



Produced by Charles Keller and David Widger





THE EVOLUTION OF MODERN MEDICINE




A SERIES OF LECTURES DELIVERED AT YALE UNIVERSITY

ON THE SILLIMAN FOUNDATION

IN APRIL, 1913


by William Osler




THE SILLIMAN FOUNDATION

IN the year 1883 a legacy of eighty thousand dollars was left to the
President and Fellows of Yale College in the city of New Haven, to be
held in trust, as a gift from her children, in memory of their beloved
and honored mother, Mrs. Hepsa Ely Silliman.

On this foundation Yale College was requested and directed to establish
an annual course of lectures designed to illustrate the presence and
providence, the wisdom and goodness of God, as manifested in the natural
and moral world. These were to be designated as the Mrs. Hepsa Ely
Silliman Memorial Lectures. It was the belief of the testator that any
orderly presentation of the facts of nature or history contributed
to the end of this foundation more effectively than any attempt to
emphasize the elements of doctrine or of creed; and he therefore
provided that lectures on dogmatic or polemical theology should be
excluded from the scope of this foundation, and that the subjects should
be selected rather from the domains of natural science and history,
giving special prominence to astronomy, chemistry, geology and anatomy.

It was further directed that each annual course should be made the basis
of a volume to form part of a series constituting a memorial to Mrs.
Silliman. The memorial fund came into the possession of the Corporation
of Yale University in the year 1901; and the present volume constitutes
the tenth of the series of memorial lectures.


CONTENTS

Chapter I.   Origin Of Medicine
Chapter II.  Greek Medicine
Chapter III. Mediaeval Medicine
Chapter IV.  The Renaissance and the Rise of Anatomy and Physiology
Chapter V.   The Rise and Development of Modern Medicine
Chapter VI.  The Rise of Preventive Medicine




PREFACE

THE manuscript of Sir William Osler's lectures on the "Evolution of
Modern Medicine," delivered at Yale University in April, 1913, on the
Silliman Foundation, was immediately turned in to the Yale University
Press for publication. Duly set in type, proofs in galley form had been
submitted to him and despite countless interruptions he had already
corrected and revised a number of the galleys when the great war came.
But with the war on, he threw himself with energy and devotion into
the military and public duties which devolved upon him and so never
completed his proof-reading and intended alterations. The careful
corrections which Sir William made in the earlier galleys show that the
lectures were dictated, in the first instance, as loose memoranda for
oral delivery rather than as finished compositions for the eye, while
maintaining throughout the logical continuity and the engaging con moto
which were so characteristic of his literary style. In revising the
lectures for publication, therefore, the editors have merely endeavored
to carry out, with care and befitting reverence, the indications
supplied in the earlier galleys by Sir William himself. In supplying
dates and references which were lacking, his preferences as to editions
and readings have been borne in mind. The slight alterations made, the
adaptation of the text to the eye, detract nothing from the original
freshness of the work.

In a letter to one of the editors, Osler described these lectures as "an
aeroplane flight over the progress of medicine through the ages." They
are, in effect, a sweeping panoramic survey of the whole vast field,
covering wide areas at a rapid pace, yet with an extraordinary variety
of detail. The slow, painful character of the evolution of medicine from
the fearsome, superstitious mental complex of primitive man, with his
amulets, healing gods and disease demons, to the ideal of a clear-eyed
rationalism is traced with faith and a serene sense of continuity. The
author saw clearly and felt deeply that the men who have made an idea or
discovery viable and valuable to humanity are the deserving men; he
has made the great names shine out, without any depreciation of the
important work of lesser men and without cluttering up his narrative
with the tedious prehistory of great discoveries or with shrill claims
to priority. Of his skill in differentiating the sundry "strains"
of medicine, there is specific witness in each section. Osler's wide
culture and control of the best available literature of his subject
permitted him to range the ampler aether of Greek medicine or the
earth-fettered schools of today with equal mastery; there is no quickset
of pedantry between the author and the reader. The illustrations (which
he had doubtless planned as fully for the last as for the earlier
chapters) are as he left them; save that, lacking legends, these have
been supplied and a few which could not be identified have with regret
been omitted. The original galley proofs have been revised and corrected
from different viewpoints by Fielding H. Garrison, Harvey Cushing,
Edward C. Streeter and latterly by Leonard L. Mackall (Savannah, Ga.),
whose zeal and persistence in the painstaking verification of citations
and references cannot be too highly commended.

In the present revision, a number of important corrections, most of
them based upon the original MS., have been made by Dr. W.W. Francis
(Oxford), Dr. Charles Singer (London), Dr. E.C. Streeter, Mr. L.L.
Mackall and others.

This work, composed originally for a lay audience and for popular
consumption, will be to the aspiring medical student and the hardworking
practitioner a lift into the blue, an inspiring vista or "Pisgah-sight"
of the evolution of medicine, a realization of what devotion,
perseverance, valor and ability on the part of physicians have
contributed to this progress, and of the creditable part which our
profession has played in the general development of science.

The editors have no hesitation in presenting these lectures to the
profession and to the reading public as one of the most characteristic
productions of the best-balanced, best-equipped, most sagacious and most
lovable of all modern physicians.

F.H.G.


BUT on that account, I say, we ought not to reject the ancient Art, as
if it were not, and had not been properly founded, because it did
not attain accuracy in all things, but rather, since it is capable of
reaching to the greatest exactitude by reasoning, to receive it and
admire its discoveries, made from a state of great ignorance, and as
having been well and properly made, and not from chance. (Hippocrates,
On Ancient Medicine, Adams edition, Vol. 1, 1849, p. 168.)


THE true and lawful goal of the sciences is none other than this: that
human life be endowed with new discoveries and powers. (Francis Bacon,
Novum Organum, Aphorisms, LXXXI, Spedding's translation.)


A GOLDEN thread has run throughout the history of the world, consecutive
and continuous, the work of the best men in successive ages. From point
to point it still runs, and when near you feel it as the clear and
bright and searchingly irresistible light which Truth throws forth when
great minds conceive it. (Walter Moxon, Pilocereus Senilis and Other
Papers, 1887, p. 4.)


FOR the mind depends so much on the temperament and disposition of the
bodily organs that, if it is possible to find a means of rendering men
wiser and cleverer than they have hitherto been, I believe that it is in
medicine that it must be sought. It is true that the medicine which is
now in vogue contains little of which the utility is remarkable; but,
without having any intention of decrying it, I am sure that there is
no one, even among those who make its study a profession, who does not
confess that all that men know is almost nothing in comparison with
what remains to be known; and that we could be free of an infinitude
of maladies both of body and mind, and even also possibly of the
infirmities of age, if we had sufficient knowledge of their causes,
and of all the remedies with which nature has provided us. (Descartes:
Discourse on the Method, Philosophical Works. Translated by E. S.
Haldane and G. R. T. Ross. Vol. I, Cam. Univ. Press, 1911, p. 120.)




CHAPTER I -- ORIGIN OF MEDICINE




INTRODUCTION

SAIL to the Pacific with some Ancient Mariner, and traverse day by day
that silent sea until you reach a region never before furrowed by keel
where a tiny island, a mere speck on the vast ocean, has just risen from
the depths, a little coral reef capped with green, an atoll, a mimic
earth, fringed with life, built up through countless ages by life on the
remains of life that has passed away. And now, with wings of fancy,
join Ianthe in the magic car of Shelley, pass the eternal gates of the
flaming ramparts of the world and see his vision:

     Below lay stretched the boundless Universe!
     There, far as the remotest line
     That limits swift imagination's flight,
     Unending orbs mingled in mazy motion,
     Immutably fulfilling
     Eternal Nature's law.
     Above, below, around,
     The circling systems formed
     A wilderness of harmony.
     (Daemon of the World, Pt. I.)

And somewhere, "as fast and far the chariot flew," amid the mighty
globes would be seen a tiny speck, "earth's distant orb," one of "the
smallest lights that twinkle in the heavens." Alighting, Ianthe
would find something she had probably not seen elsewhere in her magic
flight--life, everywhere encircling the sphere. And as the little coral
reef out of a vast depth had been built up by generations of polyzoa,
so she would see that on the earth, through illimitable ages, successive
generations of animals and plants had left in stone their imperishable
records: and at the top of the series she would meet the thinking,
breathing creature known as man. Infinitely little as is the architect
of the atoll in proportion to the earth on which it rests, the polyzoon,
I doubt not, is much larger relatively than is man in proportion to
the vast systems of the Universe, in which he represents an
ultra-microscopic atom less ten thousand times than the tiniest of the
"gay motes that people the sunbeams." Yet, with colossal audacity, this
thinking atom regards himself as the anthropocentric pivot around which
revolve the eternal purposes of the Universe. Knowing not whence he
came, why he is here, or whither he is going, man feels himself of
supreme importance, and certainly is of interest--to himself. Let us
hope that he has indeed a potency and importance out of all proportion
to his somatic insignificance. We know of toxins of such strength that
an amount too infinitesimal to be gauged may kill; and we know that
"the unit adopted in certain scientific work is the amount of emanation
produced by one million-millionth of a grain of radium, a quantity
which itself has a volume of less than a million-millionth of a cubic
millimetre and weighs a million million times less than an exceptionally
delicate chemical balance will turn to" (Soddy, 1912). May not man be
the radium of the Universe? At any rate let us not worry about his size.
For us he is a very potent creature, full of interest, whose mundane
story we are only beginning to unravel.

Civilization is but a filmy fringe on the history of man. Go back as far
as his records carry us and the story written on stone is of yesterday
in comparison with the vast epochs of time which modern studies demand
for his life on the earth. For two millions (some hold even three
millions) of years man lived and moved and had his being in a world very
different from that upon which we look out. There appear, indeed, to
have been various types of man, some as different from us as we are
from the anthropoid apes. What upstarts of yesterday are the Pharaohs in
comparison with the men who survived the tragedy of the glacial period!
The ancient history of man--only now beginning to be studied--dates
from the Pliocene or Miocene period; the modern history, as we know it,
embraces that brief space of time that has elapsed since the earliest
Egyptian and Babylonian records were made. This has to be borne in mind
in connection with the present mental status of man, particularly in his
outlook upon nature. In his thoughts and in his attributes, mankind at
large is controlled by inherited beliefs and impulses, which countless
thousands of years have ingrained like instinct. Over vast regions of
the earth today, magic, amulets, charms, incantations are the chief
weapons of defense against a malignant nature; and in disease, the
practice of Asa(*) is comparatively novel and unusual; in days of
illness many millions more still seek their gods rather than the
physicians. In an upward path man has had to work out for himself
a relationship with his fellows and with nature. He sought in the
supernatural an explanation of the pressing phenomena of life, peopling
the world with spiritual beings, deifying objects of nature, and
assigning to them benign or malign influences, which might be invoked or
propitiated. Primitive priest, physician and philosopher were one, and
struggled, on the one hand, for the recognition of certain practices
forced on him by experience, and on the other, for the recognition
of mystical agencies which control the dark, "uncharted region" about
him--to use Prof. Gilbert Murray's phrase--and were responsible for
everything he could not understand, and particularly for the mysteries
of disease. Pliny remarks that physic "was early fathered upon the
gods"; and to the ordinary non-medical mind, there is still something
mysterious about sickness, something outside the ordinary standard.

     (*) II Chronicles xvi, 12.

Modern anthropologists claim that both religion and medicine took origin
in magic, "that spiritual protoplasm," as Miss Jane Harrison calls it.
To primitive man, magic was the setting in motion of a spiritual power
to help or to hurt the individual, and early forms may still be studied
in the native races. This power, or "mana," as it is called, while
possessed in a certain degree by all, may be increased by practice.
Certain individuals come to possess it very strongly: among native
Australians today it is still deliberately cultivated. Magic in healing
seeks to control the demons, or forces; causing disease; and in a way it
may be thus regarded as a "lineal ancestor of modern science" (Whetham),
which, too, seeks to control certain forces, no longer, however,
regarded as supernatural.

Primitive man recognized many of these superhuman agencies relating
to disease, such as the spirits of the dead, either human or animal,
independent disease demons, or individuals who might act by controlling
the spirits or agencies of disease. We see this today among the <DW64>s
of the Southern States. A Hoodoo put upon a <DW64> may, if he knows of
it, work upon him so powerfully through the imagination that he becomes
very ill indeed, and only through a more powerful magic exercised by
someone else can the Hoodoo be taken off.

To primitive man life seemed "full of sacred presences" (Walter Pater)
connected with objects in nature, or with incidents and epochs in life,
which he began early to deify, so that, until a quite recent period, his
story is largely associated with a pantheon of greater and lesser
gods, which he has manufactured wholesale. Xenophanes was the earliest
philosopher to recognize man's practice of making gods in his own image
and endowing them with human faculties and attributes; the Thracians,
he said, made their gods blue-eyed and red-haired, the Ethiopians,
snub-nosed and black, while, if oxen and lions and horses had hands
and could draw, they would represent their gods as oxen and lions and
horses. In relation to nature and to disease, all through early history
we find a pantheon full to repletion, bearing testimony no less to the
fertility of man's imagination than to the hopes and fears which led
him, in his exodus from barbarism, to regard his gods as "pillars of
fire by night, and pillars of cloud by day."

Even so late a religion as that of Numa was full of little gods to be
invoked on special occasions--Vatican, who causes the infant to utter
his first cry, Fabulinus, who prompts his first word, Cuba, who keeps
him quiet in his cot, Domiduca, who watches over one's safe home-coming
(Walter Pater); and Numa believed that all diseases came from the gods
and were to be averted by prayer and sacrifice. Besides the major gods,
representatives of Apollo, AEsculapius and Minerva, there were scores of
lesser ones who could be invoked for special diseases. It is said that
the young Roman mother might appeal to no less than fourteen goddesses,
from Juno Lucina to Prosa and Portvorta (Withington). Temples were
erected to the Goddess of Fever, and she was much invoked. There is
extant a touching tablet erected by a mourning mother and inscribed:

     Febri divae, Febri
     Sancte, Febri magnae
     Camillo amato pro
     Filio meld effecto. Posuit.

It is marvellous what a long line of superhuman powers, major and minor,
man has invoked against sickness. In Swinburne's words:

     God by God flits past in thunder till his glories turn to shades,
     God by God bears wondering witness how his Gospel flames and
     fades;
     More was each of these, while yet they were, than man their
     servant seemed;
     Dead are all of these, and man survives who made them while he
     dreamed.

     Most of them have been benign and helpful gods.  Into the dark
     chapters relating to demonical possession and to witchcraft we
     cannot here enter. They make one cry out with Lucretius (Bk. V):

     O genus infelix humanum, talia divis
     Cum tribuit facta atque iras adjunxit acerbas!
     Quantos tum gemitus ipsi sibi, quantaque nobis
     Vulnera, quas lacrimas peperere minoribu' nostris.

In every age, and in every religion there has been justification for
his bitter words, "tantum religio potuit suadere malorum"--"Such wrongs
Religion in her train doth bring"--yet, one outcome of "a belief in
spiritual beings"--as Tylor defines religion--has been that man has
built an altar of righteousness in his heart. The comparative method
applied to the study of his religious growth has shown how man's
thoughts have widened in the unceasing purpose which runs through his
spiritual no less than his physical evolution. Out of the spiritual
protoplasm of magic have evolved philosopher and physician, as well
as priest. Magic and religion control the uncharted sphere--the
supernatural, the superhuman: science seeks to know the world, and
through knowing, to control it. Ray Lankester remarks that Man is
Nature's rebel, and goes on to say: "The mental qualities which have
developed in Man, though traceable in a vague and rudimentary condition
in some of his animal associates, are of such an unprecedented power and
so far dominate everything else in his activities as a living organism,
that they have to a very large extent, if not entirely, cut him off from
the general operation of that process of Natural Selection and survival
of the fittest which up to their appearance had been the law of the
living world. They justify the view that Man forms a new departure in
the gradual unfolding of Nature's predestined scheme. Knowledge, reason,
self-consciousness, will, are the attributes of Man."(1) It has been
a slow and gradual growth, and not until within the past century has
science organized knowledge--so searched out the secrets of Nature, as
to control her powers, limit her scope and transform her energies. The
victory is so recent that the mental attitude of the race is not yet
adapted to the change. A large proportion of our fellow creatures still
regard nature as a playground for demons and spirits to be exorcised or
invoked.

     (1) Sir E. Ray Lankester:  Romanes Lecture, "Nature and Man,"
     Oxford Univ. Press, 1905, p. 21.

Side by side, as substance and shadow--"in the dark backward and abysm
of time," in the dawn of the great civilizations of Egypt and Babylon,
in the bright morning of Greece, and in the full noontide of modern
life, together have grown up these two diametrically opposite views of
man's relation to nature, and more particularly of his personal relation
to the agencies of disease.

The purpose of this course of lectures is to sketch the main features of
the growth of these two dominant ideas, to show how they have influenced
man at the different periods of his evolution, how the lamp of reason,
so early lighted in his soul, burning now bright, now dim, has never,
even in his darkest period, been wholly extinguished, but retrimmed
and refurnished by his indomitable energies, now shines more and more
towards the perfect day. It is a glorious chapter in history, in which
those who have eyes to see may read the fulfilment of the promise of
Eden, that one day man should not only possess the earth, but that he
should have dominion over it! I propose to take an aeroplane flight
through the centuries, touching only on the tall peaks from which may be
had a panoramic view of the epochs through which we pass.




ORIGIN OF MEDICINE

MEDICINE arose out of the primal sympathy of man with man; out of the
desire to help those in sorrow, need and sickness.

     In the primal sympathy
     Which having been must ever be;
     In the soothing thoughts that spring
     Out of human suffering.

The instinct of self-preservation, the longing to relieve a loved one,
and above all, the maternal passion--for such it is--gradually softened
the hard race of man--tum genus humanum primum mollescere coepit. In
his marvellous sketch of the evolution of man, nothing illustrates more
forcibly the prescience of Lucretius than the picture of the growth of
sympathy: "When with cries and gestures they taught with broken words
that 'tis right for all men to have pity on the weak." I heard the
well-known medical historian, the late Dr. Payne, remark that "the basis
of medicine is sympathy and the desire to help others, and whatever is
done with this end must be called medicine."

The first lessons came to primitive man by injuries, accidents, bites
of beasts and serpents, perhaps for long ages not appreciated by his
childlike mind, but, little by little, such experiences crystallized
into useful knowledge. The experiments of nature made clear to him the
relation of cause and effect, but it is not likely, as Pliny suggests,
that he picked up his earliest knowledge from the observation of
certain practices in animals, as the natural phlebotomy of the plethoric
hippopotamus, or the use of emetics from the dog, or the use of enemata
from the ibis. On the other hand, Celsus is probably right in his
account of the origin of rational medicine. "Some of the sick on account
of their eagerness took food on the first day, some on account of
loathing abstained; and the disease in those who refrained was more
relieved. Some ate during a fever, some a little before it, others after
it had subsided, and those who had waited to the end did best. For the
same reason some at the beginning of an illness used a full diet, others
a spare, and the former were made worse. Occurring daily, such things
impressed careful men, who noted what had best helped the sick, then
began to prescribe them. In this way medicine had its rise from
the experience of the recovery of some, of the death of others,
distinguishing the hurtful from the salutary things" (Book I). The
association of ideas was suggestive--the plant eyebright was used for
centuries in diseases of the eye because a black speck in the flower
suggested the pupil of the eye. The old herbals are full of similar
illustrations upon which, indeed, the so-called doctrine of signatures
depends. Observation came, and with it an ever widening experience. No
society so primitive without some evidence of the existence of a healing
art, which grew with its growth, and became part of the fabric of its
organization.

With primitive medicine, as such, I cannot deal, but I must refer to
the oldest existing evidence of a very extraordinary practice, that of
trephining. Neolithic skulls with disks of bone removed have been found
in nearly all parts of the world. Many careful studies have been made
of this procedure, particularly by the great anatomist and surgeon,
Paul Broca, and M. Lucas-Championniere has covered the subject in a
monograph.(2) Broca suggests that the trephining was done by scratching
or scraping, but, as Lucas-Championniere holds, it was also done by a
series of perforations made in a circle with flint instruments, and a
round piece of skull in this way removed; traces of these drill-holes
have been found. The operation was done for epilepsy, infantile
convulsions, headache, and various cerebral diseases believed to be
caused by confined demons, to whom the hole gave a ready method of
escape.

     (2) Lucas-Championniere: Trepanation neolithique, Paris,
     1912.

The practice is still extant. Lucas-Championniere saw a Kabyle thoubib
who told him that it was quite common among his tribe; he was the son of
a family of trephiners, and had undergone the operation four times,
his father twelve times; he had three brothers also experts; he did not
consider it a dangerous operation. He did it most frequently for pain in
the head, and occasionally for fracture.

The operation was sometimes performed upon animals. Shepherds trephined
sheep for the staggers. We may say that the modern decompression
operation, so much in vogue, is the oldest known surgical procedure.




EGYPTIAN MEDICINE

OUT of the ocean of oblivion, man emerges in history in a highly
civilized state on the banks of the Nile, some sixty centuries ago.
After millenniums of a gradual upward progress, which can be traced in
the records of the stone age, civilization springs forth Minerva-like,
complete, and highly developed, in the Nile Valley. In this sheltered,
fertile spot, neolithic man first raised himself above his kindred races
of the Mediterranean basin, and it is suggested that by the accidental
discovery of copper Egypt "forged the instruments that raised
civilization out of the slough of the Stone Age" (Elliot Smith). Of
special interest to us is the fact that one of the best-known names
of this earliest period is that of a physician--guide, philosopher and
friend of the king--a man in a position of wide trust and importance.
On leaving Cairo, to go up the Nile, one sees on the right in the desert
behind Memphis a terraced pyramid 190 feet in height, "the first large
structure of stone known in history." It is the royal tomb of Zoser, the
first of a long series with which the Egyptian monarchy sought "to adorn
the coming bulk of death." The design of this is attributed to Imhotep,
the first figure of a physician to stand out clearly from the mists of
antiquity. "In priestly wisdom, in magic, in the formulation of wise
proverbs, in medicine and architecture, this remarkable figure of
Zoser's reign left so notable a reputation that his name was never
forgotten, and 2500 years after his death he had become a God of
Medicine, in whom the Greeks, who called him Imouthes, recognized their
own AEsculapius."(3) He became a popular god, not only healing men when
alive, but taking good care of them in the journeys after death. The
facts about this medicinae primus inventor, as he has been called, may
be gathered from Kurt Sethe's study.(4) He seems to have corresponded
very much to the Greek Asklepios. As a god he is met with comparatively
late, between 700 and 332 B.C. Numerous bronze figures of him remain.
The oldest memorial mentioning him is a statue of one of his priests,
Amasis (No. 14765 in the British Museum). Ptolemy V dedicated to him a
temple on the island of Philae. His cult increased much in later days,
and a special temple was dedicated to him near Memphis Sethe suggests
that the cult of Imhotep gave the inspiration to the Hermetic
literature. The association of Imhotep with the famous temple at Edfu is
of special interest.

     (3) Breasted:  A History of the Ancient Egyptians, Scribner,
     New York, 1908, p. 104.

     (4) K. Sethe:  Imhotep, der Asklepios der Aegypter, Leipzig,
     1909 (Untersuchungen, etc., ed. Sethe, Vol. II, No. 4).

Egypt became a centre from which civilization spread to the other
peoples of the Mediterranean. For long centuries, to be learned in all
the wisdom of the Egyptians meant the possession of all knowledge. We
must come to the land of the Nile for the origin of many of man's
most distinctive and highly cherished beliefs. Not only is there a
magnificent material civilization, but in records so marvellously
preserved in stone we may see, as in a glass, here clearly, there
darkly, the picture of man's search after righteousness, the earliest
impressions of his moral awakening, the beginnings of the strife
in which he has always been engaged for social justice and for the
recognition of the rights of the individual. But above all, earlier and
more strongly than in any other people, was developed the faith that
looked through death, to which, to this day, the noblest of their
monuments bear an enduring testimony. With all this, it is not
surprising to find a growth in the knowledge of practical medicine; but
Egyptian civilization illustrates how crude and primitive may remain a
knowledge of disease when conditioned by erroneous views of its nature.
At first, the priest and physician were identified, and medicine never
became fully dissociated from religion. Only in the later periods did
a special group of physicians arise who were not members of priestly
colleges.(6) Maspero states that the Egyptians believed that disease
and death were not natural and inevitable, but caused by some malign
influence which could use any agency, natural or invisible, and very
often belonged to the invisible world. "Often, though, it belongs to
the invisible world, and only reveals itself by the malignity of
its attacks: it is a god, a spirit, the soul of a dead man, that has
cunningly entered a living person, or that throws itself upon him
with irresistible violence. Once in possession of the body, the evil
influence breaks the bones, sucks out the marrow, drinks the blood,
gnaws the intestines and the heart and devours the flesh. The invalid
perishes according to the progress of this destructive work; and death
speedily ensues, unless the evil genius can be driven out of it before
it has committed irreparable damage. Whoever treats a sick person
has therefore two equally important duties to perform. He must first
discover the nature of the spirit in possession, and, if necessary, its
name, and then attack it, drive it out, or even destroy it. He can
only succeed by powerful magic, so he must be an expert in reciting
incantations, and skilful in making amulets. He must then use medicine
(drugs and diet) to contend with the disorders which the presence of the
strange being has produced in the body."(6)

     (5) Maspero:  Life in Ancient Egypt and Assyria, London,
     1891, p. 119.

     (6) Maspero:  Life in Ancient Egypt and Assyria, London,
     1891, p. 118.

     (7) W. Wreszinski:  Die Medizin der alten Aegypter, Leipzig,
     J. C. Hinrichs, 1909-1912.

In this way it came about that diseases were believed to be due to
hostile spirits, or caused by the anger of a god, so that medicines,
no matter how powerful, could only be expected to assuage the pain; but
magic alone, incantations, spells and prayers, could remove the disease.
Experience brought much of the wisdom we call empirical, and the
records, extending for thousands of years, show that the Egyptians
employed emetics, purgatives, enemata, diuretics, diaphoretics and
even bleeding. They had a rich pharmacopoeia derived from the animal,
vegetable and mineral kingdoms. In the later periods, specialism reached
a remarkable development, and Herodotus remarks that the country was
full of physicians;--"One treats only the diseases of the eye, another
those of the head, the teeth, the abdomen, or the internal organs."

Our knowledge of Egyptian medicine is derived largely from the
remarkable papyri dealing specially with this subject. Of these, six or
seven are of the first importance. The most famous is that discovered by
Ebers, dating from about 1500 B.C. A superb document, one of the
great treasures of the Leipzig Library, it is 20.23 metres long and 30
centimetres high and in a state of wonderful preservation. Others are
the Kahun, Berlin, Hearst and British Museum papyri. All these have now
been published--the last three quite recently, edited by Wreszinski.(7)
I show here a reproduction from which an idea may be had of these
remarkable documents. They are motley collections, filled with
incantations, charms, magical formulae, symbols, prayers and
prescriptions for all sorts of ailments. One is impressed by the
richness of the pharmacopoeia, and the high development which the art
of pharmacy must have attained. There were gargles, salves, snuffs,
inhalations, suppositories, fumigations, enemata, poultices and
plasters; and they knew the use of opium, hemlock, the copper salts,
squills and castor oil. Surgery was not very highly developed, but
the knife and actual cautery were freely used. Ophthalmic surgery was
practiced by specialists, and there are many prescriptions in the papyri
for ophthalmia.

One department of Egyptian medicine reached a high stage of development,
vis., hygiene. Cleanliness of the dwellings, of the cities and of the
person was regulated by law, and the priests set a splendid example in
their frequent ablutions, shaving of the entire body, and the spotless
cleanliness of their clothing. As Diodorus remarks, so evenly ordered
was their whole manner of life that it was as if arranged by a learned
physician rather than by a lawgiver.

Two world-wide modes of practice found their earliest illustration in
ancient Egypt. Magic, the first of these, represented the attitude of
primitive man to nature, and really was his religion. He had no idea
of immutable laws, but regarded the world about him as changeable and
fickle like himself, and "to make life go as he wished, he must be able
to please and propitiate or to coerce these forces outside himself."(8)

     (8) L. Thorndike:  The Place of Magic in the Intellectual
     History of Europe, New York, 1905, p. 29.

The point of interest to us is that in the Pyramid Texts--"the oldest
chapter in human thinking preserved to us, the remotest reach in the
intellectual history of man which we are now able to discern"(9)--one of
their six-fold contents relates to the practice of magic. A deep belief
existed as to its efficacy, particularly in guiding the dead, who
were said to be glorious by reason of mouths equipped with the charms,
prayers and ritual of the Pyramid Texts, armed with which alone could
the soul escape the innumerable dangers and ordeals of the passage
through another world. Man has never lost his belief in the efficacy
of magic, in the widest sense of the term. Only a very few of the most
intellectual nations have escaped from its shackles. Nobody else has
so clearly expressed the origins and relations of magic as Pliny in
his "Natural History."(10) "Now, if a man consider the thing well,
no marvaile it is that it hath continued thus in so great request and
authoritie; for it is the onely Science which seemeth to comprise in
itselfe three possessions besides, which have the command and rule
of mans mind above any other whatsoever. For to begin withall, no man
doubteth but that Magicke tooke root first, and proceeded from Physicke,
under the presence of maintaining health, curing, and preventing
diseases: things plausible to the world, crept and insinuated farther
into the heart of man, with a deepe conceit of some high and divine
matter therein more than ordinarie, and in comparison whereof, all
other Physicke was but basely accounted. And having thus made way and
entrance, the better to fortifie it selfe, and to give a goodly colour
and lustre to those fair and flattering promises of things, which our
nature is most given to hearken after, on goeth the habite also and
cloake of religion: a point, I may tell you, that even in these daies
holdeth captivate the spirit of man, and draweth away with it a greater
part of the world, and nothing so much. But not content with this
successe and good proceeding, to gather more strength and win a
greater name, shee entermingled with medicinable receipts and religious
ceremonies, the skill of Astrologie and arts Mathematicall; presuming
upon this, That all men by nature are very curious and desirous to know
their future fortunes, and what shall betide them hereafter, persuading
themselves, that all such foreknowledge dependeth upon the course and
influence of the starres, which give the truest and most certain light
of things to come. Being thus wholly possessed of men, and having their
senses and understanding by this meanes fast ynough bound with three
sure chains, no marvell if this art grew in processe of time to such
an head, that it was and is at this day reputed by most nations of
the earth for the paragon and cheefe of all sciences: insomuch as
the mightie kings and monarchs of the Levant are altogether ruled and
governed thereby."

     (9) Breasted:  Development of Religion and Thought in
     Ancient Egypt, New York, 1912, p. 84.

     (10) The Historie of the World, commonly called the Naturall
     Historie of C. Plinius Secundus, translated into English by
     Philemon Holland, Doctor in Physieke, London, 1601, Vol. II,
     p. 371, Bk. XXX, Chap. I, Sect. 1.

The second world-wide practice which finds its earliest record among
the Egyptians is the use secretions and parts of the animal body as
medicine. The practice was one of great antiquity with primitive man,
but the papyri already mentioned contain the earliest known records.
Saliva, urine, bile, faeces, various parts of the body, dried and
powdered, worms, insects, snakes were important ingredients in the
pharmacopoeia. The practice became very widespread throughout the
ancient world. Its extent and importance may be best gathered from
chapters VII and VIII in the 28th book of Pliny's "Natural History."
Several remedies are mentioned as derived from man; others from the
elephant, lion, camel, crocodile, and some seventy-nine are prepared
from the hyaena. The practice was widely prevalent throughout the
Middle Ages, and the pharmacopoeia of the seventeenth and even of the
eighteenth century contains many extraordinary ingredients. "The Royal
Pharmacopoeia" of Moses Charras (London ed., 1678), the most scientific
work of the day, is full of organotherapy and directions for the
preparation of medicines from the most loathsome excretions. A curious
thing is that with the discoveries of the mummies a belief arose as to
the great efficacy of powdered mummy in various maladies. As Sir Thomas
Browne remarks in his "Urn Burial": "Mummy has become merchandize.
Mizraim cures wounds, and Pharaoh is sold for balsams."

One formula in everyday use has come to us in a curious way from the
Egyptians. In the Osiris myth, the youthful Horus loses an eye in his
battle with Set. This eye, the symbol of sacrifice, became, next to the
sacred beetle, the most common talisman of the country, and all museums
are rich in models of the Horus eye in glass or stone.

"When alchemy or chemistry, which had its cradle in Egypt, and derived
its name from Khami, an old title for this country, passed to the hands
of the Greeks, and later of the Arabs, this sign passed with it. It
was also adopted to some extent by the Gnostics of the early Christian
church in Egypt. In a cursive form it is found in mediaeval translations
of the works of Ptolemy the astrologer, as the sign of the planet
Jupiter. As such it was placed upon horoscopes and upon formula
containing drugs made for administration to the body, so that the
harmful properties of these drugs might be removed under the influence
of the lucky planet. At present, in a slightly modified form, it still
figures at the top of prescriptions written daily in Great Britain
(Rx)."(11)

     (11) John D. Comrie:  Medicine among the Assyrians and
     Egyptians in 1500 B.C., Edinburgh Medical Journal, 1909, n.
     s., II, 119.

For centuries Egyptian physicians had a great reputation, and in the
Odyssey (Bk. IV), Polydamna, the wife of Thonis, gives medicinal plants
to Helen in Egypt--"a country producing an infinite number of drugs
. . . where each physician possesses knowledge above all other men."
Jeremiah (xlvi, 11) refers to the virgin daughter of Egypt, who should
in vain use many medicines. Herodotus tells that Darius had at his court
certain Egyptians, whom he reckoned the best skilled physicians in all
the world, and he makes the interesting statement that: "Medicine is
practiced among them on a plan of separation; each physician treats
a single disorder, and no more: thus the country swarms with medical
practitioners, some under taking to cure diseases of the eye, others of
the head, others again of the teeth, others of the intestines, and some
those which are not local."(12)

     (12) The History of Herodotus, Blakesley's ed., Bk. II, 84.

A remarkable statement is made by Pliny, in the discussion upon the
use of radishes, which are said to cure a "Phthisicke," or ulcer of the
lungs--"proofe whereof was found and seen in AEgypt by occasion that the
KK. there, caused dead bodies to be cut up, and anatomies to be made,
for to search out the maladies whereof men died."(13)

     (13) Pliny, Holland's translation, Bk. XIX, Chap. V, Sect.
     26.

The study of the anatomy of mummies has thrown a very interesting light
upon the diseases of the ancient Egyptians, one of the most prevalent
of which appears to have been osteo-arthritis. This has been studied by
Elliot Smith, Wood Jones, Ruffer and Rietti. The majority of the lesions
appear to have been the common osteo-arthritis, which involved not only
the men, but many of the pet animals kept in the temples. In a much
higher proportion apparently than in modern days, the spinal column was
involved. It is interesting to note that the "determinative" of old age
in hieroglyphic writing is the picture of a man afflicted with arthritis
deformans. Evidences of tuberculosis, rickets and syphilis, according to
these authors, have not been found.

A study of the internal organs has been made by Ruffer, who has shown
that arterio-sclerosis with calcification was a common disease 8500
years ago; and he holds that it could not have been associated with hard
work or alcohol, for the ancient Egyptians did not drink spirits, and
they had practically the same hours of work as modern Egyptians, with
every seventh day free.




ASSYRIAN AND BABYLONIAN MEDICINE

OF equally great importance in the evolution of medicine was the
practically contemporary civilization in Mesopotamia. Science here
reached a much higher stage then in the valley of the Nile. An elaborate
scheme of the universe was devised, a system growing out of the
Divine Will, and a recognition for the first time of a law guiding
and controlling heaven and earth alike. Here, too, we find medicine
ancillary to religion. Disease was due to evil spirits or demons. "These
'demons'--invisible to the naked eye were the precursors of the modern
'germs' and 'microbes,' while the incantations recited by the priests
are the early equivalents of the physician's prescriptions. There
were different incantations for different diseases; and they were
as mysterious to the masses as are the mystic formulas of the modern
physician to the bewildered, yet trusting, patient. Indeed, their
mysterious character added to the power supposed to reside in the
incantations for driving the demons away. Medicinal remedies accompanied
the recital of the incantations, but despite the considerable progress
made by such nations of hoary antiquity as the Egyptians and Babylonians
in the diagnosis and treatment of common diseases, leading in time to
the development of an extensive pharmacology, so long as the cure
of disease rested with the priests, the recital of sacred formulas,
together with rites that may be conveniently grouped under the head of
sympathetic magic, was regarded as equally essential with the taking of
the prescribed remedies."(14)

     (14) Morris Jastrow:  The Liver in Antiquity and the
     Beginnings of Anatomy.  Transactions College of Physicians,
     Philadelphia, 1907, 3. s., XXIX, 117-138.

Three points of interest may be referred to in connection with
Babylonian medicine. Our first recorded observations on anatomy are in
connection with the art of divination--the study of the future by the
interpretation of certain signs. The student recognized two divisions
of divination--the involuntary, dealing with the interpretation of signs
forced upon our attention, such as the phenomena of the heavens, dreams,
etc., and voluntary divination, the seeking of signs, more particularly
through the inspection of sacrificial animals. This method reached an
extraordinary development among the Babylonians, and the cult spread to
the Etruscans, Hebrews, and later to the Greeks and Romans.

Of all the organs inspected in a sacrificial animal the liver, from its
size, position and richness in blood, impressed the early observers as
the most important of the body. Probably on account of the richness in
blood it came to be regarded as the seat of life--indeed, the seat of
the soul. From this important position the liver was not dislodged for
many centuries, and in the Galenic physiology it shared with the heart
and the brain in the triple control of the natural, animal and vital
spirits. Many expressions in literature indicate how persistent was this
belief. Among the Babylonians, the word "liver" was used in hymns and
other compositions precisely as we use the word "heart," and Jastrow
gives a number of illustrations from Hebrew, Greek and Latin sources
illustrating this usage.

The belief arose that through the inspection of this important organ in
the sacrificial animal the course of future events could be predicted.
"The life or soul, as the seat of life, in the sacrificial animal is,
therefore, the divine element in the animal, and the god in accepting
the animal, which is involved in the act of bringing it as an offering
to a god, identifies himself with the animal--becomes, as it were, one
with it. The life in the animal is a reflection of his own life,
and since the fate of men rests with the gods, if one can succeed in
entering into the mind of a god, and thus ascertain what he purposes to
do, the key for the solution of the problem as to what the future has in
store will have been found. The liver being the centre of vitality--the
seat of the mind, therefore, as well as of the emotions--it becomes in
the case of the sacrificial animal, either directly identical with the
mind of the god who accepts the animal, or, at all events, a mirror in
which the god's mind is reflected; or, to use another figure, a watch
regulated to be in sympathetic and perfect accord with a second watch.
If, therefore, one can read the liver of the sacrificial animal, one
enters, as it were, into the workshop of the divine will."(15)

     (15) Morris Jastrow: loc. cit., p. 122.

Hepatoscopy thus became, among the Babylonians, of extraordinary
complexity, and the organ of the sheep was studied and figured as early
as 3000 B.C. In the divination rites, the lobes, the gall-bladder, the
appendages of the upper lobe and the markings were all inspected with
unusual care. The earliest known anatomical model, which is here shown,
is the clay model of a sheep's liver with the divination text dating
from about 2000 B.C., from which Jastrow has worked out the modern
anatomical equivalents of the Babylonian terms. To reach a decision on
any point, the phenomena of the inspection of the liver were carefully
recorded, and the interpretations rested on a more or less natural and
original association of ideas. Thus, if the gall-bladder were swollen on
the right side, it pointed to an increase in the strength of the King's
army, and was favorable; if on the left side, it indicated rather
success of the enemy, and was unfavorable. If the bile duct was long, it
pointed to a long life. Gallstones are not infrequently mentioned in
the divination texts and might be favorable, or unfavorable. Various
interpretations were gathered by the scribes in the reference note-books
which serve as guides for the interpretation of the omens and for
text-books of instructions in the temple schools (Jastrow).

The art of divination spread widely among the neighboring nations. There
are many references in the Bible to the practice. The elders of Moab
and Midian came to Balaam "with the rewards of divination in their hand"
(Numbers xxii, 7). Joseph's cup of divination was found in Benjamin's
sack (Genesis xliv, 5, 12); and in Ezekiel (xxi, 21) the King of Babylon
stood at the parting of the way and looked in the liver. Hepatoscopy was
also practiced by the Etruscans, and from them it passed to the
Greeks and the Romans, among whom it degenerated into a more or less
meaningless form. But Jastrow states that in Babylonia and Assyria,
where for several thousand years the liver was consistently employed
as the sole organ of divination, there are no traces of the rite having
fallen into decay, or having been abused by the priests.

