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.
In the clinical field also it has received a great enlargement.
1843) found an adequate field for the clinical and pathological parts of their work.
In France, in the wards of the Hotel Dieu, Guillaume Benjamin Duchenne (1806-1875), in association with Trousseau and in his private clinic, pursued his memorable clinical and therapeutical researches into the diseases of the nervous system; and Jean M.
It is noteworthy that concurrently with the rise of clinical study the works of Hippocrates were more and more valued, while Galen began to sink into the background.
Robert James Graves (1796-1853) was a most eminent clinical teacher and observer, whose lectures are regarded as the 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.
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.
Now the cellular pathology of the blood, investigated by the aid of modern staining methods, is as important as that of the solid organs; no clinical investigator - indeed, apart from research, no practitioner at this day - can dispense with examination of the blood for purposes of diagnosis; its coagulability and the kinds and the variations of the cells it contains being evidence of many def i nitely morbid states of the body.
To the value of stains in clinical diagnosis, especially in investigation of perversions of the blood in many maladies, we have already made some reference.
Starting from 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 combination of both methods made a new era in clinical medicine.
The combination of clinical and anatomical research led, as in the hands of the great French physicians, to important discoveries by English investigators.
Several of these physicians were also eminent for their clinical teaching - an art in which Englishmen had up till then been greatly deficient.
In place of it, systematic clinical classes have become part of the scheme of every efficient school of medicine.
In heart disease the chief work of the latter half of the 19th century was, in the first quarter, such clinical work as that of William Stokes and Peter Mere Latham (1789-1875); and in the second quarter the fuller comprehension of the vascular system, central and peripheral, with its cycles and variations of blood pressure, venous and arterial.
Charcot, who was a good linguist and well acquainted with the literature of his own as well as of other countries, excelled as a clinical observer and a pathologist.
He observed the car's interior with the clinical distance of a scientist.
In 1789 he exchanged his chemistry lectureship for that of the theory and practice of physic; and when the medical college, which he had helped to found, was absorbed by the university of Pennsylvania in 1791 he became professor of the institutes of medicine and of clinical practice, succeeding in 1796 to the chair of the theory and practice of medicine.
Although it cannot be said that the science of medicine was advanced at Salerno, still its decline was arrested at a time when every other branch of learning was rapidly falling into decay; and there can be no doubt that the observation of patients in hospitals, and probably clinical instruction, were made use of in learning and teaching.
Upon this too static a view, both of clinical type and of post-mortem-room pathology, came a despairing spirit, almost of fatalism, which in the contemplation of organic ruins lost the hope of cure of organic diseases.
Such was medicine, statically ordered in pathology, statically ordered in its clinical concepts, when, on the 24th of November 1859 the Origin of Species was published.
In another direction the foundations of modern medicine were being laid during the 16th century - namely, by the introduction of clinical instruction in hospitals.
In this Italy, and especially the renowned school of Padua, took the first step, where Giovanni De Monte (Montanus), (1498-1552), already mentioned as a humanist, gave clinical lectures on the patients in the hospital of St Francis, which may still be read with interest.
The method of clinical instruction in hospitals, commenced by the Italians, was introduced into Holland, where it was greatly developed, especially at Leiden, in the hands of Francis de la Bo gy, called Sylvius (1641-1672).
As the organizer, and almost the constructor, of the modern method of clinical instruction, the services of Boerhaave to the progress of medicine were immense, and can hardly be overrated.
This, the old "Vienna School," was not distinguished for any notable discoveries, but for success in clinical teaching, and for its sound method of studying the actual facts of disease during life and after death, which largely contributed to the establishment of the "positive medicine" of the 19th century.
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.
To the establishment of this new conception the improvement and general use of the clinical thermometer gave invaluable advantages.
It is obvious that the results of such advances prescribe for the clinical physician methods which cannot be pursued without expert assistance; a physician engaged in busy prac- Spec;a;ism.
That the division of labour, which may seem to disintegrate the calling of the physician, really unites it, is well seen in the clinical laboratories which were initiated in the later 19th century, and which are destined to a great future.
By the approach of skilled pathologists to the clinical wards, a link is forged between practitioners and the men of science who pursue pathology disinterestedly.
The first clinical laboratory seems to have been that of Von Ziemssen (1829-1902) at Munich, founded in 1885; and, although his example has not yet been followed as it ought to have been, enough has been done in this way, at Johns Hopkins University and elsewhere, to prove the vital importance of the system to the progress of modern medicine.
The three days that must pass before any clinical effect is obtained renders it useless in an emergency.
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.
