英语论文网

PRE-history OF PHYSICAL DIAGNOSIS

-- 留学生论文网rise of surgery in hospitals and general practice

-- surgery becoming more theoretical and expansionist

-- some physicians become interested in the anatomical aspects of internal disease

-- occasional use of physical methods to identify disease in patients -- e.g. Leopold Auenbrugger in Vienna introduces auscultation in 1761

-- but such methods not widely adopted 
 

THE FRENCH REVOLUTION (1789) AND MEDICINE

-- elite medical and surgical institutions abolished

-- deregulation of medical education

-- private courses flourish
-- hospital teaching also

-- state medical system reconstructed from 1794

-- more egalitarian
-- especially surgery

-- medical education system also reconstructed

-- state-run Schools of Health established alongside private and hospital schools
-- large increase in student numbers
-- surgeons dominate the reforms – curriculum now combines medicine and surgery
-- anatomy as basic medical training
-- officiers de santé  1802

XAVIER BICHAT (1771-1802)

-- trained as a surgeon but aspires to be a physician

-- running private anatomy school in Paris from 1796

-- investigates the anatomy of the internal organs

-- concerned with their function as well as structure

-- draws up a taxonomy of the tissues

-- including experimental work on their secretory functions

-- conducts post-mortem studies of the anatomy of the major body cavities -- peritoneum, pericardium, pleura

-- combines knowledge of local seats of disease with account of general effects in terms of illness

--> new science of pathological anatomy

THE ADOPTION OF BICHAT’S IDEAS

-- continuing tension between medical and surgical points of view within the reformed Schools of Health

-- struggles over curriculum and conduct of examination boards

-- Bichat combines medical and surgical perspectives

-- idea of “common practice” gradually incorporated into the medical curriculum

 
THEOPHILE LAENNEC (1775-1826)

-- teaching in Paris hospitals from 1804

-- and conducting anatomical investigations on Bichatian system

-- new social relations of practice in the Parisian hospitals

-- large numbers of poor patients, many of them dying
-- no expectation that doctors cure them
-- scepticism towards old therapeutic principles
-> therapeutic nihilism and expectant therapy
-- hospitals as museums of disease

-- Laennec (and others) constructing natural history of disease in the living -- nosology

-- correlating symptoms while alive with anatomical changes at post-mortem
-- notes accumulation of fluid in body cavities (following Bichat)

-- Laennec looks for a way to identify such changes in living patients

-- revives the practice of auscultation
-- develops the stethoscope -- Mediate Auscultation (1919)
 

THE ADOPTION OF LAENNEC’S METHODS

-- pathological anatomy and auscultation provide new basis for prognosis

-- predictions during life can be confirmed post-mortem
-- demonstration of the doctor’s power to understand disease

-- therapeutic innovations more difficult to identify at the time