Makers of Modern Medicine

It is interesting also to note that both men found their prospects of reward, not in the good will of their contemporaries, nor even the prospect of fame, but in the hope that their work would be useful in lessening the sum of human suffering. Laennec said: "It suffices for me if I can only feel sure that this method will commend itself to a few worthy and learned men who will make it of use to many patients. I shall consider it ample, yea more than sufficient reward for my labor, if it should prove the means by which a single human being is snatched from untimely death."

Laennec's words are almost an echo fifty years afterward of Auenbrugger's expressions, just quoted: "I console myself," he said, "with the thought that I have accomplished a work which will earn the gratitude of all true devotees of the art of medicine, since I have succeeded in making clear many things which shed not a little light on the chapter of the obscure diseases of the chest, in which our knowledge has hitherto been so very incomplete."

As a rule it may be said that medical observers whose genius leads them to step across the narrow line that separates the known from the unknown are likely to lack the appreciation of their own generation. Long before Auenbrugger or Laennec, Harvey, the discoverer of the circulation of the blood, said to friends that he did not expect any one of his generation to accept the new doctrine, and it is well known that the great medical men of the time did not accept it. Harvey is not an isolated example, and even in our own time real medical progress sometimes waits for years for recognition, while well-advertised pretended advances are occupying the centre of the stage. Auenbrugger's discovery made its impress, however, and was never entirely lost to sight. Even before his death there was the consoling prospect of its meeting with adequate attention.

De Haen's successor in Vienna, Maximilian Stoll, treated Auenbrugger's work very differently from his predecessors, and was the first to introduce it practically into clinical medical training. Stoll did not hesitate in his clinic, on the strength of what was discovered by means of percussion, to attempt the evacuation of fluid from the pleural cavity on a number of occasions. It can be easily understood that with their lack of knowledge of the necessity for thorough cleanliness in the surgical sense, such an operation might readily be followed by discouragingly fatal results. This actually happened in Stoll's own experience. He does not, however, seem to have abandoned his practice of tapping the chest because of this. He insisted to his students that Auenbrugger more than anyone else had experience in removing fluid, and especially purulent collections, from the chest, and he recommended the practice to them. He added that medicine owed as much to Auenbrugger for his rational method of treating effusions into the pleural cavity, whether of pus or serum, as for his diagnostic sign by which the presence of the fluid could surely be recognized.

Some of Stoll's pupils took up the work of commending Auenbrugger's method, and a little book written by one of them, Eyerel, came into the hands of the distinguished French physician, Corvisart. Eyerel did not hesitate to say, in his treatise on empyema, that the practice of percussion of the thorax, a diagnostic method introduced by the very distinguished Vienna physician, Auenbrugger, had been of great help to them in the study of this disease.

Once the great French professor of medicine, Corvisart, took it up, the new method of diagnosis was destined to have an immediate and world-wide vogue. Corvisart was not only a power in medicine because of his faculty of observation and his thorough appreciation of the work of others, but he was the court physician of the first Napoleon, and this gave any ideas that he favored many adventitious chances for publicity. Napoleon's well-known faculty for selecting men for special positions whose genius was calculated to be of service to him was never less at fault than when he violated most of the court medical traditions in Paris and chose Corvisart for the imperial physician. Corvisart's selection was the result of Napoleon's appreciation of his new method of diagnosis, namely, that of percussion, in chest diseases.

The Emperor himself was suffering from a persistent cold and was told that Corvisart, instead of following the traditional method of feeling the pulse, looking very wisely at the tongue and then gazing learnedly into space, conducted an actual examination of the chest and sounded it carefully all over, in order to determine where abnormal conditions might exist. This struck Napoleon as a very practical and possibly valuable feature of diagnosis. Accordingly Corvisart was summoned to give his professional opinion. After the consultation he was made the Emperor's private physician. When Corvisart took up the subject of percussion of the chest, it was practically unknown in Europe outside of Vienna. Even in the city of its origin, as we have seen, it was not well appreciated. Auenbrugger's little book had fallen into oblivion. Corvisart obtained his hint as to the possible value of percussion from Stoll's and Eyerel's appreciative remarks with regard to it. The Frenchman used the method to some extent and, realizing its value, resolved to call the attention of his countrymen and the medical world to this very helpful aid in diagnosis. It was at this time that he came upon Auenbrugger's original monograph. Instead then of writing himself on the subject, he translated Auenbrugger's little book into French and made a commentary on it.

