a history of science-4- 第31部分

From　the　fact　that　certain　persons；　usually　milkmaids；　who　had　suffered　from　cow…pox　seemed　to　be　immuned　to　small…pox；　it　would　seem　a　very　simple　process　of　deduction　to　discover　that　cow…pox　inoculation　was　the　solution　of　the　problem　of　preventing　the　disease。　But　there　was　another　form　of　disease　which；　while　closely　resembling　cow…pox　and　quite　generally　confounded　with　it；　did　not　produce　immunity。　The　confusion　of　these　two　forms　of　the　disease　had　constantly　misled　investigations　as　to　the　possibility　of　either　of　them　immunizing　against　smallpox；　and　the　confusion　of　these　two　diseases　for　a　time　led　Jenner　to　question　the　possibility　of　doing　so。　After　careful　investigations；　however；　he　reached　the　conclusion　that　there　was　a　difference　in　the　effects　of　the　two　diseases；　only　one　of　which　produced　immunity　from　small…pox。

〃There　is　a　disease　to　which　the　horse；　from　his　state　of　domestication；　is　frequently　subject；〃　wrote　Jenner；　in　his　famous　paper　on　vaccination。　　〃The　farriers　call　it　the　grease。　It　is　an　inflammation　and　swelling　in　the　heel；　accompanied　at　its　commencement　with　small　cracks　or　fissures；　from　which　issues　a　limpid　fluid　possessing　properties　of　a　very　peculiar　kind。　This　fluid　seems　capable　of　generating　a　disease　in　the　human　body　（after　it　has　undergone　the　modification　I　shall　presently　speak　of）　which　bears　so　strong　a　resemblance　to　small…pox　that　I　think　it　highly　probable　it　may　be　the　source　of　that　disease。

〃In　this　dairy　country　a　great　number　of　cows　are　kept；　and　the　office　of　milking　is　performed　indiscriminately　by　men　and　maid　servants。　　One　of　the　former　having　been　appointed　to　apply　dressings　to　the　heels　of　a　horse　affected　with　the　malady　I　have　mentioned；　and　not　paying　due　attention　to　cleanliness；　incautiously　bears　his　part　in　milking　the　cows　with　some　particles　of　the　infectious　matter　adhering　to　his　fingers。　When　this　is　the　case　it　frequently　happens　that　a　disease　is　communicated　to　the　cows；　and　from　the　cows　to　the　dairy…maids；　which　spreads　through　the　farm　until　most　of　the　cattle　and　domestics　feel　its　unpleasant　consequences。　This　disease　has　obtained　the　name　of　Cow…Pox。　It　appears　on　the　nipples　of　the　cows　in　the　form　of　irregular　pustules。　At　their　first　appearance　they　are　commonly　of　a　palish　blue；　or　rather　of　a　color　somewhat　approaching　to　livid；　and　are　surrounded　by　an　inflammation。　　These　pustules；　unless　a　timely　remedy　be　applied；　frequently　degenerate　into　phagedenic　ulcers；　which　prove　extremely　troublesome。　　The　animals　become　indisposed；　and　the　secretion　of　milk　is　much　lessened。　Inflamed　spots　now　begin　to　appear　on　different　parts　of　the　hands　of　the　domestics　employed　in　milking；　and　sometimes　on　the　wrists；　which　run　on　to　suppuration；　first　assuming　the　appearance　of　the　small　vesications　produced　by　a　burn。　Most　commonly　they　appear　about　the　joints　of　the　fingers　and　at　their　extremities；　but　whatever　parts　are　affected；　if　the　situation　will　admit　the　superficial　suppurations　put　on　a　circular　form　with　their　edges　more　elevated　than　their　centre　and　of　a　color　distinctly　approaching　to　blue。　Absorption　takes　place；　and　tumors　appear　in　each　axilla。　The　system　becomes　affected；　the　pulse　is　quickened；　shiverings；　succeeded　by　heat；　general　lassitude；　and　pains　about　the　loins　and　limbs；　with　vomiting；　come　on。　　The　head　is　painful；　and　the　patient　is　now　and　then　even　affected　with　delirium。　These　symptoms；　varying　in　their　degrees　of　violence；　generally　continue　from　one　day　to　three　or　four；　leaving　ulcerated　sores　about　the　hands　which；　from　the　sensibility　of　the　parts；　are　very　troublesome　and　commonly　heal　slowly；　frequently　becoming　phagedenic；　like　those　from　which　they　sprang。　During　the　progress　of　the　disease　the　lips；　nostrils；　eyelids；　and　other　parts　of　the　body　are　sometimes　affected　with　sores；　but　these　evidently　arise　from　their　being　heedlessly　rubbed　or　scratched　by　the　patient's　infected　fingers。　No　eruptions　on　the　skin　have　followed　the　decline　of　the　feverish　symptoms　in　any　instance　that　has　come　under　my　inspection；　one　only　excepted；　and　in　this　case　a　very　few　appeared　on　the　arms：　they　were　very　minute；　of　a　vivid　red　color；　and　soon　died　away　without　advancing　to　maturation；　so　that　I　cannot　determine　whether　they　had　any　connection　with　the　preceding　symptoms。

