text:
Title: An Epitome of the History of Medicine
Author: Park, Roswell
*** Start of this Doctrine Publishing Corporation Digital Book "An Epitome of the History of Medicine" ***
AN EPITOME OF THE HISTORY OF MEDICINE
By Roswell Park, A.M., M.D.
Professor of Surgery in the Medical Department of the University of
Buffalo, etc.
Based Upon A Course Of Lectures Delivered In The University Of Buffalo.
Illustrated with Portraits and Other Engravings.
The F. A. Davis Company. [Registered At Stationers' Hall. London, Eng.]
"Destiny Reserves for us Repose Enough."--Fernel.
TO MY COLLEAGUES
MEDICAL FACULTY OF THE UNIVERSITY OF BUFFALO,
Who Authorized and Encouraged this First Attempt in the Medical Schools
of this Country to Give Systematic Instruction in the History or the
Science which they Teach,
Is Dedicated.
The history of medicine has been sadly neglected in our medical schools.
The valuable and fruitful lessons which it tells of _what not to do_
have been completely disregarded, and in consequence the same gross
errors have over and over been repeated. The following pages represent
an effort to bring the most important facts and events comprised within
such history into the compass of a medical curriculum, and, at the same
time, to rehearse them in such manner that the book may be useful and
acceptable to the interested layman.,--i.e., to popularize the subject.
This effort first took form in a series of lectures given in the Medical
Department of the University of Buffalo. The subject-matter of these
lectures has been rearranged, enlarged, and edited, in order to make it
more presentable for easy reading and reference. I have also tried, so
far as I could in such brief space, to indicate the relationship
which has ever existed between medicine, philosophy, natural science,
theology, and even _belles-lettres_. Particularly is the history of
medicine inseparable from a consideration of the various notions and
beliefs that have at times shaken the very foundation of Christendom and
the Church, and for reasons which appear throughout the book.
The history of medicine is really a history of human error and of human
discovery. During the past two thousand years it is hard to say which
has prevailed. Notwithstanding, had it not been for the latter the total
of the former would have been vastly greater. A large part of my effort
has been devoted to considering the causes which conspired to prevent
the more rapid development of our art. If among these the frowning or
forbidding attitude of the Church figures most prominently, it must not
be regarded as any expression of a quarrel with the Church of to-day.
But let any one interested read President White's _History of the
Warfare of Science with Theology_, the best presentation of the subject,
and he can take no issue with my statements.
Reverence for the true, the beautiful, and the good has characterized
physicians in all times and climes. But little of the true, the
beautiful, or the good crept into the transactions of the Church for
many centuries, and we suffer, to-day, more from its interference in
time past than from all other causes combined. The same may be said of
theology, which is as separate from religion as darkness from light.
Only when students of science emancipated themselves from the prejudices
and superstitions of the theologians did medicine make more than barely
perceptible progress.
In this connection I would like to quote a paragraph from an article
by King, in the _Nineteenth Century_ for 1893: "The difficulties under
which medical science labored may be estimated from the fact that
dissection was forbidden by the clergy of the Middle Ages on the ground
that it was impious to mutilate a form made in the image of God. We
do not find this pious objection interfering with such mutilation when
effected by means of the rack and wheel and such other clerical, rather
than medical, instruments."
Written history is, to a certain extent at least, plagiarism; and I make
no apology for having borrowed my facts from whatever source could
best furnish them, but wish cheerfully and publicly to acknowledge my
indebtedness to the works mentioned below, those especially of Renouard,
Baas, and Sprengel, and to various biographical dictionaries. I have
not even scrupled to take bodily sentences or expressions from these
authorities, but have tried to so indicate them when I could.
The writer takes pleasure in acknowledging here the obligations which
both he and the publishers feel to Dr. Joseph H. Hunt, of Brooklyn, N.
Y., from whose extensive and valuable collection have been furnished the
originals for most of the portraits in the following pages, and to
Dr. F. P. Henry, Honorary Librarian of the College of Physicians of
Philadelphia, through whose courtesy was obtained the privilege of
reproducing the illustrations of instruments and operations from some
of the rare old works in the college library. The kind co-operation of
these gentlemen has given a distinct and added value to the contents of
this little work.
LIST OF PRINCIPAL WORKS CONSULTED.
Baas, Outlines of the History of Medicine. Translated by Henderson. New
York, 1889.
Berdoe, Origin and Growth of the Heeding Art. London, 1893.
Bouchut, Histoire de la Médecine. Paris, 1873.
Dezeimeris, Lettres sur VHistoire de la Médecine. Paris, 1838.
Dietionnaire Historique de la Médecine. Paris, 1828.
Haeser, Geschiehte der Medicin. Jena, 1853.
Hirsch, Biographisehes Lexikon des Hervorragendeu der Aerzte aller
Zeiten und Vülker. Wien und Leipzig, 1884.
Portal, Histoire de VAnatomie et de la Chirurgie. Paris, 1770.
South, Memorials of the Craft of Surgery in England. London, 1886.
Sprexgel, Geschicute der Chirurgie. Halle, 1819.
CHAP I.
Medicine Among the Hebrews, the Egyptians, the Orientals, the Chinese,
and the Early Greeks.--The Asclepiadæ.--Further Arrangement into Periods
(Renouard's Classification). The Age of Foundation.--The Primitive;
Sacred, or Mystic; and Philosophic Periods.--Systems in
Vogue: Dogmatism, Methodism, Empiricism,
Eclecticism.--Hippocrates...................................... 1-29
CHAP II.
AGE OF Foundation (continued).--Anatomic Period: Influence of the
Alexandrian Library. Herophilus and Erasistratus. Aretæus. Cel-sus.
Galen.--Empiricism: Asclepiades.--Methodism: Theinison.--Eclecticism.
Age of Transition.--Greek Period: Oribasins. Ætius. Alexander of
Tralles. Paulus Ægineta............ 30-56
CHAP III.
Age of Transition (continued).--Arabic Period: Alkindus. Mesue.
Rhazes. Haly-Abbas. Avicenna. Albucassis. Avenzoar. Averroës.
Maimonides.--School of Salernum: Constantinus Africanus. Roger
of Salerno. Roland of Parma. The Four Masters. John of
Procida................................................. 57-85
CHAP IV
Age of Transition ( concluded).--The School of Montpellier: Raimond
Lulli. John of Gaddesden. Arnold of Villanova. Establishment of Various
Universities. Gerard of Cremona. William of Salicet. Lanfranc. Mondino.
Guy de Chauliac. Age of Renovation.--Erudite Period, including the
Fifteenth and Sixteenth Centuries. Thomas Linacre. Sylvius. Vesalius.
Columbus. Eustaclius. Fallopius. Fabricius ab Aquapendente. Fabricius
Hildanus.. 86-113
CHAP V.
Age of Renovation (continued).--Erudite Period (continued): Beni-vieni.
Jean Fern el. Porta. Severino. Incorporation of Brother-hood of St. Come
into the University of Paris. Ambroise Paré. Guillemeau. Influence
of the Occult Sciences: Agrippa. Jerome Cardan. Paracelsus. Botal.
Joubert...................... 114-147
CHAP VI.
Age of Renovation (continued).--Stndent-life During the Fifteenth
and Sixteenth Centuries. Ceremonials Previous to Dissection.--Reform
Period: The Seventeenth, Eighteenth, and Nineteenth Centuries. Modern
Realism in Medicine and Science. Introduction of the Cell-doctrine.
Discovery of the Circulation. William Harvey. Malpighi. Leuwenhoek.
Correct-Doctrine of Respiration. Discovery of the Lymphatic Circulation.
The Nervous System. Discovery of Cinchona. Development in Obstetric
Art, in Medical Jurisprudence, and in Oral Clinical Teaching. Van
Helmont.--The Iatrochemical System: Le Bôe. Thomas Willis... 148-170
CHAP VII.
Age of Renovation (continued).--latromechanical School: Santoro.
Borelli. Sydenham. Sir Thomas Browne.--Surgery: Denis. F. Collot.
Dionis. Baulot (Frère Jacques). Scultetus. Rau. Wiseman. Cowper. Sir C.
Wren the Discoverer of Hypodermatic Medication. Anatomical Discoveries.
General Condition of the Profession During the Seventeenth Century.
The Eighteenth Century. Boerliaave. Gaub.--Animism:
Stahl.--Jlechanico-dynamic System: Hoffmann. Cullen.--Old Vienna
School: Van Swieten. De Haën.--Vitalism: Bordeu. Erasmus Darwin
.................171-202
CHAP VIII.
Age of Renovation (continued).--Animal Magnetism: Mesmer. Braid.
--Brunonianism: John Brown.--Realism: Pinel. Bichat. Avenbrugger.
Werlliof. Frank.--Surgery: Petit. Desault. Scarpa. Gimbernat. Heister.
Von Siebold. Richter. Cheselden. Monro (1st). Pott. John Hunter. B.
Bell, J. Bell, C. Bell. Smellie. Denman.--Revival of Experimental Study:
Haller. Winslow. Portal. Yieq d'Azvr. Morgagni.--Inoculation against
Smallpox: Lady Montagu. Edward Jenner.............................
CHAP IX.
Age of Renovation (continued).--The Eighteenth Century; General
Considerations. Foundation of Learned Societies, etc. The Royal College
of Surgeons; the Josephinum.--The Nineteenth Century Realistie Reaction
Against Previous Idealism. Influence of Comte, of Claude Bernard,
and of Charles Darwin. Influence Exerted by Other Sciences.--Theory
of Excitement: Roeschlaub.--Stimolo and Contrastimolo:
Kasori.--Homoeopathy: Halineiaim.--Isopatly, Electrohomoeopathy
of Mattei.--Cranioscopy, or Phrenology: Gall and Spurzlieim.--The
Physiological Theory: Broussais.--Paris Pathological School:
Cruveillier. Andral. Louis. Magendie. Trousseau. Claude
Bernard.--British Medicine: Bell and Hall. Travel's.--Germany, School
of Natural Philosophy: Johannes Müller.--School of Natural
History: Schonlein.--New Vienna School: Rokitansky.
Skoda.................................... 230-252
CHAP X.
Age of Transition (concluded).--New Vienna School (concluded): von
Hebra. Czermak and Türck. Juger. Arlt. Gruber. Politzer.--German
School of Physiological Medicine: Roser.--School of Rational
Medicine: Henle.--Pseudoparacelsism: Rademaeher.--Hydrotherapeutics:
Priessnitz.--Modern Vitalism: Virchow.--Seminalism: Bouchut.--Parasitism
and the Germ-theory: Davaine. Pasteur. Chauveau. Klebs. F. J.
Cohn. Koch. Lister.--Advances in Physical Diagnosis: Laënnec.
Piorry.--Surgery: Delpecli. Stro-meyer. Sims. Bozeman. McDowell. Boyer.
Larrey. Dupuytren. Cloquet. Civiale. Vidal. Velpeau. Malgaigne.
Nélaton. Sir Astley Cooper. Brodie. Guthrie. Syme. Simpson. Langenbeck.
Billroth.................................................. 253-275
CHAP XI.
History of Medicine in America.--The Colonial Physicians. Medical Study
under Preceptors. Inoculation against Small-pox. Military Surgery During
the Revolutionary War. Earliest Medical Teaching and Teachers in this
Country. The First Medical Schools. Benjamin Rush. The First Medical
Journals. Brief List of the Best-Known American Physicians and
Surgeons.... 276-299
CHAP XII.
The History of Anæsthesia.--Anæsthesia and Analgesia. Drugs Possessing
Narcotic Properties in use since Prehistoric Times. Mandragora; Hemp;
Hasheesh. Sulphuric Ether and the Men Concerned in its Introduction as
an Anæsthetic--Long, Jackson, Wells, and Morton. Morton's First Public
Demonstration of the Value of Ether. Morton Entitled to the Credit of
its Introduction. Chloroform and Sir Janies Simpson. Cocaine and Karl
Koller.............................................. 300-315
CHAP XIII.
The History of Antisepsis.--Sepsis, Asepsis, and Antisepsis. The
Germ-theory of Disease. Gay-Lussac's Researches. Schwann. Tyndall.
Pasteur. Davaine. Lord Lister and his Epoch-making Revolution in
Surgical Methods. Modifications of his Earlier Technique without Change
in Underlying Principles, which Still Remain Unshaken. Changes Effected
in Consequence. Comparison of Old and Modern Statistics...........
CHAP XIV.
Ax Epitome of the History of Dentistry.--Rude Dentistry of Prehistoric
Times. Early Instruments for Extraction Made of Lead. Dentistry on the
Same Low Plane as Medicine During the First. Half of the Christian Era.
Dentistry Taught at the School of Salernum. Progress of the Art on the
Continent. Prosthesis and Substitutes for Human Teeth. Introduction of
Porcelain for Artificial Teeth; of Metal and of Vulcanized Rubber for
Plates; of Plaster for Impressions. From being a Trade, Dentistry is now
a Profession, in which Americans lead the World. Statistics... 330-341
LIST OF ILLUSTRATIONS.
1. Æsculapius,..................................007
2. Offering to Æsculapius,......................009
3. Hippocrates,.................................019
4. Aulus Cornelius Celsus,......................035
5. The Conversion of Galen,.....................037
6. Averroës,....................................064
7. Andreas Vesalius,............................105
8. Title-page, Seven Books of the Anatomy,......106
9. IV, Forceps for Extracting Balls.............108
10. Gabriel Fallopius,..........................109
11. Forms of Forceps for Enlarging Wounds,......111
12. Body Showing Various Kinds of Wounds,.......117
13. Mode of Extracting Leaden Bullets,..........121
14. Ambroise Parc,..............................124
15. Pliers, Iron for Actual Cautery,............126
16. Swan's Beak, Used for Dilating..............129
17. Instruments for the Extraction of Balls,....131
18. Spéculums for the Mouth and Womb, etc.,.....133
19. Amputation Instruments,.....................135
20. Different Forms of Trephines and Pliers,....137
21. Philip Theophrastus Paracelsus,.............143
22. William Harvey, M.D.,.......................156
23. Thomas Sydenham,............................173
24. Straight Saws and Divers Scraping Tools,....179
25. Surgical Treatment of Dislocations,.........181
26. Operations on the Arms and Lower Limbs,.....185
27. Surgical Operations on the Breast, etc.,....187
28. Boerhaave,..................................193
29. John Brown, M.D.,...........................205
30. Ph. Pinel,..................................207
31. Marie François Xavier Bicliat, M.D.,........208
32. William Hunter, M.D., F.R.S.,...............217
33. John Hunter,................................219
34. J. F. Blumenbacli,..........................223
35. Edward Jenner, M.D.,........................227
36. Samuel Hahnemann,...........................242
37. Rudolph Virchow,............................257
38. Bernhard von Langenbeck,....................265
39. Theodor Billroth,...........................266
40. Sir Astley Cooper, Bart.,...................272
41. Sir Benjamin Collins Brodie, F.R.S.,........273
42. B. Waterhouse, M.D.,........................280
43. Surgeon's Hall,.............................281
44. Benjamin Rush, M.D.,........................284
45. George B. Wood, M.D.,.......................286
46. Robley Dunglison, M.D.,.....................287
47. Austin Flint, M.D.,.........................288
48. Isaac Ray, M.D.,............................289
49. Philip Sung Physick, M.D.,..................291
50. Ephraim McDowell, M.D.,.....................292
51. S. D. Gross, M.D., LL.D.,...................294
52. J. Marion Sims, M.D.,.......................296
53. D. Hayes Agnew, M.D., LL.D.,................297
54. William T. G. Morton, M.D.,.................307
55. Dr. Morton, October 16, 1846,...............309
56. Lord Lister, M.D., D.C.L., LL.D.,...........323
AN EPITOME OF THE HISTORY OF MEDICINE.
CHAPTER I.
_Medicine Among the Hebrews, the Egyptians, the Orientals, the Chinese,
( Renouard's Classification). The Age of Foundation.--The Primitive;
Sacred, or Mystic; and Philosophic Periods.--Systems in Vogue:
Dogmatism, Methodism, Empiricism, Eclecticism.--Hippocrates, born 460
B.C._
Of the{001} origin of medicine but little need be said by way of
preface, save that it must have been nearly contemporaneous with
the origin of civilization. The lower animals when sick or wounded
instinctively lessen or alter their diet, seek seclusion and rest,
and even in certain cases seek out some particular herb or healing
substance. Thus, too, does the savage in his primitive state; and
experience and superstition together have led nearly all the savage
tribes into certain habits and forms in case of injury or disease.
For us the history of medicine must necessarily begin with the written
history of events, and its earliest endeavors need detain us but a very
short time. Its earliest period is enveloped in profound obscurity, and
so mingled with myth and table as to be very uncertain. It embraces
an indefinite time, during which medicine was not a science, but an
undigested collection of experimental notions,--vaguely described,
disfigured by tradition, and often made inutile by superstition and
ignorance. The earliest records of probable authenticity are perhaps to
be met with in the Scriptures, from which may be gathered here and there
a fair notion of Egyptian knowledge and practice. Thus we read that
Joseph commanded his servants and physicians to embalm him, this being
about 1700 B.C.. It shows that Egypt at that time possessed a class of
men who practiced the{002} healing art, and that they also embalmed
the dead, which must have both required and furnished a crude idea
of general anatomy. We are also informed from other sources that so
superstitious were the Egyptians that they not only scoffed at, but
would stone, the embalmers, for whom they had sent, after the completion
of their task. The probably mythical being whom the Egyptians called
Thoth, whom the Greeks named Hermes and the Latins Mercury, passed
among the Egyptians as the inventor of all sciences and arts. To him are
attributed an enormous number of writings concerning all subjects. Some
have considered him as identical with Bacchus, Zoroaster, Osiris, Isis,
Serapis, Apollo, and even Shem, the son of Xoah. Others have thought
him to be a god. It is now almost certain that the books attributed to
Hermes were not the work of anyone hand or of any one age. The-last six
volumes of the forty-two composing the encyclopaedia, with which Hermes
is credited, refer to medicine, and embrace a body of doctrines fairly
complete and well arranged. Of these six, the first treats of anatomy;
the second, of diseases; the third, of instruments; the fourth, of
remedies; the fifth, of diseases of the eye; and the sixth, of diseases
of women. In completeness and arrangement it rivals, if not surpasses,
the Hippocratic collection, which it antedated by perhaps a thousand
years. The Egyptians appear at first to have exposed their sick in
public (at least, so says Strabo), so that if any of those who passed by
had been similarly attacked they might give their advice for the benefit
of the sufferers. In fact, according to Herodotus, the same custom
prevailed among the Babylonians and Lusitanians. At a later date all who
were thus cured were required to go to the temples and there inscribe
their symptoms and what had helped them. The temples of Canopus and
Vulcan at Memphis became the principal depots for these records, which
were kept as carefully as were the archives of the nation, and were open
for{003} public reference. These records, being under the control of the
priests, were mainly studied by them, who later collected a great mass
of facts of more or less importance, and endeavored to found upon the
knowledge thus collected an exclusive practice of the art of medicine.
In this way they formed their medical code, which was called by Diodorus
the Hiera Sacra, _Sacred Book_, from whose directions they were never
allowed to swerve. It was perhaps this code which was later attributed
to Hermes, and that made up the collection spoken of by Clement of
Alexandria. If in following these rules they could not save their
patients they were held blameless, but were punished with death if any
departure from them were not followed by success.
I have spoken of embalming as practiced by the Egyptians. It was of
three grades: the first reserved for men of position and means, which
cost one talent, and according to which the brain was removed by an
opening through the nasal fossæ, and the intestines through an opening
on the left side of the abdomen, after which both cavities were stuffed
with spices and aromatics; then the body was washed and spread over with
gum and wrapped in bandages of linen. The second grade was adopted by
families of moderate means; and the third was resorted to by the poor,
consisting simply in the washing of the body and maceration in lye for
seventy days.
Pliny assures us that the kings of Egypt permitted the opening of
corpses for the purpose of discovering the causes of disease, but this
was only permitted by the Ptolemies, under whose reign anatomy was
carried to a very high degree of cultivation.
The medicine of the Hebrews is known generally through the Sacred
Scriptures, especially through the writings attributed to Moses, which
embraced rules of the highest sagacity, especially in public hygiene.
The book of Leviticus{004} is largely made up of rules concerning
matters of public health. In the eleventh chapter, for instance, meat
of the rabbit and the hog is proscribed, as apparently injurious in the
climate of Egypt and India; it, however, has been suggested that there
was such variation of names or interpretation thereof as to make it
possible that our rabbit and hog are not the animals alluded to by
Moses. The twelfth and fifteenth chapters of the same book were designed
to regulate the relation of man and wife and the purification of women,
their outlines being still observed in some localities by certain sects,
while the hygienic measure of circumcision then insisted upon is still
observed as a religious rite among the descendants of Moses. For the
prevention of the spread of leprosy, the measures suggested by Moses
could not now be surpassed, although ancient authors have confounded
under this name divers affections, probably including syphilis, to
which, however, the same hygienic rules should apply. Next to Moses in
medical lore should be mentioned Solomon, to whom is attributed a very
high degree of knowledge of natural history, and who, Josephus claimed,
had such perfect knowledge of the properties of all the productions
of nature that he availed himself of it to compound remedies extremely
useful, some of which had even the virtues necessary to cast out devils.
The most conspicuous feature in the life of the Indian races is their
division into castes, of which the most noble is that of the priests,
or Brahmins, who in ancient times alone had the privilege of practicing
medicine. Their Organon of Medicine, or collection of medical knowledge,
was a hook which they called _Vagadasastir_. It was not systematically
arranged, and in it demonology played a large rôle. They held the human
body to consist of 100,000 parts, of which 17,000 were vessels, each one
of which was composed of seven tubes, giving passage to ten species of
gases, which by their conflicts engendered a number of diseases.{005}
They placed the origin of the pulse in a reservoir located behind the
umbilicus. This was four fingers wide by two long, and divided into
72,000 canals, distributed to all parts of the body. The physician
examined not only the pulse of his patient, but the dejecta, consulted
the stars, the flight of birds, noted any incidental occurrence during
his visits, and made up his prognosis from a multitude of varying
circumstances, omitting only those which were really valuable, namely,
the symptoms indicating the state of the organs. Ancient Hindoo
charlatan priests let fall from the end of a straw a drop of oil into
the patient's water. If the oil was precipitated and attached itself to
the bottom of the vessel, they predicted an unfavorable result; if, on
the contrary, it floated, they gave a favorable prognosis. This is,
so far as we know, the earliest recorded way of testing the specific
gravity of the urine.
With all their absurdities, however, the Indians appear to have done
some things that we scarcely do to-day: they arè said to have had an
ointment that caused the cicatrices of variola to disappear, and they
cured the bites of venomous serpents with remedies whose composition has
been lost.
The antiquity of the Chinese is simply lost in tradition and fable. From
time immemorial their rulers have taken extraordinary care to prevent
contact and interchange of ideas with foreigners. For 4000 years their
manners, laws, religious beliefs, language, and territory have scarcely
changed. In this respect they stand alone among the nations of the
earth. They attribute the invention of medicine to one of their emperors
named Hoam-ti, who was the third of the first dynasty, and whose
supposititious date is 2687 B.C. He is considered to be the author of
the work which still serves them as a medical guide. It is, however,
more probably an apochryphal book. Its philosophy was of a sphygmic
kind,--i.e., based upon the pulse, which they divided{006} into the
supreme or celestial, the middle, and the inferior or terrestrial; by
the examination of which the Chinese physician was supposed not only to
show the seat of disease, but to judge of its duration and gravity. It
is related that one of the ancient Chinese emperors directed the dead
bodies of criminals to be opened, but this is questionable, since it
is certain that they have the most profound ignorance of rudimentary
anatomy, and glaring errors abound in their system. Being thus replete
with errors, and possessing no anatomical knowledge, their surgery was
of the most barbarous type. No one dared attempt a bloody operation; the
reduction of hernia was unknown; a cataract was regarded as beyond their
resources; and even venesection was never practiced. On the other hand,
they employed cups, and acupuncture, fomentation, plasters of all kinds,
lotions, and baths. The moxa, or red-hot button, was in constant use,
and they had their magnetizers, who appear to have been convulsionists.
For a long time there existed at Pekin an Imperial School of Medicine,
but now there is no such organization nor any regulation for the
privilege of practicing medicine or surgery since 1792. At least until
lately the country and the cities were infested with quacks, who dealt
out poison and death with impunity. They practiced most murderous
methods in place of the principles of midwifery. Only since the
civilized missionaries have penetrated into their country has there been
any improvement in this condition of affairs.
It is Greece which furnishes us with the most interesting and the most
significant remains of the history of medicine during antiquity, as she
furnishes every other art with the same historical advantages. During
the period preceding the Trojan War there is little hut myth and
tradition. Leclerc catalogued some thirty divinities, heroes or
heroines, who were supposed to have invented or cultivated some of the
branches of medicine. _Melampus_ is perhaps{007} the first of these who
immortalized himself by extraordinary cures, especially on the daughters
of Proetus, King of Argos. These young princesses, having taken vows
of celibacy, became subjects of hysterical monomania, with delusions,
during which they imagined themselves transformed into cows and roamed
the forests instead of the palaces. This nervous delusion spread to and
involved many other women, and became a serious matter.
[Illustration: 0027]
Melampus, the shepherd, having observed the purgative effects upon goats
of white hellebore, gave to the young women milk in which this plant
had been steeped, thereby speedily effecting a cure. Scarcely less
distinguished than Melampus was _Chiron_. He was mainly distinguished
because he was the preceptor of _Æsculapius_, the most eminent of early
Greeks in this field. By some Æsculapius was considered the son of
Apollo by the nymph Coronis.
Several{008} cities of Greece contended for the honor of his birthplace,
as they did for that of Homer. That he was famous at the time of the
Argonautic expedition is seen by the fact that the twins Castor and
Pollux desired him to accompany the expedition as surgeon. Be his origin
what it may, Æsculapius was the leading character in medicine of all the
ancients, with the possible exception of Hermes among the Egyptians; in
fact, some scholars consider the two identical. Temples were erected in
his honor, priests were consecrated to them, and schools of instruction
were there established. It is related that Pluto, god of hell, alarmed
at the diminishing number of his daily arrivals, complained to Jupiter,
who destroyed the audacious healer--on which account, some wit has said,
"the modern children of Æsculapius abstain from performing prodigies,"
But the true Æsculapians, the successors of the demigod, wrere imitated
or copied by the crowd of charlatans and quacks, calling themselves
theosophs, thaumaturgs, and so on, and not alone at that date, but for
generations and centuries thereafter, Paracelsus and Mesmer being
fair examples of this class. The poet Pindar, who lived seven or eight
hundred years after Æsculapius, says that he cured ulcers, wounds,
fever, and pain of all who applied to him by enchantment, potions,
incisions, and by external applications. *
*  Third Pythian Ode,
The followers of Æsculapius, and the priests in the temples dedicated to
him, soon formed a separate caste, transmitting from one to another, as
a family heritage, their medical knowledge. At first no one was admitted
to practice the sacred science unless lie joined the priesthood,
although later this secrecy was relaxed. They initiated strangers,
provided they fulfilled the test which they made. Some kind of medical
instruction was given in each temple. The three most celebrated temples
to Æsculapius were that of Rhodes, already extinct by the time of
Hippocrates; that{009} of Cnidus, which published a small repertory; and
finally that of Cos, most celebrated of all, because of the illustrious
men who emanated from this school. In these temples votive tablets were
fastened in large numbers, after the fashion of the Egyptians, the same
giving the name of the patient, his affliction, and the manner of
his cure. For example, such a one as this: "Julien vomited blood,
and appeared lost beyond recovery. The oracle ordered him to take the
pine-seeds from the altar, which they had three days mingled with honey;
he did so, and was cured."
Having solemnly thanked the god, he went away. There is reason to think
that the priests of these temples made for their own uses much more
minute and accurate accounts, which should be of some real service,
since the writings which have come down to us evince a habit of close
observation and clear description of disease. During the Trojan War{010}
two men are frequently mentioned by Homer as possessing great surgical
skill. These were _Machaon_ and _Podalirius_. They were regarded as
sons of Æsculapius, the former being the elder. The first account of
venesection, although not authentic, refers to the bleeding practiced
by the latter upon the daughter of the King of Caria, upon whose shores
Podalirius was cast by tempest after the ruin of Priam's kingdom.
Whether he was the first of all men to practice it or not, it is
certain that the act of venesection goes back long prior to the era of
Hippocrates, who speaks of it as frequently performed.
Many of the deities upon Olympus seem at one time or another to have
usurped medical functions. Apollo, the reputed father of Æsculapius,
appropriated nearly everything under the name of Pæon, who assumed
the privilege of exciting or subduing epidemics. Juno was supposed
to preside at accouchements, and in both the Iliad and Odyssey it is
indicated that Apollo was considered as the cause of all the natural
deaths among men, and Diana of those among women.
The long Trojan War appears to have been an epoch-making event in
the medical and surgical history of those times, as was the Civil War
recently in our country. Certain vague and indefinite practices then
took more fixed form, and from that time on medicine may be said to have
been furnished with a history. After the dethronement of Priam and the
destruction of his capital, navigation was free and unrestricted. The
Hellenists covered with their colonies both shores of the Mediterranean,
and their navigators even passed the pillars of Hercules. By these means
the worship of Æsculapius passed from Greece into what is now Asia,
Africa, and Italy. In his temple at Epidaurus was a statue of colossal
size made of gold and ivory. The dialogues of Plato, especially the
Phædo, make it apparent that the cock was the animal sacrificed to him,
and hence sacred to the god of medicine. The priests attached to{011}
his worship were called _Asclepiacloe_, or descendants of Æsculapius.
The temples were usually hygienically located near thermal springs or
fountains and among groves. Pilgrimages were made from all quarters,
and these localities became veritable health-resorts. A well-regulated
dietary, pure air, temperate habits, and faith stimulated to a fanatical
degree combined and sufficed for cures which even nowadays would be
regarded as wonderful. The priests prescribed venesection, purgatives,
emetics, friction, sea-baths, and mineral waters, as they appeared to
be indicated. The imagination of the patient was continually stimulated,
and at the same time controlled. Before interrogating the oracles they
must be purified by abstinence, prayer, and sacrifice. Sometimes they
were obliged to lie in the temple for one or more nights. The gods
sometimes revealed themselves in mysterious ways, at times devouring
the cakes upon the altars under the guise of a serpent, or again causing
dreams which were to be interpreted by^the priests. There can be no
doubt that sometimes, at least, the grossest frauds and the basest
trickery were relied upon for the purpose of impressing the minds
of those weakened by abstinence or influenced by drugs. Mercenary
considerations were not lacking; moreover, cures were often not obtained
until zeal had been redoubled by largely increased contributions to the
treasury of the temples. In the neighborhood of many of these temples
serpents abounded, non-venomous and easily tamed. These were employed by
the priests in various supernatural performances by which the ignorant
people were astonished and profoundly impressed. In fact, the serpent
and the serpent-myth played a very large rôle in the early history of
medicine as well as that of religion and religious symbolism.
It will thus be seen that during the space of about 700 years medicine
underwent a transformation in Greece. It was first domestic and
popular, practiced by shepherds, soldiers,{012} and others; then became
sacerdotal; after the Trojan War it was confined to the vicinity of the
temples and practiced in the name of some divinity; and finally it was
wrapped in mystery and mystic symbolism, where superstition was
played upon and credulity made to pay its reward. Down to the time of
Hippocrates the Asclep-iadæ rendered some genuine service to science,
especially by inculcating habits of observation, in which Hippocrates
excelled above all. Later, however, down to the time of the Christian
era, medicine in the temples declined, and became, in fact, a system
based upon the grossest jugglery.
It is time now that we make a systematic attempt to classify events in
the history of medicine, and to recognize certain distinct epochs as
they have occurred. For this purpose I know of no better arrangement
than that of Renouard, which, in the main, I shall follow, at least
during the forepart of this book. In this sense he divides the past into
three ages, known, respectively, as the _Age of Foundation, the Age
of Transition, and the Age of Renovation_. Each of these chronological
divisions is subdivided into periods, of which the first contains
four:--
AGE OF FOUNDATION.
1. The _Primitive Period_, or that of _Instinct_, beginning with myth,
and ending with the destruction of Troy 1184 years before Christ.
2. The _Sacred, or Mystic, Period_, ending with the dispersion of the
Pythagorean Society, 500 years before Christ.
3. The _Philosophic Period_, terminating with the foundation of the
Alexandrian library, 320 years before Christ.
4. The _Anatomic Period_, ending with the death of Galen, about A.D.
THE SECOND AGE, OR THAT OF TRANSITION, is divided into a fifth, or
_Greek Period_, ending at the burning of the Alexandrian library, A.D.
640, and a sixth, _Arabic Period_, ending with the revival of letters,
A.D. 1400.
THE THIRD AGE, OR THAT OF RENOVATION,{013} includes the seventh, or
_Erudite Period_, comprising the fifteenth and sixteenth centuries, and
eighth, or _Reform Period_, comprising the seventeenth, eighteenth, and
nineteenth centuries.
Examining this table for a moment, it will be seen that so far we have
dealt with the Primitive Period and the Sacred, or Mystic, Period.
Before passing on to the Philosophic Period let us for a moment follow
Renouard, who likens the three schools of medical belief in the earlier
part of the Primary Age, or the Age of Foundation, to the three schools
of cosmogony, which obtained among the Greeks. The first of these
was headed by Pythagoras, who regarded the universe as inhabited by
acknowledged sentient principles which governed all substances in a
determined way for preconceived purposes. Animals, plants, and even
minerals were supposed to possess vivifying spirits, and above them
all was a supreme principle. To this school corresponded the so-called
Dogmatic School of medicine, attributed to Hippocrates, which was the
precursor of modern vitalism, and regarded diseases as indivisible
units from beginning to termination; in other words, they consisted of a
regular programme of characteristic systems, successive periods, and
of long course, either for the better or worse; that was one of the
characteristic dogmas of the Hippocratic teaching. The Second System of
cosmogony was that founded by Leucippus and Democritus, who explained
all natural phenomena without recourse to the intervention of
intelligent principles. All things for them existed as the necessary
result of the eternal laws of matter. They denied preconceived purposes
and ridiculed final causes. To this system corresponded that in medicine
which has been termed _Methodism_ (medically and literally speaking) and
which recognized as its founders Æsculapius and Themison. The believers
in this doctrine attempted to apply the atomic theory of Democritus
and{014} Epicurus to the theory and practice of medicine. Atoms of
various size were supposed to pass and repass without cessation through
cavities or pores in the human body. So long as the atoms and pores
maintained a normal relationship of size and proportion health was
maintained, but it was deranged so soon as the exactness of these
relations was destroyed or interfered with. The Dogmatists considered
vital reaction as a primary phenomenon, while with the Methodists it
was secondary. The Third System of cosmogony, founded by Parmenides and
Pyrrho, believed in the natural improvement of bodies in their endless
reproduction and change, and concluded that wisdom consisted in
remaining in doubt; in other words, they were the agnostics of that day.
"What is the use," said they, "of fatiguing the mind in endeavoring to
comprehend what is beyond its capability." Later they were known as
Skeptics and Zetetics, to indicate that they were always in search of
truth without flattering them selves that they had found it. To them
corresponded a third class of physicians, with Philinus and Serapis at
their head, who deemed that proximate causes and primitive phenomena of
disease were inaccessible to observation; that all that is affirmed
on these subjects is purely hypothetical, and hence unworthy of
consideration in choosing treatment. For them objective symptoms--or,
as we would say, signs--constituted the natural history of disease,
they thus believing that their remedies could only be suggested by
experience, since nothing else could reveal itself to them. They
therefore took the name of _Empirics_.
Finally a fourth class of physicians arose who would not adopt any one
of these systems exclusively, but chose from each what seemed to them
most reasonable and satisfactory. They called themselves _Eclectics_,
wishing thereby to imply that they made rational choice of what seemed
best. The idea conveyed in the term "eclecticism" has been fairly
criticised for this reason: eclecticism is in reality neither{015} a
system nor a theory; it is individual pretension elevated to the dignity
of dogma. The true eclectic recognizes no other rule than his particular
taste, reason, or fancy, and two or more eclectics have little or
nothing in common. If that were true two thousand years ago, it is not
much less so to-day. The eclectic carefully avoids the discussion of
principles, and has neither taste nor capacity for abstract reasoning,
although he may be a good practitioner; not that he has no ideas, but
that his ideas form no working system. With him medical tact--i.e.,
cultivated instinct--replaces principle.
The eclectic of our day, however, is only an empiric in disguise,--that
is, a man whose opinions are based on comparison of observed facts, but
whose theoretical ideas do not go beyond phenomena.
In older days philosophy embraced the whole of human knowledge, and
the philosopher was not permitted to be unacquainted with any of its
branches. Now physics, metaphysics, natural history, etc., are arranged
into separate sciences, and the sum-total of knowledge is too great to
be compassed by any one man.
Pythagoras was the last of the Greek sages who made use of hieroglyphic
writings and transmitted his doctrine in ancient language. Born at
Samos, he was, first of all, an athlete; but one day, hearing a lecture
no immortality of the soul, he was thereby so strongly attracted to
philosophy that he renounced all other occupation to devote himself to
it. He studied arduously in Egypt, in Phoenicia, in Chaldea, and even,
it is said, in India, where he was initiated into the secrets of
the Brahmins and Magi. Finally, returning to his own country, he
was received by the tyrant Polycrates, but not made to feel at home.
Starting on his travels again, he assisted at one of the Olympic games,
and, being recognized, was warmly greeted. He sailed to the south of
Italy, landed at Crotona, and lodged with Milo, the athlete. Commencing
here{016} his lectures, he soon gathered around him a great number of
disciples, of whom he required a very severe novitiate, lasting even
five or six years, during which they had to abstain almost entirely
from conversation, and live upon a very frugal diet. Those only who
persevered were initiated later into the mysteries of the order. His
disciples had for him most profound veneration, and were accustomed
to decide all disputes witlr: "The master has said it." Pythagoras
possessed immense knowledge; he invented the theorem of the square
of the hypothenuse, and he first divided the year into 365 days and 6
hours. He seems to have suspected the movements of our planetary system.
He traveled from place to place, and founded schools and communities
wherever he went, which exercised, at least at first, only the happiest
influence; but the success and influence which their learning gave them
later made his disciples bold, and then dishonest, and his communities
were finally dispersed by angry mobs, which forced their members to
conceal or expatriate themselves; and so, even during the life-time
of its founder, the Pythagorean Society was destroyed, and never
reconstructed.
With Pythagoras and his disciples numbers played a very important
rôle, and the so-called language of numbers was first taught by him.
He considered the unit as the essential principle of all things, and
designated God by the figure 1 and matter by the figure 2, and then he
expressed the universe by 12, as representing the juxtaposition of 1 and
2. As 12 results from multiplying 3 by 4, he conceived the universe as
composed of three distinct worlds, each of which was developed in four
concentric spheres, and these spheres corresponded to the primitive
elements of fire, air, earth, and water. The application of the number
12 to express the universe Pythagoras had received from the Chaldeans
and Egyptians--it being the origin of the institution of the zodiac.
Although this is digressing, it serves to show what enormous importance
the people of that{017} time attached to numbers, especially to the
ternary and quarternary periods in the determination of critical days
in illness. Pythagoras was the founder of a philosophic system of great
grandeur, beauty, and, in one sense, completion, embracing, as it does,
and uniting by common bounds God, the universe, time, and eternity;
furnishing an explanation of all natural phenomena, which, if not true,
was at that time acceptable, and which appears in strong and favorable
contrast as against the mythological systems of pagan priests. No wonder
that it captivated the imagination and understanding of the thinking
young men of that day. Had they continued in the original purity of life
and thought in which he indoctrinated them there is no knowing how
long the Pythagorean school might have continued. But after it had been
dissolved by the storm of persecution, its members were scattered all
over Greece and even beyond. Now no longer held by any bonds, many of
them revealed the secrets of their doctrine, to which circumstance we
owe the little knowledge thereof we now possess.
The Pythagoreans apparently first introduced the custom of visiting
patients in their own homes, and they went from city to city and house
to house in performance of this duty. On this account they were called
Periodic or Ambulant physicians, in opposition to the Asclepiadæ, who
prescribed only in the temples. Empedocles, of Agrigentum, well known
in the history of philosophy, was perhaps the most famous of
these physicians. Let the following incident witness his sagacity:
Pestilential fevers periodically ravaged his native city. He observed
that their appearance coincided with the return of the sirocco, which
blows in Sicily on its western side. He therefore advised to close by
a wall, as by a dam, the narrow gorge from which this wind blew upon
Agrigentum. His advice was followed and his city was made free from the
pestilence.
Again, the inhabitants of Selinus were ravaged by epidemic{018} disease.
A sluggish stream filled the city with stagnant water from which
mephitic vapors arose. Empedocles caused two small rivulets to be
conducted into it, which made its current more rapid; the noxious vapors
dispersed and the scourge subsided.
_The Gymnasia_.--Before we proceed to a somewhat more detailed, but
brief, account of Hippocrates, it is necessary to say a word or two
of the ancient gymnasia of Greece, which were used long before the
Asclepiadæ had practiced or begun to teach. In these gymnasia were three
orders of physicians: first, the director, called the Gym-nasiarch;
second, the subdirector, or Gymnast, who directed the pharmaceutical
treatment of the sick; and, lastly, the Iatroliptes, who put up
prescriptions, anointed, bled, gave massage, dressed wounds and ulcers,
reduced dislocations, treated abscesses, etc. Of the gymnasiarclis
wonderful stories are told evincing their sagacity, which, though
somewhat fabulous, indicate the possession of a very high degree
of skill of a certain kind. Of one of the most celebrated of these,
Herodicus, we may recall Plato's accusation, who reprimanded him
severely for succeeding too well in prolonging the lives of the aged.