Corvisart was Laennec's patron in medicine, his favorite teacher, and the man to whom the great French physician owed much of his early inspiration. It is no little merit in Corvisart's career thus to have been the connecting link between the men who did most for the practical science of medicine, and especially for the important but obscure chapter of diseases of the chest. He did not attempt at all to claim for himself any of the merit that he felt should rightfully go to Auenbrugger, and while his own observations and writings established percussion upon a firm basis and extended its knowledge, he shares the immortality of his discoverer, and comes down to us in medical history as an example of the reward of having rendered faithfully what was due, where it was due. It has been the custom to praise Corvisart for his justice toward Auenbrugger. Mere justice seems scarcely a worthy reason for praise of a great man, yet the history of medicine is so full of failures on the part of subsequent observers to acknowledge priority of discovery, that perhaps the praise does not seem quite as futile as it otherwise would.

It is not surprising then that Corvisart's pupil Laennec should have appreciated very thoroughly the value of Auenbrugger's discovery. In the preface of his book on Mediate Auscultation, Laennec bewails the fact that men are generally neglectful of discoveries made in their own time, and fail to give them the attention they deserve. He attributes this neglect rather to the well-known carelessness of men than to any deliberate failure to recognize the merit of contemporary work. He says:

"Lack of attention is an extremely common failing of all men. What it takes years and hard labor to acquire, is not infrequently passed over without notice. Auenbrugger's method, published some fifty years ago, though capable of being learned in a few days, and without difficulty, and of being put into practice without the use of any instruments, although snatched from oblivion by my illustrious preceptor, Professor Corvisart, and made clearer than it had been left even by the author himself, is not as yet in ordinary use among physicians. Even the wonderful invention of the illustrious Jenner, though received with so much praise, and with regard to whose efficaciousness numberless confirmatory observations have been made, is already somewhat less prominent in the minds of men than it should be, or at least it would be, only for the fact that the governments of many countries, provinces and cities, the foresight of the clergy, of the authorities of all kinds, and the advice of the best physicians have exerted all their influence to keep it at public expense constantly in practice."

After about ten years of service at the Spanish military hospital, Auenbrugger resigned his position there and took up private practice. In this he was eminently successful, being, as might be expected, especially in demand for cases involving affections of the thorax. His practice appears to have been to a great extent among the better class of people, but he seems never to have neglected the poorer patients whom he had come to know during his hospital experience. There are traditions in Vienna of his unfailing willingness to assist the poor and even to put himself to considerable inconvenience in order to be of service to them.

Tradition tells that he was very conscientious in the pursuit of his vocation as a physician, and among the family relics there is preserved a small lantern which he kept always by his bedside, to light him on his visits to the sick when called out at night. It must not be forgotten that city streets were not regularly lighted at the end of the eighteenth century, and night calls even in city work must have been a source of great annoyance and discomfort. There is a family tradition, too, that the night bell at his house was connected directly with Auenbrugger's room, so that the others of the household might not be disturbed when night callers came for him. Every tradition points to him as a man among men in his unselfish readiness to save others trouble, and do all the good in his power.

Auenbrugger was, according to well-grounded traditions, especially admirable in his relations toward other members of the medical profession. This may not seem a very significant sign of amiability to those outside the profession, but it is well recognized that even great physicians have not always been known to get on well with brother practitioners. Auenbrugger has, besides, the pleasant reputation of having been of great material assistance to a number of needy medical students during the time of their university careers, and to have frequently lent a helping hand to young practitioners in the city, who probably found it quite as discouraging, beginning practice in those days, as any of their young confreres of this generation find it at the present time.

To physicians and medical students when ill, Auenbrugger was almost unceasing in attention. Two or three physicians of the generation immediately after his attributed to his unselfish care and devotion to them their recovery from what would otherwise have been mortal illnesses. In this way Auenbrugger seems to have been a man whom everyone who came to know him, even slightly, learned to love and respect. His relations to his family and relatives were always of the most happy, kind character, and family traditions show that his fatherly care was befittingly returned to him in his old age. The number of his friends was very great, and he counted among them some of the most distinguished inhabitants of the Austrian capital.

Notwithstanding his devotion to his practice, Auenbrugger did not cease to make observations that occasionally he considered worthy of being committed to paper. He was especially careful in the study of his cases, and left fully written records of over 400 important cases that he had studied very faithfully. His attention seems to have been attracted particularly to certain mental diseases. This work was done half a century before even the first beginnings of the modern classifications of mental diseases were attempted. He wrote a short article with regard to mania and its treatment, and a longer article on melancholia. How well he recognized the essential feature of this latter affection and the main symptom that must be guarded against, can be gathered very well from the title of his paper, which he called "The Still Madness, or the Impulse to Self-Murder."

It is about the time that he was engaged in the study of melancholia, perhaps as a contrast to sadder things, that he wrote a comic opera, of which we shall have more to say presently. His description of the conditions that he saw during an epidemic of dysentery that occurred in Vienna show how exact and careful a clinical observer he could be, and that the demands of his practice did not absorb all his attention to the detriment of his faculty for observation. He seems himself to have suffered from a severe attack of typhus fever which raged epidemically in Vienna in 1798.