In Roman times, Philostratus gives an account of the trial of Apollonius
of Tyana,(16) accused of human hepatoscopy by sacrificing a boy in
the practice of magic arts against the Emperor. "The liver, which the
experts say is the very tripod of their art, does not consist of pure
blood; for the heart retains all the uncontaminated blood, and irrigates
the whole body with it by the conduits of the arteries; whereas the
gall, which is situated next the liver, is stimulated by anger and
depressed by fear into the hollows of the liver."

We have seen how early and how widespread was the belief in amulets and
charms against the occult powers of darkness. One that has persisted
with extraordinary tenacity is the belief in the Evil Eye the power
of certain individuals to injure with a look. Of general belief in the
older civilizations, and referred to in several places in the Bible,
it passed to Greece and Rome, and today is still held fervently in many
parts of Europe. The sign of "le corna,"--the first and fourth fingers
extended, the others turned down and the thumb closed over them,--still
used against the Evil Eye in Italy, was a mystic sign used by the Romans
in the festival of Lemuralia. And we meet with the belief also in this
country. A child with hemiplegia, at the Infirmary for Diseases of the
Nervous System, Philadelphia, from the central part of Pennsylvania, was
believed by its parents to have had the Evil Eye cast upon it.

The second contribution of Babylonia and Assyria to medicine--one that
affected mankind profoundly--relates to the supposed influence of the
heavenly bodies upon man's welfare. A belief that the stars in their
courses fought for or against him arose early in their civilizations,
and directly out of their studies on astrology and mathematics. The
Macrocosm, the heavens that "declare the glory of God," reflect, as in
a mirror, the Microcosm, the daily life of man on earth. The first step
was the identification of the sun, moon and stars with the gods of
the pantheon. Assyrian astronomical observations show an extraordinary
development of practical knowledge. The movements of the sun and moon
and of the planets were studied; the Assyrians knew the precession of
the equinoxes and many of the fundamental laws of astronomy, and the
modern nomenclature dates from their findings. In their days the signs
of the zodiac corresponded practically with the twelve constellations
whose names they still bear, each division being represented by the
symbol of some god, as the Scorpion, the Ram, the Twins, etc. "Changes
in the heavens . . . portended changes on earth. The Biblical expression
'hosts of heaven' for the starry universe admirably reflects the
conception held by the Babylonian astrologers. Moon, planets and stars
constituted an army in constant activity, executing military manoeuvres
which were the result of deliberation and which had in view a fixed
purpose. It was the function of the priest--the barqu, or 'inspector,'
as the astrologer as well as the 'inspector' of the liver was called--to
discover this purpose. In order to do so, a system of interpretation was
evolved, less logical and less elaborate than the system of hepatoscopy,
which was analyzed in the preceding chapter, but nevertheless meriting
attention both as an example of the pathetic yearning of men to
peer into the minds of the gods, and of the influence that
Babylonian-Assyrian astrology exerted throughout the ancient world"
(Jastrow).(17)

     (16) Philostratus:  Apollonius of Tyana, Bk. VIII, Chap.
     VII, Phillimore's transl., Oxford, 1912, II, 233.  See,
     also, Justin: Apologies, edited by Louis Pautigny, Paris,
     1904, p. 39.

     (17) M. Jastrow:  Aspects of Religious Belief and Practice
     in Babylonia and Assyria, New York, 1911, p. 210.

With the rationalizing influence of the Persians the hold of astrology
weakened, and according to Jastrow it was this, in combination with
Hebrew and Greek modes of thought, that led the priests in the three
centuries following the Persian occupation, to exchange their profession
of diviners for that of astronomers; and this, he says, marks the
beginning of the conflict between religion and science. At first an
expression of primitive "science," astrology became a superstition, from
which the human mind has not yet escaped. In contrast to divination,
astrology does not seem to have made much impression on the Hebrews and
definite references in the Bible are scanty. From Babylonia it passed to
Greece (without, however, exerting any particular influence upon Greek
medicine). Our own language is rich in words of astral significance
derived from the Greek, e.g., disaster.

The introduction of astrology into Europe has a passing interest.
Apparently the Greeks had made important advances in astronomy before
coming in contact with the Babylonians,--who, in all probability,
received from the former a scientific conception of the universe. "In
Babylonia and Assyria we have astrology first and astronomy afterwards,
in Greece we have the sequence reversed--astronomy first and astrology
afterwards" (Jastrow).(18)

     (18) M. Jastrow:  Aspects of Religious Belief and Practice
     in Babylonia and Assyria, New York, 1911, p. 256.

It is surprising to learn that, previous to their contact with the
Greeks, astrology as relating to the individual--that is to say,
the reading of the stars to determine the conditions under which the
individual was born--had no place in the cult of the Babylonians and
Assyrians. The individualistic spirit led the Greek to make his gods
take note of every action in his life, and his preordained fate might
be read in the stars.--"A connecting link between the individual and the
movements in the heavens was found in an element which they shared in
common. Both man and stars moved in obedience to forces from which there
was no escape. An inexorable law controlling the planets corresponded to
an equally inexorable fate ordained for every individual from his birth.
Man was a part of nature and subject to its laws. The thought could
therefore arise that, if the conditions in the heavens were studied
under which a man was born, that man's future could be determined in
accord with the beliefs associated with the position of the planets
rising or visible at the time of birth or, according to other views, at
the time of conception. These views take us back directly to the system
of astrology developed by Babylonian baru priests. The basis on which
the modified Greek system rests is likewise the same that we have
observed in Babylonia--a correspondence between heaven and earth, but
with this important difference, that instead of the caprice of the
gods we have the unalterable fate controlling the entire universe--the
movements of the heavens and the life of the individual alike"
(Jastrow).(19)

     (19) Ibid., pp. 257-258.

From this time on until the Renaissance, like a shadow, astrology
follows astronomy. Regarded as two aspects of the same subject, the one,
natural astrology, the equivalent of astronomy, was concerned with the
study of the heavens, the other, judicial astrology, was concerned with
the casting of horoscopes, and reading in the stars the fate of the
individual.

As I mentioned, Greek science in its palmy days seems to have been very
free from the bad features of astrology. Gilbert Murray remarks that
"astrology fell upon the Hellenistic mind as a new disease falls upon
some remote island people." But in the Greek conquest of the Roman mind,
astrology took a prominent role. It came to Rome as part of the great
Hellenizing movement, and the strength of its growth may be gauged from
the edicts issued against astrologers as early as the middle of the
second century B.C. In his introduction to his recent edition of Book II
of the Astronomicon of Manilius, Garrod traces the growth of the
cult, which under the Empire had an extraordinary vogue. "Though these
(heavenly) signs be far removed from us, yet does he (the god) so make
their influences felt, that they give to nations their life and their
fate and to each man his own character."(20) Oracles were sought on all
occasions, from the planting of a tree to the mating of a horse, and the
doctrine of the stars influenced deeply all phases of popular thought
and religion. The professional astrologers, as Pliny(21) says, were
Chaldeans, Egyptians and Greeks. The Etruscans, too, the professional
diviners of Rome, cultivated the science. Many of these "Isiaci
conjectores" and "astrologi de circo" were worthless charlatans, but
on the whole the science seems to have attracted the attention of
thoughtful men of the period. Garrod quotes the following remarkable
passage from Tacitus: "My judgment wavers," he says, "I dare not say
whether it be fate and necessity immutable which governs the changing
course of human affairs--or just chance. Among the wisest of the
ancients, as well as among their apes, you will find a conflict of
opinion. Many hold fixedly the idea that our beginning and our end--that
man himself--is nothing to the Gods at all. The wicked are in prosperity
and the good meet tribulation. Others believe that Fate and the facts
of this world work together. But this connection they trace not to
planetary influences but to a concatenation of natural causes. We choose
our life that is free: but the choice once made, what awaits us is fixed
and ordered. Good and evil are different from the vulgar opinion of
them. Often those who seem to battle with adversity are to be accounted
blessed; but the many, even in their prosperity, are miserable. It needs
only to bear misfortune bravely, while the fool perishes in his wealth.
Outside these rival schools stands the man in the street. No one will
take from him his conviction that at our birth are fixed for us the
things that shall be. If some things fall out differently from what was
foretold, that is due to the deceit of men that speak what they know
not: calling into contempt a science to which past and present alike
bear a glorious testimony" (Ann. vi, 22).

     (20) Manili Astronomicon Liber II, ed. H. W. Garrod, Oxford,
     1911, p. lxix, and II, ll. 84-86.

     (21) Pliny:  Natural History, Bk. XVIII, Chap. XXV, Sect.
     57.

Cato waged war on the Greek physicians and forbade "his uilicus all
resort to haruspicem, augurem, hariolum Chaldaeum," but in vain; so
widespread became the belief that the great philosopher, Panaetius (who
died about 111 B.C.), and two of his friends alone among the stoics,
rejected the claims of astrology as a science (Garrod). So closely
related was the subject of mathematics that it, too, fell into
disfavor, and in the Theodosian code sentence of death was passed upon
mathematicians. Long into the Middle Ages, the same unholy alliance
with astrology and divination caused mathematics to be regarded with
suspicion, and even Abelard calls it a nefarious study.

The third important feature in Babylonian medicine is the evidence
afforded by the famous Hammurabi Code (circa 2000 B.C.)--a body of laws,
civil and religious, many of which relate to the medical profession.
This extraordinary document is a black diorite block 8 feet high, once
containing 21 columns on the obverse, 16 and 28 columns on the reverse,
with 2540 lines of writing of which now 1114 remain, and surmounted by
the figure of the king receiving the law from the Sun-god. Copies of
this were set up in Babylon "that anyone oppressed or injured, who had
a tale of woe to tell, might come and stand before his image, that of a
king of righteousness, and there read the priceless orders of the King,
and from the written monument solve his problem" (Jastrow). From the
enactments of the code we gather that the medical profession must have
been in a highly organized state, for not only was practice regulated
in detail, but a scale of fees was laid down, and penalties exacted
for malpraxis. Operations were performed, and the veterinary art was
recognized. An interesting feature, from which it is lucky that we have
in these days escaped, is the application of the "lex talionis"--an eye
for an eye, bone for a bone, and tooth for a tooth, which is a striking
feature of the code.

Some of the laws of the code may be quoted:


Paragraph 215. If a doctor has treated a gentleman for a severe wound
with a bronze lances and has cured the man, or has opened an abscess of
the eye for a gentleman with the bronze lances and has cured the eye of
the gentleman, he shall take ten shekels of silver.

218. If the doctor has treated a gentleman for a severe wound with a
lances of bronze and has caused the gentleman to die, or has opened
an abscess of the eye for a gentleman and has caused the loss of the
gentleman's eye, one shall cut off his hands.

219. If a doctor has treated the severe wound of a slave of a poor man
with a bronze lances and has caused his death, he shall render slave for
slave.

220. If he has opened his abscess with a bronze lances and has made him
lose his eye, he shall pay money, half his price.

221. If a doctor has cured the shattered limb of a gentleman, or has
cured the diseased bowel, the patient shall give five shekels of silver
to the doctor.

224. If a cow doctor or a sheep doctor has treated a cow or a sheep for
a severe wound and cured it, the owner of the cow or sheep shall give
one-sixth of a shekel of silver to the doctor as his fee.(22)

     (22) The Oldest Code of Laws in the World; translated by C.
     H. W. Johns, Edinburgh, 1903.




HEBREW MEDICINE

THE medicine of the Old Testament betrays both Egyptian and Babylonian
influences; the social hygiene is a reflex of regulations the origin
of which may be traced in the Pyramid Texts and in the papyri. The
regulations in the Pentateuch codes revert in part to primitive times,
in part represent advanced views of hygiene. There are doubts if the
Pentateuch code really goes back to the days of Moses, but certainly
someone "learned in the wisdom of the Egyptians" drew it up. As
Neuburger briefly summarizes:

"The commands concern prophylaxis and suppression of epidemics,
suppression of venereal disease and prostitution, care of the skin,
baths, food, housing and clothing, regulation of labour, sexual life,
discipline of the people, etc. Many of these commands, such as Sabbath
rest, circumcision, laws concerning food (interdiction of blood and
pork), measures concerning menstruating and lying-in women and those
suffering from gonorrhoea, isolation of lepers, and hygiene of the
camp, are, in view of the conditions of the climate, surprisingly
rational."(23)

     (23) Neuburger:  History of Medicine, Oxford University
     Press, 1910, Vol. I, p. 38.

Divination, not very widely practiced, was borrowed, no doubt, from
Babylonia. Joseph's cup was used for the purpose, and in Numbers, the
elders of Balak went to Balaam with the rewards of divination in their
hands. The belief in enchantments and witchcraft was universal, and the
strong enactments against witches in the Old Testament made a belief in
them almost imperative until more rational beliefs came into vogue in
the eighteenth and nineteenth centuries.

Whatever view we may take of it, the medicine of the New Testament is
full of interest. Divination is only referred to once in the Acts (xvi,
16), where a damsel is said to be possessed of a spirit of divination
"which brought her masters much gain by soothsaying." There is only one
mention of astrology (Acts vii, 43); there are no witches, neither
are there charms or incantations. The diseases mentioned are numerous:
demoniac possession, convulsions, paralysis, skin diseases,--as
leprosy,--dropsy, haemorrhages, fever, fluxes, blindness and deafness.
And the cure is simple usually a fiat of the Lord, rarely with a prayer,
or with the use of means such as spittle. They are all miraculous,
and the same power was granted to the apostles--"power against unclean
spirits, to cast them out, to heal all manner of sickness and all manner
of disease." And more than this, not only the blind received their
sight, the lame walked, the lepers were cleansed, the deaf heard, but
even the dead were raised up. No question of the mandate. He who went
about doing good was a physician of the body as well as of the soul, and
could the rich promises of the Gospel have been fulfilled, there would
have been no need of a new dispensation of science. It may be because
the children of this world have never been able to accept its hard
sayings--the insistence upon poverty, upon humility, upon peace that
Christianity has lost touch no less with the practice than with the
principles of its Founder. Yet, all through the centuries, the Church
has never wholly abandoned the claim to apostolic healing; nor is there
any reason why she should. To the miraculous there should be no
time limit--only conditions have changed and nowadays to have a
mountain-moving faith is not easy. Still, the possession is cherished,
and it adds enormously to the spice and variety of life to know that men
of great intelligence, for example, my good friend, Dr. James J. Walsh
of New York, believe in the miracles of Lourdes.(24) Only a few weeks
ago, the Bishop of London followed with great success, it is said, the
practice of St. James. It does not really concern us much--as Oriental
views of disease and its cure have had very little influence on
the evolution of scientific medicine--except in illustration of the
persistence of an attitude towards disease always widely prevalent,
and, indeed, increasing. Nor can we say that the medicine of our great
colleague, St. Luke, the Beloved Physician, whose praise is in the
Gospels, differs so fundamentally from that of the other writings of the
New Testament that we can claim for it a scientific quality. The stories
of the miracles have technical terms and are in a language adorned
by medical phraseology, but the mental attitude towards disease
is certainly not that of a follower of Hippocrates, nor even of a
scientifically trained contemporary of Dioscorides.(25)

     (24) Psychotherapy, New York, 1919, p. 79, "I am convinced
     that miracles happen there. There is more than natural power
     manifest."

     (25) See Luke the Physician, by Harnack, English ed., 1907,
     and W. K. Hobart, The Medical Language of St. Luke, 1882.




CHINESE AND JAPANESE MEDICINE

CHINESE medicine illustrates the condition at which a highly
intellectual people may arrive, among whom thought and speculation were
restricted by religious prohibitions. Perhaps the chief interest in its
study lies in the fact that we may see today the persistence of views
about disease similar to those which prevailed in ancient Egypt and
Babylonia. The Chinese believe in a universal animism, all parts being
animated by gods and spectres, and devils swarm everywhere in numbers
incalculable. The universe was spontaneously created by the operation
of its Tao, "composed of two souls, the Yang and the Yin; the Yang
represents light, warmth, production, and life, as also the celestial
sphere from which all those blessings emanate; the Yin is darkness,
cold, death, and the earth, which, unless animated by the Yang or
heaven, is dark, cold, dead. The Yang and the Yin are divided into an
infinite number of spirits respectively good and bad, called shen and
kwei; every man and every living being contains a shen and a kwei,
infused at birth, and departing at death, to return to the Yang and the
Yin. Thus man with his dualistic soul is a microcosmos, born from the
Macrocosmos spontaneously. Even every object is animated, as well as the
Universe of which it is a part."(26)

     (26) J. J. M. de Groot:  Religious System of China, Vol. VI,
     Leyden, 1910, p. 929.

In the animistic religion of China, the Wu represented a group of
persons of both sexes, who wielded, with respect to the world of
spirits, capacities and powers not possessed by the rest of men. Many
practitioners of Wu were physicians who, in addition to charms and
enchantments, used death-banishing medicinal herbs. Of great antiquity,
Wu-ism has changed in some ways its outward aspect, but has not altered
its fundamental characters. The Wu, as exorcising physicians and
practitioners of the medical art, may be traced in classical literature
to the time of Confucius. In addition to charms and spells, there were
certain famous poems which were repeated, one of which, by Han Yu, of
the T'ang epoch, had an extraordinary vogue. De Groot says that the
"Ling," or magical power of this poem must have been enormous, seeing
that its author was a powerful mandarin, and also one of the loftiest
intellects China has produced. This poetic febrifuge is translated in
full by de Groot (VI, 1054-1055), and the demon of fever, potent chiefly
in the autumn, is admonished to begone to the clear and limpid waters of
the deep river.

In the High Medical College at Court, in the T'ang Dynasty, there
were four classes of Masters, attached to its two High Medical Chiefs:
Masters of Medicine, of Acupuncture, of Manipulation, and two Masters
for Frustration by means of Spells.

Soothsaying and exorcism may be traced far back to the fifth and sixth
centuries B.C.

In times of epidemic the specialists of Wu-ism, who act as seers,
soothsayers and exorcists, engage in processions, stripped to the waist,
dancing in a frantic, delirious state, covering themselves with blood by
means of prick-balls, or with needles thrust through their tongues, or
sitting or stretching themselves on nail points or rows of sword edges.
In this way they frighten the spectres of disease. They are nearly
all young, and are spoken of as "divining youths," and they use an
exorcising magic based on the principle that legions of spectres prone
to evil live in the machine of the world. (De Groot, VI, 983-985.)

The Chinese believe that it is the Tao, or "Order of the Universe,"
which affords immunity from evil, and according to whether or no the
birth occurred in a beneficent year, dominated by four double cyclical
characters, the horoscope is "heavy" or "light." Those with light
horoscopes are specially prone to incurable complaints, but much harm
can be averted if such an individual be surrounded with exorcising
objects, if he be given proper amulets to wear and proper medicines to
swallow, and by selecting for him auspicious days and hours.

Two or three special points may be referred to. The doctrine of the
pulse reached such extraordinary development that the whole practice
of the art centred round its different characters. There were scores
of varieties, which in complication and detail put to confusion the
complicated system of some of the old Graeco-Roman writers. The basic
idea seems to have been that each part and organ had its own proper
pulse, and just as in a stringed instrument each chord has its own tone,
so in the human body, if the pulses were in harmony, it meant health; if
there was discord, it meant disease. These Chinese views reached
Europe in the seventeenth and eighteenth centuries, and there is a very
elaborate description of them in Floyer's well-known book.(27) And the
idea of harmony in the pulse is met with into the eighteenth century.

     (27) Sir John Floyer:  The Physician's Pulse Watch, etc.,
     London, 1707.

Organotherapy was as extensively practiced in China as in Egypt. Parts
of organs, various secretions and excretions are very commonly used. One
useful method of practice reached a remarkable development, viz., the
art of acupuncture--the thrusting of fine needles more or less deeply
into the affected part. There are some 388 spots on the body in which
acupuncture could be performed, and so well had long experience taught
them as to the points of danger, that the course of the arteries may be
traced by the tracts that are avoided. The Chinese practiced inoculation
for smallpox as early as the eleventh century.

Even the briefest sketch of the condition of Chinese medicine leaves the
impression of the appalling stagnation and sterility that may afflict a
really intelligent people for thousands of years. It is doubtful if they
are today in a very much more advanced condition than were the Egyptians
at the time when the Ebers Papyrus was written. From one point of view
it is an interesting experiment, as illustrating the state in which
a people may remain who have no knowledge of anatomy, physiology or
pathology.

Early Japanese medicine has not much to distinguish it from the Chinese.
At first purely theurgic, the practice was later characterized by
acupuncture and a refined study of the pulse. It has an extensive
literature, largely based upon the Chinese, and extending as far back as
the beginning of the Christian era. European medicine was introduced by
the Portuguese and the Dutch, whose "factory" or "company" physicians
were not without influence upon practice. An extraordinary stimulus was
given to the belief in European medicine by a dissection made by
Mayeno in 1771 demonstrating the position of the organs as shown in
the European anatomical tables, and proving the Chinese figures to be
incorrect. The next day a translation into Japanese of the anatomical
work of Kulmus was begun, and from its appearance in 1773 may be dated
the commencement of reforms in medicine. In 1793, the work of de Gorter
on internal medicine was translated, and it is interesting to know that
before the so-called "opening of Japan" many European works on medicine
had been published. In 1857, a Dutch medical school was started in Yedo.
Since the political upheaval in 1868, Japan has made rapid progress in
scientific medicine, and its institutions and teachers are now among the
best known in the world.(28)

     (28) See Y. Fujikawa, Geschichte der Medizin in Japan,
     Tokyo, 1911.




CHAPTER II -- GREEK MEDICINE

OGRAIAE gentis decus! let us sing with Lucretius, one of the great
interpreters of Greek thought. How grand and how true is his paean!

     Out of the night, out of the blinding night
     Thy beacon flashes;--hail, beloved light
     Of Greece and Grecian; hail, for in the mirk
     Thou cost reveal each valley and each height.

     Thou art my leader, and the footprints shine,
     Wherein I plant my own....

     * * * * *

     The world was shine to read, and having read,
     Before thy children's eyes thou didst outspread
     The fruitful page of knowledge, all the wealth
     Of wisdom, all her plenty for their bread.

     (Bk. III.--Translated by D. A. Slater.)


     Let us come out of the murky night of the East, heavy with
     phantoms,
     into the bright daylight of the West, into the company of men
     whose
     thoughts made our thoughts, and whose ways made our ways--the men
     who first dared to look on nature with the clear eyes of the
     mind.

Browning's famous poem, "Childe Roland to the Dark Tower Came," is an
allegory of the pilgrimage of man through the dark places of the earth,
on a dismal path beset with demons, and strewn with the wreckage of
generations of failures. In his ear tolled the knell of all the lost
adventurers, his peers, all lost, lost within sight of the dark Tower
itself--

     The round squat turret, blind as the fool's heart,
     Built of brown stone, without a counterpart
     In the whole world.

lost in despair at an all-encircling mystery. Not so the Greek Childe
Roland who set the slug-horn to his lips and blew a challenge. Neither
Shakespeare nor Browning tells us what happened, and the old legend,
Childe Roland, is the incarnation of the Greek spirit, the young,
light-hearted master of the modern world, at whose trumpet blast the
dark towers of ignorance, superstition and deceit have vanished into
thin air, as the baseless fabric of a dream. Not that the jeering
phantoms have flown! They still beset, in varied form, the path of each
generation; but the Achaian Childe Roland gave to man self-confidence,
and taught him the lesson that nature's mysteries, to be solved, must
be challenged. On a portal of one of the temples of Isis in Egypt was
carved: "I am whatever hath been, is, or ever will be, and my veil no
man has yet lifted."

The veil of nature the Greek lifted and herein lies his value to us.
What of this Genius? How did it arise among the peoples of the AEgean
Sea? Those who wish to know the rock whence science was hewn may read
the story told in vivid language by Professor Gomperz in his "Greek
Thinkers," the fourth volume of which has recently been published
(Murray, 1912; Scribner, 1912). In 1912, there was published a book by
one of the younger Oxford teachers, "The Greek Genius and Its Meaning to
Us,"(1) from which those who shrink from the serious study of Gomperz'
four volumes may learn something of the spirit of Greece. Let me quote a
few lines from his introduction:

     (1) By R. W. Livingstone, Clarendon Press, Oxford, 1912 (2d
     ed., revised, 1915).

"Europe has nearly four million square miles; Lancashire has 1,700;
Attica has 700. Yet this tiny country has given us an art which we,
with it and all that the world has done since it for our models, have
equalled perhaps, but not surpassed. It has given us the staple of our
vocabulary in every domain of thought and knowledge. Politics, tyranny,
democracy, anarchism, philosophy, physiology, geology, history--these
are all Greek words. It has seized and up to the present day kept hold
of our higher education. It has exercised an unfailing fascination, even
on minds alien or hostile. Rome took her culture thence. Young Romans
completed their education in the Greek schools.... And so it was with
natures less akin to Greece than the Roman. St. Paul, a Hebrew of the
Hebrews, who called the wisdom of the Greeks foolishness, was drawn
to their Areopagus, and found himself accommodating his gospel to the
style, and quoting verses from the poets of this alien race. After him,
the Church, which was born to protest against Hellenism, translated its
dogmas into the language of Greek thought and finally crystallized them
in the philosophy of Aristotle."

Whether a plaything of the gods or a cog in the wheels of the universe
this was the problem which life offered to the thinking Greek; and in
undertaking its solution, he set in motion the forces that have made
our modern civilization. That the problem remains unsolved is nothing
in comparison with the supreme fact that in wrestling with it, and in
studying the laws of the machine, man is learning to control the
small section of it with which he is specially concerned. The veil of
thaumaturgy which shrouded the Orient, while not removed, was rent in
twain, and for the first time in history, man had a clear vision of the
world about him--"had gazed on Nature's naked loveliness" ("Adonais")
unabashed and unaffrighted by the supernatural powers about him. Not
that the Greek got rid of his gods--far from it!--but he made them so
like himself, and lived on terms of such familiarity with them that they
inspired no terror.(2)

     (2) "They made deities in their own image, in the likeness
     of an image of corruptible man.  Sua cuique deu fit dira
     cupido. 'Each man's fearful passion becomes his god.'  Yes,
     and not passions only, but every impulse, every aspiration,
     every humour, every virtue, every whim.  In each of his
     activities the Greek found something wonderful, and called
     it God: the hearth at which he warmed himself and cooked his
     food, the street in which his house stood, the horse he
     rode, the cattle he pastured, the wife he married, the child
     that was born to him, the plague of which he died or from
     which he recovered, each suggested a deity, and he made one
     to preside over each. So too with qualities and powers more
     abstract." R.W. Livingstone:  The Greek Genius and Its
     Meaning to Us, pp. 51-52.

Livingstone discusses the Greek Genius as displayed to us in certain
"notes"--the Note of Beauty--the Desire for Freedom--the Note
of Directness--the Note of Humanism--the Note of Sanity and of
Many-sidedness. Upon some of these characteristics we shall have
occasion to dwell in the brief sketch of the rise of scientific medicine
among this wonderful people.

We have seen that the primitive man and in the great civilizations of
Egypt and Babylonia, the physician evolved from the priest--in Greece
he had a dual origin, philosophy and religion. Let us first trace the
origins in the philosophers, particularly in the group known as the
Ionian Physiologists, whether at home or as colonists in the south of
Italy, in whose work the beginnings of scientific medicine may be found.
Let me quote a statement from Gomperz:

"We can trace the springs of Greek success achieved and maintained
by the great men of Hellas on the field of scientific inquiry to a
remarkable conjunction of natural gifts and conditions. There was the
teeming wealth of constructive imagination united with the sleepless
critical spirit which shrank from no test of audacity; there was the
most powerful impulse to generalization coupled with the sharpest
faculty for descrying and distinguishing the finest shades of phenomenal
peculiarity; there was the religion of Hellas, which afforded complete
satisfaction to the requirements of sentiment, and yet left the
intelligence free to perform its destructive work; there were the
political conditions of a number of rival centres of intellect, of
a friction of forces, excluding the possibility of stagnation, and,
finally, of an order of state and society strict enough to curb the
excesses of 'children crying for the moon,' and elastic enough not to
hamper the soaring flight of superior minds.... We have already made
acquaintance with two of the sources from which the spirit of criticism
derived its nourishment--the metaphysical and dialectical discussions
practiced by the Eleatic philosophers, and the semi-historical method
which was applied to the myths by Hecataeus and Herodotus. A third
source is to be traced to the schools of the physicians. These aimed at
eliminating the arbitrary element from the view and knowledge of nature,
the beginnings of which were bound up with it in a greater or less
degree, though practically without exception and by the force of an
inner necessity. A knowledge of medicine was destined to correct that
defect, and we shall mark the growth of its most precious fruits in the
increased power of observation and the counterpoise it offered to hasty
generalizations, as well as in the confidence which learnt to reject
untenable fictions, whether produced by luxuriant imagination or by
a priori speculations, on the similar ground of self-reliant
sense-perception."(3)

     (3) Gomperz: Greek Thinkers, Vol. I, p. 276.

The nature philosophers of the Ionian days did not contribute much
to medicine proper, but their spirit and their outlook upon nature
influenced its students profoundly. Their bold generalizations on the
nature of matter and of the elements are still the wonder of chemists.
We may trace to one of them, Anaximenes, who regarded air as the primary
principle, the doctrine of the "pneuma," or the breath of life--the
psychic force which animates the body and leaves it at death--"Our
soul being air, holds us together." Of another, the famous Heraclitus,
possibly a physician, the existing fragments do not relate specially to
medicine; but to the philosopher of fire may be traced the doctrine of
heat and moisture, and their antitheses, which influenced practice
for many centuries. There is evidence in the Hippocratic treatise peri
sarkwn of an attempt to apply this doctrine to the human body. The
famous expression, panta rhei,--"all things are flowing,"--expresses
the incessant flux in which he believed and in which we know all matter
exists. No one has said a ruder thing of the profession, for an extant
fragment reads: ". . . physicians, who cut, burn, stab, and rack the
sick, then complain that they do not get any adequate recompense for
it."(4)

     (4) J. Burnet:  Early Greek Philosophy, 1892, p. 137,
     Bywater's no. LVIII.

The South Italian nature philosophers contributed much more to the
science of medicine, and in certain of the colonial towns there were
medical schools as early as the fifth century B.C. The most famous of
these physician philosophers was Pythagoras, whose life and work had an
extraordinary influence upon medicine, particularly in connection
with his theory of numbers, and the importance of critical days. His
discovery of the dependence of the pitch of sound on the length of the
vibrating chord is one of the most fundamental in acoustics. Among the
members of the school which he founded at Crotona were many physicians.
who carried his views far and wide throughout Magna Graecia. Nothing in
his teaching dominated medicine so much as the doctrine of numbers, the
sacredness of which seems to have had an enduring fascination for the
medical mind. Many of the common diseases, such as malaria, or typhus,
terminating abruptly on special days, favored this belief. How dominant
it became and how persistent you may judge from the literature upon
critical days, which is rich to the middle of the eighteenth century.

One member of the Crotonian school, Alcmaeon, achieved great distinction
in both anatomy and physiology. He first recognized the brain as the
organ of the mind, and made careful dissections of the nerves, which he
traced to the brain. He described the optic nerves and the Eustachian
tubes, made correct observations upon vision, and refuted the common
view that the sperma came from the spinal cord. He suggested the
definition of health as the maintenance of equilibrium, or an "isonomy"
in the material qualities of the body. Of all the South Italian
physicians of this period, the personality of none stands out in
stronger outlines than that of Empedocles of Agrigentum--physician,
physiologist, religious teacher, politician and poet. A wonder-worker,
also, and magician, he was acclaimed in the cities as an immortal god
by countless thousands desiring oracles or begging the word of healing.
That he was a keen student of nature is witnessed by many recorded
observations in anatomy and physiology; he reasoned that sensations
travel by definite paths to the brain. But our attention must be
confined to his introduction of the theory of the four elements--fire,
air, earth and water--of which, in varying quantities, all bodies were
made up. Health depended upon the due equilibrium of these primitive
substances; disease was their disturbance. Corresponding to those were
the four essential qualities of heat and cold, moisture and dryness, and
upon this four-fold division was engrafted by the later physicians the
doctrine of the humors which, from the days of Hippocrates almost to our
own, dominated medicine. All sorts of magical powers were attributed to
Empedocles. The story of Pantheia whom he called back to life after a
thirty days' trance has long clung in the imagination. You remember
how Matthew Arnold describes him in the well-known poem, "Empedocles on
Etna"--

     But his power
     Swells with the swelling evil of this time,
     And holds men mute to see where it will rise.
     He could stay swift diseases in old days,
     Chain madmen by the music of his lyre,
     Cleanse to sweet airs the breath of poisonous streams,
     And in the mountain-chinks inter the winds.
     This he could do of old--(5)

a quotation which will give you an idea of some of the powers attributed
to this wonder-working physician.

     (5) Poetical Works of Matthew Arnold, Macmillan & Co., 1898,
     p. 440.

But of no one of the men of this remarkable circle have we such definite
information as of the Crotonian physician Democedes, whose story
is given at length by Herodotus; and his story has also the great
importance of showing that, even at this early period, a well-devised
scheme of public medical service existed in the Greek cities. It dates
from the second half of the sixth century B.C.--fully two generations
before Hippocrates. A Crotonian, Democedes by name, was found among the
slaves of Oroetes. Of his fame as a physician someone had heard and he
was called in to treat the dislocated ankle of King Darius. The wily
Greek, longing for his home, feared that if he confessed to a knowledge
of medicine there would be no chance of escape, but under threat of
torture he undertook a treatment which proved successful. Then Herodotus
tells his story--how, ill treated at home in Crotona, Democedes went to
AEgina, where he set up as a physician and in the second year the State
of AEgina hired his services at the price of a talent. In the third
year, the Athenians engaged him at 100 minae; and in the fourth,
Polycrates of Samos at two talents. Democedes shared the misfortunes of
Polycrates and was taken prisoner by Oroetes. Then Herodotus tells how
he cured Atossa, the daughter of Cyrus and wife of Darius, of a severe
abscess of the breast, but on condition that she help him to escape, and
she induced her husband to send an expedition of exploration to Greece
under the guidance of Democedes, but with the instructions at all
costs to bring back the much prized physician. From Tarentum, Democedes
escaped to his native city, but the Persians followed him, and it was
with the greatest difficulty that he escaped from their hands. Deprived
of their guide, the Persians gave up the expedition and sailed for Asia.
In palliation of his flight, Democedes sent a message to Darius that
he was engaged to the daughter of Milo, the wrestler, who was in high
repute with the King.(6)

     (6) The well-known editor of Herodotus, R. W. Macan, Master
     of University College, Oxford, in his Hellenikon.  A Sheaf
     of Sonnets after Herodotus (Oxford, 1898) has included a
     poem which may be quoted in connection with this incident:

     NOSTALGY
     Atossa, child of Cyrus king of kings,
     healed by Greek science of a morbid breast,
     gave lord Dareios neither love nor rest
     till he fulfilled her vain imaginings.
     "Sir, show our Persian folk your sceptre's wings!
     Enlarge my sire's and brother's large bequest.
     This learned Greek shall guide your galleys west,
     and Dorian slave-girls grace our banquetings."
     So said she, taught of that o'er-artful man,
     the Italiote captive, Kroton's Demokede,
     who recked not what of maladies began,
     nor who in Asia and in Greece might bleed,
     if he--so writes the guileless Thurian--
     regained his home, and freedom of the Mede.

Plato has several references to these state physicians, who were
evidently elected by a public assembly: "When the assembly meets to
elect a physician," and the office was yearly, for in "The Statesman" we
find the following:(7) "When the year of office has expired, the
pilot, or physician has to come before a court of review" to answer
any charges. The physician must have been in practice for some time
and attained eminence, before he was deemed worthy of the post of state
physician.

     (7) Jowett:  Dialogues of Plato, 3d ed., Statesman, Vol. IV,
     p. 502 (Stephanus, II, 298 E)

"If you and I were physicians, and were advising one another that we
were competent to practice as state-physicians, should I not ask about
you, and would you not ask about me, Well, but how about Socrates
himself, has he good health? and was anyone else ever known to be cured
by him whether slave or freeman?"(7a)

     (7a) Jowett:  Dialogues of Plato, 3d ed., Gorgias, Vol. II,
     p. 407 (Stephanus, I, 514 D).

All that is known of these state physicians has been collected by
Pohl,(8) who has traced their evolution into Roman times. That they were
secular, independent of the AEsculapian temples, that they were well
paid, that there was keen competition to get the most distinguished
men, that they were paid by a special tax and that they were much
esteemed--are facts to be gleaned from Herodotus and from the
inscriptions. The lapidary records, extending over 1000 years, collected
by Professor Oehler(8a) of Reina, throw an important light on the state
of medicine in Greece and Rome. Greek vases give representations of
these state doctors at work. Dr. E. Pottier has published one showing
the treatment of a patient in the clinic.(8b)

     (8) R. Pohl:  De Graecorum medicis publicis, Berolini,
     Reimer, 1905; also Janus, Harlem, 1905, X, 491-494.

     (8a) J Oehler:  Janus, Harlem, 1909, XIV, 4; 111.

     (8b) E. Pottier:  Une clinique grecque au Ve siecle,
     Monuments et Memoires, XIII, p. 149. Paris, 1906 (Fondation
     Eugene Piot).

That dissections were practiced by this group of nature philosophers is
shown not only by the studies of Alcmaeon, but we have evidence that one
of the latest of them, Diogenes of Apollonia, must have made elaborate
dissections. In the "Historia Animalium"(9) of Aristotle occurs his
account of the blood vessels, which is by far the most elaborate met
with in the literature until the writings of Galen. It has, too, the
great merit of accuracy (if we bear in mind the fact that it was not
until after Aristotle that arteries and veins were differentiated), and
indications are given as to the vessels from which blood may be drawn.

     (9) The Works of Aristotle, Oxford, Clarendon Press, Vol.
     IV, 1910, Bk. III, Chaps. II-IV, pp. 511b-515b.




ASKLEPIOS

No god made with hands, to use the scriptural phrase, had a more
successful "run" than Asklepios--for more than a thousand years the
consoler and healer of the sons of men. Shorn of his divine attributes
he remains our patron saint, our emblematic God of Healing, whose figure
with the serpents appears in our seals and charters. He was originally a
Thessalian chieftain, whose sons, Machaon and Podalirius, became famous
physicians and fought in the Trojan War. Nestor, you may remember,
carried off the former, declaring, in the oft-quoted phrase, that a
doctor was better worth saving than many warriors unskilled in the
treatment of wounds. Later genealogies trace his origin to Apollo,(10)
as whose son he is usually regarded. "In the wake of northern tribes
this god Aesculapius--a more majestic figure than the blameless leech
of Homer's song--came by land to Epidaurus and was carried by sea to
the east-ward island of Cos.... Aesculapius grew in importance with the
growth of Greece, but may not have attained his greatest power until
Greece and Rome were one."(11)

     (10) W. H. Roscher:  Lexikon der griechischen und romischen
     Mythologie, Leipzig, 1886, I, p. 624.

     (11) Louis Dyer:  Studies of the Gods in Greece, 1891, p.
     221.

A word on the idea of the serpent as an emblem of the healing art which
goes far back into antiquity. The mystical character of the snake, and
the natural dread and awe inspired by it, early made it a symbol of
supernatural power. There is a libation vase of Gudea, c. 2350 B.C.,
found at Telloh, now in the Louvre (probably the earliest representation
of the symbol), with two serpents entwined round a staff (Jastrow, Pl.
4). From the earliest times the snake has been associated with mystic
and magic power, and even today, among native races, it plays a part in
the initiation of medicine men.

In Greece, the serpent became a symbol of Apollo, and prophetic
serpents were kept and fed at his shrine, as well as at that of his son,
Asklepios. There was an idea, too, that snakes had a knowledge of herbs,
which is referred to in the famous poem of Nikander on Theriaka.(12) You
may remember that when Alexander, the famous quack and oracle monger,
depicted by Lucian, started out "for revenue," the first thing he did
was to provide himself with two of the large, harmless, yellow snakes of
Asia Minor.

     (12) Lines 31, etc., and Scholia; cf. W. R. Halliday: Greek
     Divination, London, 1913, p. 88.

The exact date of the introduction of the cult into Greece is not known,
but its great centres were at Epidaurus, Cos, Pergamos and Tricca. It
throve with wonderful rapidity. Asklepios became one of the most popular
of the gods. By the time of Alexander it is estimated that there were
between three and four hundred temples dedicated to him.