Von Barensprung (1822-1865) and Ludwig Traube (1818-1876) did the same service; but it is to the work of Karl August Wunderlich (1815-1877) that we owe the establishment of this means of precision as a method of regular observation both in pathology and in clinical medicine.
And museum of morbid anatomy, and was fusing these gains in the laboratory so as to claim for itself, as a special branch of science by virtue of peculiar concepts, its due place and provision - provision in the establishment of chairs and of special laboratories for its chemical and biological subdivisions - clinical medicine, by the formal provision of disciplinary classes, was illustrating the truth of the experience that teaching and research must go hand-in-hand, the one reinforcing the other: that no teacher can be efficient unless he be engaged in research also; nay, that for the most part even the investigator needs the encouragement of disciples.
It is on clinical grounds that beriberi, scarlet fever, measles, &c., are recognized as belonging to the same class, and evolving in phases which differ not in intimate nature but in the more superficial and inessential characters of time, rate and polymorphism; and the impression is gaining strength that acute rheumatism belongs to the group of the infections, certain sore throats, chorea and other apparently distinct maladies being terms of this series.
If we consult the medical works even of the middle of the 19th century we shall find that, in the light of the present time, accurate knowledge in this sphere, whether clinical, pathological or therapeutical, could scarcely be said to exist.
It is needless to point out how such paths of disease, in their association with characteristic symptoms, have illuminated the clinical features of disease as well as the processes of normal function.
In 1861 an alleged "centre" of speech was detected, by a combination of clinical and pathological researches, by Paul Broca (1824-1880).
By photography and diagrammatic records the clinical work of hospital wards has been brought into some better definition, and teaching made more accurate and more impressive.
Savill, Clinical Medicine (1909); W.
But when we come to study his observations on the natural history of disease as presented in the living subject, we recognize at once the presence of a great clinical physician.
In chronic disease and in health the use of alcohol as an aid to digestion is without the support of clinical or laboratory experience, the beneficial action being at least neutralized by undesirable effects produced elsewhere.
In 1815 he was appointed to the chair of clinical surgery, and became head surgeon at the Hotel-Dieu.
From 1757 he delivered lectures on clinical medicine in the Royal Infirmary.
The clinical uses of physostigmine are based upon the facts of its pharmacology, as above detailed.
Connected with the university are also physiological, pathological and chemical institutes, five clinical departments and a laboratory.
The city is the seat of Toledo University, including Toledo Medical College (1880), which is affiliated, for clinical purposes, with the Toledo Hospital (1876).
The clinical influence of digitalis upon the heart is very well defined.
The institution embraces a college of liberal arts, a college of engineering, a college of law (united in 1897 with the law school of Cincinnati College, then the only surviving department of that college, which was founded as Lancaster Seminary in 1815 and was chartered as Cincinnati College in 1819), a college of medicine (from 1819 to 1896 the Medical College of Ohio; the college occupies the site of the old M`Micken homestead), a college for teachers, a graduate school, and a technical school (founded in 1886 and transferred to the university in 1901); while closely affiliated with it are the Clinical and Pathological School of Cincinnati and the Ohio College of Dentistry.
In 1842 he removed to Paris for the sake of its wider clinical opportunities, and there he worked until his death over thirty years later.
In 1714, when he was appointed rector of the university, he succeeded Govert Bidloo (1649-1713) in the chair of practical medicine, and in this capacity he had the merit of introducing the modern system of clinical instruction.
When, towards the end of his student-days in Berlin, he was acting as clinical assistant in the eye department of the Berlin Hospital, he noticed that in keratitis and corneal wounds healing took place without the appearance of plastic exudation.
Defined on an etiological as well as a clinical basis - namely, the mild or spring group, which includes tertian and quartan.
The medical school, a department of Washington University, includes laboratory, anatomical, clinical and other buildings.
In the fourth place, these views of the "natural history of disease" (in modern language) led to habits of minute observation and accurate interpretation of symptoms, in which the Hippocratic school was unrivalled in antiquity, and has been the model for all succeeding ages, so that even in these days, with our enormous advances in knowledge, the true method of clinical medicine may be said to be the method of Hippocrates.
William Stokes (1804-1878) was especially known for his works on diseases of the chest and of the heart, and for his clinical teaching.
By his almost exhaustive comparison of febrile movements as symptomatic processes Wunderlich dealt the last blow to the expiring doctrine of the "entity" of "fever"; while on the clinical side Bretonneau and Louis, in 1862-1872, by their careful clinical and pathological studies of forms of fever, relieved the new doctrine of the extravagances of Broussais, and prepared the way for the important distinction of enteric from typhus fever by A.
And yet, didn't clinical words like selective reduction and gestational carrier mask the facts?