Whatever else may be said, we must acknowledge that above all others
the Greeks recognized the value of physical culture in the prevention of
infirmity, and of all physical methods in the treatment of disease.
By their wise enactments with reference to these matters they set an
example which modern legislators have rarely, if ever, been wise
enough to follow,--an example of compulsory physical training for the
young,--and thereby built up a nation of athletes and a people of rugged
constitution among whom disease was almost unknown.
I come now to the so-called _Philosophic Period_, or the third period in
the Age of Foundation, which is inseparably connected with the name of
_Hippocrates_. This central figure in the history of ancient medicine
was born on the Island{019} of Cos, of a family in which the practice of
medicine was hereditary, who traced their ancestors on the male side to
Æsculapius, and on the female side to Hercules. The individual to whom
every one refers under this name was the second of seven; the date of
his birth goes back to 460 B.C., but of his life and his age at death we
do not know; some say he lived to be over one hundred years of age.
It is certain that he traveled widely, since his writings evince the
knowledge thus gained. He was a contemporary of Socrates, although
somewhat younger, and lived in the age of Pericles,--the golden age for
science and art in Greece.
The Island of Cos is now called Stan-Co, and is situated not far
from the coast of Ionia. Formerly it was considered as having a most
salubrious climate; now that it is under the dominion of the Turks,
it is considered most unhealthy. It possessed a temple dedicated to
Æsculapius and{020} a celebrated medical school. But Hippocrates, not
satisfied with what he could learn here, visited the principal foreign
cities, and seems to have been a most accurate and painstaking observer
and collector of notes. That he achieved great renown in his life is
known, since Plato and even Aristotle refer to him as their authority
in very many matters. His children and grandchildren followed in his
footsteps, and published their writings under the same name; it has,
therefore, become difficult to distinguish his works from theirs.
Finally, authors more unscrupulous, who bore no relationship to him,
attached his name to their own writings. But the true were, as a rule,
easily distinguished from the spurious, and were carefully separated by
those in charge of the Alexandrian library.
The enumeration of his writings by different authors varies very much.
Renouard, who seems to have studied the subject very carefully, gives
the following as appearing to him to be the authentic list of writings
of Hippocrates the Second,--i.e., the Great: The _Prognostic_, the
_Aphorisms_, the first and third books of _Epidemics_, that on
_Regimen in Acute Disease_, that on _Airs, Waters, and Places, that on
Articulations and Luxations_, that on _Fractures_, and the _Mochlic_, or
the treatise on instruments and reduction. This list does not
comprise the fourth part of the entire Hippocratic collection, but its
authenticity appears to be undoubted, and it suffices, as Renouard says,
to justify the enthusiasm of his contemporaries and the admiration
of posterity. Later, joined with the writings of Pythagoras, Plato,
Aristotle, and others, they constituted the so-called _Hippocratic
collection_, which was a definite part of the great libraries of
Alexandria and Pergamos, and formed the most ancient authentic monument
of medical science.
Respect for the bodies of the dead was a religious observance in all
Greece, and prevented the dissection of the human body. Consequently
the knowledge of anatomy possessed by Hippocrates must have been meagre.
Nevertheless,{021} he described lesions, like wounds of the head, of
the heart, the glands, the nature of bones, etc. It being impossible to
establish a physiology without an anatomical basis, it is not strange
that we find but little physiology in the Hippocratic writings, and
that this little is very crude and incorrect. Arteries and veins
were confounded, and nerves, tendons, ligaments, and membranes were
represented as analogous or interchangeable tissues. The physiologists
of those days abandoned themselves to transcendental speculation
concerning the nature and principles of life, which some placed in
moisture, others in fire, etc. Speculation, thus run wild, prevented
such accurate observation as might have greatly enhanced the progress of
physiological knowledge.
Hippocrates wrote at least three treatises concerning hygiene: The
first, on _Airs, Waters, and Places_; the second, on _Regimen_;
the third, on _Salubrious Diet_,--practically an abridgement of the
preceding, in which he recommends the habit of taking one or two vomits
systematically every month. The classification of diseases into internal
or medical, and external or surgical, is not modern, but is due to
Hippocrates; neither is it philosophic, although it is very convenient.
With so little knowledge of physiology and pathology as the ancients
had, it is not strange that they ascribed undue importance to external
appearance; in other words, to what has been termed _semeiotics_, which
occupies a very considerable place in the medical treatises of the
Asclep-iadæ. Indeed, the writings on this subject constitute more than
one-eighth part of the entire Hippocratic collection. To prognosis,
also, Hippocrates ascribed very great importance, saying that "The best
physician is the one who is able to establish a prognosis, penetrating
and exposing first of all, at the bedside, the present, the past,
and the future of his patients, and adding what they omit in their
statements. He gains their confidence, and being convinced{022} of
his superiority of knowledge they do not hesitate to commit themselves
entirely into his hands. He can treat, also, so much better their
present condition in proportion as he shall be able from it to foresee
the future," etc.
To the careful scrutiny of facial appearances, the position, and other
body-marks about the patient he attributed very great importance;
in fact, so positive was he about these matters that he embodied the
principal rules of semeiotics into aphorisms, to which, however, there
came later so many exceptions that they lost much of their value. From
certain passages in his book on _Prediction_, and from the book on
_Treatment_, which is a part of the Hippocratic collection, it appears
that it was the custom then of physicians to announce the probable issue
of the disease upon the first or second visit,--a custom which still
prevails in China and in Turkey, It gave the medical man the dignity
of an oracle when right, but left him in a very awkward position when
To Hippocrates we are indebted for the classification of sporadic,
epidemic, and endemic forms, as well as for the division of disease into
acute and chronic. Hippocrates wrote extensively on internal disease,
including some particular forms of it, such as epilepsy, which was
called the sacred disease; also fragments on diseases of girls, relating
particularly to hysteria; also a book on the nature of woman, an
extensive treatise on diseases of women, and a monograph on sterility.
That Hippocrates was a remarkably close observer of disease as it
appeared to him his books amply prove; in fact, they almost make one
think that close observation is one of the lost arts, being only open
to the objection that too much weight was attached to insignificant
external appearances, speculation on which detracted from consideration
of the serious feature of the case. His therapeutics, considering the
crude information of the time, was a vast improvement on that which
had preceded,{023} and really entitled him to his title of "Great
Physician."
Of external diseases and their surgical therapeutics he wrote fully: on
_The Laboratory of the Surgeon_, dealing with dressings, bandaging,
and operating; on _Fractures_; and on _Articulations and Dislocations_;
showing much more anatomical knowledge than was possessed by his
contemporaries. The _Mochlic_ was an abridgment of former treatises; in
_Wounds of the Head_ he formulated the dictum concerning the possible
danger of trifling wounds and the possible recovery from those most
serious, so often ascribed to Sir Astlev Cooper. Other monographs, also,
he wrote, on _Diseases of the Eye_, on _Fistula_, and on _Hoemorrhoids_.
He described only a small number of operations, however, and all
the Hippocratic writings on surgery would make but a very incomplete
treatise as compared with those that belong to the next historical
epoch; all of which we have to ascribe--in the main--to prejudice
against dissection and ignorance of anatomy.
From the earliest times physicians and writers occupied themselves
largely with obstetrics, as was most natural. The Hippocratic collection
includes monographs on _Generation; the Nature of the Infant;
the Seventh Month of Pregnancy; the Eighth Month of Pregnancy; on
Accouchement; Superfoetation; on Dentition; on Diseases of Women; on
Extraction of the Dead Foetus_. The treatise on superfcetation concerned
itself mainly with obstetrics.
On epidemics Hippocrates writes extensively, showing that he had
studied them carefully. He was among the first to connect meteorological
phenomena with those of disease during given seasons of the year,
expressing the hope that by the study of storms it would be possible to
foresee the advent of the latter, and prepare for them. Seven books of
the Hippocratic collection bear the title of _Epidemics_, although only
two of them are exclusively devoted to this subject. In these books were
contained a long{024} list of clinical observations relating to various
diseases. They constituted really a clinical study of disease.
The collection of Hippocrates's _Aphorisms_ fills seven of the books;
no medical work of antiquity can compare with these. Physicians
and philosophers of many centuries have professed for them the same
veneration as the Pythagoreans manifested for their golden verses. They
were considered the crowning glory of the collection. Even within a
short time past the Faculty of Paris required aspirants for the medical
degree to insert a certain number of these in their theses, and only the
political revolution of France served to cause a discontinuance of
this custom. These aphorisms formed, says Littré, "a succession of
propositions in juxtaposition, but not united." It has always been and
always will be disadvantageous for a work to be written in that style,
since such aphorisms lose all their general significance; and that which
seems isolated in itself becomes more so when introduced into modern
science, with which it has but little practical relationship. But not so
if the mind conceive of the ideas which prevailed when these aphorisms
were written; in this light, when they seem most disjoined they are most
related to a common doctrine by which they are united, and in this view
they no longer appear as detached sentences.
The school of the Asclepiadæ has been responsible for certain theories
which have been more or less prominent during the earlier historical
days. One of these which prevailed throughout the Hippocratic works is
that of _Coction and Crisis_. By the former term is meant thickening
or elaboration of the humors in the body, which was supposed to be
necessary for their elimination in some tangible form. Disease was
regarded as an association of phenomena resulting from efforts made
by the conservative principles of life to effect a coction,--i.e., a
combination of the morbific matter in the economy, it being held
that the latter could not be properly expelled until thus united and
prepared{025} so as to form excrementitious material. This elaboration
was supposed to be brought about by the vital principles, which
some called nature (_Physis_), some spirit (_Psyche_), some breath
(_Pneuma_), and some heat (_Thermon_).
The gradual climax of morbid phenomena has, since the days of
Hippocrates, been commonly known as _Crisis_; it was regarded as the
announcement of the completion of the union by coction. The day on which
it was accomplished was termed _critical_, as were also the signs which
preceded or accompanied it, and for the crisis the physician anxiously
watched. Coction having been effected and crisis occurring, it only
remained to evacuate the morbific material--which nature sometimes
spontaneously accomplished by the critical sweat, urination, or
stools, or sometimes the physician had to come to her relief by the
administration of diuretics, purgatives, etc. The term "critical period"
was given to the number of days necessary for coction, which in its
perfection was supposed to be four, the so-called quarternary, while the
septenary was also held in high consideration. Combination of figures
after the Pythagorean fashion produced many complicated periods,
however, and so periods of 34, 40, and 60 days were common. This
doctrine of crisis in disease left an impress upon the medical mind not
yet fully eliminated. Celsus was the most illustrious of its adherents,
but it can be recognized plainly in the teachings of Galen, Sydenham,
Stahl, Van Swieten, and many others. In explanation, it must be said
that there have always existed diseases of nearly constant periods,
these being nearly all of the infectious form, and that the whole
"critical" doctrine is founded upon the recognition of this natural
The Hippocratic books are full, also, of the four elements,--earth,
water, air, and fire; four elementary qualities,--namely, heat, cold,
dryness, and moisture; and the four cardinal humors,--blood, bile,
atrabile, and phlegm.
Owing{026} to the poverty of knowledge of physics and chemistry
possessed by the ancients, and notwithstanding their errors and
imperfections, the doctrine of Dogmatism, founded upon the theory of
coction and humors, was the most intelligible and complete among the
medical doctrines of antiquity, responding better, as it did, to the
demands of the science of that day. That Hippocrates was a profound
observer is shown in this: that he reminds both philosophers and
physicians that the nature of man cannot be well known without the aid
of medical observation, and that nothing should be affirmed concerning
that nature until by our senses we have become certain of it. In this
maxim he took position opposed to the Pythagorean doctrine, and included
therein the germ of a new philosophy of which Plato misconceived, and of
which Aristotle had a very faint glimpse.
Another prominent theory throughout the Hippocratic books is that of
Fluxions, meaning thereby about what we would call congestions, or
conditions which we would say were ordinarily caused by cold, though
certain fluxions were supposed to be caused by heat, because the
tissues thereby became rarefied, their pores enlarged, and their humor
attenuated so that it flowed easily when compressed. The whole theorv of
fluxion was founded on the densest ignorance of tissues and the laws
of physics, the body of man being sometimes likened to a sponge and
sometimes to a sieve. The treatment recommended was almost as crazy as
the theory. Certain other theories have complicated or disfigured the
Hippocratic writings, and certain have been founded on the consideration
of two elements--i.e., fire and earth--or on the consideration of one
single element which was supposed to be air,--the breath, or _pneuma_;
and there was--lastly--the theory of any _excedent_, which is very
vague; of all of these we may say that they are not of sufficient
interest to demand expenditure of our time.
The eclat{027} which the second (i.e., the Great) Hippocrates gave to
the school of Asclepiadæ in the Island of Cos long survived, and
many members of his family followed in his footsteps. Among his most
prominent successors were _Polybius, Diodes, and Praxagoras_, also of
Cos,--the last of the Asclepiadæ mentioned in history. Praxagoras was
distinguished principally for his anatomical knowledge; like Aristotle,
he supposed that the veins originated from the heart, but did not
confound these vessels with the arteries, as his predecessors had done,
but supposed that they contained only air, or the vital spirit. It has
been claimed that he dissected the human body. He laid the foundation
of sphygmology, or study of the pulse, since Hippocratic writers rarely
alluded to arterial pulsations and described them as of only secondary
The predominating theory in the Island of Cos was that which made health
dependent on the exact proportion and play of the elements of the body,
and on perfect combination of the four cardinal humors. This was the
prevailing doctrine,--i.e., the Ancient Medical Dogmatism, so named
because it embraced the most profound dogmas in medicine, and was taught
exclusively until the foundation of the school at Alexandria.
Two men, however, more commonly ranked among philosophers than among
physicians of antiquity, dissected the statements of Hippocrates, and
embodied them more or less in their own teachings, and thus exercised a
great influence on the progress of the human mind, particularly in
the direction of medical study. The first of these was Plato, profound
moralist, eloquent writer, and most versatile thinker of his day or
any other. He undertook the study of disease, not by observation (the
empirical or experimental method), but by pure intuition. He seemed
to have never discovered that his meditations were taken in the wrong
direction, and that the method did not conduce to the discovery of
abstract truths. He gave beauty an abstract{028} existence, and affirmed
that all things beautiful are beautiful because of the presence of
beauty. This reminds one of that famous response in the school of the
Middle Ages to a question: "Why does opium produce sleep?" the answer
being: "Because it possesses the sleepy principle." Plato introduced
into natural science a doctrine of final causes. He borrowed from
Pythagoras the dogma of homogeneity of matter, and claimed that it had a
triangular form.
_Aristotle_, equally great thinker with Plato, but whose mental activity
was manifest in other channels, was born in Stagyrus, in Macedonia. He
was fascinated by the teachings of Plato, and attained such eminence
as a student that King Philip of Macedon made him preceptor to his son
Alexander, subsequently the Great, by whom he was later furnished with
sufficient funds to form the first known museum in natural history.--a
collection of rare objects of every sort, transmitted, many of them, by
the royal hands of his former student from the remote depths of Asia.
Aristotle, by long odds the greatest naturalist of antiquity, laid the
first philosophic basis for empiricism. He admitted four elements--fire,
air, earth, and water--and believed them susceptible of mutual
transmutation. He studied the nature of the soul and that of the animal
body; regarded heat and moisture as two conditions indispensable to
life; described the brain with some accuracy, but without the least idea
of its true function; said that the nerves proceeded from the heart;
termed the aorta a nervous vein; and made various other mistakes which
to us seem inexcusable. Nevertheless, he was rich in many merits, and no
one of his age studied or searched more things than he, nor introduced
so many new facts. Although he never dissected human bodies, he
nevertheless corrected errors in anatomy held to by the Hippocratic
school. He dissected a large number of animals of every species, and
noted the varieties of size and shape of hearts of various animals
and birds. In{029} other words, he created a comparative anatomy
and physiology, and the plan that he traced was so complete that two
thousand years later the great French naturalist Cuvier followed it
quite closely. If he be charged with having propagated a taste for
scholastic subtleties, he also furnished an example of patient and
attentive observation of Nature. His history of animals is a storehouse
of knowledge, and his disciples cultivated with zeal anatomy,
physiology, and natural history. His successor, Theophrastus, was the
most eminent botanist of antiquity.
It will thus be seen that Plato and Aristotle were the eminent
propagators of two antagonistic opinions. One supposed knowledge to be
derived by mental intuition, and the other that all ideas are due to
sensation. Both count among moderns some partisans of the greatest
acumen: Descartes, Leibnitz, and Kant being followers of Plato, and
Bacon, Locke, Hume, and Condillac, of Aristotle.
The excuse for stating these things, which apparently do not so closely
concern the history of medicine, must be that of the learned interpreter
of the doctrine of Cuvier, that "The first question in science is always
a question of method."
Hippocrates formed a transition between a period of mythology and that
of history. His doctrine was received by contemporaries and by posterity
with a veneration akin to worship. No other man ever obtained homage so
elevated, constant, and universal. A little later ignorance reigned in
the school that he made celebrated. Methods and theories were propagated
there under the shadow of his name which he would have disowned.
Medical science now changes its habitation as well as its aspect, and
from the record of Hippocrates and his work we turn to the fourth period
of the Age of Foundation,--namely, the _Anatomic_, which extends from
the foundation of the Alexandrian library, 320 B.C., up to the death of
Galen, about the year A.D. 200.
CHAPTER II.
_Age of Foundation (continued).--Anatomic Period: Influence of the
Alexandrian Library. Herophilus and Erasistratus. Aretæus, f B.C. 170.
Celsus, A.D. 1-65 (?). Galen.--Empiricism: Asclepiades B.C.
100 (?).--Methodism: Theinison, B.C. 50 (?).--Eclecticism. Age of
Transition, A.D. 201-1400.--Greek Period: Oribasius, 326-403. Ætius,
502-575. Alexander of Tralles, 525-605. Paul us Ægineta, 625-690._
Fourth, or Anatomic,{030} Period.--As already seen, Alexander the Great
and his successors collected the intellectual and natural riches of the
universe, as they knew them, and placed them at the disposal of
studious men to benefit humanity; their complete value has not yet been
exhausted, and never can be. This undertaking was carried out under
conditions that made it one of extreme difficulty. Manuscripts were then
rare and most costly; but few copies of a given work were in existence,
often only one, and these were held almost priceless. Under these
circumstances the establishment of a public library and of a museum was
an act of philanthropy and liberality simply beyond eulogy, and did more
to immortalize the founder of the collection than all his victories and
other achievements.
This appears to have also occurred to two of Alexander's
lieutenants--one Eumenes, Governor of Pergamos, and the other, Ptolemy,
Governor of Egypt. After the death of the conqueror his generals
shook of all dependence upon the central government, and endeavored to
centralize their own authority. But these two were the only ones among
so many leaders who did not devote all their attention to armies and
invasion, but interested themselves in commerce and arts. So active were
they in the enterprise that Eumenes had gathered two hundred thousand
volumes for the library at Pergamos, and Ptolemy six to seven hundred
thousand for that of Alexandria. The latter was divided{031} into two
parts, the greater and the lesser, the latter of which was kept in the
temple of Serapis, hence known as the _Serapium_. These notable efforts
to found enormous collections first excited praiseworthy rivalry among
contemporaries and rulers, which, however, degenerated into contemptible
jealousy, so that some of the rulers of Alexandria even went so far as
to interdict the exportation of papyrus, in order to prevent the making
of copies for the library of Pergamos. But the effect was unexpected,
since it led to the invention of the paper of Pergamos, otherwise called
parchment, which completely displaced the bark from which papyri were
made. Be this as it was, the collection at Alexandria had a much
more marked influence on the medical study of the future than that of
Pergamos, and calls for our particular notice. About it sprang up first
a collection of learned men, and then the inevitable result--a school of
learning. It was Ptolemy Soter who called around him the most renowned
men of his day. He provided them with homes adjoining the library,
endowed them with salaries, and charged them with the classification and
collation of manuscripts, or with the giving of instruction by lectures
and discussions. Ptolemy himself sometimes took part in these feasts
of reason, which became still more frequent and formal under his son
Ptolemy Philadelphia. These were called the Feasts of the Muses and of
Apollo,--_i.e., ludi musarum_,--and, consequently, the place where
they were held came to be termed the "_museum_." Often the subjects
for discussion were announced in advance, and those who gained the most
applause received rewards in accordance with the merits of their work.
Among those who enjoyed these advantages under the reign of these
two Ptolemies are prominently named two physicians, Herophilus and
Erasistratus, the latter said to be the grandson of Aristotle. It was
under this Philadelphus that the Hebrew wise men translated into Greek
the Holy Scriptures, which translation has since{032} been called the
Septuagint--so called because it is supposed to have been translated by
the members of the Sanhedrim, which was composed of about seventy
men, or because, according to another legend, it was translated by
seventy-two men in seventy-two hours. These _savants_ of ancient Egypt,
thus supported by the dynasty of the Lagides, gave the first place to
the science of medicine. As regards this study, the school of Alexandria
eclipsed almost from its origin the ancient schools of Cos and Pergamos,
and during its existence was the leading institution of its kind in the
world. At the time of Galen it was sufficient to have studied there,
and even to have resided a short time in Alexandria, to obtain the
reputation of being a physician. Nearly all the scholars of these five
centuries had received instruction in this school. The principal reason
for its eminence in medical instruction was the practice of dissection
of human bodies, which, under the Ptolemies, was allowed and
recommended, and by which the science of medicine received an
extraordinary impulse. Although the prejudice of Egyptians was very
strong against those who touched a dead body, the Ptolemies themselves
are said to have participated in this kind of anatomical study, thus
destroying by their example the odium previously attached to dissection.
Strange to say, however, the practice of dissection fell into disuse
toward the end of this Anatomic Period, and scholars preferred to
indulge in subtle metaphysical discussions rather than study human
tissues. But the principal reason for giving up this practice was the
Roman domination of Egypt, the Romans, inconsistently, being perfectly
willing to see any amount of bloodshed in the arena, and all sorts
of inhumanities practiced upon living human beings, but holding that
contact with a corpse was profanation; so that not a single anatomist
of reputation had his origin in ancient Rome. "If on any occasion," says
Renouard, "a foreign physician attached to the king or general desired
to avail himself of the occasions{033} that were afforded to examine the
structures of the internal parts of the human body, he was obliged to
conceal and carry off during the night some body abandoned to the birds
of prey." To complete the melancholy termination of the Anatomic Period,
the labors of the writers of those days were all lost by the burning of
the great library by Julius Cæsar, which was the beginning of the
chain of disasters with which Egypt was accursed under Roman
dominion. Although Mark Antony, induced thereto by the endearments
and solicitations of Cleopatra, transported the library of Pergamos
to Alexandria, even this was unavailing to restore the position of
the school, since the atrocious and imbecile Caracalla took from the
pensioners of the museum their privileges of common residence and every
other advantage, and suppressed all public exhibitions and discussions.
I can mention but few of the names most eminent during this Anatomic
Period, and but a short account of the life and work of each.
The first deserving of mention was Herophilus, who was born in Chalcedon
about the end of the fourth century before Christ, and supposed to be
the first to undertake systematic dissection of the human body. The
so-called Torcular Herophili, or common meeting-place of the sinuses at
the occiput, named after him, gives evidence of his influence upon the
study of anatomy. He wrote on all departments of medical science,
concerning the eyes, the pulse, midwifery, etc., as well as numerous
commentaries upon the Hippocratic writings,--describing the membranes of
the brain and its vessels, the choroid plexus, the ventricles of the
brain, the tunics of the eye, the intestinal canal, and certain portions
of the vascular system. He alluded to the thoracic duct without knowing
its purpose, and gave a more accurate description of the genitalia than
any previous writer. Strange to say, but little is known of his later
life, and of his death absolutely nothing.
Erasistratus{034} was the son of Cleombrotus, a student of Metrodorus,
and lived for some time at the court of Seleucus Nicator, whose son,
Antiochus, he healed of a secret ailment, which happened to be a
desperate love-affair with his mother-in-law, Stratonice. He wrote
extensively on fevers, hygiene, paralyses, therapeutics, and many other
subjects; regarded most diseases as due to overindulgence in food, which
is not digested, and consequently putrefies. Plethora was for him the
prevailing disease, against which he employed not only venesection, but
fasting, and bandaging of the extremities. He was a diligent student
of anatomy, and carefully described the brain in many of its grosser
features, regarding it as the seat of the soul and the centre of the
nerves. He also described more exactly than his predecessors the
valves of the heart, which organ he regarded as the origin of veins and
arteries. He discovered the lymph-vessels, and maintained, against Plato
and others, that the epiglottis prevents the entrance of fluids into
the lungs, but he supposed digestion to be produced by mechanical
trituration in the stomach, and preferred gymnastics, exercise, diet,
and baths to drugs or other therapeutic measures. He died about 280 B.C.
Aretæus, who died about 170 B.C., was one of the most brilliant lights
of antiquity previous to the Christian era, but, in spite of all this,
of his life very little is known. He came from Cappadocia about the
end of the reign of Nero, and lived in Alexandria. That he lived in
Alexandria is apparent from his numerous references to its location, to
the habits and therapeutics of the Egyptians, and to the geography
of the country. Furthermore, references to its diseases abound in
his writings, so that it is made to appear that he had had the best
advantages there, although he must have traveled extensively. But a
small portion of his writings remain, and these consist, for the
most part, of compendiums of pathology and therapeutics. He described
disease, not in anatomical order from head to foot, but under{035} the
classification of acute and chronic. With the exception of Hippocrates,
he has shown himself the most free from vague, arbitrary speculation,
and from the dogmatism of the schools of any writer of antiquity. He,
more than any other up to his time, endeavored to found pathology upon
a sound anatomical basis. For every picture of disease he endeavored to
provide a suitable anatomical accompaniment. This appears particularly,
for instance, in his description of intestinal ulcers due to dysentery,
or the paralyses following brain affections, or his description of
pharyngeal diphtherias, of which he gave a good account under the name
of Syriac or Egyptian ulcers. Pulmonary tuberculosis, tetanus, and anal
fistula are amply mentioned in his writings.
His therapeutics were simple and rational; he laid great stress upon
dietetic treatment. His surgical writings appear to have all been lost,
but there is every reason to think that he brought to bear upon{036}
external medicine the same good sense which he applied to internal
affections.
Cornelius Celsus, the most celebrated author for a number of centuries,
was born in Rome about the time of Christ. Brilliant as he was, he
exerted a wide-spread influence for centuries. The exact date of his
death is unknown. He was a contemporary of the greatest philosophers,
poets, and _savants_ of Rome during its most brilliant period.
He studied rhetoric, philosophy, the art of war, economics, and
medicine--he was, in fact, a walking encyclopaedia of the knowledge of
his day; but it is in medicine that he shows to best advantage, and in
his capacity as a physician he was and is best known. The direction in
which Celsus appears to least advantage is in failure of power of direct
observation, and in yielding unquestioning obedience to the views and
dicta of Hippocrates, for whom he possessed the greatest reverence,
not being able to brook any serious contradiction or opposition to his
opinions. In this reverence for Hippocratic authority he was followed by
many less prominent successors, the consequence being a failure to train
men as observers, the endeavor being to make them simply storehouses of
information derived from Hippocratic writings. As a result, Celsus wrote
but little, or else his writings are lost. He contented himself mostly
with a mere commentary upon the writings which he so highly revered.
But little of his writings remain, and these pertain mostly to the
therapeutics of curable disease, dietetic, pharmaceutical, and surgical.
Although he exercised great authority during his period, he was later
totally supplanted by Galen, and his views are seldom mentioned in the
writings of those subsequent to this great physician. His death must
have taken place during the first century after Christ.
Of all the students of Hippocratic dogmatism, the most earnest,
skillful, and learned was Claudius Galen, a native of Pergamos, a place
already celebrated for its temple dedicated{037} to Æsculapius, for
its school of medicine, and for a library which had been removed to
Alexandria. He was placed by his father under the most distinguished
teachers in all of the sciences, and even as a young man showed
extraordinary progress, and became early a disputant with the most
erudite in grammar, history, mathematics, and philosophy. He has related
how in two different dreams he was urged by Apollo to study medicine. He
traveled widely for instruction, and remained some time in Alexandria.
On his return to his own country he was charged by its ruler to dress
the wounded in the great circus, which furnished him opportunity
for displaying all his anatomical knowledge and surgical skill. Not
remaining long at home, he went to Rome, where his renown had preceded
him, and where, by his brilliant elocution, his accurate logic, and{038}
his profound erudition, as well as his versatility and practical skill,
he at once took the highest place. But here his rapid success, his
vanity, his disdain for his colleagues, and his useless boasting, as
well as his natural jealousy, gained him the enmity of nearly all his
contemporaries, and his stay at Rome was thereby made very disagreeable.
In his work on _Prenotions_ he accuses his colleagues of base jealousy
and stupid ignorance, lavishes upon them such epithets as "thieves" and
"poisoners," and closes by saying that after having unmasked them he
would leave them to their evil designs by abandoning the great city to
seek a home in a smaller place, where the surroundings would be to him
more congenial. This threat he carried out, but soon returned to Rome
upon the invitation of the Emperors Marcus Aurelius and Lucius Yerus,
whose confidence, as well as that of their successors, he enjoyed. He is
supposed to have lived to the age of seventy-one, and to have died about
200 A.D. Galen strongly denied being attached to any of the sects of his
day, and regarded as slaves those who took the title of Hippocratists,
Praxagoreans, Herophilists, and so on. Nevertheless, his predilection
in favor of the Hippocratic writings is well marked, for lie explains,
comments upon, and expands them at length, refutes the objections of
their adversaries, and gives them the highest place. He says: "No one
before me has given the true method of treating disease; Hippocrates,
I confess, lias heretofore shown the path, but as he was the first to
enter it he was not able to go as far as he wished.... He has not made
all the necessary distinctions, and is often obscure, as is usually the
case with ancients when they attempt to be concise. He says very little
of complicated diseases; in a word, he has only sketched what another
was to complete; he has opened the path, but has left it for a successor
to enlarge and make it plain." This implies how he regarded himself as
the successor of Hippocrates, and how littleweight{039} he attached to
the labors of others. He held that there were three sorts of principles
in man: spirits, humors, and solids. Throughout his metaphysical
speculations Galen reproduces and amplifies the Hippocratic dogmatism.
Between perfect health and disease there were, he thought, eight kinds
of temperaments or imperfect mixtures compatible with the exercise of
the functions of life. With Plato and Aristotle, he thought the human
soul to be composed of three faculties or parts: the vegetative,
residing in the liver; the irascible, having its seat in the heart; and
the rational, which resides in the brain. He divided diseases of the
solids of the body into what he called distempers; he distinguished
between the continued and intermittent fevers, regarding the quotidian
as being caused by phlegm, the tertian as due to yellow bile, and the
quartan as due to atrabile. In the doctrine of coction, crises, and
critical days he agreed with Hippocrates; with him he also agreed in the
positive statement that diseases are cured by their contraries. From all
this it will be seen that Galen must be regarded as one of the earliest
of Hippocratic dogmatists. He was a most extensive writer, and it
is said that the total number of his works exceeded one hundred. His
contributions to anatomy were not insignificant. For myology he did a
great deal. He wrote a monograph on the skeleton in which he recommended
that bones be seen and handled, not merely studied from books, and that
the student should go to Alexandria, where teachers would place before
him the real human skeleton. It has been inferred that there was not, in
his time, in Rome a single skeleton. He wrote fifteen books on anatomy,
of which six are lacking; also an extensive treatise on the lesions of
the human body, distributed among seventeen books which have come down
to us. He is supposed to have introduced the term "symphysis," and he
described nearly every bone in the human body. By him the muscles were
no longer considered as inert masses and tissue-layers{040} serving
to cover the bones, but he classified them according to their distinct
functions, and studied separately their form and uses. The location of
the vessels and nerves between them was also noted, and it was proved
that muscles were indispensable to the accomplishment of voluntary
motions. Galen was, perhaps, the first vivisector of all, since he
exposed muscles of living animals, and showed how alternate tension and
relaxation of distinct groups set the bones in motion, after the manner
of levers; he named a great number of them, but, curiously, took no note
of others. His classification according to their uses is followed down
to the present day--i.e., flexors, extensors, etc.
The Hippocratic authors confounded the arteries with the veins.
Praxagoras first distinguished two kinds of vessels which he supposed
to contain air, whence the name artery. Aristotle and Erasistratus
maintained this view, which prevailed until the time of Galen, who
devoted a book to the refutation of it, basing his argument upon the
observation that always when an artery is wounded blood gushes out.
How near he came to being the discoverer of the circulation may thus be
seen. A little less reverence for authority and a little more capacity
for observation would have placed him in possession of the knowledge,
lack of which for so many centuries retarded the whole profession.
He thought the veins originated from the liver--in this respect being
behind Aristotle--but considered the heart as the common source of the
arteries and veins. Even the portal system of veins confused him, and he
erroneously described a superior and inferior aorta, but atoned for
this by describing the umbilical veins and arteries. Aristotle also had
supposed all the nerves originated from the heart, but Galen stated that
they are derived from the brain and spinal marrow, and pointed out two
kinds of nerves: those of sensation, which he thought proceeded from the
brain, and those of motion, which he considered{041} to originate in
the spinal marrow. Thus, he described distinct nerves of sensation and
motion, but sadly confused their anatomy. He seems also to have had some
notion of the great sympathetic, although it was by no means accurate.
He suggested the division of the principal nerves, in order to prove
the fact that nervous energy is transmitted from the encephalon to other
parts of the body. He speaks of glands, and thought they discharged
their secretions through veins into the various cavities, but regarded
them rather as receptacles of excrementitious matter than as agents for
secretion of valuable fluids. He even regarded the mammæ as glandular
bodies in this sense, although he knew, of course, the value of their
secretion. To Galen we owe the division of the body into cranial,
thoracic, and abdominal cavities, whose proper viscera and envelopes he
described. He spoke of the heart as having the appearance of a muscle,
but differing from it. He regarded it as the source of natural heat,
and the seat of anger and of violent passions. He appreciated that
inspiration is carried on by enlargement of the thoracic cavity. He
thought that atmospheric air entered the cavity of the cranium through
the cribriform plate of the ethmoid and passed out by the same route,
carrying with it excrementitious humors from the brain, which were
discharged into the nasal fossæ. But some portion of air thus entering
remained, according to his views, and combined with the vital spirits in
the anterior ventricles of the brain, from which combination originated
the animal spirits and immediate agents of the rational soul. These
acquired their last attenuation in the fourth ventricle, whence they
would pass out drop by drop through a round, narrow tube.
From this brief _résumé_ of the anatomy and physiology of Galen it
will be seen that by the end of the second century of the Christian era
immense progress had been made since the foundation of the Alexandrian
school, and that it was due to the impetus in the study of anatomy
given by Herophilus{042} and Erasistratus, who not only made numerous
dissections, but resorted to frequent vivisections. It is even said that
Herophilus did not hesitate to employ his knife on live criminals
who were subjected to him for experiment; but this has been a popular
tradition about almost every anatomist of antiquity, and there is
no evidence in confirmation of the unkind rumor, although that such
experiments might be legally and justly performed has occurred to the
minds of many. But zeal for dissection rapidly cooled off, and Galen
barely mentions five or six men who devoted themselves to it in the
space of nearly four hundred years down to his time. He speaks of
_Rufus_ of Ephesus,--who lived under Trajan of _Marinus_,--who wrote
in the beginning of the second century A.D., and of _Quintus_, who
instructed his own preceptor. None of them left a reputation, however,
approaching that of Herophilus and Erasistratus, with whom Galen alone
could compare by the number of his experiments and his discoveries.
Galen strove as hard as one of his position might, by example and
precept, to awaken in his contemporaries a desire for anatomical
knowledge, but could not overcome their indifference. After him the
practice of dissection appears to have been lost, either from the
redoubled prejudices of the superstitious, who opposed it, or as
the result of the apathetic ignorance or the ignorant apathy of the
It has been shown that, during the Hippocratic era and subsequently, the
physicians even of primitive times followed more or less by instinct the
empirical method. Acron of Agrigentum was a contemporary of Pythagoras,
and affirmed that experience is the only true foundation of the healing
art. Hippocrates, however, showed himself more anxious to report
faithfully clinical facts than to dispute theoretical views.
The surprising progress in anatomy and physiology made during the first
portion of the Anatomic Period and during{043} the better days of
the Alexandrian institute did not keep men from confounding several
different points in the Hippocratic doctrine, by which confidence in
the same was naturally shaken. Thus many new speculations were hazarded
which nullified each other. In the midst of this confusion practitioners
continued to seek in experience a refuge from the incessant variations
of dogmatism and the sterile incertitude of the skeptics. Thus,
empiricism as a school of practice became placed upon a firmer and
firmer foundation, and the empirics of that day seem to have laid the
true basis of our art. Their doctrine took at first a rapid growth, and
Galen spoke of it with great regard. The circumstances under which it
was proclaimed were most favorable for its propagation. Theories
had fallen into confusion; practice, methods, and opinions were
questionable. Everything was conjecture, and that which rested on the
evidence of facts was by the empirics received with enthusiasm. Although
founded on pure observation, it did not put an end to differences of
opinion, and in the eyes of the ancients it lacked in solidity, because
it did not attach itself to any philosophic theory then known. This
doctrine was then best able to captivate physicians on account of its
simplicity, contrasted with the general inability to satisfy speculative
minds; but for this very reason it subsequently fell into disgrace, and
the term "empiricism" became synonymous with ignorance. For centuries
condemned and despised, it was revived from its long humiliation under
the name of the Experimental Method, and achieved, after the labors of
Bacon, Locke, and Condillac, almost universal dominion in the sciences.
This doctrine had been proclaimed for about a century during the period
of which we now speak, but later led men into a fondness for secondary
generalities or for the elevation and magnifying of trifles, which
confused their minds and terminated its usefulness to science.
Meanwhile, a man of great intelligence, renowned as an
elocutionist, well{044} versed in the doctrine of philosophers and
grammarians--namely, _Asclepiades_, of Bythinia--came to Rome with the
intention of teaching rhetoric. By his talent and personal address he
soon became one of the most illustrious persons in the Roman Republic;
so early as 150 B.C. he enjoyed a high reputation as a rhetorician, and
was one of the intimate friends of Cicero; nevertheless, he abandoned
letters, undertook the practice of medicine, and sought moreover to
create a new system, being unwilling to follow in the track of his
predecessors. Imbued with the philosophy of Epicurus, who was then in
high repute, he deduced from it a theory which was in harmony with the
philosophy of the day. He thought that the elements of the body existed
from eternity; that they were indivisible, impalpable, and perceptible
to the reason only. These elements he named _atoms_, which were supposed
to be animated by perpetual motion, and from which, by their frequent
encounters and fortuitous contention, all sensible phenomena were
supposed to result. He explained the properties of the body by saying
that compounds were aggregates of atoms, differing very much from atoms
themselves. Solid silver, he said, is white, but, reduced to powder,
appears black; the horn of the goat, on the contrary, is black, but
if it be razed its particles are white. This, it will be seen, was
the parent of our present atomic theory. He ridiculed the theories of
Hippocrates concerning coction, crises, etc., and sarcastically called
the Hippocratic treatise on therapeutics "a meditation on death."
Asclepiades based his own therapeutics on endeavors so to enlarge
the pores of the human body that disease could find egress, or so to
constrict them that it could not enter; consequently he rejected
all violent remedies, such as vomits, purges, etc., and his favorite
remedies were hygienic,--for the most part bodily exercise.
A celebrated disciple of Asclepiades was _Themison_, of Laodicea
(b.c. 50), who was led by the teachings of his master to{045} lay the
foundation of the so-called _Methodism_ as opposed to _Dogmatism_ in the
school of Cos. By him and his followers a very arbitrary arrangement of
diseases was made, according to what they considered the constrictive,
or contractive; the fluxionary,--congested or relaxed; and the mixed
forms. From this division of diseases it appears that, according to
the methodists, there were only two kinds of therapeutic indications
to follow,--namely, to relax where there was constriction, to constrict
where there was relaxation. They, however, admitted a third creditable
result, which they called prophylactic; but the pure methodists, such
as Ccelius Aurelianus, admitted neither specific disease nor specific
remedies, and erased from their materia medica purgatives, diuretics,
emmenagogues, nauseants, etc.
According to the methodist doctrine, the study of medicine was so
abridged that one of its prominent exponents said that he felt able
to teach the whole of medical science in six months. It made rapid
progress, and consequently was most attractive to the numerous young
neophytes who were anxious to finish their apprenticeship and hasten
into practice. It is not one of the smallest of the services which Galen
rendered to his time and to posterity that he demolished the sophistry
of the methodists, demonstrated the insufficiency of their practice, and
brought to bear upon them the wittiest satire, calling them the asses
of Thessaly, alluding thereby to their lack of literature and medical
instruction.
In summing up, then, the basis for the various systems of medicine
during this period of antiquity, it is seen that the most ancient
doctrine of all--_Dogmatism_--directs our attention especially to the
animal economy in health and disease; that it took account of the union
of vital forces, of sympathies in the organism, and of nature's efforts
to repel both internal and external deleterious influences, which{046}
providential tendency manifests itself especially in certain acute
diseases. This was the strong side of dogmatism. Its weak side consisted
in this: that it was held that the causes of diseases inhere in the
access of certain qualities and humors along with organic forces,--such
as dryness or moisture in combination with bile or atrabile,--and the
treatment was directed against these supposed causes. It was on account
of this weakness that the enemies of dogmatism attacked it. The empirics
opposed the idea that inaccessible and occult causes of disease could
become the basis for rational treatment. They affirmed that there was no
consistent relation of antagonism or similitude between the disease and
the remedies which cured it.
