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The Evolution of Modern Medicine

William Osler

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The Evolution of Modern Medicine

by William Osler

December, 1998 [Etext #1566]

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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 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

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 negroes of the Southern States. A

Hoodoo put upon a negro 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.It s

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

colored 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 colored 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 cretin. 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 homo 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 negroes 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 colored 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 he 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 The Project Gutenberg Etext of The Evolution of Modern Medicine

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