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

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

ities of a patient suffering from chronic pleurisy we can find the description to become classic of liver cirrhosis as well. In this respect, however, we may note that in Laennec's pathologic material there are conspicuously few registrations of renal changes from the internist's view or indications about sclerotic deformities of the coronaries. We know that attention was drawn to the former group of illness only later, after Bright. The causal connection between the anginas and coronary occlustion, however, had been pointed out in the 18th century (Fothergill). Could it be possibe that Laennec was not convinced or not convinced enough of this and that would have influenced his perceptions? When describing the state of the patient, Laennec often use classical constitutional terms (bilioso-sanguinical, lymphatico-nervosus, etc.) The disproportion of organs as a morbid factor often occurs in his reasonings. We know that he had a profound knowledge of classical medicine and wrote his thesis on Hippocrates. In nosological orientation he carefully registrated the appearance of types of diseases characteristic of the given place and period. Following Sydenham's example he made an account of the periodical occurrences of diseases clustering occasionally in Paris. He noticed for example that at the end of the 18th century the "bilious constitution" prevailed which supported the humoral concept generally accepted then. From 1804 on the "inflammatory" changes came forth which promoted the spread of fashionable antiflogistic treatments. In this relation he warned of the mistake of schematic one-sidedness : "Bien peu de médecins sont capables, merne après une longue pratique, de voir les objets sous un autre aspect, que l'école de leur temps."

6 Thus, on the one hand Laennec, worked on a new approach of local organic deformities and the recognition of their regularities, on the other hand he stood for the holistic view of past centuries in his interpretation of pathogenesis. From this point of view he linked closely to Sydenham and the medical culture of the great clinicians of the 18th century. Twenty years after the publication of the "Traité", there appeared in Vienna in 1839 Joseph Skoda's work entitled "Abhandlung über Perkussion und Auskultation" reflecting faithfully the important evolution of clinical diagnostic that took place in the course of these two decades. From 1832 Skoda as an internist at the Allgemeine Krankenhaus of Vienna, got into close professional connection with Rokitansky's institute of pathological anatomy, where he could conduct his diagnostic studies for years. As it is known from his biographic data, even as a medical student he excelled by his extraordinary sense for mathematics, physics and especially for acoustical physics. He made use of his ability in the elaboration of physical diagnostics on a scientific level. He owed much to the friendly cooperation of Rokitansky and his collègues, to the high intellectual atmosphere and hypercritical spirit there. A critical stand characterized first of all Skoda's chef-d'oeuvre the "Abhandlung" as well. Surveying the new diagnostic methods he more or less got involved into polemy with every important author. It is conspicuous how much the number of cited authors had increased compared to those mentioned by Laennec in the "Traité". There are about ten times as many names including still familiar ones like e. g. Stokes, Hope, Bouilleaud, Wintrich, Chomel, Magendie, Piorry and of course Laennec. Skoda's research program is well shown in the following lines: "Wir müssen alle mögliche Verschiedenheiten des Perkussionsschalles kennen lernen; wir müssen die BedinG Laennec, R. Th.: Traité de l'auscultation médiate. Paris, 1819, II. p. 86