The _Methodists_ somewhat improved on the doctrine of empiricism, but
ran wild in its improvement and erected over their fundamental theory
such a superstructure of secondary and tertiary generalities as to cause
the fundamental part to be entirely obscured from sight.
There were not lacking, in those days of old, certain educated
physicians who more or less vaguely comprehended that the entire truth
of medicine did not inhere in any one of these systems, but that there
was good and evil in each. These men, not being able to establish
general rules, tried to decide practical questions according to
their fancy or their reason. They assumed the name of _Eclectics_ or
_Episynthetics_, meaning thereby that they adopted no exclusive system,
but selected from each that which seemed to them best. They did not
constitute a sect, because they had no precise dogmas nor theories, but
they should not be confounded with the Pyrrhonians, who held to doubt
as a fundament doctrine, the true eclectic doubting only that which he
could not understand. True eclecticism in medicine, however, is
rather the absence of fixed principles, or, as Renouard says, it is
"individualism erected into a dogma, which escapes refutation because
it is deficient{047} in principle." Many became eclectics to avoid
discussing principles, and made of it a shelter. In one sense, then,
an eclectic is one destitute of profound convictions, who sides with
no particular party, is committed to no person or doctrine, and who
is often so indifferent that he cannot judge with impartiality;
consequently, to be truly eclectic is different from being an adherent
of a school of eclecticism.
During the historic period just reviewed, anatomy and physiology made
most progress, next internal and external nosography, and next to these
medical and surgical therapeutics, and although Coelius Aurelianus and
Aretæus have left to us by far the best books issued up to their times,
nevertheless not one of the writers of this period has achieved the
distinction in which Hippocrates is held, since he, perhaps more than
any other, combined intelligence, sincerity, disinterestedness, love of
his art, and humanity.
Under the classification of Renouard, already alluded to, the so-called
_Age of Transition_ includes centuries commencing with the death of
Galen, about A.D. 201, and ending with the revival of letters in Europe,
about the year 1400. The first period of this transition age is the
so-called Greek Period, which ends with the burning of the Alexandrian
library, A.D. 640.
At the time when this historic period commenced all the known world was
under the dominance of a single man. The power of Septimus Severus had
more extent than that of Alexander the Great, and bid fair to be of a
much longer existence. The Roman dominion, cemented by seven hundred
years of bold and persevering government, seemed almost immovable. While
the savages upon its frontiers occasionally troubled its peace, none
were strong enough to penetrate its centres or place it in real peril.
The great civil wars had ceased, or changed their object.
Both the{048} people and the senate, those two eternal competitors, had
gotten over the struggle for supreme power; monarchial government was
accepted as a matter of fact, and the citizens contended only for choice
of a master.
Similar changes had taken place in the domain of the mind; philosophical
discussions, which were so essentially a part of the schools of
the ancient Greeks, had nearly lost their interest and were being
discontinued. Such disputes as took place related less to principle
than to interpretation of the language of the teacher. In morals, Plato,
Epicurus, and Zeno were followed until the principles of Christianity
gradually supplanted their teaching; in physics and metaphysics the
authority of Aristotle, and in medicine that of Galen, were simply
undisputed.
Conditions being such as these, there was naturally but one sect
in medicine, and one method of study and practice. Medical science
retrograded rather than progressed, sad to say, and was undisturbed by
any remarkable revolution. The scepter of medicine passed from the hands
of one nation to those of another, and the language of Hippocrates and
Galen was later replaced, as will duly be seen, by that of Avicenna and
Albucassis. But this Greek Period, which is one of transition, offers
little for our consideration more than the lives and writings of four
of its most eminent physicians, who by their study in the school of
Alexandria, and by their writings and teachings, left reputations which
were sustained until the invasion of the Arabs. Of these it may be said
that, while they did little or nothing original, and simply commented
upon the writings of Hippocrates and Galen, they kept burning the torch
of medical learning which else had been almost extinguished by their
indolent contemporaries. Of these various commentators--for they were
little more than that--the first of any importance after Galen was
_Oribasius_, who was horn in Pergamos (328-403); he early attached
himself to the fortunes of Julian the Apostate, and followed him into
Gaul when he was{049} made its governor. Julian appreciated the good
qualities of Oribasius, made him an intimate friend, and after
he himself became emperor appointed his friend as quæstor at
Constantinople. After the emperor's untimely death, Oribasius remained
faithful to his memory, but his jealous colleagues so falsely and so
successfully misrepresented his fidelity that he was disgraced, spoiled
of his office and property, and banished among a barbarous people.
In this new field, however, he displayed such courage, effected such
extraordinary cures, discoursed so eloquently, and so attached to
himself the savage men around him, that he was by them regarded as a
god. The fame of this homage in time reached the ears of the Emperors
Valens and Valentinianus, who recalled him, reimbursed him for his
losses, and permitted him to enjoy his high reputation and fortune to
the end of his days. He was held to be the wisest man of his time,
most skillful in medicine, and the most charming in conversation. He
dedicated a collection of seventy books to Julian, his first patron, and
edited, at a later period, an abridgment of this work for the benefit
of his son. His principal merit consisted in reproducing the ideas of
others with such clearness, order, and precision that the summaries that
he gives of them are often preferable to the originals. What he has said
of pregnant women, nursing, and the earliest education of the child has
been copied literally by writers for twelve centuries since his time. It
must be said of him, however, that his prepossession in favor of Galen
was so great that he adopted servilely his ideas and even his words to
such an extent that he has been surnamed "the ape of Galen."
_Ætius_ was born in Mesopotamia in the year 502 and died in 575. He
studied at Alexandria, and afterward went to Constantinople, where he
became a chamberlain at court. Ætius was the first medical man of any
note who professed Christianity, as is shown by such passages as this
one: he said that{050} in the composition of certain medicaments the
following words should be repeated in a low voice: "May the God of
Abraham, the God of Isaac, and the God of Jacob deign to bestow upon
this medicament such and such virtues." In another place he recommends
that to extract a bone from the throat the following words be
pronounced: "Bone--as Christ caused Lazarus to come forth from the
sepulchre, as Jonah came out of the whale's belly--come out of the
throat or go down." But he exhibits the same credulity in not doubting
the miraculous virtues attributed by the quacks of his day to most
remedies.
Like Oribasius, he collected everything that he found remarkable in the
writings of his predecessors, and has preserved certain fragments
of antiquity which would otherwise have been lost. His work formed
a complete manual of medicine and surgery, except that it lacked
anatomical descriptions and references to dislocations and fractures.
_Alexander_ of Tralles (525-605), a city of Lydia, where Greek was
spoken, was a son of the physician Stephen, and the most celebrated of
five sons, who were all distinguished for their learning. He traveled
extensively, and fixed his residence in Rome, where he became
celebrated. He lived to an advanced age, and, being no longer able to
practice, composed a treatise of twelve books, exclusively devoted to
affections that did not require the aid of surgery. He professed the
greatest veneration for Galen, but did not blindly adopt his opinions.
He described the first reported case of excessive hunger and pain due to
intestinal worms; he advised venesection in the foot rather than in the
arm; but with all his sound judgment and mental enlightenment he had
faith in amulets and talismans, and widely recommended them. It may be
said for him, such was the universal prejudice of his age, the whole
world being plunged in superstition, that it was necessary for every one
to pay some tribute to the prevailing belief; and we may add that it is
necessary to make this excuse for some who practice much{051} nearer to
ourselves than did those ancient physicians.
_Paul, or Paulus_, surnamed _Ægineta_ (because he was born in the Island
of Ægina), was among the last of the Greek physicians who have special
interest for us. It is supposed that he died about A.D. 690. He traveled
extensively, and his skill in surgery and obstetrics rendered him
celebrated even among the Arabs, whose midwives sent for him in
consultation from great distances. He composed a compendium of medicine,
divided into seven books, and not only did not hesitate to borrow from
his predecessors, but quoted from them most extensively; a number of his
chapters were taken almost _verbatim_ from Oribasius; however, he made
no secret of it, but rather boasted that he had judiciously sought to
appropriate the best of the writings of those he most revered. He showed
originality, however, in the treatment of hydrocephalus, in advising
paracentesis of the thorax and abdomen, in the extraction of calculi
from the bladder, in the treatment of aneurism, the excision of
hypertrophied mammæ in men, etc. He was the first to describe varicose
aneurism, and the first to perform the operation of bronchotomy after
the method borrowed from _Antyllus_, of which he has transmitted a very
detailed account. Of this Antyllus, by the way, it may be added,
_en passant_, that he was one of the most distinguished and original
surgeons of antiquity. He flourished during the third century after
Christ; was the first to describe the extraction of small cataracts; and
is, perhaps, best known to the surgical world to-day by his exceedingly
bold plan of opening aneurisms, so successfully imitated a generation or
so ago by James Syme.
It has already been seen that before and during the early centuries of
the Christian era the secrets and learning of the physicians tended to
pass gradually into the hands of the priests. It was so in the temples
of ancient Greece, it was so in Alexandria, it became so in Rome, it has
been so even{052} in modern times, although only for brief periods
of time. This has come about in some measure from the cupidity of
the clerical orders, partly because it required a certain amount of
intelligence and knowledge to become a priest, and partly because, owing
to ignorance, credulity, and superstition, diseases have at all
times been regarded by the ignorant as evidence of divine wrath and
chastisement, or of diabolical or occult influences, rather than the
effect of natural causes. Hence men have turned ever toward prayers,
exorcism, and expiation, especially when exhorted thereto by the
priests. This has been the sacerdotal aspect of the practice of medicine
in all times, and when the priests have usurped therapeutic functions
they have done harm rather than good. So long as theology and science
work hand in hand, each redounds to the credit of the other, but always
in the history of man when theology has appropriated that which did not
belong to it it has brought ridicule upon itself and has delayed the
progress of knowledge. There have been frequent rebellions against
religious authority in ancient as in modern times. For instance, at the
commencement of the fifth century before Christ the Pythagoreans were
dispersed, and the doctrines of Cos and Cnidus--i.e. the Hippocratic
teachings--were promulgated; and again, in the course of events, when
the descendants of Æsculapius became servile attendants at the temple
and adjuncts to the priesthood or a part of it. At first, in Alexandria,
the physicians were supreme; their disciples, however, had the same
blind reverence for authority that too many workers in the field of
theology have evinced, and men once more practiced medicine on the
traditions of the past, and in so doing allied themselves more and more
to the temples in Rome. At first, the oldest and best instructed of the
relatives treated the diseases of his family as he understood them;
simply shared this duty with its other members. Cato, the censor, was
much engrossed with this domestic medicine;{053} he wrote a book in
which he recommended cabbage as a sovereign remedy in many diseases. He
venerated the number 3, as did the Pythagoreans; did not disdain to
transmit to posterity certain medical words which it was believed should
be repeated to assist in the reduction of dislocations and fractures.
This old censor seemed to have a profound hatred for medical men, and
most absurd ideas of their works and claims, although doubtless many
Greek physicians who came to Rome merited the invectives which he
launched against them. Then came Asclepiades, of Bythinia, as already
mentioned, whose talents were far superior to those of his Roman
contemporaries, and who did not need to call to his aid charlatanism and
deceit. This medical hero unfortunately had many worthless and dishonest
imitators, who appealed to superstition and ignorance in every dishonest
way, and who desired to be judged by the luxury and elegance they
displayed. Hence for a long time in Rome medicine was practiced without
license. The Emperor Anthony the Pious was the first to occupy himself
with regulating the practice of medicine. He granted certain immunities,
but did ask for proof of qualifications. A certain physician to Nero,
Adromachus, was honored by the emperor with the title of Archiater.--
i.e., royal healer.--but Galen, who was physician to Marcus Aurelius,
never bore it. From the time of Constantine the Great, however, the
title is frequently met with in the edicts of the emperors. In fact,
there were two sorts of these.--one named the Palatine, who belonged to
the household of the reigning monarch and who held high rank among the
nobility; and the other called the Popular Archiaters, who were
public-health officers. No one could practice medicine in the
jurisdiction of one of these without examination and authorization.
Those who transgressed this regulation were punished with a fine of two
thousand drachmas. The Popular Archiaters were pensioned by the city,
enjoyed certain privileges, and had to{054} attend the poor
gratuitously. Practitioners who were not members of the College of
Archiaters had no pay, no rights, nor emoluments. The Popular Archiaters
were elected by the citizens from many candidates who had proved their
capacity before the college of this medical organization. The evils of
medical anarchy were thus remedied; this happy condition existed until
the empire was broken up by barbarism.
It is during this period--about 400 A.D.--that we first find a class of
citizens to whom was delegated the duty of preparing drugs ordered by
physicians. Their duties were in some respects similar to those of our
apothecaries, although in attainment and in social position they were
far below the physicians. They were termed _pharmacopolists_.
It is worth while to stop a moment to inquire what were the medical
charitable institutions of antiquity. Even in the days of ancient Athens
there was a certain gymnasium, called the Cynosarga, in which abandoned
and illegitimate children were brought up at public expense until such
time as they were able to serve their country. A little later several
private institutions of this kind were established. Rome in her earlier
day never had such institutions. To be sure, she distributed provisions,
or else remitted taxes, to parents who were unable to support their
children, or even permitted them to destroy their newborn children when
unable to maintain them; but there were no bonds of sympathy which
induced the patricians to succor the plebeians in time of disease and
distress; slaves were cared for as were cattle. It is one of the debts
we owe Christianity that, under its influence, the first almshouses and
retreats were established in Rome. It has been said that the Emperor
Marcus Aurelius first instituted anything like a dispensary service in
the Sacred City. We are told, also, of an illustrious woman, St.
Pauline, living in the midst of the greatest wealth and pomp,{055} who
retired from society and devoted her life to charity and self-denial.
She went to Jerusalem, united with other Christian women of the same
mission, and formed, under the direction of St. Jerome, a sisterhood
whose members divided their time between reading sacred books and doing
good works. They offered an asylum for the faithful and a hospice for
the benefit of the indigent sick, and even established a home for
convalescents outside the city-walls. After the model thus set, heathen
emperors, Christian kings, and Moslem caliphs showed their zeal in this
good direction by the erection of sumptuous edifices and other rich
endowments for the relief of suffering human beings.
Reviewing now the Greek period, let it be remembered that in the time of
Galen animals were dissected, and that he made anatomical demonstrations
on monkeys; that sometimes the corpses of the enemy were rudely
dissected upon the field of battle, but that finally the practice of
dissection fell into disuse, and human anatomy was studied only from
books, the early Christians having evinced even more horror of the
dead body for the purposes of anatomical study than did their pagan
predecessors, while the Fathers of primitive times launched their
anathemas against the dissection of human remains. Here, again, as
usual, the interference of the church worked only general harm.
This abandonment of anatomy contributed doubtless to the decadence of
medicine; by the rapid extension of Christianity the pagan schools were
disorganized and broken up, the profane sciences (such as medicine)
were discarded, and the teachers still remaining in the old schools were
ruined. Passion for religious controversy was engendered and took the
place of study or original research, even to such an extent as to
hasten the fall of the Empire of the East. In addition to these factors,
reverence for authority of the past--that terribly oppressive weight
which has kept down so much which would otherwise{056} have risen early,
and which has been the greatest enemy of human learning--permitted the
explanation of natural phenomena to be sought only in the writings of
revered ancients, and not in living beings. No one dared to advocate
changes in regard to received doctrines, and there could be no such
thing as progress. Only two men in the lapse of four centuries showed
any originality; these were Alexander of Tralles and Paul of Ægina,
whose lives have already been briefly rehearsed. It is with some relief,
however, that we can think that this period, so unfruitful in scientific
progress, was not so in social amelioration. By the organization of
the institutions above alluded to charlatanism was checked, by the
requirement of capability and good character society was benefited, and
the charitable institutes of this epoch perhaps gave the world its
best models in teaching and an insight into the most valuable means of
medical instruction. Of the old Greek Period, then, we may say that it
accrues rather to the benefit of humanity than to that of science.
CHAPTER III.
_Age of Transition (continued).--Arabic Period: A.D. 640-1400. Alkindus,
873. Mesue, 777-857. Rhazes, 850-932. Haly-Abas, 994. Avicenna,
980-1037. Albucassis, 1122. Avenzoar, 1113-1161. Averroës, 11661198.
Maimonides, 1135-1204. School of Salernum: Constantinus Afri-canus,
1018-1085. Roger of Salerno, 1210. Roland of Parma, 1250. The Four
Masters, 1270 (?). John of Procida._
The Arabic{057} Period, which began with the second destruction of the
Alexandrian Library--640 A.D.--ends with the fourteenth century. At
the commencement of this period the Roman Empire of the West scarcely
existed: the magnificent territory which composed it had been overrun
and subdued by barbarous tribes from the forests of the North, while
from its ruins had risen several independent kingdoms,--that of the
Franks in Gallia, of the Visigoths in Spain, and of the Lombards in
Italy. The last of the Western emperors of note was Justinian, whose
army and generals--especially the genius and heroic devotion of
Belisarius--threw some glory upon Italy, Sicily, Africa, and Spain.
Meantime the Empire of the East, surrounded by enemies, and harassed
from all directions, still sustained itself with vigor. The Turks had
begun to show themselves on the banks of the Danube; those eternal
enemies of Rome--the Persians--made incessant war; and a new and
terrible enemy had sprung up in the deserts of Arabia. Then came one
who was at the same time legislator, prophet, and conqueror, and united
under one faith and one leader tribes hitherto divided and warring
against each other. Thus arose a powerful and enthusiastic nation,
animated by thirst for conquest and ardor for proselytism. In less than
a century after the first preaching of Mahomet, all of Arabia, India,
Syria, and Egypt were in the hands of his followers. In the year 640
Amrou effected the conquest of Egypt, seized Alexandria, and the
great library of five hundred thousand volumes was, by order of Omar
(successor to{058} Mahomet), delivered over to the flames; and the
historian Abulpharagius declares that these books served for six months
to heat the public baths, four thousand in number. Such were the first
fruits of the establishment of Islam. * Happily, zeal of proselytism
somewhat abated among the Mussulman princes, and religious fervor gave
place to policy; so that the later Arabian caliphs showed themselves,
in general, the protectors of the arts and sciences. Some, indeed,
endeavored to collect the _débris_ of the scattered treasures that
had been so fortunate as to escape the ignorant fanaticism of their
predecessors; and others, more tolerant even than the Christian princes
of the time, received without distinction all men of merit who took
refuge in their State, gave them employment, and recompensed them for
their services. On this account philosophers and persecuted "heretics"
sought an asylum among infidels, and found there the protection which
Christianity did not afford,--in return for which they gave their
protectors the benefits of Greek civilization.
* See a very vigorous denial of this historical statement in
The Nineteenth Century, October, 1894, page 555.
Of all the Moslem rulers, the most distinguished for love of learning
and general enlightenment was Haroun-al-Raschid, the Charlemagne of
the East, contemporary and emulator of the glory of the emperor of the
Franks, the hero of a hundred Arabic poems, whose dominion extended
from the borders of the Indus to the heart of the Spanish peninsula.
He embellished Bagdad, his capital, with schools and hospitals. His son
Almamon founded the Academy of Bagdad, which became the most celebrated
of the age; likewise spared no pains to draw to his court the most
illustrious men of all countries. He enjoined each of his ambassadors to
purchase all the writings of the philosophers and physicians that
could be found, and these he required to be translated into Arabic; his
interpreter, Honain, a Christian, was employed at translating for
forty-five{059} years, and received, for each book rendered into Arabic,
literally its weight in gold.
The eclat which the Moorish caliphs shed upon Spain from the tenth to
the thirteenth century is well known. The cities of Cordova, Toledo,
Seville, and Murcia possessed public libraries and academies, and
students from all parts of Europe flocked to them to be instructed in
arts and sciences; the library of Cordova alone embraced more than two
hundred and twenty-four thousand volumes. Thus it will be seen that
the dominion of mental and temporal affairs passed from the Greeks and
Romans to the Saracens.
Arabian medicine constitutes one of the most interesting chapters in the
history of our art. An offspring from Greek schools, it was for nearly
one hundred years the fostermother of that art, and, although it gave
rise to no great discovery nor wonderful step in advance during all this
period, it nevertheless kept alive all the learning of the past,
and clarified rather than made it turbid. In the sixth century the
Nestorians (followers of Bishop Nestor), having been driven out of
Syria, settled in Persia, Mesopotamia, and Arabia, and there founded
schools and other institutions such as they had had at home,--schools
in which, beside the ordinary philosophic studies, medicine received
a share of attention. Thus it came about that by the seventh century
Arabian physicians were everywhere known and in high repute. Naturally
the basis for their studies embodied the writings of Hippocrates, Galen,
Oribasius, and Paul of Ægina; and the first Arabian works consisted
solely of translations from the Greek, first out of their Syriac
rendering, and later from the originals. Indeed, so much eminence was
finally achieved by Arabian physicians that more than four hundred are
known by name as authors.
The first author deserving of mention was _Bachtischua_, of Nestorian
stock, celebrated in Jondisapur, director of the medical school, and
later physician to Caliph El-Mansur, in Bagdad.{060} Of his descendants
several became well known in the same field.
Alkindus--this being the Latin arrangement of his Arabic name--came from
a Persian family, who lived first in Basara and later at the court of
the caliphs El-Monon and El-Motasin, in Bagdad. He enjoyed a very high
reputation as physician, philosopher, astronomer, and mathematician, and
died A.D. 873. Mesue, the first of his name, sometimes known as Janus
Damascenus, was director of the hospital in Bagdad and physician to
Haroun-al-Raschid. He was born in 777, wrote extensively (since at least
forty of his works have been catalogued), and died in 857 in Samarra.
Serapion the elder, also sometimes known as Janus Damascenus, and whose
Arabic name was Serafiun, was born in Damascus--the exact data is
not known--and died some time prior to A.D. 930. He was author of two
volumes of aphorisms concerning the practice of medicine, which had at
his time the greatest repute.
The most celebrated of the early Arabian physicians was Rhazes, born in
the Persian province of Khorassan A.D. 850. According to the historians
of his nation he was a universal genius, equally famous in music,
astronomy, mathematics, chemistry, and medicine; he was surnamed "The
Experienced." At the age of fifty he was one of the most distinguished
professors in the Academy of Bagdad, where students came from great
distances to listen to him. Chosen from among a hundred colleagues to
direct the grand hospital of that city, he displayed indefatigable zeal
and most scholarly learning, even to his old age and in spite of loss of
sight, which overtook him at the age of eighty, when his reputation was
at its height. Two years after this misfortune--i.e., in 932--he died.
His generosity, which was proverbial, and his compassion for the poor
left him penniless at the time of his death. Some two hundred and
thirty-seven monographs of his have been{061} catalogued, though the
greater number of his works are practically lost. Two treatises on
medicine remain which afford excellent counsel in many respects; among
other matters he advises:--
"Study carefully the antecedents of the man to whose care you propose
to confide all you have most dear in this world,--that is, your life and
the lives of your wife and children. If the man is dissipated, is given
to frivolous pleasures, cultivates with too much zeal the arts foreign
to his profession, still more if he be addicted to wine and debauchery,
refrain from committing into such hands lives so precious."
His greatest publication was _Continens_--extracts compiled from all
authors for his own use--divided into thirty-seven books, constituting
an abridgment of the science of medicine and surgery up to his time;
and, notwithstanding its imperfect state, this work was held in greatest
reverence, and was a common source of knowledge among Orientals long
after his day.
Haly-Abbas, a Persian by birth, flourished fifty years after Rhazes, and
died A.D. 994. His _Almalelci_, in twenty volumes, constituted a quite
complete system of theory and practice of medicine, which, however,
was in large measure taken from Rhazes's _Continens_. It is generally
regarded as the best work of any of the physicians of the Arabic Period;
it is divided into three parts--a book on Health, a book on Death, and a
book of Signs--and it is interesting to know that the portion devoted
to midwifery and obstetrics was in the hands not only of the profession,
but also of the midwives.
Avicenna--Latinized form of his Arabic name, Ebn Sina--was born in
Bokhara in 980. From his earliest youth he manifested a remarkable
disposition for scientific study, and it is claimed that he mastered the
entire Koran at the age of ten years; also that he devoted his
entire days and the greater part of his nights to research, mastering
philosophy,{062} mathematics, astronomy, and, later, medicine, which
he studied at the university at Bagdad, in which city his talents were
chiefly exhibited. He was received at court, loaded with favors, and
elevated to the dignity of Vizier, but suddenly fell into disgrace, was
deprived of property, imprisoned, and even threatened with execution.
After two years, however, he was restored to liberty, and once more
possessed the consideration of the public and the court, becoming
the recipient of new honors. Meantime he had given himself up
to intemperance, by which his previously robust constitution was
undermined, and this, with excessive labor, brought about his demise
at the too early age of fifty-six, in the year 1037. He was author of
several books, the chief being the _Canon Medicinae_, which remained
a classic for six centuries, constituting the medical code of Asia
and Saracenic Europe; no author since Galen had enjoyed so wide and
extensive authority in the medical world; and in the various medical
schools professors, for the most part, confined themselves to reading
the _Canon_ from their desks, explaining and commenting upon its text.
The work was divided into five volumes, of which the first two comprised
the principles of physiology, pathology, hygiene, and therapeutics,
arranged to conform to the teachings of Aristotle and Galen; the third
and fourth dealt with treatment; and the fifth wras devoted to the
preparation and composition of remedies. Avicenna appears to have
surpassed in subtlety both Aristotle and Galen; he was fond of
metaphysical speculation, and his works were too much filled out with
subtleties of language rather than with true science. Authors of this
period were fond of torturing in every way possible the writings
which they undertook to edit or quote from, and, instead of devoting
themselves to original research, wasted time in seeking for vague and
hidden meanings. That man was most esteemed as learned who could see the
greatest subtlety in some passage from one of{063} the ancient writers;
consequently, that which was obscure or unintelligible was deemed the
most sublime and philosophic. A very brief study of the _Canon_, for
instance, will show this, while in graphic pictures of disease the work
by no means approaches those of Aretæus or Alexander of Tralles, for
Avicenna too often contented himself with mentioning merely a list of
symptoms without indicating in any way their progression, characters,
or duration. Undoubtedly just was the criticism of an Arabian poet: "His
philosophy had no sound foundation, and his medical knowledge availed
him naught for the possession of personal health and long life."
Albucassis was born in Zahra, near Cordova, about the beginning of
the eleventh century, and is supposed to have died A.D. 1122, at the
advanced age of one hundred and one. He was author of an abridgment, or
compilation, devoted to the practice of medicine, the only novelty of
which is a small portion devoted to surgery, in which are described
certain instruments. He says:--
"I have detailed briefly the methods of operations; I have described all
necessary instruments, and I present their forms by means of drawings;
in a word, I have omitted nothing of what can shed light to the
profession.... But one of the principal reasons why it is so rare to
meet a successful surgeon is that the apprenticeship of this branch
is very long, and he who devotes himself to it must be versed in the
science of anatomy, of which Galen has transmitted us the knowledge....
In fine, no one should permit himself to attempt this difficult
art without having a perfept knowledge of anatomy and the action of
remedies."
Not a word is said about dissections, however, from which we conclude
that they were not tolerated in his time. He resorted enthusiastically
to the cautery, and recommended it in spontaneous luxations and the
commencement of curvature of the spine. He refers particularly to
instrumental{064} delivery and the extraction of the after-birth, and,
when speaking of fractures and dislocations, he remarks: "This part of
surgery has been abandoned to men of vulgar and uncultivated minds, for
which reason it has fallen into undeserved contempt."
Avenzoar, born in 1113, of a Spanish family which had many illustrious
scions, was instructed in medicine by his father, and ultimately
achieved great celebrity throughout Spain and Africa; for a time he
lived at the court of the Prince of Seville, loaded with honors and
presents, and finally was made Vizier. Among other works he wrote
a treatise on renal diseases, in which he outlined the treatment of
calculus and described an operation therefor. He died in 1161.
Averroës (as he is generally known, though his Arabic name was Aben
Roschd) was born A.D. 1166, in Cordova, where{065} his father held
official position. After being grounded in philosophy, mathematics, and
other sciences he became a pupil in medicine under Avenzoar. The greater
part of his life wras passed in Seville, where he was greatly esteemed
and finally knighted. In 1195 he was called to the court of the King
of Spain and Morocco, in Cordova, where he received the highest honors,
only, however, through some misunderstanding, to be disgraced; but he
soon afterward recovered his former position and dignities. He wrote
extensively not only on medicine, but on philosophy, his writings taking
throughout a more or less dialectic character. He died in 1198, and
from him descended a number of physicians who achieved more or less
_Maimonides_ was born in Cordova, A.D. 1135. He early devoted himself
to the Talmud, and in his extended travels visited Jerusalem; he even
founded a school of philosophy in the East, which, however, had only a
brief existence. He died in 1204. He ranked higher in philosophy than
in medical art, and seems to have been imbued with the methods of his
teacher, Averroës, and is generally regarded as a theorist rather than
as a practical physician, although he wrote more or less on medical
topics, and is particularly remembered for an essay upon poisons. He was
about the last of the Arabians who deserves special mention.
During the period which was nearing its close at the time of the death
of Maimonides, the Arabs embraced with much ardor the study of medicine,
and translated into their language nearly all the treasures that had
been amassed by the Greeks; indeed, the preservation of many of the
great writings which would otherwise have been lost is due solely
to this fact. Strange to say, however, the Arabians neglected Latin
authors, and apparently possessed no knowledge of Celsus or Coelius
Aurelianus. As religious prejudices prohibited dissections, they were
obliged{066} to rely solely upon the anatomical descriptions of Galen,
and succeeded in increasing the errors of the original by inaccurate
translations. So far as originality of observation goes, the Arabians
were in most respects behind the Greeks; nevertheless, they were the
first to differentiate eruptive fevers, to which the latter paid little
or no attention. The Arabian school also supplied the knowledge of
purgatives, such as cassia and manna, which replaced the drastics
employed by the ancients; also the mode of preparation of syrups,
tinctures, distilled waters, pomades, and plasters.
While the Arabians were gradually rising by their power, intelligence,
and renown, the Greeks were declining in inverse ratio; the genius,
courage, and ancient virtues of the latter grew weaker and weaker, until
they seemed on the verge of extinction. In the medical history of these
centuries, in all Europe not under Moslem rule, there was but one man
entitled to mention as an author in medicine,--viz., John Actuarius,
the son of one Zacharia. He lived at the close of the thirteenth and the
beginning of the fourteenth century; was employed at Constantinople,
his surname being the honorary title of the court-physicians. He is more
commonly known as Zacharia. Of his life we know little, save that he
wrote several volumes, for the most part abridgments or commentaries on
the doctrine of Galen. He laid great stress on the theory of critical
days, and sustained his views by astronomical hypotheses most
ingeniously combined. His was the first Greek work in which were
mentioned the remedies introduced by the Arabians, yet he has not a word
to say of variola, measles, spina ventosa, and other affections fully
described by Arabic authors. He held remarkable views concerning
the nature of man, whom he supposed to be formed by the union of
two contrary substances,--the soul and the body; described somewhat
elaborately an imaginary plexus of veins connected with the
digestive{067} organs, through which the animal spirits were elaborated
and purified; also, and quite methodically, for his age, he explained
the functions of the animal economy and the etiology of disease.
While the clouds that befogged the study of medicine in the Empire of
the East thus grew heavier and heavier, we must not be blind to the
melancholy spectacle concerning the provinces composing the Empire
of the West. Barbarians in swarms, from the forests of Germany and
Scandinavia, had swept its various portions, pillaging, destroying, and
reducing to slavery its inhabitants. In southern Europe everything was
changed. Each generation witnessed some new and unheard-of invader, who
demanded his share of booty and renown and left a track of desolation
behind him. There was a brief period of order when Charlemagne reunited
under one dominion these divers races and seemed to have resuscitated
the Western Empire; but no sooner was he dead than its elements, being
devoid of affinity, broke apart. Former vassals, no longer restrained by
the firm hand of the emperor, made common warfare against his successors
and against each other, and for several ages there was nothing but a
succession of wars and invasions. Feudalism gave some sort of character
to this military anarchy by affording repose and, in a measure, security
for those who had hitherto been trampled under foot; but learning
and the sciences fell into complete neglect, and it was with great
difficulty that a very small number of men found within the pale of the
church a limited protection that enabled them to devote themselves
to the study of medicine and ecclesiastical law. Near the end of the
eleventh century, however, the enthusiasm of the crusades whetted anew
the turbulent appetite of the Christian barons, and led these lords of
western Europe, with their belligerent spirits, to the East, as a result
of which people hitherto oppressed could breathe more freely. A few
States recovered their{068} independence; some semblance of law was
established; municipal institutions were organized, and establishments
consecrated to public use were founded and multiplied; finally, in
the course of the thirteenth and fourteenth centuries, the cloud which
covered the face of Roman Catholic Europe was in some measure dispersed,
and men of talent and even genius began to appear upon the scene;
everything about them being so obscure, they shone like stars in
the firmament. In letters, for instance, there were Dante, Petrarch,
Boccaccio; in mathematics, Leonard, of Pisa, the first in Europe to
understand and employ figures and algebraic characters, although Cuvier
has claimed this distinction for Gerbert, a Benedictine monk of the
tenth century, who subsequently became Pope Sylvester II. At this time,
although in scholastic estimation medicine, theology, and philosophy
alone were fit to entertain the human mind, the natural sciences were
not without occasional representatives. Roger Bacon was three
centuries in advance of scientific reform, and endeavored to introduce
experimental philosophy, and so fully convinced some of his auditors
that they subscribed £2000 sterling to provide for the expense of
his experiments; this was money most happily employed, since it made
possible a number of important discoveries. It is said that Bacon
knew the properties of convex and concave lenses, and was the first to
conceive of the microscope and telescope; his astronomical knowledge led
him to demand a reform in the calendar, which Gregory XIII carried out
three centuries later; he had knowledge of gunpowder and its effects,
and was, in fact, the wizard of his day; but his boldness and
originality drew upon him the enmity of the church, by which he was
persecuted and finally condemned to imprisonment for life upon a diet of
bread and water, although he was ultimately released, in 1266, by Pope
Clement IV. He wrote extensively, but only fragments of his works
exist, since the friars believed{069} them tainted with witchcraft and
prevented their publication.
Before and during the time of Roger Bacon the philosophers were divided
into two parties, which engaged in very unseemly and unphilosophic
strife. One was termed the _Realist_, and believed, with Plato, that
ideas are self-existent and independent of the mind,--in other words,
veritable entities; the other, the _Nominalist_, held, with Aristotle,
that general ideas are pure abstractions formed by the mind with the
aid of sensations received from without, without which they could never
exist,--that is, if a being could be imagined without sensibilities and
the power of sensation, such being would be destitute of ideas. These
two parties kept up a very active warfare, and enlisted the aid of both
civil and ecclesiastical authorities, the result being persecution of
each other, and that general unsatisfactory conflict into which theology
and metaphysical speculation always force those who indulge in them.
Now, regarding the condition of medical affairs in the Empire of the
West: Down to the seventh century, in Rome, there were court-archiaters
who were attached to the retinues of the nobles, and in each large city
popular archiaters formed a college charged with sanitary matters, the
instruction and examination of candidates, and gratuitous services to
the poor. Although there is little definite information available, it
is probable that after the ruin of Alexandria much the same medical
organization obtained in those provinces as continued under the Greek
Empire at Constantinople. Under Arab sway we know very little of what
rules or regulations governed instruction in medicine and its practice;
and, so soon as one of these countries fell under the rule of the
Turks, all scientific institutions seem to have decayed or been
discontinued,--or, as Renouard states it: "If we may judge by what still
exists to-day in this unfortunate country (Turkey), consumed by the
power of ignorance{070} and despotism, the most complete anarchy
followed all older organizations."
In southern Europe, however, things had not gone on quite so badly,
although at first barbarous invasion caused everywhere disorder and
confusion, and the Christian States of the Western Empire yet presented
after three or four centuries a chaotic condition of affairs. The
ecclesiastical schools, which were under the care of the church, still
pursued courses of literary and scientific instruction; in the time of
Charlemagne, for instance, the colleges of the cathedrals, and even some
of the monasteries, taught medicine in a very limited way under the
name of physics. Thus all the liberal professions--that of medicine
included--fell under the domination of the clergy, and priests, abbots,
and bishops became court-physicians. The monks of Mount Cassin, of the
order of St. Benoit, enjoyed for a long time a great reputation for
medical skill; and among these in the tenth century was an abbot named
Berthier Didier, who became Pope Victor III toward the close of the
eleventh century, and one Constantine, surnamed the African. Of
the ecclesiastics who from the ninth to the eleventh century were
distinguished by the knowledge of medicine, there were Hugues, abbot
of St. Denis, physician to the King of France; Didon, abbot of Sens;
Sigoal, abbot of Epernay; Archbishop Milo, etc. Even several religious
orders of women undertook, to a certain extent, the practice of
medicine, and Hildegarde, who was abbess of the convent of Rupertsburg,
near Bingen, is credited with having written a treatise on _Materia
Medica_.
From the ninth to the thirteenth century the Jews shared with the clergy
the monopoly of the healing art. Many of these studied under Arabian
physicians, and, though the canons of the church forbade them to in any
way minister to the ailments of Christians, they were still called upon
in time of need, and even in many instances had access to the palaces of
archbishops, cardinals, and popes.
The education{071} of Christian priests and infidel practitioners
embraced really very little, and consisted, for the most part, of
knowledge of a few symptoms and possession of a few receipts; books were
excessively rare and expensive, capable teachers lacking, and a good
medical education out of the question. There was no law nor public
regulation which concerned the practice of medicine, and any who desired
could enter upon it; while besides the priests and the Jews--which
latter stood at the top of the scale--there was a multitude of
charlatans of the lowest order, such as barbers, keepers of baths, and
even a few women. The morality of this vulgar herd was on a level with
its knowledge. I have said the practice of medicine was not regulated
by law, yet Theodoric, King of the Visigoths, enacted a statute that no
physician should bleed a woman of noble birth without the assistance
of a relative or domestic; that if a physician in treating a patient or
dressing a wound happened to harm a gentleman he should pay a forfeit of
one hundred sous, and if the patient died from the operation he should
be handed over to the relatives of the deceased, who could do with him
whatever they pleased; while if he crippled or caused the death of a
serf, he was to be held accountable only for the loss, and compelled
to supply another. This remained in force from the sixth to the twelfth
century, and was made to apply chiefly to the practice of surgery, which
had been abandoned to individuals of the lowest condition. The practice
of internal medicine was, for the principal part, the privilege of the
clergy, and it is not likely the secular power ever expected that
one protected with the title of priest should be handed over to the
relatives of the dead. It furthermore appears that the practice of
medicine as divorced from surgery led to such irregularities in the
manners and conduct of the clergy that from the twelfth century popes
and councils of the church repeatedly forbade the medical art to those
in holy orders or under vows; but that this prohibition{072} was often
violated is shown by the frequent reiteration of inhibitory laws. During
the twelfth century the secular authority was also affected by abuses.
Roger, founder of the kingdom of Sicily, one of the first Christian
princes of the Middle Ages, gave special attention thereto, and in 1140
proclaimed that every one who wished to practice medicine must present
himself before a magistrate and obtain authorization, under pain of
imprisonment and confiscation of goods. Other sovereigns followed this
example, and regulating ordinances were gradually established, which
ultimately led to the institution of medical faculties and university
degrees.
During the Middle Ages, in the Empire of the West, arose the School of
Salernum, which became so celebrated that, like that of Alexandria, it
deserves special mention. The modern city of Salerno is situated on the
Neapolitan Gulf, about thirty miles southeast of the city of Naples,
with a population of but a few thousand souls. The ancient city stood
upon a height in the rear of the present town, where the ruins of its
mediaeval citadel are still to be seen. It first appeared in history
194 B.C., when a Roman colony was founded, was a municipal town of
importance, and appears even at this early day to have been a health
resort, since Horace informs us he had been advised to substitute
its cool baths for the warm ones of Baiæ. During the stormy centuries
following the downfall of the Western Empire, Salerno successively
submitted to the sway of the Goths, Lombards, Franks, Saracens, and
Greeks, as the vicissitudes of Avar compelled. Under the Lombards it
became the residence of the Duke of Benevcntum, and, in 1075, when
taken by Robert Guiscard of Normandy, it fell to the crown of Naples,
in consequence of which in the fourteenth century, the heir apparent of
this kingdom took the title of Prince of Salernum.
During the Middle Ages here flourished a medical school, important not
alone because of its celebrity at the time, but{073} for its effect upon
the medical history of the future. Its origin is obscure, though it has
been ascribed to Charlemagne in 802; again, its founding has been held
to be the work of fugitives from Alexandria when that city was captured
by the Saracens, 640 A.D.; some attribute it to the Benedictine order of
monks, others to Saracens, etc. The foundation by Alexandrian fugitives
is probably conjectural, yet it must be admitted there is some evidence
of knowledge of Arabian medicine in Salernum as early as this. Be the
origin what it may, it is certain that the Benedictine monks exercised
a very important influence upon this school, and there is considerable
reason to think that it was really originated by them. Their monastery
of Monte Casino was located about fifty miles the other side of Naples,
occupying the site of an ancient temple of Apollo; the rules of the
order enjoined the care of the sick and treatment by prayer, and St.