His worship was introduced into Rome at the time of the Great Plague at
the beginning of the third century B.C. (as told by Livy in Book XI),
and the temple on the island of Tiber became a famous resort. If you can
transfer in imagination the Hot Springs of Virginia to the neighborhood
of Washington, and put there a group of buildings such as are
represented in these outlines of Caton's(13) (p. 52), add a sumptuous
theatre with seating capacity for 20,000, a stadium 600 feet long with
a seating capacity of 12,000, and all possible accessories of art and
science, you will have an idea of what the temple at Epidaurus, a few
miles from Athens, was. "The cult flourished mostly in places which,
through climatic or hygienic advantages, were natural health resorts.
Those favoured spots on hill or mountain, in the shelter of forests, by
rivers or springs of pure flowing water, were conducive to health. The
vivifying air, the well cultivated gardens surrounding the shrine, the
magnificent view, all tended to cheer the heart with new hope of cure.
Many of these temples owed their fame to mineral or merely hot springs.
To the homely altars, erected originally by sacred fountains in the
neighbourhood of health-giving mineral springs, were later added
magnificent temples, pleasure-grounds for festivals, gymnasia in
which bodily ailments were treated by physical exercises, baths and
inunctions, also, as is proved by excavations, living rooms for the
patients. Access to the shrine was forbidden to the unclean and the
impure, pregnant women and the mortally afflicted were kept away; no
dead body could find a resting-place within the holy precincts, the
shelter and the cure of the sick being undertaken by the keepers of inns
and boarding-houses in the neighbourhood. The suppliants for aid had
to submit to careful purification, to bathe in sea, river or spring, to
fast for a prescribed time, to abjure wine and certain articles of
diet, and they were only permitted to enter the temple when they were
adequately prepared by cleansing, inunction and fumigation. This lengthy
and exhausting preparation, partly dietetic, partly suggestive, was
accompanied by a solemn service of prayer and sacrifice, whose symbolism
tended highly to excite the imagination."(14)

     (13) Caton:  Temples and Ritual of Asklepios, 2d ed.,
     London, 1900.

     (14) Max Neuburger:  History of Medicine, English
     translation, Oxford, 1910, p. 94.

The temples were in charge of members of the guild or fraternity, the
head of which was often, though not necessarily, a physician. The Chief
was appointed annually. From Caton's excellent sketch(15) you can get a
good idea of the ritual, but still better is the delightful description
given in the "Plutus" of Aristophanes. After offering honey-cakes and
baked meats on the altar, the suppliants arranged themselves on the
pallets.

     (15) Caton:  Temples and Ritual of Asklepios, 2d ed.,
     London, 1900.


     Soon the Temple servitor
     Put out the lights and bade us fall asleep,
     Nor stir, nor speak, whatever noise we heard.
     So down we lay in orderly repose.
     And I could catch no slumber, not one wink,
     Struck by a nice tureen of broth which stood
     A little distance from an old wife's head,
     Whereto I marvellously longed to creep.
     Then, glancing upwards, I beheld the priest
     Whipping the cheese-cakes and figs from off
     The holy table; thence he coasted round
     To every altar spying what was left.
     And everything he found he consecrated
     Into a sort of sack--(16)

a procedure which reminds one of the story of "Bel and the Dragon." Then
the god came, in the person of the priest, and scanned each patient.
He did not neglect physical measures, as he brayed in a mortar cloves,
Tenian garlic, verjuice, squills and Sphettian vinegar, with which he
made application to the eyes of the patient.

     (16) Aristophanes:  B. B. Roger's translation, London, Bell
     & Sons, 1907, Vol. VI, ll. 668, etc., 732 ff.


     Then the God clucked,
     And out there issued from the holy shrine
     Two great, enormous serpents....
     And underneath the scarlet cloth they crept,
     And licked his eyelids, as it seemed to me;
     And, mistress dear, before you could have drunk
     Of wine ten goblets, Wealth arose and saw.(17)


     (17) Ibid.

The incubation sleep, in which indications of cure were divinely sent,
formed an important part of the ritual.

The Asklepieion, or Health Temple of Cos, recently excavated, is of
special interest, as being at the birthplace of Hippocrates, who was
himself an Asklepiad. It is known that Cos was a great medical school.
The investigations of Professor Rudolf Hertzog have shown that this
temple was very nearly the counterpart of the temple at Epidaurus.

The AEsculapian temples may have furnished a rare field for empirical
enquiry. As with our modern hospitals, the larger temple had rich
libraries, full of valuable manuscripts and records of cases. That there
may have been secular Asklepiads connected with the temple, who were
freed entirely from its superstitious practices and theurgic rites, is
regarded as doubtful; yet is perhaps not so doubtful as one might think.
How often have we physicians to bow ourselves in the house of Rimmon!
It is very much the same today at Lourdes, where lay physicians have to
look after scores of patients whose faith is too weak or whose maladies
are too strong to be relieved by Our Lady of this famous shrine. Even in
the Christian era, there is evidence of the association of distinguished
physicians with AEsculapian temples. I notice that in one of his
anatomical treatises, Galen speaks with affection of a citizen of
Pergamos who has been a great benefactor of the AEsculapian temple of
that city. In "Marius, the Epicurean," Pater gives a delightful sketch
of one of those temple health resorts, and brings in Galen, stating that
he had himself undergone the temple sleep; but to this I can find no
reference in the general index of Galen's works.

From the votive tablets found at Epidaurus, we get a very good idea of
the nature of the cases and of the cures. A large number of them have
now been deciphered. There are evidences of various forms of diseases
of the joints, affections of women, wounds, baldness, gout; but we are
again in the world of miracles, as you may judge from the following:
"Heraicus of Mytilene is bald and entreats the God to make his hair
grow. An ointment is applied over night and the next morning he has a
thick crop of hair."

There are indications that operations were performed and abscesses
opened. From one we gather that dropsy was treated in a novel way:
Asklepios cuts off the patient's head, holds him up by the heels, lets
the water run out, claps on the patient's head again. Here is one of the
invocations: "Oh, blessed Asklepios, God of Healing, it is thanks to
thy skill that Diophantes hopes to be relieved from his incurable and
horrible gout, no longer to move like a crab, no longer to walk upon
thorns, but to have sound feet as thou hast decreed."

The priests did not neglect the natural means of healing. The
inscriptions show that great attention was paid to diet, exercise,
massage and bathing, and that when necessary, drugs were used. Birth and
death were believed to defile the sacred precincts, and it was not until
the time of the Antonines that provision was made at Epidaurus for these
contingencies.

One practice of the temple was of special interest, viz., the incubation
sleep, in which dreams were suggested to the patients. In the religion
of Babylonia, an important part was played by the mystery of sleep, and
the interpretation of dreams; and no doubt from the East the Greeks took
over the practice of divination in sleep, for in the AEsculapian
cult also, the incubation sleep played a most important role. That it
continued in later times is well indicated in the orations of Aristides,
the arch-neurasthenic of ancient history, who was a great dreamer of
dreams. The oracle of Amphiaraus in Attica sent dreams into the hearts
of his consultants. "The priests take the inquirer, and keep him fasting
from food for one day, and from wine for three days, to give him perfect
spiritual lucidity to absorb the divine communication" (Phillimore's
"Apollonius of Tyana," Bk. II, Ch. XXXVII). How incubation sleep was
carried into the Christian Church, its association with St. Cosmas and
St. Damian and other saints, its practice throughout the Middle Ages,
and its continuation to our own time may be read in the careful study
of the subject made by Miss Hamilton (now Mrs. Dickens).(18) There are
still in parts of Greece and in Asia Minor shrines at which incubation
is practiced regularly, and if one may judge from the reports, with as
great success as in Epidaurus. At one place in Britain, Christchurch
in Monmouthshire, incubation was carried on till the early part of the
nineteenth century. Now the profession has come back to the study
of dreams,(19) and there are professors as ready to give suggestive
interpretations to them, as in the days of Aristides. As usual,
Aristotle seems to have said the last word on the subject: "Even
scientific physicians tell us that one should pay diligent attention to
dreams, and to hold this view is reasonable also for those who are not
practitioners but speculative philosophers,"(20) but it is asking too
much to think that the Deity would trouble to send dreams to very simple
people and to animals, if they were designed in any way to reveal the
future.

In its struggle with Christianity, Paganism made its last stand in the
temples of Asklepios. The miraculous healing of the saints superseded
the cures of the heathen god, and it was wise to adopt the useful
practice of his temple.

     (18) Mary Hamilton:  Incubation, or the Cure of Disease in
     Pagan Temples and Christian Churches, London, 1906.

     (19) Freud:  The Interpretation of Dreams, translation of
     third edition by A. A. Brill, 1913.

     (20) Aristotle:  Parva Naturalia, De divinatione per
     somnium, Ch. I, Oxford ed., Vol. III, 463 a.




HIPPOCRATES AND THE HIPPOCRATIC WRITINGS

DESERVEDLY the foundation of Greek Medicine is associated with the name
of Hippocrates, a native of the island of Cos; and yet he is a shadowy
personality, about whom we have little accurate first-hand information.
This is in strong contrast to some of his distinguished contemporaries
and successors, for example, Plato and Aristotle, about whom we have
such full and accurate knowledge. You will, perhaps, be surprised to
hear that the only contemporary mention of Hippocrates is made by Plato.
In the "Protagoras," the young Hippocrates, son of Apollodorus has
come to Protagoras, "that mighty wise man," to learn the science and
knowledge of human life. Socrates asked him: "If . . . you had thought
of going to Hippocrates of Cos, the Asclepiad, and were about to give
him your money, and some one had said to you, 'You are paying money to
your namesake Hippocrates, O Hippocrates; tell me, what is he that
you give him money?' how would you have answered?" "I should say," he
replied, "that I gave money to him as a physician." "And what will he
make of you?" "A physician," he said. And in the Phaedrus, in reply to
a question of Socrates whether the nature of the soul could be known
intelligently without knowing the nature of the whole, Phaedrus replies:
"Hippocrates, the Asclepiad, says that the nature, even of the body,
can only be understood as a whole." (Plato, I, 311; III, 270--Jowett, I,
131, 479.)

Several lives of Hippocrates have been written. The one most frequently
quoted is that of Soranus of Ephesus (not the famous physician of the
time of Trajan), and the statements which he gives are usually accepted,
viz., that he was born in the island of Cos in the year 460 B.C.; that
he belonged to an Asklepiad family of distinction, that he travelled
extensively, visiting Thrace, Thessaly, and various other parts of
Greece; that he returned to Cos, where he became the most renowned
physician of his period, and died about 375 B.C. Aristotle mentions him
but once, calling him "the great Hippocrates." Busts of him are common;
one of the earliest of which, and I am told the best, dating from Roman
days and now in the British Museum, is here represented.

Of the numerous writings attributed to Hippocrates it cannot easily be
determined which are really the work of the Father of Medicine himself.
They were collected at the time of the Alexandrian School, and it became
customary to write commentaries upon them; much of the most important
information we have about them, we derive from Galen. The earliest
manuscript is the "Codex Laurentianus" of Florence, dating from the
ninth century, a specimen page of which (thanks to Commendatore Biagi)
is annexed. Those of you who are interested, and wish to have full
references to the various works attributed to Hippocrates, will find
them in "Die Handschriften der antiken Aerzte" of the Prussian Academy,
edited by Diels (Berlin, 1905). The Prussian Academy has undertaken the
editorship of the "Corpus Medicorum Graecorum." There is no complete
edition of them in English. In 1849 the Deeside physician, Adams,
published (for the Old Sydenham Society) a translation of the most
important works, a valuable edition and easily obtained. Littre's
ten-volume edition "OEuvres completes d'Hippocrate," Paris, 1839-1861, is
the most important for reference. Those of you who want a brief but
very satisfactory account of the Hippocratic writings, with numerous
extracts, will find the volume of Theodor Beck (Jena, 1907) very useful.

I can only indicate, in a very brief way, the special features of the
Hippocratic writings that have influenced the evolution of the science
and art of medicine.

The first is undoubtedly the note of humanity. In his introduction to,
"The Rise of the Greek Epic,"(21) Gilbert Murray emphasizes the idea of
service to the community as more deeply rooted in the Greeks than in
us. The question they asked about each writer was, "Does he help to make
better men?" or "Does he make life a better thing?" Their aim was to
be useful, to be helpful, to make better men in the cities, to correct
life, "to make gentle the life of the world." In this brief phrase were
summed up the aspirations of the Athenians, likewise illuminated in that
remarkable saying of Prodicus (fifth century B.C.), "That which benefits
human life is God." The Greek view of man was the very antithesis of
that which St. Paul enforced upon the Christian world. One idea pervades
thought from Homer to Lucian-like an aroma--pride in the body as a
whole. In the strong conviction that "our soul in its rose mesh" is
quite as much helped by flesh as flesh by the soul the Greek sang his
song--"For pleasant is this flesh." Just so far as we appreciate the
value of the fair mind in the fair body, so far do we apprehend ideals
expressed by the Greek in every department of life. The beautiful soul
harmonizing with the beautiful body was as much the glorious ideal of
Plato as it was the end of the education of Aristotle. What a splendid
picture in Book III of the "Republic," of the day when ". . . our youth
will dwell in a land of health, amid fair sights and sounds and receive
the good in everything; and beauty, the effluence of fair works, shall
flow into the eye and ear like a health-giving breeze from a purer
region, and insensibly draw the soul from earliest years into likeness
and sympathy with the beauty of reason." The glory of this zeal for
the enrichment of this present life was revealed to the Greeks as to no
other people, but in respect to care for the body of the common man, we
have only seen its fulfilment in our own day, as a direct result of
the methods of research initiated by them. Everywhere throughout the
Hippocratic writings we find this attitude towards life, which has never
been better expressed than in the fine phrase, "Where there is love of
humanity there will be love of the profession." This is well brought
out in the qualifications laid down by Hippocrates for the study of
medicine. "Whoever is to acquire a competent knowledge of medicine ought
to be possessed of the following advantages: a natural disposition;
instruction; a favourable position for the study; early tuition; love of
labour; leisure. First of all, a natural talent is required, for when
nature opposes, everything else is vain; but when nature leads the way
to what is most excellent, instruction in the art takes place, which
the student must try to appropriate to himself by reflection, becoming a
nearly pupil in a place well adapted for instruction. He must also bring
to the task a love of labour and perseverance, so that the instruction
taking root may bring forth proper and abundant fruits." And the
directions given for the conduct of life and for the relation which the
physician should have with the public are those of our code of ethics
today. Consultations in doubtful cases are advised, touting for fees is
discouraged. "If two or more ways of medical treatment were possible,
the physician was recommended to choose the least imposing or
sensational; it was an act of 'deceit' to dazzle the patient's eye by
brilliant exhibitions of skill which might very well be dispensed
with. The practice of holding public lectures in order to increase
his reputation was discouraged in the physician, and he was especially
warned against lectures tricked out with quotations from the poets.
Physicians who pretended to infallibility in detecting even the minutest
departure from their prescriptions were laughed at; and finally,
there were precise by-laws to regulate the personal behaviour of the
physician. He was enjoined to observe the most scrupulous cleanliness,
and was advised to cultivate an elegance removed from all signs of
luxury, even down to the detail that he might use perfumes, but not in an
immoderate degree."(22) But the high-water mark of professional morality
is reached in the famous Hippocratic oath, which Gomperz calls "a
monument of the highest rank in the history of civilization." It is of
small matter whether this is of Hippocratic date or not, or whether
it has in it Egyptian or Indian elements: its importance lies in the
accuracy with which it represents the Greek spirit. For twenty-five
centuries it has been the "credo" of the profession, and in many
universities it is still the formula with which men are admitted to the
doctorate.

     (21) Oxford.  Clarendon Press, 2d ed., 1911.

     (22) Gomperz:  Greek Thinkers, Vol. I, p. 281.

I swear by Apollo the physician and AEsculapius and Health (Hygieia) and
All-Heal (Panacea) and all the gods and goddesses, that, according to
my ability and judgment, I will keep this oath and this stipulation--to
reckon him who taught me this art equally dear to me as my parents, to
share my substance with him, and relieve his necessities if required; to
look upon his offspring in the same footing as my own brothers, and
to teach them this art, if they shall wish to learn it, without fee
or stipulation; and that by precept, lecture, and every other mode of
instruction, I will impart a knowledge of my art to my own sons, and
those of my teachers, and to disciples bound by a stipulation and oath
according to the law of medicine, but to none others. I will follow
that system of regimen which, according to my ability and judgement, I
consider for the benefit of my patients, and abstain from whatever is
deleterious and mischievous.

I will give no deadly medicine to anyone if asked, nor suggest any such
counsel; and in like manner I will not give to a woman a pessary to
produce abortion.

With purity and with holiness I will pass my life and practice my art.

(I will not cut persons labouring under the stone, but will leave this
to be done by men who are practitioners of this work.)

Into whatsoever houses I enter, I will go into them for the benefit
of the sick, and will abstain from every voluntary act of mischief and
corruption, and, further, from the abduction of females or males,
of freemen and slaves. Whatever, in connection with my professional
practice, or not in connection with it, I see or hear, in the life of
men, which ought not to be spoken of abroad, I will not divulge, as
reckoning that all such should be kept secret.

While I continue to keep this Oath unviolated, may it be granted to me
to enjoy life and the practice of the art, respected by all men, in all
times! But should I trespass and violate this Oath, may the reverse be
my lot!

(Adams, II, 779, cf. Littre, IV, 628.)


In his ideal republic, Plato put the physician low enough, in the last
stratum, indeed, but he has never been more honorably placed than in
the picture of Athenian society given by this author in the "Symposium."
Here the physician is shown as a cultivated gentleman, mixing in the
best, if not always the most sober, society. Eryximachus, the son of
Acumenus, himself a physician, plays in this famous scene a typical
Greek part(22a)--a strong advocate of temperance in mind and body,
deprecating, as a physician, excess in drink, he urged that conversation
should be the order of the day and he had the honor of naming the
subject--"Praise of the God of Love." Incidentally Eryximachus gives his
view of the nature of disease, and shows how deeply he was influenced by
the views of Empedocles:". . . so too in the body the good and healthy
elements are to be indulged, and the bad elements and the elements of
disease are not to be indulged, but discouraged. And this is what the
physician has to do, and in this the art of medicine consists: for
medicine may be regarded generally as the knowledge of the loves
and desires of the body and how to satisfy them or not; and the best
physician is he who is able to separate fair love from foul, or to
convert one into the other; and he who knows how to eradicate and how to
implant love, whichever is required, and can reconcile the most hostile
elements in the constitution and make them loving friends, is a skilful
practitioner."

     (22a) Professor Gildersleeve's view of Eryximachus is less
     favorable (Johns Hopkins University Circular, Baltimore,
     January, 1887). Plato, III, 186--Jowett, I, 556.

The second great note in Greek medicine illustrates the directness
with which they went to the very heart of the matter. Out of mysticism,
superstition and religious ritual the Greek went directly to nature and
was the first to grasp the conception of medicine as an art based on
accurate observation, and an integral part of the science of man. What
could be more striking than the phrase in "The Law," "There are,
in effect, two things, to know and to believe one knows; to know is
science; to believe one knows is ignorance"?(23) But no single phrase in
the writings can compare for directness with the famous aphorism which
has gone into the literature of all lands: "Life is short and Art
is long; the Occasion fleeting, Experience fallacious, and Judgment
difficult."

     (23) Littre:  OEuvres d'Hippocrate, Vol. IV, pp. 641-642.

Everywhere one finds a strong, clear common sense, which refuses to
be entangled either in theological or philosophical speculations. What
Socrates did for philosophy Hippocrates may be said to have done for
medicine. As Socrates devoted himself to ethics, and the application
of right thinking to good conduct, so Hippocrates insisted upon the
practical nature of the art, and in placing its highest good in the
benefit of the patient. Empiricism, experience, the collection of facts,
the evidence of the senses, the avoidance of philosophical speculations,
were the distinguishing features of Hippocratic medicine. One of the
most striking contributions of Hippocrates is the recognition that
diseases are only part of the processes of nature, that there is nothing
divine or sacred about them. With reference to epilepsy, which was
regarded as a sacred disease, he says, "It appears to me to be no wise
more divine nor more sacred than other diseases, but has a natural cause
from which it originates like other affections; men regard its nature
and cause as divine from ignorance." And in another place he remarks
that each disease has its own nature, and that no one arises without a
natural cause. He seems to have been the first to grasp the conception
of the great healing powers of nature. In his long experience with the
cures in the temples, he must have seen scores of instances in which the
god had worked the miracle through the vis medicatrix naturae; and
to the shrewd wisdom of his practical suggestions in treatment may be
attributed in large part the extraordinary vogue which the great Coan
has enjoyed for twenty-five centuries. One may appreciate the veneration
with which the Father of Medicine was regarded by the attribute "divine"
which was usually attached to his name. Listen to this for directness
and honesty of speech taken from the work on the joints characterized
by Littre as "the great surgical monument of antiquity": "I have
written this down deliberately, believing it is valuable to learn of
unsuccessful experiments, and to know the causes of their non-success."

The note of freedom is not less remarkable throughout the Hippocratic
writings, and it is not easy to understand how a man brought up and
practicing within the precincts of a famous AEsculapian temple could
have divorced himself so wholly from the superstitions and vagaries
of the cult. There are probably grounds for Pliny's suggestion that he
benefited by the receipts written in the temple, registered by the
sick cured of any disease. "Afterwards," Pliny goes on to remark in
his characteristic way, "hee professed that course of Physicke which is
called Clinice Wherby physicians found such sweetnesse that afterwards
there was no measure nor end of fees," ('Natural History,' XXIX, 1).
There is no reference in the Hippocratic writings to divination;
incubation sleep is not often mentioned, and charms, incantations or the
practice of astrology but rarely. Here and there we do find practices
which jar upon modern feeling, but on the whole we feel in reading the
Hippocratic writings nearer to their spirit than to that of the Arabians
or of the many writers of the fifteenth and sixteenth centuries A. D.
And it is not only against the thaumaturgic powers that the Hippocratic
writings protested, but they express an equally active reaction against
the excesses and defects of the new philosophy, a point brought out very
clearly by Gomperz.(24) He regards it as an undying glory of the school
of Cos that after years of vague, restless speculation it introduces
"steady sedentary habits into the intellectual life of mankind."
'Fiction to the right! Reality to the left!' was the battle-cry of this
school in the war they were the first to wage against the excesses and
defects of the nature-philosophy. Though the protest was effective in
certain directions, we shall see that the authors of the Hippocratic
writings could not entirely escape from the hypotheses of the older
philosophers.

     (24) Gomperz:  Greek Thinkers, Vol. I, p. 296.

I can do no more than indicate in the briefest possible way some of the
more important views ascribed to Hippocrates. We cannot touch upon the
disputes between the Coan and Cnidian schools.(25) You must bear in
mind that the Greeks at this time had no human anatomy. Dissections
were impossible; their physiology was of the crudest character, strongly
dominated by the philosophies. Empedocles regarded the four elements,
fire, air, earth and water, as "the roots of all things," and this
became the corner stone in the humoral pathology of Hippocrates. As in
the Macrocosm--the world at large there were four elements, fire, air,
earth, and water, so in the Microcosm--the world of man's body--there
were four humors (elements), viz.,blood, phlegm, yellow bile (or
choler) and black bile (or melancholy), and they corresponded to the four
qualities of matter, heat, cold, dryness and moisture. For more than two
thousand years these views prevailed. In his "Regiment of Life" (1546)
Thomas Phaer says:". . . which humours are called ye sones of the
Elements because they be complexioned like the foure Elements, for like
as the Ayre is hot and moyst: so is the blooud, hote and moyste. And as
Fyer is hote and dry: so is Cholere hote and dry. And as water is colde
and moyst: so is fleume colde and moyste. And as the Earth is colde and
dry: so Melancholy is colde and dry."(26)

     (25) The student who wishes a fuller account is referred to
     the histories of (a) Neuburger, Vol. 1, Oxford, 1910; (b)
     Withington, London, 1894.

     (26) Thomas Phaer:  Regiment of Life, London, 1546.

As the famous Regimen Sanitatis of Salernum, the popular family
hand-book of the Middle Ages, says:

     Foure Humours raigne within our bodies wholly,
     And these compared to foure elements.(27)

     (27) The Englishman's Doctor, or the Schoole of Salerne, Sir
     John Harington's translation, London, 1608, p. 2.  Edited by
     Francis R. Packard, New York, 1920, p. 132. Harington's book
     originally appeared dated:  London 1607. (Hoe copy in the
     Henry E. Huntington Library.)

According to Littre, there is nowhere so strong a statement of these
views in the genuine works of Hippocrates, but they are found at
large in the Hippocratic writings, and nothing can be clearer than the
following statement from the work "The Nature of Man": "The body of
man contains in itself blood and phlegm and yellow bile and black bile,
which things are in the natural constitution of his body, and the
cause of sickness and of health. He is healthy when they are in
proper proportion between one another as regards mixture and force and
quantity, and when they are well mingled together; he becomes sick when
one of these is diminished or increased in amount, or is separated in
the body from its proper mixture, and not properly mingled with all the
others." No words could more clearly express the views of disease which,
as I mentioned, prevailed until quite recent years. The black bile,
melancholy, has given us a great word in the language, and that we have
not yet escaped from the humoral pathology of Hippocrates is witnessed
by the common expression of biliousness--"too much bile"--or "he has a
touch of the liver." The humors, imperfectly mingled, prove irritant in
the body. They are kept in due proportion by the innate heat which, by
a sort of internal coction gradually changes the humors to their proper
proportion. Whatever may be the primary cause of the change in the
humors manifesting itself in disease, the innate heat, or as Hippocrates
terms it, the nature of the body itself, tends to restore conditions to
the norm; and this change occurring suddenly, or abruptly, he calls the
"crisis," which is accomplished on some special day of the disease, and
is often accompanied by a critical discharge, or by a drop in the body
temperature. The evil, or superabundant, humors were discharged and
this view of a special materies morbi, to be got rid of by a natural
processor a crisis, dominated pathology until quite recently.
Hippocrates had a great belief in the power of nature, the vis
medicatrix naturae, to restore the normal state. A keen observer and
an active practitioner, his views of disease, thus hastily sketched,
dominated the profession for twenty-five centuries; indeed, echoes of
his theories are still heard in the schools, and his very words are
daily on our lips. If asked what was the great contribution to medicine
of Hippocrates and his school we could answer--the art of careful
observation.

In the Hippocratic writings is summed up the experience of Greece to the
Golden Age of Pericles. Out of philosophy, out of abstract speculation,
had come a way of looking at nature for which the physicians were mainly
responsible, and which has changed forever men's views on disease.
Medicine broke its leading strings to religion and philosophy--a
tottering, though lusty, child whose fortunes we are to follow in these
lectures. I have a feeling that, could we know more of the medical
history of the older races of which I spoke in the first lecture, we
might find that this was not the first-born of Asklepios, that there
had been many premature births, many still-born offspring, even
live-births--the products of the fertilization of nature by the human
mind; but the record is dark, and the infant was cast out like Israel in
the chapter of Isaiah. But the high-water mark of mental achievement
had not been reached by the great generation in which Hippocrates had
labored. Socrates had been dead sixteen years, and Plato was a man of
forty-five, when far away in the north in the little town of Stagira, on
the peninsula of Mount Athos in Macedoniawas, in 384 B.C., born a "man
of men," the one above all others to whom the phrase of Milton may be
applied. The child of an Asklepiad, Nicomachus, physician to the father
of Philip, there must have been a rare conjunction of the planets at
the birth of the great Stagirite. In the first circle of the "Inferno,"
Virgil leads Dante into a wonderful company, "star-seated" on the
verdure (he says)--the philosophic family looking with reverence on "the
Master of those who know"--il maestro di color che sanno.(28) And with
justice has Aristotle been so regarded for these twenty-three
centuries. No man has ever swayed such an intellectual empire--in logic,
metaphysics, rhetoric, psychology, ethics, poetry, politics and natural
history, in all a creator, and in all still a master. The history of
the human mind--offers no parallel to his career. As the creator of
the sciences of comparative anatomy, systematic zoology, embryology,
teratology, botany and physiology, his writings have an eternal
interest. They present an extraordinary accumulation of facts relating
to the structure and functions of various parts of the body. It is an
unceasing wonder how one man, even with a school of devoted students,
could have done so much.

     (28) The "Good collector of qualities," Dioscorides,
     Hippocrates, Avicenna, Galen and Averroes were the medical
     members of the group.  Dante, Inferno, canto iv.

Dissection--already practiced by Alcmaeon, Democritus, Diogenes and
others--was conducted on a large scale, but the human body was still
taboo. Aristotle confesses that the "inward parts of man are known
least of all," and he had never seen the human kidneys or uterus. In his
physiology, I can refer to but one point--the pivotal question of the
heart and blood vessels. To Aristotle the heart was the central organ
controlling the circulation, the seat of vitality, the source of
the blood, the place in which it received its final elaboration and
impregnation with animal heat. The blood was contained in the heart
and vessels as in a vase--hence the use of the term "vessel." "From the
heart the blood-vessels extend throughout the body as in the anatomical
diagrams which are represented on the walls, for the parts lie round
these because they are formed out of them."(29) The nutriment oozes
through the blood vessels and the passages in each of the parts "like
water in unbaked pottery." He did not recognize any distinction between
arteries and veins, calling both plebes (Littre); the vena cave is the
great vessel, and the aorta the smaller; but both contain blood. He did
not use the word "arteria" (arthria) for either of them. There was no
movement from the heart to the vessels but the blood was incessantly
drawn upon by the substance of the body and as unceasingly renewed by
absorption of the products of digestion, the mesenteric vessels taking
up nutriment very much as the plants take theirs by the roots from the
soil. From the lungs was absorbed the pneuma, or spiritus, which was
conveyed to the heart by the pulmonary vessels--one to the right,
and one to the left side. These vessels in the lungs, "through mutual
contact" with the branches of the trachea, took in the pneuma. A point
of interest is that the windpipe, or trachea, is called "arteria," both
by Aristotle and by Hippocrates ("Anatomy," Littre, VIII, 539). It was
the air-tube, disseminating the breath through the lungs. We shall see
in a few minutes how the term came to be applied to the arteries, as
we know them. The pulsation of the heart and arteries was regarded by
Aristotle as a sort of ebullition in which the liquids were inflated by
the vital or innate heat, the fires of which were cooled by the pneuma
taken in by the lungs and carried to the heart by the pulmonary vessels.

     (29) De Generatione Animalium, Oxford translation, Bk. II,
     Chap. 6, Works V, 743 a.

In Vol. IV of Gomperz' "Greek Thinkers," you will find an admirable
discussion on Aristotle as an investigator of nature, and those of
you who wish to study his natural history works more closely may do so
easily--in the new translation which is in process of publication by the
Clarendon Press, Oxford. At the end of the chapter "De Respiratione" in
the "Parva Naturalia" (Oxford edition, 1908), we have Aristotle's
attitude towards medicine expressed in a way worthy of a son of the
profession:

"But health and disease also claim the attention of the scientist, and
not merely of the physician, in so far as an account of their causes is
concerned. The extent to which these two differ and investigate diverse
provinces must not escape us, since facts show that their inquiries are,
at least to a certain extent, conterminous. For physicians of culture
and refinement make some mention of natural science, and claim to derive
their principles from it, while the most accomplished investigators
into nature generally push their studies so far as to conclude with an
account of medical principles." (Works, III,480 b.)

Theophrastus, a student of Aristotle and his successor, created the
science of botany and made possible the pharmacologists of a few
centuries later. Some of you doubtless know him in another guise--as the
author of the golden booklet on "Characters," in which "the most eminent
botanist of antiquity observes the doings of men with the keen and
unerring vision of a natural historian" (Gomperz). In the Hippocratic
writings, there are mentioned 236 plants; in the botany of Theophrastus,
455. To one trait of master and pupil I must refer--the human feeling,
not alone of man for man, but a sympathy that even claims kinship with
the animal world. "The spirit with which he (Theophrastus) regarded the
animal world found no second expression till the present age" (Gomperz).
Halliday, however, makes the statement that Porphyry(30) goes as far as
any modern humanitarian in preaching our duty towards animals.

     (30) W. R. Halliday:  Greek Divination, London, Macmillan &
     Co., 1913.




ALEXANDRIAN SCHOOL

FROM the death of Hippocrates about the year 375 B.C. till the founding
of the Alexandrian School, the physicians were engrossed largely in
speculative views, and not much real progress was made, except in the
matter of elaborating the humoral pathology. Only three or four men of
the first rank stand out in this period: Diocles the Carystian, "both
in time and reputation next and second to Hippocrates" (Pliny), a keen
anatomist and an encyclopaedic writer; but only scanty fragments of his
work remain. In some ways the most important member of this group was
Praxagoras, a native of Cos, about 340 B.C. Aristotle, you remember,
made no essential distinction between arteries and veins, both of which
he held to contain blood: Praxagoras recognized that the pulsation
was only in the arteries, and maintained that only the veins contained
blood, and the arteries air. As a rule the arteries are empty after
death, and Praxagoras believed that they were filled with an aeriform
fluid, a sort of pneuma, which was responsible for their pulsation.
The word arteria, which had already been applied to the trachea, as an
air-containing tube, was then attached to the arteries; on account of
the rough and uneven character of its walls the trachea was then called
the arteria tracheia, or the rough air-tube.(31a) We call it simply the
trachea, but in French the word trachee-artere is still used.

     (31a) Galen:  De usu partium, VII, Chaps. 8-9.

Praxagoras was one of the first to make an exhaustive study of the
pulse, and he must have been a man of considerable clinical acumen, as
well as boldness, to recommend in obstruction of the bowels the opening
of the abdomen, removal of the obstructed portion and uniting the ends
of the intestine by sutures.

After the death of Alexander, Egypt fell into the hands of his famous
general, Ptolemy, under whose care the city became one of the most
important on the Mediterranean. He founded and maintained a museum, an
establishment that corresponded very much to a modern university, for
the study of literature, science and the arts. Under his successors,
particularly the third Ptolemy, the museum developed, more especially
the library, which contained more than half a million volumes. The
teachers were drawn from all centres, and the names of the great
Alexandrians are among the most famous in the history of human
knowledge, including such men as Archimedes, Euclid, Strabo and Ptolemy.

In mechanics and physics, astronomy, mathematics and optics, the work
of the Alexandrians constitutes the basis of a large part of our modern
knowledge. The school-boy of today--or at any rate of my day--studies
the identical problems that were set by Euclid 300 B.C., and the student
of physics still turns to Archimedes and Heron, and the astronomer to
Eratosthenes and Hipparchus. To those of you who wish to get a brief
review of the state of science in the Alexandrian School I would
recommend the chapter in Vol. I of Dannemann's history.(31)

     (31) Friedrich Dannemann: Grundriss einer Geschichte der
     Naturwissenschaften, Vol. I, 3d ed., Leipzig, 1908.

Of special interest to us in Alexandria is the growth of the first great
medical school of antiquity. Could we have visited the famous museum
about 300 B.C., we should have found a medical school in full operation,
with extensive laboratories, libraries and clinics. Here for the first
time the study of the structure of the human body reached its full
development, till then barred everywhere by religious prejudice; but
full permission was given by the Ptolemies to perform human dissection
and, if we may credit some authors, even vivisection. The original
writings of the chief men of this school have not been preserved, but
there is a possibility that any day a papyrus maybe found which will
supplement the scrappy and imperfect knowledge afforded us by Pliny,
Celsus and Galen. The two most distinguished names are Herophilus--who,
Pliny says, has the honor of being the first physician "who searched
into the causes of disease"--and Erasistratus.

Herophilus, ille anatomicorum coryphaeus, as Vesalius calls him, was a
pupil of Praxagoras, and his name is still in everyday use by medical
students, attached to the torcular Herophili. Anatomy practically dates
from these Alexandrines, who described the valves of the heart, the
duodenum, and many of the important parts of the brain; they recognized
the true significance of the nerves (which before their day had been
confounded with the tendons), distinguished between motor and sensory
nerves, and regarded the brain as the seat of the perceptive faculties
and voluntary action. Herophilus counted the pulse, using the
water-clock for the purpose, and made many subtle analyses of its rate
and rhythm; and, influenced by the musical theories of the period,
he built up a rhythmical pulse lore which continued in medicine until
recent times. He was a skilful practitioner and to him is ascribed the
statement that drugs are the hands of the gods. There is a very modern
flavor to his oft-quoted expression that the best physician was the man
who was able to distinguish between the possible and the impossible.

Erasistratus elaborated the view of the pneuma, one form of which he
believed came from the inspired air, and passed to the left side of
the heart and to the arteries of the body. It was the cause of the
heart-beat and the source of the innate heat of the body, and it
maintained the processes of digestion and nutrition. This was the vital
spirit; the animal spirit was elaborated in the brain, chiefly in the
ventricles, and sent by the nerves to all parts of the body, endowing
the individual with life and perception and motion. In this way a great
division was made between the two functions of the body, and two sets
of organs: in the vascular system, the heart and arteries and abdominal
organs, life was controlled by the vital spirits; on the other hand,
in the nervous system were elaborated the animal spirits, controlling
motion, sensation and the various special senses. These views on the
vital and animal spirits held unquestioned sway until well into the
eighteenth century, and we still, in a measure, express the views of the
great Alexandrian when we speak of "high" or "low" spirits.




GALEN

PERGAMON has become little more than a name associated in our memory
with the fulminations of St. John against the seven churches of Asia;
and on hearing the chapter read, we wondered what was "Satan's seat" and
who were the "Nicolaitanes" whose doctrine he so hated. Renewed interest
has been aroused in the story of its growth and of its intellectual
rivalry with Alexandria since the wonderful discoveries by German
archaeologists which have enabled us actually to see this great Ionian
capital, and even the "seat of Satan." The illustration here shown is of
the famous city, in which you can see the Temple of Athena Polis on the
rock, and the amphitheatre. Its interest for us is connected with the
greatest name, after Hippocrates, in Greek medicine, that of Galen, born
at Pergamon A. D. 130, in whom was united as never before--and
indeed one may say, never since--the treble combination of observer,
experimenter and philosopher. His father, Nikon, a prosperous architect,
was urged in a dream to devote his son to the profession of medicine,
upon which study the lad entered in his seventeenth year under Satyrus.
In his writings, Galen gives many details of his life, mentioning the
names of his teachers, and many incidents in his Wanderjahre, during
which he studied at the best medical schools, including Alexandria.
Returning to his native city he was put in charge of the gladiators,
whose wounds he said he treated with wine. In the year 162, he paid
his first visit to Rome, the scene of his greatest labors. Here he gave
public lectures on anatomy, and became "the fashion." He mentions
many of his successes; one of them is the well-worn story told also of
Erasistratus and Stratonice, but Galen's story is worth telling, and it
is figured as a miniature in the manuscripts of his works. Called to see
a lady he found her suffering from general malaise without any fever
or increased action of the pulse. He saw at once that her trouble was
mental and, like a wise physician, engaged her in general conversation.
Quite possibly he knew her story, for the name of a certain actor,
Pylades, was mentioned, and he noticed that her pulse at once increased
in rapidity and became irregular. On the next day he arranged that the
name of another actor, Morphus, should be mentioned, and on the third
day the experiment was repeated but without effect. Then on the fourth
evening it was again mentioned that Pylades was dancing, and the pulse
quickened and became irregular, so he concluded that she was in love
with Pylades. He tells how he was first called to treat the Emperor
Marcus Aurelius, who had a stomach-ache after eating too much cheese. He
treated the case so successfully that the Emperor remarked, "I have but
one physician, and he is a gentleman." He seems to have had good fees,
as he received 400 aurei (about 2000) for a fortnight's attendance upon
the wife of Boethus.

He left Rome for a time in 168 A. D. and returned to Pergamon, but was
recalled to Rome by the Emperor, whom he accompanied on an expedition
to Germany. There are records in his writings of many journeys, and busy
with his practice in dissections and experiments he passed a long and
energetic life, dying, according to most authorities, in the year 200
A.D.

A sketch of the state of medicine in Rome is given by Celsus in the
first of his eight books, and he mentions the names of many of the
leading practitioners, particularly Asclepiades, the Bithynian, a man
of great ability, and a follower of the Alexandrians, who regarded all
disease as due to a disturbed movement of the atoms. Diet, exercise,
massage and bathing were his great remedies, and his motto--tuto, cito
et jucunde--has been the emulation of all physicians. How important
a role he and his successors played until the time of Galen may be
gathered from the learned lectures of Sir Clifford Allbutt(32) on "Greek
Medicine in Rome" and from Meyer-Steineg's "Theodorus Priscianus und die
romische Medizin."(33) From certain lay writers we learn that it was the
custom for popular physicians to be followed on their rounds by crowds
of students. Martial's epigram (V, ix) is often referred to:

     Languebam: sed tu comitatus protinus ad me
     Venisti centum, Symmache, discipulis.
     Centum me tegigere manus Aquilone gelatae
     Non habui febrem, Symmache, nunc habeo.

     (32) Allbutt:  British Medical Journal, London, 1909, ii, 1449;
     1515; 1598.

     (33) Fischer, Jena, 1909.

