Virchow, op.cit., note 23, p

opposed so called "therapeutic experiments" , i.e. the blind and wild application of drugs until one would eventually find an effective substance.

In my view Virchow made indirectly a lasting influence upon medical therapy in gently reconciling theory and practice. His guiding slogan was Sclentia est potentia. He managed to instil hospital physicians

(clinicians) with an optimism which made them feel that their task - once perceived to be hopeless and doomed to fail - was worthwhile:

Even if the dissection halls are now fuller than ever, if pathological anatomy gains more and more ground at universities and in hospitals, even if the microscope gains in popularity as an indispensable tool in the hands of physicians, nevertheless only sheer ignorance or blindness could still insist that nowadays medical practice is exhausted in the

dissection rooms, that pathological anatomy dominates medicine suppressing it rather than serving her, that the essential end of medical action is being forgotten over the occupation with the microscope. No longer do doctors pass each other with a conspiratory arrogant s m i l e . A n d should they pause on their way in order to discuss the

'cell', for their practice does not kill their grasp of theory - so be it. They shall hardly forget the sick whom they have been sent for

In 1865 Zenker and Ziemssen inaugurated the medical journal Deutsches Archiv für Klinische Medicin:

Contemplating the present state of affairs it is obvious that the reign of pessimism is over.

Everywhere we detect physicians realizing that they

The original text uses the term 'Augurenlacheln' . G.Biichmann, GeflUaelte Worte. Frankfurt/Main, Ullstein, 1986, p. 313: This term was first used in Cicero's manuscript "De divinatione" (11,24,51) referring to a remark by Cato. 'Augurenlacheln' describes a presumptuous grin exchanged between conspiring insiders.

F.Zenker & H.v.Ziemssen, 'Vorwort', Dt.Archiv f.Klin.Med.. 1865, Vol.l, pp.7-8

ought to be and can be the assistants of suffering humans.

Virchow’s natural scientific method instructed physicians to focus their attention, to be methodical and to "think microscopically". This mental act of concentration tamed o n e ’s own imaginations and vanity and thus taught self discipline. The same restraint and discipline had to be exercised in medical therapy. This translated itself into the following three principles of therapy: Combined endeavour to enlarge the means of medication, localized and precise (specific)

application of therapeutic agents and definition of their indication.®’

As a consequence of new insight into pathological processes we see everywhere fresh therapeutic

endeavour, partly on novel grounds, which define new indications. In order to suffice they carefully

assess and test the results and open up new avenues .®®

Contrary to orthodox historical opinion the pathological anatomical orientation was perceived as beneficial and productive for medical diagnosis and therapy by contemporary clinicians:

Within a few decades pathological anatomy

has inaugurated such a knowledge of the material organic alteration which - even if still far from perfection - leaves everything behind which had been investigated in the preceding centuries. The

knowledge of anatomical alteration (which we know

Ibid., p.7

®’ A.Eulenburg, op.cit., note 2, p.25

8 8

from post mortem examination) prompted such a strong desire to make them accessible to the physician's eye also in the living body. Such diagnostic

aspiration knew well how to develop satisfactorily the necessary tools. Physical diagnostics,

percussion and auscultation, developed alongside pathological anatomy - likewise the physician's mind did not rest till it found new ways to direct light to the inner organs thus making them accessible to the doctor's senses. This aspiration was crowned with ample success. What the eye can discern can now be reached by the hand to fight against disease on the spot where formerly the medical art only managed to cope via deceptive excursions with illusory media of illusive effects. What the hand can not reach physical technology is able to unravel with new methods. The triumphs of

gynaecology since it based its diagnosis on the examination with eye and hand, the booming

laryngoscopy with its therapeutic successes...speak volumes of the development of our science.

Contemporary literature celebrated the successful development of clinical diagnostics. Particularly the introduction of optic devices like the laryngoscope or the ophthalmoscope received proud and frequent praise:

Everywhere where the mirror used as diagnostic aid has cast its rays the perfected examination method has been succeeded by a localising method of

cure

The emergence of local therapy - mostly surgical - was perceived as a direct result from the general introduction of the vaginal speculum into gynaecology and from the application of the laryngoscope and

rhinoscope in the local treatment of diseases of the upper respiratory tract. Suddenly also the local treatment of organic regions which had so far been inaccessible even by the aided eye was pushed forward

Ibid., pp.9-10 Ibid.

with "instrumental methods" of considerable innovative character:

Independently of optic appliances the local treatment of such bodily regions which are not accessible by direct ocular examination...tries to reach diseased tissues as directly as possible with the aid of other artifice and instruments. In many cases they are very successful. Today liquid

substances can be directed to the deepest branches of the trachea or even the lung after having been vaporized by apparatus with compression-pumps and having been inhaled through mouth pieces. The same method of inhalation is successfully utilized in

local therapy of afflictions of the left heart. Such tangible advances motivated the physicians immensely and restored their lost faith in their

capabilities. They suddenly felt a reassuring sense of vocation.

Concrete results were generated, numerous enough to elate the previously depressed spirits. The joys of success motivated active intervention and an

expansion of research into every direction.^ It was not so much the recently acquired

pathological anatomical knowledge per se, as Zenker and Ziemssen claimed, which was responsible for the rapid growth of physical diagnostics, but rather the

anatomical thought process by which it was motivated: "Where is the seat of the disease?"

Simultaneously Virchow had rehabilitated the role of empiricism and clinical bedside observation as

H.Immermann, 'Ueber die therapeutischen