors in a work called Traite d'Auscultation Mediate,[2] a work which forms one of the landmarks of scientific medicine. By mediate auscultation is meant, of course, the interrogation of the chest with the aid of the little instrument already referred to, an instrument which its originator thought hardly worth naming until various barbarous appellations were applied to it by others, after which Laennec decided to call it the stethoscope, a name which it has ever since retained.