And in the "Apollonius of Tyana" by Philostratus, when Apollonius
wishes to prove an alibi, he calls to witness the physicians of his sick
friend, Seleucus and Straloctes, who were accompanied by their clinical
class to the number of about thirty students.(34) But for a first-hand
sketch of the condition of the profession we must go to Pliny, whose
account in the twenty-ninth book of the "Natural History" is one of the
most interesting and amusing chapters in that delightful work. He quotes
Cato's tirade against Greek physicians,--corrupters of the race, whom he
would have banished from the city,--then he sketches the career of some
of the more famous of the physicians under the Empire, some of whom must
have had incomes never approached at any other period in the history of
medicine. The chapter gives a good picture of the stage on which Galen
(practically a contemporary of Pliny) was to play so important a role.
Pliny seems himself to have been rather disgusted with the devious paths
of the doctors of his day, and there is no one who has touched with
stronger language upon the weak points of the art of physic. In one
place he says that it alone has this peculiar art and privilege, "That
whosoever professeth himself a physician, is straightwaies beleeved, say
what he will: and yet to speake a truth, there are no lies dearer sold
or more daungerous than those which proceed out of a Physician's mouth.
Howbeit, we never once regard or look to that, so blind we are in our
deepe persuasion of them, and feed our selves each one in a sweet hope
and plausible conceit of our health by them. Moreover, this mischief
there is besides, That there is no law or statute to punish the
ignorance of blind Physicians, though a man lost his life by them:
neither was there ever any man knowne, who had revenge of recompence for
the evill intreating or misusage under their hands. They learne their
skill by endaungering our lives: and to make proofe and experiments of
their medicines, they care not to kill us."(35) He says it is hard
that, while the judges are carefully chosen and selected, physicians
are practically their own judges, and that of the men who may give us a
quick despatch and send us to Heaven or Hell, no enquiry or examination
is made of their quality and worthiness. It is interesting to read so
early a bitter criticism of the famous "Theriaca," a great compound
medicine invented by Antiochus III, which had a vogue for fifteen
hundred years.

     (34) Bk. VIII, Chap. VII.

     (35) Pliny:  Natural History (XXIX, 1), Philemon Holland's
     version, London, 1601, II, 347.

But we must return to Galen and his works, which comprise the most
voluminous body of writings left by any of the ancients. The great
edition is that in twenty-two volumes by Kuhn (1821-1833). The most
useful editions are the "Juntines" of Venice, which were issued in
thirteen editions. In the fourth and subsequent editions a very useful
index by Brassavola is included. A critical study of the writings is at
present being made by German scholars for the Prussian Academy, which
will issue a definitive edition of his works.

Galen had an eclectic mind and could not identify himself with any
of the prevailing schools, but regarded himself as a disciple of
Hippocrates. For our purpose, both his philosophy and his practice are
of minor interest in comparison with his great labors in anatomy and
physiology.

In anatomy, he was a pupil of the Alexandrians to whom he constantly
refers. Times must have changed since the days of Herophilus, as Galen
does not seem ever to have had an opportunity of dissecting the human
body, and he laments the prejudice which prevents it. In the study of
osteology, he urges the student to be on the lookout for an occasional
human bone exposed in a graveyard, and on one occasion he tells of
finding the carcass of a robber with the bones picked bare by birds and
beasts. Failing this source, he advises the student to go to Alexandria,
where there were still two skeletons. He himself dissected chiefly
apes and pigs. His osteology was admirable, and his little tractate "De
Ossibus" could, with very few changes, be used today by a hygiene class
as a manual. His description of the muscles and of the organs is very
full, covering, of course, many sins of omission and of commission, but
it was the culmination of the study of the subject by Greek physicians.

His work as a physiologist was even more important, for, so far as we
know, he was the first to carry out experiments on a large scale. In the
first place, he was within an ace of discovering the circulation of
the blood. You may remember that through the errors of Praxagoras and
Erasistratus, the arteries were believed to contain air and got their
name on that account: Galen showed by experiment that the arteries
contain blood and not air. He studied particularly the movements of
the heart, the action of the valves, and the pulsatile forces in the
arteries. Of the two kinds of blood, the one, contained in the venous
system, was dark and thick and rich in grosser elements, and served for
the general nutrition of the body. This system took its origin, as
is clearly shown in the figure, in the liver, the central organ of
nutrition and of sanguification. From the portal system were absorbed,
through the stomach and intestines, the products of digestion. From the
liver extend the venae cavae, one to supply the head and arms, the other
the lower extremities: extending from the right heart was a branch,
corresponding to the pulmonary artery, the arterial vein which
distributed blood to the lungs. This was the closed venous system. The
arterial system, shown, as you see, quite separate in Figure 31, was
full of a thinner, brighter, warmer blood, characterized by the presence
of an abundance of the vital spirits. Warmed in the ventricle, it
distributed vital heat to all parts of the body. The two systems were
closed and communicated with each other only through certain pores or
perforations in the septum separating the ventricles. At the periphery,
however, Galen recognized (as had been done already by the Alexandrians)
that the arteries anastomose with the veins, ". . . and they mutually
receive from each other blood and spirits through certain invisible and
extremely small vessels."

It is difficult to understand how Galen missed the circulation of the
blood. He knew that the valves of the heart determined the direction
of the blood that entered and left the organ, but he did not appreciate
that it was a pump for distributing the blood, regarding it rather as
a fireplace from which the innate heat of the body was derived. He knew
that the pulsatile force was resident in the walls of the heart and in
the arteries, and he knew that the expansion, or diastole, drew blood
into its cavities, and that the systole forced blood out. Apparently his
view was that there was a sort of ebb and flow in both systems--and yet,
he uses language just such as we would, speaking of the venous system
as ". . . a conduit full of blood with a multitude of canals large and
small running out from it and distributing blood to all parts of the
body." He compares the mode of nutrition to irrigating canals and
gardens, with a wonderful dispensation by nature that they should
"neither lack a sufficient quantity of blood for absorption nor
be overloaded at any time with excessive supply." The function of
respiration was the introduction of the pneuma, the spirits which passed
from the lungs to the heart through the pulmonary vessels. Galen went a
good deal beyond the idea of Aristotle, reaching our modern conception
that the function is to maintain the animal heat, and that the
smoky matters derived from combustion of the blood are discharged by
expiration.

I have dwelt on these points in Galen's physiology, as they are
fundamental in the history of the circulation; and they are sufficient
to illustrate his position. Among his other brilliant experiments were
the demonstration of the function of the laryngeal nerves, of the
motor and sensory functions of the spinal nerve roots, of the effect
of transverse incision of the spinal cord, and of the effect of
hemisection. Altogether there is no ancient physician in whose writings
are contained so many indications of modern methods of research.

Galen's views of disease in general are those of Hippocrates, but
he introduces many refinements and subdivisions according to the
predominance of the four humors, the harmonious combination of
which means health, or eucrasia, while their perversion or improper
combination leads to dyscrasia, or ill health. In treatment he had not
the simplicity of Hippocrates: he had great faith in drugs and collected
plants from all parts of the known world, for the sale of which he
is said to have had a shop in the neighborhood of the Forum. As I
mentioned, he was an eclectic, held himself aloof from the various
schools of the day, calling no man master save Hippocrates. He might
be called a rational empiricist. He made war on the theoretical
practitioners of the day, particularly the Methodists, who, like some
of their modern followers, held that their business was with the disease
and not with the conditions out of which it arose.

No other physician has ever occupied the commanding position of
"Clarissimus" Galenus. For fifteen centuries he dominated medical
thought as powerfully as did Aristotle in the schools. Not until the
Renaissance did daring spirits begin to question the infallibility of
this medical pope. But here we must part with the last and, in many
ways, the greatest of the Greeks--a man very much of our own type, who,
could he visit this country today, might teach us many lessons. He would
smile in scorn at the water supply of many of our cities, thinking
of the magnificent aqueducts of Rome and of many of the colonial
towns--some still in use--which in lightness of structure and in
durability testify to the astonishing skill of their engineers. There
are country districts in which he would find imperfect drainage and
could tell of the wonderful system by which Rome was kept sweet and
clean. Nothing would delight him more than a visit to Panama to see what
the organization of knowledge has been able to accomplish. Everywhere
he could tour the country as a sanitary expert, preaching the gospel
of good water supply and good drainage, two of the great elements in
civilization, in which in many places we have not yet reached the Roman
standard.




CHAPTER III -- MEDIAEVAL MEDICINE

THERE are waste places of the earth which fill one with terror--not
simply because they are waste; one has not such feelings in the desert
nor in the vast solitude of the ocean. Very different is it where the
desolation has overtaken a brilliant and flourishing product of man's
head and hand. To know that

     . . . the Lion and the Lizard keep
     The Courts where Jamshyd gloried and drank deep

sends a chill to the heart, and one trembles with a sense of human
instability. With this feeling we enter the Middle Ages. Following the
glory that was Greece and the grandeur that was Rome, a desolation came
upon the civilized world, in which the light of learning burned low,
flickering almost to extinction. How came it possible that the gifts
of Athens and of Alexandria were deliberately thrown away? For three
causes. The barbarians shattered the Roman Empire to its foundations.
When Alaric entered Rome in 410 A. D., ghastly was the impression made
on the contemporaries; the Roman world shuddered in a titanic spasm
(Lindner). The land was a garden of Eden before them, behind a howling
wilderness, as is so graphically told in Gibbon's great history. Many of
the most important centres of learning were destroyed, and for centuries
Minerva and Apollo forsook the haunts of men. The other equally
important cause was the change wrought by Christianity. The brotherhood
of man, the care of the body, the gospel of practical virtues formed the
essence of the teaching of the Founder--in these the Kingdom of Heaven
was to be sought; in these lay salvation. But the world was very evil,
all thought that the times were waxing late, and into men's minds
entered as never before a conviction of the importance of the four
last things--death, judgment, heaven and hell. One obstacle alone stood
between man and his redemption, the vile body, "this muddy vesture of
decay," that so grossly wrapped his soul. To find methods of bringing it
into subjection was the task of the Christian Church for centuries. In
the Vatican Gallery of Inscriptions is a stone slab with the single word
"Stercoriae," and below, the Christian symbol. It might serve as a motto
for the Middle Ages, during which, to quote St. Paul, all things were
"counted dung but to win Christ." In this attitude of mind the wisdom
of the Greeks was not simply foolishness, but a stumbling-block in the
path. Knowledge other than that which made a man "wise unto salvation"
was useless. All that was necessary was contained in the Bible or taught
by the Church. This simple creed brought consolation to thousands and
illumined the lives of some of the noblest of men. But, "in seeking a
heavenly home man lost his bearings upon earth." Let me commend for your
reading Taylor's "Mediaeval Mind."(1) I cannot judge of its scholarship,
which I am told by scholars is ripe and good, but I can judge of its
usefulness for anyone who wishes to know the story of the mind of man
in Europe at this period. Into the content of mediaeval thought only
a mystic can enter with full sympathy. It was a needful change in the
evolution of the race. Christianity brought new ideals and new motives
into the lives of men. The world's desire was changed, a desire for the
Kingdom of Heaven, in the search for which the lust of the flesh, the
lust of the eye and the pride of life were as dross. A master-motive
swayed the minds of sinful men and a zeal to save other souls occupied
the moments not devoted to the perfection of their own. The new
dispensation made any other superfluous. As Tertullian said:
Investigation since the Gospel is no longer necessary. (Dannemann, Die
Naturw., I, p. 214.) The attitude of the early Fathers toward the body
is well expressed by Jerome. "Does your skin roughen without baths? Who
is once washed in the blood of Christ needs not wash again." In this
unfavorable medium for its growth, science was simply disregarded, not
in any hostile spirit, but as unnecessary.(2) And a third contributing
factor was the plague of the sixth century, which desolated the whole
Roman world. On the top of the grand mausoleum of Hadrian, visitors at
Rome see the figure of a gilded angel with a drawn sword, from which
the present name of the Castle of St. Angelo takes its origin. On the
twenty-fifth of April, 590, there set out from the Church of SS.
Cosmas and Damian, already the Roman patron saints of medicine, a vast
procession, led by St. Gregory the Great, chanting a seven-fold litany
of intercession against the plague. The legend relates that Gregory
saw on the top of Hadrian's tomb an angel with a drawn sword, which he
sheathed as the plague abated.

     (1) H. O. Taylor:  The Mediaeval Mind, 2 vols., Macmillan Co.,
     New York, 1911.  (New edition, 1920.)

     (2) Ibid., Vol. 1, p. 13: "Under their action (the Christian
     Fathers) the peoples of Western Europe, from the eighth to the
     thirteenth century, passed through a homogeneous growth, and
     evolved a spirit different from that of any other period of
     history--a spirit which stood in awe before its monitors divine
     and human, and deemed that knowledge was to be drawn from the
     storehouse of the past; which seemed to rely on everything except
     its sin-crushed self, and trusted everything except its senses;
     which in the actual looked for the ideal, in the concrete saw the
     symbol, in the earthly Church beheld the heavenly, and in fleshly
     joys discerned the devil's lures; which lived in the unreconciled
     opposition between the lust and vain-glory of earth and the
     attainment of salvation; which felt life's terror and its
     pitifulness, and its eternal hope; around which waved concrete
     infinitudes, and over which flamed the terror of darkness and the
     Judgment Day."

Galen died about 200 A.D.; the high-water mark of the Renaissance, so
far as medicine is concerned, was reached in the year 1542. In order to
traverse this long interval intelligently, I will sketch certain great
movements, tracing the currents of Greek thought, setting forth in their
works the lives of certain great leaders, until we greet the dawn of our
own day.

After flowing for more than a thousand years through the broad plain of
Greek civilization, the stream of scientific medicine which we have
been following is apparently lost in the morass of the Middle Ages; but,
checked and blocked like the White Nile in the Soudan, three channels
may be followed through the weeds of theological and philosophical
speculation.




SOUTH ITALIAN SCHOOL

A WIDE stream is in Italy, where the "antique education never stopped,
antique reminiscence and tradition never passed away, and the literary
matter of the pagan past never faded from the consciousness of the more
educated among the laity and clergy."(3) Greek was the language of South
Italy and was spoken in some of its eastern towns until the thirteenth
century. The cathedral and monastic schools served to keep alive the
ancient learning. Monte Casino stands pre-eminent as a great hive of
students, and to the famous Regula of St. Benedict(4) we are indebted
for the preservation of many precious manuscripts.

     (3) H. O. Taylor:  The Mediaeval Mind, Vol. I, p. 251.

     (4) De Renzi:  Storia Documentata della Scuola Medica di Salerno,
     2d ed., Napoli, 1867, Chap. V.

The Norman Kingdom of South Italy and Sicily was a meeting ground of
Saracens, Greeks and Lombards. Greek, Arabic and Latin were in constant
use among the people of the capital, and Sicilian scholars of the
twelfth century translated directly from the Greek.

The famous "Almagest" of Ptolemy, the most important work of ancient
astronomy, was translated from a Greek manuscript, as early as 1160, by
a medical student of Salerno.(5)

     (5) Haskins and Lockwood:  Harvard Studies in Classical
     Philology, 1910, XXI, pp. 75-102.

About thirty miles southeast of Naples lay Salernum, which for centuries
kept alight the lamp of the old learning, and became the centre of
medical studies in the Middle Ages; well deserving its name of "Civitas
Hippocratica." The date of foundation is uncertain, but Salernitan
physicians are mentioned as early as the middle of the ninth century,
and from this date until the rise of the universities it was not only a
great medical school, but a popular resort for the sick and wounded. As
the scholar says in Longfellow's "Golden Legend":

     Then at every season of the year
     There are crowds of guests and travellers here;
     Pilgrims and mendicant friars and traders
     From the Levant, with figs and wine,
     And bands of wounded and sick Crusaders,
     Coming back from Palestine.

There were medical and surgical clinics, foundling hospitals, Sisters
of Charity, men and women professors--among the latter the famous
Trotula--and apothecaries. Dissections were carried out, chiefly upon
animals, and human subjects were occasionally used. In the eleventh and
twelfth centuries, the school reached its height, and that remarkable
genius, Frederick II, laid down regulations for a preliminary study
extending over three years, and a course in medicine for five years,
including surgery. Fee tables and strict regulations as to practice were
made; and it is specifically stated that the masters were to teach
in the schools, theoretically and practically, under the authority of
Hippocrates and Galen. The literature from the school had a far-reaching
influence. One book on the anatomy of the pig illustrates the popular
subject for dissection at that time.(6) The writings, which are
numerous, have been collected by De Renzi.(7)

     (6) "And dissections of the bodies of swine
     As likest the human form divine."--Golden Legend.

     (7) S. de Renzi: Collectio Salernitana, 5 vols., Naples,
     1852-1859; P. Giacosa: Magistri Salernitani, Turin, 1901.

The "Antidotarium" of Nicolaus Salernitanus, about 1100, became the
popular pharmacopoeia of the Middle Ages, and many modern preparations
may be traced to it.

The most prominent man of the school is Constantinus Africanus, a native
of Carthage, who, after numerous journeys, reached Salernum about the
middle of the eleventh century. He was familiar with the works both of
the Greeks and of the Arabs, and it was largely through his translations
that the works of Rhazes and Avicenna became known in the West.

One work above all others spread the fame of the school--the Regimen
Sanitatis, or Flos Medicinae as it is sometimes called, a poem on
popular medicine. It is dedicated to Robert of Normandy, who had been
treated at Salernum, and the lines begin: "Anglorum regi scripsit schola
tota Salerni . . . " It is a hand-book of diet and household medicine,
with many shrewd and taking sayings which have passed into popular use,
such as "Joy, temperance and repose Slam the door on the doctor's nose."
A full account of the work and the various editions of it is given
by Sir Alexander Croke,(8) and the Finlayson lecture (Glasgow Medical
Journal, 1908) by Dr. Norman Moore gives an account of its introduction
into the British Isles.

     (8) Regimen Sanitutis Salernitanum; a Poem on the Preservation of
     Health in Rhyming Latin Verse, Oxford, D.A. Talboys, 1830.




BYZANTINE MEDICINE

THE second great stream which carried Greek medicine to modern days runs
through the Eastern Empire. Between the third century and the fall of
Constantinople there was a continuous series of Byzantine physicians
whose inspiration was largely derived from the old Greek sources. The
most distinguished of these was Oribasius, a voluminous compiler, a
native of Pergamon and so close a follower of his great townsman that he
has been called "Galen's ape." He left many works, an edition of which
was edited by Bussemaker and Daremberg. Many facts relating to the older
writers are recorded in his writings. He was a contemporary, friend as
well as the physician, of the Emperor Julian, for whom he prepared an
encyclopaedia of the medical sciences.

Other important Byzantine writers were Aetius and Alexander of Tralles,
both of whom were strongly under the influence of Galen and Hippocrates.
Their materia medica was based largely upon Dioscorides.

From Byzantium we have the earliest known complete medical manuscript,
dating from the fifth century--a work of Dioscorides--one of the most
beautiful in existence. It was prepared for Anicia Juliana, daughter of
the Emperor of the East, and is now one of the great treasures of the
Imperial Library at Vienna.(9) From those early centuries till the fall
of Constantinople there is very little of interest medically. A few
names stand out prominently, but it is mainly a blank period in our
records. Perhaps one man may be mentioned, as he had a great influence
on later ages--Actuarius, who lived about 1300, and whose book on
the urine laid the foundation of much of the popular uroscopy and
water-casting that had such a vogue in the sixteenth and seventeenth
centuries. His work on the subject passed through a dozen Latin
editions, but is best studied in Ideler's "Physici et medici Graeci
minores" (Berlin, 1841).

     (9) It has been reproduced by Seatone de Vries, Leyden, 1905,
     Codices graeci et latini photographice depicti, Vol. X.

The Byzantine stream of Greek medicine had dwindled to a very tiny rill
when the fall of Constantinople (1453) dispersed to the West many Greek
scholars and many precious manuscripts.




ARABIAN MEDICINE

THE third and by far the strongest branch of the Greek river reached the
West after a remarkable and meandering course. The map before you shows
the distribution of the Graeco-Roman Christian world at the beginning of
the seventh century. You will notice that Christianity had extended
far eastwards, almost to China. Most of those eastern Christians were
Nestorians and one of their important centres was Edessa, whose school
of learning became so celebrated. Here in the fifth century was built
one of the most celebrated hospitals of antiquity.

Now look at another map showing the same countries about a century
later. No such phenomenal change ever was made within so short space
of time as that which thus altered the map of Asia and Europe at this
period. Within a century, the Crescent had swept from Arabia through the
Eastern Empire, over Egypt, North Africa and over Spain in the West, and
the fate of Western Europe hung in the balance before the gates of Tours
in 732. This time the barbaric horde that laid waste a large part of
Christendom were a people that became deeply appreciative of all that
was best in Graeco-Roman civilization and of nothing more than of its
sciences. The cultivation of medicine was encouraged by the Arabs in a
very special way. Anyone wishing to follow the history of the medical
profession among this remarkable people will find it admirably presented
in Lucien Leclerc's "Histoire de la medecine arabe" (Paris, 1876).
An excellent account is also given in Freind's well-known "History of
Medicine" (London, 1725-1726). Here I can only indicate very briefly the
course of the stream and its freightage.

With the rise of Christianity, Alexandria became a centre of bitter
theological and political factions, the story of which haunts the
memory of anyone who was so fortunate as to read in his youth Kingsley's
"Hypatia." These centuries, with their potent influence of neoplatonism
on Christianity, appear to have been sterile enough in medicine. I have
already referred to the late Greeks, Aetius and Alexander of Tralles.
The last of the Alexandrians was a remarkable man, Paul of AEgina, a
great name in medicine and in surgery, who lived in the early part of
the seventh century. He also, like Oribasius, was a great compiler. In
the year 640, the Arabs took Alexandria, and for the third time a great
library was destroyed in the "first city of the West." Shortly after
the conquest of Egypt, Greek works were translated into Arabic, often
through the medium of Syriac, particularly certain of Galen's books
on medicine, and chemical writings, which appear to have laid the
foundation of Arabian knowledge on this subject.

Through Alexandria then was one source: but the special development of
the Greek science and of medicine took place in the ninth century under
the Eastern Caliphates. Let me quote here a couple of sentences from
Leclerc (Tome I, pp. 91-92):

"The world has but once witnessed so marvellous a spectacle as that
presented by the Arabs in the ninth century. This pastoral people, whose
fanaticism had suddenly made them masters of half of the world, having
once founded their empire, immediately set themselves to acquire that
knowledge of the sciences which alone was lacking to their greatness. Of
all the invaders who competed for the last remains of the Roman Empire
they alone pursued such studies; while the Germanic hordes, glorying
in their brutality and ignorance, took a thousand years to re-unite the
broken chain of tradition, the Arabs accomplished this in less than a
century. They provoked the competition of the conquered Christians--a
healthy competition which secured the harmony of the races.

"At the end of the eighth century, their whole scientific possessions
consisted of a translation of one medical treatise and some books on
alchemy. Before the ninth century had run to its close, the Arabs were
in possession of all the science of the Greeks; they had produced from
their own ranks students of the first order, and had raised among their
initiators men who, without them, would have been groping in the dark;
and they showed from this time an aptitude for the exact sciences, which
was lacking in their instructors, whom they henceforward surpassed."

It was chiefly through the Nestorians that the Arabs became acquainted
with Greek medicine, and there were two famous families of translators,
the Bakhtishuas and the Mesues, both Syrians, and probably not
very thoroughly versed in either Greek or Arabic. But the prince of
translators, one of the finest figures of the century, was Honein, a
Christian Arab, born in 809, whose name was Latinized as Joannitius.
"The marvellous extent of his works, their excellence, their importance,
the trials he bore nobly at the beginning of his career, everything
about him arouses our interest and sympathy. If he did not actually
create the Oriental renaissance movement, certainly no one played in
it a more active, decided and fruitful part."(10) His industry was
colossal. He translated most of the works of Hippocrates and Galen,
Aristotle and many others. His famous "Introduction" or "Isagoge,"
a very popular book in the Middle Ages, is a translation of the
"Microtegni" of Galen, a small hand-book, of which a translation is
appended to Cholmeley's "John of Gaddesden."(11) The first printed
edition of it appeared in 1475 (see Chapter IV) at Padua.

     (10) Leclerc:  Histoire de la medecine arabe, Tome I, p. 139.

     (11) Oxford, Clarendon Press, 1912, pp. 136-166. The Mesues also
     did great work, and translations of their compilations,
     particularly those of the younger Mesue, were widely distributed
     in manuscript and were early printed (Venice, 1471) and
     frequently reprinted, even as late as the seventeenth century.

Leclerc gives the names of more than one hundred known translators who
not only dealt with the physicians but with the Greek philosophers,
mathematicians and astronomers. The writings of the physicians of India
and of Persia were also translated into Arabic.

But close upon the crowd of translators who introduced the learning of
Greece to the Arabians came original observers of the first rank, to a
few only of whom time will allow me to refer. Rhazes, so called from the
name of the town (Rai) in which he was born, was educated at the great
hospital at Bagdad in the second half of the ninth century. With a true
Hippocratic spirit he made many careful observations on disease, and
to him we owe the first accurate account of smallpox, which he
differentiated from measles. This work was translated for the old
Sydenham Society by W.A. Greenhill (1848), and the description given
of the disease is well worth reading. He was a man of strong powers
of observation, good sense and excellent judgment. His works were very
popular, particularly the gigantic "Continens," one of the bulkiest of
incunabula. The Brescia edition, 1486, a magnificent volume, extends
over 588 pages and it must weigh more than seventeen pounds. It is an
encyclopaedia filled with extracts from the Greek and other writers,
interspersed with memoranda of his own experiences. His "Almansor" was
a very popular text-book, and one of the first to be printed. Book IX
of "Almansor" (the name of the prince to whom it was addressed) with the
title "De aegritudinibus a capite usque ad pedes," was a very favorite
mediaeval text-book. On account of his zeal for study Rhazes was known
as the "Experimentator."

The first of the Arabians, known throughout the Middle Ages as the
Prince, the rival, indeed, of Galen, was the Persian Ibn Sina, better
known as Avicenna, one of the greatest names in the history of medicine.
Born about 980 A. D. in the province of Khorasan, near Bokhara, he has
left a brief autobiography from which we learn something of his early
years. He could repeat the Koran by heart when ten years old, and at
twelve he had disputed in law and in logic. So that he found medicine
was an easy subject, not hard and thorny like mathematics and
metaphysics! He worked night and day, and could solve problems in his
dreams. "When I found a difficulty," he says, "I referred to my notes
and prayed to the Creator. At night, when weak or sleepy, I strengthened
myself with a glass of wine."(12) He was a voluminous writer to whom
scores of books are attributed, and he is the author of the most famous
medical text-book ever written. It is safe to say that the "Canon" was
a medical bible for a longer period than any other work. It "stands for
the epitome of all precedent development, the final codification of all
Graeco-Arabic medicine. It is a hierarchy of laws liberally illustrated
by facts which so ingeniously rule and are subject to one another, stay
and uphold one another, that admiration is compelled for the sagacity
of the great organiser who, with unparalleled power of systematisation,
collecting his material from all sources, constructed so imposing an
edifice of fallacy. Avicenna, according to his lights, imparted to
contemporary medical science the appearance of almost mathematical
accuracy, whilst the art of therapeutics, although empiricism did
not wholly lack recognition, was deduced as a logical sequence from
theoretical (Galenic and Aristotelian) premises. Is it, therefore,
matter for surprise that the majority of investigators and practitioners
should have fallen under the spell of this consummation of formalism and
should have regarded the 'Canon' as an infallible oracle, the more so
in that the logical construction was impeccable and the premises, in
the light of contemporary conceptions, passed for incontrovertible
axioms?"(13)

     (12) Withington:  Medical History, London, 1894, pp. 151-152.

     (13) Neuburger:  History of Medicine, Vol. I, pp. 368-369.

Innumerable manuscripts of it exist: of one of the most beautiful,
a Hebrew version (Bologna Library), I give an illustration. A Latin
version was printed in 1472 and there are many later editions, the last
in 1663. Avicenna was not only a successful writer, but the prototype
of the successful physician who was at the same time statesman, teacher,
philosopher and literary man. Rumor has it that he became dissipated,
and a contemporary saying was that all his philosophy could not make him
moral, nor all his physic teach him to preserve his health. He enjoyed a
great reputation as a poet. I reproduce a page of a manuscript of one of
his poems, which we have in the Bodleian Library. Prof. A.V.W. Jackson
says that some of his verse is peculiarly Khayyamesque, though he
antedated Omar by a century. That "large Infidel" might well have
written such a stanza as

     From Earth's dark centre unto Saturn's Gate
     I've solved all problems of this world's Estate,
     From every snare of Plot and Guile set free,
     Each bond resolved, saving alone Death's Fate.

His hymn to the Deity might have been written by Plato and rivals the
famous one of Cleanthes.(14) A casual reader gets a very favorable
impression of Avicenna. The story of his dominion over the schools in
the Middle Ages is one of the most striking in our history. Perhaps we
feel that Leclerc exaggerates when he says: "Avicenna is an intellectual
phenomenon. Never perhaps has an example been seen of so precocious,
quick and wide an intellect extending and asserting itself with so
strange and indefatigable an activity." The touch of the man never
reached me until I read some of his mystical and philosophical writings
translated by Mehren.(15) It is Plato over again. The beautiful allegory
in which men are likened to birds snared and caged until set free by the
Angel of Death might be met with anywhere in the immortal Dialogues.
The tractate on Love is a commentary on the Symposium; and the essay on
Destiny is Greek in spirit without a trace of Oriental fatalism, as you
may judge from the concluding sentence, which I leave you as his special
message: "Take heed to the limits of your capacity and you will arrive
at a knowledge of the truth! How true is the saying:--Work ever and to
each will come that measure of success for which Nature has designed
him." Avicenna died in his fifty-eighth year. When he saw that physic
was of no avail, resigning himself to the inevitable, he sold his goods,
distributed the money to the poor, read the Koran through once every
three days, and died in the holy month of Ramadan. His tomb at Hamadan,
the ancient Ecbatana, still exists, a simple brickwork building,
rectangular in shape, and surrounded by an unpretentious court. It was
restored in 1877, but is again in need of repair. The illustration here
shown is from a photograph sent by Dr. Neligan of Teheran. Though
dead, the great Persian has still a large practice, as his tomb is much
visited by pilgrims, among whom cures are said to be not uncommon.

     (14) "L'hymne d'Avicenne" in:  L'Elegie du Tograi, etc., par P.
     Vattier, Paris, 1660.

     (15) Traites mystiques d'Abou Ali al-Hosain b.  Abdallah b.  Sina
     ou d'Avicenne par M. A. F. Mehren, Leyden, E. J. Brill, Fasc.
     I-IV, 1889-1899.

The Western Caliphate produced physicians and philosophers almost as
brilliant as those of the East. Remarkable schools of medicine
were founded at Seville, Toledo and Cordova. The most famous of the
professors were Averroes, Albucasis and Avenzoar. Albucasis was "the
Arabian restorer of surgery." Averroes, called in the Middle Ages "the
Soul of Aristotle" or "the Commentator," is better known today among
philosophers than physicians. On the revival of Moslem orthodoxy he
fell upon evil days, was persecuted as a free-thinker, and the saying is
attributed to him--"Sit anima mea cum philosophic."

Arabian medicine had certain very definite characteristics: the basis
was Greek, derived from translations of the works of Hippocrates and
Galen. No contributions were made to anatomy, as dissections were
prohibited, nor to physiology, and the pathology was practically that
of Galen. Certain new and important diseases were described; a number
of new and active remedies were introduced, chiefly from the vegetable
kingdom. The Arabian hospitals were well organized and were deservedly
famous. No such hospital exists today in Cairo as that which was built
by al-Mansur Gilafun in 1283. The description of it by Makrizi, quoted
by Neuburger,(16) reads like that of a twentieth century institution
with hospital units.

(16) "I have founded this institution for my equals and for those
beneath me, it is intended for rulers and subjects, for soldiers and for
the emir, for great and small, freemen and slaves, men and women."
"He ordered medicaments, physicians and everything else that could
be required by anyone in any form of sickness; placed male and female
attendants at the disposal of the patients, determined their pay,
provided beds for patients and supplied them with every kind of covering
that could be required in any complaint. Every class of patient was
accorded separate accommodation: the four halls of the hospital were
set apart for those with fever and similar complaints; one part of the
building was reserved for eye-patients, one for the wounded, one for
those suffering from diarrhoea, one for women; a room for convalescents
was divided into two parts, one for men and one for women. Water was
laid on to all these departments. One room was set apart for cooking
food, preparing medicine and cooking syrups, another for the compounding
of confections, balsams, eye-salves, etc. The head-physician had an
apartment to himself wherein he delivered medical lectures. The number
of patients was unlimited, every sick or poor person who came found
admittance, nor was the duration of his stay restricted, and even those
who were sick at home were supplied with every necessity."--Makrizi.

"In later times this hospital was much extended and improved. The
nursing was admirable and no stint was made of drugs and appliances;
each patient was provided with means upon leaving so that he should
not require immediately to undertake heavy work." Neuburger: History of
Medicine, Vol. 1, p. 378.


It was in the domain of chemistry that the Arabs made the greatest
advances. You may remember that, in Egypt, chemistry had already made
considerable strides, and I alluded to Prof. Elliot Smith's view that
one of the great leaps in civilization was the discovery in the Nile
Valley of the metallurgy of copper. In the brilliant period of the
Ptolemies, both chemistry and pharmacology were studied, and it seems
not improbable that, when the Arabs took Alexandria in the year 640,
there were still many workers in these subjects.

The most famous of those early Arabic writers is the somewhat mythical
Geber, who lived in the first half of the eighth century, and whose
writings had an extraordinary influence throughout the Middle Ages.
The whole story of Geber is discussed by Berthelot in his "La chimie
au moyen age" (Paris, 1896). The transmission of Arabian science to
the Occident began with the Crusades, though earlier a filtering of
important knowledge in mathematics and astronomy had reached Southern
and Middle Europe through Spain. Among the translators several names
stand out prominently. Gerbert, who became later Pope Sylvester II, is
said to have given us our present Arabic figures. You may read the story
of his remarkable life in Taylor,(17) who says he was "the first mind
of his time, its greatest teacher, its most eager learner, and most
universal scholar." But he does not seem to have done much directly for
medicine.

     (17) The Mediaeval Mind, Vol. I, p. 280.

The Graeco-Arabic learning passed into Europe through two sources. As
I have already mentioned, Constantinus Africanus, a North African
Christian monk, widely travelled and learned in languages, came to
Salernum and translated many works from Arabic into Latin, particularly
those of Hippocrates and Galen. The "Pantegni" of the latter became one
of the most popular text-books of the Middle Ages. A long list of other
works which he translated is given by Steinschneider.(17a) It is not
unlikely that Arabic medicine had already found its way to Salernum
before the time of Constantine, but the influence of his translations
upon the later Middle Ages was very great.

     (17a) Steinschneider:  Virchow's Arch., Berl., 1867, xxxvii, 351.

The second was a more important source through the Latin translators
in Spain, particularly in Toledo, where, from the middle of the twelfth
till the middle of the thirteenth century, an extraordinary number of
Arabic works in philosophy, mathematics and astronomy were translated.
Among the translators, Gerard of Cremona is prominent, and has been
called the "Father of Translators." He was one of the brightest
intelligences of the Middle Ages, and did a work of the first importance
to science, through the extraordinary variety of material he put in
circulation. Translations, not only of the medical writers, but of an
indiscriminate crowd of authors in philosophy and general literature,
came from his pen. He furnished one of the first translations of
the famous "Almagest" of Ptolemy, which opened the eyes of his
contemporaries to the value of the Alexandrian astronomy.(18) Leclerc
gives a list of seventy-one works from his hand.

     (18) For an account of that remarkable work see German
     translation by Manitius, Leipzig, 1912.

Many of the translators of the period were Jews, and many of the works
were translated from Hebrew into Latin. For years Arabic had been the
learned language of the Jews, and in a large measure it was through them
that the Arabic knowledge and the translations passed into South and
Central Europe.

The Arab writer whose influence on mediaeval thought was the most
profound was Averroes, the great commentator on Aristotle.




THE RISE OF THE UNIVERSITIES


THE most striking intellectual phenomenon of the thirteenth century is
the rise of the universities. The story of their foundation is fully
stated in Rashdall's great work (Universities of Europe in the Middle
Ages, Oxford, 1895). Monastic and collegiate schools, seats of learning
like Salernum, student guilds as at Bologna, had tried to meet the
educational needs of the age. The word "university" literally means
an association, and was not at first restricted to learned bodies. The
origin appears to have been in certain guilds of students formed for
mutual protection associated at some place specially favorable for
study--the attraction generally being a famous teacher. The University
of Bologna grew up about guilds formed by students of law, and at
Paris, early in the twelfth century, there were communities of teachers,
chiefly in philosophy and theology. In this way arose two different
types of mediaeval university. The universities of Northern Italy were
largely controlled by students, who were grouped in different "nations."
They arranged the lectures and had control of the appointment of
teachers. On the other hand, in the universities founded on the Paris
model the masters had control of the studies, though the students, also
in nations, managed their own affairs.

Two universities have a special interest at this period in connection
with the development of medical studies, Bologna and Montpellier. At
the former the study of anatomy was revived. In the knowledge of the
structure of the human body no advance had been made for more than a
thousand years--since Galen's day. In the process of translation from
Greek to Syriac, from Syriac to Arabic, from Arabic to Hebrew, and from
Hebrew or Arabic to Latin, both the form and thought of the old Greek
writers were not infrequently confused and often even perverted, and
Galen's anatomy had suffered severely in the transmission. Our earliest
knowledge of the teaching of medicine at Bologna is connected with a
contemporary of Dante, Taddeo Alderotti, who combined Arabian erudition
with the Greek spirit. He occupied a position of extraordinary
prominence, was regarded as the first citizen of Bologna and a public
benefactor exempt from the payment of taxes. That he should have
acquired wealth is not surprising if his usual fees were at the rate
at which he charged Pope Honorius IV, i.e., two hundred florins a day,
besides a "gratification" of six thousand florins.

The man who most powerfully influenced the study of medicine in Bologna
was Mundinus, the first modern student of anatomy. We have seen that
at the school of Salernum it was decreed that the human body should be
dissected at least once every five years, but it was with the greatest
difficulty that permission was obtained for this purpose. It seems
probable that under the strong influence of Taddeo there was an
occasional dissection at Bologna, but it was not until Mundinus
(professor from 1306 to 1326) took the chair that the study of anatomy
became popular. The bodies were usually those of condemned criminals,
but in the year 1319 there is a record of a legal procedure against four
medical students for body-snatching--the first record, as far as I know,
of this gruesome practice. In 1316, Mundinus issued his work on anatomy,
which served as a text-book for more than two hundred years. He quotes
from Galen the amusing reasons why a man should write a book: "Firstly,
to satisfy his own friends; secondly, to exercise his best mental
powers; and thirdly, to be saved from the oblivion incident to old age."
Scores of manuscripts of his work must have existed, but they are now
excessively rare in Italy. The book was first printed at Pavia in 1478,
in a small folio without figures. It was very often reprinted in the
fifteenth and sixteenth centuries. The quaint illustration shows us the
mediaeval method of teaching anatomy: the lecturer sitting on a chair
reading from Galen, while a barber surgeon, or an "Ostensor," opens the
cavities of the body.

I have already referred to the study of medicine by women at Salernum.
Their names are also early met with in the school of Bologna. Mundinus
is said to have had a valuable assistant, a young girl, Alessandra
Giliani, an enthusiastic dissector, who was the first to practice the
injection of the blood vessels with  liquids. She died, consumed
by her labors, at the early age of nineteen, and her monument is still
to be seen.

Bologna honored its distinguished professors with magnificent tombs,
sixteen or seventeen of which, in a wonderful state of preservation,
may still be seen in the Civic Museum. That of Mundinus also exists--a
sepulchral bas-relief on the wall of the Church of San Vitale at
Bologna.(19)

     (19) For these figures and for points relating to the old school
     at Bologna see F. G. Cavezza:  Le Scuole dell' antico Studio
     Bolognese, Milano, 1896.

The other early mediaeval university of special interest in medicine is
that of Montpellier. With it are connected three teachers who have left
great names in our story--Arnold of Villanova, Henri de Mondeville and
Guy de Chauliac. The city was very favorably situated not far from the
Spanish border, and the receding tide of the Arab invasion in the eighth
century had left a strong Arabic influence in that province. The date
of the origin of the university is uncertain, but there were teachers of
medicine there in the twelfth century, though it was not until 1289 that
it was formally founded by a papal bull.

Arnold of Villanova was one of the most prolific writers of the Middle
Ages. He had travelled much, was deeply read in Arabic medicine and was
also a student of law and of philosophy. He was an early editor of the
Regimen Sanitatis, and a strong advocate of diet and hygiene. His views
on disease were largely those of the Arabian physicians, and we
cannot see that he himself made any very important contribution to our
knowledge; but he was a man of strong individuality and left an enduring
mark on mediaeval medicine, as one may judge from the fact that among
the first hundred medical books printed there were many associated
with his name. He was constantly in trouble with the Church, though
befriended by the Popes on account of his medical knowledge. There is
a Bull of Clement V asking the bishops to search for a medical book by
Arnold dedicated to himself, but not many years later his writings were
condemned as heretical.

