Antall József szerk.: Orvostörténeti közlemények 97-99. (Budapest, 1982)

TANULMÁNYOK - Birtalan Győző: Laennec és Skoda, a belgyógyászati diagnosztika klasszikusai (angol nyelven)

aetiologically. Since we cannot speak of systematic aetiological researches at that time, this seemed rather a promise of future. In this field, interestingly enough, patho-chemical investigations were the most trusted. The chemical analysis of organs and body humours came up frequently. Hi. Starting from the anatomo-pathological findings of particular diseases, to profit of the so gained knowledge for clinical practice, following considerations mentioned above. This latter became the natural spiritual field of Laennec. Besides him, many followed that way. It was due to his personal genius that from among the several gifted contemporaries mainly his scientific oeuvre formed the future of the pathological-anatomical trend. Many restricted this field of research. Bichat for example concentrated exclusively on the laws of inflammatory and tumoral deformities. Broussais, with his vast anatomopathological experience, emphasized only the inflammatory signs — and the inflammations of the intestinal tract particularly — as being the essential difference in most diseases. The experience of a high number of dissections could not assure clearvoyance in itself, anyway. Laennec mentions an author of the name Walther who had performed 5500 dissections but was unable to understand the essence of the pathology of pleuritis and peritonitis that was later described by Bichat. It often happened that certain forms of diseases were overgeneralized. Bayle, who excelled in the research of tuberculosis, considered aspecific pulmonary abscesses as tuberculotic and failed to distinct tuberculotic and melanotic lymph nodes. Corvisart overemphasized the aetiological role of venereal diseases in the development of endocardial growths. The other extreme in making mistakes was overdifferentiation. It happened both in nosological classification and differential diagnostics. Such mistakes were made by Laennec, too. He overclassilied the kinds and symptomatology of respiratory catarrhs. Besides tuberculotic phthisis he described "nervous" phthisis and the "catarrhe simulant la phtisie". He attributed too much importance to the symptom of "pectoriloqui" in pointing out pulmonary cavern and to "egofonia" in pointing out pleural cavity fluid. All this could be corrected later by Skoda on the grounds of a more abstract, analyzing, functional physical view. But in the 1810s Laennec was first of all interested in practical clinical diagnostics. He aimed at three goals in this respect: i. to state in the cadaver the pathologic physical traits — at the level of surgical diagnosis — which characterize the affected organ; ii. to recognize them in the living from positive signs ad far as possible, separating off accompanying symptoms (including also "vital troubles") ; Hi. to fight against the diseases by means experience had proved eifective. Undoubtedly, the results of the third point might have met the least his expectations. The value of empirically based contemporary therapy proved very modest in difficult cases. Among the routine procedures we find mustard plaster, leech, ice packs, laudanum, herbal teas, which are mostly anti-inflammatory treatments. Although Laennec felt strong aversion to the one-sided concept of inflammation discredited also by broussaisism. Presumably this was also a cause for his wrong insistence on tuberculosis being not an inflammatory procedure but a malignant hyperplasia. Besides traditional natural therapies Laennec also tried to draw therapeutic conclusions from well-known local, organic deformities. He precised the indications for blood-letting. He warned that in such cases one should rely rather on the intensity of heart sound than on the tension of the pulse. In case of fading heart sounds bleeding is dangerous. He gives logical indications for the letting of pulmonary or pleural cavity purulence or, in case pf necessity, for pericardicentesis. While critically revising the processes qualified as inflammatory, his attention