Benedict himself was credited with performing miraculous cures. The
rules which forbade public instruction were gradually discarded, for
in the ninth century Abbot Bertharius wrote two books on the art of
healing, and by the tenth century Monte Casino had acquired great
reputation as a medical school, and was sought by medically-inclined
monks from all quarters. A little later (1022) King Henry II, of
Bavaria, Emperor of Germany, is said to have been cut for stone by St.
Benedict himself, who appeared in ghostly form and operated with such
skill that on awaking the royal patient found the calculus in his hand,
and only the cicatrix of the wound through which it had been removed.
Of course, the grateful emperor could do no less than richly endow the
monastery, and bestow upon it additional privileges.
Desiderius, the Benedictine abbot from 1058 to 1086, and in the eleventh
century promoted to the papal chair under the title of Victor III, was
distinguished for his attainments in medicine and in music, and founded
a new hospital in connection with the monastery; he also composed
four{074} books detailing the miraculous cures wrought by his patron
saint. It was really within this monastery that Constantine the African,
one of the most learned men and the most famous Christian physician of
his time, compiled his numerous medical treatises.
About Constantine there is much of romance. He was born in Carthage in
1018 and died in 1085. He visited all the prominent schools of his day
in Egypt, Bagdad, Babylon, and even India, and for thirty-nine years
pursued the various branches of knowledge away from home. Returning to
Carthage, misunderstood and feared, he was accused of practicing sorcery
and compelled to fly to save his life. Disguised as a beggar he escaped
to Salernum, which had been recently captured by Robert Guiscard, and on
the recommendation of some royal visitor, who had known him at another
court, he was made private secretary to Guiscard. His new duties soon
became irkscme, however, and he retired to a cloister to devote himself
to literary labors. These, for the most part, were translations of Greek
and Arabic writings, often made _verbatim_ and without credit. Whatever
may be said about this lack of honesty, and the barbaric nature of his
Latin, credit must be given him for reviving the study of Hippocrates
and Galen in France; and he is generally credited with being the first
to introduce into Europe knowledge of Arabian medicine.
From Monte Casino the Benedictines at an early day spread to Salernum,
where, by the middle of the tenth century, three monasteries were
established, in all of which were kept holy relics. It now appears that,
although there may have been some previous institution of learning at
this point, and possibly even medical teachers, the real organization of
a regular school of medicine was due to the Benedictines. In the annals
of Naples of the middle of the ninth century the names of Salernian
physicians are mentioned; and it is known that toward the close of the
tenth century{075} Archbishop Verdun visited Salernum for relief from
vesical calculus, and there died.
The earliest medical writings of this school which have been preserved
are found in the _Compendium Salernitanum_, discovered in manuscript
form in 1837; and among the more prominent authors quoted are:
Petronius, who wrote about 1035; Gariopontus, who wrote about 1040;
Bartholomæus, Ferrarius, and Affiacius,--the latter a disciple of
Constantius Africanus.
The preaching of Peter the Hermit, which marked the close of the
eleventh century, was followed by an outburst of crusading enthusiasm
that quickly converted Europe into a vast camp, and Salernum, being
situated upon the highroad to the East, was benefited in no small degree
and its reputation as a medical school materially enhanced; likewise its
teachers gained in experience as regards military surgery. In this way
it became a favorite resort for crusaders when disabled, wounded, or
diseased. Robert of Normandy, son of the conqueror, returning from the
Holy Land, remained here for some time with a poisoned wound in the arm,
received in 1097 at the siege of Jerusalem, and it was decided it could
be healed only by sucking out the poison, a process deemed dangerous to
the operator. History declares that Robert's wife, daughter of Goeffrey,
Earl of Conversana, being denied permission, took advantage of her
husband's unconsciousness during sleep to withdraw the poison, when the
wound speedily healed. At the time of the departure of Robert, hastened
by the death of his brother William, John of Milan, the then chief of
the medical school, presented him with the famous _Regimen Sanitatis
Salerni_, said to have been composed largely for Robert's benefit.
This was a Latin poem that enjoyed most unexampled popularity for many
generations, and was the _vade mecum_ of well-educated physicians for
centuries. It is said to have passed through two hundred and forty
different editions, and that more than one hundred manuscript{076}
copies are to-day to be found in various European libraries. The latest
English version was published by Professor Ordronaux in 1871. A sample
is here submitted:--
"Salerno's school in conclave high unites
To counsel England's king, and thus indites:
If thou to health and vigor would'st attain,
Shun mighty cares; all anger deem profane;
From heavy suppers and much wine abstain;
Nor trivial count it after pompous fare
To rise from table and to take the air.
Shun idle noonday slumbers, nor delay
The urgent calls of nature to obey.
These rules if thou wilt follow to the end,
Thy life to greater length thou may'st extend."
During the twelfth and thirteenth centuries the glory of the School of
Salerno reached its zenith; it was the most famous school of medicine in
Europe, and was fostered by various kings. The celebrated Jew, Benjamin
of Tudela, traveling from Spain to India, visited Salernum in 1164, and
called it the "principal university of Christendom." Early in the
twelfth century flourished Cophon, Archimatheus, and Nicholas, surnamed
Præpositus, all of whom were distinguished teachers. The latter
published a work known as _Antidotarium_, which was for several
centuries the standard pharmacopoeia, and which contained a table
of weights that corresponded very closely to those of the modern
apothecary. The younger Cophon, who has been confounded with his father
(as both seem to have written extensively), wrote two treatises,--one on
the anatomy of the hog, the other entitled _Ars Medendi_. The first is
interesting as the only anatomical treatise of this school which has
been preserved, and is an index of the degradation of anatomical science
of that time.
The names of John and Matthew Platearius are of frequent occurrence
in the records of this school, and have given rise to considerable
confusion; the former is supposed to have{077} been the husband of
Trotula, a female physician, of whom I shall have more to say later.
Bernard the Provincial, who seems to have escaped the notice of most
historians, wrote about 1155, and his commentary offers much interesting
information concerning the therapeutics of the day; he formulated a
large number of recipes to enable the sick to escape the omnipotence of
the apothecaries, and recommended wine for the delicate stomachs of the
more exalted of the clergy, and, inasmuch as these stomachs did not
bear medicine well, he directed, in accordance with the practice of
Archbishop Æfanus, that emetics should be prescribed _after_ meals, when
their action is less injurious and more agreeable; he advised young men
and women tormented with love which they could not gratify to tie
their hands behind their backs and drink water from a vessel in which
a red-hot iron had been cooled. Indeed, his work is full of curious
information and advice, and is not without therapeutic interest.
A name which figures largely in the history of this school is that of
Magister Salernus, about which there is great uncertainty; it is not
positively known whether this refers to a particular person or is a
generic name covering various individuals. The name has been mentioned
as that of one of the four reputed founders of the school; it is
positive that there are certain treatises which bear this name, which
give an appearance of authenticity to it as an individual title.
In the latter half of the twelfth century lived John of St. Paul, one
of the teachers of Gilbert the Englishman; also Musandinus, who left a
curious treatise on dietetics; and Urso, who wrote on the pulse and on
the urine. Here in 1190 resided and studied a certain Alcadinus, from
Syracuse, whose knowledge of philosophy and medicine was such that he
acquired great reputation, and was made a professor; he even composed
Latin medical poems.
Just at the close of this century flourished Ægidius, who studied{078}
at Salernum, and also at Montpellier, where a school of medicine had
been founded in 1180; he was physician to Philip Augustus, of France,
and became professor in the University of Paris. Three treatises, all
in Latin hexameter, are ascribed to him. A contemporary was Johanes
Rogerus, of Palermo, a graduate of Salernum and author of several
Early in the thirteenth century flourished Roger of Parma, one of the
most distinguished of the alumni of this school and the earliest
pioneer in modern surgery; his work on this topic, familiarly known as
_Rogeriana_, enjoyed the greatest reputation in its day, and was for
a long time the surgical text-book of Italy; his predilection for
poultices and moist dressings in the treatment of wounds, abscesses,
and ulcers became, in the hands of his successors, the distinguishing
feature of the surgery of Salernum in opposition to the school at
Bologna, where Hugo Di Lucca and Theo-doric (his great rival) contended
for the superiority of the dry treatment. Roger was also the first to
use the term _seton_, and to give practical demonstration to this means
of derivation.
Roland of Parma, a pupil of Roger, and a surgeon of great distinction,
became professor at Bologna, and wrote a treatise on surgery, which was,
for the most part, a commentary on the works of his master. The treatise
of Roger and that of Roland furnished the basis for a work entitled _The
Treatise of the Four Masters_, supposed to have been written about
1270, and manuscripts of which have been long known in various European
libraries. It is divided into four books, displays no little surgical
ability, and from its title would appear to have been the joint
composition of four teachers; indeed, it was long attributed to
Archimatheus, Platearius, Petro Cellus, and Affiacius, though it is now
pretty generally understood to be the product of but a single pen and
its author most likely a Frenchman. The ascription of authorship to four
masters was probably for the purpose{079} of increasing its weight and
authority, and it constituted a reliable exposition of the surgery of
Salernum in its day. It is quoted quite freely by Guy de Chauliac,
who was the restorer of French surgery in the fourteenth century, and
occasionally by later writers.
Another of the distinguished Salernian physicians of the thirteenth
century, one highly esteemed by Frederick II, was John of Procida, who
also was active in producing--if not the real author of--the massacre of
the Sicilian Vespers, A.D. 1282. In a dispute concerning the question of
the two Sicilies he embraced the cause of Prince Manfred, for which he
was banished by Charles of Anjou, and took refuge at the court of Peter
III, of Arragon, by whom he was created a baron; and he was influential
in persuading the latter to assert his claim to the throne of Sicily.
By various intrigues at different courts he succeeded in organizing an
alliance, which betrayed its existence in this massacre, and finally
resulted in the overthrow of the French in Sicily and the transfer
of the island to the crown of Spain. He was author of at least two
treatises devoted to medicine and philosophy.
Other writers of the School of Salernum were: a learned Jew of
Agrigentum known as "Farragus," Matthew Sylvaticus, Graphæus, and
Cappola. About the middle of the fifteenth century flourished Saladino,
famous as an authority on materia medica.
It is of no small interest that now, for the first time in history,
women began to figure somewhat prominently as writers, practitioners,
and even teachers of medicine. About the middle of the eleventh century
appeared a work, entitled _De Midierium Passionibus_, attributed to the
before-mentioned Trotula, wife of John Platearius, which has descended
even to these days. There is nothing in the work to indicate the name
or sex of the author, who is invariably spoken of in the third person;
consequently Trotula's connection therewith has often been disputed.
It mentions{080} a certain "_aqua mirabilis_" composed largely of
brandy, which spirit is said to have first been employed medicinally by
Thaddeus of Florence, who died in 1295; there is also an account of a
patient who _wore spectacles!_ The diseases of women and children are
also largely dealt with. The work is undoubtedly an anonymous production
of the eleventh century, disfigured by additions of a later day, and
ascribed to Trotula, perhaps, because of the celebrity that attached
to her; at all events, it is the earliest work ascribed to a female
physician, and thus possesses special claims to interest.
Later we read of Sichelguada, wife of Robert Guiscard and a graduate of
Salernum, who endeavored to poison her step-son, Bohemond, in order to
secure the succession of her own child. This infamous plot was furthered
by some of the Salernian physicians, and thwarted only by the prompt
action of Guiscard, who swore he would slay his wife with his own sword
should the malady of Bohemond prove fatal.
Certain other female physicians of this period are mentioned, notably
Abella, who, in spite of the modesty that is supposed to hedge about
her sex, produced in Latin hexameter a work entitled _De Natura Seminis
Hominis_. Mercuriolus, in the fifteenth century, produced treatises
on the cure of wounds, pestilent fevers, and on the nails. The most
celebrated of all, however, appears to have been Calenda, who lived
during the reign of that notorious profligate, John II, of Naples
(1414-1435), and who was particularly distinguished for her personal
attractions. She graduated with great honor from the school at Salernum,
and soon after, in 1423, married a nobleman of the court, which
perhaps accounts for the fact that she never exercised the privilege
of authorship. A little later, Marguerite, of Sicily or Naples, also a
Salernian graduate, acquired an extended professional reputation, and
was licensed to-practice by Ladislaus, King of Poland.
Daremberg{081} informs us that there were numerous female physicians
at Salernum, much sought after because of their talents, and, moreover,
highly esteemed by the professors of the school, who freely quoted the
writings of their fair pupils and contemporaries; further, that they
employed ointments in paralyses; fumigations, vapors, and antimony for
coughs; and lotions of aloe and rose-water for swellings of the face;
they combined scientific knowledge with facetious playfulness in a
manner peculiar to the sex, in that they tendered unsuspecting beaux
bouquets of roses doctored with powdered euphorbium, and hugely enjoyed
the forced sternutations of their victims.
It will thus be seen what a wide-spread and long-continued influence
the school of Salernum exerted. At first physics and philosophy were the
principal branches taught, but later the other sciences were cultivated.
The Emperor Frederick II united the different schools of the city into
a university,--a term, however, that, as then applied, appears to
have corresponded to what in the nineteenth century is understood by
_corporation_. The emperor likewise published several decrees which
revised the duties and privileges of practitioners of medicine and
surgery in his kingdom, and, in 1224, ordered that no person should
practice within the two Sicilies until examined by the faculty of the
university and licensed at the royal hands; further, practitioners
were compelled to devote at least one year to the study of anatomy. The
faculty at this time consisted of ten professors, whose salary probably
depended upon the number of pupils. A candidate for graduation was
required to present proof of majority, of legitimacy of birth, and of
proper duration of preliminary study, and then was examined publicly in
the _Synopsis_ of Galen, the _Aphorisms_ of Hippocrates, or the Canon of
Avicenna. On passing he swore to conform to all the regulations hitherto
observed in medicine, to give gratuitous treatment to the poor, and to
expose all apothecaries detected{082} in adulterating drugs. A book was
then placed in his hands, a ring upon his finger, and a laurel crown
upon his head, when he was "dismissed with a kiss." The degree conferred
was that of "_Magister_"--the modern title of Doctor being at that
period employed almost exclusively to designate a public teacher or
professor.
But the watchfulness of King Frederick was not confined alone to
the regulation of medical study within his kingdom. The number of
professional visits, and the recompense therefor, were fixed by law.
Every physician was compelled to visit his patients twice daily, and
even once at night as well, if summoned, and for this attendance was
permitted a daily fee equivalent to fourteen cents for patients within
the city, while for calls without the city the largest legal charge was
one dollar and thirteen cents, provided he paid his own expenses.
The earlier teachings and practice of Salernum were a curious mixture
of methodism, dogmatism, and superstition. The latter may be better
understood when it is recalled that the practice of medicine for an
extended period was confined almost exclusively to ecclesiastics, who by
their very education were prone to superstition and upheld the efficacy
of charms and relics, and the active intervention of saints and martyrs
as well as the myrmidons of evil; hence arose many of the conflicts and
absurd notions peculiar to the period. The prevalence of the doctrine
of medical methodism was due to the character of the writings most
accessible to students of that day,--such as those of Ccelius Aurelianus
and others; and it is curious that Celsus, the most elegant of medical
authors, was never popular among medical monks. The Hellenic language
having almost disappeared from Italy by the sixth century, the works of
the Greek authors had become a sealed book to a vast majority, even of
the better educated; hence the purer sources of medical knowledge
were not available. Although the school of Salernum, at a later date,
prided{083} itself upon its devotion to the "Father of Medicine,"
the Hippocratic writings were not known at this period; and, when
Constantine the African, by the translation of Arabian works, introduced
a new element into the Salernian school, he ingrafted upon its medical
teaching a form of doctrine which found a congenial atmosphere, in which
it throve vigorously, while, a century later, the translations of Gerard
of Cremona gave a stronger impulse to the growth of Hippocratic medicine
than to Hippocratic doctrine.
From the _Commentary of the Four Masters_ we learn that Salernian
practitioners recognized the diagnostic importance of nausea, vomiting,
and the flow of blood from the ears in injuries to the head; that
they resorted to the trepan for depressed fractures and the relief of
intracranial extravasation; that hernia cerebri was treated by pressure
and caustics; that ligatures, both above and below the opening, were
applied for the treatment of wounds of the carotid arteries and jugular
veins. It was advised to decline patients suffering from wounds of
the heart, lungs, diaphragm, stomach, or liver, in order to avoid the
disgrace of losing them; and in penetrating wounds of the intestines and
in those complicated with protrusion of the wounded gut instruction was
given how to envelop them in the warm abdomen of a slaughtered animal
until natural color and temperature were restored, and then to insert a
cannula of alder-wood into the wounded intestine, which was to be neatly
closed and stitched; finally, the protrusion was to be carefully washed
with warm water and returned into the abdominal cavity, enlarging the
opening for this purpose, if necessary. Also was advised the extraction
of diseased teeth; and the operation of lithotomy was described with
considerable care. Compound fractures were to be treated with splints.
On the whole, this commentary of the alleged Four Masters is the most
interesting and ancient Salernian work which has been{084} preserved,
and is well worthy the attention of even modern surgeons.
Such was the school of Salernum in its prime, during the twelfth and
thirteenth centuries. My readers will not have failed to note how few
names have been mentioned which are prominent in medical history, and
how few improvements were made in medical art by those who have been
mentioned. One naturally inquires, then, what was the source of the
wide-spread fame of Salerno as a school, since it was distinguished
neither by notable discovery in science nor by celebrated teachers, and
the predominant element was doubtless one of obstinate conservatism and
unswerving devotion to ancient doctrines. Founded during the dark period
of the Middle Ages, at a time when ignorance, bigotry, and superstition
prevailed, it preserved, amidst the gloom that had settled upon Europe,
a few rays of that intellectual light which had shown so brightly in the
golden ages of Roman history. These rays, made more conspicuous by the
intellectual night which they barely illumined, were a beacon for
men who were groping for more light. Thus the name of Salernum became
synonymous with intellectual advancement in later ages. As the parent
and model of our modern university system, Salernum yet deserves, in a
measure, to enjoy the esteem of a numerous scholastic offspring. At a
time when priests were particularly active in passing off rudimentary
knowledge for the science of healing this school began to secure all
information possible from the laity for the progressive development of
medicine. It began, in other words, to hold aloof and then to break away
from the fetters of a fanatical church. Its decline, too, was as rapid
as its career had been brilliant. One very serious blow was struck
when, in 1224, Frederick II founded the University of Naples and forbade
Neapolitan subjects to seek instruction at any other university. The
next year a revolt in the city provoked the closure of the schools{085}
of Bologna, which were, however, opened again two years later. Within
a short time the universities of Naples, Montpellier, Padua, Paris, and
Bologna all entered into a contest for pre-eminence with a rivalry which
was not always generous. In 1224, it is said, the latter university had
no less than ten thousand students. Happily, however, the period of
the Renaissance proved to be one of emancipation from the fetters of
ignorance and superstition, making an appeal for liberty which the
conservatism of Salernum could not brook. Roger Bacon, in England;
Lanfranc and Guy de Chauliac, in France; Mondino, at Bologna, and
Savonarola, at Padua, found no rivals at Salernum to successfully
contest their fame. Thus this ancient school fell behind the age, and in
a short time sank into a mediocrity which was scarcely brightened by the
reflection of a departed glory. In 1342 Robert I renewed the decree of
Frederick II, which closed all the schools in his kingdom save those of
Naples, but excepted Salernum solely because of its antiquity and the
traditions of his predecessors. In 1413 King Ladislaus excepted the
Salernian alumni and professors from all taxes, duties, and tribute.
In the middle of the fourteenth century the poet Petrarch speaks of the
school as a memory of the past; but its last appearance was in 1748,
when a dispute at Paris relating to the rank of physicians and surgeons
was referred to Salerno's university for arbitration and final decision.
In 1811 a formal decree reduced this parent of all European universities
to a mere gymnasium or preparatory school; and now one may wander
through the streets of the modern town and among the ruins of its
ancient predecessor and seek in vain to trace some reminder of those who
were illustrious during some of the most terrible ages in the world's
history. No echo of tradition, no stone of ancient edifice, no library
preserving precious manuscripts, not even an edition of the old
Salernian regimen, in the whole city; in fact, none now so poor as to do
it reverence.
_Age of Transition (concluded).--The School of Montpellier: Raimond
Lulli, 1235-1315. John of Gaddesden, 1305--(?). Arnold of Villanova,
12341313. Establishment of Various Universities. Gerard of Cremona,
1187. William of Salicet, 1280. Lanfranc, 1315. Mondino, 1275-1327.
Guy de Chauliac, 1300-1370. Age of Renovation, 1400 to Present
Time.--Erudite Period, including Fifteenth and Sixteenth Centuries.
Thomas Linacre, 1461-1524. Sylvius, 1478-1555. Vesalius, 1514-1564.
Columbus, 1490-1559. Eustachius, 1500-1574. Fallopius, 1523-1562.
Fabricius ab Aquapendente, 1537-1619. Fabricius Hildanus, 1560-1634._
Although{086} I have taken up so much time with an account of the
school of Salernum, a few words must be devoted to the school of
Montpellier, which was second in time and in importance among the great
influences in the culture of western Europe. There was a time when to
have studied there lent a special halo of glory, for, being near the
sea, and in the vicinity of thermal baths, even so early as A.D. 1153 it
was famous as a school of medicine; moreover, those who presided over
it did not lapse unconditionally into mediæval philosophy, with its
bewildering subtleties. It is said to have been founded A.D. 738, but
first mention of it as a source of medical education occurs in 1137,
when Bishop Adelbert II, of Mayence, visited the city to listen to its
medical teachers. A faculty of philosophy was added in 1242, and one of
law in 1298. Within the walls of the city sojourned both Christians and
Jews, the latter being subject directly to the civil authorities, and
particularly esteemed as translators. One of the most famous of the sons
of Israel was Profatius Judicus, who became a rector of the faculty.
Prior to 1370, when the university became subject to the kings of
France, it was under the control of the Pope; and then, as now, the
school of medicine was the chief ornament of this ancient seat of
learning.
One of the most illustrious and famous pupils of Montpellier{087} was
that religious mystic and alchemistic visionary, Raimond Lull, or Lulli,
a would-be transmuter of metals and seeker for the philosopher's stone.
Born in 1234, at the age of thirty he began to see visions, and was
thereby roused from an atheistic tendency to soon become wonderfully
pious; ultimately he entered the order of Minorites, studied Arabic,
and appeared as a missionary in Africa, seeking to convert the
Saracens--who, however, declined the honor, and finally (in 1315)
rewarded his zeal by stoning him to death. Beside works on alchemy and
theology, he wrote on medical subjects, and, like all great minds of the
period, passed among the common people as a sorcerer in league with the
devil. Nevertheless, he was a notable figure in his age and country.
Quite celebrated became the compendium of Gilbert of England (1290),
which contained the same speculative nonsense, the same polypharmacy,
and the same superstition as other works of that time; what little it
contained of value was taken largely from other writers. While this
Gilbert, often known as Gilbertus Anglicus, was not the first English
writer on practical medicine, he was the earliest whose works have been
preserved.
Still more famous was John Gaddesden, physician-in-ordinary to the King
of England, professor in Merton College, Oxford, who wrote the famous
treatise known as _Rosa Anglica_, which appeared between 1305 and 1315.
This treatise was characterized by mysticism and disgusting therapeutic
measures, and tainted by medical avarice, superstition, and charlatanry.
Gaddesden was, perhaps, the first to formally recommend the "laying
on of hands" by the king for the cure of scrofula (first performed by
Edward the Confessor--1042-1056), whence comes the ancient name for
this disease,--i.e., "king's evil." *
*A special "Service of Healing" was used in the English
Church under Henry VIII, 1484-1509.
Arnold{088} de Villeneuve (1234-1313) studied seven years at
Montpellier, twenty years at Paris, visited all the universities in
Italy, then went to Spain to levy on the Arabian authors. He wrote on
medicine, theology and especially on chemistry--in which art he obtained
great renown both as an author and teacher. To him is due the discovery
of spirit of wine, oil of turpentine, aromatic waters, besides several
preparations of less note, and the introduction of chemical compounds
into therapeutics. His was a very stirring life, for he traveled
extensively; he became a teacher at Bologna, and physician to Peter III,
of Arragon. Shortly before his demise he went to Paris, having fallen
under the ban because of a declaration that papal bulls, far from being
sacredly inspired, were human works, and that acts of charity were
dearer to God than hecatombs, etc. He finally perished by shipwreck, but
the spirit of fanaticism followed him after death, for his volumes were
condemned by the Inquisition, because they commended experiments rather
than mere speculations. In spite of his general honesty in accordance
with the spirit of the times he inculcated deceit in medicine, and
one of his declarations is: "If thou canst not find anything in the
examination of the renal secretion, declare that an obstruction of the
liver exists. Particularly use the word 'obstruction,' since it is
not understood, and it is of great importance that people should not
understand what thou say est." He was one of the first to administer
brandy, which he regarded as the elixir of life--whence the modern _Eau
de Vie_.
Connected with this school, also, or well known as having studied there,
were many men whose names became more or less famous--among them John
Arden, who settled in London about the middle of the fourteenth century;
Vinario, a contemporary of Guy de Cliauliac, and the well-known surgeon
and anatomist Henri de Mondeville, who was a teacher of Guy de Chauliac.
But an idea of the doctrines prevalent in the medical literature of this
part of the{089} world, at this time, may be had from the fact that most
writers chose titles for their works after the style of ballad singers:
for instance, those describing the plague and venereal diseases were
called _Flowers and Lilies of Medicine_; the _Rosa Anglica_ of John
Gaddesden was another example. Matters had arrived at such a pass,
indeed, that men of science no longer hesitated to confess superstition
and mingle it openly with deceit, to oppose the interests of the most
needy, and to extort from their fellow-creatures fees in proportion to
their supposed ability to pay.
In the time of Charlemagne each cathedral possessed a school in which
were taught arithmetic, theology, singing, and sometimes medicine;
the Episcopal College had medical teachers who gave advice and dressed
wounds at the doors of the Church of Notre Dame, Paris; but when the
medical profession had been divorced from the sacerdotal by councils and
popes, many of these cathedral schools closed. In order to preserve the
jurisdiction which they for a long time had exercised over the learned
professions, many were erected into universities, and thus the clergy
gave instruction in philosophy, theology, and later in medicine. During
the thirteenth century arose many of the great universities in Europe,
notably those of Bologna, Padua, and Naples, in Italy; of Paris,
Montpellier, and Toulouse, in France; of Valencia and Tortosa, in Spain;
of Oxford, in England. Pope Innocent III by papal bull guaranteed
that the professors and students at Paris should be exempt from all
excommunications save those which emanated directly from the Holy See;
French sovereigns conferred many privileges upon the universities, and
soon the members of the University of Paris formed practically a second
city, with its own laws, customs, police, citizens, and magistrates.
Still, however, all science belonged to the clergy, and its teachers,
though removed from the cloister, were none the less Roman Catholic; so
that the popes reigned over the people through the parish clergy,
and over{090} the latter by the clerical teachers and professors.
Nevertheless, in all candor it must be acknowledged that these studious
men, thus associated together for mutual instruction and emulation
in learning, contributed, in a large measure, to elevate Christian
civilization above all others, though several generations were required
to secure the results calculated to make men celebrated; hence the
early periods of the universities developed very few names. Many were
conspicuous by their love of instruction, but not by originality
of research. Men undertook expensive and wearisome voyages without
encouragement or hope of reward, simply to obtain some rare manuscript
or to hear some renowned professor; and they appeal to us of the
nineteenth century by their devotion, if not by the results of their
Among the somewhat scattered and more or less eminent men of this
period was Gerard, of Cremona in Lombardy, a man of great purity and
studiousness, who arduously pursued all that Latin authors could teach
him, and, not being able to procure in Italy certain manuscripts which
dated from the time of Ptolemy, determined to go to Toledo in search of
an Arabian translation. At this time he was unacquainted with Arabic,
but soon mastered it, and--armed with this powerful resource, which
no other physician had possessed since the time of Constantine the
African--he could not see so many Arabic works devoted to all branches
of science as were gathered at the Spanish University without a desire
to translate and transmit the same to his own country; hence he gave the
remainder of his life to this work. He rendered into Latin the treatises
of Hippocrates and Galen, of Serapion, and of all the famous Arabian
authors from the time of Phazes, including the _Canon_ of Avicenna and
the work on surgery by Albucassis. He died at the age of seventy-three,
in 1187, at Cremona, and left all his books to the monastery of St.
Lucy, within whose walls he was buried.
William{091} of Salicet, born at Plaisance in the first years of the
thirteenth century, became a professor in the University of Bologna,
and later at Verona. He wrote extensively on medicine, and earned a
reputation as a surgeon that preserves his fame to the present day.
It is claimed that his status in medical literature depends, in large
measure, upon the fact that he was, perhaps, the first to refuse slavish
obedience to preceding authors, preferring, instead, to draw upon the
results of personal study and experience. He died in 1280.
Lanfranc, or Lanfranchi (according to whether one prefers his French or
Italian name), studied under William of Salicet. Of his early life very
little is known, save that he practiced surgery in Milan at the time
of the great dissension between the Guelphs and Ghibellines, and, for
attaching himself to the weaker party, was exiled and forced to seek an
asylum in France; he resided in Lyons for several years, and here wrote
a work on minor surgery; in 1295 he went to Paris on the invitation of
the faculty of medicine, opened a course on surgery which met with great
success, and then published a second and larger treatise on the subject.
It is said of him by Malgaigne that, less from his fault perhaps than
that of his age, after his death (about 1315) surgery began to decline.
From the time of Brunus, who practiced in Padua in 1250, the barbers
had done the scarifying and bleeding. After the time of Lanfranchi there
were others who applied leeches and often cauteries, and even the women
meddled with surgery and in all operations competed with the barbers;
the lay surgeons held themselves rivals to the clergy. Lanfranchi
inherited from his old master, William, an aversion for them all, and
often had to contend with uneducated and incompetent laymen. Clerical
surgeons regarded operations as beneath their dignity; and Lanfranchi,
who deplored this condition of affairs, confessed he had sometimes
bled with his own hands, but had never operated for ascites, hernia,
cataract, or stone.
John{092} Pitard has descended to fame not as a writer, but as the
founder of the surgical schools of St. Come and St. Damien, which occupy
so eminent a position in the surgical annals of France. In 1306 he was
surgeon to the King of France, Philip le Bel, and the sworn surgeon
of Chatelet. The College of St. Come, in 1311, was only a little
brotherhood of lay-surgeons, who gradually grew in importance as the
result of the obstinate struggles sustained,--on the one hand, against
the faculty of medicine, and, on the other, against the barber-surgeons.
Malgaigne has, with great patience and clearness, shown that the
importance of this body of men has been greatly exaggerated by
historians; he has traced their various turns of fortune from beginning
to end; I shall have occasion to consider them again farther on.
Mondino, sometimes known as Mundinus, born in 1275, became a professor
in the University of Bologna, and died in 1327. He was the author of
a celebrated treatise on anatomy, said to have reached twenty-five
editions, and which was the first of its kind since Galen. This science
had been greatly neglected; in Salernum, for instance, they were, for
a long time, contented with the treatise of Copho on the anatomy of
the hog, and most of the anatomical knowledge of the age was apparently
derived from this source; Mondino resurrected the study and pursued it
with interest and enthusiasm, though under the greatest difficulties.
His works for more than two centuries, along with the writings of Galen
and the Arabic authors, served for anatomical demonstration, although
very incomplete,--as witness the statement:--
"Beneath the veins of the forearm we see many muscles and many large
and strong cords, of which it is not necessary to attempt the anatomy
on such a corpse (i.e., a recent one), but on one dried in the sun for
three years, as I have shown otherwise, in developing the number{093}
and the anatomy of those of the superior and inferior extremity."
On the other hand, he took the opposite course to discover and
demonstrate the nerves, and advised maceration in running water. It
required almost superhuman boldness to substitute demonstrations on the
human cadaver for those upon swine, yet this was done by Mondino; and at
the time the prejudice against dissection was so general that for more
than a century after Mondino--who died in 1327--no one dared, at least
publicly, to emulate his example. It was in the year 1315 that he
publicly dissected the bodies of two women in Bologna. Anatomical study
was further complicated at this time by certain bulls of Pope Boniface
VIII, forbidding evisceration or boiling or cooking any part of the
human body; these deliverances were really aimed, not against scientific
investigation, but at the absurd custom introduced by the crusaders of
cutting up and boiling the bodies of their relatives who died in
infidel countries, in order to send them home for burial in holy ground;
nevertheless, the papal injunction certainly operated to discourage and
prohibit anatomical dissection, since nearly two hundred years later
the University of Tübingen was obliged to apply to Pope Sixtus IV for
permission to authorize dissection.
Guy de Chauliac, born in Gévaudan about 1300. was the most famous
physician and surgeon in Christendom during the Arabic period. He
studied at the cathedral college of Mende, which at that time was
quite celebrated, and was taught medicine at Montpellier under the best
masters of his day. It is probable, also, that he studied in Paris, and
certain that later, in Bologna, he saw dissections made. Dissatisfaction
with the writings of the ancients and the knowledge which he obtained at
the schools stimulated his own powers of observation, and he became,
in every respect, an original student and acquired a degree{094}
of erudition far more extended than that possessed by any of his
contemporaries. He practiced in various places, longest at Lyons; and
finally entered the service of Pope Clement VI, at Avignon, and probably
enjoyed the same honor under Innocent V and Urban V; when the latter was
made pope, in 1362, de Chauliac became his chaplain, or chapel-reader.
In 1363 he published a work on surgery called _The Inventory_, upon
which his fame chiefly rests, though several other volumes emanated from
his pen. None knew better than he how to unite respect for the ancients
with justice toward contemporaries, and he cited a large number of
Greek, Arabian, and Latin authors, some of whom are now utterly unknown.
The sciences, he declared, are "created by successive additions; the
same man cannot lay the foundation and perfect the superstructure. We
are as children carried on the neck of a giant; aided by the labors of
our predecessors we see all that they have seen, and something beside."
In tracing the character of a surgeon he recommends that he be "learned,
expert, ingenious, bold where he is sure, timid when in doubt, avoiding
bad cures and practices, being gracious to the sick, generous and
compassionate, wise in prediction, chaste, sober, pitiful, and merciful;
not covetous nor extortionate, but receiving moderate fees according to
the circumstances of his patients, the character of the case, and his
own dignity."
"Never since Hippocrates," says Malgaigne, "has medicine learned a
language stamped with such nobility and in such few words." Although
a follower of Galen, in anatomy he insisted on the necessity of
dissection, and proposed to make use of the corpses of executed
criminals for this purpose. The drawings made by Henri de Mondeville
were known to him; he divided abscesses into hot and cold, although
among the latter he included oedcma, tympanites, dropsy, scirrhus, and
other conditions. In practice he was more timid, yet more active,{095}
than Lan franchi, who never cut for stone, but left that operation
to the traveling surgeons. De Ghauliac described it as he had seen it
performed; he opened the abdomen for dropsy, did not hesitate to attempt
the radical cure of hernia, and operated for cataract. The plague which
raged during the fourteenth century and depopulated the known world of
one-fourth of its inhabitants, twice appeared in Avignon while Guy de
Chauliac was a resident there--and he acknowledges that nothing but
shame prevented him from fleeing. He remained at his post, visited the
sick, and was himself attacked and left for dead. "In this frightful
position he had sufficient presence of mind to follow the peculiarities
of his case, analyze his own sufferings, and to give a description
of them worthy of Hippocrates" (Renouard). His work soon became the
surgical code of Christendom, and was commented upon and translated into
all tongues, remaining for a long time a classic, and even at this
day it preserves much of its interest as representing the condition of
medical science at the close of the Middle Ages; moreover, its literary
style was much superior to that of any of his contemporaries, all of
whom wrote very barbarous Latin. He died about 1370.
With the death of de Chauliac terminates our interest, not merely in the
Arabian physicians and those who were intimately connected with them,
but in the so-called Arabic Period. It may be added, in passing, that
the followers of Mahomet, like those of Christ, erected by the side of
each of their mosques a school, and often a hospital, endowed with more
or less generosity by caliphs or the wealthy, who hoped to purchase
redemption and eternal happiness by such liberality.
A certain number of religious orders or communities were established
during the Middle Ages to give succor to the deserving sick, the
most widely known being those of St. Mary; St. Lazarus; St. John, of
Jerusalem; and the Daughters{096} of God. To be sure, some, through the
endowment of the opulent, became rich beyond all reason, and
departed from their primitive purposes, and thus not only excited the
covetousness of monarchs, but had even the temerity to resist their
authority. This compelled, every now and again, a suppression of some
order or institution--partly, perhaps, for laxity of morals, and
partly because of their turbulence. Of this period it may be said
that charitable zeal for the sick was never more pronounced; princes,
bishops, and popes gave examples of devotion by dressing with their own
hands the ulcers of lepers--and leprosy was in those days a frightful
disease, having been contracted by the crusaders in the Orient, and
everywhere spread as they returned, being, moreover, favored by the
miserable uncleanliness which was then so common. Ignorance, dread, and
fear rendered this disease worse than usual, and it was confounded
with other maladies less formidable. It has been estimated that in the
fifteenth century Europe harbored no less than nineteen thousand lepers;
and that the disease was a great terror is manifest by the excessive
caution taken against its spread: its victims were forbidden to enter
cities, and on the highway were compelled to stand aside lest they
should taint passers-by with their breath; even a healthy person
convicted of being touched by a leper was banished from society; any
infraction of these rules was punishable by death. It will thus be seen
what depth of genuine humanity it required to have anything to do with
one of these outcasts.
Another institution prevailed widely during these days,--namely, public
baths, which were established in nearly every city and increased to such
an extent that in the fifteenth century the bathers of Paris constituted
a powerful brotherhood, so powerful, in fact, that Jacque Despars,
physician to Charles VII, and one of the most renowned professors of the
faculty, for speaking openly against{097} the abuse of public baths, was
obliged to leave the capital to avoid persecution.
A study of the general history of the Arabic Period reveals that the
Arabs, previously obscure and uncivilized, emerged rapidly from the
demi-savage state, and took the first rank among the polished nations of
the world. During the earliest portion of this period these people were
religious vandals and destructive fanatics, but later embraced with
enthusiasm and persistence a study of the humanities, and endeavored to
repair their early ravages by collecting the _débris_ of the literary
and scientific monuments of Greece; but, though they cultivated medicine
with zeal and success, they added little to the Greek treasures. Later,
Arabia was overrun by hordes from the deserts of Tartary, a people yet
more barbarous and unknown, who established themselves in all parts of
the globe then under Saracenic dominion, and by their brutal despotism
degraded the Arabians to a condition approaching that from which
they had emerged. This seems to have been ever the result of Turkish
conquest.
Meanwhile the Greek nation, which was for so many ages at the head of
civilization, gradually lost its power, virtue, courage, glory, and
independence, and continued to descend, until now it exercises no
influence whatever on the course of events. During the course of the
Arabic Period only one Grecian physician merits mention on account of
his writings, and in these there was nothing-new except what he had
borrowed without credit from the Saracens.
The Empire of the West,--that is the western part of the ancient Roman
Empire,--after subjugation by barbarians from Germany and Scandinavia,
fell under a cloud whose darkness overwhelmed it. Its people, however,
gradually received new life by commingling their blood with that of the
invaders. Later they were able to repulse the Saracens{098} who poured
in upon them from Spain; then they turned their armies against each
other, and wrought mutual havoc and ruin for several centuries. Again,
roused by religious fanaticism, as had been the Mohammedans previously,
they rushed by thousands upon the plains of Asia Minor, Syria, and
Egypt, which had been for centuries occupied by the Arabs; and their
adventures and enterprises, and the new and varied scenes through which
they passed, gave rise among the "Francs" to some taste for poetry
and works of imagination During the twelfth and thirteenth centuries
governments became more stable, liberal institutions were created, the
rust of ignorance gradually disappeared, and by the end of the Arabic
Period there were really apparent brilliant streaks of mentality in the
horizon of the nations of Europe. In this progressive movement the
study of medicine shared. In the thirteenth century it was worthily
represented in Italy, in Paris, and became established in Montpellier.
Notwithstanding, up to this time physicians apparently only knew how to
timidly follow in the track of the Arabians, and approached little, or
not at all, in their studies, the purer lore of the Greeks.
THE AGE OF RENOVATION.
This Age of Renovation (extending from the commencement of the fifteenth
century to the present time, according to Renouard's classification) is
divided into the Erudite Period, comprising the fifteenth and sixteenth
centuries, and the Reform Period, comprising the seventeenth and
eighteenth centuries, and one should add, in fact, the nineteenth. In
general literature this age is known as that of the Renaissance, and is
one of whose beginning a great deal has been written, and so much better
than I can put it in this brief work, that to general sources I should
perhaps refer those who are interested in knowing how and why there came
about such a tremendous{099} change in methods and habits of thought and
in acquirement of knowledge. But it is the history of medicine that at
this time we particularly desire, and our minds must be, in some slight
degree, prepared for the great changes to be recounted by some, with
the conditions which brought about this revolution. It was truly an
awakening in every department of knowledge and along every line of
study; it was as if the minds of men had been dormant and lost their
power of receptivity, and, after a long period of torpor, awakened in a
new atmosphere amid new surroundings; as if there had burst upon them a
sudden appreciation of ability to do things hitherto undreamed of, and
to acquire knowledge such as hitherto had been possessed by none. Once
free from the shackles imposed by authority of the past, these minds
severed their Gothic bonds, and started forth in every direction with
the ardor of youth and the interest of novelty, all engaging in the
general enterprise of erecting from the _débris_ of antique science a
new temple to the mind in which to worship. While some delved among the
records of the past, others sought to bind the past and present, and
others, bolder yet, cut entirely loose from it, rejected all tradition,
and would fain have built this temple with entirely new materials.