In Henri de Mondeville we have the typical mediaeval surgeon, and we
know his work now very thoroughly from the editions of his "Anatomy"
and "Surgery" edited by Pagel (Berlin, 1889-1892), and the fine French
edition by Nicaise (Paris, 1893). The dominant Arabic influence is seen
in that he quotes so large a proportion of these authors, but he was an
independent observer and a practical surgeon of the first rank. He had a
sharp wit and employed a bitter tongue against the medical abuses of his
day. How the Hippocratic humors dominated practice at this time you may
see at a glance from the table prepared by Nicaise from the works of de
Mondeville. We have here the whole pathology of the period.

     ===============================================================

     TABLEAU DES HUMEURS
     D'APRES H. DE MONDEVILLE
     Flegme naturel.
     F. aqueux.
     Flegme                                  F. mucilagineux.
     F. vitreux.
     Flegme non naturel     F sale.
     F. doux.
     F. pontique, 2 especes.
     F. acide, 2 especes.
     Bile naturelle.
     Bile                                    B. citrine.
     B. vitelline
     Bile non naturelle     B. praline.
     B. aerugineuse.
     B. brulee, 3 especes.
     Sang             naturel.
     non naturel, 5 especes.
     Melancolie       naturelle.
     non naturelle, 5 especes.
     ===============================================================

A still greater name in the history of this school is Guy de Chauliac,
whose works have also been edited by Nicaise (Paris, 1890). His
"Surgery" was one of the most important text-books of the late Middle
Ages. There are many manuscripts of it, some fourteen editions in the
fifteenth century and thirty-eight in the sixteenth, and it continued to
be reprinted far into the seventeenth century. He too was dominated
by the surgery of the Arabs, and on nearly every page one reads of
the sages Avicenna, Albucasis or Rhazes. He lays down four conditions
necessary for the making of a surgeon--the first is that he must be
learned, the second, expert, the third that he should be clever, and the
fourth that he should be well disciplined.

You will find a very discerning sketch of the relation of these two men
to the history of surgery in the address given at the St. Louis Congress
in 1904 by Sir Clifford Allbutt.(20) They were strong men with practical
minds and good hands, whose experience taught them wisdom. In both there
was the blunt honesty that so often characterizes a good surgeon, and I
commend to modern surgeons de Mondeville's saying: "If you have operated
conscientiously on the rich for a proper fee, and on the poor for
charity, you need not play the monk, nor make pilgrimages for your
soul."

     (20) Allbutt:  Historical Relations of Medicine and Surgery,
     London, Macmillan Co., 1905.

One other great mediaeval physician may be mentioned, Peter of Abano (a
small town near Padua, famous for its baths). He is the first in a long
line of distinguished physicians connected with the great school of
Padua. Known as "the Conciliator," from his attempt to reconcile the
diverse views on philosophy and medicine, he had an extraordinary
reputation as a practitioner and author, the persistence of which
is well illustrated by the fact that eight of the one hundred and
eighty-two medical books printed before 1481 were from his pen. He seems
to have taught medicine in Paris, Bologna and Padua. He was a devoted
astrologer, had a reputation among the people as a magician and, like
his contemporary, Arnold of Villanova, came into conflict with the
Church and appears to have been several times before the Inquisition;
indeed it is said that he escaped the stake only by a timely death.
He was a prolific commentator on Aristotle, and his exposition of the
"problems" had a great vogue. The early editions of his texts are among
the most superb works ever printed. He outlived his reputation as a
magician, and more than a century after his death Frederick, Duke of
Urbino, caused his effigies to be set up over the gate of the palace at
Padua with this inscription:

     PETRUS APONUS PATAVINUS PHILOSOPHIAE MEDICINAEQUE
     SCIENTISSIMUS, OB IDQUE, CONCILIATORIS NOMEN
     ADEPTUS, ASTROLOGIAE VERO ADEO PERITUS,
     UT IN MAGIAE SUSPICIONEM INCIDERIT,
     FALSOQUE DE HAERESI POSTULATUS,
     ABSOLUTUS FUERIT.(21)

     (21) Naude:  History of Magick, London, 1657, p. 182, or the
     original: Apologie pour les grands hommes soupconnez de magic,
     e.g., ed. Amst., 1719, p. 275.

It is said that Abano caused to be painted the astronomical figures in
the great hall of the palace at Padua.

One characteristic of mediaeval medicine is its union with theology,
which is not remarkable, as the learning of the time was chiefly in
the hands of the clergy. One of the most popular works, the "Thesaurus
Pauperum," was written by Petrus Hispanus, afterwards Pope John XXI.
We may judge of the pontifical practice from the page here reproduced,
which probably includes, under the term "iliac passion," all varieties
of appendicitis.

For our purpose two beacons illuminate the spirit of the thirteenth
century in its outlook on man and nature. Better than Abelard or St.
Thomas Aquinas, and much better than any physicians, Albertus Magnus and
Roger Bacon represent the men who were awake to greet the rising of the
sun of science. What a contrast in their lives and in their works! The
great Dominican's long life was an uninterrupted triumph of fruitful
accomplishment--the titanic task he set himself was not only completed
but was appreciated to the full by his own generation--a life not only
of study and teaching, but of practical piety. As head of the order in
Germany and Bishop of Regensburg, he had wide ecclesiastical influence;
and in death he left a memory equalled only by one or two of his
century, and excelled only by his great pupil, Thomas Aquinas. There are
many Alberts in history--the Good, the Just, the Faithful--but there is
only one we call "Magnus" and he richly deserved the name. What is his
record? Why do we hold his name in reverence today?

Albertus Magnus was an encyclopaedic student and author, who took all
knowledge for his province. His great work and his great ambition was to
interpret Aristotle to his generation. Before his day, the Stagirite was
known only in part, but he put within the reach of his contemporaries
the whole science of Aristotle, and imbibed no small part of his spirit.
He recognized the importance of the study of nature, even of testing
it by way of experiment, and in the long years that had elapsed since
Theophrastus no one else, except Dioscorides, had made so thorough
a study of botany. His paraphrases of the natural history books
of Aristotle were immensely popular, and served as a basis for all
subsequent studies. Some of his medical works had an extraordinary
vogue, particularly the "De Secretis Mulierum" and the "De Virtutibus
Herbarum," but there is some doubt as to the authorship of the first
named, although Jammy and Borgnet include it in the collected editions
of his works. So fabulous was his learning that he was suspected of
magic and comes in Naude's list of the wise men who have unjustly
been reputed magicians. Ferguson tells(22) that "there is in actual
circulation at the present time a chapbook . . . containing charms,
receipts, sympathetical and magicalcures for man and animals, . . .
which passes under the name of Albertus." But perhaps the greatest claim
of Albertus to immortality is that he was the teacher and inspirer
of Thomas Aquinas, the man who undertook the colossal task of fusing
Aristotelian philosophy with Christian theology, and with such success
that the "angelic doctor" remains today the supreme human authority of
the Roman Catholic Church.

     (22) Bibliotheca Chemica, 1906, Vol. I, p. 15.

A man of much greater interest to us from the medical point of view is
Roger Bacon and for two reasons. More than any other mediaeval mind he
saw the need of the study of nature by a new method. The man who could
write such a sentence as this: "Experimental science has three great
prerogatives over other sciences; it verifies conclusions by direct
experiment; it discovers truth which they never otherwise would reach;
it investigates the course of nature and opens to us a knowledge of the
past and of the future," is mentally of our day and generation. Bacon
was born out of due time, and his contemporaries had little sympathy
with his philosophy, and still less with his mechanical schemes and
inventions. From the days of the Greeks, no one had had so keen an
appreciation of what experiment meant in the development of human
knowledge, and he was obsessed with the idea, so commonplace to us, that
knowledge should have its utility and its practical bearing. "His chief
merit is that he was one of the first to point the way to original
research--as opposed to the acceptance of an authority--though he
himself still lacked the means of pursuing this path consistently. His
inability to satisfy this impulse led to a sort of longing, which is
expressed in the numerous passages in his works where he anticipates
man's greater mastery over nature."(23)

     (23) Dannemann: Die Naturwissenschaften in ihrer Entwicklung und
     in ibrem Zusammenhange, Leipzig, 1910, Vol. I, pp. 278-279.

Bacon wrote a number of medical treatises, most of which remain in
manuscript. His treatise on the "Cure of Old Age and the Preservation of
Youth" was printed in English in 1683.(24) His authorities were largely
Arabian. One of his manuscripts is "On the Bad Practices of Physicians."
On June 10, 1914, the eve of his birth, the septencentenary of Roger
Bacon will be celebrated by Oxford, the university of which he is the
most distinguished ornament. His unpublished MSS. in the Bodleian will
be issued by the Clarendon Press (1915-1920), and it is hoped that his
unpublished medical writings will be included.

     (24) It may be interesting to note the three causes to which he
     attributes old age:  "As the World waxeth old, Men grow old with
     it: not by reason of the Age of the World, but because of the
     great Increase of living Creatures, which infect the very Air,
     that every way encompasseth us, and Through our Negligence in
     ordering our Lives, and That great Ignorance of the Properties
     which are in things conducing to Health, which might help a
     disordered way of Living, and might supply the defect of due
     Government."

What would have been its fate if the mind of Europe had been ready for
Roger Bacon's ferment, and if men had turned to the profitable studies
of physics, astronomy and chemistry instead of wasting centuries over
the scholastic philosophy and the subtleties of Duns Scotus, Abelard and
Thomas Aquinas? Who can say? Make no mistake about the quality of these
men--giants in intellect, who have had their place in the evolution of
the race; but from the standpoint of man struggling for the mastery of
this world they are like the members of Swift's famous college "busy
distilling sunshine from cucumbers." I speak, of course, from the
position of the natural man, who sees for his fellows more hope from the
experiments of Roger Bacon than from the disputations of philosophy on
the "Instants, Familiarities, Quiddities and Relations," which so roused
the scorn of Erasmus.




MEDIAEVAL MEDICAL STUDIES

IT will be of interest to know what studies were followed at a mediaeval
university. At Oxford, as at most of the continental universities, there
were three degrees, those of Bachelor, Licentiate and Doctor. The books
read were the "Tegni" of Galen, the "Aphorisms" of Hippocrates, the "De
Febribus" of Isaac and the "Antidotarium" of Nicolaus Salernitanus: if
a graduate in arts, six years' study in all was required, in other
faculties, eight. One gets very full information on such matters from
a most interesting book, "Une Chaire de Medecine au XVe Siecle," by Dr.
Ferrari (Paris, 1899). The University of Pavia was founded in 1361, and
like most of those in Italy was largely frequented by foreigners, who
were arranged, as usual, according to their nationalities; but the
students do not appear to have controlled the university quite so much
as at Bologna. The documents of the Ferrari family, on which the work is
based, tell the story of one of its members, who was professor at Pavia
from 1432 to 1472. One is surprised at the range of studies in certain
directions, and still more at the absence of other subjects. A list is
given of the teachers in medicine for the year 1433, twenty in all, and
there were special lectures for the morning, afternoon and evening. The
subjects are medicine, practical medicine, physics, metaphysics, logic,
astrology, surgery and rhetoric: very striking is the omission of
anatomy, which does not appear in the list even in 1467. The salaries
paid were not large, so that most of the teachers must have been in
practice: four hundred and five hundred florins was the maximum.

The dominance of the Arabians is striking. In 1467, special lectures
were given on the "Almansor" of Rhazes, and in the catalogue of
the Ferrari's library more than one half of the books are Arabian
commentaries on Greek medicine. Still more striking evidence of their
influence is found in the text-book of Ferrari, which was printed in
1471 and had been circulated earlier in MS. In it Avicenna is quoted
more than 3000 times, Rhazes and Galen 1000, Hippocrates only 140
times. Professor Ferrari was a man who played an important role in
the university, and had a large consultation practice. You will be
interested to know what sort of advice he gave in special cases. I have
the record of an elaborate consultation written in his own hand, from
which one may gather what a formidable thing it was to fall into the
hands of a mediaeval physician. Signor John de Calabria had a digestive
weakness of the stomach, and rheumatic cerebral disease, combined with
superfluous heat and dryness of the liver and multiplication of choler.
There is first an elaborate discussion on diet and general mode of life;
then he proceeds to draw up certain light medicines as a supplement,
but it must have taken an extensive apothecary's shop to turn out the
twenty-two prescriptions designed to meet every possible contingency.

One of the difficulties in the early days of the universities was to
procure good MSS. In the Paris Faculty, the records of which are the
most complete in Europe, there is an inventory for the year 1395 which
gives a list of twelve volumes, nearly all by Arabian authors.(25)
Franklin gives an interesting incident illustrating the rarity of
medical MSS. at this period. Louis XI, always worried about his health,
was anxious to have in his library the works of Rhazes. The only copy
available was in the library of the medical school. The manuscript was
lent, but on excellent security, and it is nice to know that it was
returned.

     (25) Franklin:  Recherches sur la Bibliotheque de la Faculte de
     Medecine de Paris, 1864.

It is said that one of the special advantages that Montpellier had over
Paris was its possession of so many important MSS., particularly
those of the Arabian writers. Many "Compendia" were written containing
extracts from various writers, and no doubt these were extensively
copied and lent or sold to students. At Bologna and Padua, there were
regulations as to the price of these MSS. The university controlled the
production of them, and stationers were liable to fines for inaccurate
copies. The trade must have been extensive in those early days, as
Rashdall mentions that in 1323 there were twenty-eight sworn booksellers
in Paris, besides keepers of bookstalls in the open air.




MEDIAEVAL PRACTICE

THE Greek doctrine of the four humors  all the conceptions of
disease; upon their harmony alone it was thought that health depended.
The four temperaments, sanguine, phlegmatic, bilious and melancholic,
corresponded with the prevalence of these humors. The body was composed
of certain so-called "naturals," seven in number--the elements,
the temperaments, the humors, the members or parts, the virtues
or faculties, the operations or functions and the spirits. Certain
"non-naturals," nine in number, preserved the health of the body, viz.
air, food and drink, movement and repose, sleeping and waking, excretion
and retention, and the passions. Disease was due usually to alterations
in the composition of the humors, and the indications for treatment were
in accordance with these doctrines. They were to be evacuated, tenuated,
cooled, heated, purged or strengthened. This humoral doctrine prevailed
throughout the Middle Ages, and reached far into modern times--indeed,
echoes of it are still to be heard in popular conversations on the
nature of disease.

The Arabians were famous for their vigor and resource in matters of
treatment. Bleeding was the first resort in a large majority of all
diseases. In the "Practice" of Ferrari there is scarcely a malady
for which it is not recommended. All remedies were directed to the
regulation of the six non-naturals, and they either preserved health,
cured the disease or did the opposite. The most popular medicines were
derived from the vegetable kingdom, and as they were chiefly those
recommended by Galen, they were, and still are, called by his name.
Many important mineral medicines were introduced by the Arabians,
particularly mercury, antimony, iron, etc. There were in addition scores
of substances, the parts or products of animals, some harmless, others
salutary, others again useless and disgusting. Minor surgery was in the
hands of the barbers, who performed all the minor operations, such as
bleeding; the more important operations, few in number, were performed
by surgeons.




ASTROLOGY AND DIVINATION

AT this period astrology, which included astronomy, was everywhere
taught. In the "Gouernaunce of Prynces, or Pryvete of Pryveties,"
translated by James Yonge, 1422,(26) there occurs the statement:
"As Galian the lull wies leche Saith and Isoder the Gode clerk, hit
witnessith that a man may not perfitely can the sciens and craft of
Medissin but yef he be an astronomoure."

     (26) Early English Text Society, Extra Series, No. LXXIV, p. 195,
     1898; Secreta Secretorum, Rawl. MS. B., 490.

We have seen how the practice of astrology spread from Babylonia and
Greece throughout the Roman Empire. It was carried on into the Middle
Ages as an active and aggressive cult, looked upon askance at times
by the Church, but countenanced by the courts, encouraged at the
universities, and always by the public. In the curriculum of the
mediaeval university, astronomy made up with music, arithmetic and
geometry the Quadrivium. In the early faculties, astronomy and astrology
were not separate, and at Bologna, in the early fourteenth century, we
meet with a professorship of astrology.(27) One of the duties of this
salaried professor, was to supply "judgements" gratis for the benefit of
enquiring students, a treacherous and delicate assignment, as that most
distinguished occupant of the chair at Bologna, Cecco d'Ascoli, found
when he was burned at the stake in 1357, a victim of the Florentine
Inquisition.(28)

     (27) Rashdall:  Universities of Europe in the Middle Ages, Vol.
     I, p. 240.

     (28) Rashdall, l.c., Vol. I, p. 244.--Rashdall also mentions that
     in the sixteenth century at Oxford there is an instance of a
     scholar admitted to practice astrology. l.c., Vol. II, p. 458.

Roger Bacon himself was a warm believer in judicial astrology and in the
influence of the planets, stars and comets on generation, disease and
death.

Many of the stronger minds of the Renaissance broke away from the
follies of the subject. Thus Cornelius Agrippa in reply to the request
of a friar to consult the stars on his behalf says:(29) "Judicial
astrology is nothing more than the fallacious guess of superstitious
men, who have founded a science on uncertain things and are deceived by
it: so think nearly all the wise; as such it is ridiculed by some most
noble philosophers; Christian theologians reject it, and it is condemned
by sacred councils of the Church. Yet you, whose office it is to
dissuade others from these vanities, oppressed, or rather blinded by I
know not what distress of mind, flee to this as to a sacred augur, and
as if there were no God in Israel, that you send to inquire of the god
of Ekron."

     (29) H. Morley:  The Life of Henry Cornelius Agrippa, London,
     1856, Vol. II, p. 138.

In spite of the opposition of the Church astrology held its own; many of
the universities at the end of the fifteenth century published almanacs,
usually known as "Prognosticons," and the practice was continued far
into the sixteenth century. I show you here an illustration. Rabelais,
you may remember, when physician to the Hotel Dieu in Lyons, published
almanacs for the years 1533, 1535, 1541, 1546. In the title-page he
called himself "Doctor of Medicine and Professor of Astrology," and they
continued to be printed under his name until 1556. In the preparation
of these he must have had his tongue in his cheek, as in his famous
"Pantagrueline Prognostication," in which, to satisfy the curiosity of
all good companions, he had turned over all the archives of the heavens,
calculated the quadratures of the moon, hooked out all that has ever
been thought by all the Astrophils, Hypernephilists, Anemophylakes,
Uranopets and Ombrophori, and felt on every point with Empedocles.(30)

     (30) Pantagrueline Prognostication, Rabelais, W. F. Smith's
     translation, 1893, Vol. II, p. 460.

Even physicians of the most distinguished reputation practised judicial
astrology. Jerome Cardan was not above earning money by casting
horoscopes, and on this subject he wrote one of his most popular books
(De Supplemento Almanach, etc., 1543), in which astronomy and
astrology are mixed in the truly mediaeval fashion. He gives in it some
sixty-seven nativities, remarkable for the events they foretell, with an
exposition. One of the accusations brought against him was that he had
"attempted to subject to the stars the Lord of the stars and cast our
Saviour's horoscope."(31) Cardan professed to have abandoned a practice
looked upon with disfavor both by the Church and by the universities,
but he returned to it again and again. I show here his own horoscope.
That remarkable character, Michael Servetus, the discoverer of the
lesser circulation, when a fellow student with Vesalius at Paris, gave
lectures upon judicial astrology, which brought him into conflict with
the faculty; and the rarest of the Servetus works, rarer even than
the "Christianismi Restitutio," is the "Apologetica disceptatio pro
astrologia," one copy of which is in the Bibliotheque Nationale. Nor
could the new astronomy and the acceptance of the heliocentric views
dislocate the popular belief. The literature of the seventeenth century
is rich in astrological treatises dealing with medicine.

     (31) De Thou, Lib. LXII, quoted by Morley in Life of Jerome
     Cardan, Vol. II, p. 294.

No one has ever poured such satire upon the mantic arts as did Rabelais
in chapter twenty-five of the third book of "Pantagruel." Panurge goes
to consult Her Trippa--the famous Cornelius Agrippa, whose opinion
of astrology has already been quoted, but who nevertheless, as court
astrologer to Louise of Savoy, had a great contemporary reputation.
After looking Panurge in the face and making conclusions by metoposcopy
and physiognomy, he casts his horoscope secundum artem, then, taking a
branch of tamarisk, a favorite tree from which to get the divining
rod, he names some twenty-nine or thirty mantic arts, from pyromancy to
necromancy, by which he offers to predict his future. While full of rare
humor, this chapter throws an interesting light on the extraordinary
number of modes of divination that have been employed. Small wonder that
Panurge repented of his visit! I show here the title-page of a popular
book by one of the most famous of the English astrological physicians,
Nicholas Culpeper.

Never was the opinion of sensible men on this subject better expressed
than by Sir Thomas Browne:(32) "Nor do we hereby reject or condemn a
sober and regulated Astrology; we hold there is more truth therein than
in ASTROLOGERS; in some more than many allow, yet in none so much
as some pretend. We deny not the influence of the Starres, but often
suspect the due application thereof; for though we should affirm that
all things were in all things; that Heaven were but Earth Celestified,
and earth but Heaven terrestrified, or that each part above had an
influence upon its divided affinity below; yet how to single out these
relations, and duly to apply their actions, is a work ofttimes to be
effected by some revelation, and Cabala from above, rather than any
Philosophy, or speculation here below."

     (32) Sir Thomas Browne:  Pseudodoxia Epidemica, Bk. IV, Chap.
     XIII. (Wilkin's ed., Vol. III, p. 84.)

As late as 1699, a thesis was discussed at the Paris Faculty, "Whether
comets were harbingers of disease," and in 1707 the Faculty negatived
the question propounded in a thesis, "Whether the moon had any sway on
the human body."

The eighteenth and nineteenth centuries saw, among intelligent men, a
progressive weakening of the belief in the subject; but not even the
satire of Swift, with his practical joke in predicting and announcing
the death of the famous almanac maker, nor contemptuous neglect of the
subject of late years sufficed to dispel the belief from the minds of
the public. Garth in the Dispensary (1699) satirizes the astrological
practitioners of his day:

     The Sage in Velvet Chair, here lolls at Ease
     To promise future Health for present Fees
     Then as from Tripod solemn Sham reveals
     And what the Stars know nothing of foretell. (Canto ii.)

The almanacs of Moore and Zadkiel continue to be published, and
remain popular. In London, sandwich men are to be met with carrying
advertisements of Chaldeans and Egyptians who offer to tell your fortune
by the stars. Even in this country, astrology is still practiced to
a surprising extent if one may judge from advertisements in certain
papers, and from publications which must have a considerable sale. Many
years ago, I had as a patient an estimable astrologer, whose lucrative
income was derived from giving people astral information as to the rise
and fall of stocks. It is a chapter in the vagaries of the human mind
that is worth careful study.(33) Let me commend to your reading the
sympathetic story called "A Doctor of Medicine" in the "Rewards and
Fairies" of Kipling. The hero is Nicholas Culpeper, Gent., whose picture
is here given. One stanza of the poem at the end of the story, "Our
Fathers of Old," may be quoted:

     Wonderful tales had our fathers of old--
     Wonderful tales of the herbs and the stars--
     The Sun was Lord of the Marigold,
     Basil and Rocket belonged to Mars.
     Pat as a sum in division it goes--
     (Every plant had a star bespoke)--
     Who but Venus should govern the Rose?
     Who but Jupiter own the Oak?
     Simply and gravely the facts are told
     In the wonderful books of our fathers of old.

     (33) It is not generally known that Stonewall Jackson practiced
     astrology. Col. J. W. Revere in "Keel and Saddle" (Boston, 1872)
     tells of meeting Jackson in 1852 on a Mississippi steamer and
     talking with him on the subject. Some months later, Revere
     received a letter from Jackson enclosing his (Revere's)
     horoscope.  There was a "culmination of the malign aspect during
     the first days of May, 1863--both will be exposed to a common
     danger at the time indicated."  At the battle of
     Chancellorsville, May 9, 1863, Revere saw Jackson mortally
     wounded!

James J. Walsh of New York has written a book of extraordinary interest
called "The Thirteenth, Greatest of Centuries." I have not the necessary
knowledge to say whether he has made out his case or not for art and for
literature. There was certainly a great awakening and, inspired by high
ideals, men turned with a true instinct to the belief that there was
more in life than could be got out of barren scholastic studies. With
many of the strong men of the period one feels the keenest mental
sympathy. Grosseteste, the great Clerk of Lincoln, as a scholar, a
teacher and a reformer, represents a type of mind that could grow
only in fruitful soil. Roger Bacon may be called the first of
the moderns--certainly the first to appreciate the extraordinary
possibilities which lay in a free and untrammelled study of nature.
A century which could produce men capable of building the Gothic
cathedrals may well be called one of the great epochs in history, and
the age that produced Dante is a golden one in literature. Humanity has
been the richer for St. Francis; and Abelard, Albertus and Aquinas form
a trio not easy to match, in their special departments, either before or
after. But in science, and particularly in medicine, and in the advance
of an outlook upon nature, the thirteenth century did not help man very
much. Roger Bacon was "a voice crying in the wilderness," and not one of
the men I have picked out as specially typical of the period instituted
any new departure either in practice or in science. They were servile
followers, when not of the Greeks, of the Arabians. This is attested by
the barrenness of the century and a half that followed. One would have
thought that the stimulus given by Mundinus to the study of anatomy
would have borne fruit, but little was done in science during the two
and a half centuries that followed the delivery of his lectures and
still less in the art. While William of Wykeham was building Winchester
Cathedral and Chaucer was writing the Canterbury Tales, John of
Gaddesden in practice was blindly following blind leaders whose
authority no one dared question.

The truth is, from the modern standpoint the thirteenth was not the
true dawn brightening more and more unto the perfect day, but a glorious
aurora which flickered down again into the arctic night of mediaevalism.

To sum up--in medicine the Middle Ages represent a restatement from
century to century of the facts and theories of the Greeks modified here
and there by Arabian practice. There was, in Francis Bacon's phrase,
much iteration, small addition. The schools bowed in humble, slavish
submission to Galen and Hippocrates, taking everything from them but
their spirit and there was no advance in our knowledge of the structure
or function of the body. The Arabians lit a brilliant torch from Grecian
lamps and from the eighth to the eleventh centuries the profession
reached among them a position of dignity and importance to which it is
hard to find a parallel in history.




CHAPTER IV -- THE RENAISSANCE AND THE RISE OF ANATOMY AND PHYSIOLOGY

THE "reconquest of the classic world of thought was by far the most
important achievement of the fifteenth and sixteenth centuries.
It absorbed nearly the whole mental energy of the Italians.... The
revelation of what men were and what they wrought under the influence of
other faiths and other impulses, in distant ages with a different ideal
for their aim, not only widened the narrow horizon of the Middle Ages,
but it also restored self-confidence to the reason of humanity."(1)

     (1) J. A. Symonds:  The Renaissance in Italy; the Revival of
     Learning, 1877, p. 52.

Everywhere throughout the Middle Ages learning was the handmaid of
theology. Even Roger Bacon with his strong appeal for a new method
accepted the dominant mediaeval conviction--that all the sciences did
but minister to their queen, Theology. A new spirit entered man's heart
as he came to look upon learning as a guide to the conduct of life.
A revolution was slowly effected in the intellectual world. It is
a mistake to think of the Renaissance as a brief period of sudden
fruitfulness in the North Italian cities. So far as science is
concerned, the thirteenth century was an aurora followed by a long
period of darkness, but the fifteenth was a true dawn that brightened
more and more unto the perfect day. Always a reflex of its period,
medicine joined heartily though slowly in the revolt against
mediaevalism. How slowly I did not appreciate until recently. Studying
the earliest printed medical works to catch the point of view of the men
who were in the thick of the movement up to 1480--which may be taken to
include the first quarter of a century of printing--one gets a startling
record. The mediaeval mind still dominates: of the sixty-seven
authors of one hundred and eighty-two editions of early medical books,
twenty-three were men of the thirteenth and fourteenth centuries, thirty
men of the fifteenth century, eight wrote in Arabic, several were of
the School of Salernum, and only six were of classical antiquity, viz.,
Pliny (first 1469), Hippocrates (1473) (Hain (*)7247), Galen (1475)
(Hain 7237), Aristotle (1476), Celsus (1478), and Dioscorides
(1478).(**)

     (*) This asterisk is used by Hain to indicate that he had seen a
     copy.--Ed.

     (**) Data added to a manuscript taken from the author's summary
     on "Printed Medical Books to 1480" in Transactions of the
     Bibliographical Society, London, 1916, XIII, 5-8, revised from
     its "News-Sheet" (February, 1914). "Of neither Hippocrates nor
     Galen is there an early edition; but in 1473 at Pavia appeared an
     exposition of the Aphorisms of Hippoerates, and in 1475 at Padua
     an edition of the Tegni or Notes of Galen."  Ibid., p. 6.
     Osler's unfinished Illustrated Monograph on this subject is now
     being printed for the Society of which he was President.--Ed.

The medical profession gradually caught the new spirit. It has been well
said that Greece arose from the dead with the New Testament in the one
hand and Aristotle in the other. There was awakened a perfect passion
for the old Greek writers, and with it a study of the original
sources, which had now become available in many manuscripts. Gradually
Hippocrates and Galen came to their own again. Almost every professor
of medicine became a student of the MSS. of Aristotle and of the Greek
physicians, and before 1530 the presses had poured out a stream of
editions. A wave of enthusiasm swept over the profession, and the best
energies of its best minds were devoted to a study of the Fathers. Galen
became the idol of the schools. A strong revulsion of feeling arose
against the Arabians, and Avicenna, the Prince, who had been clothed
with an authority only a little less than divine, became anathema. Under
the leadership of the Montpellier School, the Arabians made a strong
fight, but it was a losing battle all along the line. This group
of medical humanists--men who were devoted to the study of the old
humanities, as Latin and Greek were called--has had a great and
beneficial influence upon the profession. They were for the most part
cultivated gentlemen with a triple interest--literature, medicine and
natural history. How important is the part they played may be gathered
from a glance at the "Lives" given by Bayle in his "Biographic Medicale"
(Paris, 1855) between the years 1500 and 1575. More than one half of
them had translated or edited works of Hippocrates or Galen; many of
them had made important contributions to general literature, and a large
proportion of them were naturalists: Leonicenus, Linacre, Champier,
Fernel, Fracastorius, Gonthier, Caius, J. Sylvius, Brasavola, Fuchsius,
Matthiolus, Conrad Gesner, to mention only those I know best, form a
great group. Linacre edited Greek works for Aldus, translated works
of Galen, taught Greek at Oxford, wrote Latin grammars and founded
the Royal College of Physicians.(*) Caius was a keen Greek scholar,
an ardent student of natural history, and his name is enshrined as
co-founder of one of the most important of the Cambridge colleges.
Gonthier, Fernel, Fuchs and Mattioli were great scholars and greater
physicians. Champier, one of the most remarkable of the group, was
the founder of the Hotel Dieu at Lyons, and author of books of a
characteristic Renaissance type and of singular bibliographical
interest. In many ways greatest of all was Conrad Gesner, whose mors
inopinata at forty-nine, bravely fighting the plague, is so touchingly
and tenderly mourned by his friend Caius.(2) Physician, botanist,
mineralogist, geologist, chemist, the first great modern bibliographer,
he is the very embodiment of the spirit of the age.(2a) On the flyleaf
of my copy of the "Bibliotheca Universalis" (1545), is written a fine
tribute to his memory. I do not know by whom it is, but I do know from
my reading that it is true:

     (*) Cf.  Osler:  Thomas Linacre, Cambridge University Press,
     1908.--Ed.

     (2) Joannis Caii Britanni de libris suis, etc., 1570.

     (2a) See J. C. Bay:  Papers Bibliog. Soc. of America, 1916, X,
     No. 2, 53-86.

"Conrad Gesner, who kept open house there for all learned men who came
into his neighborhood. Gesner was not only the best naturalist among the
scholars of his day, but of all men of that century he was the pattern
man of letters. He was faultless in private life, assiduous in study,
diligent in maintaining correspondence and good-will with learned men in
all countries, hospitable--though his means were small--to every scholar
that came into Zurich. Prompt to serve all, he was an editor of other
men's volumes, a writer of prefaces for friends, a suggestor to young
writers of books on which they might engage themselves, and a great
helper to them in the progress of their work. But still, while finding
time for services to other men, he could produce as much out of his own
study as though he had no part in the life beyond its walls."

A large majority of these early naturalists and botanists were
physicians.(3) The Greek art of observation was revived in a study of
the scientific writings of Aristotle, Theophrastus and Dioscorides and
in medicine, of Hippocrates and of Galen, all in the Greek originals.
That progress was at first slow was due in part to the fact that the
leaders were too busy scraping the Arabian tarnish from the pure gold of
Greek medicine and correcting the anatomical mistakes of Galen to bother
much about his physiology or pathology. Here and there among the great
anatomists of the period we read of an experiment, but it was the art of
observation, the art of Hippocrates, not the science of Galen, not the
carefully devised experiment to determine function, that characterized
their work. There was indeed every reason why men should have been
content with the physiology and pathology of that day, as, from a
theoretical standpoint, it was excellent. The doctrine of the four
humors and of the natural, animal and vital spirits afforded a ready
explanation for the symptoms of all diseases, and the practice of the
day was admirably adapted to the theories. There was no thought of, no
desire for, change. But the revival of learning awakened in men at
first a suspicion and at last a conviction that the ancients had left
something which could be reached by independent research, and gradually
the paralytic-like torpor passed away.

     (3) Miall:  The Early Naturalists, London, 1912.

The sixteenth and seventeenth centuries did three things in
medicine--shattered authority, laid the foundation of an accurate
knowledge of the structure of the human body and demonstrated how its
functions should be studied intelligently--with which advances, as
illustrating this period, may be associated the names of Paracelsus,
Vesalius and Harvey.




PARACELSUS

PARACELSUS is "der Geist der stets verneint." He roused men against the
dogmatism of the schools, and he stimulated enormously the practical
study of chemistry. These are his great merits, against which must be
placed a flood of hermetical and transcendental medicine, some his own,
some foisted in his name, the influence of which is still with us.

"With what judgment ye judge it shall be judged to you again" is the
verdict of three centuries on Paracelsus. In return for unmeasured abuse
of his predecessors and contemporaries he has been held up to obloquy
as the arch-charlatan of history. We have taken a cheap estimate of
him from Fuller and Bacon, and from a host of scurrilous scribblers
who debased or perverted his writings. Fuller(4) picked him out as
exemplifying the drunken quack, whose body was a sea wherein the tide
of drunkenness was ever ebbing and flowing--"He boasted that shortly
he would order Luther and the Pope, as well as he had done Galen and
Hippocrates. He was never seen to pray, and seldome came to Church.
He was not onely skilled in naturall Magick (the utmost bounds whereof
border on the suburbs of hell) but is charged to converse constantly
with familiars. Guilty he was of all vices but wantonnesse: . . . "

     (4) Fuller:  The Holy and Profane State, Cambridge, 1642, p. 56.

Francis Bacon, too, says many hard things of him.(5)

     (5) Bacon:  Of the Proficience and Advancement of Learning, Bk.
     II, Pickering ed., London, 1840, p. 181.  Works, Spedding ed.,
     III, 381.

To the mystics, on the other hand, he is Paracelsus the Great, the
divine, the most supreme of the Christian magi, whose writings are too
precious for science, the monarch of secrets, who has discovered the
Universal Medicine. This is illustrated in Browning's well-known poem
"Paracelsus," published when he was only twenty-one; than which there
is no more pleasant picture in literature of the man and of his
aspirations. His was a "searching and impetuous soul" that sought to win
from nature some startling secret--". . . a tincture of force to flush
old age with youth, or breed gold, or imprison moonbeams till they
change to opal shafts!" At the same time with that capacity for
self-deception which characterizes the true mystic he sought to cast

     Light on a darkling race; save for that doubt,
     I stood at first where all aspire at last
     To stand:  the secret of the world was mine.
     I knew, I felt (perception unexpressed,
     Uncomprehended by our narrow thought,
     But somehow felt and known in every shift
     And change in the spirit,--nay, in every pore
     Of the body, even)--what God is, what we are,
     What life is--. . .(6)

     (6) Robert Browning:  Paracelsus, closing speech.

Much has been done of late to clear up his story and his character.
Professor Sudhoff, of Leipzig, has made an exhaustive bibliographical
study of his writings,(7) there have been recent monographs by Julius
Hartmann, and Professors Franz and Karl Strunz,(8) and a sympathetic
summary of his life and writings has been published by the late Miss
Stoddart.(9) Indeed there is at present a cult of Paracelsus. The
hermetic and alchemical writings are available in English in the edition
of A. E. Waite, London, 1894. The main facts of his life you can find
in all the biographies. Suffice it here to say that he was born at
Einsiedeln, near Zurich, in 1493, the son of a physician, from whom
he appears to have had his early training both in medicine and in
chemistry. Under the famous abbot and alchemist, Trithemiusof Wurzburg,
he studied chemistry and occultism. After working in the mines at
Schwatz he began his wanderings, during which he professes to have
visited nearly all the countries in Europe and to have reached India
and China. Returning to Germany he began a triumphal tour of practice
through the German cities, always in opposition to the medical faculty,
and constantly in trouble. He undoubtedly performed many important
cures, and was thought to have found the supreme secret of alchemistry.
In the pommel of his sword he was believed to carry a familiar spirit.
So dominant was his reputation that in 1527 he was called to the chair
of physic in the University of Basel. Embroiled in quarrels after
his first year he was forced to leave secretly, and again began his
wanderings through German cities, working, quarrelling, curing, and
dying prematurely at Saltzburg in 1541--one of the most tragic figures
in the history of medicine.

     (7) Professor Sudhoff:  Bibliographia Paracelsica, Berlin, 1894,
     1899.

     (8) R. Julius Hartmann:  Theophrast von Hohenheim, Berlin, 1904;
     ditto, Franz Strunz, Leipzig, 1903.

     (9) Anna M. Stoddart:  The Life of Paracelsus, London, John
     Murray, 1911.

Paracelsus is the Luther of medicine, the very incarnation of the spirit
of revolt. At a period when authority was paramount, and men blindly
followed old leaders, when to stray from the beaten track in any field
of knowledge was a damnable heresy, he stood out boldly for independent
study and the right of private judgment. After election to the chair at
Basel he at once introduced a startling novelty by lecturing in German.
He had caught the new spirit and was ready to burst all bonds both in
medicine and in theology. He must have startled the old teachers and
practitioners by his novel methods. "On June 5, 1527, he attached a
programme of his lectures to the black-board of the University inviting
all to come to them. It began by greeting all students of the art of
healing. He proclaimed its lofty and serious nature, a gift of God to
man, and the need of developing it to new importance and to new renown.
This he undertook to do, not retrogressing to the teaching of the
ancients, but progressing whither nature pointed, through research into
nature, where he himself had discovered and had verified by prolonged
experiment and experience. He was ready to oppose obedience to old
lights as if they were oracles from which one did not dare to differ.
Illustrious doctor smight be graduated from books, but books made not a
single physician.(10) Neither graduation, nor fluency, nor the knowledge
of old languages, nor the reading of many books made a physician, but
the knowledge of things themselves and their properties. The business
of a doctor was to know the different kinds of sicknesses, their
causes, their symptoms and their right remedies. This he would teach, for
he had won this knowledge through experience, the greatest teacher, and
with much toil. He would teach it as he had learned it, and his lectures
would be founded on works which he had composed concerning inward and
external treatment, physic and surgery."(11) Shortly afterwards, at
the Feast of St. John, the students had a bonfire in front of the
university. Paracelsus came out holding in his hands the "Bible of
medicine," Avicenna's "Canon," which he flung into the flames saying:
"Into St. John's fire so that all misfortune may go into the air with
the smoke." It was, as he explained afterwards, a symbolic act: "What
has perished must go to the fire; it is no longer fit for use: what is
true and living, that the fire cannot burn." With abundant confidence in
his own capacity he proclaimed himself the legitimate monarch, the very
Christ of medicine. "You shall follow me," cried he, "you, Avicenna,
Galen, Rhasis, Montagnana, Mesues; you, Gentlemen of Paris, Montpellier,
Germany, Cologne, Vienna, and whomsoever the Rhine and Danube nourish;
you who inhabit the isles of the sea; you, likewise, Dalmatians,
Athenians; thou, Arab; thou, Greek; thou, Jew; all shall follow me, and
the monarchy shall be mine."(12)

     (10) And men have oft grown old among their books
     To die case hardened in their ignorance.

     --Paracelsus, Browning.