Auenbrugger had a wide circle of interests beyond the subject of medicine. There is a family tradition that he had a magnificent library. He seems with true Viennese spirit to have been a great devotee of the opera, and to have had an especial liking for music. He wrote the text, score, and libretto of a comic opera with the title, "The Chimney Sweep." This operetta evidently enjoyed more than a succes d'estime, and further writing in this line was confidently expected from him by his friends. There is even a story to the effect that the Empress Maria Theresa, of whom he was an intimate friend, and who made use, it is said, of his counsel in political matters more than once, asked him why he did not follow up his first success in operatic writing. His blunt reply shows how intimate must have been his relations with the great empress. He said he had things much better with which to occupy himself than the writing of comic operas.

Seeing that he was so favored at court, it is not surprising to find the family tradition that Auenbrugger was associated with many of the most prominent persons in the Austrian capital during his lifetime. He was a special friend of and spent a great deal of time with the famous philosopher, Werner. As he grew older he delighted especially in music, and spent many hours at the house of Baron Zois, where many of the distinguished European musicians were to be found and where famous matinee concerts were given every Sunday from twelve to two. The day and the time may seem strange to foreigners, but Vienna still has concerts at this time on Sunday, and after the Viennese have gone to Mass in the morning they think that they could not occupy themselves better than with listening to good music in the middle of the day.

Toward the end of his life, Auenbrugger lived during the summer time in the suburb of Rossau and cultivated a little garden, taking the greatest pleasure in spending his time at this simple occupation. It is a source of satisfaction to find that though Auenbrugger's medical work failed during his life to attract the attention it deserved, he had his reward, for his patient investigations in earlier life, in a peaceful and contented ending to a career that had been so worthy of what was best in the man. He lived to celebrate his golden wedding in 1804 and was especially happy in the almost constant companionship of the good wife who had proved so faithful a helpmate during her long life. After her death, which took place the year following the celebration of their jubilee, his vitality and his contentment with life seemed to abandon him. He was a changed man and kept himself for the most part to his room. He went to bed very early and did not care to see anyone but his near relatives. His last illness was the result of a cold, and his advanced age, eighty-seven, left him little resistive vitality. He retained his consciousness until the very end, and said the day before his death that the next day would be his last.

Shortly before noon of the day of his death he looked at the clock in his room and said that when the hands would point to two o'clock he would be no more. His prophecy came true.

Vienna has never had the reputation of honoring its great geniuses during their lifetime, unless they happened to belong to the higher nobility. The exclusiveness of court society at the capital made itself felt in all circles, and the consequence was that genius sprung from the lower orders was almost sure not to receive its due share of attention. The comparative neglect of Auenbrugger does not seem so bad when we recall the case of Mozart. Music has always been one of the special fads of the Austrian and the Viennese pride themselves on their appreciation of it. Mozart, however, perhaps the greatest musical genius that ever lived, received some attention during his life, but passed away almost unnoticed at the early age of thirty-five, was buried in a common trench with the poor people of the city, and now Vienna cannot find his resting place. There is a magnificent monument to him, but his bones lie with his own people forever.

Outside the circle of his personal friends Auenbrugger did not receive much attention, so that even the year of his death was until recently more or less uncertain and the resting place of his remains continues to be unknown. The present generation of medical men has done more to afford the due meed of praise to Auenbrugger than any preceding generation. The interest in tuberculosis particularly has led medical men to appreciate all the significance of Auenbrugger's work, and the practical importance of his discovery for the early recognition and consequently for the cure of the disease. The appreciation of Auenbrugger in our time has been so flattering as quite to make up for previous neglect. His name has been linked with that of Laennec as the great discoverers of physical diagnosis in chest diseases.

At the opening of his address as President of the American Climatological Association, some five years ago, Dr. Edward O. Otis, of Boston, said:

"It is quite improbable, I think, that we should be here to-day, or, indeed, have an existence as a society largely devoted to the consideration of diseases of the chest, were it not for the methods of thoracic examination which Auenbrugger and Laennec have given us in their discoveries of percussion and auscultation. Without these two precious methods of investigation we could scarcely have arrived at any degree of precision or certainty in thoracic pathology and might have been not unlike the old physicians and surgeons, 'who would swear,' as Morgagni says, 'that there was fluid in the chest when in reality there was not a single drachm, or perform paracentesis of the thorax upon a duke for an empyema which did not exist.'"