Now, what led to this sudden awakening? Was it chance, or the effect
of certain causes which had long been operating'? It has been seen that
hospitals and various institutions, whose foundations were dedicated to
humanity, were erected in all parts of Europe; that gradually there
had come about a better social organization; that there had been a
diminution of conflicts between princes and their vassals, and the
relations between the two were more nearly at an equilibrium. Moreover,
the invention of the compass, which rendered long voyages less dangerous
and more frequent, opened up to trade regions hitherto inaccessible or
unknown, and attracted interest toward commerce as a means of pecuniary
gain. The telescope had been invented, and{100} astronomy was able to
seize upon some of the facts by it revealed, and thereby to make more
interesting calculations concerning the motions of celestial bodies,
and attain a knowledge of our solar system and its laws. Gradually the
microscope shed light upon the hitherto unseen; engraving on copper had
added its power of illustration to the works of the great writers as
they appeared; but above all, that which brought about this condition of
affairs was the discovery of the art of printing. The first attempts
in this direction were made between the years 1435 and 1440, and by
the united efforts of three men, whose names deserve mention so long as
their art persists,--namely, Guttenberg, Faust, and Shoeffer. Thanks
to them, the same information could be multiplied in manifold form
and transmitted to all parts of the civilized globe. In this way
intelligence and reason become triumphant; thenceforward the dominion of
brute force was broken, and knowledge, because capable of dissemination,
became imperishable.
At the commencement of the Erudite Period Arabic literature still
predominated in medicine. Rhazes, Haly-Abbas, and Avicenna were
universally invoked and explained. But a taste for Greek literature
began to prevail in the universities of Italy, and was finally extended
to every part of Europe, especially after the taking of Constantinople
by Mahomet II, Emperor of the Turks, in 1453. This disaster, which at
first bade fair to be a mortal blow to Greek literature and language,
strange to say, served only to hasten their resurrection in the
Occident. Constantinople having been given over to pillage at this time,
most of its learned men escaped, carrying with them all manuscripts that
could be seized; most of these found refuge in Italy, and enlightened
protectors in the allpowerful prince of the house of Medici, in
Florence, in the popes at Rome, and in Alphonso, of Arragon, King of
Naples and Sicily. Everywhere these fugitives spread the knowledge{101}
of the masterpieces of Greek literature and art, and in this way a taste
for books, libraries, and sound erudition was diffused, while the Greek
and Latin classics were hunted up and published with great patience
and ardor; thus the works of the old writers were edited, translated,
commented upon, and everywhere disseminated throughout Europe.
Among those who devoted themselves to the thankless task of editing,
and purifying from interpolations, the works of the classic writers was
Nicholas Léonicenus, born near Vincenza in the year 1428, who studied
medicine at Padua and taught it for more than sixty years at Ferrara.
He possessed great vigor of mind, with purity of manners and serenity of
soul, and was the first to translate directly from Greek into Latin
the aphorisms of Hippocrates and portions of the writings of Galen.
He combated in every way the infatuation of his contemporaries for the
Arabians and their lore, and called attention to many of the errors
of men who, like Pliny the naturalist, had fallen for lack of fully
understanding the Greek authors they compiled. At the ripe age of
ninety-six he died, regretted by all.
Thomas Linacre, of Canterbury, a contemporary of Léonicenus, though
younger (1461-1524), studied first at the University of Oxford, went
to Italy in 1484, and in Florence attracted the attention of Lorenzo de
Medici, who made him the companion of his own children, to whom he gave
the best possible advantages. In due time he returned to England, where
his talents speedily won him high station, and he became physician
to King Henry VIII, and later to Queen Mary. Linacre was the first
Englishman, it is said, who spoke purely the language of the Romans. He
translated several books of Galen that are still esteemed; and caused
the founding of two chairs, one at Oxford, the other at Cambridge,
whose incumbents were charged with the duty of explaining the works of
Hippocrates{102} and Galen. But he is most entitled to the gratitude of
his countrymen for his influence in founding the College of London. To
appreciate properly its importance and his merits, we must remember the
obstacles that had to be surmounted; for at that time bishops alone
had the right to accord, in their own dioceses, permission to practice
medicine, and, consequently, the healing art was abandoned entirely to
monks and illiterate empirics. It was well that Linacre had influence at
court, else he could never have obtained the reform of such overwhelming
abuses; but he triumphed in spite of powerful opposition, and secured
the issue of letters patent which prohibited the practice of medicine by
any one who had not received a degree in one of the two universities in
the kingdom, and been examined by the President of the College of London
assisted by three others. This was the achievement which gave this
learned man the title of "Restorer of Medicine" in England.
Léonicenus and Linacre, who were of the early Erudite Period, also merit
mention not merely because of literary talents, but because they were
the first eminent physicians to embrace the study of Greek classics,
and to propagate the knowledge therein contained. Subsequently others
followed the same course,--too many, in fact, to be enumerated; but it
was easy to follow after such leaders. From the time when men began
to realize the superiority of Greek models over prolix Arabian
commentaries, they were anxious to seek the light at its source, and
applied themselves with avidity to the study of the originals. At this
time copies of Greek authors were few in number and in a deplorable
condition, owing to neglect. To rediscover them, to purify, to eliminate
what was not original, to rearrange, and finally to multiply by the aid
of the printing-press was an extended labor requiring great knowledge,
rare sagacity, and commendable patience. One of the greatest
publications in medical literature belonging to this epoch was a
complete edition of the Hippocratic writings, translated{103} into Latin
by Anuce Foes,--a poor, but learned, practitioner, who lived on the
products of his business as pension physician in the city of Metz,--and
issued from Frankfort-on-the-Main in 1495. To this master-work Foes
consecrated forty years of his life. Another treatise belonging to this
same time, less important, perhaps, from a medical point of view, but
nevertheless showing great erudition, was a treatise on the gymnastics
of the ancients, by _Jerome Mercurial_ is, a work said to be not less
precious to historians than antiquarians. It was by such intense zeal
and hard labor that true erudition was restored in Europe.
Following now some of the special branches of medical learning and their
development, let us look first at anatomy and physiology. I have already
related the salient points of the life and labors of Mondino, of whom
it is said that, about the year 1315, while professor at Bologna,
he dissected the bodies of two women, and shortly after published an
epitome of anatomy illustrated with wood-cuts. Also has been mentioned
the prohibition of anatomical study pronounced by Pope Boniface VIII, in
1300. It was only toward the close of the fifteenth and the early years
of the sixteenth century that this prejudice began to abate; the popes,
who then stood at the head of scientific movements, withdrew their
interdictions, and the universities of Italy gave public dissections.
Achillini, Benedetti, and Jacques Berenger dissected at Bologna, Padua,
and Pavia, previous to the year 1500; soon afterward their example was
generally followed.
Jacques Dubois, whose name was Latinized into Jacobus Sylvius, was born
in 1478, in a village near Amiens; he studied in Paris, where he worked
most industriously at anatomy, which later he was so successful in
teaching. He was the first to arrange all the muscles of the human body,
to determine their functions, and to give names to those of them which
had not yet been so designated. He discovered{104} the valves of the
large veins, and was the first to study the blood-vessels by means of
colored injections. He gave the same careful attention to pharmacy, and
in Paris, before a large class of students, began lectures, on anatomy,
physiology, hygiene, pathology, and therapeutics; these he continued
until the faculty, on account of jealousy, interrupted them. He then,
in 1529, went to Montpellier, but returned two years later to become a
member of the faculty, and once more lectured with the greatest eclat.
Later yet he became a successor to Vidius in the Royal College,--a
position he retained up to his death in 1555. His medical writings were
extensive and marked by great accuracy, while for anatomy he did a great
deal, contributing much to popularize it. He dissected a great number
of animals and as many human cadavers as he could procure, the number,
however, being small. Unfortunately, he subordinated all his own
research to the authority of Galen, being himself among those anatomists
who permitted themselves to be so far misled.
The man of genius and courage, who accepted the truth of what his eyes
revealed to him, and who was the true reformer in anatomy, was Andreas
Vesalius, born at Brussels, in 1514, of a family already illustrious
in medicine. He studied at the University of Louvain, where he early
revealed the inclinations of the anatomist, since in his leisure moments
he was wont to amuse himself in dissecting small animals. Near Louvain
was a place where criminals were executed; and Vesalius, having observed
the body of one from which the soft parts had all been cleaned away by
ravenous birds, only the bones and ligaments remaining, detached the
extremities separately, and then carried off the trunk by night, thus
possessing himself of his first skeleton. Attracted by the fame of
Sylvius, lie afterward went to Paris to become his pupil, but, not
content with the lessons of his master, continued to observe for
himself. On the hill Montfauçon, where executions{105} took place, he
disputed with dogs and vultures for the remains of criminals, or by
stealth disinterred bodies from the cemeteries at the greatest personal
risk. So great was his application that his progress became rapid,
and at the age of twenty he gave instruction to fellow-students; at
twenty-two he became Professor of Anatomy at Padua, being appointed
by the Senate of Venice; at twenty-nine he issued his great work on
anatomy, which showed a completeness that left far in the rear all that
had hitherto been published on this subject. The following year he was
called by the Emperor Charles V to the court of Madrid, then the most
brilliant in Europe, where he became the first physictan, and from this
time abandoned his anatomical labors.
He was the first who dared to dispute the words of Galen and point
out his errors,--to ascertain that the greater{107} part of Galen's
descriptions, having been made from monkeys, did not correctly represent
human anatomy. This audacity raised a crowd of vehement opponents, the
least reasonable and most fanatic being his old master, Sylvius; but
even these onslaughts could not conceal the truth. The minds of men
generally were ripe for the revolution whose signal-fire was thus
lighted, and no sooner did Vesalius appeal from the decision of Galen
to observation of nature than a crowd of anatomists were ready to follow
his method. He died in 1564.
One who, at Padua, had been first his pupil, then his
co-laborer,--namely, Columbus, born at Cremona in 1490,--succeeded him.
Columbus criticised, in some respects, the statements of his eminent
predecessor, which he could better do, since he is said to have
dissected fourteen bodies every year, as well as to have practiced
venesection. He came so near to discovering the mystery of the
circulation that it is strange how he could have missed it. He even
appreciated the systole and diastole of the heart and the connection
thereof with dilatation and contraction of the arteries. He knew,
also, that the pulmonary veins conducted arterial blood, and that the
pericardium was a shut sac. He even appreciated the lesser circulation,
since he described how the blood left the right side of the heart and
passed into the lungs, and came back through the veins into the left
ventricle; because of this discovery, and in spite of his utter failure
to appreciate the greater circulation, he has been by some regarded as
entitled to the credit which is universally given to Harvey. From his
position as teacher in Padua Columbus was called to Pisa, and from Pisa
to Rome, where he died in 1559.
Another of the great anatomists of this period, second only in fame
to Vesalius, was Eustachius, born about the beginning of the sixteenth
century. He became physician to the Duke of Urbino, and in Rome a city
physician and professor of anatomy, continuing to teach in the latter
city until{109} overtaken by his final sickness. He was a defender of
Galen rather than an opponent, and sought to shelter his reputation from
the attacks of Vesalius. In his praise it must be said that, for his
day, he was a great anatomist; his chief discoveries were in the domain
of comparative anatomy. He brought to bear upon his work a knowledge of
embryology which enabled him, for instance, to describe the kidneys and
the teeth much more accurately than would otherwise have been possible;
he noted, also the pathological changes in bodies dissected, and is
brought daily to our minds as we think of the connecting channel between
the pharynx and the middle ear, to which his name has been given.
He died in 1574.
Fallopius, born in Modena, in 1523, was professor successively at
Ferrara, Pisa, and Padua. He cultivated anatomy with the greatest ardor,
and, in consequence, his name is also linked with that of Vesalius,
as are those of Herophilus and Erasistratus in the history of ancient
anatomy. His anatomical researches included all parts of the human body,
and his name has been given to the tube through which the ovum enters
the cavity of the uterus. Death overtook him in the year 1562.
Jerome Fabricius, better known as _Fabricius ab Aquapendente_, was born
in the town of the latter name, near the southern end of the Apennines,
in 1537, received his no early{110} education in Padua, and studied
anatomy under Fallopius, whose assistant he also was. After the death
of the latter he succeeded to the professorship of anatomy, and later
built, at his own expense, a large anatomical theater, in which he
lectured and demonstrated to students from all parts of the world.
Toward the end of his life he had accumulated a large number of
specimens, and published extensively on anatomy, embryology, physiology,
and surgery. Though often accredited with discovering the valves of the
veins, he is not entitled to that honor, since Erasistratus, Sylvius,
Vesalius, and others had previously described them, Estiennes had seen
them in the azygos veins, and Canano in other veins. His true claim to
glory rests upon embryological researches, which he was the first to
undertake in a comparative way. In _De Formato Foetu_ he elucidated
the development of the embryo and its membranes by a long list of
observations on lower animals of many species. He was probably the first
to describe the uterine decidua. Fabricius died in 1619.
This Fabricius must not be confused with the almost-as-renowned
Fabricius Hildanus, who was born in Hilden, near Düsseldorf, in 1560.
Under the German name of Wilhelm Fabry he became widely known as a
surgeon, and, after traveling through France, settled in Hilden,
but later moved to Cologne, where he founded an academy. His first
treatise--on gangrene and sphacelus--quickly made him known, and went
through eleven editions. From Cologne he went successively to Genf,
Lausanne, and Polen; returned to Cologne; and finally, after several
other visits, settled in Bern, where he died of gout and asthma (in
1634.). His frequent changes of location were, perhaps, less the result
of instability than a testimony to his reputation, inasmuch as he was
invited from one place to another. He has been, with propriety, named
the "German Paré," since he rendered such great service to German
surgery,{111} and was not only an expert therein, but likewise a
cultivated physician and polished humanitarian; in fact he was ahead
of his time, by many years, in these regards, as is shown by his
recommending amputation in cases of gangrene, and his writings
concerning gunshot wounds. He enjoyed a ripe experience also in
obstetrics, and even instructed his wife in the obstetric art and
praised her ability most highly. His most important contributions
to literature were in the field of surgery, and these passed through
numerous editions, while his opinions and practice are quoted even
to-day.
During this epoch many modifications were introduced and improvements
made in the teaching of medicine. Permanent amphitheaters were
established for dissection, and chairs of anatomy created, their
incumbents being paid out of the public treasury. The popes, appear to
have taken the initiative in this respect,{112} which accounts for the
great number of subjects with which Eustachius was supplied, as compared
with Vesalius, who obtained only two or three in a year. Up to this
time _the razor had been the sole instrument of dissection_, but was now
replaced by the scalpel, which remains in use to-day. By the labors of
the few men mentioned anatomy acquired a degree of perfection which it
had never attained under the Greeks. Skillful artists put their
labors upon paper, and plates and descriptions made from anatomical
preparations represented the various parts of the human body with more
fidelity than had been supposed possible. Nerves, tendons, and ligaments
were no longer confused, but traced so far as possible from origin to
ramifications. Ancient errors generally were corrected. It was proven
that there was no bony structure in the tissue of the heart, that the
partition between its cavities was not porous; and attentive examination
of its valves led to the discovery of the lesser circulation by
Columbus. Michael Servetus, whom John Calvin burned at the stake, was
perhaps the first to note this phenomenon. He saw that the blood could
not penetrate directly from the right into the left cavity of the heart,
but that it was necessary for the whole fluid to pass through the lungs,
where it became impregnated with the vital spirit of the atmosphere, and
reached afterward the left auricle; the position of the valves in the
pulmonary arteries and veins clearly confirmed his conjecture. Moreover
the size of the pulmonary arteries was enormous, and disproportionate
to the quantity of blood necessary for the nutrition of the lungs,
which seemed to prove that this was not, as had been believed, the
sole purpose of those vessels. It was about this time that Fabricius ab
Aquapendente pointed out valves in veins in various parts of the body,
and that Columbus and Andreas Cesalpinus explained more fully the
mechanism of the lesser circulation; in fact, the former so closely
approached an appreciation of the{113} purpose of the vascular system
that some have thought he really knew it, but the passages in his
writings thought to sustain this opinion are not at all conclusive. He
seems to have confused the action of the heart during sleep with that
during the waking hours; and although he realized that the blood could
not flow backward through the arteries, that the vena cava was the only
vessel which permitted the entrance of blood into the heart, and though
he spoke of anastomosis between arteries and veins and remarked that if
a band be applied around a limb the veins swell below the ligature, he
contented himself with comparing the motion of the blood with the flux
and reflux of Euripus, as Aristotle had done. It is even thus that
he tortured his mind in trying to reconcile two irreconcilable
theories,--i.e., the opinion of the ancients on the motion of the blood
and recent discoveries in the anatomy of the vascular system.
CHAPTER V.
_Age of Renovation (continued).--Erudite Period (continued): Benivieni,
11502. Jean Fern el, 1497-1553. Porta, 1536-1615. Severino, 1580-1656.
Incorporation of Brotherhood of St. Come into the University of Paris,
1515. Ambroise Paré, 1510-1590. Guillemeau, 1550-1613. Influence of the
Occult Sciences: Agrippa, 1486-1535. Jerome Cardan, f 1501. Paracelsus,
14931541. Botal, born 1530. Joubert, 1529-1583._
In the{114} domain of pathology the Arabs had added only a very small
number of observations to those contained in the works of Galen. The
most interesting of these pertain to eruptive fevers. Most of
their writers contented themselves with making an inventory of the
acquisitions of the past, as did Guy de Chauliac, and this was about all
they could do under existing circumstances; although they did not make
discoveries, they prepared the way for their successors.
Two men about this time did a great deal in the direction of creating
a desire for post-mortem study of cases, and in illustrating and
succinctly describing symptoms.
The first of these was Benivieni, a Florentine, who died in 1502--the
date of his birth being uncertain. To him, more than to any other, we
owe the commencement of the study of gross pathology and pathological
anatomy. He was the first to consider the knowledge that might be
obtained by opening bodies for the sole purpose of ascertaining
the location and cause of the diseases from which they had died. As
Malgaigne remarks: "A eulogy which he merits, and which he shared with
no other person, and which has not been accorded to him up to this time
by the many historians of surgery who have superficially searched among
these precious sources, is that he was the first who had the habit,
felt the need, and set the useful example, which he transmitted to his
successors, of searching in the cadaver, according to the title of his
book, for the concealed causes of disease." The work referred to by
Malgaigne was{115} entitled: _Concerning Some of the Secret and Strange
Causes of Disease_ and was published in Florence in 1507. It is poor in
quotations, but rich in original observations, which pertain especially
to the etiology of disease, and gives a very concise symptomatology and
history of each affection of which it treats, as well as a pathological
explanation. Benivieni's observations on gall-stone, on the anatomical
lesions of heart diseases, and on the conveyance of syphilis from
the mother to the foetus were original, as well as many observations
concerning the presence of worms and other parasites in the body.
He did not limit himself to dissection of his own cases, but sought
autopsies in the cases of others. He examined the bodies of those who
had been hung, always thinking to find in them something of interest.
In this regard he was followed by one already mentioned,--namely,
Eustachius.
After these two the men who most cultivated pathology and anatomy in the
sixteenth century were Rembert Dodoens and Marcellus Donatus. The former
was born in 1517, in Mecheln, traveled extensively, was physician to
Maximilian II and the Emperor Rudolph, and died in 1585. The latter
lived and worked in the latter half of the sixteenth century, the dates
of his birth and death being somewhat uncertain.
The next man whom we must mention is one who did a great deal for
internal medicine, pathology, and anatomy. Jean Fernel, who has been
surnamed "the modern Galen," was born in Clermont in 1497. Even as a boy
he showed great aptitude, and very early made himself a reputation in
philosophy, law, and mathematics. In 1530 he was received as doctor,
with the unanimous applause of the entire faculty of Paris. He seems to
have been stimulated by this only to more extended study; in fact,
so hard did he work at his studies that his friends became seriously
alarmed for his health, and remonstrated with him; they received
for reply: "_Destiny reserves{116} for us repose enough_." He became
physician to King Henry II, of France, and in the midst of a very
extensive practice undertook to collect all the medical knowledge
scattered in the Greek, Arabic, and Latin works, in order to form from
it a body of doctrines. His work was written with a purity and elegance
of Latin that reminds one of Cicero. Throughout its pages he was
philosophic, and sought to unite the apparently irreconcilable doctrines
of Plato and Aristotle.
He divided medical science into three great sections,--physiology,
pathology, and therapeutics. In his explanations of disease he was too
often fanciful, following the speculations mainly of Galen, and making
free use of the hypotheses of humors, temperaments, vital spirits,
etc.; but the following statement of his would do credit to a trained
pathologist of to-day: "As for myself, I shall never believe I have
profound knowledge of any affection if I do not know positively, just
as if I could see it with my eyes, in what part of the human body is
the disease, its primitive seat, what suspicion of organic lesions
constitute it, whence it proceeded, if it exists idiopathically or by
sympathy, or if it be kept up by some exterior cause. He who pretends to
be a rational physician must sound each of these subjects, and discern
them by certain signs." The problem which he thus set himself he
certainly, for his own part, considered as solved, although it was not
long before his solutions were set aside and the original uncertainty
reappeared.
In therapeutics he very early laid down the fundamental maxim that every
disease must be combated by contrary remedies, justifying this by every
species of argument, amounting to this: that every disease must be
combated by its contrary because all that cures a disease is contrary
to it. This was, in part, the doctrine of "_Contraria contrariis
curantur_"--the antithesis of the equally absurd sophism: "_Similia
similibus curantur_" which three hundred years later was erected into an
excuse for the foundation of an{118} alleged new school. There can be
no doubt that Fernel rendered very great service to his time and to
subsequent generations, despite the fact that his recommendations and
statements were too often founded upon sophistry.
Just here we must digress for a moment to consider the status of
bleeding. Hippocrates and Galen had advised to bleed largely from the
arm on the affected side in pleurisy and pneumonia. That practice was
gradually abandoned as Greek traditions were lost sight of, and finally
the Arabs substituted for it something entirely different,--namely,
pricking a vein in the foot in order to let blood flow drop by drop.
Their method prevailed throughout Europe until the commencement of
the sixteenth century, or about the time when Fernel appeared upon the
scene. A Parisian physician named Brissot had revived the ancient (the
Greek) practice during an epidemic of pleurisy, and had obtained thereby
astonishing success, which he hastened to publish, commending the method
employed. He thus created a great uproar in the medical world. The
innovation found foes and defenders, and disputes grew warm, even to
the fever point. Finally, the ancient method was generally revived, and
Fernel accepted it.
Felix Plater was born in 1536, in Basel, Switzerland, and died in 1614.
He had several sons who made their mark in medicine. In his large work,
which preceded that of Fernel, he took perhaps the first step in an
unexplored route,--namely, in the classification of disease _according
to the totality of apparent symptoms_. Defective as this classification
appears in our eyes, its author lived a long life as a very
distinguished practitioner and professor in his native town.
Giovanni Batista Porta was born in Naples in 1536, traveled extensively
in Italy, France, and Spain, and founded in 1560 an Academy of the
Segreti. He was accused of magic, and was compelled to refute the
charges in Rome.{119} He died in 1615, having been one of the leading
scientists of his time, and the founder of modern optics. In the first
edition of his _Magia Naturalis_, published in Naples, 1587, is found
the first description of the camera obscura,--of course, in a very
incomplete form and without lenses.
Severino was a celebrated surgeon of Naples. He was born in 1580, in
Calabria, studied in Naples, became a doctor in Salernum, and then
became professor of anatomy in his native town. For a long time the
victim of intrigue and of persecution by the Inquisition, he was finally
driven out of Naples, but was called back by the populace. He then
became the most celebrated teacher of his time, writing extensively on a
variety of subjects. He died in 1656 of the plague, an epidemic of which
was at that time raging in central Italy.
Arriving now at the surgery of this Age, we find that matters were more
chaotic than in other departments of medicine, and for reasons which are
easily given and appreciated. While, ordinarily, external diseases are
more easily discerned than internal, and while in a corresponding degree
they can be more satisfactorily treated; while, in other words, external
pathology has ordinarily taken precedence of internal in professional
as in lay minds, this view seems to have been inverted for a time
during the Middle Ages. Previous to the period now under discussion the
sciences had generally declined in Europe, and surgery had fallen even
lower than medicine, for the reason that medicine was in the hands of
the priests, who had at that time something of a liberal education,
while the practice of surgery was abandoned to a class of ignorant
barbers, bathers, and bone-setters. No mechanic or artisan could take as
an apprentice any youth without a certificate affirming his legitimate
birth, and that he came from a family in which there were neither
barbers, bath-keepers, shepherds, nor butchers. Among the men who were
thus made social outcasts{120} were those into whose hands most of the
surgery of the fifteenth century fell. This was particularly the case
in Germany, and other European countries were little in advance. We have
seen that in France and in Italy Lanfranc and Guy de Chauliac did their
best to rescue surgery from the hands of these men, but their efforts
did not prevent it from being completely abandoned by the clergy, who
devoted themselves to the practice of medicine.
When we come to inquire the reason for this--in other words, why an
art so useful as surgery, and one which made such requirements
for knowledge, sagacity, and dexterity, whose necessity was almost
continually felt, particularly during these troublous times of
almost constant warfare, should be so neglected by men who could best
comprehend its utility and respond to its requirements--it is difficult
to find a satisfactory answer. The social condition of the times sheds
some light upon the question. The nations of southern Europe were
socially divided at that time into the nobility, who were nearly always
at war; the clergy, who monopolized learning and filled the so-called
liberal professions; and, finally, the common people, who were common
prey for both the other classes, and who yet had to support both without
having any privileges of their own. While the practice of medicine was
a clerical right, the canon of the church prohibited physicians from
drawing blood, under pain of excommunication; and hence surgery, shunned
by the priests, to whom it naturally belonged in connection with the
practice of medicine, fell into the hands of the ignorant and vulgar,
who practiced it in a purely mechanical way, without knowledge or
appreciation of its possibilities. In addition to this, there was an
almost total lack of detailed and precise anatomical knowledge, and but
small reason to expect that the ignorant practitioners of surgery would
feel the need of such knowledge. Moreover, most of the operators were
itinerants, going from city to city, stopping so long as they had cases
to operate upon or until{122} some reverse forced them to depart. Most
of these men limited themselves to one or two sorts of operations. Some
operated for cataract, others for stone, others for hernia, nearly every
one having a secret method which was transmitted to his posterity as a
In the history of medicine certain family names of itinerant operators
have been preserved; for example, the Branca, the Norsini, in Italy, and
the Colot in France.
Under such conditions there could be no such thing as the profession
of the surgeon. The prejudice against dissection did not begin to abate
until the thirteenth century, when a very few of the clergy dared, in
a very timid manner, to perform surgical operations. Their numbers
increased in the course of the fourteenth and fifteenth centuries, and
in the sixteenth had become considerable. Most of the great anatomists
of that period--such as Benivieni, de Carpi, Vesalius, Fallopius, and
Fabricius ab Aquapendente--were great surgeons.
In due time it came about that while the clerical physicians were
willing to descend to the rank of operators, the lay-surgeons aspired
to the rank of doctors of medicine. This transformation took place
especially in France, the only country where at that time there was a
special college of surgeons--the small Brotherhood of St. Come, already
alluded to, which was always contending against the faculty on one hand
and against the barber-surgeons on the other, with varying results, and
which, at last, sought peace with the university and was received by it.
This took place in 1515, and was the renaissance of surgery, not only
for Paris, but for the whole world. By this reunion the faculty acquired
authority over the barbers, who were admitted to their lectures and took
courses in anatomy and surgery, gradually attaining a knowledge which
entitled them to be called barber-surgeons; their rights were not
curtailed, but made more difficult of procurement, for, in addition
to passing their initiation for the privilege of becoming
barbersurgeons,{123} they also had to pass an examination before the
physicians and the two surgeons of the king, at Chatelet, for the right
to practice surgery. The surgeons, as the price of their submission to
the faculty, had, beside the university privilege, a sort of supremacy
over the barbers; and thus it happened that the barbers were admitted to
the rank of surgeons at St. Come, and that the surgeons of St. Come were
admitted as barber-surgeons by the faculty of medicine. In this double
capacity they approached nearer the profession of medicine, from which
they should never have been separated, while surgery became an art which
received numerous improvements. We must now devote a little time to the
consideration of at least two or three of the men who most contributed
to extend and elevate it.
Among those who most contributed to make the period of which we are now
speaking a glorious one, raising himself from the lowest walks of life
to the attainment of the highest professional honors, is Ambroise Paré,
whose name will never die while the art of surgery is taught. Paré was
born about the year 1510, at Laval, of poor parents. He was an early
apprentice to the provincial barber-surgeons, after which a natural
ambition for improvement led him to Paris (about the year 1532), where
he studied three years at the Hôtel-Dieu, and obtained the confidence of
his teachers to such an extent that he sometimes operated for them. He
never learned Latin, the language at that time of the books and of the
schools. Paré was most fond of recalling his hospital experience; he
counted it among the highest honors of his life that he should have
enjoyed what he there did enjoy, and gives us to suppose that he was
a favorite upon whom peculiar favors were conferred. In one of his
writings, a physician of Milan having expressed astonishment at so young
a man's knowledge, he remarks with pride: "But the good man did not
know that I had been house-surgeon for three years at the Hôtel-Dieu de
Paris." The functions of the barber apprentices in the hospital{124} in
those days were probably to make dressings and bleedings, and sometimes
post-mortem examinations ordered by the chiefs, to assist the latter in
their operations, and to act in case of emergency; in other words, to
do about as the _internes_ at present do. They probably found there a
precious and rare opportunity for anatomical dissection, but it does not
appear that they had regular clinical instruction.
Communication between master and pupil depended absolutely on the
pleasure of the former.
In 1537 Paré was made surgeon to the Colonel-General of Infantry, René
de Montijean, with whom he made his first campaign in Italy. (This was
in the army which King Francis I assembled in Provence with which to
repulse the invasion of Charles V.) He had never seen war nor recent
gunshot wounds, and only knew of them by what he had read in the
writings of John de Vigo. This was at{125} a time when it was the custom
of surgeons to pour boiling oil into every amputation or other wound
in order to check haemorrhage; and Paré's experience in this, his first
campaign, put him in the way of his first discovery,--a discovery which
will never be forgotten. He has recounted in his _Book of Arquebus
Wounds_ and in his great _Apology_ how after the affair of Pas-de-Suze
he watched the other surgeons, dreaming of nothing else but to imitate
them as far as he could; how the boiling oil gave out; how his anxiety
about it prevented him from sleeping; and how to his great wonder he
found that the wounded who had submitted to the operation suffered more
than the others. This set him to thinking, and led him, a young man
without name or authority, without letters or philosophical studies,
to observe, to reason, and to combat a doctrine which was universally
admitted and which the highest surgical authorities of the day
sustained. At that time all authors who had spoken of gunshot wounds
considered them as poisonous and complicated with burns; consequently
they gave the precept to cauterize with boiling oil or a red-hot iron,
and at the same time to administer certain alexipharmics which should
serve as internal antidotes. John de Vigo, physician to Pope Julius
II, assures us that the danger of these wounds results from the round
formation of the balls, from heat, and from the poisonous qualities
communicated to them by the powder. His theory and the method of
treatment above given had been adopted without contradiction until the
day when Paré dared to utter the first protest against them.
After a campaign of three years, in which he lost his master, he
returned to Paris and married. In 1543 he was in the army of Perpignan,
in the service of de Rohan, grand lord of Brittany, where he gave
continuous proof of his sagacity. It was after this campaign that
his reputation, so well established among warriors and the nobility,
inspired Sylvius with the desire of seeing him. Paré has recounted{126}
how, in a conversation which they had together, he insisted upon the
then entirely new precept, of which he had made many applications, that
in order to extract bullets it was best to place the wounded in the
position in which they were at the moment of injury.
Sylvius,{127} then at the height of his fame, invited the young
physician to dinner, and listened to him with great attention while he
explained his views on gunshot wounds, which made such an impression
upon the mind of the host that he besought him eagerly to write them out
and make them public. Encouraged by this advice from so high a source,
Paré prepared his text, illustrated it, and in the year 1545 brought
out his little work, which marked in a manner so glorious the revival of
French surgery. It was published by Gaulterot, the sworn bookseller
of the University of Paris, and was entitled "_The Manner of Treating
Wounds made by Arquebuses and other Fire-arms, and those made by Arrows,
Darts, and the Like; and also by Burns made Especially by Gunpowder_.
Composed by Ambroise Paré, Master Barber-Surgeon in Paris."
A few months later appeared the second edition, in which he still
recommended the actual cautery in haemorrhage; but each day he meditated
upon the subject, and on one occasion discussed it with two surgeons of
St. Come, submitting to them the idea that, since ligatures were applied
to veins and arteries, and to recent wounds, there was nothing to
prevent their being equally applied to amputations. Both agreed with
him, and opportunity soon presented itself at the siege of Damvilliers,
when a gentleman had his leg crushed by a shot from the fortress. Paré
made an amputation, omitting for the first time the use of the cautery,
and had the happiness to save his patient, who, full of joy at having
escaped the red-hot iron, said he had got clear of his leg on very good
terms. This was, in truth, the actual renaissance of surgery, which had
been to that time a torture, but which became thereafter a blessed art.
It was a barber-surgeon who produced the double marvel. This took place
in 1552.
In 1554, after other campaigns, Paré was made, without examination,
Master of the College of St. Come, and in 1559 was included among the
surgeons of King Henry II (who{128} was killed in a tourney, in Paris,
in 1559)r which position he retained with Francis II and Charles IX. The
latter raised him to the highest position among his surgeons, and King
Henry III retained him, which caused the witty and true remark that the
kings of France transferred him to their successors as a legacy of the
crown.
Many anecdotes are related of Paré to show the remarkable esteem in
which he was held by public and private citizens. For instance, in
October, 1552, one of the most eminent generals of Charles V laid seige
to the city of Metz, and the emperor came in person to join the army.
Within the walls of this beleaguered city were gathered nearly all the
nobility and princes of France. The city was defended by the Duke of
Guise, and the besieged soldiers were at that time suffering alike from
the attacks of the enemy, the results of the siege, and the rigors of
a frightful winter. The duke had established two hospitals for the
soldiers, and had put into requisition the barber-surgeons of the
city, giving them money with which to furnish their supplies. But these
surgeons were sadly incompetent against the combination of unfavorable
circumstances, consequently nearly all the wounded perished, and a
horrible suspicion was roused among the soldiers that they had been
poisoned. Under these circumstances the duke dispatched one of his
captains to the king to say that the place could hold out for ten
months, and asked at the same time for fresh medicine. The king sent for
Paré, gave him money, directed him to take all the medicine he thought
necessary, and furnished him a letter to Marshal St. Andre, who
commanded in Verdun, and who bribed an Italian captain for fifteen
hundred crowns to introduce into the besieged city the celebrated
surgeon. The expedition was perilous, and Paré himself would have
willingly remained in Paris. But he entered Metz on the 8th of December,
at midnight, without an accident. Having passed already sixteen years in
war, he was{130} known to the chiefs and common soldiers. The day after
his arrival, the duke, who knew how to strike the imagination, presented
him on the ramparts to all the princes, lords, and captains, who
embraced and received him with clamor. By the soldiers he was received
with shouts of triumph. "We shall not die," they exclaimed; "even though
wounded; Paré is among us!" From this time the defense was conducted
with renewed vigor, and it has been universally conceded that to the
presence of this single man the city was indebted for its salvation. The
siege itself was not raised until after a terrific conflict. On the very
day of Paré's arrival he began to treat the leg of one of the prominent
officers, who for four days had been in charge of a charlatan, and had
suffered horrible tortures. The next day he decided to trephine another,
who had been struck on the head by a fragment of stone, and who had been
insensible for fourteen days. Both patients recovered.
The little brotherhood of surgeons of St. Come were ready to seize on
every circumstance which might redound to their advantage, and desired
to have within their ranks the man who enjoyed such great renown. They,
therefore, admitted him to an examination, in spite of the statute which
required that the candidate should understand Latin, and in spite of
opposition by the professors of the university.{132} They not only
admitted him to all their degrees, but awarded him a reception,--a
hitherto unknown honor.
Description of Fig. 17.--A, the instrument named, on account
of its figure, lizard's beak; in Latin, "_rostrum lacerti_."
It is used to extract balls which have been flattened or
imbedded in bone. A displays particularly the cannula. B,
hinge, by means of which the lizard's beak is opened and
closed as much or as little as the surgeon wishes. C, the
rod which opens and closes the lizard's beak. When drawn
upon it closes and when pushed it opens the instrument. D,
dilator and mirror: in Latin, "_dilatatorium,
speculum_." The instrument is somewhat roughened and
dentated in order to take a firm hold of whatever it grasps.
It may serve two purposes: first, to dilate and enlarge the
wound so that it may be seen to the bottom, and also to make
way for some instrument, as pincers or crow's beak, and to
grasp more easily and withdraw the foreign body; secondly,
it may itself serve to extract the foreign body,--e.g., a,
double-headed ball; b, a small chain; c, c, some pieces of
mail. E, E, crane's beak; in Latin, "rostrum gruinum." H2,
H, duck's beak; in Latin, "rostrum arserinum." K, sound. L,
ball-extraetor without cannula. M, cannula with handle.
Paré in his time met with a success which to-day would be pronounced
extraordinary. He seemed to inspire the wounded with the utmost
confidence, and to possess greatness and firmness of character in the
highest degree. It is perhaps, even more extraordinary that with so
strong a character he should have so long retained favor at court. In
the midst of the excitement of camps, and a very extended practice,
he found time to read all that had been published on his art, and to
compose himself a great number of works, enriching all branches of
surgery. Instead of keeping secret his inventions, as was the custom of
the time, he made them as public as possible, saying, in the preface of
his large work on surgery: "For my part, I have dispensed liberally to
everybody the gifts that God has conferred upon me, and I am none the
worse for it; just as the light of a candle will not diminish no matter
how many may come to light their torches by it."
Besides his smaller treatises, his large, collective works passed
through a number of editions, and were everywhere reprinted and studied.
Not only was he great in surgery, but he attained a high degree of
expertness in midwifery. Among other things, he restored the forgotten
practice of podalic version in cases where this procedure is necessary.
The doctrine of Paré on gunshot wounds was rapidly disseminated. From
1550, Maggi, of Bologna, advocated it without giving credit to its real
author, and sustained it by decisive experiments. He observed that
none of the wounded felt any heat, and that the torn portions of their
clothing showed no trace of fire; and he shot balls through packages of
powder without setting them on fire. At the same time Lange spread this
view in Germany, and Botal, of Turin,{134} took it up (withholding,
however, the true author's name).
While Ambroise Paré did not disdain to act as accoucheur, it was his
friend and pupil, Jacob Guillemeau (1550-1613), who, in the sixteenth
century, most occupied himself with the practice of obstetrics. We owe
to Guillemeau the first improvements that the moderns made in this art;
for instance, the proposition to rapidly and artificially terminate
parturition in cases of considerable haemorrhage or when the woman is
taken with convulsions during labor. Guillemeau supported this practice
on the authority of Hippocrates, and operated on a great number of
patients, proving its value and the danger of its neglect.
The Cæsarean operation was known to the ancient Greeks and Romans,
but had been abandoned during the Middle Ages. It' remained for the
accoucheurs and surgeons of the sixteenth century to re-establish it.
Among others, Rousset, physician to the Duke of Savoy, who recommended
it very warmly, reported several cases where it had a happy issue for
both mother and child. He even reported the most remarkable case of
all,--that of a woman who was six times delivered by this operation,
and who perished in the seventh confinement, because, as he states,
the surgeon who had been accustomed to operate on her was absent.
Unfortunately, this case is not authenticated.
Nothing shows better how the art of observation and accurate description
of phenomena had progressed at the time of the revival of letters than
the number of new diseases of which the authors of that period make
mention. Then, for the first time did one read of whooping-cough,
miliaria, scurvy, plica polonica, syphilis, and raphania. It is scarcely
credible that these diseases fell upon Europe at this particular time.
It is more probable that they had a more ancient existence and were not
recognized.
Even to-day medical men are divided in their own opinions on the origin
of syphilis, some believing that it was{136} developed spontaneously
in Europe toward the close of the sixteenth century, others that it was
imported from the New World, others that it had a most ancient origin,
and others yet that it represented a degenerated form of leprosy.
Certain it is that syphilis appeared almost simultaneously in all parts
of Europe,--at Bologna, Halle, Brunswick, in Lombardy, Apulia,
Auvergne, and so on. Léonicenus attributed this sudden outbreak to an
extraordinary inundation that occurred in all parts of Italy toward
the close of the fourteenth century, and supported his views with the
authority of Hippocrates and Galen. Others attributed it to astrological
influence; while still others regarded it as a scourge of God with which
to punish men and turn them away from unbridled libertinism, Fallopius
thought venereal disease was engendered by the poison which the
perfidious Neapolitans had thrown into the wells from which the French
drew their water. These wild views simply indicate the spirit of the
age. Oviedo published in 1545 a history of the West Indies, in which he
states that syphilis originated in America. He held that when Columbus
returned from his second expedition to the New World, in 1496, his men
enlisted under Gonsalvo de Cordova to go and fight the French, who had
invaded the Kingdom of Naples, and that they communicated to the French
and Neapolitans the disease which they had brought from San Domingo.
Unhappily for his veracity, it is certain that syphilis broke out in
Naples at least two years before the arrival of the Spanish fleet. It is
equally certain that at none of the points at which Columbus touched
on his return from his first expedition was there any manifestation of
syphilis for years.