     (11) Anna M. Stoddart:  Life of Paracelsus, London, 1911, pp.
     95-96.

     (12) Browning's Paracelsus, London, 1835, p. 206 (note).

This first great revolt against the slavish authority of the schools had
little immediate effect, largely on account of the personal vagaries of
the reformer--but it made men think. Paracelsus stirred the pool as had
not been done for fifteen centuries.

Much more important is the relation of Paracelsus to the new chemical
studies, and their relation to practical medicine. Alchemy, he held, "is
to make neither gold nor silver: its use is to make the supreme
sciences and to direct them against disease." He recognized three
basic substances, sulphur, mercury and salt, which were the necessary
ingredients of all bodies organic or inorganic. They were the basis of
the three principles out of which the Archaeus, the spirit of nature,
formed all bodies. He made important discoveries in chemistry; zinc, the
various compounds of mercury, calomel, flowers of sulphur, among others,
and he was a strong advocate of the use of preparations of iron and
antimony. In practical pharmacy he has perhaps had a greater reputation
for the introduction of a tincture of opium--labdanum or laudanum--with
which he effected miraculous cures, and the use of which he had probably
learned in the East.

Through Paracelsus a great stimulus was given to the study of chemistry
and pharmacy, and he is the first of the modern iatro-chemists. In
contradistinction to Galenic medicines, which were largely derived
from the vegetable kingdom, from this time on we find in the literature
references to spagyric medicines and a "spagyrist" was a Paracelsian who
regarded chemistry as the basis of all medical knowledge.

One cannot speak very warmly of the practical medical writings of
Paracelsus. Gout, which may be taken as the disease upon which he had
the greatest reputation, is very badly described, and yet he has one or
two fruitful ideas singularly mixed with mediaeval astrology; but he
has here and there very happy insights, as where he remarks "nec praeter
synoviam locqum alium ullum podagra occupat."(13) In the tract on
phlebotomy I see nothing modern, and here again he is everywhere
dominated by astrological ideas--"Sapiens dominatur astris."

     (13) Geneva ed., 1658, Vol. I, p. 613.

As a protagonist of occult philosophy, Paracelsus has had a more
enduring reputation than as a physician. In estimating his position
there is the great difficulty referred to by Sudhoff in determining
which of the extant treatises are genuine. In the two volumes issued in
English by Waite in 1894, there is much that is difficult to read and
to appreciate from our modern standpoint. In the book "Concerning Long
Life" he confesses that his method and practice will not be intelligible
to common persons and that he writes only for those whose intelligence
is above the average. To those fond of transcendental studies they
appeal and are perhaps intelligible. Everywhere one comes across
shrewd remarks which prove that Paracelsus had a keen belief in the
all-controlling powers of nature and of man's capacity to make those
powers operate for his own good: "the wise man rules Nature, not Nature
the wise man." "The difference between the Saint and the Magus is that
the one operates by means of God, and the other by means of Nature."
He had great faith in nature and the light of nature, holding that man
obtains from nature according as he believes. His theory of the three
principles appears to have controlled his conception of everything
relating to man, spiritually, mentally and bodily; and his threefold
genera of disease corresponded in some mysterious way with the three
primary substances, salt, sulphur and mercury.

How far he was a believer in astrology, charms and divination it is not
easy to say. From many of the writings in his collected works one would
gather, as I have already quoted, that he was a strong believer. On the
other hand, in the "Paramirum," he says: "Stars control nothing in us,
suggest nothing, incline to nothing, own nothing; they are free from
us and we are free from them" (Stoddart, p. 185). The Archaeus, not the
stars, controls man's destiny. "Good fortune comes from ability, and
ability comes from the spirit" (Archaeus).

No one has held more firmly the dualistic conception of the healing art.
There are two kinds of doctors; those who heal miraculously and those
who heal through medicine. Only he who believes can work miracles. The
physician has to accomplish that which God would have done miraculously,
had there been faith enough in the sick man (Stoddart, p. 194). He
had the Hippocratic conception of the "vis medicatrix naturae"--no one
keener since the days of the Greeks. Man is his own doctor and finds
proper healing herbs in his own garden: the physician is in ourselves,
in our own nature are all things that we need: and speaking of wounds,
with singular prescience he says that the treatment should be defensive
so that no contingency from without could hinder Nature in her work
(Stoddart, p. 213).

Paracelsus expresses the healing powers of nature by the word "mumia,"
which he regarded as a sort of magnetic influence or force, and he
believed that anyone possessing this could arrest or heal disease
in others. As the lily breaks forth in invisible perfume, so healing
influences may pass from an invisible body. Upon these views of
Paracelsus was based the theory of the sympathetic cure of disease
which had an extraordinary vogue in the late sixteenth and seventeenth
centuries, and which is not without its modern counterpart.

In the next century, in Van Helmont we meet with the Archaeus everywhere
presiding, controlling and regulating the animate and inanimate bodies,
working this time through agents, local ferments. The Rosicrucians had
their direct inspiration from his writings, and such mystics as the
English Rosicrucian Fludd were strong Paracelsians.(14)

     (14) Robert Fludd, the Mystical Physician, British Medical
     Journal, London, 1897, ii, 408.

The doctrine of contraries drawn from the old Greek philosophy,
upon which a good deal of the treatment of Hippocrates and Galen was
based--dryness expelled by moisture, cold by heat, etc.--was opposed by
Paracelsus in favor of a theory of similars, upon which the practice of
homeopathy is based. This really arose from the primitive beliefs, to
which I have already referred as leading to the use of eyebright in
diseases of the eye, and cyclamen in diseases of the ear because of its
resemblance to that part; and the Egyptian organotherapy had the same
basis,--spleen would cure spleen, heart, heart, etc. In the sixteenth
and seventeenth centuries these doctrines of sympathies and antipathies
were much in vogue. A Scotchman, Sylvester Rattray, edited in the
"Theatrum Sympatheticum"(15) all the writings upon the sympathies and
antipathies of man with animal, vegetable and mineral substances, and
the whole art of physics was based on this principle.

     (15) Rattray:  Theatrum Sympatheticum, Norimberge, MDCLXII.

Upon this theory of "mumia," or magnetic force, the sympathetic cure of
disease was based. The weapon salve, the sympathetic ointment, and the
famous powder of sympathy were the instruments through which it acted.
The magnetic cure of wounds became the vogue. Van Helmont adopted these
views in his famous treatise "De Magnetica Vulnerum Curatione,"(16) in
which he asserted that cures were wrought through magnetic influence.
How close they came to modern views of wound infection may be judged
from the following: "Upon the solution of Unity in any part the ambient
air . . . repleted with various evaporations or aporrhoeas of mixt
bodies, especially such as are then suffering the act of putrefaction,
violently invadeth the part and thereupon impresseth an exotic miasm or
noxious diathesis, which disposeth the blood successively arriving at
the wound, to putrefaction, by the intervention of fermentation." With
his magnetic sympathy, Van Helmont expressed clearly the doctrine of
immunity and the cure of disease by immune sera: "For he who has once
recovered from that disease hath not only obtained a pure balsaamical
blood, whereby for the future he is rendered free from any recidivation
of the same evil, but also infallibly cures the same affection in his
neighbour . . . and by the mysterious power of Magnetism transplants
that balsaam and conserving quality into the blood of another." He was
rash enough to go further and say that the cures effected by the relics
of the saints were also due to the same cause--a statement which led to
a great discussion with the theologians and to Van Helmont's arrest for
heresy, and small wonder, when he makes such bold statements as "Let the
Divine enquire only concerning God, the Naturalist concerning Nature,"
and "God in the production of miracles does for the most part walk hand
in hand with Nature."

     (16) An English translation by Walter Charleton appeared in 1650,
     entitled "A Ternary of Paradoxes."

That wandering genius, Sir Kenelm Digby, did much to popularize this
method of treatment by his lecture on the "Powder of Sympathy."(17) His
powder was composed of copperas alone or mixed with gum tragacanth.
He regarded the cure as effected through the subtle influence of the
sympathetic spirits or, as Highmore says, by "atomicall energy wrought
at a distance," and the remedy could be applied to the wound itself,
or to a cloth soaked in the blood or secretions, or to the weapon that
caused the wound. One factor leading to success may have been that
in the directions which Digby gave for treating the wound (in the
celebrated case of James Howell, for instance), it was to be let alone
and kept clean. The practice is alluded to very frequently by the poets.
In the "Lay of the Last Minstrel" we find the following:

     (17) French edition, 1668, English translation, same year. For a
     discussion on the author of the weapon salve see Van Helmont, who
     gives the various formulas.  Highmore (1651) says the "powder is
     a Zaphyrian salt calcined by a celestial fire operating in Leo
     and Cancer into a Lunar complexion."

     But she has ta'en the broken lance,
     And wash'd it from the clotted gore,
     And salved the splinter o'er and o'er.
     William of Deloraine, in trance,
     Whene'er she turn'd it round and round,
     Twisted, as if she gall'd his wound,
     Then to her maidens she did say,
     That he should be whole man and sound,

     (Canto iii, xxiii.)

and in Dryden's "Tempest" (V, 1) Ariel says:

     Anoint the Sword which pierc'd him with the Weapon-Salve,
     And wrap it close from Air till I have time
     To visit him again.

From Van Helmont comes the famous story of the new nose that dropped off
in sympathy with the dead arm from which it was taken, and the source
of the famous lines of Hudibras. As I have not seen the original story
quoted of late years it may be worth while to give it: "A certain
inhabitant of Bruxels, in a combat had his nose mowed off, addressed
himself to Tagliacozzus, a famous Chirurgein, living at Bononia, that he
might procure a new one; and when he feared the incision of his own arm,
he hired a Porter to admit it, out of whose arm, having first given
the reward agreed upon, at length he dig'd a new nose. About thirteen
moneths after his return to his own Countrey, on a sudden the ingrafted
nose grew cold, putrified, and within few days drops off. To those of
his friends that were curious in the exploration of the cause of this
unexpected misfortune, it was discovered, that the Porter expired,
neer about the same punctilio of time, wherein the nose grew frigid and
cadaverous. There are at Bruxels yet surviving, some of good repute, that
were eye-witnesses of these occurrences."(18)

     (18) Charleton:  Of the Magnetic Cure of Wounds, London, 1650, p.
     13.

Equally in the history of science and of medicine, 1542 is a starred
year, marked by a revolution in our knowledge alike of Macrocosm and
Microcosm. In Frauenburg, the town physician and a canon, now nearing
the Psalmist limit and his end, had sent to the press the studies of a
lifetime--"De revolutionibus orbium coelestium." It was no new thought,
no new demonstration that Copernicus thus gave to his generation.
Centuries before, men of the keenest scientific minds from Pythagoras on
had worked out a heliocentric theory, fully promulgated by Aristarchus,
and very generally accepted by the brilliant investigators of the
Alexandrian school; but in the long interval, lapped in Oriental
lethargy, man had been content to acknowledge that the heavens declare
the glory of God and that the firmament sheweth his handiwork. There
had been great astronomers before Copernicus. In the fifteenth century
Nicholas of Cusa and Regiomontanus had hinted at the heliocentric
theory; but 1512 marks an epoch in the history of science, since for all
time Copernicus put the problem in a way that compelled acquiescence.

Nor did Copernicus announce a truth perfect and complete, not to be
modified, but there were many contradictions and lacunae which the work
of subsequent observers had to reconcile and fill up. For long years
Copernicus had brooded over the great thoughts which his careful
observation had compelled. We can imagine the touching scene in the
little town when his friend Osiander brought the first copy of the
precious volume hot from the press, a well enough printed book. Already
on his deathbed, stricken with a long illness, the old man must have had
doubts how his work would be received, though years before Pope Clement
VII had sent him encouraging words. Fortunately death saved him from the
"rending" which is the portion of so many innovators and discoverers.
His great contemporary reformer, Luther, expressed the view of the day
when he said the fool will turn topsy-turvy the whole art of astronomy;
but the Bible says that Joshua commanded the Sun to stand still, not
the Earth. The scholarly Melanchthon, himself an astronomer, thought
the book so godless that he recommended its suppression (Dannemann,
Grundriss). The church was too much involved in the Ptolemaic system to
accept any change and it was not until 1822 that the works of Copernicus
were removed from the Index.




VESALIUS

THE same year, 1542, saw a very different picture in the far-famed city
of Padua, "nursery of the arts." The central figure was a man not yet in
the prime of life, and justly full of its pride, as you may see from
his portrait. Like Aristotle and Hippocrates cradled and nurtured in an
AEsculapian family, Vesalius was from his childhood a student of nature,
and was now a wandering scholar, far from his Belgian home. But in Italy
he had found what neither Louvain nor Paris could give, freedom in
his studies and golden opportunities for research in anatomy. What an
impression he must have made on the student body at Padua may be judged
from the fact that shortly after his graduation in December, 1537,
at the age of twenty-four, he was elected to the chair of anatomy and
surgery. Two things favored him--an insatiate desire to see and handle
for himself the parts of the human frame, and an opportunity, such as
had never before been offered to the teacher, to obtain material for the
study of human anatomy. Learned with all the learning of the Grecians
and of the Arabians, Vesalius grasped, as no modern before him had done,
the cardinal fact that to know the human machine and its working, it is
necessary first to know its parts--its fabric.

To appreciate the work of this great man we must go back in a brief
review of the growth of the study of anatomy.

Among the Greeks only the Alexandrians knew human anatomy. What their
knowledge was we know at second hand, but the evidence is plain that
they knew a great deal. Galen's anatomy was first-class and was based
on the Alexandrians and on his studies of the ape and the pig. We have
already noted how much superior was his osteology to that of Mundinus.
Between the Alexandrians and the early days of the School of Salernum we
have no record of systematic dissections of the human body. It is even
doubtful if these were permitted at Salernum. Neuburger states that the
instructions of Frederick II as to dissections were merely nominal.

How atrocious was the anatomy of the early Middle Ages may be gathered
from the cuts in the works of Henri de Mondeville. In the Bodleian
Library is a remarkable Latin anatomical treatise of the late thirteenth
century, of English provenance, one illustration from which will suffice
to show the ignorance of the author. Mundinus of Bologna, one of the
first men in the Middle Ages to study anatomy from the subject, was
under the strong domination of the Arabians, from whom he appears to
have received a very imperfect Galenic anatomy. From this date we meet
with occasional dissections at various schools, but we have seen that in
the elaborate curriculum of the University of Padua in the middle of the
fifteenth century there was no provision for the study of the subject.
Even well into the sixteenth century dissections were not common, and
the old practice was followed of holding a professorial discourse,
while the butcher, or barber surgeon, opened the cavities of the body. A
member of a famous Basel family of physicians, Felix Plater, has left
us in his autobiography(19) details of the dissections he witnessed at
Montpellier between November 14, 1552, and January 10, 1557, only eleven
in number. How difficult it was at that time to get subjects is shown by
the risks they ran in "body-snatching" expeditions, of which he records
three.

     (19) There is no work from which we can get a better idea of the
     life of the sixteenth-century medical student and of the style of
     education and of the degree ceremonies, etc.  Cumston has given
     an excellent summary of it (Johns Hopkins Hospital Bulletin,
     1912, XXIII, 105-113).

And now came the real maker of modern anatomy. Andreas Vesalius had a
good start in life. Of a family long associated with the profession,
his father occupied the position of apothecary to Charles V, whom he
accompanied on his journeys and campaigns. Trained at Louvain, he had,
from his earliest youth, an ardent desire to dissect, and cut up mice
and rats, and even cats and dogs. To Paris, the strong school of the
period, he went in 1533, and studied under two men of great renown,
Jacob Sylvius and Guinterius. Both were strong Galenists and regarded
the Master as an infallible authority. He had as a fellow prosector,
under the latter, the unfortunate Servetus. The story of his troubles
and trials in getting bones and subjects you may read in Roth's
"Life."(20) Many interesting biographical details are also to be found
in his own writings. He returned for a time to Louvain, and here he
published his first book, a commentary on the "Almansor" of Rhazes, in
1537.

     (20) M. Roth:  Andreas Vesalius Bruxellensis, Berlin, 1892. An
     excellent account of Vesalius and his contemporaries is given by
     James Moores Ball in his superbly printed Andreas Vesalius, the
     Reformer of Anatomy, St. Louis, 1910.

Finding it difficult, either in Paris or Louvain, to pursue his
anatomical studies, he decided to go to Italy where, at Venice and
Padua, the opportunities were greater. At Venice, he attended the
practice of a hospital (now a barracks) which was in charge of the
Theatiner Order. I show you a photograph of the building taken last
year. And here a strange destiny brought two men together. In 1537,
another pilgrim was working in Venice waiting to be joined by his six
disciples. After long years of probation, Ignatius Loyola was ready to
start on the conquest of a very different world. Devoted to the sick
and to the poor, he attached himself to the Theatiner Order, and in the
wards of the hospital and the quadrangle, the fiery, dark-eyed, little
Basque must frequently have come into contact with the sturdy young
Belgian, busy with his clinical studies and his anatomy. Both were to
achieve phenomenal success--the one in a few years to revolutionize
anatomy, the other within twenty years to be the controller of
universities, the counsellor of kings, and the founder of the most
famous order in the Roman Catholic Church. It was in this hospital that
Vesalius made observations on the China-root, on which he published a
monograph in 1546. The Paduan School was close to Venice and associated
with it, so that the young student had probably many opportunities of
going to and fro. On the sixth of December, 1537, before he had reached
his twenty-fourth year and shortly after taking his degree, he was
elected to the chair of surgery and anatomy at Padua.

The task Vesalius set himself to accomplish was to give an accurate
description of all the parts of the human body, with proper
illustrations. He must have had abundant material, more, probably, than
any teacher before him had ever had at his disposal. We do not know
where he conducted his dissections, as the old amphitheatre has
disappeared, but it must have been very different from the tiny one
put up by his successor, Fabricius, in 1594. Possibly it was only a
temporary building, for he says in the second edition of the "Fabrica"
that he had a splendid lecture theatre which accommodated more than five
hundred spectators (p. 681).

With Vesalius disappeared the old didactic method of teaching anatomy.
He did his own dissections, made his own preparations, and, when human
subjects were scarce, employed dogs, pigs or cats, and occasionally a
monkey. For five years he taught and worked at Padua. He is known
to have given public demonstrations in Bologna and elsewhere. In the
"China-root" he remarks that he once taught in three universities in one
year. The first fruit of his work is of great importance in connection
with the evolution of his knowledge. In 1538, he published six
anatomical tables issued apparently in single leaves. Of the famous
"Tabulae Anatomicae" only two copies are known, one in the San
Marco Library, Venice, and the other in the possession of Sir John
Stirling-Maxwell, whose father had it reproduced in facsimile (thirty
copies only) in 1874. Some of the figures were drawn by Vesalius
himself, and some are from the pencil of his friend and countryman,
Stephan van Calcar. Those plates were extensively pirated. About this
time he also edited for the Giunti some of the anatomical works of
Galen.(21)

     (21) De anatomicis administrationibus, De venarum arterinrumque
     dissectione, included in the various Juntine editions of Galen.

We know very little of his private life at Padua. His most important
colleague in the faculty was the famous Montanus, professor of medicine.
Among his students and associates was the Englishman Caius, who lived in
the same house with him. When the output is considered, he cannot have
had much spare time at Padua.

He did not create human anatomy--that had been done by the
Alexandrians--but he studied it in so orderly and thorough a manner
that for the first time in history it could be presented in a way that
explained the entire structure of the human body. Early in 1542 the MS.
was ready; the drawings had been made with infinite care, the blocks for
the figures had been cut, and in September, he wrote to Oporinus urging
that the greatest pains should be taken with the book, that the paper
should be strong and of equal thickness, the workmen chosen for their
skill, and that every detail of the pictures must be distinctly visible.
He writes with the confidence of a man who realized the significance of
the work he had done. It is difficult to speak in terms of moderation of
the "Fabrica." To appreciate its relative value one must compare it with
the other anatomical works of the period, and for this purpose I
put before you two figures from a text-book on the subject that was
available for students during the first half of the sixteenth century.
In the figures and text of the "Fabrica" we have anatomy as we know it;
and let us be honest and say, too, largely as Galen knew it. Time will
not allow me to go into the question of the relations of these two
great anatomists, but we must remember that at this period Galen ruled
supreme, and was regarded in the schools as infallible. And now, after
five years of incessant labor, Vesalius was prepared to leave his
much loved Padua and his devoted students. He had accomplished an
extraordinary work. He knew, I feel sure, what he had done. He knew that
the MSS. contained something that the world had not seen since the great
Pergamenian sent the rolls of his "Manual of Anatomy" among his friends.
Too precious to entrust to any printer but the best--and the best in the
middle of the sixteenth century was Transalpine--he was preparing to go
north with the precious burden. We can picture the youthful teacher--he
was but twenty-eight--among students in a university which they
themselves controlled--some of them perhaps the very men who five years
before had elected him--at the last meeting with his class, perhaps
giving a final demonstration of the woodcuts, which were of an accuracy
and beauty never seen before by students' eyes, and reading his
introduction. There would be sad hearts at the parting, for never had
anyone taught anatomy as he had taught it--no one had ever known anatomy
as he knew it. But the strong, confident look was on his face and with
the courage of youth and sure of the future, he would picture a happy
return to attack new and untried problems. Little did he dream that his
happy days as student and teacher were finished, that his work as an
anatomist was over, that the most brilliant and epoch-making part of his
career as a professor was a thing of the past. A year or more was spent
at Basel with his friend Oporinus supervising the printing of the
great work, which appeared in 1543 with the title "De Humani Corporis
Fabrica." The worth of a book, as of a man, must be judged by results,
and, so judged, the "Fabrica" is one of the great books of the world,
and would come in any century of volumes which embraced the richest
harvest of the human mind. In medicine, it represents the full flower
of the Renaissance. As a book it is a sumptuous tome a worthy setting
of his jewel--paper, type and illustration to match, as you may see for
yourselves in this folio--the chef d'oeuvre of any medical library.

In every section, Vesalius enlarged and corrected the work of Galen.
Into the details we need not enter: they are all given in Roth's
monograph, and it is a chapter of ancient history not specially
illuminating.

Never did a great piece of literary work have a better setting. Vesalius
must have had a keen appreciation of the artistic side of the art of
printing, and he must also have realized the fact that the masters of
the art had by this time moved north of the Alps.

While superintending the printing of the precious work in the winter of
1542-1543 in Basel, Vesalius prepared for the medical school a skeleton
from the body of an executed man, which is probably the earliest
preparation of the kind in Europe. How little anatomy had been studied
at the period may be judged from that fact that there had been
no dissection at Basel since 1531.(22) The specimen is now in the
Vesalianum, Basel, of which I show you a picture taken by Dr. Harvey
Cushing. From the typographical standpoint no more superb volume
on anatomy has been issued from any press, except indeed the second
edition, issued in 1555. The paper is, as Vesalius directed, strong and
good, but it is not, as he asked, always of equal thickness; as a rule
it is thick and heavy, but there are copies on a good paper of a much
lighter quality. The illustrations drawn by his friend and fellow
countryman, van Calcar, are very much in advance of anything previously
seen, except those of Leonardo. The title-page, one of the most
celebrated pictures in the history of medicine, shows Vesalius in
a large amphitheatre (an imaginary one of the artist, I am afraid)
dissecting a female subject. He is demonstrating the abdomen to a group
of students about the table, but standing in the auditorium are elderly
citizens and even women. One student is reading from an open book. There
is a monkey on one side of the picture and a dog on the other. Above
the picture on a shield are the three weasels, the arms of Vesal. The
reproduction which I show you here is from the "Epitome"--a smaller work
issued before (?) the "Fabrica," with rather larger plates, two of which
represent nude human bodies and are not reproduced in the great work.
The freshest and most beautiful copy is the one on vellum which formerly
belonged to Dr. Mead, now in the British Museum, and from it this
picture was taken. One of the most interesting features of the book are
the full-page illustrations of the anatomy of the arteries, veins
and nerves. They had not in those days the art of making corrosion
preparations, but they could in some way dissect to their finest
ramifications the arteries, veins and nerves, which were then spread on
boards and dried. Several such preparations are now at the College of
Physicians in London, brought from Padua by Harvey. The plates of the
muscles are remarkably good, more correct, though not better perhaps, on
the whole, than some of Leonardo's.

     (22) The next, in 1559, is recorded by Plater in his
     autobiography, who gave a public dissection during three days in
     the Church of St. Elizabeth.

Vesalius had no idea of a general circulation. Though he had escaped
from the domination of the great Pergamenian in anatomy, he was still
his follower in physiology. The two figures annexed, taken from one
of the two existing copies of the "Tabulae Anatomica," are unique in
anatomical illustration, and are of special value as illustrating the
notion of the vascular system that prevailed until Harvey's day. I
have already called your attention to Galen's view of the two separate
systems, one containing the coarse, venous blood for the general
nutrition of the body, the other the arterial, full of a thinner, warmer
blood with which were distributed the vital spirits and the vital
heat. The veins had their origin in the liver; the superior vena cava
communicated with the right heart, and, as Galen taught, some blood was
distributed to the lungs; but the two systems were closed, though Galen
believed there was a communication at the periphery between the
arteries and veins. Vesalius accepted Galen's view that there is some
communication between the venous and arterial systems through pores
in the septum of the ventricles, though he had his doubts, and in the
second edition of his book (1555) says that inspite of the authority
of the Prince of Physicians he cannot see how the smallest quantity of
blood could be transmitted through so dense a muscular septum. Two years
before this (1553),(*) his old fellow student, Michael Servetus, had in
his "Christianismi Restitutio" annatomical touch with one another!

     (*) See the Servetus Notes in the Osler Anniversary Volumes, New
     York, 1919, Vol. II.--Ed.

The publication of the "Fabrica" shook the medical world to its
foundations. Galen ruled supreme in the schools: to doubt him in the
least particular roused the same kind of feeling as did doubts on the
verbal inspiration of the Scriptures fifty years ago! His old teachers
in Paris were up in arms: Sylvius, nostrae aetatis medicorum decus, as
Vesalius calls him, wrote furious letters, and later spoke of him as
a madman (vaesanus). The younger men were with him and he had many
friends, but he had aroused a roaring tide of detraction against which
he protested a few years later in his work on the "China-root," which
is full of details about the "Fabrica." In a fit of temper he threw
his notes on Galen and other MSS. in the fire. No sadder page exists in
medical writings than the one in which Vesalius tells of the burning of
his books and MSS. It is here reproduced and translated.(23) His life
for a couple of years is not easy to follow, but we know that in 1546
he took service with Charles V as his body physician, and the greatest
anatomist of his age was lost in the wanderings of court and campaigns.
He became an active practitioner, a distinguished surgeon, much
consulted by his colleagues, and there are references to many of his
cases, the most important of which are to internal aneurysms, which he
was one of the first to recognize. In 1555 he brought out the second
edition of the "Fabrica," an even more sumptuous volume than the first.

     (23) Epistle on China-root, 1546, p. 196.  Vesalius may be quoted
     in explanation--in palliation:

"All these impediments I made light of; for I was too young to seek
gain by my art, and I was sustained by my eager desire to learn and to
promote the studies in which I shared. I say nothing of my diligence in
anatomizing--those who attended my lectures in Italy know how I spent
three whole weeks over a single public dissection. But consider that in
one year I once taught in three different universities. If I had put
off the task of writing till this time; if I were now just beginning
to digest my materials; students would not have had the use of my
anatomical labours, which posterity may or may not judge superior to
the rechauffes formerly in use, whether of Mesua, of Gatinaria, of some
Stephanus or other on the differences, causes and symptoms of diseases,
or, lastly, of a part of Servitor's pharmacopoeia. As to my notes, which
had grown into a huge volume, they were all destroyed by me; and on the
same day there similarly perished the whole of my paraphrase on the ten
books of Rhazes to King Almansor, which had been composed by me with far
more care than the one which is prefaced to the ninth book. With
these also went the books of some author or other on the formulae and
preparation of medicines, to which I had added much matter of my own
which I judged to be not without utility; and the same fate overtook all
the books of Galen which I had used in learning anatomy, and which I had
liberally disfigured in the usual fashion. I was on the point of leaving
Italy and going to Court; those physicians you know of had made to the
Emperor and to the nobles a most unfavourable report of my books and of
all that is published nowadays for the promotion of study; I therefore
burnt all these works that I have mentioned, thinking at the same time
that it would be an easy matter to abstain from writing for the future.
I must show that I have since repented more than once of my impatience,
and regretted that I did not take the advice of the friends who were
then with me."


There is no such pathetic tragedy in the history of our profession.
Before the age of thirty Vesalius had effected a revolution in anatomy;
he became the valued physician of the greatest court of Europe; but call
no man happy till he is dead! A mystery surrounds his last days. The
story is that he had obtained permission to perform a post-mortem
examination on the body of a young Spanish nobleman, whom he had
attended. When the body was opened, the spectators to their horror saw
the heart beating, and there were signs of life! Accused, so it is said,
by the Inquisition of murder and also of general impiety he only escaped
through the intervention of the King, with the condition that he make a
pilgrimage to the Holy Land. In carrying this out in 1564 he was wrecked
on the island of Zante, where he died of a fever or of exhaustion, in
the fiftieth year of his age.

To the North American Review, November, 1902, Edith Wharton contributed
a poem on "Vesalius in Zante," in which she pictures his life, so
full of accomplishment, so full of regrets--regrets accentuated by the
receipt of an anatomical treatise by Fallopius, the successor to the
chair in Padua! She makes him say:

     There are two ways of spreading light; to be
     The candle or the mirror that reflects it.
     I let my wick burn out--there yet remains
     To spread an answering surface to the flame
     That others kindle.

But between Mundinus and Vesalius, anatomy had been studied by a group
of men to whom I must, in passing, pay a tribute. The great artists
Raphael, Michael Angelo and Albrecht Durer were keen students of the
human form. There is an anatomical sketch by Michael Angelo in the
Ashmolean Museum, Oxford, which I here reproduce.(*) Durer's famous work
on "Human Proportion," published in 1528, contains excellent figures,
but no sketches of dissections. But greater than any of these, and
antedating them, is Leonardo da Vinci, the one universal genius in
whom the new spirit was incarnate--the Moses who alone among his
contemporaries saw the promised land. How far Leonardo was indebted to
his friend and fellow student, della Torre, at Pavia we do not know,
nor does it matter in face of the indubitable fact that in the
many anatomical sketches from his hand we have the first accurate
representation of the structure of the body. Glance at the three figures
of the spine which I have had photographed side by side, one from
Leonardo, one from Vesalius and the other from Vandyke Carter, who did
the drawings in Gray's "Anatomy" (1st ed., 1856). They are all of the
same type, scientific, anatomical drawings, and that of Leonardo was
done fifty years before Vesalius! Compare, too, this figure of the
bones of the foot with a similar one from Vesalius.(24) Insatiate
in experiment, intellectually as greedy as Aristotle, painter, poet,
sculptor, engineer, architect, mathematician, chemist, botanist,
aeronaut, musician and withal a dreamer and mystic, full accomplishment
in any one department was not for him! A passionate desire for a mastery
of nature's secrets made him a fierce thing, replete with too much
rage! But for us a record remains--Leonardo was the first of modern
anatomists, and fifty years later, into the breach he made, Vesalius
entered.(25)

     (*) This plate was lacking among the author's illustrations, but
     the Keeper of the Ashmolean Museum remembers his repeatedly
     showing special interest in the sketch reproduced in John
     Addington Symonds's Life of Michelangelo, London, 1893, Vol. I,
     p. 44, and in Charles Singer's Studies in the History and Method
     of Science, Oxford, 1917, Vol. I, p. 97, representing Michael
     Angelo and a friend dissecting the body of a man, by the light of
     a candle fixed in the body itself.--Ed.

     (24) He was the first to make and represent anatomical cross
     sections. See Leonardo:  Quaderni d'Anatomia, Jacob Dybwad,
     Kristiania, 1911-1916, Vol. V.

     (25) See Knox:  Great Artists and Great Anatomists, London, 1862,
     and Mathias Duval in Les Manuserits de Leonard de Vince: De
     l'Anatomie, Feuillets A, Edouard Rouveyre, Paris, 1898. For a
     good account of Leonardo da Vinci see Merejkovsky's novel, The
     Forerunner, London, 1902, also New York, Putnam.




HARVEY

LET us return to Padua about the year 1600. Vesalius, who made the
school the most famous anatomical centre in Europe, was succeeded by
Fallopius, one of the best-known names in anatomy, at whose death an
unsuccessful attempt was made to get Vesalius back. He was succeeded in
1565 by a remarkable man, Fabricius (who usually bears the added name
of Aquapendente, from the town of his birth), a worthy follower of
Vesalius. In 1594, in the thirtieth year of his professoriate, he built
at his own expense a new anatomical amphitheatre, which still exists
in the university buildings. It is a small, high-pitched room with six
standing-rows for auditors rising abruptly one above the other. The
arena is not much more than large enough for the dissecting table which,
by a lift, could be brought up from a preparing room below. The study of
anatomy at Padua must have declined since the days of Vesalius if this
tiny amphitheatre held all its students; none the less, it is probably
the oldest existing anatomical lecture room, and for us it has a very
special significance.

Early in his anatomical studies Fabricius had demonstrated the valves in
the veins. I show you here two figures, the first, as far as I know, in
which these structures are depicted. It does not concern us who first
discovered them; they had doubtless been seen before, but Fabricius
first recognized them as general structures in the venous system, and he
called them little doors--"ostiola."

The quadrangle of the university building at Padua is surrounded by
beautiful arcades, the walls and ceilings of which are everywhere
covered with the stemmata, or shields, of former students, many of them
brilliantly painted. Standing in the arcade on the side of the "quad"
opposite the entrance, if one looks on the ceiling immediately above the
capital of the second column to the left there is seen the stemma which
appears as tailpiece to this chapter, put up by a young Englishman,
William Harvey, who had been a student at Padua for four years. He
belonged to the "Natio Anglica," of which he was Conciliarius, and
took his degree in 1602. Doubtless he had repeatedly seen Fabricius
demonstrate the valves of the veins, and he may indeed, as a senior
student, have helped in making the very dissections from which the
drawings were taken for Fabricius' work, "De Venarum Osteolis," 1603.
If one may judge from the character of the teacher's work the sort of
instruction the student receives, Harvey must have had splendid training
in anatomy. While he was at Padua, the great work of Fabricius, "De
Visione, Voce et Auditu" (1600) was published, then the "Tractatus de
Oculo Visusque Organo" (1601), and in the last year of his residence
Fabricius must have been busy with his studies on the valves of the
veins and with his embryology, which appeared in 1604. Late in life,
Harvey told Boyle that it was the position of the valves of the veins
that induced him to think of a circulation.

Harvey returned to England trained by the best anatomist of his day. In
London, he became attached to the College of Physicans, and taking his
degree at Cambridge, he began the practice of medicine. He was elected
a fellow of the college in 1607 and physician to St. Bartholomew's
Hospital in 1609. In 1615 he was appointed Lumleian lecturer to the
College of Physicians, and his duties were to hold certain "public
anatomies," as they were called, or lectures. We know little or nothing
of what Harvey had been doing other than his routine work in the care
of the patients at St. Bartholomew's. It was not until April, 1616, that
his lectures began. Chance has preserved to us the notes of this first
course; the MS. is now in the British Museum and was published in
facsimile by the college in 1886.(26)

     (26) William Harvey:  Prelectiones Anatomiae Universalis, London,
     J. & A. Churchill, 1886.

The second day lecture, April 17, was concerned with a description of
the organs of the thorax, and after a discussion on the structure and
action of the heart come the lines:

     W. H. constat per fabricam cordis sanguinem
     per pulmones in Aortam perpetuo
     transferri, as by two clacks of a
     water bellows to rayse water
     constat per ligaturam transitum sanguinis
     ab arteriis ad venas
     unde perpetuum sanguinis motum
     in circulo fieri pulsu cordis.

The illustration will give one an idea of the extraordinarily crabbed
hand in which the notes are written, but it is worth while to see the
original, for here is the first occasion upon which is laid down in
clear and unequivocal words that the blood CIRCULATES. The lecture gave
evidence of a skilled anatomist, well versed in the literature from
Aristotle to Fabricius. In the MS. of the thorax, or, as he calls it,
the "parlour" lecture, there are about a hundred references to some
twenty authors. The remarkable thing is that although those lectures
were repeated year by year, we have no evidence that they made any
impression upon Harvey's contemporaries, so far, at least, as to excite
discussions that led to publication. It was not until twelve years
later, 1628, that Harvey published in Frankfurt a small quarto volume
of seventy-four pages,(27) "De Motu Cordis." In comparison with the
sumptuous "Fabrica" of Vesalius this is a trifling booklet; but if not
its equal in bulk or typographical beauty (it is in fact very poorly
printed), it is its counterpart in physiology, and did for that science
what Vesalius had done for anatomy, though not in the same way. The
experimental spirit was abroad in the land, and as a student at Padua,
Harvey must have had many opportunities of learning the technique of
vivisection; but no one before his day had attempted an elaborate piece
of experimental work deliberately planned to solve a problem relating to
the most important single function of the body. Herein lies the special
merit of his work, from every page of which there breathes the modern
spirit. To him, as to Vesalius before him, the current views of the
movements of the blood were unsatisfactory, more particularly the
movements of the heart and arteries, which were regarded as an active
expansion by which they were filled with blood, like bellows with air.
The question of the transmission of blood through the thick septum
and the transference of air and blood from the lungs to the heart were
secrets which he was desirous of searching out by means of experiment.

     (27) Harvey:  Exercitatio Anatomica de Motu Cordis et Sanguinis
     in Animalibus, Francofurti, 1628.

One or two special points in the work may be referred to as illustrating
his method. He undertook first the movements of the heart, a task so
truly arduous and so full of difficulties that he was almost tempted to
think with Fracastorius that "the movement of the heart was only to be
comprehended by God." But after many difficulties he made the following
statements: first, that the heart is erected and raises itself up into
an apex, and at this time strikes against the breast and the pulse is
felt externally; secondly, that it is contracted every-way, but more
so at the sides; and thirdly, that grasped in the hand it was felt
to become harder at the time of its motion; from all of which actions
Harvey drew the very natural conclusion that the activity of the heart
consisted in a contraction of its fibres by which it expelled the blood
from the ventricles. These were the first four fundamental facts which
really opened the way for the discovery of the circulation, as it did
away with the belief that the heart in its motion attracts blood into
the ventricles, stating on the contrary that by its contraction it
expelled the blood and only received it during its period of repose or
relaxation. Then he proceeded to study the action of the arteries and
showed that their period of diastole, or expansion, corresponded with
the systole, or contraction, of the heart, and that the arterial pulse
follows the force, frequency and rhythm of the ventricle and is, in
fact, dependent upon it. Here was another new fact: that the pulsation
in the arteries was nothing else than the impulse of the blood within
them. Chapter IV, in which he describes the movements of the auricles
and ventricles, is a model of accurate description, to which little has
since been added. It is interesting to note that he mentions what is
probably auricular fibrillation. He says: "After the heart had ceased
pulsating an undulation or palpitation remained in the blood itself
which was contained in the right auricle, this being observed so long as
it was imbued with heat and spirit." He recognized too the importance of
the auricles as the first to move and the last to die. The accuracy and
vividness of Harvey's description of the motion of the heart have been
appreciated by generations of physiologists. Having grasped this first
essential fact, that the heart was an organ for the propulsion of blood,
he takes up in Chapters VI and VII the question of the conveyance of the
blood from the right side of the heart to the left. Galen had already
insisted that some blood passed from the right ventricle to the
lungs--enough for their nutrition; but Harvey points out, with Colombo,
that from the arrangement of the valves there could be no other view
than that with each impulse of the heart blood passes from the right
ventricle to the lungs and so to the left side of the heart. How
it passed through the lungs was a problem: probably by a continuous
transudation. In Chapters VIII and IX he deals with the amount of blood
passing through the heart from the veins to the arteries. Let me quote
here what he says, as it is of cardinal import:

"But what remains to be said upon the quantity and source of the blood
which thus passes, is of a character so novel and unheard of that I not
only fear injury to myself from the envy of a few, but I tremble lest
I have mankind at large for my enemies, so much doth wont and custom
become a second nature. Doctrine once sown strikes deeply its root, and
respect for antiquity influences all men. Still the die is cast, and my
trust is in my love of truth, and the candour of cultivated minds."(28)
Then he goes on to say:

     (28) William Harvey:  Exercitatio Anatomica de Motu Cordis et
     Sanguinis in Animalibus, Francofurti, 1628, G. Moreton's
     facsimile reprint and translation, Canterbury, 1894, p. 48.

"I began to think whether there might not be A MOVEMENT, AS IT WERE, IN
A CIRCLE. Now this I afterwards found to be true; and I finally saw that
the blood, forced by the action of the left ventricle into the arteries,
was distributed to the body at large, and its several parts, in the same
manner as it is sent through the lungs, impelled by the right ventricle
into the pulmonary artery, and that it then passed through the veins and
along the vena cava, and so round to the left ventricle in the manner
already indicated."(29)

     (29) Ibid. p. 49.