〃Thus　the　disease　makes　its　progress　from　the　horse　（as　I　conceive）　to　the　nipple　of　the　cow；　and　from　the　cow　to　the　human　subject。

〃Morbid　matter　of　various　kinds；　when　absorbed　into　the　system；　may　produce　effects　in　some　degree　similar；　but　what　renders　the　cow…pox　virus　so　extremely　singular　is　that　the　person　that　has　been　thus　affected　is　forever　after　secure　from　the　infection　of　small…pox；　neither　exposure　to　the　variolous　effluvia　nor　the　insertion　of　the　matter　into　the　skin　producing　this　distemper。〃＇2＇


In　1796　Jenner　made　his　first　inoculation　with　cowpox　matter；　and　two　months　later　the　same　subject　was　inoculated　with　small…pox　matter。　But；　as　Jenner　had　predicted；　no　attack　of　small…pox　followed。　Although　fully　convinced　by　this　experiment　that　the　case　was　conclusively　proven；　he　continued　his　investigations；　waiting　two　years　before　publishing　his　discovery。　Then；　fortified　by　indisputable　proofs；　he　gave　it　to　the　world。　The　immediate　effects　of　his　announcement　have　probably　never　been　equalled　in　the　history　of　scientific　discovery；　unless；　perhaps；　in　the　single　instance　of　the　discovery　of　anaesthesia。　In　Geneva　and　Holland　clergymen　advocated　the　practice　of　vaccination　from　their　pulpits；　in　some　of　the　Latin　countries　religious　processions　were　formed　for　receiving　vaccination；　Jenner's　birthday　was　celebrated　as　a　feast　in　Germany；　and　the　first　child　vaccinated　in　Russia　was　named　〃Vaccinov〃　and　educated　at　public　expense。　In　six　years　the　discovery　had　penetrated　to　the　most　remote　corners　of　civilization；　it　had　even　reached　some　savage　nations。　And　in　a　few　years　small…pox　had　fallen　from　the　position　of　the　most　dreaded　of　all　diseases　to　that　of　being　practically　the　only　disease　for　which　a　sure　and　easy　preventive　was　known。

Honors　were　showered　upon　Jenner　from　the　Old　and　the　New　World；　and　even　Napoleon；　the　bitter　hater　of　the　English；　was　among　the　others　who　honored　his　name。　　On　one　occasion　Jenner　applied　to　the　Emperor　for　the　release　of　certain　Englishmen　detained　in　France。　　The　petition　was　about　to　be　rejected　when　the　name　of　the　petitioner　was　mentioned。　〃Ah；〃　said　Napoleon；　〃we　can　refuse　nothing　to　that　name！〃

It　is　difficult　for　us　of　to…day　clearly　to　conceive　the　greatness　of　Jenner's　triumph；　for　we　can　only　vaguely　realize　what　a　ruthless　and　ever…present　scourge　smallpox　had　been　to　all　previous　generations　of　men　since　history　began。　　Despite　all　efforts　to　check　it　by　medication　and　by　direct　inoculation；　it　swept　now　and　then　over　the　earth　as　an　all…devastating　pestilence；　and　year　by　year　it　claimed　one…tenth　of　all　the　beings　in　Christendom　by　death　as　its　average　quota　of　victims。　〃From　small…pox　and　love　but　few　remain　free；〃　ran　the　old　saw。　A　pitted　face　was　almost　as　much　a　matter　of　course　a　hundred　years　ago　as　a　smooth　one　is　to…day。

Little　wonder；　then；　that　the　world　gave　eager　acceptance　to　Jenner's　discovery。　　No　urging　was　needed　to　induce　the　majority　to　give　it　trial；　passengers　on　a　burning　ship　do　not　hold　aloof　from　the　life…boats。　Rich　and　poor；　high　and　low；　sought　succor　in　vaccination　and　blessed　the　name　of　their　deliverer。　Of　all　the　great　names　that　were　before　the　world　in　the　closing　days　of　the　century；　there　was　perhaps　no　other　one　at　once　so　widely　known　and　so　uniformly　reverenced　as　that　of　the　great　English　physician　Edward　Jenner。　　Surely　there　was　no　other　one　that　should　be　recalled　with　greater　gratitude　by　posterity。



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　wor