At this time the venereal disease, so-called, included those conditions
which we now differentiate under the names of syphilis, chancroid, and
gonorrhoea,--a confusion of diseases{138} which persisted even up to
the time of John Hunter. It is worth while to publish this fact, since
writers of two or three hundred years ago may not have meant by the
term "syphilis" just what we would mean to-day. Without going into this
question here, it is enough to say that one who reads intelligently may
see in the Sacred Scriptures unmistakable allusions to this disease. If
the statements of David, as contained in the Psalms, are reliable, he
was himself a serious sufferer from it. The ancient Greek and Arabian
physicians make mention of lesions which could only be attributed to
this disease; and the Latin satirists, like Horace and Juvenal,
describe symptoms of a certain kind as being the fruit only of shameful
practices.
It is most likely that the sudden appearance of syphilis in nearly all
parts of Europe at about the same time, which has been regarded as so
extraordinary, can be explained by the clearer distinctions physicians
began to make between symptoms of this disease and those of leprosy.
Arrangements for the cure of lepers were very complete, and such
syphilitic patients as responded kindly to the treatment thereby
established themselves in a very different category of disease.
The first writer to systematically consider venereal disease was Astruc,
who was born in Languedoc in 1684 and died in 1766. He was the principal
advocate of the view that syphilis had an American origin, in which
view he was bitterly opposed by Sanchez, a Portuguese physician, who
collected a large amount of evidence to the effect that its first
ravages were observed in Italy.
Summing up this whole matter, we may agree with Jourdan, who has
examined all the opinions of these writers, and who, in his treatise
published in 1826, concluded that all symptoms which had been hitherto
connected with syphilis had been known and described from the remotest
antiquity, but were not supposed to proceed{139} from a common source,
and to be attached to the same cause, until after the close of the
fifteenth century.
THE INFLUENCE OF THE OCCULT SCIENCES ON THE MEDICINE OF THIS PERIOD.
Most of the partisans of occult science were restless minds, such as
are found in all ages, who chafed under the yoke of authority, and
who practiced as well as deduced their lines of thought and conduct
in accordance with their own ideas. Some of these men did not lack in
sagacity, imagination, or audacity, but almost all of them lacked in
consistency of idea and dignity of thought. Most of them lived isolated
lives, apart from each other and from the rest of the world, and were,
to a large extent, what we would now regard as "cranks." While they
made a wide departure from accredited doctrine, they depended upon
imagination rather than upon reason. This happened to be a period,
however, when such men achieved great notoriety,--more so than the same
class of individuals have done since their time.
Cornelius Agrippa (born in 1486) was an early promoter of occult
science. He came of a noble family of Cologne, received the best
éducation of his time, was a man of varied attainments, great
inconsistency in conduct, and a caustic humor which everywhere made him
enemies and prevented him from having any settled abode. He wandered
from place to place, sometimes honored with the favor of the nobility
and sometimes plunged into extreme misery. He early became a
secretary in the court of Emperor Maximilian I, and under that monarch
distinguished himself in the army by such bravery as to win him spurs as
a knight. Soon disgusted with the profession of arms, he devoted himself
to law and medicine, but his intemperate pen soon drew him into quarrels
and persecution. At Dole he fell out with the monks; at Paris{140} and
Turin he compromised himself with the theologians; at Metz he incurred
the animosity of the Jacobins for attacking the prevailing opinion that
St. Ann had three husbands. He became a vagabond and almost a beggar
in Germany, England, and Switzerland, and then went to Lyons, where the
mother of Francis I, who was then Queen Regent, made him her physician.
He soon lost favor here, and was disgraced and banished; then he went to
the Low Countries, where he was imprisoned on account of his treatise
on _The Vanity of the Sciences._ Afterward he returned to Lyons, was
imprisoned anew, for an old libel against his former patron, and finally
died in the hospital of Grenoble, in 1535, at the age of about fifty.
His treatise on _The Vanity of the Sciences_ made him most trouble,
and showed best both his bitterness of spirit and the extent of his
learning. Herein he laid down the paradox, which was later renewed
and sustained by Rousseau, that there is nothing more pernicious and
injurious to common life, or more pestilential to the salvation of
souls, than the arts and sciences. He founded this thesis on Scriptural
authority, and supported it by profane testimony.
The conclusions which Agrippa drew were not so strange to the eyes
of his contemporaries as they are to ours. Long before him, men of
character and attainments, such as Pic de la Mirandola and Bessarion,
had attempted to introduce the Platonic idea, that the best means of
acquiring science and truth were introspective. They were, moreover,
persuaded that a great number of phenomena and events have their origin
in astral influences. From this system to the extravagance of the Cabal
* is but{141} a step; indeed, the Christian doctrine, that events and
phenomena are influenced by the direct intervention of the deity or of
the devil, is but a small transposition. The cabalistic theory, summed
up, was that all the events of life and all the phenomena of nature
proceed from influences which gods, devils, or the stars exercised on
the "archetype"'--that is, on the essential spirit, or substance. He who
could withdraw his spirit possessed supernatural faculties. The day and
the hour of birth, according to this view, were under the domination
of particular stars and each of the principal members of the body was
supposed to correspond with some planet or constellation. This is the
fundamental idea underlying the pictures--which are still to be found on
almanacs used by quack-medicine firms--of the individual whose interior
is so completely and uncomfortably exposed, while around him are
arranged the signs of the zodiac, with indications as to which part of
the body is governed by each.
* Cabal, or Kabbalah: A theosophieal or mystic speculative
system, of Hebrew origin, which flourished from the tenth to
the sixteenth century. It included a mystic theosophy and
cosmogony, attributing to deity neither will, desire, nor
action, but teaching that from it emanated wisdom, grace,
intellect, power, beauty, firmness, and other attributes. It
also ascribed hidden meanings to the sacred Hebrew writings
and words. Even in the letters and forms of the sacred words
the followers of the cabal pretended to find wonderful and
hidden meanings; hence the modern expression "cabalistic."
The teachings of the cabal were esoteric, of course, and
inculcated mysticism and occultism in everything, but
appear to have been more or less influenced by neoplatonism.
Occult philosophy, built upon this foundation, was divided into four
branches: _theosophy,_ to which a man raised himself by prayer; _magic_,
or the art of controlling demons; _astrology_, or the art of reading
future events by the stars; and _alchemy_, which teaches the secret of
extracting the essence or the archetype of substances,--i.e., virtually
the secret of the philosopher's stone, by which metals were to be
transmuted and then abolished.
And so the errors of science, the prejudices of the superstitious, the
excitement of the religious, and the cupidity of the rich and powerful,
all concurred to propagate the faults of the cabal at the close of the
Middle Ages. Never were there seen so many sorcerers, astrol-ogists,
and alchemists; never were prophecies, visions, and prodigies so common.
Whatever happened, it was pretended{142} that it had been announced
by some previous sign, or that it was a revelation of the future. This
particular kind of folly persisted in Germany longer than in any other
part of the world. Even Martin Luther seemed to share many of the
cabalistic views, and his alleged struggle with the devil, his adventure
with the inkstand, and so on, contributed much to spread them, and were,
perhaps, the most prominent illustrations of their general acceptance.
Surely, these were the Dark Ages.
Jerome Cardan was born at Pavia in 1501. His life, like that of Agrippa,
was one of vicissitude and inconsistency. Being the idol of his mother
and the detestation of his father produced a peculiar effect upon his
character. When he began to study he made rapid progress, and at the
age of twenty-two was able to discuss publicly all questions. About
two years later he received his doctor's hat. He practiced medicine in
various places until he was thirty-three, and was then made professor
of mathematics at Milan. He occupied this position but two years, then
traveled in Germany, France, and England, and returning to Italy was
imprisoned for debt in Bologna, and finally obtained a pension from the
pope, in Rome, where he died in 1556. He was a man of great attainments
and sagacity; his literary style was dignified, and, if he had not
developed such a taste for the marvelous, such inconceivable credulity
and superstition, and such vanity and boasting, he would have been a
remarkable character in his age. Leibnitz said of him: "Notwithstanding
his faults, Cardan was a great man and, without his defects, would have
been incomparable." He wrote extensively on philosophy, mathematics,
and medicine. Sometimes he admitted to his writings the most absurd
statements of visions, etc., and again affirmed that he had never
devoted himself to cabalistic art, blamed those who practiced it, and
jeered at those who believed in it. He wrote extensively on chiromancy.
For his own follies and misfortunes he apologized,{143} attributing them
all to the influences of the stars.
The most colossal figure in this collection of mediaeval charlatans and
knaves was Paracelsus. He was born in 1493, near Zurich, of a well-to-do
family, his father being a physician. He had a good preliminary
education, and then visited the various universities, or rather
university towns; but, instead of listening to the professors,
Paracelsus associated with clever women, barbers, magicians, alchemists,
and the like, from whom he acquired much information. He was led at once
to the vagaries of the cabal, and, according to his own statement, he
did not open a book for ten years. He neglected his studies and forgot
his Latin, so that he became incapable of expressing himself in{144}
that language. From the age of twenty-five he became a hard drinker, and
this habit ultimately worked his ruin. One of his disciples says of him
that during the two years which he passed with him he was so inclined
to drinking and debauchery that he could scarcely be seen for an hour or
two without being full of wine, although that condition did not prevent
him from being admired by every one as a second Æsculapius.
At this time Paracelsus was between thirty-three and thirty-five years
of age, and at, apparently, the most brilliant period of his life. He
had written extensively and with emphasis of his numerous cures,
after the fashion of charlatans of those days,--and, unfortunately, of
to-day,--and claimed to be possessed of infallible secrets against the
most intractable diseases. He had just been called to Basel to the chair
of physic and surgery, and crowds of curious and idle persons attended
his lectures, which he gave in the vernacular, and not, as was
customary in those days, in Latin. In order to strike his auditors with
astonishment, he began by burning the works of Galen and Avicenna, and
then reading from his own writings, breaking off from time to time into
the statement: "Know, ye doctors, that my hat knows more than you;
that my beard is more experienced than your academies. Greeks, Latins,
Arabians, French, Italians, Jews, Christians, and Mohammedans, you
must follow me; I shall not follow you, for I am your monarch, and
sovereignty belongs to me." As may be imagined, his professorship
was not one of long duration, and he soon had few or no listeners.
In consequence of some mishaps he left Basel quite precipitately, his
departure causing no such sensation as his arrival. He then resumed his
nomadic life, and we find him at Alsace in 1528, at Nuremberg in 1529,
at St. Galle in 1531, at Mindelheim in 1540, and in the following year
at Salzburg, where he died in the hospital at the age of forty-eight.
Few men there are of whom so much good and so much{145} evil has been
written as of Paracelsus. Few are there of whom it is to-day so hard
to judge, since, if we refer to his contemporaries, they disagree
completely concerning him, and if we refer to his own writings we fall
into still greater chaos and have to abandon the attempt. His writings
show ideas without connection, observations which contradict each other,
and phrases which defy comprehension. At one moment he gives proof of
admirable penetration, at the next simply abject nonsense.
That he exerted an influence upon his time is certain, but that this
influence was retrograde rather than progressive seems quite likely. His
exact duplicate has probably never existed since his time, and we
may say that never was there another man like Aurelius Phillip-pus
Theophrastus Paracelsus Bombastus ab Hohenheim--his full name.
Although this man was such a prominent character in his day, his name
must be erased from the list of those who have contributed to the
world's progress. He was simply a pretended reformer, who counted as
nothing the most erudite writings, and who relied solely on his own
experience. He had the most profound self-confidence, and played upon
the credulity of his neighbors and victims with the toys which were
furnished him by the prevalent cabalistic notions of the day. The school
which he would have founded was nothing but a school of ignorance,
dissipation, and boasting--a school of medical dishonesty. In a word, it
was, as Renouard has said, "a school of which Thessalus, of Tralles, had
been the Corypheus in antiquity, which John of Gaddesden revived in the
Middle Ages, and to which Paracelsus gave a new development."
While, as has been briefly recounted, the partisans of the occult
sciences strove to completely overturn the scientific edifice of
antiquity, other reformers, more sensible and{146} less daring, were
content to expose its defects without attacking it in its entirety.
These were, for the most part, enlightened men, and at the same time
free thinkers,--friends of progress, and not of destruction. During the
sixteenth century these men were few in number, but at least three or
four of them deserve mention.
John Argentier was born in Piedmont, and taught in Naples, Pisa,
and Turin. He did not hesitate to take issue with the theories
and statements of Galen, and criticised those who adopted them too
servilely. Of him it may be said that, although styled a reformer,
nevertheless, he kept too near to the doctrines of those against whom he
inveighed to seriously weaken their position.
Leonard Botal, also a Piedmontese, was born in 1530. First a surgeon in
the French army, he later became physician to the kings Charles IX
and Henri III. He was the first to recommend frequent and general
bloodletting. Apparently before his time this practice was greatly
restrained. He carried his views so far as to maintain that an infirm
old man should be bled from two to six times a year, and that it was
good custom to open the veins of healthy individuals every six months.
He wrote a remarkable memoir on the cure of disease by blood-letting.
It is not to be denied that he obtained some remarkable success with his
copious venesections, and it must be said, in his defense, that, if he
overdid it, his contemporaries did not resort to it often enough, and
that his own practices were instructive to others. In his writings he
united independence and energy of thought with elegance and purity of
Joubert (1529-1583) was Chancellor in the University of Montpellier and
physician to King Henri III. He wrote a treatise on _Popular Errors_,
which had an unheard-of success. In less than six months there were
sold nearly five thousand copies, which, considering the times,{147}
constituted a prodigious edition. For one thing, it was written in
the common tongue, and so placed within the reach of all. It was also
diversified with anecdotes and jokes, some of which were not of the most
delicate character; in fact, the author endeavored to atone for some of
its salacity by dedicating it to Queen Marguerite. He really proposed
for his main purpose a serious and useful one,--namely, that of
combating prejudices which were both injurious and ridiculous. Although
we may make light of Joubert's treatise, it certainly achieved a useful
end by dissipating a multitude of errors, giving information to those
who could scarcely get it as well from any other source. That it was
full of defects is simply another form of saying that it was published
in the middle of the sixteenth century.
It was during this period of which we have written that the separation
of the priesthood from medicine was completed. From the sixteenth
century celibacy was not obligatory on physicians in the Kingdom of
France, and they no longer enjoyed ecclesiastical benefices. At this
time, too, surgery, which had naturally been separated from medicine,
began to approach it, the combination thus gradually brought about
inuring to the benefit of all concerned. From now on, the professors of
St. Come were on the same level as the professors of the university,
and enjoyed equal privileges. Institutions for instruction in medicine
increased, and those which already existed were developed. Amphitheaters
for dissection were open in every city in Europe. Hospitals and
dispensaries were established alongside the schools, and by the various
governments more attention was paid to the protection of the public
from imposition, and to the amelioration of every evil affecting either
public or private health.
CHAPTER VI.
_Age of Renovation (continued).--Student-life During the Fifteenth and
Sixteenth Centuries. Ceremonials Previous to Dissection.--Reform Period:
The Seventeenth, Eighteenth, and Nineteenth Centuries. Modern Realism
in Medicine and Science. Introduction of the Cell-doctrine. Discovery
of the Circulation. William Harvey, 1578-1637. Malpighi, 1628-1694.
Leuwenhoek, 1632-1723. Correct Doctrine of Respiration. Discovery of
the Lymphatic Circulation. The Nervous System. Discovery of Cinchona.
Development in Obstetric Art, in Medical Jurisprudence, in Oral Clinical
Teaching. Van Helmont, 1578-1644.--The Iatrochemical System: Le Bôe,
1614-1672. Thomas Willis, 1622-1675._
For a{148} long time the Italian universities held the first rank; next
came the French; and last the German, although all were well attended.
The most famous were the medical faculties of Bologna, Pisa, Padua; then
Paris, Montpellier, and, finally, Basel.
A little of what concerned the student-life of this period may not be
amiss. The students chose the rector and officers of the universities,
sometimes even the teachers, and assisted in determining the curriculum
of study, the execution of which they watched. In some of the Scotch
universities even now the students choose the rector.
The students were divided, usually according to country, into bodies
denominated "nations" (some having special seals), which were the
parents of the present stu-dent-corps in German universities. Certain
representatives, known as vice-rectors, were chosen from each of these
corps and constituted a so-called college of rectors which negotiated
with the officials of the State, and possessed a power that was
preserved until the end of the sixteenth century.
The poorer class of students passed from one school to another,
supporting themselves by singing, begging, or stealing, and were
sometimes guilty of great barbarities. The younger scholars, called
"Schutzen," were compelled to perform{149} most menial duties for their
older comrades, the "Bacchanten,"--much like the system of fagging
still in vogue in English grammar-schools; and when the bacchantes were
admitted to the university proper they were required to pass through
an initiation, or hazing, which eclipsed anything known in these
days; indeed, the antiquity of fagging may be traced back even to the
philosophic schools of Athens. The habits of the traveling scholars
led many of them into dissolute and vicious ways, though some attained
respectable positions,--possibly even eminence. The students who were
better situated financially; for the most part entered the Italian
universities.
Already mention has been made of the enormous number of students
congregated during this age in Bologna and in Naples. In the small
University of Wettenburg there were, in 1520, only about six hundred
students; in Erfurt, three hundred, and this number dwindled two years
later to fifteen; in 1500 Leipzig had four hundred students; at the
same time there were about seven thousand in the University of Vienna.
Students and teachers migrated from one place to another, and faculties
were constantly changing. Great teachers were received with great
ceremony. Bitter struggles and disputes between teachers sometimes
occurred; it is related of Pistorius, who died in 1523, and Pollich,
deceased in 1513, that they conceived a violent enmity toward each other
because of antagonistic views relative to the epidemic or contagious
character of syphilis, and both ultimately left Leipzig for other
schools.
Some curious customs prevailed. In teaching anatomy, while the learned
teachers explained the parts as exposed, the dissections were left to
barbers as being unworthy of an educated medical gentleman. While the
cadavers were mainly the corpses of executed criminals, it was thought
that before and after each special dissection religious ceremonies were
appropriate, and such were often held; it was also believed that all
who came in contact with such a corpse{150} would be made disreputable
unless it were itself first made reputable; hence the professors first
read aloud a decree to that effect from the magistrate, and then, by
order of the senate of the faculty, stamped upon the breast of the
corpse the seal of the university. The body was next carried into
the anatomical hall, and the cover of the box in which it had been
transported was returned to the executioner, who remained at some
distance for this purpose. If the corpse was one that had been
decapitated, during these solemn ceremonies the head was placed between
its legs. Finally, an entertainment with music, often furnished by
itinerant actors, was given. But this folly was gradually discontinued,
and by the second half of the sixteenth century public dissection was
performed without recourse to such mummeries. The price of skeletons
in those days was high; the University of Hiedelberg, in 1669, paid
seventy-two dollars for one.
The practitioners of the sixteenth century were often quite as roving
as the students and professors, though those who held positions as State
physicians were bound by contract to a fixed residence for a certain
time. In 1519 the State physician of Heilbronn received a salary of
twenty-one dollars per year and his firewood, but could not leave
the city over night without permission of the burgomaster. Medical
attendants of the King of Spain were required to kneel down when they
felt the king's pulse. There were few physicians who acquired wealth,
although Fabricius ab Aquapendente left a fortune of two hundred
thousand ducats.
The Reform Period is the name which Renouard has given to the time
beginning with the commencement of the seventeenth century,--a time when
the domain of natural science was daily enlarged, and when observation
had enriched human knowledge with multitudes of new facts, some of which
harmonized with, and some of which were in opposition to, prevailing
doctrines. Men whose knowledge{151} equaled their genius began to need
a radical reform, and by such men intellectual improvement was begun
by which the decrepit theories of the schools of the Middle Ages were
eradicated and by which there were substituted for them others which
harmonized much better with known phenomena. To the period of worship of
ancient authority succeeded one characterized by a desire to shake
off the yoke of the same, and men now struggled, as it were, to free
themselves from the tyranny of the past. As Galileo was the torch-bearer
for regeneration of the knowledge of physics, and as Kepler, and
others already named, or to be named, did as much for other branches
of science, so there were not lacking those who broke away from the
restraint of authority in medicine, and began to beat or choose paths
for themselves among the facts which experimental science furnished
With the approach of the seventeenth century there was evident
improvement in both the social and mental status of medical men. While
political humiliation and exhaustion were everywhere noted, in the field
of literature it was evident that the line had advanced. What may have
been the effect of thirty years of religious war, with other political
struggles carried on under the hypocritical cloak of religion, may be
imagined, if not fully described; the devastation of whole countries by
disease, and notably by the plague,--the poverty and hunger consequent
upon the ravages of perpetual war (it is stated that even so late as
1792 there were still in Saxony 535 wasted and extinct villages), to
say nothing of the barbarity and immorality resulting therefrom,--all
combined to make the early part of the seventeenth century a most
mournful epoch. It is not strange that, with poverty, superstition and
great rudeness of manners prevailed, or that trials for witchcraft and
persecutions by the Jesuit Inquisition were common. That any advance
should{152} have been made under such circumstances speaks well for the
progress of the human mind. That this advance was slight in Germany
and central Europe is not strange, though other countries were able
to quietly enlarge their scientific borders. Now it was that England,
Italy, and the Netherlands, which took but little part in the warlike
struggles of the century, acquired leadership in medicine, and were
seconded by the French. In Great Britain, science had been fostered
by various kings, and particularly by Charles II, who professed to be
something of a chemist; in fact, an epidemic of scientific interest fell
upon the English court.
The seventeenth century, in contrast to the idealistic sixteenth,
witnessed the advent of modern realism in almost all departments of
thought. Medicine furnished the first example in what we are accustomed
to-day to speak of as the exact method; hence, the century is of great
importance, in that physicists and chemists began to be original,
instead of mere followers of the past. The most notable feature
of medicine was the promulgation of three medical systems: the
pietistically colored Paracelsism of Van Hel-mont; the chemical
system of Sylvius; and the iatro-cliemical system of the physicist and
mechanician, Borelli. This period is, moreover, illumined by the life of
one great practitioner, whose name will be imperishable in the history
of our art,--namely, Sydenham.
The principal tendency of the time was toward skepticism, which had
begun in the preceding century with Montaigne, and was continued by
Charron, under the patronage of Queen Marguerite of Navarre; it was the
fundamental idea of Pierre Bayle, the author of the great dictionary.
Opposed thereto was the supernatural philosophy, or the theosophic,
cabalistic, or mystic. The leading exponent of the latter was Boehme,
who was a business colleague of the celebrated "Meistersinger," Hans
Sachs, in Germany, and of Blaise Pascal and his contemporary.
Malebranche,{153} in France. The doctrine of Lord Bacon, Lord Verulam
(1561-1626), a man who showed himself as exalted in mind as he was
mean in personal traits, was of great importance Bacon is a landmark
in history as the defender and eulogist of modern realism,--i.e., of
inductive philosophy. While personally contributing but little to the
advance of science, he taught a great method; as Gruen says, he was the
philosopher of patents and profit; he recognized the compass, the art of
printing, and gunpowder as great inventions, but placed little value on
the discovery of Copernicus, having little comprehension of mathematics.
Hobbes and Locke went farther into realistic philosophy, and the latter
was an exponent later of pure empiricism.
In the seventeenth century, also, zoology and botany were largely
extended. In it lived Swammerdam (1637-1680), famous as a naturalist,
physiologist, linguist, poet, and _savant_; there were others, also,
whose names are better known in the history of collateral science than
in medicine, and who left conclusive demonstrations in accordance with
their theories, and made daily use of the microscope, simple as it then
was. The term "cell" had been introduced by Hooke in 1667, and Malpighi
and Grew were the founders of the cell-doctrine. The astronomical laws
discovered by Copernicus changed the course of the world's thought; and
now appeared the brilliant Kepler (1571-1630), and Galileo (15641642),
the defender of the Copernican system, and the persecuted discoverer of
the law of falling bodies, of the thermometer, the telescope, and
the movements of Jupiter; also, Sir Isaac Newton (1642-1727), whose
discovery of the laws of gravitation in 1665 marked an era in the
history of science. This century, too, gave birth to Romer, who in 1675
calculated the velocity of light; Huyghens (1627-1693), who discovered
the polarization of light and the satellites of Saturn; James Gregory,
who in 1663 made{154} a reflecting telescope with a metallic concave
mirror; Torricelli, who in 1643 measured the weight of the air;
Gascoigne, who invented the micrometer in 1639; and Napier, who invented
logarithms in 1700.
Now chemistry, having ceased to be alchemy, began to don the dignity
of a science _per se_, and it may be claimed that medicine derived no
slight benefit therefrom. Scientific societies and journals arose at
this period, and were all of good service to medicine in their way.
The church scented danger to the faith in everything which related to
natural science, and founded certain secret associations, especially in
Italy; the Accademia Degli Lyncei, so called from its seal, which bore
the image of a fox or lynx, founded in Rome in 1603, was one of these.
Counter-societies, or, rather, societies with opposite purposes, were
also started, and the original and private so-called Invisible Society,
which was originated mainly by Milton, in 1645, and remodeled by Charles
II in 1662, is now the flourishing Royal Society. In France the Academy
was founded in 1665 by Colbert, but developed its first real activity
thirty-five years later.
Those who to-day are so familiar with the course of the circulation of
the blood through the arteries and veins find it difficult to understand
how the recognition of this phenomenon could have been so long
delayed; it seems so simple, yet to the ancients it was perfectly
incompre-hensible! Although every one had recognized that blood would
flow from an incision, few stopped to reason thereupon. From time
immemorial it had been supposed that the veins had their origin in
the liver, and were the only vessels which contained blood, since the
arteries were always found empty after death; the latter were held to
contain only air or spirit. The circulation was supposed to leave and
return to the liver through the venous canals by undulating movements
similar to those of the waves of the ocean; and this was the doctrine of
the Asclepiadæ,{155} and probably of Erasistratus. Galen modified this
view by showing that the arteries contained blood; he knew it was
poured into the right cavities of the heart by the great veins, but he
believed that only a small quantity passed from the right ventricle
into the lungs, and that the major portion reached the left ventricle by
passing through pores in the inner ventricular septum. This opinion was
uncontested until the middle of the sixteenth century.
Then the theologian, Michael Servetus, who, in 1553, perished as the
victim of Calvin's jealousy, denied the passage of the blood through
this septum, contending that it was returned from the lungs to the left
side of the heart by the pulmonary veins. This was a happy thought,
and a great step toward the truth. Soon after Columbus demonstrated
anatomically that the conjecture of Servetus was plausible, by showing
the function and real use of the valves of the heart. Cesalpinus came
still nearer to the truth, and explained, as did Columbus, the course
of the circulation through the lungs, but he opined that blood and vital
spirits passed from the arteries into the veins during sleep, because at
that time there was swelling of the latter and diminution of the pulse.
Valves in the veins were known, and it had been shown that ligature of
an artery in the living animal stopped the flow below it, while if a
vein were tied there was shrinkage above the ligature, and swelling
below it. Such was the state of science at the beginning of the
seventeenth century; there remained, practically, but one step to
take,--to find the true course of the blood.
William Harvey was born in Folkestone, Kent, in 1578 and died in London
in 1637. He first studied at Cambridge, entering at the age of fifteen;
subsequently traveled in France, Germany, and Italy, remaining in
Padua from 1599 to 1602, in order to hear the lectures of Fabricius ab
Aquapendente. With the title of "Doctor" he returned{156} and settled in
London and soon became a member of the College of Medicine, of which he
was made a regent in 1613; in time he became physician to James I,
and, on the demise of this sovereign, to Charlçs I; to the latter he
dedicated his chief work. During the civil war he was driven from place
to place, and, finally, to Oxford, where he surrendered himself to the
Parliamentary troops, after which he again resided in London with his
brothers, who had become rich. Modesty led him to decline the high
distinction of President of the College of Physicians, and he lived
a quiet and retired life, occupied with his studies and, in his later
years, investigations in mathematics. Soon after 1613 he began, through
his lectures, to make known the doctrine of the circulation of the
blood; but he did not publish the results of his researches until 1628,
after submitting them to fifteen years of proofs and counterproofs{157}
of every kind. So bitter was the opposition of his contemporaries to the
new doctrine that he at one time lost a part of his practice, and
was even held to be demented. It is characteristic of the fate of new
truths, as well as of that age of dominant authority, that his first
publication--_Concerning the Motions of the Heart and the Blood_--was
unable to pass censorship in England, and therefore appeared in a
foreign country (Frankfort, in 1628) when he was fifty years old; but
his second treatise on the same subject, in reply to Riolan, a professor
in the Faculty of Paris, was published in Cambridge in 1649.
"So much care and circumspection in search for truth, so much modesty
and firmness in its demonstration, so much clearness and method in the
development of his ideas," says Renouard, "should have prepossessed
every one in favor of the theory of Harvey; but, on the contrary, it
caused a general stupefaction in the medical world, and gave rise to
great opposition."
This theory, which to-day appears so natural that we conceive with
difficulty why it was not sooner discovered, was nothing less than
a revolution in physiology; it excited a tremendous controversy that
continued more than twenty-five years, and in which mingled every one
possessed of any pretension to knowledge of anatomy or physiology; even
naturalists and philosophers took part in the dispute. René Descartes
was the first to declare in its favor and to support it by experiment;
John Walæus (Jan de Wale), the celebrated Professor of Anatomy in
the University of Leyden, confirmed it by new observations; finally
Plempius, of Louvain, for a time one of the most fiery of opponents,
succumbed to the truth, and in 1652 passed publicly to the ranks of
Harvey's followers--no small triumph!
During these long debates Harvey remained always dignified and firm,
although the early attacks rendered him unduly sensitive regarding
others which he anticipated.
About{158} his only answer to the arguments adduced against him, was to
add new proofs and new experiments to those already published. The only
one of his adversaries who obtained a direct response was Riolan,
who possessed immense influence among his contemporaries as a man of
attainments; Riolan combated with equal violence and obstinacy the other
great discovery of the age,--viz., the circulation of the lymph.
Harvey ultimately, however, had the satisfaction of seeing his theory
universally adopted. But his services were not limited to this one
discovery. He made most interesting observations on generation, both in
man and in animals; on midwifery; and on the structure and diseases of
the uterus.
The intermediary system and bond of union between the arteries and
veins, so very essential, yet up to this time unknown, was discovered by
the great Malpighi, who was born in 1628 near Bologna, became professor
in its university, and discovered in the lungs and mesentery of frogs,
in 1661, the capillary circulation. He first described the corpuscles
of the blood in 1665; he also discovered the lung-cells, as well as the
cutaneous glands, certain portions of the kidney, and the pigmentary
layer of the skin, named after him (_rete Malpighi_), which later
furnished the first explanation of the difference of color in different
In 1690 Leuwenhoek (1632-1723), who had been making observations on
the larvæ of frogs and other small animals, was able to see with his
improved microscope the movements of the blood in the small vessels, and
gave the important testimony of his observations. In 1687 Cowper saw the
passage of the arterial into the venous current in the mesentery of a
cat. The capillary connection between the two vascular systems was first
demonstrated by Marchetti, but was best shown by Ruysch (1638-1731),
professor at Amsterdam, the famous inventor of minute injections, who
greatly advanced anatomy by the formation of collections, one of which
was brought into Russia by Peter{159} the Great at an expense of
about seventy-five thousand dollars. The Russian transporters of the
collection, however, drank the alcohol in which many of the preparations
were preserved, and a portion of the specimens was thus ruined.
Further illustration and amplification of Harvey's views came from
various sources; the last, perhaps, from Nich-olaus Steno (1638-1686),
who was first a professor in Copenhagen, then a bishop and peripatetic
converter of heretics. Steno first proved the heart to be a muscle that
contracts actively and expels the blood. The duct that bears his name
was discovered during his residence in Leyden or at Amsterdam. His name
is written also "Stenson."
While ancient anatomists were able to describe in a general way the form
of the lungs, their location, consistency, the ring-like structure of
the trachea, and the first division of the bronchi, they did not go
farther, but blindly accepted the prevalent theory that the bronchial
tubes anastomosed with the terminal pulmonary veins, and that in this
way atmospheric fluid was conveyed from the respiratory organs into the
heart. On such vague and erroneous data was constructed the theory that
the air was drawn into the lungs by the heat of the heart, which was the
reservoir of the vital spirits; that in penetrating through the smaller
tubes it was rarefied, its thinnest part passing into the heart, where
it served as material for the formation of the vital spirit, its grosser
part being exhaled. In other words, respiration was supposed to have two
purposes one to refresh the lungs, which, being porous and inflammable,
would otherwise take fire from the heart, or focus of animal heat; the
other to furnish the pneuma, or ether, which was employed by the heart
in the formation of animal spirits. Harvey's discovery upset all this,
in great measure.
Next it was shown that pulmonary veins carried nothing to the heart
except blood. And now, during this Reform{160} Period, the purpose of
the movements of the chest was better studied, for Borelli, Helvetius,
and Haller made many experiments, as the result of which it was
determined that during inspiration the thorax is enlarged in all
directions, and during expiration partly collapsed by relaxation of
muscles, and that there never is any empty space between the lungs and
the sides of the chest; further, that air is drawn into the chest by the
tendency of all gases or fluids to maintain an equilibrium, or, in
other words, because Nature abhors a vacuum. This being settled,
various pneumatic theories were adopted and abandoned, all of which had
subsequently to give way before a knowledge of what really occurs. The
truth was conceived of by Mayow in 1668. It had been noticed that blood
which appeared black in issuing from the veins, became red in contact
with the air, and direct observation proved a similar change of color
to take place during its passage from the pulmonary veins during life.
Goodwin, opening the thorax of a frog, was the first to see this, and
Hessenfratz filled a silk bladder with venous blood, and, plunging it
into an atmosphere of oxygen, saw the blood change from black to red.
In this way and by the later labors of Bichat and Lavoisier were
clearly established the mechanism and the purpose of the function of
The discovery of the lymphatic vessels and their purpose was scarcely
less remarkable than that of the circulation, though marked by less
eclat because it was not the work of one man, but a matter of slow
development. Herophilus and Erasistratus had seen white vessels
connected with the lymph-nodes in the mesentery of animals, and supposed
them to be arteries full of air. Galen disputed this, for he believed
that the intestinal chyle was carried by the veins of the mesentery into
the liver. In 1563 Eustachius described the thoracic duct in the horse.
In 1622 Aselli, Professor of Anatomy at Milan, discovered the lacteal
vessels in a dog which had been killed immediately after partaking{161}
of food; having pricked one of these by mistake, he saw a white fluid
issue from it. Repeating the experiment, he became certain that the
white threads were vessels which drew the chyle from the intestines.
He observed the valves with which they are supplied, and supposed these
vessels all met in the pancreas and continued on into the liver. In
1647 Pecquet, while still a student at Montpellier, discovered the
lymph-reservoir, or _receptaculum chyli_, and the canal which leads from
it (the thoracic duct), which he followed to its termination in the
left subclavian vein. Having ligated the duct, he saw it swell below and
become empty above the ligature. He studied the courses of the lacteals,
and convinced himself that they all entered into the common reservoir.
This discovery gave the last blow to the ancient theory which attributed
to the liver the function of blood-making, and confirmed the doctrine of
Harvey. Strangely enough, the latter united with Riolan in opposing the
discovery of Pecquet and denying its significance. From this time the
lymphatic vessels and glands became objects of common interest and were
investigated by many anatomists,--by Bartholin, Ruysch, the Hunters,
Hewson, and, above all, by Mascagni, who was the first to give a graphic
description of the whole lymphatic apparatus.
The ancients confounded, under the name "neuron," nerves, tendons,
ligaments, and membranes; even Aristotle regarded the brain as an inert
mass devoid of sensation, and supposed the nerves to originate in the
heart. Rufus, of Ephesus, remarked that Herophilus distinguished
three sorts of nerves,--the first serving for sensation and motion
and proceeding from the brain and spinal marrow, the second and third
serving to unite bones and muscles.
Galen also shared in this error, but, nevertheless, described the
brain-membranes and the difference between white and gray matter; he
supposed the cerebrum to be the seat of the soul and origin of sensory
nerves, and that the cerebellum{162} gave rise to nerves of motion;
the pulsation of the cerebrum exposed was held to be a sort of brain
respiration. Galen came very near recognizing the distinction between
nerves and tendons, but nevertheless confused them. The anatomists of
the sixteenth century described certain portions of the nervous system
with, more exactness than did Galen, but not with such positiveness as
to prevent Cesalpinus from renewing the Aristotelian theory that the
heart was the origin of sensation and the seat of the soul. Nearly two
centuries later Baglivi advanced a theory which referred vital movement
to the heart and the dura mater.
The progress which accrued to comparative anatomy and physiology, and
the experiments which were made on animals, during this period, shed
a great deal of light upon the nervous system. The researches of
Vieussens, Haller, Meckel, Vicq d'Azyr, Scarpa, Soemmering, and others
had already rendered it manifest that the brain was the organ of
sensation and voluntary motion, and Bichat had proposed to divide the
nervous system into cerebrospinal and sympathetic branches.
Now, too, Kepler discovered that the crystalline lens was not the seat
of vision, as had been supposed, but that its function, like that of
other lenses, is the refraction of light. He observed that the image
of objects is depicted upon the retina, and (with Schemer) demonstrated
that the expansion of the optic nerve in the retina is the essential
part in the organ of sight. Obviously, also, interest in the anatomy of
the eye, which these observations everywhere stimulated, was, in a great
measure, aided by the researches of Newton on light and color.
About this time, too, Casserius and others studied the auditory
apparatus and described the ossicles, the small muscles of the internal
ear, and the semicircular canals; they even followed the acoustic nerve.
By the researches of a number of French and Italian anatomists it was
likewise{163} established that the true seat of hearing lies within
the internal ear, the external parts being merely of assistance in
conducting sound.
Thomas Willis was one of the first to consider the brain as an
assemblage of organs and to assign special functions to certain of its
divisions; he thus became a pioneer in cerebral localization, although
most of his conjectures were inaccurate or fanciful. The workings of
the brain were also studied by Pinel and others, who observed that
in certain conditions of mania or partial insanity some of the mental
faculties--such as memory, judgment, imagination, or will--were
abolished or suspended, while other faculties were preserved; hence it
was inferred that each faculty must have its own seat. The views thus
enunciated were carried to an absurd degree by Gall, and later by
Spurzheim, who made an entirely new classification, believing the
cranium to be molded in a reasonably exact manner upon the brain, and
that, by inspection of the exterior, the character of a given individual
could be read. They thus founded the pseudoscience denominated
phrenology, which we now know has practically nothing to justify itself.
About the middle of the seventeenth century Glisson (a professor in the
University of Oxford) recognized a property pertaining to all living
tissue, which he termed irritability, and which he regarded as
sufficient cause for all the phenomena of life; he enunciated certain
views that, in times past, have had an important bearing upon the
pathology of disease, but which were forgotten for sixty years or more
until revamped by the Dutch anatomist, Goerter. It was the latter,
with the great Haller, who, by a series of very ingenious experiments,
elevated the suppositions of Glisson to the dignity of demonstrated
facts. In 1747 the results of Haller's researches were published under
the modest title of _First Lines in Physiology_; the author was,
in fact, the great exponent of the doctrine of irritability in{164}
neurophysiology, and for this deserves to be remembered wherever the
history of our art is spoken of. This theory of irritability was applied
to pathology by Fabre, of Paris, who refuted the mechanical theory of
Boerhaave on inflammation, proving that the latter proceeds not
from obstruction of the capillaries, but from exaltation of their
irritability. It was also applied in many ways by Bichat, who enjoyed a
brief, though memorable, career. The theory of irritability, along with
the truths established by John Hunter in his researches on the blood,
made a very distinct advance in the physiological knowledge of the
seventeenth century, and the researches of those who contributed so much
to its advance are well worthy of study even at the present day. In this
line of investigation should, perhaps, also be mentioned the names
of Winslow, Albinus, the two Monroes, besides vicq d'Azyr, and others
already named.
I have so far discussed the development of theories and researches of
individuals. During the earlier portion of the seventeenth century there
happened something which gave to materia medica a remedy so valuable,
and which attracted such wide-spread attention, that it deserves special
mention, I refer to the discovery of that great febrifuge, Peruvian
bark. Malarial fevers had been known as early as the time of
Hippocrates, and were universally treated largely with purgatives,
sometimes with venesections. There had been no notable improvement in
the management of pyrexias of this class down to 1638, when the Countess
of Cinchon, wife of the Viceroy of Peru, became a prey to a fever which
nothing could remove. It is said a Spaniard learned from the natives
the secret of the bark, and advised its employment, whereby the countess
recovered her health. This is the generally received account, although
it has been widely discredited, and Humboldt expresses decided doubts
as to the source whence the first knowledge of the bark was derived. Be
this as it may, however,{165} it is certain that, in 1639, the countess
and her physician, de Vega, imported into Spain a quantity of ground
Peruvian bark, and distributed it to various persons, though it was not
made an article of general commerce until ten years later, when it was
exploited by the Jesuits, who had received a large supply; in Spain
it was known as the "countess's powder," and in Italy as "Jesuit" or
"cardinal" powder. Being very high-priced, it was soon so sophisticated
as to be quite unreliable. Condamine, the botanist, having been sent
to America for other purposes, determined the botanical position of the
tree and described several species of cinchona, one of which is known by
his name. To him is due the generic title bestowed in acknowledgment
of the services rendered by the countess, who introduced the bark
into Europe. Many vain attempts were made to determine the chemical
composition of the powder, and it remained for two French chemists to
isolate and separate its most important alkaloid. The first who wrote
upon the therapy of cinchona was Barba, a Spanish physician, whose work
was printed in Seville in 1642. After its introduction into England
Peruvian bark fell into disrepute, owing to improper administration,
whereby death was caused in certain instances; and it was this latter
fact that instigated Sydenham to investigate it still more accurately.