The experiments dealing with the transmission of blood in the veins
are very accurate, and he uses the old experiment that Fabricius had
employed to show the valves, to demonstrate that the blood in the veins
flows towards the heart. For the first time a proper explanation of the
action of the valves is given. Harvey had no appreciation of how
the arteries and veins communicated with each other. Galen, you may
remember, recognized that there were anastomoses, but Harvey preferred
the idea of filtration.

The "De Motu Cordis" constitutes a unique piece of work in the history
of medicine. Nothing of the same type had appeared before. It is
a thoroughly sensible, scientific study of a definite problem, the
solution of which was arrived at through the combination of accurate
observation and ingenious experiment. Much misunderstanding has arisen
in connection with Harvey's discovery of the circulation of the blood.
He did not discover that the blood moved,--that was known to Aristotle
and to Galen, from both of whom I have given quotations which indicate
clearly that they knew of its movement,--but at the time of Harvey not a
single anatomist had escaped from the domination of Galen's views.
Both Servetus and Colombo knew of the pulmonary circulation, which was
described by the former in very accurate terms. Cesalpinus, a great
name in anatomy and botany, for whom is claimed the discovery of the
circulation, only expressed the accepted doctrines in the following
oft-quoted phrase:

"We will now consider how the attraction of aliment and the process
of nutrition takes place in plants; for in animals we see the aliment
brought through the veins to the heart, as to a laboratory of innate
heat, and, after receiving there its final perfection, distributed
through the arteries to the body at large, by the agency of the spirits
produced from this same aliment in the heart."(30) There is nothing
in this but Galen's view, and Cesalpinus believed, as did all his
contemporaries, that the blood was distributed through the body by the
vena cava and its branches for the nourishment of all its parts.(*) To
those who have any doubts as to Harvey's position in this matter I would
recommend the reading of the "De Motu Cordis" itself, then the various
passages relating to the circulation from Aristotle to Vesalius. Many
of these can be found in the admirable works of Dalton, Flourens,
Richet and Curtis.(31) In my Harveian Oration for 1906(32) I have dealt
specially with the reception of the new views, and have shown how long
it was before the reverence for Galen allowed of their acceptance. The
University of Paris opposed the circulation of the blood for more than
half a century after the appearance of the "De Motu Cordis."

     (30) De Plantis, Lib I, cap. 2.

     (*) Cesalpinus has also a definite statement of the circlewise
     process.--Ed.

     (31) J. C. Dalton Doctrines of the Circulation, Philadelphia,
     1884; Flourens Histoire de la decouverte de la circulation du
     sang, 2d ed., Paris, 1857; Charles Richet Harvey, la circulation
     du sang, Paris, 1879; John G. Curtis Harvey's views on the use of
     Circulation, etc., New York, 1916.

     (32) Osler An Alabama Student and Other Biographical Essays,
     Oxford, 1908, p. 295.

To summarize--until the seventeenth century there were believed to
be two closed systems in the circulation, (1) the natural, containing
venous blood, had its origin in the liver from which, as from a
fountain, the blood continually ebbed and flowed for the nourishment of
the body; (2) the vital, containing another blood and the spirits, ebbed
and flowed from the heart, distributing heat and life to all parts. Like
a bellows the lungs fanned and cooled this vital blood. Here and there
we find glimmering conceptions of a communication between these systems,
but practically all teachers believed that the only one of importance
was through small pores in the wall separating the two sides of the
heart. Observation--merely looking at and thinking about things--had
done all that was possible, and further progress had to await the
introduction of a new method, viz., experiment. Galen, it is true, had
used this means to show that the arteries of the body contained blood
and not air. The day had come when men were no longer content with
accurate description and with finely spun theories and dreams. It was
reserved for the immortal Harvey to put into practice the experimental
method by which he demonstrated conclusively that the blood moved in a
circle. The "De Motu Cordis" marks the final break of the modern spirit
with the old traditions. It took long for men to realize the value of
this "inventum mirabile" used so effectively by the Alexandrians--by
Galen--indeed, its full value has only been appreciated within the past
century. Let me quote a paragraph from my Harveian Oration.(33) "To the
age of the hearer, in which men had heard and heard only, had succeeded
the age of the eye in which men had seen and had been content only
to see. But at last came the age of the hand--the thinking, devising,
planning hand, the hand as an instrument of the mind, now re-introduced
into the world in a modest little monograph from which we may date the
beginning of experimental medicine."

     (33) Osler:  An Alabama Student, etc., pp. 329-330.

Harvey caught the experimental spirit in Italy, with brain, eye and hand
as his only aids, but now an era opened in which medicine was to derive
an enormous impetus from the discovery of instruments of precision. "The
new period in the development of the natural sciences, which reached
its height in the work of such men as Galileo, Gilbert and Kepler, is
chiefly characterized by the invention of very important instruments for
aiding and intensifying the perceptions of the senses, by means of which
was gained a much deeper insight into the phenomena than had hitherto
been possible. Such instruments as the earlier ages possessed were
little more than primitive hand-made tools. Now we find a considerable
number of scientifically made instruments deliberately planned for
purposes of special research, and as it were, on the threshold of the
period stand two of the most important, the compound microscope and
the telescope. The former was invented about 1590 and the latter about
1608."(34) It was a fellow professor of the great genius Galileo who
attempted to put into practice the experimental science of his friend.
With Sanctorius began the studies of temperature, respiration and the
physics of the circulation. The memory of this great investigator has
not been helped by the English edition of his "De Statica Medicina," not
his best work, with a frontispiece showing the author in his dietetic
balance. Full justice has been done to him by Dr. Weir Mitchell in
an address as president of the Congress of Physicians and Surgeons,
1891.(35) Sanctorius worked with a pulsilogue devised for him by
Galileo, with which he made observations on the pulse. He is said
to have been the first to put in use the clinical thermometer. His
experiments on insensible perspiration mark him as one of the first
modern physiologists.

     (34) Dannemann:  Die Naturwissenschaften in ihrer
     Entwickelung..., Vol. II, p. 7, Leipzig, 1911.

     (35) See Transactions Congress Physicians and Surgeons, 1891, New
     Haven, 1892, II, 159-181.

But neither Sanctorius nor Harvey had the immediate influence upon their
contemporaries which the novel and stimulating character of their work
justified. Harvey's great contemporary, Bacon, although he lost his
life in making a cold storage experiment, did not really appreciate the
enormous importance of experimental science. He looked very coldly upon
Harvey's work. It was a philosopher of another kidney, Rene Descartes,
who did more than anyone else to help men to realize the value of the
better way which Harvey had pointed out. That the beginning of wisdom
was in doubt, not in authority, was a novel doctrine in the world,
but Descartes was no armchair philosopher, and his strong advocacy and
practice of experimentation had a profound influence in directing men to
"la nouvelle methode." He brought the human body, the earthly machine,
as he calls it, into the sphere of mechanics and physics, and he wrote
the first text-book of physiology, "De l'Homme." Locke, too, became the
spokesman of the new questioning spirit, and before the close of the
seventeenth century, experimental research became all the mode. Richard
Lower, Hooke and Hales were probably more influenced by Descartes
than by Harvey, and they made notable contributions to experimental
physiology in England. Borelli, author of the famous work on "The Motion
of Animals" (Rome, 1680-1681), brought to the study of the action of
muscles a profound knowledge of physics and mathematics and really
founded the mechanical, or iatromechanical school. The literature and
the language of medicine became that of physics and mechanics: wheels
and pulleys, wedges, levers, screws, cords, canals, cisterns, sieves and
strainers, with angles, cylinders, celerity, percussion and resistance,
were among the words that now came into use in medical literature.
Withington quotes a good example in a description by Pitcairne, the Scot
who was professor of medicine at Leyden at the end of the seventeenth
century. "Life is the circulation of the blood. Health is its free and
painless circulation. Disease is an abnormal motion of the blood, either
general or local. Like the English school generally, he is far more
exclusively mechanical than are the Italians, and will hear nothing of
ferments or acids, even in digestion. This, he declares, is a purely
mechanical process due to heat and pressure, the wonderful effects of
which may be seen in Papin's recently invented 'digester.' That the
stomach is fully able to comminute the food may be proved by the
following calculation. Borelli estimates the power of the flexors of the
thumb at 3720 pounds, their average weight being 122 grains. Now, the
average weight of the stomach is eight ounces, therefore it can develop
a force of 117,088 pounds, and this may be further assisted by the
diaphragm and abdominal muscles the power of which, estimated in the
same way, equals 461,219 pounds! Well may Pitcairne add that this
force is not inferior to that of any millstone."(36) Paracelsus gave an
extraordinary stimulus to the study of chemistry and more than anyone
else he put the old alchemy on modern lines. I have already quoted his
sane remark that its chief service is in seeking remedies. But there is
another side to this question. If, as seems fairly certain, the Basil
Valentine whose writings were supposed to have inspired Paracelsus was
a hoax and his works were made up in great part from the writings
of Paracelsus, then to our medical Luther, and not to the mythical
Benedictine monk, must be attributed a great revival in the search
for the Philosopher's Stone, for the Elixir of Life, for a universal
medicine, for the perpetuum mobile and for an aurum potabile.(37) I
reproduce, almost at random, a page from the fifth and last part of the
last will and testament of Basil Valentine (London, 1657), from which
you may judge the chemical spirit of the time.

     (36) Withington:  Medical History from the Earliest Times,
     London, 1891, Scientific Press, p. 317.

     (37) See Professor Stillman on the Basil Valentine hoax, Popular
     Science Monthly, New York, 1919, LXXXI, 591-600.

Out of the mystic doctrines of Paracelsus arose the famous "Brothers of
the Rosy Cross." "The brotherhood was possessed of the deepest knowledge
and science, the transmutation of metals, the perpetuum mobile and
the universal medicine were among their secrets; they were free from
sickness and suffering during their lifetime, though subject finally to
death."(38)

     (38) Ferguson:  Bibliotheca Chemica, Vol. II, p. 290.  For an
     account of Fludd and the English Rosicrucians see Craven's Life
     of Fludd, Kirkwall, 1902.

A school of a more rational kind followed directly upon the work of
Paracelsus, in which the first man of any importance was Van Helmont.
The Paracelsian Archeus was the presiding spirit in living creatures,
and worked through special local ferments, by which the functions of the
organs are controlled. Disease of any part represents a strike on the
part of the local Archeus, who refuses to work. Though full of fanciful
ideas, Van Helmont had the experimental spirit and was the first chemist
to discover the diversity of gases. Like his teacher, he was in revolt
against the faculty, and he has bitter things to say of physicians. He
got into trouble with the Church about the magnetic cure of wounds, as
no fewer than twenty-seven propositions incompatible with the Catholic
faith were found in his pamphlet (Ferguson). The Philosophus per ignem,
Toparcha in Merode, Royenborch, as he is styled in certain of his
writings, is not an easy man to tackle. I show the title-page of the
"Ortus Medicinae," the collection of his works by his son. As with the
pages of Paracelsus, there are many gems to be dug out. The counterblast
against bleeding was a useful protest, and to deny in toto its utility
in fever required courage--a quality never lacking in the Father of
Modern Chemistry, as he has been called.

A man of a very different type, a learned academic, a professor
of European renown, was Daniel Sennert of Wittenberg, the first to
introduce the systematic teaching of chemistry into the curriculum,
and who tried to harmonize the Galenists and Paracelsians. Franciscus
Sylvius, a disciple of Van Helmont, established the first chemical
laboratory in Europe at Leyden, and to him is due the introduction of
modern clinical teaching. In 1664 he writes: "I have led my pupils
by the hand to medical practice, using a method unknown at Leyden, or
perhaps elsewhere, i.e., taking them daily to visit the sick at the
public hospital. There I have put the symptoms of disease before their
eyes; have let them hear the complaints of the patients, and have asked
them their opinions as to the causes and rational treatment of each
case, and the reasons for those opinions. Then I have given my own
judgment on every point. Together with me they have seen the happy
results of treatment when God has granted to our cares a restoration of
health; or they have assisted in examining the body when the patient has
paid the inevitable tribute to death."(39)

     (39) Withington:  Medical History from the Earliest Times,
     London, 1894, pp. 312-313.

Glauber, Willis, Mayow, Lemery, Agricola and Stahl led up to Robert
Boyle, with whom modern chemistry may be said to begin. Even as late as
1716, Lady Mary Wortley Montagu in Vienna found that all had transferred
their superstitions from religion to chemistry; "scarcely a man of
opulence or fashion that has not an alchemist in his service." To one
scientific man of the period I must refer as the author of the first
scientific book published in England. Dryden sings:

     Gilbert shall live till load-stones cease to draw
     Or British fleets the boundless ocean awe.

And the verse is true, for by the publication in 1600 of the "De
Magnete" the science of electricity was founded. William Gilbert was a
fine type of the sixteenth-century physician, a Colchester man, educated
at St. John's College, Cambridge. Silvanus Thompson says: "He is beyond
question rightfully regarded as the Father of Electric Science. He
founded the entire subject of Terrestrial Magnetism. He also made
notable contributions to Astronomy, being the earliest English expounder
of Copernicus. In an age given over to metaphysical obscurities and
dogmatic sophistry, he cultivated the method of experiment and of
reasoning from observation, with an insight and success which entitles
him to be regarded as the father of the inductive method. That method,
so often accredited to Bacon, Gilbert was practicing years before
him."(40)

     (40) Silvanus P. Thompson:  Gilbert of Colchester, Father of
     Electrical Science, London, Chiswick Press, 1903, p. 3.




CHAPTER V -- THE RISE AND DEVELOPMENT OF MODERN MEDICINE

THE middle of the seventeenth century saw the profession thus far on
its way--certain objective features of disease were known, the art of
careful observation had been cultivated, many empirical remedies had
been discovered, the coarser structure of man's body had been well
worked out, and a good beginning had been made in the knowledge of how
the machinery worked--nothing more. What disease really was, where
it was, how it was caused, had not even begun to be discussed
intelligently.

An empirical discovery of the first importance marks the middle of the
century. The story of cinchona is of special interest, as it was the
first great specific in disease to be discovered. In 1638, the wife
of the Viceroy of Peru, the Countess of Chinchon, lay sick of an
intermittent fever in the Palace of Lima. A friend of her husband's,
who had become acquainted with the virtues, in fever, of the bark of
a certain tree, sent a parcel of it to the Viceroy, and the remedy
administered by her physician, Don Juan del Vego, rapidly effected
a cure. In 1640, the Countess returned to Spain, bringing with her
a supply of quina bark, which thus became known in Europe as "the
Countess's Powder" (pulvis Comitissae). A little later, her doctor
followed, bringing additional quantities. Later in the century,
the Jesuit Fathers sent parcels of the bark to Rome, whence it was
distributed to the priests of the community and used for the cure of
ague; hence the name of "Jesuits' bark." Its value was early recognized
by Sydenham and by Locke. At first there was a great deal of opposition,
and the Protestants did not like it because of its introduction by the
Jesuits. The famous quack, Robert Talbor, sold the secret of preparing
quinquina to Louis XIV in 1679 for two thousand louis d'or, a pension
and a title. That the profession was divided in opinion on the subject
was probably due to sophistication, or to the importation of other and
inert barks. It was well into the eighteenth century before its virtues
were universally acknowledged. The tree itself was not described until
1738, and Linnaeus established the genus "Chinchona" in honor of the
Countess.(1)

     (1) Clements R. Markham:  Peruvian Bark, John Murray, London,
     1880; Memoir of the Lady Anna di Osoria, Countess of Chinchona
     and Vice-Queen of Peru, 1874.

A step in advance followed the objective study of the changes wrought in
the body by disease. To a few of these the anatomists had already called
attention. Vesalius, always keen in his description of aberrations from
the normal, was one of the first to describe internal aneurysm. The
truth is, even the best of men had little or no appreciation of the
importance of the study of these changes. Sydenham scoffs at the value
of post-mortems.

Again we have to go back to Italy for the beginning of these studies,
this time to Florence, in the glorious days of Lorenzo the Magnificent.
The pioneer now is not a professor but a general practitioner, Antonio
Benivieni, of whom we know very little save that he was a friend of
Marsilio Ficino and of Angelo Poliziano, and that he practiced in
Florence during the last third of the fifteenth century, dying in 1502.
Through associations with the scholars of the day, he had become a
student of Greek medicine and he was not only a shrewd and accurate
observer of nature but a bold and successful practitioner. He had formed
the good habit of making brief notes of his more important cases, and
after his death these were found by his brother Jerome and published in
1507.(2) This book has a rare value as the record of the experience of
an unusually intelligent practitioner of the period. There are in all
111 observations, most of them commendably brief. The only one of any
length deals with the new "Morbus Gallicus," of which, in the short
period between its appearance and Benivieni's death, he had seen enough
to leave a very accurate description; and it is interesting to note that
even in those early days mercury was employed for its cure. The surgical
cases are of exceptional interest, and No. 38 refers to a case of angina
for which he performed a successful operation. This is supposed to have
been a tracheotomy, and if so, it is the first in the fourteen centuries
that had elapsed since the days of Antyllus.(3) There are other
important cases which show that he was a dexterous and fearless surgeon.
But the special interest of the work for us is that, for the first time
in modern literature, we have reports of post-mortem examinations made
specifically with a view to finding out the exact cause of death. Among
the 111 cases, there are post-mortem records of cases of gallstones,
abscess of the mesentery, thrombosis of the mesenteric veins, several
cases of heart disease, senile gangrene and one of cor villosum. From no
other book do we get so good an idea of a practitioner's experience at
this period; the notes are plain and straightforward, and singularly
free from all theoretical and therapeutic vagaries. He gives several
remarkable instances of faith healing.

     (2) De abditis nonnullis ac mirandis morborum et sanationum
     causis. 8th, Florence, Gandhi, 1507.

     (3) Possibly it was only a case of angina Ludovici, or
     retro-pharyngeal abscess.

To know accurately the anatomical changes that take place in disease is
of importance both for diagnosis and for treatment. The man who created
the science, who taught us to think anatomically of disease,
was Morgagni, whose "De sedibus et causis morborum per anatomen
indagatis"(4) is one of the great books in our literature. During the
seventeenth century, the practice of making post-mortem examinations
had extended greatly, and in the "Sepulchretum anatomicum" of Bonetus
(1679), these scattered fragments are collected.(5) But the work
of Morgagni is of a different type, for in it are the clinical and
anatomical observations of an able physician during a long and active
life. The work had an interesting origin. A young friend interested in
science and in medicine was fond of discoursing with Morgagni about his
preceptors, particularly Valsalva and Albertini, and sometimes the young
man inquired about Morgagni's own observations and thoughts. Yielding
to a strong wish, Morgagni consented to write his young friend familiar
letters describing his experiences. I am sorry that Morgagni does not
mention the name of the man to whom we are so much indebted, and who,
he states, was so pleased with the letters that he continually solicited
him to send more and more "till he drew me on so far as the seventieth;
. . . when I begged them of him in order to revise their contents; he
did not return them, till he had made me solemnly promise, that I would
not abridge any part thereof" (Preface).

     (4) Venice, 1761.

     (5) Boerhaave remarked that if a man wished to deserve or get a
     medical degree from ONE medical author let it be this. (James
     Atkinson: Medical Bibliography, 1834, 268.)

Born in 1682, Morgagni studied at Bologna under Valsalva and Albertini.
In 1711, he was elected professor of medicine at Padua. He published
numerous anatomical observations and several smaller works of less
importance. The great work which has made his name immortal in
the profession, appeared in his eightieth year, and represents the
accumulated experience of a long life. Though written in the form
of letters, the work is arranged systematically and has an index of
exceptional value. From no section does one get a better idea of the
character and scope of the work than from that relating to the heart
and arteries--affections of the pericardium, diseases of the valves,
ulceration, rupture, dilation and hypertrophy and affections of the
aorta are very fully described. The section on aneurysm of the
aorta remains one of the best ever written. It is not the anatomical
observations alone that make the work of unusual value, but the
combination of clinical with anatomical records. What could be more
correct than this account of angina pectoris--probably the first in the
literature? "A lady forty-two years of age, who for a long time, had
been a valetudinarian, and within the same period, on using pretty quick
exercise of body, she was subject to attacks of violent anguish in the
upper part of the chest on the left side, accompanied with a difficulty
of breathing, and numbness of the left arm; but these paroxysms soon
subsided when she ceased from exertion. In these circumstances, but with
cheerfulness of mind, she undertook a journey from Venice, purposing
to travel along the continent, when she was seized with a paroxysm, and
died on the spot. I examined the body on the following day.... The aorta
was considerably dilated at its curvature; and, in places, through
its whole tract, the inner surface was unequal and ossified. These
appearances were propagated into the arteria innominata. The aortic
valves were indurated...." He remarks, "The delay of blood in the aorta,
in the heart, in the pulmonary vessels, and in the vena cave, would
occasion the symptoms of which the woman complained during life; namely,
the violent uneasiness, the difficulty of breathing, and the numbness of
the arm."(6)

     (6) Cooke's Morgagni, Vol. 1, pp. 417-418. I cannot too warmly
     commend to young clinicians the reading of Morgagni.  English
     editions are available--Alexander's three-volume translation of
     1769 and Cooke's Abridgement (London, 1822), of which there was
     an American edition published in Boston in 1824.

Morgagni's life had as much influence as his work. In close
correspondence with the leading men of the day, with the young and
rising teachers and workers, his methods must have been a great
inspiration; and he came just at the right time. The profession was
literally ravaged by theories, schools and systems--iatromechanics,
iatrochemistry, humoralism, the animism of Stahl, the vitalistic
doctrines of Van Helmont and his followers--and into this metaphysical
confusion Morgagni came like an old Greek with his clear observation,
sensible thinking and ripe scholarship. Sprengel well remarks that "it
is hard to say whether one should admire most his rare dexterity and
quickness in dissection, his unimpeachable love of truth and justice in
his estimation of the work of others, his extensive scholarship and rich
classical style or his downright common sense and manly speech."

Upon this solid foundation the morbid anatomy of modern clinical
medicine was built. Many of Morgagni's contemporaries did not fully
appreciate the change that was in progress, and the value of the new
method of correlating the clinical symptoms and the morbid appearances.
After all, it was only the extension of the Hippocratic method
of careful observation--the study of facts from which reasonable
conclusions could be drawn. In every generation there had been men of
this type--I dare say many more than we realize--men of the Benivieni
character, thoroughly practical, clear-headed physicians. A model of
this sort arose in England in the middle of the seventeenth century,
Thomas Sydenham (1624-1689), who took men back to Hippocrates, just as
Harvey had led them back to Galen. Sydenham broke with authority
and went to nature. It is extraordinary how he could have been so
emancipated from dogmas and theories of all sorts. He laid down the
fundamental proposition, and acted upon it, that "all disease could be
described as natural history." To do him justice we must remember,
as Dr. John Brown says, "in the midst of what a mass of errors and
prejudices, of theories actively mischievous, he was placed, at a time
when the mania of hypothesis was at its height, and when the practical
part of his art was overrun and stultified by vile and silly nostrums"
("Horae Subsecivae," Vol. I, 4th ed., Edinburgh, 1882, p. 40).

Listen to what he says upon the method of the study of medicine: "In
writing therefore, such a natural history of diseases, every merely
philosophical hypothesis should be set aside, and the manifest and
natural phenomena, however minute, should be noted with the utmost
exactness. The usefulness of this procedure cannot be easily overrated,
as compared with the subtle inquiries and trifling notions of modern
writers, for can there be a shorter, or indeed any other way of coming
at the morbific causes, or discovering the curative indications than by
a certain perception of the peculiar symptoms? By these steps and helps
it was that the father of physic, the great Hippocrates, came to excel,
his theory being no more than an exact description or view of nature. He
found that nature alone often terminates diseases, and works a cure with
a few simple medicines, and often enough with no medicines at all."

Towards the end of the century many great clinical teachers arose, of
whom perhaps the most famous was Boerhaave, often spoken of as the Dutch
Hippocrates, who inspired a group of distinguished students. I have
already referred to the fact that Franciscus Sylvius at Leyden was the
first among the moderns to organize systematic clinical teaching. Under
Boerhaave, this was so developed that to this Dutch university students
flocked from all parts of Europe. After teaching botany and chemistry,
Boerhaave succeeded to the chair of physic in 1714. With an unusually
wide general training, a profound knowledge of the chemistry of the
day and an accurate acquaintance with all aspects of the history of
the profession, he had a strongly objective attitude of mind towards
disease, following closely the methods of Hippocrates and Sydenham. He
adopted no special system, but studied disease as one of the phenomena
of nature. His clinical lectures, held bi-weekly, became exceedingly
popular and were made attractive not less by the accuracy and care with
which the cases were studied than by the freedom from fanciful doctrines
and the frank honesty of the man. He was much greater than his published
work would indicate, and, as is the case with many teachers of the first
rank, his greatest contributions were his pupils. No other teacher of
modern times has had such a following. Among his favorite pupils may
be mentioned Haller, the physiologist, and van Swieten and de Haen, the
founders of the Vienna school.

In Italy, too, there were men who caught the new spirit, and appreciated
the value of combining morbid anatomy with clinical medicine. Lancisi,
one of the early students of disease of the heart, left an excellent
monograph on the subject, and was the first to call special attention
to the association of syphilis with cardio-vascular disease. A younger
contemporary of his at Rome, Baglivi, was unceasing in his call to
the profession to return to Hippocratic methods, to stop reading
philosophical theories and to give up what he calls the "fatal itch" to
make systems.

The Leyden methods of instruction were carried far and wide throughout
Europe; into Edinburgh by John Rutherford, who began to teach at the
Royal Infirmary in 1747, and was followed by Whytt and by Cullen; into
England by William Saunders of Guy's Hospital. Unfortunately the
great majority of clinicians could not get away from the theoretical
conceptions of disease, and Cullen's theory of spasm and atony exercised
a profound influence on practice, particularly in this country, where it
had the warm advocacy of Benjamin Rush. Even more widespread became the
theories of a pupil of Cullen's, John Brown, who regarded excitability
as the fundamental property of all living creatures: too much of this
excitability produced what were known as sthenic maladies, too little,
asthenic; on which principles practice was plain enough. Few systems of
medicine have ever stirred such bitter controversy, particularly on the
Continent, and in Charles Creighton's account of Brown(7) we read
that as late as 1802 the University of Gottingen was so convulsed by
controversies as to the merits of the Brunonian system that contending
factions of students in enormous numbers, not unaided by the professors,
met in combat in the streets on two consecutive days and had to be
dispersed by a troop of Hanoverian horse.

     (7) Dictionary of National Biography, London, 1886, VII, 14-17.

But the man who combined the qualities of Vesalius, Harvey and Morgagni
in an extraordinary personality was John Hunter. He was, in the first
place, a naturalist to whom pathological processes were only a small
part of a stupendous whole, governed by law, which, however, could
never be understood until the facts had been accumulated, tabulated and
systematized. By his example, by his prodigious industry, and by his
suggestive experiments he led men again into the old paths of Aristotle,
Galen and Harvey. He made all thinking physicians naturalists, and he
lent a dignity to the study of organic life, and re-established a close
union between medicine and the natural sciences. Both in Britain and
Greater Britain, he laid the foundation of the great collections and
museums, particularly those connected with the medical schools. The
Wistar-Horner and the Warren Museums in this country originated with men
greatly influenced by Hunter. He was, moreover, the intellectual father
of that interesting group of men on this side of the Atlantic who, while
practising as physicians, devoted much time and labor to the study of
natural history; such men as Benjamin Smith Barton, David Hossack, Jacob
Bigelow, Richard Harlan, John D. Godman, Samuel George Morton, John
Collins Warren, Samuel L. Mitchill and J. Ailken Meigs. He gave an
immense impetus in Great Britain to the study of morbid anatomy, and
his nephew, Matthew Baillie, published the first important book on the
subject in the English language.

Before the eighteenth century closed practical medicine had made great
advance. Smallpox, though not one of the great scourges like plague
or cholera, was a prevalent and much dreaded disease, and in civilized
countries few reached adult life without an attack. Edward Jenner, a
practitioner in Gloucestershire, and the pupil to whom John Hunter gave
the famous advice: "Don't think, try!" had noticed that milkmaids
who had been infected with cowpox from the udder of the cow were
insusceptible to smallpox. I show you here the hand of Sarah Nelmes with
cowpox, 1796. A vague notion had prevailed among the dairies from time
immemorial that this disease was a preventive of the smallpox. Jenner
put the matter to the test of experiment. Let me quote here his own
words: "The first experiment was made upon a lad of the name of Phipps,
in whose arm a little vaccine virus was inserted, taken from the hand
of a young woman who had been accidentally infected by a cow.
Notwithstanding the resemblance which the pustule, thus excited on
the boy's arm, bore to variolous inoculation, yet as the indisposition
attending it was barely perceptible, I could scarcely persuade myself
the patient was secure from the Small Pox. However, on his being
inoculated some months afterwards, it proved that he was secure."(8)
The results of his experiments were published in a famous small quarto
volume in 1798.(*) From this date, smallpox has been under control.
Thanks to Jenner, not a single person in this audience is pockmarked!
A hundred and twenty-five years ago, the faces of more than half of you
would have been scarred. We now know the principle upon which protection
is secured: an active acquired immunity follows upon an attack of a
disease of a similar nature. Smallpox and cowpox are closely allied and
the substances formed in the blood by the one are resistant to the
virus of the other. I do not see how any reasonable person can oppose
vaccination or decry its benefits. I show you the mortality figures(9)
of the Prussian Army and of the German Empire. A comparison with
the statistics of the armies of other European countries in which
revaccination is not so thoroughly carried out is most convincing of its
efficacy.

     (8) Edward Jenner:  The Origin of the Vaccine Inoculation,
     London, 1801.

     (*) Reprinted by Camac:  Epoch-making Contributions to Medicine,
     etc., 1909.--Ed.

     (9) Jockmann:  Pocken und Vaccinationlehre, 1913.

The early years of the century saw the rise of modern clinical medicine
in Paris. In the art of observation men had come to a standstill.
I doubt very much whether Corvisart in 1800 was any more skilful in
recognizing a case of pneumonia than was Aretaeus in the second century
A. D. But disease had come to be more systematically studied; special
clinics were organized, and teaching became much more thorough. Anyone
who wishes to have a picture of the medical schools in Europe in the
first few years of the century, should read the account of the travels
of Joseph Frank of Vienna.(10) The description of Corvisart is of a
pioneer in clinical teaching whose method remains in vogue today
in France--the ward visit, followed by a systematic lecture in the
amphitheatre. There were still lectures on Hippocrates three times a
week, and bleeding was the principal plan of treatment: one morning
Frank saw thirty patients, out of one hundred and twelve, bled!
Corvisart was the strong clinician of his generation, and his accurate
studies on the heart were among the first that had concentrated
attention upon a special organ. To him, too, is due the reintroduction
of the art of percussion in internal disease discovered by Auenbrugger
in 1761.

     (10) Joseph Frank:  Reise nach Paris (etc.), Wien, 1804-05.

The man who gave the greatest impetus to the study of scientific
medicine at this time was Bichat, who pointed out that the pathological
changes in disease were not so much in organs as in tissues. His
studies laid the foundation of modern histology. He separated the
chief constituent elements of the body into various tissues possessing
definite physical and vital qualities. "Sensibility and contractability
are the fundamental qualities of living matter and of the life of our
tissues. Thus Bichat substituted for vital forces 'vital properties,'
that is to say, a series of vital forces inherent in the different
tissues."(11) His "Anatomic Generale," published in 1802, gave an
extraordinary stimulus to the study of the finer processes of disease,
and his famous "Recherches sur la Vie et sur la Mort" (1800) dealt
a death-blow to old iatromechanical and iatrochemical views. His
celebrated definition may be quoted: "La vie est l'ensemble des
proprietes vitales qui resistent aux proprietes physiques, ou bien la
vie est l'ensemble des fonctions qui resistent a la mort." (Life is the
sum of the vital properties that withstand the physical properties,
or, life is the sum of the functions that withstand death.) Bichat is
another pathetic figure in medical history. His meteoric career ended
in his thirty-first year: he died a victim of a post-mortem wound
infection. At his death, Corvisart wrote Napoleon: "Bichat has just died
at the age of thirty. That battlefield on which he fell is one which
demands courage and claims many victims. He has advanced the science of
medicine. No one at his age has done so much so well."

     (11) E. Boinet:  Les doctrines medicules, leur evolution, Paris,
     1907, pp. 85-86.

It was a pupil of Corvisart, Rene Theophile Laennec, who laid the
foundation of modern clinical medicine. The story of his life is well
known. A Breton by birth, he had a hard, up-hill struggle as a young
man--a struggle of which we have only recently been made aware by the
publication of a charming book by Professor Rouxeau of Nantes--"Laennec
avant 1806." Influenced by Corvisart, he began to combine the accurate
study of cases in the wards with anatomical investigations in the
dead-house. Before Laennec, the examination of a patient had been
largely by sense of sight, supplemented by that of touch, as in
estimating the degree of fever, or the character of the pulse.
Auenbrugger's "Inventum novum" of percussion, recognized by Corvisart,
extended the field; but the discovery of auscultation by Laennec, and
the publication of his work--"De l'Auscultation Mediate," 1819,--marked
an era in the study of medicine. The clinical recognition of individual
diseases had made really very little progress; with the stethoscope
begins the day of physical diagnosis. The clinical pathology of the
heart, lungs and abdomen was revolutionized. Laennec's book is in the
category of the eight or ten greatest contributions to the science
of medicine.(*) His description of tuberculosis is perhaps the most
masterly chapter in clinical medicine. This revolution was effected by
a simple extension of the Hippocratic method from the bed to the
dead-house, and by correlating the signs and symptoms of a disease with
its anatomical appearances.

     (*) John Forbes's translation of Auenbrugger and part of his
     translation of Lacnnec are reprinted in Camac's Epoch-making
     Contributions, etc., 1909.--Ed.

The pupils and successors of Corvisart--Bayle, Andral, Bouillaud,
Chomel, Piorry, Bretonneau, Rayer, Cruveilhier and Trousseau--brought a
new spirit into the profession. Everywhere the investigation of disease
by clinical-pathological methods widened enormously the diagnostic
powers of the physician. By this method Richard Bright, in 1836, opened
a new chapter on the relation of disease of the kidney to dropsy, and to
albuminous urine. It had already been shown by Blackwell and by Wells,
the celebrated Charleston (S.C.) physician, in 1811, that the urine
contained albumin in many cases of dropsy, but it was not until
Bright began a careful investigation of the bodies of patients who had
presented these symptoms, that he discovered the association of various
forms of disease of the kidney with anasarca and albuminous urine. In no
direction was the harvest of this combined study more abundant than in
the complicated and confused subject of fever. The work of Louis and of
his pupils, W.W. Gerhard and others, revealed the distinction between
typhus and typhoid fever, and so cleared up one of the most obscure
problems in pathology. By Morgagni's method of "anatomical thinking,"
Skoda in Vienna, Schonlein in Berlin, Graves and Stokes in Dublin,
Marshall Hall, C. J. B. Williams and many others introduced the new and
exact methods of the French and created a new clinical medicine. A
very strong impetus was given by the researches of Virchow on cellular
pathology, which removed the seats of disease from the tissues,
as taught by Bichat, to the individual elements, the cells. The
introduction of the use of the microscope in clinical work widened
greatly our powers of diagnosis, and we obtained thereby a very much
clearer conception of the actual processes of disease. In another way,
too, medicine was greatly helped by the rise of experimental pathology,
which had been introduced by John Hunter, was carried along by Magendie
and others, and reached its culmination in the epoch-making researches
of Claude Bernard. Not only were valuable studies made on the action of
drugs, but also our knowledge of cardiac pathology was revolutionized
by the work of Traube, Cohnheim and others. In no direction did the
experimental method effect such a revolution as in our knowledge of the
functions of the brain. Clinical neurology, which had received a great
impetus by the studies of Todd, Romberg, Lockhart Clarke, Duchenne and
Weir Mitchell, was completely revolutionized by the experimental work
of Hitzig, Fritsch and Ferrier on the localization of functions in
the brain. Under Charcot, the school of French neurologists gave great
accuracy to the diagnosis of obscure affections of the brain and spinal
cord, and the combined results of the new anatomical, physiological and
experimental work have rendered clear and definite what was formerly the
most obscure and complicated section of internal medicine. The end of
the fifth decade of the century is marked by a discovery of supreme
importance. Humphry Davy had noted the effects of nitrous oxide. The
exhilarating influence of sulphuric ether had been casually studied, and
Long of Georgia had made patients inhale the vapor until anaesthetic and
had performed operations upon them when in this state; but it was not
until October 16, 1846, in the Massachusetts General Hospital, that
Morton, in a public operating room, rendered a patient insensible with
ether and demonstrated the utility of surgical anaesthesia. The rival
claims of priority no longer interest us, but the occasion is one of
the most memorable in the history of the race. It is well that our
colleagues celebrate Ether Day in Boston--no more precious boon has ever
been granted to suffering humanity.(*)

     (*) Cf. Osler:  Proc. Roy. Soc. Med., XI, Sect. Hist.  Med., pp.
     65-69, 1918, or, Annals Med. Hist., N.Y., I, 329-332. Cf. also
     Morton's publications reprinted in Camac's book cited above.--Ed.

In 1857, a young man, Louis Pasteur, sent to the Lille Scientific
Society a paper on "Lactic Acid Fermentation" and in December of the
same year presented to the Academy of Sciences in Paris a paper on
"Alcoholic Fermentation" in which he concluded that "the deduplication
of sugar into alcohol and carbonic acid is correlative to a phenomenon
of life." A new era in medicine dates from those two publications. The
story of Pasteur's life should be read by every student.(*) It is one of
the glories of human literature, and, as a record of achievement and of
nobility of character, is almost without an equal.

     (*) Osler wrote a preface for the 1911 English edition of the
     Life by Vallery-Radot.--Ed.

At the middle of the last century we did not know much more of the
actual causes of the great scourges of the race, the plagues, the fevers
and the pestilences, than did the Greeks. Here comes Pasteur's great
work. Before him Egyptian darkness; with his advent a light that
brightens more and more as the years give us ever fuller knowledge. The
facts that fevers were catching, that epidemics spread, that infection
could remain attached to articles of clothing, etc., all gave support to
the view that the actual cause was something alive, a contagium vivum.
It was really a very old view, the germs of which may be found in the
Fathers, but which was first clearly expressed--so far as I know--by
Fracastorius, the Veronese physician, in the sixteenth century, who
spoke of the seeds of contagion passing from one person to another;(12)
and he first drew a parallel between the processes of contagion and
the fermentation of wine. This was more than one hundred years before
Kircher, Leeuwenhoek and others began to use the microscope and to see
animalcula, etc., in water, and so give a basis for the "infinitely
little" view of the nature of disease germs. And it was a study of the
processes of fermentation that led Pasteur to the sure ground on which
we now stand.

     (12) Varro, in De Re Rustica, Bk. I, 12 (circa 40 B.C.), speaks
     of minute organisms which the eye cannot see and which enter the
     body and cause disease.

Out of these researches arose a famous battle which kept Pasteur hard at
work for four or five years--the struggle over spontaneous generation.
It was an old warfare, but the microscope had revealed a new world, and
the experiments on fermentation had lent great weight to the omne vivum
ex ovo doctrine. The famous Italians, Redi and Spallanzani, had led the
way in their experiments, and the latter had reached the conclusion
that there is no vegetable and no animal that has not its own germ. But
heterogenesis became the burning question, and Pouchet in France, and
Bastian in England, led the opposition to Pasteur. The many famous
experiments carried conviction to the minds of scientific men, and
destroyed forever the old belief in spontaneous generation. All along,
the analogy between disease and fermentation must have been in Pasteur's
mind; and then came the suggestion, "What would be most desirable is to
push those studies far enough to prepare the road for a serious
research into the origin of various diseases." If the changes in lactic,
alcoholic and butyric fermentations are due to minute living organisms,
why should not the same tiny creatures make the changes which occur
in the body in the putrid and suppurative diseases? With an accurate
training as a chemist, having been diverted in his studies upon
fermentation into the realm of biology, and nourishing a strong
conviction of the identity between putrefactive changes of the body
and fermentation, Pasteur was well prepared to undertake investigations
which had hitherto been confined to physicians alone.

So impressed was he with the analogy between fermentation and the
infectious diseases that, in 1863, he assured the French Emperor of
his ambition "to arrive at the knowledge of the causes of putrid and
contagious diseases." After a study upon the diseases of wines, which
has had most important practical bearings, an opportunity arose which
changed the whole course of his career, and profoundly influenced the
development of medical science. A disease of the silkworm had, for some
years, ruined one of the most important industries in France, and in
1865 the Government asked Pasteur to give up his laboratory work and
teaching, and to devote his whole energies to the task of investigating
it. The story of the brilliant success which followed years of
application to the problem will be read with deep interest by every
student of science. It was the first of his victories in the application
of the experimental methods of a trained chemist to the problems
of biology, and it placed his name high in the group of the most
illustrious benefactors of practical industries.

