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Medicine
(Part 36)



Rise of the Positive School in France

The reform of medicine in France must be dated from the great intellectual awakening caused by the Revolution, but more definitely starts with the researches in anatomy and physiology of Marie François Xavier Bichat (1771-1802). The importance in science of Bichat’s classical works, especially of the Anatomie générale, cannot be estimated here; we can only point out their value as supplying a new basis for pathology or the science of disease. Among the most ardent of his followers was François Joseph Victor Broussais (1772-1838), whose theoretical views, partly founded on those of Brown and partly on the so-called vitalist school of Bordeu and Barthez, differed from these essentially in being avowedly based on anatomical observations. Broussais’s chief aim was to find an anatomical basis for all diseases, but he is especially known for his attempt to explain all fevers as a consequence of irritation or inflammation of the intestinal canal (gastroentérite). A number of other maladies, especially general diseases and those commonly regarded as nervous were attributed to the same cause. It would be impossible now to trace the steps which led to this wild and long since exploded theory. It led, among other consequences, to an enormous misuse of bleeding. Leeches were his favourite instruments, and so much so that he said to have used 100,000 in his own hospital wards during one year. He was equaled if not surpassed in this excess by his follower Bouillaud, known for his important work on heart diseases. Broussais’s system, to which he gave the name of "Médecine Physiologique" did much indirect good, in fixing attention upon morbid changes in the organs, and thus led to the rise of the strongly opposed anatomical and pathological school of Corvisart, Laennec, and Bayle.

Jean Nicolas Corvisart (1755-1821) has already been mentioned as the translator and introducer into France of Avenbrugger’s work on percussion. He introduced some improvements in the method, but the only real advance was the introduction of mediate percussion by Piorry in 1828. The discovery had, however, yet to be completed by that of auscultation, or listening to sounds produced in the chest by breathing, the movements of the heart, &c. The combination of these methods constitutes what is now known as physical diagnosis. René Théophile Hyacinthe Laennec (1781-1826) was the inventor of this most important perhaps of all methods of medical research. Except for some trifling notices of sounds heard in certain disease, this method was entirely new. It was definitely expounded in an almost complete form in his work De l’auscultation médiate, published in 1819. Laennec attached undue importance to the use of the stethoscope, and laid too much weight on specific signs of specific diseases; otherwise his method in its main features has remained unchanged. The result of his discovery was an entire revolution in the knowledge of diseases of the chest; but it would be a mistake to forget than an essential factor in this revolution was the simultaneous study of the condition of the diseases organs as seen after death. Without the latter, it is difficult to see how the information conveyed by sounds could ever have been verified. This increase of knowledge is therefore due, not to auscultation alone, but to auscultation combined with morbid anatomy. In the case of Laennec himself this qualification takes nothing from his fame, for he studied so minutely the relations of post-mortem appearances to symptoms during life that, had he not discovered auscultation, his researches in morbid anatomy would have made him famous. The pathologico-anatomical method was also followed with great zeal and success by Gaspard Laurent Bayle (1774-1816), whose researches on tubercle, and the changes of the lungs and other organs in consumption, are the foundation of most that has been done since his time. It was of course antecedent to the discovery of auscultation. Starting form these men arose a school of physicians who endeavoured to give to the study of symptoms the same precision as belonged to anatomical observations, and by the combinations of both methods made a new era in clinical medicine. Among these were Chomel (1788-1858), Louis (1787-1872), Cruveilhier (1791-1874), and Audral (1797-1876). Louis, by his researches on pulmonary consumption and typhoid fever, had the chief merit of refuting the doctrines of Broussais. In another respect also he aided in establishing an exact science of medicine by the introduction of the numerical or statistical method. By this method only can the fallacies which are attendant on drawing conclusions form isolated cases be avoided: and thus the chief objection which has been made to regarding medicine as an inductive science has been removed. Louis’s method was improved and systematized by Gavarret; and its utility is now universally recognized. Space does not permit us to trace further the history of this brilliant period of French medicine, during which the superiority of the school of Paris could hardly be contested. We can only mentioned the names of Bretonneau (1771-1862, Rostan (1790-1866), D’Alibert (1766-1837), Rayer (1793-1867), and Trousseau (1801-1866), the eloquent and popular teacher.





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