There has never been introduced into medicine any one drug which has
proved itself so generally valuable and so widely effective as cinchona
and its products.
As little progress had been made in obstetrics as in other branches
of applied medicine or surgery. The custom of employing midwives was
general, and these, for the most part, were ignorant and filthy
old women, slaves of routine procedures that had obtained from time
immemorial. Educated accoucheurs were called only in extraordinary
cases; but with progress the prejudice which excluded educated
physicians from the practice of midwifery gradually gave{166} way,
and there was opened for obstetrics a new era. In the beginning of the
seventeenth century the initiative was taken by Louise Bourgeois, the
_sage femme_ of Marie de Medicis, who in 1626 published a collection of
observations concerning sterility, abortion, fecundity, accouchement,
and diseases of women and children generally; it embodied several
distinctly new ideas. A little later (in 1668), Mauriceau, of Paris,
chief accoucheur to the Hôtel-Dieu, published his treatise on diseases
of pregnancy and childbirth, which was translated into all the languages
of Europe and became a powerful agent for good, not alone that it
represented an advance in knowledge, but it stimulated such rivals
and successors as Devanter, Peu, Paul Portal, and Delamotte to further
research. About this time the Chamberlains, an English family devoted
to the practice of midwifery, invented an instrument to facilitate the
extraction of the foetal head when arrested, and one of them went to
Paris, and, failing of success there, went on to Holland, where he sold
his secret to two Dutch practitioners, who kept it only too faithfully.
In 1721, Palfvn, a surgeon of Ghent, while seeking to fathom the device
of the Chamberlains, conceived a _tire tête_ (literally a head-drawer)
composed of two steel spoons, and hastened to publish an account
thereof,--a praiseworthy act, whereby he merits distinction as the
inventor of the forceps. As modified by Smellie in England and Levret in
France, the obstetrical forceps ranks among the most useful discoveries
of modern surgery, and, although not in common use until about a century
ago, it may be said that the invention has been the means of saving the
lives of countless women and children.
Medical jurisprudence also seems to have had its beginning during this
century. It had long been the practice to summon physicians to court
in order to enlighten the judiciary in questions demanding particular
knowledge in physics and medicine; indeed, the practice began{167} under
the first Christian emperors, and owes its origin to ecclesiastical
authority. Charlemagne confirmed in this regard what Justinian was
perhaps the first to ordain. The tribunal of Châtelet, according to
Renouard, appears to have been the first which comprehended the great
utility of consultation with expert physicians; an edict of Philip le
Bel, in 1311, qualified Master John Potard with the title "Sworn Surgeon
of Châtelet", and the constitution promulgated by Charles V, in 1552, gave
great importance to medical jurisprudence, as it treated in detail of
infanticide, wounds, poisons, abortion, and other such crimes. Early in
the seventeenth century Fidelis collated all that had been written on
this subject, and thus published the first special treatise on legal
medicine.
Some writers claim to have discovered traces of clinical teaching in the
history of Arabian universities, but, as Renouard says, the presence of
a few pupils during visitations and consultations no more constituted
real clinical teaching than the practice adopted by some practitioners
of ancient Rome of being ever surrounded by a group of spectators whom
they dignified with the title of disciples. The first attempt at real
clinical teaching appears to have been in the hospital of St. Francis,
in Padua, in 1558, by Botoni and Oddi. About the beginning of the
seventeenth century Otto de Heurne, of the University of Leyden,
introduced bedside instruction, which was continued by le Boe, sometimes
called Sylvius, with the result of drawing-large crowds of students
to Leyden from 1658 to 1672. Notwithstanding the success attained, the
practice was neglected by the successors of Sylvius until renewed by
Boerhaave, who, invested with several functions at the University of
Leyden, also occupied the chair of medicine. So great was the renown
of Boerhaave that, despite the poverty of the resources of the Leyden
hospital, people came to consult him from the most distant countries,
and he was a correspondent of several crowned heads, even of the Pope,
although{168} himself a Protestant. During his life and long afterward
he exerted an immense influence in medicine, and while, perhaps,
inferior in genius to some of his contemporaries, he had a wider
reputation, and his doctrines prevailed longer. The great success of
his clinics decided in favor of this method of teaching, and in 1715 the
Pope established in Rome a similar institution, under the direction
of the celebrated Lancisi. Soon Edinburgh, Vienna, Pavia, and other
universities followed suit, the first clinical chair in Paris being held
by Corvisart, and the first in Vienna by Van Swieten. After the demise
of Boerhaave, the school of Leyden rapidly declined, while those of
Edinburgh and Vienna became rivals for the first place. It is thus seen
that after an interruption of more than two thousand years clinical
teaching was revived and became more brilliant than ever before.
I now propose to recount the methods and deeds of some of those
concerned in the development of systems, so called, and make mention of
the most prominent medical men in national and historical order. This
will not prevent going back to philosophical conclusions or reflections
upon the philosophy of the history of medicine, when it may seem wise so
to digress.
First, of the system of J. B. Van Helmont, which in its day was most
highly regarded, and which seems to have been, in some measure, a
rearrangement of the views of Paracelsus into a mystic and pietistic
system based upon mechanical principles. Van Helmont was born in
Brussels in 1578, and was so precocious that he entered the University
of Louvain at an age which would have enabled him, had he so desired, to
obtain the degree of Magister when only seventeen years old, he deemed
the degree frivolous. He had studied mathematics, astronomy, philosophy,
and astrology. Going now to the Jesuits, who at that time, even, taught
music, he soon became dissatisfied, and turned to the study of stoical
philosophy. Believing that the{169} Capuchins (who were mere lascivious
gluttons, and considered even washing unchristian) were the true stoics,
he sought to join this order, but ere long abandoned them and resumed
his studies in law, botany, and medicine. For the latter Van Helmont had
at first little respect, since his studies in this line did not enable
him to rid himself of the itch. He soon again lapsed to the monastics,
and came to the conclusion that wisdom, like the grace of God, was
obtainable only by fasting, supplication, and poverty; accordingly he
practiced medicine among the poor as a labor of love (having received
his degree of Doctor in 1599). During his travels he became familiar
with the writings of Paracelsus, which he studied zealously. Finally
he settled down in Vilvorde, where he practiced medicine and chemistry
until his death (in 164-4).
Like most "systems," that of Van Helmont is valued only as an expression
of the spirit of the age, since it embodied largely the pantheism of
Paracelsus, merely cloaked with a more religious or monkish dress. He
held that the general cause of disease was the fall of man; though
there also figured a subsidiary cause, which he denominated Archeus,--a
faculty of appetite seated in the spleen or in the stomach; thus dropsy
was a hindrance of renal excretion by the enraged Archeus. Demons,
witches, and ghosts were included in Van Helmont's system as causes of
disease. Indeed, the man seems to have been a second Paracelsus, lacking
only in the dishonesty and bombast of the latter. He had no followers of
any prominence, and the "system" soon lapsed into obscurity.
The Chemical, or Iatrochemical, System was originated by le Bôe,
commonly known as Sylvius (but who must not be confounded with the great
anatomist of the same name). Le Bôe was born in Hanau in 161-4; studied
in Paris, Leyden, and Basel; received his doctorate from the latter
university at the age of twenty, and practiced in Switzerland with great
success until 1660, when he accepted{170} a professorship in Leyden;
here he was distinguished for his eloquence, wealth, and sociability,
as well as for the great number of pupils that were attracted by his
clinical method of teaching. His system embraced a peculiar phantasy,
being based upon the elements of chemistry, the new knowledge of the
circulation, the latest physiological teachings, and the old doctrine
of the spirituous or innate heat of the heart, which he claimed to
have felt with his finger. He asserted his theories were founded upon
experience, but the truth is, they were inaccurate deductions from
experimental observations, many of which were wholly irrelevant. The
majority of diseases, he taught, were produced by excess of acidity or
alkalinity. For him, the three great fluids of the body were the saliva,
the pancreatic fluid, and the bile, while health consisted in the
undisturbed performance in the body of the process of fermentation;
and the saliva was supposed to give rise to hectic fevers, because
such manifest exacerbation after eating. Stereotyped theory and equally
stereotyped therapeutics gained for him, for a short time, a large
following, but later raised numerous opponents, who alleged that his
system caused as many human lives as the whole thirty years' war. He
died in 1672.
To the same iatrochemical school is generally assigned Thomas Willis,
born in Oxford in 1622 (died in 1675), who rendered great service to
anatomy, especially to anatomy of the nervous system, although his
teaching was disfigured by certain unsupported theories. Like Van
Helmont, he had been destined for theology, but turned his attention to
medicine. Ultimately he became Professor of Philosophy in the University
of Oxford. He first described the so-called circle of Willis, whence
its name; also ascribed diseases, especially those of the blood, to
fermentation, in which the vital spirits played the chief part. He
accounted for hysteria, for instance, by the union of the spiritus with
imperfectly purified blood.
CHAPTER VII.
_Age of Rénovation--(continued).--Iatromechanical School: Santoro,
15611635. Borelli, 1608-1679. Sydenham, 1624-1689. Sir Thomas Browne,
1605-1682.--Surgery: Denis, f 1704. F. Collot, f 1706. Dionis, f!718.
Baulot (Frère Jacques), 1671-1714. Scultetus, 1595-1645. Rau, f 1719.
Wiseman, 1625-1686. Cowper, 1666-1709. Sir C. Wren the Discoverer of
Hypodermatic Medication. Anatomical Discoveries. General Condition of
the Profession during the Seventeenth Century. The Eighteenth
Century. Boerhaave, 1668-1738. Gaub, 1705-1780.--Animism: Stahl,
1660-1734.--Mechanico-dynamic System: Hoffmann, 1660-1742. Cullen,
1712-1790.--Old Vienna School: Van Swieten, 1700-1772. De Haën,
1704-1776.--Vitalism: Borden, 1732-1796. Erasmus Darwin, 1731-1802._
The physiology{171} of the Iatromathematical, or Iatro-mechanical, or
Iatrophysical School devoted chief consideration to the solid parts
of the economy, whose form and function it strove to discover and
demonstrate by the aid of exact methods,--that is, by calculation
and physical apparatus. Thus, it explained digestion as mechanical
trituration; secretions were referred to variation in resistance of
parts in the vascular system; warmth was supposed to be due to friction
of the blood-corpuscles; health consisted in the undisturbed performance
of the physical and mechanical processes of the body. Diseases were
explained inversely: the blood, under diseased conditions, was held to
contain pointed and angular crystals, which irritated as they passed
through the pores, or disturbed because they could not so pass.
The first to enunciate these views was Santoro, or Sanctorius, who
flourished from 1561 to 1635, and was for a while professor at Padua.
He taught how to investigate the pulse by an instrument of his own
contrivance, and how to study the temperature by means of a species of
thermometer, which was probably his own invention. (This instrument, by
the way, was invented about this time; Drebbel [1572-1634] is regarded
as the inventor of the air-thermometer, Galileo [1574-1642] of
the{172} spirit-thermometer, and Roemer [1644-1710] of the mercurial
thermometer.) Santoro studied the phenomenon of transpiration, and
constructed apparatus for bathing bed-ridden individuals; he found
that in twenty-four hours the insensible transpiration through the skin
amounted to 1 1/4 kilogrammes,--which result, compared with the results
of the present day, determined by the most complete observations,
is only twenty per cent, too high, and proves how accurately he
investigated. The important rôle of the perspiration, which he pointed
out, was made use of by the iatrochemists to vindicate their terrific
sweat-cures.
Borelli (1608-1679), of Naples, is usually regarded, however, as the
founder of the iatromechanical school. Of a quarrelsome disposition, he
could not stay long in any one place, though he ultimately settled
in Rome, where he joined the circle of _savants_ who gathered round
Christina, the daughter of Gustavus Adolphus, who had become a convert
to Catholicism. Finally Borelli entered a monastery. His services
related mainly to physiology, where, like Descartes, he followed purely
mathematical principles; he explained the action of the muscles by the
laws of the lever, calculated the mechanical work done by the heart, and
correctly ascribed inspiration to muscular action. He was the opponent
of iatrochemistry, and claimed there was no such thing as corruption
of the blood. His pupils and followers--like Bellini (1643-1704). of
Florence, who became professor in Pisa at the early age of nineteen,
and Baglivi (1668-1707), a pupil of Malpighi, and a man of universal
education--carried out and elaborated the first expressions of this
author. Borelli was the author of the oft-quoted maxim: "He who
diagnoses well cures well."
The iatromathematical system held ground for some time in Italy, and
also found followers elsewhere. For instance, Dodart (1664-1707). of
Paris, explained the voice on the mechanical principles enunciated by
Borelli and by{173} Quesnay (1694-1774). the tirst permanent secretary
of the Academy of Surgery in Paris. In England this explanation was
adopted by a number of followers, none of whom, however, was eminent
enough to justify special mention here. In Germany it obtained a certain
amount of favor, but seems not to have attracted any very eminent
disciples.
The iatromechanical school ran a course not unprofit' able to science,
yet was unfruitful of real advance in the domain of practical medicine.
The man of this particular age, who, more than any other, exerted
an influence destined to be prolonged even to the present time, and
probably much longer, who had a cool, clear, and unprejudiced spirit,
and who sought the true value of medicine, and recompense for the
same in the benefits which it brings to the sick, without scorning or
neglecting its scientific side, was Thomas Sydenham, bora at Winford
Eagle in 1624. a student at Oxford in 1642, and recipient of a
bachelor's degree of medicine in 1648.
The next{174} fifteen years of his life we know practically nothing
of, save that he spent some time in Montpellier pursuing his medical
studies. In 1663 he became a member of the Royal College of Physicians,
but did not take his degree of Doctor until 1676,--thirteen years before
his death. His chief work--_Medical Observations_--is said to have
been originally written in English, and translated into Latin; it first
appeared in 1666,--the year when fire and plague devastated London. He
died of gout in 1689, and was buried in Westminster Abbey. During the
earliest years of the plague in London he fled, as was the general
custom of that day.
His model was Hippocrates. In pathology he was a humoralist without
being a theorist. He knew only one standard,--observation and
experience. Sharing the opinions of his day, he laid but little weight
upon anatomy and physiology; yet he recognized their value when employed
in the production of hypotheses. He conceived of disease as active,
operative,--a natural effort of the body to remove morbid material from
the blood; if this effort is violent and speedy, we have to do, he
says, with an acute disease, but if slow and difficult, the condition is
chronic. Fever was supposed to result mostly from cold or from epidemic
influences. As causes of disease, he considered unknown influences
and changes of the atmosphere very important. In his special pathology
"inflammation of the blood" played the chief rôle, and upon it were made
to depend nearly all acute and some chronic diseases. He arrived at what
he called the "healing power of Nature," for which he made great claims
in his description and observation of epidemics: but he believed there
always remained a good deal for the physician to do, and in treating
syphilis he even gave mercury until two kilogrammes of saliva were
discharged daily. As compared with the therapeutics of that day his
were manifestly simple,--and yet he employed, for example,{175} eighteen
different herbs in one prescription, and that merely an ointment. The
unreliability of the action of drugs induced him to rely upon specifics,
as did Paracelsus, but he acknowledged only one such,--the then new
discovery, cinchona,--not even allowing mercury such a position in
the treatment of syphilis. Such drugs as he chose were mainly from the
vegetable kingdom.
The great importance of Sydenham, and all his statements, so far as we
are concerned, centres about his struggle for the elucidation of
the healing power of Nature, and for simple observation and simpler
treatment, as opposed to the overgrown luxuriance of previous systems
and theories. He became the standard-bearer of his age in his return to
Hippocrates's method and art of healing, which are founded on the nature
of things and on the limits of human ability.
Sydenham was vehemently opposed by Richard Morton (1625-1648), of
London, who, like Fernel, considered all diseases to be a poisoning of
the vital spirits. Sydenham was also antagonized by Gideon Harvey, who
ridiculed his medical contemporaries without stint, because most of
them, for febrile disease, gave cathartics from the second day, and
began treatment with emetics. With delightful satire Harvey divided the
physicians of the day into six classes: the Ferrea, Asinaria, Jesuitica,
Aquaria, Laniaria, and Stercoraria, according as their favorite systems
of treatment were the administration of iron, asses' milk, cinchona,
mineral water, venesection, or purgatives.
Sir Thomas Browne (1605-1682), who still enjoys a great reputation,
was the author of the works entitled _Religlo Medici and Inquiries into
Vulgar and Common Errors_. The latter appeared in 1646, but does
not seem to have protected its author from the worst error of his
age,--viz., superstition,--since, in 1664, he swore that two condemned
old women were actual witches.
Having{176} considered the progress of medicine during the seventeenth
century, it may be well to glance likewise at surgical progress. Among
the Italians Santoro, already spoken of as the inventor of various
instruments, should be mentioned; also Valsalva, who obtained a sound
reputation as an operator, employed the ligature, and recommended a
starvation plan for treating aneurism; Magati (1579-1647). who contended
against the abuses of treating wounds by filling them with plasters,
balsam, poultices, tents, etc., and of changing the dressing several
times a day.--once in four days was better, he said; Severino
(1580-1656), first a lawyer, then a professor at Xaples, and later an
eminent surgeon, a good anatomist, and a particular friend of the actual
cautery; Marchetti (1589-1673), a bold, versatile operator of Padua; and
Borri, of Milan (1625-1695), skilled as an operator and an oculist but
better known because of his sad fate, since he died in the prison of the
Inquisition, alter a prison-life of twenty-five years, on account of too
liberal religious views. There were also numerous other Italian surgeons
who made a name, especially in plastic surgery, and particularly in
that branch of it named rhinoplasty, by whose efforts one method of
manufacturing a new nose came to be known as the "Italian method."
France, we must remember, was the home, during this century of
Richelieu. Mazarin. Louis XIV. Corneille. Racine. Molière. Fénelou. La
Fontaine. Boileau, Bossuet, and many other men eminent in literature
and science. During this century the French laid the foundation for that
leadership in surgery which they maintained for nearly two centuries.
Let us mention, among their surgeons. Morel, who invented the tourniquet
at the siege of Besançon, in the year 1674. There was also Jean Baptiste
Denis (who died in 1704), physician to Louis XIV. who performed the
first transfusion of blood in man. (Transfusion of the blood of the
young into the veins of the old for the purposes of rejuvenation,{177}
was recommended by Libavius, in 1715, and Colle, of Padua, gave it
new support by describing a method for its performance. In 1729 Boyle
practiced transfusion on dogs. The London faculty sought the value of
the operation after excessive haemorrhage, and Edmund King, physician to
Charles II, in 1665 practiced transfusion from vein to vein. But Denis
was the first to carry out the operation with lamb's blood upon a
patient sinking under excessive venesection,--an operation which was
very much abused at this time.) It was in this century that the French
family of lithotomists--the Collots--distinguished themselves in their
special line. The last member of the family, Francois, died in 1706.
Their specialty must have found, at that time, considerable more
material than comes to the front to-day.
Among the general surgeons of France were de Marque (1618), who
distinguished himself as a bandager; Bienaise, who invented the bistoury
caché (1601-1631); de Launay (1649), monk and lithotomist; Goursaud,
who survived his century, and who was the first to describe stercoral
incarceration; Duverney, who demonstrated the growth and nutrition of
the bones by periosteum; Lambert, who practiced injections in hydrocele;
Andry, of Lyons, who wrote of orthopaedic surgery and originated the
name _orthopaedics_; Pierre Dionis (who died in 1718), surgeon to the
Empress Maria Theresa, famous in his art, and who first emphasized the
effects of rickets upon the pelvis; and Boulot, better known as Beaulieu
(1671-1714). who advanced himself from being a soldier and a day-laborer
to become a physician, a famous lithotomist and surgeon. He finally
joined the Franciscan order, where he obtained the name of Frère
Jacques, under which title he passed for the inventor of lateral
lithotomy. Then there were Saviard (1656-1702), surgeon-in-chief in
the Hôtel-Dieu, who, among other things, determined the seat of hernial
strangulation to be often in the neck of the sac; and Georges{178}
Mareschal (1658-1736), surgeon to Louis XIV, one of the founders of the
Academy of Surgery, who has a record of eight lithotomies performed in
half an hour, and who became famous for his services in improving the
schools of surgery in France.
In this (the seventeenth) century, also, ophthalmology was much
cultivated in France, although it was assigned to the despised surgeons.
Those who won most renown in this line were Maitre Jean and Brisseau,
who divide the honor of first recognizing the seat of true cataract.
During this period, also, Duverney, Professor of Anatomy at Paris, was
the first to systematically describe diseases of the ear in accordance
with their anatomical seat.
In Spain scholarship sank more rapidly during this century than among
any other people in history, due mainly to the loss of their political
supremacy and their commerce to the Dutch and English, and to the utter
failure, at home, of their efforts to introduce true unity of faith. In
these efforts the industrious Moors were excluded, under Philip III. In
art they maintained their standing,--attaining, in fact, in Murillo,
the acme of their fame; but in other branches of industry they rapidly
degenerated. Students of history will readily understand how little
leisure the Spaniards had at this time to devote to the cultivation
of science, including medicine and surgery. Of the two men who are
mentioned during this century as Spanish surgeons, namely, Almeida and
Ayala, we know practically nothing.
The Germans gained no such store of knowledge from their experience
during the Thirty Years' War as did the French during their campaigns.
The barber-surgeons, for the most part, still reigned supreme, and their
guild contained some men of ability and independence of thought. The
most notable man of the times was Fabricius Hildanus (1560-1634). Of
him, however, I have already spoken as belonging rather to the previous
century. He was the first learned{180} German surgeon recognized and
esteemed as such by his contemporaries. He was distinguished, also, as
an oculist and aurist, and removed a particle of iron from the cornea by
means of a magnet. A man of great operative genius, and a born surgeon,
was Purmann (1648-1721), who greatly lamented the low condition of
surgery in Germany, and regarded a knowledge of anatomy as the prime
requisite for the surgeon; he employed the speculum in the diagnosis
of syphilis, although it has been Ricord's boast that this was his own
idea. Scultetus (1595-1645), of Ulm, was a famous surgical writer of
this period, and a bandage of his devising is still in frequent use,
and bears his name. Murait, of Zürich, was also a capable surgeon
The Dutch had but few men during this century who enjoyed any reputation
as surgeons. The best among them was Rau (1658-1719), who, from being
a poor boy, became a barber, traveled extensively, and was finally made
Professor of Anatomy and Surgery in Leyden, where he introduced the
innovation of teaching practical surgery upon the cadaver. He was
especially famous as a lithotomist after the method of Frère Jacques,
although he did not give instruction on this subject in his lectures.
By the way, it is an interesting fact that the clinical histories of
many operations for stone during the seventeenth century were related
in verse, and illustrated with plates. Harvey's vivisections were also
related in verse.
Now, for the first time, do we begin to hear of English surgeons and
English surgery. The most prominent, as well as almost the earliest,
was Richard Wiseman (1595-1686), ordinary surgeon of James I, called
sometimes the "Pride of England" and sometimes the "Paré of England,"--a
bold, judicious operator, who took hold of every novelty and who
accepted the ligature of Paré (always having the actual cautery at
hand, in case the ligature should fail); he also amputated through sound
parts,{182} favored operating for strangulated hernia, and employed
the trephine zealously. The first recorded operation for external
urethrotomy for the relief of stricture is mentioned in Wiseman's
There were also William Cowper (1666-1709), a famous anatomist and
surgeon; and Woolhouse, a famous, but ignorant, itinerant oculist. Sir
Christopher Wren, architect of St. Paul's, was the first who devoted
attention to injecting medicine into the veins,--a subject studied again
much later and recently once more taken up. His example (in 1667) was
followed by others, whose experiments demonstrated, as we know to-day,
that the effects which follow the intravenous administration of drugs
are the same as follow administration by the mouth.
Midwifery during the seventeenth century advanced even more rapidly than
its mother-science surgery. The accouchement of women was intrusted in
many cases to the care of educated men, who contributed not a little
to the art. Anatomy and physiology contributed also their quota to a
clearer knowledge of these diseases. The obstetric forceps were for so
long a time kept secret that they were of small benefit at first to
the obstetric art. Among the French who were especially prominent as
promoters of midwifery must be mentioned Marguerite de la Marche, chief
midwife of the Hôtel-Dieu; Francois Mauriceau, President of the College
of St. Come; Jules Clement Delamotte, who was also a skillful surgeon;
and Portal, who first proposed version by one foot Among the Germans a
few midwives distinguished themselves as independent observers, most of
all Justine Siegemundin, daughter of a minister, who devoted herself
to midwifery with such success that she became court midwife; she
recommended puncture of the membranes for the production of artificial
delivery, and especially advocated bimanual version.
But, perhaps, the most significant advances were made in the direction
of studies in anatomy, physiology, and pathology.{183} The history
of the circulation we have already taken up. After Harvey's time, and
largely because of his researches, physiologists were divided into two
parties with regard to the origin of life. These parties were known as
_animists_ and _animalculists_. It was largely by the later researches
of Highmore (1613-1685) upon the anatomy of the testis and the
epididymis, supplemented by those of Aubrey in Florence concerning the
ovaries (which had been previously considered as female testicles), and
the researches of Stenon concerning the muscular nature of the uterus,
that a better knowledge of reproduction was established. De Graaf
(1641-1673), a physician of Delft, Holland, pointed out the ovarian
follicles, known to-day under his name, while Swammerdam (1637-1686)
studied the comparative anatomy of the ovaries,--and was, by the way,
the first to prove that the queen bee is a female. Needham, the London
anatomist and physician, and Hoboken, of Utrecht, described more
accurately the placenta and the coverings of the ovum.
Anatomical discoveries crowded along about this time. For instance,
Wharton (1610-1673) discovered the sub-maxillary duct, named after him;
Glisson (1647-1671) studied the liver and recognized its capsule, that
still bears his name; Nuck injected the lymphatics with quicksilver, and
studied the glands especially; Stenson discovered the excretory duct
of the parotid, and Rivinius (his name being translated in German,
Bachmann) found the sublingual duct; Peyer, Schafhausen, and Brunner,
the latter a professor in Heidelberg, discovered the intestinal glands
which bear their names; Wirsung, of Bavaria (who was assassinated
in 1643 by another physician), discovered in the dissecting-room of
Vesalius, at Padua, the excretory duct of the pancreas; Pacchioni
found the bodies named after him in the dura mater; Havers, of London,
discovered the synovial glands and the so-called Haversian canals;
Cowper, already mentioned, discovered the small glands named after{184}
him, located in front of the prostate, and Bartholin yet other glands,
in the labia, which bear his name; Mei-bom, professor in Helmstàdt,
discovered the small glands in the eyelids which are named after him.
Besides these, many other discoveries might be recorded here, did time
permit. One other, however, deserves to be mentioned, with which the
name of Schneider (1614-1680) must always be honorably connected. He
described the mucous membrane of the nose and demonstrated anatomically
and clinically that not the brain, but this membrane, secretes the
mucous discharge during fluxes from the nose. This overthrew at once
and forever the ancient doctrine, which included so many and various
"catarrhal" diseases. I might add also that the best and most complete
description of the{186} entire central nervous system which had been
given up to this time was furnished by Vieussens.
Description of Fig. 26.--"Of the corruption of the bones of
the arm and shin, even as far as the marrow; of the shin-
bone broken with a wound and the bones sticking out and
bound with swathe-bands brought circularly about; and of the
cutting off of the end of the hand or foot. I represents the
corruption of the bone and of the marrow of the shin-bone,
II represents the shin-bone wholly corrupted and rotten. III
represents the place where the corrupt bone was situated and
was now pulled forth with the pincers. V is that shin-bone
corrupted, which the patient laid up for a memorial. VI is
the bone of the right arm corrupted. VII represents the bone
of the arm totally corrupted and sharp, which was pulled
away with the pullers, but by pieces, without any noise or
pain. VIII shows the place where the corrupt bone of the arm
lay, which was now pulled forth, which Nature filled up with
a callous, so that the patient could perform country
business without any impediment. The patient was a
countryman of Pappatavia, whose arm a souldier broke in four
places, without any wound, anno 1636. IX is a fracture of
the shin-bone with a wound, and laying the bone naked. X is
the bone of the shin with a wound, broken, with bones
sticking forth, and bound with bands not crosswise, but
circularly brought about and laid within the capsula as it
ought to be. XI is a hand affected with a secret canker
which is cut off in the sound part, namely at the end of the
radius and cubit bone. XII is a hand that is sphacelated,
which, being laid upon the block (D), is amputated in the
sound ends of the radius and arm-bone with a chizel (E),
contrary to Hildanus, with good success. XIII is a basin
filled with oxyerat, in which swims a bladder, which, being
wet, must be applied to the mutilated part. XIV are two
swathe-bands wrapt together (F and O), whereof each hath two
ends, to bind the arm, whereof the hand at the end is cut
off. XV represents a foot that is sphacelated, which is
taken off in the mortified part, near the sound part with a
pair of pinccrs. The mortified part being removed, the rest
of the putrefaction is consumed with red-hot irons until the
patient feels the force of the fire. After this two plagets
are anointed with Hildanus, his unguent Egyptiae, which are
applied to the escar; lastly, long plaisters (7) being laid
upon it, the foot mutilated is bound with a wet band (Q} as
far as the knee, as the hand is unto the middle of the arm.
XVI are divers sorts of iron instruments and made red hot,
both to consume the remainder of the putrefied part and are
also fit to stop the flux of blood."
By the middle and latter portions of the seventeenth century most of the
better physicians and surgeons had either assumed offices and positions
in which they were supported by the State, or were settled in permanent
residences, which was not the case with the mass of physicians in the
sixteenth century. As a result the reputation of the entire profession
began to improve, while the unlimited license and absolute freedom of
practice prevailing during the Middle Ages were almost entirely done
away with. By this time the clerical element had disappeared almost
entirely from medical circles, or only dabbled in certain specialties.
The Thirty Years' War was fatal to the supremacy of the clergy in
matters of public health. Moreover, the increase of international
intercourse favored the communication of medical knowledge.
The physicians of this period were more occupied with chemistry and
physics than had ever been the case before. Nevertheless, this was also
the special age of _alchemists_ and of _impecuniosity_. According to one
of the classifications of the time, the regular profession was
supposed to include physicians, surgeons, barbers, regimental surgeons,
lithotomists, bath-keepers, midwives, nurses, apothecaries, druggists,
and even confectioners and grocers. Another list of impostors and
quacks, equally official, was made to include old women, village
priests, hermits, quacks,--
Description of Fig. 27.--"I represents the breast affected
with an ulcerated canker, the basis whereof is thrust
through with two needles drawing after them a twisted flaxen
thread. II shews how the chyrurgeon takes hold with his left
hand, of the ends of the threads that were thrust through,
and with his right hand he takes the knife and with that he
cutteth the canker out by the roots. III shews a canker cut
from the breast weighing six physical pounds. IV shews how
the chyrurgeon, after the cutting off of a breast ulceratcd,
doth lightly cautcrize the place with a red-hot iron at
least to corroborate the parts. V is the instrument of
Hierom Fabritius ab Aquapendente wherewith a fistula of the
thorax is perforated. VI is Sostratus, his band, which is
most convenient where the breast is affected with any
disease that requires binding. VII shews how Celsus cured
the sticking forth of the navil by manual operation. VIII is
a truss for the navil made of a double: cotton linncn
cloth."
--uroscopists,{187} Paracelsists, Jews, calf-doctors, executioners,
crystallomancers (a class of people--chiefly Italian--who sought after
crystals), mountebanks, vagrants, magicians, exorcists, monsters,
rat-catchers, jugglers, and gypsies. Veterinary physicians were also at
that time included in this class.
Anatomy{188} was now studied more from human bodies, and was authorized
by statute. This was especially the case in non-German institutions, to
which for this reason students flocked in great numbers. In Dresden, so
early as 1617, there was a dissecting-room in which stuffed birds, at
that time a great rarity, and similar curiosities were preserved. The
study of anatomy was at a low ebb in Germany; so that when Rolfink,
in 1629, arranged at Jena, which was then the most popular German
university, for two public dissections upon executed malefactors, it was
considered such an event that the very highest authorities were present.
But the peasantry took such fright at this occurrence that for a long
time afterward they watched their cemeteries by night lest the corpses
should be dug up and, as they said, "Rolfinked." Vienna did not possess
a skeleton until 1658. Strassburg obtained one of a male in 1671, and
several years later one of a female. In Edinburgh an anatomical theatre
was first erected in 1697 in Surgeons' Hall. It is worthy of remark that
anatomical plates, designed to be lifted off in layers, existed even at
this period. About the middle of this century there arose a dispute at
the bedside of the Margrave of Baden, between two learned professors and
the regular court physician, whether a plaster to be applied over the
patient's heart should be placed in the middle of the chest, according
to Galen, or upon the left side. The dispute was settled by opening,
before the eyes of the noble patient, a hog, by means of which it was
demonstrated that, as a matter of fact, the heart of the hog lay on
the left side. So convinced was his excellency that he dismissed the
ordinary physician, who had held a contrary opinion as to the position
of a nobleman's heart.
The general barbarity and immorality of this century were conspicuous,
especially among the upper classes, and by its close had spread from
France, became naturalized in both Germany and Italy, and extended even
to the universities,{189} their professors, and their students. The
life of the latter during this period was more vulgar and rude than ever
before, and almost more so than ever since. Pennalism--that is to say,
barbarity toward junior students--became unbounded, so that outbreaks
occurred even during lectures. At last the State authorities were
compelled to interfere. Student outrages were very frequent and often
fatal, and their outbursts were disgraceful in the extreme.
Only in France was instruction in surgery well regulated, for this was
the only country which possessed a proper surgical college. Practical
instruction was imparted to mid wives--in Paris through a special
institution, in Germany through the Midwives' Guild; the barbers, too,
continued to receive instruction from their guilds; while instruction in
pharmacy was given by the master-apothe-caries, too often dogmatically
and even farcically, serving as objects for the keen satire of Molière.
The expenses of graduation were very great, and the ceremonies sometimes
lasted two days.
In another way this same seventeenth century might be characterized
as one of aggrandizement for physicians,--that is, as one during
which their position was improved in the eyes of the public and
better supported by the State. The physicians proper--the "_medici
pitri_"--were still persons of the profoundest gravity, with fur-trained
robes, perukes, canes, and swords, when matters were prosperous, who
for their lives would do nothing more than write prescriptions in formal
style, everything else being considered beneath their dignity,--even as
they affect in England to*day. They demanded to be called in every case,
however, even though they knew nothing about it, claiming that only by
means of their presence could things certainly go right. Nevertheless,
in dangerous cases--for example, during the plague--they left the
surgeons alone, while they looked upon the sick through the windows.
In spite of this, however, they were generally esteemed and often{190}
sought for, as well in public as in private. Some of them were supplied
with large libraries by their patrons or through their positions under
the government, and most of them enjoyed moderate prosperity. Their pay
was, for the most part, regulated in accordance with a definite tariff,
while the State gradually cut down the doctor's honorarium to the pay of
a day-laborer. During that century a certain physician to a countess
in Munich received $25 as his annual stipend. For being present at a
post-mortem and rendering an opinion thereon, each physician received
$1.75. Surgeons who were zealous and eager were always highly esteemed;
they were often better educated, in many respects, because of their
extensive travels; but the social emancipation of the surgeons was not
completed until the eighteenth century. About this time amputation of
the arm was supposed to be worth 31 marks ($7.75); of the leg, 41 marks;
or, if a patient died, half this price. Lithotomy cost 51 marks, or
half of that if the patient died. For cataract operation on one eye the
surgeon received 17 marks; for a like operation on both eyes, 25 marks.
We find in medicine, as in other branches of knowledge, that each
succeeding century presents its added quota of imperishable facts,
making it still more important than its predecessor. We may say that the
fifteenth century had prepared the way for a reforming idealism which
was the principal characteristic of the sixteenth; and that in the
seventeenth century the realistic reaction against this same idealism
showed itself in the church and the State by struggles against
constituted authority, and in medical science by the domination of
inductive philosophy. The idealism of the eighteenth century was not
reformative and humanistic, but revolutionary and humanitarian. The
unsettled character of the century's events may be charged, in
some degree, to the American and French revolutions, with their
interpretation (and their attempted attainment) of the{191} so-called
"rights of man." The masses were now supposed to be released, and
philosophers created new doctrines, which had a greater influence upon
the times than ever had philosophical doctrines before. Rousseau, for
instance, aroused a revolution in politics and education, while skeptics
and materialists alike strove for general enlightenment, which was sadly
needed. Among the higher classes extravagance and immorality prevailed
extensively, among the lower classes poverty and ignorance. In Germany
the rulers even sold their subjects, as when Hesse-Cassel sold to the
English seventeen hundred mercenary soldiers, and other States sold
smaller numbers. A criminal code, published in 1769, contained seventeen
copper-plate engravings, illustrating various methods of torture. A
physician was always present when torture was inflicted, to see that the
victim's sufferings were not greater than he could bear. This inhuman
mode of eliciting testimony was last practiced in Europe in 1869, in the
Swiss Canton of Zug. Popular education was a myth, and the children of
bondmen were not permitted to learn. No wonder the French revolution was
hailed with joy along the Rhine, where it swept away at once and forever
the petty rulers, abbots, and bishops, who were the "bloodsuckers" of
the people. The numerous wars of the century had no great influence upon
the development of medicine, except in the direction of surgery.
The eighteenth century was revolutionary also in the introduction of
freedom of religious thought, so that clerical physicians disappeared
entirely from the ranks, save a few who officiated as lithotomists, like
Frère Come, or as oculists, like Wrabetz, the latter of whom was even a
professor in Prague.
This was the century, too, of Leibnitz and Kant, of Linnæus and
Lavoisier, as well as of Bach, Haydn, Beethoven, and Goethe. During it
the most conspicuous services in nearly all branches of learning were
rendered by the Germans,{192} instead of by the Italians and English, as
during' the preceding century. In fact, Germany was then at the zenith
of her glory, and supplied an impulse for all other nations.
The influence of philosophy and the natural sciences became also more
and more marked. At the head of its philosophers must be placed Leibnitz
(164:6-1716), who, by his own writings and those of his pupils, created
a philosophical school, whose influence is still every where felt.
His doctrine was dualistic: Matter is created once for all, and has no
further need of the Creator. As concerns the spiritual world, he assumed
minute, indivisible, intelligent beings, called monads,--constituents of
all bodies and all beings. In close relation with him stood Kant,
while in England Locke and Hume became leaders of the opposed and
materialistic school, declaring the brain to be an organ for the
secretion of thought.
Among the universities founded during the eighteenth century were those
of Breslau, 1702; Bonn, 1771; Stuttgart, 1781; Pesth, 1794; Gottingen,
1737; and Erlangen, 1743. Medicine was also cultivated in learned
societies, which increased constantly in numbers. In 1744 Frederick the
Great united two other societies into his Royal Academy. In Switzerland,
in 1751, was founded an association of physicians and naturalists,
while in France royal scientific societies were founded at
Bordeaux, Montpellier, Lyons, and Dijon, and the Royal Medical Society
of Paris lived from 1717 until 1788. In spite of all these opportunities
for enlightenment, everything was not yet enlightened. Then de Haën
defended the existence of demons, and Maerz, a well-known theological
teacher, in 1760 devoted a book to witches and magic. That witches were
burned publicly is a matter of history, even in America. So late as 1821
there was a statute regarding witches in Ireland, and they were burned
in Mexico as recently as 1877. But these are flying pictures of
the eighteenth century, which are meant{193} only for the moment
to illustrate the more serious topic, to which we must now address
ourselves.
First of all, the _medical systems and theories of the century_. Many
hundred years previously Galen had originated a method, which deserves,
perhaps, the title of pure eclecticism. The first purely eclectic system
similar to his originated with Boerhaave (1688-1738), perhaps the
most famous physician of his or any other century. He was the son of
a clergyman near Leyden, Holland, and was one of thirteen children.
Originally intended for the clerical profession, he had studied
philosophy, history, logic, metaphysics, philology, mathematics, as well
as theology, with great diligence. His education was, later, directed
to the study of medicine, because of the statement that the purity
of certain theological doctrines was endangered by him. So he studied
chemistry and botany, and then anatomy and medicine,{194} graduating in
1693. He practiced in Leyden with great success, and was offered a court
position. In 1709 he was tendered the chair of Medicine and Botany,
and in 1714 that of the Practice of Medicine; in 1718 he was also made
Professor of Chemistry. In all of these positions he displayed the
greatest capacity. He was a clinical teacher of rare talent, and soon
acquired such reputation as to attract to Leyden students from all parts
of the world in such numbers that no lecture-room in the university
could contain them. He was the first to give separate lectures on the
subject of ophthalmology, and employed the magnifying-glass in examining
the eye. As a practitioner he was no less popular, and he left an estate
valued at two million dollars. He was so famous that, when a Chinese
official addressed a letter "To the Most Famous Physician in Europe,"
it reached him safely. He made no distinction in his patients, and
compelled Peter the Great to wait a whole night for his turn to consult
him. His most eminent pupils were: Haller, Van Swieten, de Haën. Gaub,
and Cullen.
Boerhaave's influence and dignity, which were astonishing, even in a
physician, were based no less upon his encyclopaedic attainments than
upon the benevolence and purity of his character. He was free from
disputatiousness and vanity, although everywhere regarded as an oracle.
His universal maxim was: "Simplicity is the seal of truth," although he
never manifested this in his therapeutics. He employed the thermometer
in the axilla in examining his cases, as did the iatrophysicists of the
previous century.