In a series of studies on the diseases of beer, and on the mode of
production of vinegar, he became more and more convinced that these
studies on fermentation had given him the key to the nature of the
infectious diseases. It is a remarkable fact that the distinguished
English philosopher of the seventeenth century, the man who more
than anyone else of his century appreciated the importance of the
experimental method, Robert Boyle, had said that he who could discover
the nature of ferments and fermentation, would be more capable than
anyone else of explaining the nature of certain diseases.

In 1876 there appeared in Cohn's "Beitrage zur Morphologie der Pflanzen"
(II, 277-310), a paper on the "AEtiology of Anthrax" by a German
district physician in Wollstein, Robert Koch, which is memorable in our
literature as the starting point of a new method of research into
the causation of infectious diseases. Koch demonstrated the constant
presence of germs in the blood of animals dying from the disease. Years
before, those organisms had been seen by Pollender and Davaine, but
the epoch-making advance of Koch was to grow those organisms in a pure
culture outside the body, and to produce the disease artificially
by inoculating animals with the cultures Koch is really our medical
Galileo, who, by means of a new technique,--pure cultures and isolated
staining,--introduced us to a new world. In 1878, followed his study on
the "AEtiology of Wound Infections," in which he was able to demonstrate
conclusively the association of micro-organisms with the disease. Upon
those two memorable researches made by a country doctor rests the modern
science of bacteriology.

The next great advance was the discovery by Pasteur of the possibility
of so attenuating, or weakening, the poison that an animal inoculated
had a slight attack, recovered and was then protected against the
disease. More than eighty years had passed since on May 14, 1796, Jenner
had vaccinated a child with cowpox and proved that a slight attack of
one disease protected the body from a disease of an allied nature. An
occasion equally famous in the history of medicine was a day in 1881,
when Pasteur determined that a flock of sheep vaccinated with the
attenuated virus of anthrax remained well, when every one of the
unvaccinated infected from the same material had died. Meanwhile, from
Pasteur's researches on fermentation and spontaneous generation, a
transformation had been initiated in the practice of surgery, which,
it is not too much to say, has proved one of the greatest boons ever
conferred upon humanity. It had long been recognized that, now and
again, a wound healed without the formation of pus, that is, without
suppuration, but both spontaneous and operative wounds were almost
invariably associated with that process; and, moreover, they frequently
became putrid, as it was then called,--infected, as we should say,--the
general system became involved and the patient died of blood poisoning.
So common was this, particularly in old, ill-equipped hospitals, that
many surgeons feared to operate, and the general mortality in all
surgical cases was very high. Believing that it was from outside that
the germs came which caused the decomposition of wounds, just as
from the atmosphere the sugar solution got the germs which caused the
fermentation, a young surgeon in Glasgow, Joseph Lister, applied the
principles of Pasteur's experiments to their treatment. From Lister's
original paper(*) I quote the following: "Turning now to the question
how the atmosphere produces decomposition of organic substances, we find
that a flood of light has been thrown upon this most important subject
by the philosophic researches of M. Pasteur, who has demonstrated by
thoroughly convincing evidence that it is not to its oxygen or to any of
its gaseous constituents that the air owes this property, but to minute
particles suspended in it, which are the germs of various low forms
of life, long since revealed by the microscope, and regarded as merely
accidental concomitants of putrescence, but now shown by Pasteur to
be its essential cause, resolving the complex organic compounds into
substances of simpler chemical constitution, just as the yeast-plant
converts sugar into alcohol and carbonic acid." From these beginnings
modern surgery took its rise, and the whole subject of wound infection,
not only in relation to surgical diseases, but to child-bed fever, forms
now one of the most brilliant chapters in the history of preventive
medicine.

     (*) Lancet, March 16, 1867.  (Cf. Camac:  Epoch-making
     Contributions, etc., 1909, p. 7.--Ed.)

With the new technique and experimental methods, the discovery of the
specific germs of many of the more important acute infections followed
each other with bewildering rapidity: typhoid fever, diphtheria,
cholera, tetanus, plague, pneumonia, gonorrhoea and, most important of
all, tuberculosis. It is not too much to say that the demonstration
by Koch of the "bacillus tuberculosis" (1882) is, in its far-reaching
results, one of the most momentous discoveries ever made.

Of almost equal value have been the researches upon the protozoan forms
of animal life, as causes of disease. As early as 1873, spirilla were
demonstrated in relapsing fever. Laveran proved the association of
haematozoa with malaria in 1880. In the same year, Griffith Evans
discovered trypanosomes in a disease of horses and cattle in India, and
the same type of parasite was found in the sleeping sickness. Amoebae
were demonstrated in one form of dysentery, and in other tropical
diseases protozoa were discovered, so that we were really prepared for
the announcement in 1905, by Schaudinn, of the discovery of a protozoan
parasite in syphilis. Just fifty years had passed since Pasteur had
sent in his paper on "Lactic Acid Fermentation" to the Lille Scientific
Society--half a century in which more had been done to determine the
true nature of disease than in all the time that had passed since
Hippocrates. Celsus makes the oft-quoted remark that to determine
the cause of a disease often leads to the remedy,(*) and it is the
possibility of removing the cause that gives such importance to the new
researches on disease.

     (*) "Et causae quoque estimatio saepe morbum solvit," Celsus,
     Lib.  I, Prefatio.--Ed.




INTERNAL SECRETIONS

ONE of the greatest contributions of the nineteenth century to
scientific medicine was the discovery of the internal secretions of
organs. The basic work on the subject was done by Claude Bernard, a
pupil of the great Magendie, whose saying it is well to remember--"When
entering a laboratory one should leave theories in the cloakroom." More
than any other man of his generation, Claude Bernard appreciated the
importance of experiment in practical medicine. For him the experimental
physician was the physician of the future--a view well borne out by the
influence his epoch-making work has had on the treatment of disease. His
studies on the glycogenic functions of the liver opened the way for the
modern fruitful researches on the internal secretions of the various
glands. About the same time that Bernard was developing the laboratory
side of the problem, Addison, a physician to Guy's Hospital, in 1855,
pointed out the relation of a remarkable group of symptoms to disease
of the suprarenal glands, small bodies situated above the kidneys, the
importance of which had not been previously recognized. With the loss
of the function of these glands by disease, the body was deprived of
something formed by them which was essential to its proper working.
Then, in the last third of the century, came in rapid succession the
demonstration of the relations of the pancreas to diabetes, of the vital
importance of the thyroid gland and of the pituitary body. Perhaps no
more striking illustration of the value of experimental medicine has
ever been given than that afforded by the studies upon those glands.

The thyroid body, situated in the neck and the enlargement of which is
called goitre, secretes substances which pass into the blood, and
which are necessary for the growth of the body in childhood, for the
development of the mind and for the nutrition of the tissues of the
skin. If, following an infectious disease, a child has wasting of this
gland, or if, living in a certain district, it has a large goitre,
normal development does not take place, and the child does not grow in
mind or body and becomes what is called a <DW35>. More than this--if in
adult life the gland is completely removed, or if it wastes, a somewhat
similar condition is produced, and the patient in time loses his mental
powers and becomes fat and flabby--myxedematous. It has been shown
experimentally in various ways that the necessary elements of the
secretion can be furnished by feeding with the gland or its extracts,
and that the cretinoid or myxedematous conditions could thus be cured or
prevented.

Experimental work has also demonstrated the functions of the suprarenal
glands and explained the symptoms of Addison's disease, and chemists
have even succeeded in making synthetically the active principle
adrenalin.

There is perhaps no more fascinating story in the history of science
than that of the discovery of these so-called ductless glands. Part
of its special interest is due to the fact that clinicians, surgeons,
experimental physiologists, pathologists and chemists have all combined
in splendid teamwork to win the victory. No such miracles have ever
before been wrought by physicians as those which we see in connection
with the internal secretion of the thyroid gland. The myth of bringing
the dead back to life has been associated with the names of many great
healers since the incident of Empedocles and Pantheia, but nowadays the
dead in mind and the deformed in body may be restored by the touch
of the magic wand of science. The study of the interaction of these
internal secretions, their influence upon development, upon mental
process and upon disorders of metabolism is likely to prove in the
future of a benefit scarcely less remarkable than that which we have
traced in the infectious diseases.




CHEMISTRY

IT is not making too strong a statement to say that the chemistry and
chemical physics of the nineteenth century have revolutionized
the world. It is difficult to realize that Liebig's famous Giessen
laboratory, the first to be opened to students for practical study, was
founded in the year 1825. Boyle, Cavendish, Priestley, Lavoisier, Black,
Dalton and others had laid a broad foundation, and Young, Frauenhofer,
Rumford, Davy, Joule, Faraday, Clerk-Maxwell, Helmholtz and others
built upon that and gave us the new physics and made possible our age
of electricity. New technique and new methods have given a powerful
stimulus to the study of the chemical changes that take place in the
body, which, only a few years ago, were matters largely of speculation.
"Now," in the words of Professor Lee, "we recognize that, with its
living and its non-living substances inextricably intermingled, the
body constitutes an intensive chemical laboratory in which there is ever
occurring a vast congeries of chemical reactions; both constructive and
destructive processes go on; new protoplasm takes the place of old. We
can analyze the income of the body and we can analyze its output, and
from these data we can learn much concerning the body's chemistry. A
great improvement in the method of such work has recently been secured
by the device of inclosing the person who is the subject of the
experiment in a respiration calorimeter. This is an air-tight chamber,
artificially supplied with a constant stream of pure air, and from which
the expired air, laden with the products of respiration, is withdrawn
for purposes of analysis. The subject may remain in the chamber for
days, the composition of all food and all excrete being determined, and
all heat that is given off being measured. Favorable conditions are
thus established for an exact study of many problems of nutrition. The
difficulties increase when we attempt to trace the successive steps in
the corporeal pathway of molecule and atom. Yet these secrets of the
vital process are also gradually being revealed. When we remember that
it is in this very field of nutrition that there exist great popular
ignorance and a special proneness to fad and prejudice, we realize how
practically helpful are such exact studies of metabolism."(13)

     (13) Frederick S. Lee, Ph.D.: Scientific Features of Modern
     Medicine, New York, 1911.  I would like to call attention to this
     work of Professor Lee's as presenting all the scientific features
     of modern medicine in a way admirably adapted for anyone, lay or
     medical, who wishes to get a clear sketch of them.




CHAPTER VI -- THE RISE OF PREVENTIVE MEDICINE

THE story so far has been of men and of movements--of men who have,
consciously or unconsciously, initiated great movements, and of
movements by which, nolens volens, the men of the time were moulded and
controlled. Hippocrates, in the tractate on "Ancient Medicine," has a
splendid paragraph on the attitude of mind towards the men of the past.
My attention was called to it one day in the Roman Forum by Commendatore
Boni, who quoted it as one of the great sayings of antiquity. Here it
is: "But on that account, I say, we ought not to reject the ancient Art,
as if it were not, and had not been properly founded, because it did
not attain accuracy in all things, but rather, since it is capable of
reaching to the greatest exactitude by reasoning, to receive it and
admire its discoveries, made from a state of great ignorance, and as
having been well and properly made, and not from chance."(1)

     (1) The Works of Hippocrates, Adams, Vol. I, p. 168, London, 1849
     (Sydenham Society).

I have tried to tell you what the best of these men in successive ages
knew, to show you their point of outlook on the things that interest
us. To understand the old writers one must see as they saw, feel as they
felt, believe as they believed--and this is hard, indeed impossible! We
may get near them by asking the Spirit of the Age in which they lived
to enter in and dwell with us, but it does not always come. Literary
criticism is not literary history--we have no use here for the former,
but to analyze his writings is to get as far as we can behind the
doors of a man's mind, to know and appraise his knowledge, not from our
standpoint, but from that of his contemporaries, his predecessors and
his immediate successors. Each generation has its own problems to face,
looks at truth from a special focus and does not see quite the same
outlines as any other. For example, men of the present generation
grow up under influences very different from those which surrounded my
generation in the seventies of the last century, when Virchow and
his great contemporaries laid the sure and deep foundations of modern
pathology. Which of you now knows the "Cellular Pathology" as we did? To
many of you it is a closed book,--to many more Virchow may be thought a
spent force. But no, he has only taken his place in a great galaxy. We
do not forget the magnitude of his labors, but a new generation has new
problems--his message was not for you--but that medicine today runs in
larger moulds and turns out finer castings is due to his life and work.
It is one of the values of lectures on the history of medicine to
keep alive the good influences of great men even after their positive
teaching is antiquated. Let no man be so foolish as to think that he has
exhausted any subject for his generation. Virchow was not happy when he
saw the young men pour into the old bottle of cellular pathology the new
wine of bacteriology. Lister could never understand how aseptic surgery
arose out of his work. Ehrlich would not recognize his epoch-making
views on immunity when this generation has finished with them. I believe
it was Hegel who said that progress is a series of negations--the
denial today of what was accepted yesterday, the contradiction by each
generation of some part at least of the philosophy of the last; but all
is not lost, the germ plasm remains, a nucleus of truth to be fertilized
by men often ignorant even of the body from which it has come. Knowledge
evolves, but in such a way that its possessors are never in sure
possession. "It is because science is sure of nothing that it is always
advancing" (Duclaux).

History is the biography of the mind of man, and its educational
value is in direct proportion to the completeness of our study of the
individuals through whom this mind has been manifested. I have tried
to take you back to the beginnings of science, and to trace its gradual
development, which is conditioned by three laws. In the first place,
like a living organism, truth grows, and its gradual evolution may
be traced from the tiny germ to the mature product. Never springing,
Minerva-like, to full stature at once, truth may suffer all the hazards
incident to generation and gestation. Much of history is a record of the
mishaps of truths which have struggled to the birth, only to die or else
to wither in premature decay. Or the germ may be dormant for centuries,
awaiting the fullness of time.

Secondly, all scientific truth is conditioned by the state of knowledge
at the time of its announcement. Thus, at the beginning of the
seventeenth century, the science of optics and mechanical appliances had
not made possible (so far as the human mind was concerned) the existence
of blood capillaries and blood corpuscles. Jenner could not have
added to his "Inquiry" a study on immunity; Sir William Perkin and the
chemists made Koch technique possible; Pasteur gave the conditions that
produced Lister; Davy and others furnished the preliminaries necessary
for anaesthesia. Everywhere we find this filiation, one event following
the other in orderly sequence--"Mind begets mind," as Harvey (De
Generatione) says; "opinion is the source of opinion. Democritus with
his atoms, and Eudoxus with his chief good which he placed in pleasure,
impregnated Epicurus; the four elements of Empedocles, Aristotle;
the doctrines of the ancient Thebans, Pythagoras and Plato; geometry,
Euclid."(2)

     (2) Works of William Harvey, translated by Robert Willis, London,
     1847, p. 532.

And, thirdly, to scientific truth alone may the <DW25> mensura principle
be applied, since of all mental treasures of the race it alone compels
general acquiescence. That this general acquiescence, this aspect of
certainty, is not reached per saltum, but is of slow, often of difficult
growth,--marked by failures and frailties, but crowned at last with
an acceptance accorded to no other product of mental activity,--is
illustrated by every important discovery from Copernicus to Darwin.

The difficulty is to get men to the thinking level which compels the
application of scientific truths. Protagoras, that "mighty-wise man,"
as Socrates called him, who was responsible for the aphorism that man
is the measure of all things, would have been the first to recognize the
folly of this standard for the people at large. But we have gradually
reached a stage in which knowledge is translated into action, made
helpful for suffering humanity, just as the great discoveries in physics
and chemistry have been made useful in the advance of civilization.
We have traced medicine through a series of upward steps--a primitive
stage, in which it emerged from magic and religion into an empirical
art, as seen among the Egyptians and Babylonians; a stage in which the
natural character of disease was recognized and the importance of its
study as a phenomenon of nature was announced; a stage in which the
structure and functions of the human body were worked out; a stage in
which the clinical and anatomical features of disease were determined;
a stage in which the causes of disorders were profitably studied, and
a final stage, into which we have just entered, the application of the
knowledge for their prevention. Science has completely changed man's
attitude towards disease.

Take a recent concrete illustration. A couple of years ago in
Philadelphia and in some other parts of the United States, a very
peculiar disease appeared, characterized by a rash upon the skin and
moderate fever, and a constitutional disturbance proportionate to the
extent and severity of the eruption. The malady first broke out in the
members of a crew of a private yacht; then in the crews of other boats,
and among persons living in the boarding-houses along the docks. It was
the cause of a great deal of suffering and disability.

There were three courses open: to accept the disease as a visitation
of God, a chastening affliction sent from above, and to call to aid the
spiritual arm of the church. Except the "Peculiar People" few now take
this view or adopt this practice. The Christian Scientist would probably
deny the existence of the rash and of the fever, refuse to recognize
the itching and get himself into harmony with the Infinite. Thirdly, the
method of experimental medicine.

First, the conditions were studied under which the individual cases
occurred. The only common factor seemed to be certain straw mattresses
manufactured by four different firms, all of which obtained the straw
from the same source.

The second point was to determine the relation of the straw to the rash.
One of the investigators exposed a bare arm and shoulder for an hour
between two mattresses. Three people voluntarily slept on the mattresses
for one night. Siftings from the straw were applied to the arm,
under all of which circumstances the rash quickly developed, showing
conclusively the relation of the straw to the disease.

Thirdly, siftings from the straw and mattresses which had been
thoroughly disinfected failed to produce the rash.

And fourthly, careful inspection of the siftings of the straw disclosed
living parasites, small mites, which when applied to the skin quickly
produced the characteristic eruption.




SANITATION

WHEN the thoughtful historian gets far enough away from the nineteenth
century to see it as a whole, no single feature will stand out with
greater distinctness than the fulfilment of the prophecy of Descartes
that we could be freed from an infinity of maladies both of body and
mind if we had sufficient knowledge of their causes and of all the
remedies with which nature has provided us. Sanitation takes its place
among the great modern revolutions--political, social and intellectual.
Great Britain deserves the credit for the first practical recognition of
the maxim salus populi suprema lex. In the middle and latter part of
the century a remarkable group of men, Southwood Smith, Chadwick, Budd,
Murchison, Simon, Acland, Buchanan, J.W. Russell and Benjamin Ward
Richardson, put practical sanitation on a scientific basis. Even
before the full demonstration of the germ theory, they had grasped the
conception that the battle had to be fought against a living contagion
which found in poverty, filth and wretched homes the conditions for its
existence. One terrible disease was practically wiped out in twenty-five
years of hard work. It is difficult to realize that within the memory of
men now living, typhus fever was one of the great scourges of our large
cities, and broke out in terrible epidemics--the most fatal of all to
the medical profession. In the severe epidemic in Ireland in the forties
of the last century, one fifth of all the doctors in the island died
of typhus. A better idea of the new crusade, made possible by new
knowledge, is to be had from a consideration of certain diseases against
which the fight is in active progress.

Nothing illustrates more clearly the interdependence of the sciences
than the reciprocal impulse given to new researches in pathology
and entomology by the discovery of the part played by insects in the
transmission of disease. The flea, the louse, the bedbug, the house fly,
the mosquito, the tick, have all within a few years taken their places
as important transmitters of disease. The fly population may be taken
as the sanitary index of a place. The discovery, too, that insects are
porters of disease has led to a great extension of our knowledge of
their life history. Early in the nineties, when Dr. Thayer and I were
busy with the study of malaria in Baltimore, we began experiments on
the possible transmission of the parasites, and a tramp, who had been
a medical student, offered himself as a subject. Before we began, Dr.
Thayer sought information as to the varieties of mosquitoes known in
America, but sought in vain: there had at that time been no systematic
study. The fundamental study which set us on the track was a
demonstration by Patrick Manson,(3) in 1879, of the association of
filarian disease with the mosquito. Many observations had already
been made, and were made subsequently, on the importance of insects as
intermediary hosts in the animal parasites, but the first really great
scientific demonstration of a widespread infection through insects was
by Theobald Smith, now of Harvard University, in 1889, in a study of
Texas fever of cattle.(4) I well remember the deep impression made upon
me by his original communication, which in completeness, in accuracy of
detail, in Harveian precision and in practical results remains one of
the most brilliant pieces of experimental work ever undertaken. It is
difficult to draw comparisons in pathology; but I think, if a census
were taken among the world's workers on disease, the judgment to be
based on the damage to health and direct mortality, the votes would be
given to malaria as the greatest single destroyer of the human race.
Cholera kills its thousands, plague, in its bad years, its hundreds of
thousands, yellow fever, hookworm disease, pneumonia, tuberculosis,
are all terribly destructive, some only in the tropics, others in more
temperate regions: but malaria is today, as it ever was, a disease to
which the word pandemic is specially applicable. In this country and in
Europe, its ravages have lessened enormously during the past century,
but in the tropics it is everywhere and always present, the greatest
single foe of the white man, and at times and places it assumes the
proportions of a terrible epidemic. In one district of India alone,
during the last four months of 1908, one quarter of the total population
suffered from the disease and there were 400,000 deaths--practically
all from malaria. Today, the control of this terrible scourge is in our
hands, and, as I shall tell you in a few minutes, largely because of
this control, the Panama Canal is being built. No disease illustrates
better the progressive evolution of scientific medicine. It is one of
the oldest of known diseases. The Greeks and Graeco-Romans knew it well.
It seems highly probable, as brought out by the studies of W.H.S. Jones
of Cambridge, that, in part at least, the physical degeneration in
Greece and Rome may have been due to the great increase of this disease.
Its clinical manifestations were well known and admirably described by
the older writers. In the seventeenth century, as I have already told
you, the remarkable discovery was made that the bark of the cinchona
tree was a specific. Between the date of the Countess's recovery in Lima
and the year 1880 a colossal literature on the disease had accumulated.
Literally thousands of workers had studied the various aspects of its
many problems; the literature of this country, particularly of the
Southern States, in the first half of the last century may be said to
be predominantly malarial. Ordinary observation carried on for long
centuries had done as much as was possible. In 1880, a young French army
surgeon, Laveran by name, working in Algiers, found in the microscopic
examination of the blood that there were little bodies in the red blood
corpuscles, amoeboid in character, which he believed to be the germs of
the disease. Very little attention at first was paid to his work, and it
is not surprising. It was the old story of "Wolf, wolf"; there had been
so many supposed "germs" that the profession had become suspicious.
Several years elapsed before Surgeon-General Sternberg called the
attention of the English-speaking world to Laveran's work: it was taken
up actively in Italy, and in America by Councilman, Abbott and by others
among us in Baltimore. The result of these widespread observations
was the confirmation in every respect of Laveran's discovery of the
association with malaria of a protozoan parasite. This was step
number three. Clinical observation, empirical discovery of the cure,
determination of the presence of a parasite. Two other steps followed
rapidly. Another army surgeon, Ronald Ross, working in India, influenced
by the work of Manson, proved that the disease was transmitted by
certain varieties of mosquitoes. Experiments came in to support the
studies in etiology; two of those may be quoted. Mosquitoes which had
bitten malarial patients in Italy were sent to London and there allowed
to bite Mr. Manson, son of Dr. Manson. This gentleman had not lived out
of England, where there is now no acute malaria. He had been a perfectly
healthy, strong man. In a few days following the bites of the infected
mosquitoes, he had a typical attack of malarial fever.

     (3) Journal Linnaean Society, London, 1879, XIV, 304-311.

     (4) Medical News, Philadelphia, 1889, LV, 689-693, and monograph
     with Kilborne, Washington, 1893.

The other experiment, though of a different character, is quite as
convincing. In certain regions about Rome, in the Campania, malaria is
so prevalent that, in the autumn, almost everyone in the district is
attacked, particularly if he is a newcomer. Dr. Sambon and a friend
lived in this district from June 1 to September 1, 1900. The test was
whether they could live in this exceedingly dangerous climate for
the three months without catching malaria, if they used stringent
precautions against the bites of mosquitoes. For this purpose the hut
in which they lived was thoroughly wired, and they slept under netting.
Both of these gentlemen, at the end of the period, had escaped the
disease.

Then came the fifth and final triumph--the prevention of the disease.
The anti-malarial crusade which has been preached by Sir Ronald Ross and
has been carried out successfully on a wholesale scale in Italy and in
parts of India and Africa, has reduced enormously the incidence of
the disease. Professor Celli of Rome, in his lecture room, has an
interesting chart which shows the reduction in the mortality from
malaria in Italy since the preventive measures have been adopted--the
deaths have fallen from above 28,000 in 1888 to below 2000 in 1910.
There is needed a stirring campaign against the disease throughout the
Southern States of this country.

The story of yellow fever illustrates one of the greatest practical
triumphs of scientific medicine; indeed, in view of its far-reaching
commercial consequences, it may range as one of the first achievements
of the race. Ever since the discovery of America, the disease has been
one of its great scourges, permanently endemic in the Spanish Main,
often extending to the Southern States, occasionally into the North, and
not infrequently it has crossed the Atlantic. The records of the British
Army in the West Indies show an appalling death rate, chiefly from this
disease. At Jamaica, for the twenty years ending in 1836, the average
mortality was 101 per thousand, and in certain instances as high as 178.
One of the most dreaded of all infections, the periods of epidemics in
the Southern States have been the occasions of a widespread panic with
complete paralysis of commerce. How appalling the mortality is may be
judged from the outbreak in Philadelphia in 1793, when ten thousand
people died in three months.(5) The epidemics in Spain in the early part
of the nineteenth century were of great severity. A glance through
La Roche's great book(6) on the subject soon gives one an idea of
the enormous importance of the disease in the history of the Southern
States. Havana, ever since its foundation, had been a hotbed of yellow
fever. The best minds of the profession had been attracted to a solution
of the problem, but all in vain. Commission after commission had been
appointed, with negative results; various organisms had been described
as the cause, and there were sad illustrations of the tragedy associated
with investigations undertaken without proper training or proper
technique. By the year 1900, not only had the ground been cleared,
but the work on insect-borne disease by Manson and by Ross had given
observers an important clue. It had repeatedly been suggested that
some relation existed between the bites of mosquitoes and the tropical
fevers, particularly by that remarkable student, Nott of Mobile, and
the French physician, Beauperthuy. But the first to announce clearly the
mosquito theory of the disease was Carlos Finlay of Havana. Early in the
spring of 1900, during the occupation of Cuba by the United States, a
commission appointed by Surgeon-General Sternberg (himself one of the
most energetic students of the disease) undertook fresh investigations.
Dr. Walter Reed, Professor of Bacteriology in the Army Medical School,
was placed in charge: Dr. Carroll of the United States Army, Dr.
Agramonte of Havana and Dr. Jesse W. Lazear were the other members. At
the Johns Hopkins Hospital, we were deeply interested in the work, as
Dr. Walter Reed was a favorite pupil of Professor Welch, a warm friend
of all of us, and a frequent visitor to our laboratories. Dr. Jesse
Lazear, who had been my house physician, had worked with Dr. Thayer and
myself at malaria, and gave up the charge of my clinical laboratory to
join the commission.

     (5) Matthew Carey:  A Short Account of the Malignant Fever,
     Philadelphia, 1793.

     (6) R. La Roche:  Yellow Fever, 2 vols., Philadelphia, 1855.

Many scientific discoveries have afforded brilliant illustrations of
method in research, but in the work of these men one is at a loss to
know which to admire more--the remarkable accuracy and precision of the
experiments, or the heroism of the men--officers and rank and file of
the United States Army; they knew all the time that they were playing
with death, and some of them had to pay the penalty! The demonstration
was successful--beyond peradventure--that yellow fever could be
transmitted by mosquitoes, and equally the negative proposition--that it
could not be transmitted by fomites. An interval of twelve or more days
was found to be necessary after the mosquito has bitten a yellow fever
patient before it is capable of transmitting the infection. Lazear
permitted himself to be bitten by a stray mosquito while conducting his
experiments in the yellow fever hospital. Bitten on the thirteenth, he
sickened on the eighteenth and died on the twenty-fifth of September,
but not until he had succeeded in showing in two instances that
mosquitoes could convey the infection. He added another to the long list
of members of the profession who have laid down their lives in search
of the causes of disease. Of such men as Lazear and of Myers of the
Liverpool Yellow-Fever Commission, Dutton and young Manson, may fitly be
sung from the noblest of American poems the tribute which Lowell paid to
Harvard's sons who fell in the War of Secession:

     Many in sad faith sought for her,
     Many with crossed hands sighed for her;
     But these, our brothers, fought for her,
     At life's dear peril wrought for her,
     So loved her that they died for her.

Fortunately, the commander-in-chief at the time in Cuba was General
Leonard Wood, who had been an army surgeon, and he was the first to
appreciate the importance of the discovery. The sanitation of Havana was
placed in the hands of Dr. Gorgas, and within nine months the city was
cleared of yellow fever, and, with the exception of a slight outbreak
after the withdrawal of the American troops, has since remained free
from a disease which had been its scourge for centuries. As General Wood
remarked, "Reed's discovery has resulted in the saving of more lives
annually than were lost in the Cuban War, and saves the commercial
interest of the world a greater financial loss each year than the
cost of the Cuban War. He came to Cuba at a time when one third of the
officers of my staff died of yellow fever, and we were discouraged at
the failure of our efforts to control it." Following the example of
Havana other centres were attacked, at Vera Cruz and in Brazil, with the
same success, and it is safe to say that now, thanks to the researches
of Reed and his colleagues, with proper measures, no country need fear a
paralyzing outbreak of this once dreaded disease.

The scientific researches in the last two decades of the nineteenth
century made possible the completion of the Panama Canal. The narrow
isthmus separating the two great oceans and joining the two great
continents, has borne for four centuries an evil repute as the White
Man's Grave. Silent upon a peak of Darien, stout Cortez with eagle eye
had gazed on the Pacific. As early as 1520, Saavedra proposed to cut
a canal through the Isthmus. There the first city was founded by the
conquerors of the new world, which still bears the name of Panama.
Spaniards, English and French fought along its coasts; to it the founder
of the Bank of England took his ill-fated colony; Raleigh, Drake, Morgan
the buccaneer, and scores of adventurers seeking gold, found in fever an
enemy stronger than the Spaniard. For years the plague-stricken Isthmus
was abandoned to the <DW64>s and the half-breeds, until in 1849,
stimulated by the gold fever of California, a railway was begun by
the American engineers, Totten and Trautwine, and completed in 1855,
a railway every tie of which cost the life of a man. The dream of
navigators and practical engineers was taken in hand by Ferdinand de
Lesseps in January, 1881. The story of the French Canal Company is a
tragedy unparalleled in the history of finance, and, one may add, in the
ravages of tropical disease. Yellow fever, malaria, dysentery, typhus,
carried off in nine years nearly twenty thousand employees. The
mortality frequently rose above 100, sometimes to 130, 140 and in
September, 1885, it reached the appalling figure of 176.97 per thousand
work people. This was about the maximum death rate of the British Army
in the West Indies in the nineteenth century.

When, in 1904, the United States undertook to complete the Canal,
everyone felt that the success or failure was largely a matter of
sanitary control. The necessary knowledge existed, but under the
circumstances could it be made effective? Many were doubtful.
Fortunately, there was at the time in the United States Army a man who
had already served an apprenticeship in Cuba, and to whom more than to
anyone else was due the disappearance of yellow fever from that island.
To a man, the profession in the United States felt that could Dr. Gorgas
be given full control of the sanitary affairs of the Panama Zone, the
health problem, which meant the Canal problem, could be solved.
There was at first a serious difficulty relating to the necessary
administrative control by a sanitary officer. In an interview which Dr.
Welch and I had with President Roosevelt, he keenly felt this difficulty
and promised to do his best to have it rectified. It is an open secret
that at first, as was perhaps only natural, matters did not go very
smoothly, and it took a year or more to get properly organized. Yellow
fever recurred on the Isthmus in 1904 and in the early part of 1905. It
was really a colossal task in itself to undertake the cleaning of the
city of Panama, which had been for centuries a pest-house, the mortality
in which, even after the American occupation, reached during one
month the rate of 71 per thousand living. There have been a great many
brilliant illustrations of the practical application of science in
preserving the health of a community and in saving life, but it is safe
to say that, considering the circumstances, the past history, and the
extraordinary difficulties to be overcome, the work accomplished by
the Isthmian Canal Commission is unique. The year 1905 was devoted to
organization; yellow fever was got rid of, and at the end of the year
the total mortality among the whites had fallen to 8 per thousand,
but among the blacks it was still high, 44. For three years, with a
progressively increasing staff which had risen to above 40,000, of whom
more than 12,000 were white, the death rate progressively fell.

Of the six important tropical diseases, plague, which reached the
Isthmus one year, was quickly held in check. Yellow fever, the most
dreaded of them all, never recurred. Beri-beri, which in 1906 caused
sixty-eight deaths, has gradually disappeared. The hookworm disease,
ankylostomiasis, has steadily decreased. From the very outset, malaria
has been taken as the measure of sanitary efficiency. Throughout the
French occupation it was the chief enemy to be considered, not only
because of its fatality, but on account of the prolonged incapacity
following infection. In 1906, out of every 1000 employees there were
admitted to the hospital from malaria 821; in 1907, 424; in 1908, 282;
in 1912, 110; in 1915, 51; in 1917, 14. The fatalities from the disease
have fallen from 233 in 1906 to 154 in 1907, to 73 in 1908 and to 7 in
1914. The death rate for malarial fever per 1000 population sank from
8.49 in 1906 to 0.11 in 1918. Dysentery, next to malaria the most
serious of the tropical diseases in the Zone, caused 69 deaths in 1906;
48 in 1907; in 1908, with nearly 44,000, only 16 deaths, and in 1914,
4.(*) But it is when the general figures are taken that we see the
extraordinary reduction that has taken place. Out of every 1000 engaged
in 1908 only a third of the number died that died in 1906, and half the
number that died in 1907.

     (*) Figures for recent years supplied by editors.

In 1914, the death rate from disease among white males had fallen to
3.13 per thousand. The rate among the 2674 American women and children
connected with the Commission was only 9.72 per thousand. But by far the
most gratifying reduction is among the blacks, among whom the rate from
disease had fallen to the surprisingly low figure in 1912 of 8.77 per
thousand; in 1906 it was 47 per thousand. A remarkable result is that
in 1908 the combined tropical diseases--malaria, dysentery and
beri-beri--killed fewer than the two great killing diseases of the
temperate zone, pneumonia and tuberculosis--127 in one group and 137
in the other. The whole story is expressed in two words, EFFECTIVE
ORGANIZATION, and the special value of this experiment in sanitation is
that it has been made, and made successfully, in one of the great plague
spots of the world.

Month by month a little, gray-covered pamphlet was published by Colonel
Gorgas, a "Report of the Department of Sanitation of the Isthmian Canal
Commission." I have been one of the favored to whom it has been sent
year by year, and, keenly interested as I have always been in infectious
diseases, and particularly in malaria and dysentery, I doubt if anyone
has read it more faithfully. In evidence of the extraordinary advance
made in sanitation by Gorgas, I give a random example from one of his
monthly reports (1912): In a population of more than 52,000, the death
rate from disease had fallen to 7.31 per thousand; among the whites it
was 2.80 and among the <DW52> people 8.77. Not only is the profession
indebted to Colonel Gorgas and his staff for this remarkable
demonstration, but they have offered an example of thoroughness and
efficiency which has won the admiration of the whole world. As J. B.
Bishop, secretary of the Isthmian Canal Commission, has recently said:
"The Americans arrived on the Isthmus in the full light of these two
invaluable discoveries (the insect transmission of yellow fever and
malaria). Scarcely had they begun active work when an outbreak of yellow
fever occurred which caused such a panic throughout their force that
nothing except the lack of steamship accommodation prevented the flight
of the entire body from the Isthmus. Prompt, intelligent and vigorous
application of the remedies shown to be effective by the mosquito
discoveries not only checked the progress of the pest, but banished
it forever from the Isthmus. In this way, and in this alone, was
the building of the canal made possible. The supreme credit for its
construction therefore belongs to the brave men, surgeons of the United
States Army, who by their high devotion to duty and to humanity risked
their lives in Havana in 1900-1901 to demonstrate the truth of the
mosquito theory."(7)

     (7) Bishop:  The French at Panama, Scribner's Magazine, January,
     1913, p. 42.

One disease has still a special claim upon the public in this country.
Some fourteen or fifteen years ago, in an address on the problem of
typhoid fever in the United States, I contended that the question was
no longer in the hands of the profession. In season and out of season
we had preached salvation from it in volumes which fill state reports,
public health journals and the medical periodicals. Though much has been
done, typhoid fever remains a question of grave national concern. You
lost in this state(7a) in 1911 from typhoid fever 154 lives, every one
sacrificed needlessly, every one a victim of neglect and incapacity.
Between 1200 and 1500 persons had a slow, lingering illness. A nation of
contradictions and paradoxes--a clean people, by whom personal hygiene
is carefully cultivated, but it has displayed in matters of public
sanitation a carelessness simply criminal: a sensible people, among whom
education is more widely diffused than in any other country, supinely
acquiesces in conditions often shameful beyond expression. The solution
of the problem is not very difficult. What has been done elsewhere can
be done here. It is not so much in the cities, though here too the death
rate is still high, but in the smaller towns and rural districts, in
many of which the sanitary conditions are still those of the Middle
Ages. How Galen would have turned up his nose with contempt at the
water supply of the capital of the Dominion of Canada, scourged so
disgracefully by typhoid fever of late! There is no question that the
public is awakening, but many State Boards of Health need more efficient
organization, and larger appropriations. Others are models, and it is
not for lack of example that many lag behind. The health officers should
have special training in sanitary science and special courses leading to
diplomas in public health should be given in the medical schools. Were
the health of the people made a question of public and not of party
policy, only a skilled expert could possibly be appointed as a public
health officer, not, as is now so often the case, the man with the
political pull.

     (7a) Connecticut.

It is a long and tragic story in the annals of this country. That
distinguished man, the first professor of physic in this University
in the early years of last century, Dr. Nathan Smith, in that notable
monograph on "Typhus Fever" (1824), tells how the disease had followed
him in his various migrations, from 1787, when he began to practice, all
through his career, and could he return this year, in some hundred and
forty or one hundred and fifty families of the state he would find
the same miserable tragedy which he had witnessed so often in the
same heedless sacrifice of the young on the altar of ignorance and
incapacity.




TUBERCULOSIS

IN a population of about one million, seventeen hundred persons died of
tuberculosis in this state in the year 1911--a reduction in thirty years
of nearly 50 per cent. A generation has changed completely our outlook
on one of the most terrible scourges of the race. It is simply appalling
to think of the ravages of this disease in civilized communities. Before
the discovery by Robert Koch of the bacillus, we were helpless and
hopeless; in an Oriental fatalism we accepted with folded hands a state
of affairs which use and wont had made bearable. Today, look at the
contrast! We are both helpful and hopeful. Knowing the cause of the
disease, knowing how it is distributed, better able to recognize the
early symptoms, better able to cure a very considerable portion of all
early cases, we have gradually organized an enthusiastic campaign which
is certain to lead to victory. The figures I have quoted indicate
how progressively the mortality is falling. Only, do not let us be
disappointed if this comparatively rapid fall is not steadily maintained
in the country at large. It is a long fight against a strong enemy,
and at the lowest estimate it will take several generations before
tuberculosis is placed at last, with leprosy and typhus, among the
vanquished diseases. Education, organization, cooperation--these are the
weapons of our warfare. Into details I need not enter. The work done by
the National Association under the strong guidance of its secretary, Mr.
Farrand, the pioneer studies of Trudeau and the optimism which he has
brought into the campaign, the splendid demonstration by the New York
Board of Health of what organization can do, have helped immensely in
this world-wide conflict.


SOME years ago, in an address at Edinburgh, I spoke of the triple gospel
which man has published--of his soul, of his goods, of his body. This
third gospel, the gospel of his body, which brings man into relation
with nature, has been a true evangelion, the glad tidings of the final
conquest of nature by which man has redeemed thousands of his fellow men
from sickness and from death.

If, in the memorable phrase of the Greek philosopher, Prodicus, "That
which benefits human life is God," we may see in this new gospel a link
betwixt us and the crowning race of those who eye to eye shall look on
knowledge, and in whose hand nature shall be an open book--an approach
to the glorious day of which Shelley sings so gloriously:

     Happiness
     And Science dawn though late upon the earth;
     Peace cheers the mind, health renovates the frame;
     Disease and pleasure cease to mingle here,
     Reason and passion cease to combat there,
     Whilst mind unfettered o'er the earth extends
     Its all-subduing energies, and wields
     The sceptre of a vast dominion there.

     (Daemon of the World, Pt. II.)





End of Project Gutenberg's The Evolution of Modern Medicine, by William Osler

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