His tribute is only an echo of many others not less appreciative of Auenbrugger's important original work than have been expressed by modern medical men of all nations. The simple old German practitioner, who had the annoyance of seeing his discovery neglected by his contemporaries for so many years, has at last come into his own. There is scarcely an important medical meeting held anywhere in the world in which diseases of the chest are discussed without a mention of Auenbrugger's name. This is not surprising in Germany, but is quite as true of France, and England, and America. As Dr. Otis said, in closing the address from which we have just quoted:

"Although we possess but meagre and fragmentary records of Auenbrugger's life, there is yet enough to enable us to fill in the lines and gain a distinct idea of his personality and character. With some persons one does not need to be acquainted with much of the detail of their lives in order to know what manner of men they are; a few characteristic illustrations here and there in their career redeem the spirit and motives of their lives, and show the kind of men just as they are, quite as well and clearly as an extended and continuous biographical narrative. Always enthusiastically devoted to the study of disease, Auenbrugger escaped the not infrequent misfortune of the student, a loss of sympathy with one's kind. His love for his fellow-men, for suffering humanity, for struggling students in his own profession, kept pace with his love for medical study. He never sacrificed the man for the scientist, nor did he lose his interest for other things in life, as happens sometimes with men intensely devoted to one pursuit. A man of original powers, as some one has truly remarked, can never be confined within the limits of a single field of activity.

"He was interested in music, philosophy and the drama, and well illustrates what Dr. Da Costa has so happily styled 'the scholar in medicine.' With dignity, sympathy, enthusiasm in his profession, even to the last; ever seeking to improve and add to his art; modest, like most great men; never refusing to give what is best to suffering humanity, he richly lived out his long life. As we teach our students percussion, as a matter of just recognition and due honor let us tell them something of the life of the discoverer, and at least his name, which I fear but few, who avail themselves of the result of his long and arduous labors, know."

Auenbrugger's German biographer, Professor Clar, of Gratz, says of his early life that from his parents he received an excellent early training, especially edifying because of the exemplary Christian family life he saw about him, the piety of his father and mother, and of the other members of the family. The baptismal register of the parish church at Gratz is one of the important documents in his life history, for there is some dispute as to the exact date of his birth, as there is also with regard to his death. In 1798 he suffered from a severe attack of typhus fever, which at the time was epidemic in Vienna, and some of his biographers report his death in this year as a consequence of it. His descendants, however, have shown, by the burial register of the parish church in Vienna, that his death did not take place until May 17, 1807; from this church, of which he had been for half a century a faithful member, he was buried.

Few of the lives of the great discoverers in medicine have in them more of encouragement for the busy practitioner of medicine than that of Auenbrugger. He began his medical career by a series of practical observations that stamped him for all time as one of the great geniuses. When his discoveries failed to meet with the acceptance they deserved, he was not disturbed, and, above all, he did not insist on acrid controversy. He took up the practice of medicine and demonstrated how much his discovery could help in the diagnosis of the obscure chapter of the diseases of the chest. In the mean time he went on his way placidly doing the good that he found to do, taking care of his poor patients and faithfully tending brother-physicians who happened to be ill. He found an avocation to fill the moments spent apart from his vocation, and added to the pleasure of humanity by his work in music. All the time he remained a simple, faithful believer in the relation of Providence to man, and considered that somehow the inexplicable things of this life would find an explanation in the hereafter. He was probably the best-liked member of the profession in Vienna during his lifetime, and the profession of his native town are very proud to recall the example that he sets physicians generally in all the ethical qualities that make a physician's life not only successful in the material sense, but also in inspiration for those around him to do their duty rather than seek the fulfilment of merely selfish aims.

EDWARD JENNER, THE DISCOVERER OF VACCINATION

"It helps a man immensely to be a bit of a hero worshipper, and the stories of the lives of the masters of medicine do much to stimulate our ambition and rouse our sympathies. If the life and work of such men as Bichat and Laennec will not stir the blood of a young man and make him feel proud of France and of Frenchmen, he must be a dull and muddy-mettled rascal. In reading the life of Hunter, of Jenner, who thinks of the nationality which is merged and lost in our interest in the man and in his work! In the halcyon days of the Renaissance there was no nationalism in medicine, but a fine catholic spirit made great leaders like Vesalius, Eustachius, Stenson and others at home in every country in Europe."

--Osler, Aequanimitas and other Essays.

A very striking life in its lessons for the serious student of medical problems is that of Edward Jenner, who first demonstrated to the world that a simple attack of mild, never fatal, cowpox, deliberately acquired, might serve as a protective agent against the deadly smallpox, which before that time raged so violently all over the civilized world. His successful solution of this problem has probably saved more lives and suffering than any other single accomplishment in the whole history of medicine. While this fact is apparently not generally appreciated, Jenner's discovery did not come by mere chance, but was the result of his genius for original investigation, which led him to make many other valuable observations covering nearly the whole range of medicine; nor indeed was his activity limited to medicine alone, but extended itself to many of the allied sciences, and even to scientific departments quite beyond the domain of medicine.