Antall József szerk.: Orvostörténeti közlemények 97-99. (Budapest, 1982)
TANULMÁNYOK - Birtalan Győző: Laennec és Skoda, a belgyógyászati diagnosztika klasszikusai (angol nyelven)
gungen zu erfahren suchen, von welchen jede einzelne Schallverschiedenheit abhängig ist, und endlich das Beobachtet mit den bekannten Gesetzen des Schalles in Zusammenhang zu bringen trachten." 1 Accordingly, his investigations lead him to the elementary physics of the healthy and pathologic sounds in the lung and heart. He made clear the origin of the tympanistic sound phenomenon, the rules for sound conduction of lung formules and gave the most plausible explanation for the origin of heart sounds. He simplified and put order as far as it was possible into the confused contemporary terminology of phonetics. Absorbing in the study of these elementary phenomena, Skoda concluded that the same sound phenomena may often appear in different causes. He found himself in theoretical opposition to the semiotic view represented partly by Laennec as well, which said that from some symptom thought to be charateristic, one might conclude to special diagnoses. In connection with this he proved that extended expiration with simultaneously shortened inspiration does not stand exclusively for pulmonary tuberculosis and emphysema. Laennec's egophonia does not mean invariably free motion fluid in the thoracic cavity. The perception of "pectoriloqui" is not identic either with the diagnosis of cavern and this term actually covers bronchophonia anyhow. Hemade a terminological purification among the bronchitic rales overdifferentiated by Laennec. No doubt these factual and conceptual corrections —which effected more than certain statements by Laennec —much contributed to relieving physical diagnostics from inexactitudes and subjective traits and allowing it to develop into objective medical discipline. Simultaneously with the ripening of Skoda's conception the radical antiontological clinical trend declared in 1841 by Wunderlich and Roser as the physiological school of internal medicine, developped. In previous nosology diseases were characterized by general pathologic states like aquatic diseases, apoplexy, neural fever, etc. .. The aim had been to put the findings of the patients examination into one of the accepted types of disease. The new critical trend, however, attempted at splitting these unclear clinical pictures wich left place for several interpretation, into well definable physiological-pathological processes and understand them in their development. It was a priori distrustful of traditional nosological entities regarded by the old conception as quasi independent formations appearing under given conditions. This change of view can be expressed also with the philosophical generalization that the substantial concept of illness was substituted by a demand for the knowledge of the dynamic-dialectic laws of motion of the diseased organism. We may conceive of this need following Wunderlich's thoughts: "Ontologisch einen Typhus zu bestimmen, oder eine Wassersucht, oder einen morbus organicus cordis, oder eine Phtisie zu diagnostizieren ist keine grosse Kunst ; aber nach Art der vervielfachten Localisation genau jede kranke Stelle im Körper anzugeben, die Art, die Form, und die Ausdehnung ihres Erkrankens voraus zu Bestimmen das ist die Aufgabe der heutigen clinischen Beobachtung ... " 8 These views were shared by Skoda, and his new symptomatological analyses meant already a higher level of nosological researches, and prospectively the influenced towards the development of modern functional clinical view. In Laennec's cardiology atrioventricular dilatation due to different causes and hyper7 Skoda, J.: Abhandlung über Perkussion und Auskultation. Wien, 1864, p. 4 8 Wunderlich, C. A.: Wien und Paris. Stuttgart, 1841, p. 84