His doctrines did not form a new system, but rather a composite of
earlier systems, he stands also in the anomalous position of one who had
the whole world at his feet, and yet contributed little or nothing which
has been of essential importance. In fact, his peculiar views have been
so universally given up that they are of only meagre historic interest.
He looked upon disease as a condition in which{195} bodily action or
natural activities, being disturbed or unsettled, could take place
only with difficulty; the reverse of this, of course, constituted good
health. Fever he regarded as an effort of Nature to ward off death.
Digestion was explained, like the circulation, upon mechanical
principles. In his therapeutics, besides his efforts to sweeten
the acid, to purify the stomach, to get rid of acridities, he made
Hippocrates and Sydenham his models. His biographers say that his
medicines were less effective than his personal appearance. He left many
adherents, but no school of followers. It must be said, however, to
his credit, that, while not the first to give clinical instruction, he
permanently established a clinical method in teaching.
Gaub (1705-1780), professor in Leyden from 1731, was but little inferior
to his master, Boerhaave, in fame as a teacher. He wrote the first
complete work on the exclusive subject of general pathology. In general
therapeutics he considered the healing power of Nature amply sufficient
to remove sickness, but attributed this power sometimes to the soul and
sometimes to the body.
There arose, naturally, strenuous opposition to the views and teachings
of Boerhaave, and his principal opponent was Stahl (1660-1734), who was
one of the most important systematists of any age, a profound thinker,
and a pioneer chemist. He began lecturing in Jena at once upon his
graduation, at the age of twenty-five, and moved through two or three
different university positions until he came to Berlin at the age of
fifty-six. He was a great pietist, of uncouth manners, faithful to his
laboriously acquired convictions, and bitter and relentless against
those who could not accept them. Indeed, he regarded his convictions
as revelations from God. He looked upon the success of another as a
personal injury to himself, and from being first a croaker he became
finally a confirmed misanthrope, until he fell into actual melancholia.
Pecuniary profit he had never sought, and its pursuit he scorned.{196}
His views were dynamico-organic, pietistic, and antagonistic.
He regarded the soul as the supreme principle, life-giving and
life-preserving, not to be confounded with the spirit; when hindered or
obstructed in its operation, disease was present. The soul governed
the organism chiefly by way of the circulation; consequently, plethora
played an important rôle. To get rid of this plethora the soul employed
either fever or convulsive movements; for example, in children plethora
produces a pressure of blood to the head, and, by way of compensation,
the soul provides a haemorrhage from the nose. For reasons easily
appreciated, he regarded bleeding piles as safety-valves of the utmost
importance. Fever was a salutary effort of the soul to preserve the
body; this was true even of intermittents, and, accordingly, he never
gave cinchona. He scorned anatomy and physiology, saying, in one place,
that medicine had profited as much by the knowledge of the bones in the
ear as by a knowledge of snow which had fallen ten years previously. But
Stahl was one of the most eminent chemists of the age, and did a
great deal to liberate chemistry from the glamour of alchemy and the
domination of pharmacy, and to transform it into an independent science.
Stahl's doctrine has been called _animism_, and was a reaction against
the chemical and mechanical theories of the seventeenth century. He
gained a considerable number of followers, the most notable of them
among the French being Sauvages (1706-1767), the forerunner of Pinel and
an opponent of pure mechanics, who animated the mechanical system of
the body with Stahl's "soul." This was, par excellence, the age of
artificial systems, and so Sauvages in his classification supplied a
system which had ten classes of diseases, each of which had several
orders, and some as many as two hundred and ninety-five genera, and
two thousand four hundred species of disease!! Even Linnæus had three
hundred and twenty-five genera of disease,{197} while Cullen had only
four classes with one hundred and forty-nine genera.
The mechanico-dynamic system was a sort of compromise or mixed system,
which was held in high honor by the most eminent physicians and better
minds of the last century, and has even been prized by Sprengel as
the best of all. It was originated by Friedrich Hoffmann (1660-1742).
Hoffmann's father was a physician, and he was himself born in Halle,
whose university he attended. He acquired lasting reputation as an
oculist, and was made Professor of Anatomy, Surgery, Medicine, Physics,
and Chemistry at his _alma mater_. Our commonplace "Hoffmann's anodyne"
is named after him. He was one of the most erudite professors of his
day, more easily understood than Stahl, widely known for his fluent
diction and amiable temper, and, accordingly, won great renown for his
university. His good fortune as a practitioner was so great that even
Boerhaave declared him his own equal. As a writer he was voluminous, one
edition of his works comprising twenty-seven large volumes.
According to Hoffmann's views, life was simply mechanical movement,
especially of the heart; death, the cessation of heart-action,
putrefaction thereupon resulting. Health meant regularity of
movements; disease, a disturbance of the same. He used the word "tonus"
extensively. Ether he regarded as an important factor, producing
and maintaining movements of the body, itself extremely volatile,
corresponding largely to the "pneuma" of the ancients; it was, in fact,
a motor principle and, at the same time, the perceptive soul. Ether was
stored in the medulla, and circulated in a double way in the body; spasm
was the consequence of too strong, atony of too feeble, influx of ether.
Fever was a general spasm of the arteries and veins, having its cause in
the spinal cord. Hoffmann's therapeutics were simple, and poor in drugs.
These latter were intended to weaken, alter, or evacuate, and he{198}
was especially partial to the use of vinous remedies. The strong and
toxic drugs he used but little.
William Cullen (1712-1790), a Scotchman, rose from the deepest poverty
to the greatest celebrity. First a barber, he afterward became an
apothecary, then a ship-surgeon, then a village practitioner, finally
entering into partnership with William Hunter as a general practitioner.
Both of these eminent men being in equally poor circumstances, they
agreed to live in the same place and that, while one was studying, the
other should take care of the practice. In this way Cullen was enabled
to graduate in 1740. Six years later he taught chemistry in Glasgow,
and in ten years more came to Edinburgh as Professor of Medicine. He
continued very active and famous up to the time of his death, but died
as he had been born,--in poverty. Among his numerous other charitable
deeds, he supported the widow of Robert Burns and published the latter's
Cullen was the father of modern Solidism,--a system based upon the solid
parts of the body, the nerves being the chief agents. The life-giving
element was, in his view, an undefined, dynamic something (different
from Hoffmann's ether or Stahl's soul), which he called _nerve-force, or
nerve-principle; animal force; and brain-energy_, and in it he included
the spinal cord. His nerve-principle was supposed to produce spasms and
atony, either actively or passively. The causes of disease, while of a
debilitating character, were supposed to awaken reaction of the healing
powers of Nature; fever was a reparative effort of Nature, even in
its cold stage, the blood playing no part in it. He constructed a very
arbitrary classification of fevers, as, in fact, he did of all
diseases, his system of nosology being the secret of his reputation. His
explanation of gout was famous. That disorder, he said, depended upon
an atony in the digestive organs against which was periodically set up
a reparative effort in form of a{190} joint inflammation. In scrofula
he had to assume, in contradiction to his nervous pathology, a peculiar
acridity, and in putrid fever a putridity of the humors of the body. His
therapeutics were simple and salutary, because of his renunciation of
venesection, which was much abused in his day.
The most celebrated pupils and successors of Hoffmann were Gregory, of
Edinburgh, Gardiner, and, in Germany, the famous Thaer (1752-1828), who
finally abandoned the practice of medicine because it promised more than
it could perform, and who became a "father of husbandry."
A composite of the doctrine of Hippocrates, Sydenham, and Boerhaave was
represented in the so-called Old Vienna School, whose connection with
the lives of Maria Theresa and Joseph II deserves, at least, mention.
Its founder was Baron Van Swieten (1700-1772), of Leyden, a descendant
of a noble Jansenist family of the Netherlands, who graduated under
Boerhaave after having studied at Louvain. After the death of his
patron he was called to the assistance of the Archduchess Maria Anna, of
Austria, who was suffering from an abortion, and gave such satisfaction
that she recommended him to her sister, Maria Theresa, who up to this
time had remained sterile. To her and to her husband he gave advice
which resulted in sixteen successive pregnancies, and then, as the
result of his success, came to Vienna in 1745 as President of the
General Medical Department of Austria. He was also made censor, in
which position he incurred the enmity especially of the Jesuits and
of Voltaire, whom he robbed of their influence. He was made baron, and
became, next to Kaunitz, the most influential counselor of the empress.
His chief care was dedicated to the elevation of medical affairs in
Austria, and especially to the improvement of the medical faculty. He
had just seen success crown his efforts when he died of senile gangrene,
with the reputation of being a great physician and benefactor of
the poor. One of the greatest of his{200} services was improving the
treatment of syphilis, in which he, after the example of Paracelsus,
recommended the internal use of corrosive sublimate.
More eminent as a physician than for personal character was de Haën
(1704-1776), of The Hague,--a pupil of Boerhaave. At the suggestion
of Van Swieten, he was called, in 1754, to Vienna as president of the
clinic of the city hospital, which at that time afforded accommodation
for only twelve patients. He was the real founder of the so-called Old
Vienna School, whose merit, in contrast to the so-called new school, is
to be sought in practical and diagnostic services. As de Haën quarreled
with every one, he also did with Stoerck (1749-1803), the successor of
Van Swieten in the direction of the Austrian Medical Department, and
with Stoll (1742-1787),--a clinical teacher who was especially famous as
an epidemiologist.
Stoll lectured with great popularity until 1784, upon the completion of
the Allgemeines Krankenhaus, when he fell into the background and was
badly treated. He was the subject of numerous intrigues by his enemies,
and had a wife who embittered his life, and who even had him buried in
the dress of a Jesuit in order to injure his reputation after his death.
To his credit be it said that, changing his views of the constituents of
disease later in life and his original therapeutics becoming no longer
of use to him, he abandoned them entirely. Nevertheless his therapeutic
system flourished for a long time after him.
There were in vogue during this period numerous other doctrines, some
of which were too puerile or insubstantial to gain any foothold at all;
others exerted a certain amount of influence during the life-time of
their originators or for a generation afterward. With many of these I do
not care in any way to deal. A few others, I think, ought to be at least
mentioned in such a history as I am endeavoring to present.
There was another Hoffmann--Christopher Ludwig
Hoffmann{201} (1721-1807), of Westphalia, who devised a so-called
humoral theory in which the "acridities" of Boer-haave were mingled with
the "putridities" of the pneu-matists and the "irritability" of Glisson.
His treatment and remedies for diseases were supposed to be antiseptic,
as was very proper when dealing with putridities.
The theory known as the "Doctrine of Infarctus" had its origin with
Kampf, who died in 1753. By infarctus Kampf understood impacted fæces,
which he thought originated in the humors of the body, portal vessels,
and intestines; he recognized two kinds,--the black bilious and the
mucous. From this theory a wide-spread clyster fashion developed, and
lords and ladies vied with each other in belaboring their infarcti and
in administering enemas. As Baas says: "We cannot deny to the author
of this doctrine at least an extensive knowledge of human nature. He
supplied a universal remedial procedure, and gratified the apothecaries
with the bulkiness of the herbs required for its practice."
Quite antagonistic to the views of the Vienna School were those of the
School of Montpellier, inaugurated by Bordeu (1732-1796), and generally
known as _vitalism_. Bordeu died in the enjoyment of great reputation,
but at variance with all his colleagues. He maintained the existence
of a general life of the body,--a composite life,--resulting from the
harmonious working of the individual lives and powers of all the organs,
which were supposed to be associated with each other, but each for its
own definite function; the most important organs--the stomach, heart,
and brain--being called "the tripod of life." In pathology he laid great
weight upon crises, which were supposed to proceed from the glands.
The most important representative of vitalism was Barthez (1734-1806),
of Montpellier,--a man of great gifts and eager for knowledge. He
recognized a vital principle as the cause of the phenomena of life, but
acknowledged that{202} its nature was unknown, although he endowed it
with motion and sensibility different from a thinking mind.. Plants were
supposed to possess it likewise. Disease, he believed, was the result of
an affection of this vital principle. Every disease was divisible into
certain disease-elements, viewed as parts of the whole, and these were
again divisible into secondary elements. He explained putrid fevers as
specific vital diseases,--in which view, of course, he embodied humoral
ideas.
In Germany, at about this time, a similar doctrine obtained,--a doctrine
of vital forces,--which the versatile Reil (1759-1813) elaborated into a
Meantime, in England, a doctrine was elaborated by Erasmus Darwin
(1731-1802) which partook, in a certain degree, of the doctrines of
Stahl, Hoffmann, Haller, Brown, and Bordeu. Erasmus Darwin distinguished
himself, not only as a physician, but as a poet, philosopher, and
physiologist. He was a friend of James Watt. Of his life it is said
that by his practice and very fortunate marriages he became wealthy, ate
much, and drank nothing but water. His chief work--entitled _Zoonomia,
or the Laws of Organic Life_--was published in 1784, and is well worthy
of perusal to-day. He recognized two fundamental substances--spirit and
matter. But it is not so much for his doctrine as for his researches
into animal and plant physiology, and, reflexly, because of his more
celebrated descendant of the same name, that we owe him most gratitude.
CHAPTER VIII.
_Age of Renovation (continued).--Animal Magnetism: Mesmer, 1754-1815.
Braid.--Brunonianism: John Brown, 1735-1788.--Realism: Pinel, 17451826.
Bichat, 1771-1802. Avenbrugger, 1722-1809. Werlhof, 1699-1767. Frank,
1725-1801.--Surgery: Petit, 1674-1750. Desault, 1744-1795. Scarpa,
1772-1832. Gunbernat, 11790. Heister, 1683-1758. Von Siebold,
1736-1807. Richter, 1742-1812. Cheselden, 1688-1752. Monro (1st),
1697-1767. Pott, 1749-1787. John Hunter, 1728-1793. B. Bell,
1806; J. Bell, 1820; C. Bell, 1842. Smellie, 1680. Denman,
1753-1815.--Revival of Experimental Study: Haller, 1708-1777. Winslow,
16691760. Portal, 1742-1832. Vicq d'Azyr, 1748-1794. Morgagni,
1682-1772.--Inoculation against Small-pox: Lady Montagu, 1762. Edward
Jenner, 1749-1823._
During{204} the eighteenth century also arose the illusory doctrine of
Animal Magnetism, which obtained among all classes a following that
can be accounted for only by the attractiveness of the marvelous and
unexplained. Frank Mesmer, born near Lake Constance, in 1754, was early
a victim of romantic yearnings, and his graduating thesis, delivered in
Vienna, dealt with the influence of the planets upon man and the use
of the magnet. After traveling extensively he erected a private
institution, where he treated blind girls, fidgety old maids, and
simpletons, until his deceptive methods were unmasked by a commission
appointed by the Empress Maria Theresa, and he was compelled to leave
Vienna in twenty-four hours. This martyrdom recommended him in Paris,
where the so-called Mesmerism speedily became fashionable. He finally
undertook instructions in magnetizing, at the rate of 100 louis a head,
and founded the "Order of Harmony." His so-called _baquets_ were tubs
with magnetic ducts, partially filled with soft water and all kinds
of ingredients, and armed with iron conductors, with which his pupils,
joining hands, placed themselves in contact. At these _séances_ Mesmer
appeared in lilac-colored clothes and professed to reinforce the action
of the tubs by looks, gestures, playing upon the harmonica, and touching
the subjects with wand or fingers. "If any one,{200} particularly a
lady, had a crisis at this time, she was borne to the 'crisis-chamber'
by Mesmer himself, where he treated her alone, as only when alone, he
claimed, could he attain success." He speedily became wealthy; managed
to deceive even the Queen of France; and, when he threatened to deprive
the country of his presence, 20,000 francs were offered him to instruct
others in his art. This offer, however, the wily charlatan declined. In
1785 some fool penned an article extolling him as a worker of
miracles; this stimulated the authorities to organize a committee
of investigation, the adverse decision of which, along with some
contributory evidence, made Paris too warm for him. After the revolution
he returned, but his day had passed, and he figures no more in medical
history. He has had many imitators, and the mesmeric craze, at times,
has infested different portions of the civilized globe; even some
who were eminent in science have fallen into the snares of so-called
Mesmerism,--notably Olbers, the discoverer of a number of asteroids.
Mystic medical doctrines, founded upon Mesmer's views, still continue
in certain circles, though the majority have long since succumbed to the
advances of scientific psychology. In this connection it is proper
to speak of the revived interest in "animal magnetism" due to the
researches of Dr. James Braid, of Manchester, England. This gentleman,
in 1842, published a work which pretty thoroughly exposed the fallacies
of the doctrine of Mesmer, and expounded many of the truths that were
entangled therein. He was among the first, perhaps, to employ the phrase
"animal magnetism," and was the author of the term "hypnotism," though
in his day the popular title was _Braidism_.
During the middle of the eighteenth century arose a doctrine that, in
its novelty, ease of practical application, and apparent consistency
(through the ingenious employment of certain vital phenomena), secured
such a hold that its influence continued even into the present century.
This was{205} the "Brunonian doctrine," promulgated and upheld by
the great foe and rival of Cullen,--Doctor John Brown. In youth very
precocious, though of most humble birth, Doctor Brown had mastered the
Latin language at the early age of seven years, and three years later
essayed to learn a trade. At the age of twenty he left his native
village of Dunse for Edinburgh, seeking employment as a tutor and
intending to study theology. Poverty soon compelled him, however, to
take a rural school, but he returned a few years later (in 1759) to
the Scottish Athens and began the study of medicine, supporting himself
meantime by rendering theses into Latin and by teaching, translating,
and quizzing. Finally, he attracted the attention of Cullen, to whom he
became useful through his knowledge of the classics; but, ultimately, a
foolish quarrel made bitter enemies of the former friends. In 1770, in
private lectures, Brown{206} began to advance the theory to which he had
been led by one of his own attacks of gout that disappeared under the
use of stimulants, the disease having previously always been aggravated
by the treatment prescribed and that was held to be orthodox,--viz.,
antiphlogistic. He had now become somewhat dissolute, and the students
he gathered about him were of very much the same character; but they
formed the nidus of a great following opposed to Cullen, and quarreled
on all occasions with the adherents of the latter. Finally, Doctor Brown
removed to London, where fortune seemed to smile upon him, as he gained
rapidly in reputation and practice; indeed, he barely missed a call to
Berlin and another to Padua as a teacher, the scale being turned against
him by his dissolute habits. Though possessed of the highest mental
gifts, Brown was unfortunate in lack of mental stamina. He taught that
life is not a natural condition, but an artificial and necessary result
of constant irritations; all living beings, therefore, tend toward
death. Health is an intermediate grade of excitement; diseases, which
are either sthenic or asthenic, represent either too high or too low a
grade of excitement. It has been said that Brown's teachings slaughtered
more human beings than the French Révolution and the wars of Napoleon
combined. In England this system found no important followers, but
in America Benjamin Rush, of Philadelphia (1745-1815), distinguished
himself as an adherent. In Spain and France it found little place; but
in Italy, and later in Germany, it secured a numerous and important
following, which numbered, among others, Scarpa, Massini, and Girtanner.
Another system which attained influential development, extending even
into the present century, was the so-called _Realism_, originated by
Pin el (1745-1836). Born in poverty, and designed for the Roman
Catholic Church, Pin el did not turn his attention to medicine until his
thirtieth year,{207} but on completing his studies he rapidly rose to
positions of importance. Led to the investigation of mental diseases
by the fate of one of his particular friends, who had become insane,
escaped into the forest, and was there devoured by wolves, Pinel
speedily developed a great interest in this class of sufferers. The
lot of the insane at this time was most pitiable: they were imprisoned,
chained, and treated worse than wild beasts. In his efforts to improve
their lot, Pinel acquired the title of conservative and aristocrat,
either of which was almost equivalent to a death-sentence. Unterrified,
however, he appeared before the Paris Council and urged the adoption
of reformatory measures, replying to the challenges of skeptical and
selfregardful opponents by liberating a number of insane patients who
were in his charge. The courage thus exhibited receives appreciation in
our time, if never before. Not the least{208} of Pinel's services was
the substitution of analytical for synthetical methods; he also sought
to determine disease by a diagnosis carefully constructed from symptoms,
but unfortunately he made pathology and anatomy subordinate factors. He
was a pupil of Barthez, but he placed his preceptor's vitalism far in
the background.
Francois Bichat, born in 1771, earned high rank both as a clinician and
an anatomist. His education was begun in Nantes, but he studied surgery
and anatomy in Lyons and Montpellier, subsequently going to Paris, where
he became a member of Desault's family. After the death of his patron he
lectured on surgery, and from 1797 on anatomy. Possessed of a feverish
scientific activity, he became a member of the Société d'Emulation.
Death overtook him in 1802 as the sequel of consumption and an injury
received through a fall. He was the most capable physician of France
in his time, and, brief as w>as his span of life, he was author of nine
important volumes, the chief of which were a _Treatise on Membranes_
and works on general and pathological anatomy. From the latter a new
tendency in study took origin. He it was who gave utterance to the
aphorism: "Take away some fevers and nervous troubles, and all else
falls to the kingdom of pathological anatomy." As an evidence of his
energy, it is related that he in one winter examined seven hundred
bodies. He taught how to discriminate between disease processes,
and notably subdivided peripneumonia into pleurisy, pneumonia, and
bronchitis, these having been previously confounded. He once remarked:
"You may observe disease of the heart, lungs, abdominal viscera, etc.,
night and morning by the sick-bed for twenty years, yet the whole
furnishes merely a jumble of phenomena which unite in nothing complete;
but if you open a few bodies, you will see the obscurity speedily give
way,--a result never accomplished by observation if we do not know the
seat of the disease." To Bichat is also due our modern recognition of
cellular,{209} osseous, fibrous, and other tissues, as such, wherever
they appear throughout the body. He differentiated, without the aid
of the microscope, twenty-one different tissues as simple and similar
elements of the body, enumerating them as one does the chemical
elements; he described the stomach as composed of mucous, serous, and
muscular layers; overthrew the speculative tendency of medicine, and
placed facts in the front rank; and so conspicuous were his services
that he has been termed the "Napoleon of Medicine." He supplemented
the influence of Pinel upon the side of pathological anatomy; called
sensibility and contractility vital properties, whose alterations
constitute disease, claiming, however, that the vital properties of
individual tissues differed among themselves. His life and works are
revelations to young men and show what can be accomplished at a very
early age{210} by sufficiently active and harmoniously developed brains.
In reviewing the theories and lives of those mentioned as medical
luminaries of the eighteenth century, one experiences a feeling of
mingled respect and disappointment--respect for the devoted way in which
they worked and sought for the truth, and disappointment at so much
waste of intellectual power and labor. The lesson is also taught, and
should be impressed, that in all so-called new systems old principles
for the most part reappear, and that the labors of the past are rarely
so deliberately consulted as to guard against repetition and revamping
of theories that had long before been proved futile.
Let me now mention a few other of the physicians of the last century who
have left more or less of an impress upon their successors and upon our
science. One man, in particular, historians are wont to remember with
the honor that was denied him by his colleagues and contemporaries. I
refer to Leopold Avenbrugger, who was born in Graz in 1722, and who,
after pursuing his philosophical and professional studies in his native
city, obtained, at the age of twenty-nine, charge of a Spanish military
hospital; while thus employed lie invented the art of percussion as
applied to diagnosis. This he gave the test of experience during seven
long years before making it known to the profession, and even then it
was not appreciated, but remained practically unnoticed until after his
death, which occurred in 1809. He did receive a patent of nobility from
the Emperor Joseph II, but this hardly compensated him for the contumely
heaped upon him by his colleagues. Paulus Ægineta employed sounds and
specula; Santoro used the balance, counted the pulse, and resorted to
the use of the thermometer; Boerhaave employed the thermometer and the
simple lens; Floyer, and after him Haller, utilized the watch in marking
seconds; a Salernian practitioner utilized auscultation and percussion
in tympanites and ascites; but the{211} diagnosis of diseases of the
great viscera by percussion was never known before Avenbrugger. His
booklet of twenty-two pages, unsalable in his time, is to-day held worth
far more than its weight in gold. His famous colleague, de Haën, wrote
fifteen volumes without a word on percussion; Van Swieten did it no
greater justice; in his great treatise the _History of Medicine_,
Sprengel barely alludes to it; yet the contents of Avenbrugger's booklet
were of more practical value than all that these other men ever wrote,
or all the results of the vast and bloody campaigns during which it
slept. In 1808 this volume was rescued from oblivion by Corvisart, who
translated it into French and proclaimed its undying value.
During the earlier part of this century lived Werlhof, of Helmstâdt
(1699-1767), a far-famed observer, author, and practitioner, who
declined a professorship, and especially distinguished himself as a
writer of German poetry. Though possessed of an exceptional knowledge of
modern tongues, he wrote only in Latin,--the scientific language of
the day. In 1734 he was appointed physician to King George II, in which
position he attained world-wide fame, while indefatigable in his
efforts to elevate science. He first described the disease known by his
name,--_morbus maculosus Werlhofii_,--and struggled hard to establish in
Germany the use of cinchona.
From 1740 to 1802 flourished Wichman, of Hanover, highly esteemed as a
writer and practitioner. He is especially known for his pleas in favor
of more scientific diagnosés, and his demonstration of how to make them.
The rôle of the itch-mite in the transmission of scabies he demonstrated
upon himself; to be sure, Bonomo, a hundred years before, had called
attention thereto, but with little avail.
Another eminent Hanoverian was the fickle, stubborn, and misanthropic
Zimmerman, born in 1728, in Berne, upon whom misfortune and disease
played many shabby tricks.{212} He was, however, a man of ingenious
endowments, and merits especial regard, because he sought to free
medical science from the charge of being a secret art.
Another of the prodigies of medical history was J. P. Frank, born (1725)
in the Bavarian Palatinate, of pauper parents, and, while an infant,
abandoned by a cruel father. His early life was passed in a religious
school; at twenty-five he became a court and garrison physician, and
later a professor in Gottingen; finally he went to Vienna, where he died
in 1801. He was greatly beloved by his pupils, and Walther, the famous
surgeon, said of him: "No one ever made so elevating and permanent an
impression on me." He published an extensive work on forensic medicine
and sanitation,--wherein he took up the hygiene of the individual, of
the family, and of the school,--which constituted an effort far ahead of
anything of the kind previously known. He is also memorable for
efforts toward increasing the population, for the Thirty Years' War had
depopulated extensive districts--to such a degree, indeed that in
1750 bigamy was legalized in Nuremberg and many other towns. Frank was
distinguished for a keen and even caustic humor, whose subject was not
infrequently himself.
From 1707 to 1782 there lived in England one Sir John Pringle, chief
of the Army Medical Department, known to this day as an author upon
military hygiene. John Huxliam (1794-1868) advanced our knowledge
of putrid dissolution of the blood. John Howard (1766-1790) rendered
eminent service in prison reform. Heberden (1710-1801) was the first to
describe varicella, and also angina pectoris--which was long known as
Heberden's asthma. John Fothergil (1712-1780), a Quaker, acquired fame
by his observations on chronic angina, neuralgia, and hydrocephalus;
was likewise a benefactor of the poor, regarding them as "bridges to the
pockets of the rich"; indeed, a large part of what he gained from the
latter class{213} he bestowed in charity, and at his death left £200,000
for the same purpose. Radcliffe (1750-1814) was an eminent, witty,
successful practitioner of London, who was wont to declare that, as a
young practitioner, he possessed twenty remedies for every disease, but
at the close of his career had found twenty diseases for which he had
not one remedy. Richard Mead (1673-1754) was a prolific writer, and
the author of the first quarantine regulations adopted in England.
Contemporary with Mead was Lettsom,--the busiest, most philanthropic,
and most successful physician of his day,--whose practice, although a
large part of it was gratuitous, brought him sixty thousand dollars
a year, and who gave away immense sums for charitable purposes; also,
Thomas Dover, who invented the sedative known by his name and who died
in 1741. Akenside, physician and poet (1721-1770), wrote on dysentery.
Baillie, of Edinburgh, was the first to accurately describe the morbid
anatomy of gastric ulcer.
Among the French surgeons must be mentioned la Peyronie, of Montpellier,
born in 1668, who ultimately became director of the Academy of Surgery
and surgeon to the king. His wealth was employed for the elevation
of the craft, and he founded no less than ten different surgical
professorships at his own expense. In 1743 he effected the separation of
the surgeons from the barbers. He died in 1747, dedicating his estate
to the purpose for which he had lived. The most famous of the earlier
surgeons of this century was J. L. Petit (16741750), inventor of the
screw tourniquet, and who was called to treat Augustus the Strong,
of Poland; indeed, several other crowned heads became his patients.
Garen-geot (1688-1759), a professor in the College of St. Come,
published a work on operative surgery. Morand (1697-1773) and le Dran
were distinguished surgeons of Paris, the former especially noted for
the number of times{214} he performed paracentesis. Famous lithotomists
were le Cat and Frère Come,--whose real name was Baseilhac, and who
operated by means of the lithotome caché, Astruc (1685-1766) was a
syphilographer of extensive attainments; Quesnay (1694-1774), an eminent
and undaunted surgeon of Louis XV, who wrote on the history and progress
of surgery in France; Brasdor (1721-1776) was best known for his method
of distal ligation in aneurism; Sabatier (1732-1811) wrote a famous
treatise on operations, in which he recommended resection of the head of
the humerus.
One of the most celebrated surgeons was P, J. Desault (1744-1795), the
son of a poor farmer, originally designed for the priesthood, but who,
after obtaining a thorough mathematical education, began the study of
surgery with an ignorant master of his native town. Subsequently he went
to Paris, and here supported himself by teaching, gradually rising, step
by step, until, without collegiate education, he became professor and
chief-surgeon at the Hôtel-Dieu, where he established the first surgical
clinic. He opposed violently the prevalent abuse of the trephine, and
was also a champion of healing by first intention. A trusted friend of
Desault was Ghopart, well known because of the amputation of the foot
that bears his name. Another well-known surgeon, likewise a friend
of Desault, was Doublet; and it is somewhat remarkable that Desault,
Ghopart, and Doublet suffered persecution and perhaps martyrdom in
connection with the supposed death of the Dauphin of France,--properly
Louis XVII,--in 1795. There is evidence that the child who died in the
temple was not the dauphin, but a substitute, and these three surgeons,
who examined the corpse, had the hardihood to express their doubts.
The same day that Desault reported upon the evidence he was invited to
dinner by some members of the Convention, was taken ill at the table,
and died almost immediately after his return home, A few days{215} later
Chopart and Doublet died, also under mysterious circumstances.
Daviel (1796-1862) is remembered among French surgeons chiefly for
extraction of the lens as an independent method of treating cataract;
Tenon (172-4-1816), for his writings on the anatomy and diseases of the
eye; and Anel for originating the operation for aneurism, mistakenly
attributed to Hunter. There were also many others, of lesser note, who
distinguished themselves through special services to surgery or some of
its branches.
Among the Italians of this century may be mentioned Scarpa (1772-1832),
of Motta, professor successively in Modena and Pavia, and who advanced
our knowledge of hernia, diseases of the eyes, aneurism, and general
The most famous Spanish surgeon was Gimbernat, of Madrid (1742-1790),
for a time professor in Barcelona, who also became distinguished through
anatomical researches.
German surgeons did not rank high during the earlier half of the last
century, owing to the contempt engendered by the church for this branch
of the medical art. The fashion of imitating the French, however, led
to some surgical development. The first German surgeon of scientific
education was Heister (1683-1758), of Frankfort-on-the-Main, who,
unable to obtain honorable employment in the military service of his own
country, entered that of Holland, where he remained until the experience
of his own nation had brought about a healthy reaction. In 1720 he came
to Helmstâdt, where he developed great activity in anatomy, surgery,
and botany; also distinguished himself as a dentist and oculist, and
discussed the whole range of surgical topics from the least to the
greatest.
Bilguer (1720-1796), of Chur, became surgeon-general in Berlin, and
performed the first resection of the wrist in 1762;{216} he was an
opponent of amputation, which at that time was altogether too frequently
practiced.
Von Siebold (1736-1807) was the founder of an institution for surgical
instruction, where, for the first time in Germany, surgery was taught
clinically. He became one of the most famous teachers, and was first in
his native land to perform the operation of symphysiotomy, so recently
revived.
The greatest German surgeon of the eighteenth century, however,--one
eminent both as writer and operator,--was August Gottlieb Richter
(1742-1812), of Zorbig, a descendant of a ministerial family, who wrote
a famous work on hernia, and greatly improved all branches of surgery;
he it was that enunciated the principle of dressing wounds "quickly,
easily, and rarely."
Among English surgeons of the century must be mentioned, first of
all, Cheselden (1688-1752). wrhose name is inseparably connected with
anatomy and pathology as well as surgery At first a warm advocate of the
high operation for stone, his dexterity in lithotomy excited the wonder
of his contemporaries. He published a treatise on anatomy, and one on
the suprapubic section.
Alexander Monro, Sr. (1697-1767), of Edinburgh, was also eminent in both
anatomy and surgery, and contributed more than any other one man to
the success and reputation of the Scottish medical school. His sons,
Alexander and Donald, and his grandson, Alexander (3d), w'ere equally
celebrated in anatomy.
Charles White, of Manchester, is generally credited with having
performed, in 1768, the first subperiosteal resection of the head of the
humerus, although, as a matter of fact, this was not done until 1774,
and then by Bent, of Newcastle. He also performed resection of the
hip-joint upon the cadaver--another of the same name, Anthony White,
having done the operation on the living subject in 1721. He invented the
method of reducing dislocation of the{217} humerus with the foot in the
axilla,--a procedure that is ordinarily ascribed to Sir Astley Cooper;
also operations for false joint by the removal of the involved surfaces
of the bone.
It will be seen that the excision of the joints was peculiarly an
English method, the elbow-joint having been first excised in 1758,
by Wainman, and the knee-joint by Filkin, of Northwich. The man who
permanently attracted the attention of surgeons to these new operations
was Henry Park, a bold surgeon, who wrote in 1782. The merits of these
methods were then soon forgotten, however, and were revived in the
present century by Liston and Syme.
One of the best-known London surgeons was Percival Pott (1749-1787), who
became especially eminent through his{218} studies upon hernia, spinal
disease, and diseases of the bones and joints; his complete chirurgical
works appeared in London in 1771.
William Hunter (1718-1783), of Scotch parentage, originally a
theological student, and a pupil of Cullen, went to London in 1741,
began to lecture on anatomy and surgery in 1746, and soon acquired a
great reputation as a surgeon, obstetrician, and anatomist. He achieved
enormous success in practice, and spent £100,000 upon his house,
library, and private collections. The latter now form the Hunterian
Museum in the University of Glasgow. His magnificent plates illustrating
the gravid uterus required the labors of twenty years and appeared in
John Hunter (1728-1793), younger brother of William, enjoyed even
greater reputation than the latter. He was a pupil not only of his
brother, but also of Cheselden and Pott. Beginning the practice of
surgery in 1763, he became surgeon to St. George's Hospital in 1768,
and Surgeon-general of the English forces in 1790. So memorable were the
labors and services of this man that at the Royal College of Surgeons,
of London, there is given annually an "Hunterian Oration," intended in
some way to commemorate his labors or to draw some lesson from his life
and work, To do justice to John Hunter would require a volume, hence we
must at present dismiss the subject with this brief reference.
Almost equally famous as a surgeon, though by no means such an
omnivorous student as Hunter, was Benjamin Bell, of Edinburgh, who
died in 1806. He employed tubes of lead and silver for the purpose of
drainage. Sir Charles and John Bell, also of Edinburgh, are eminent
names pertaining to the latter part of the eighteenth and first part of
the nineteenth century. The latter was Professor of Anatomy, Surgery,
and Obstetrics, a busy practitioner, a fertile writer, and not only one
of the most successful operators of his day, but an excellent classical
scholar;{219} his _Principles of Surgery_ appeared from 1801 to 1807.
Sir Charles, who died in 1842, belongs more to the present century, but
was equally distinguished as an operator, surgeon, and writer, and best
known, perhaps, lor his _Bridgewater Treatise on the Hand_.
Among the Dutch an eminent surgeon was Peter Camper (1722-1789), who,
in order to acquire manual dexterity, learned to use various mechanical
tools. He was a fruitful author, and did not consider it beneath his
dignity to write a treatise about the best form of shoes, published in
Vienna in 1782, but recently translated and republished in England as
something new. Sandifort, of Leyden, discussed ruptures, dislocations,
etc., and reported the first observation of downward dislocation of the
femur.
As already noted, the surgeons of the eighteenth century were often
obstetricians,--William Hunter conspicuously. The{220} most important
obstetrician of his time was William Smellie (1680-1763), of London, who
invented numerous instruments, wrote a large treatise on the theory and
practice of midwifery, and greatly advanced our knowledge of deformed
pelves. He was the first to distinguish one diameter from the other,
and to point out the importance of cephalic version and version of the
breech. Parenthetically, it may be remarked that William Hunter, great
as he was, was the uncompromising foe of instrumental midwifery, and was
in the habit of showing his forceps, covered with rust, as evidence that
he never resorted to such aids. A rival of Smellie and Hunter was Thomas
Denman (1753-1815), best known, perhaps, because of his demonstration of
the portability of puerperal infection.
The researches of anatomists during the eighteenth century were, for the
most part, directed toward the minute, more difficult, and less striking
parts, and to increased thoroughness and accuracy of description.
Microscopical anatomy suffered a relative quiescence. Pathological and
general anatomy, which were destined to control the medicine of the
succeeding century, were newly created and not yet regarded as sciences
by themselves, but merely as special branches. The most important
feature was the revival and more accurate study of experimental
physiology, which had been scarcely resorted to since the time of Galen,
except for Harvey's discoveries. This revival, which really seemed
an epoch in the history of medicine, was effected by the great Haller
(1708-1777), of Berne,--a man who really deserved the title of "Great,"
as he was a universal and indefatigable _savant_, possessed of thorough
conscientiousness, marvelous capacity for work, great ingenuity, natural
endowments, and an inextinguishable love for art and science; he was
certainly one of the most versatile scholars and thinkers of any
time, distinguished not only in his chosen field of medicine, but as
a poet,{221} botanist, and statesman. Like all Swiss poets, he never
passed beyond the didactic and the homely in his versification. From his
tenth year he wrote poems in Latin and German, and even when eight years
old had made most extensive compilations from Bayle's dictionary. At
fifteen he went to the University of Tubingen, where, in the second year
of his sojourn, he disputed with one of his teachers. In 1725 he went
to Leyden, where Boerhaave and Albinus found in him a most indefatigable
follower. At nineteen he received the degree of doctor. In the excess of
his zeal for anatomy he purchased for a considerable sum, from Albinus,
half of a corpse, the other half of which his teacher had dissected;
and, while in Paris, he even engaged in grave-robbing, and, being
betrayed by his own carelessness, was compelled to save himself by
flight. In many other States, and in more than one country, he studied
with the best of teachers, lecturing at times himself. At the age of
twenty-six he became professor and hospital director at Berne, and in
1752 published his famous researches on irritability. Three years
later he accepted a call to Gottingen as Professor of Anatomy, Surgery,
Chemistry, and Botany. He was the founder of a botanical garden; for
many years was so busy that he slept and lived in his library; and, in
spite of his enormous and unique correspondence with the _savants_
of the world, he never left a letter unanswered. Strange to say, his
permanent influence upon the practice of medicine was only indirect;
and, although he was professor of surgery, and performed many
vivisections, he was never able to persuade himself to perform a
single surgical operation upon the living human being. He it was that
introduced into Germany the use of the watch in counting the pulse. Like
Hunter, Haller demands a special historian, and it is possible here to
outline only a few of the services he rendered to medicine. He enriched
the anatomy of the heart, of the brain and dura, and pointed out the
venous nature of the{222} sinuses; taught that the uterus should be
regarded as a muscle: advanced the knowledge of the lymphatic system,
and believed in and taught a developmental theory that every individual
is descended or derived from a preceding one. In the mechanism of the
heart his doctrine of irritability especially maintained itself. He
administered the death-blow to the doctrine of vital spirits, and
was, in fact, the father of modern nerve-physiology. His doctrine
of irritability moved the minds of his century in a way that has no
parallel, unless we compare it with the doctrine of Darwin. Glisson had
established the general principles of irritability, and Haller followed,
teaching it by the inductive method, and proving its existence by
experiments,--proving, moreover, that it is a peculiarity of the
muscular substance and not governed by ordinary sensation. His
researches deserve the more credit because he lacked modern aids to
physiological study. The first physiological institute was founded
in Breslau by Purkinje, some fifty years ago. Haller had no such
opportunity; even his successor, the great Müller, possessed no such
advantages. The profound impression made by Haller's teachings may be
measured by the number of his supporters and opponents; he was a great
man, second only in wide-spread influence to Boerhaave, and one who left
a more lasting impress upon the world than even the latter.
The two best known of Haller's opponents were: Wolf (1733-179-4), of
St. Petersburg, who regarded each generation as an actual new creation,
and was the first to teach the doctrine of the blastodermic membranes;
and Blumenbach (1752-1840), of Gotha, who did great service by
investigations in general anthropology, of which he was, in fact, the
founder, and whose researches in comparative anatomy and the history of
development have rendered him famous.
Of the famous anatomists of the century may be mentioned Sommerring
(1755-1830), of Frankfort,--the first to{223} distinguish the facial
and auditory nerves from eacli other, and whose published works are
well known, because of the beautiful illustrations furnished him by the
well-known artist, Koeck.
The ablest French anatomist of the century was Winslow (1669-1760),--a
man of Danish birth, but who became a professor in Paris, and is
best known by the foramen named for him. There were, also, Portal
(1742-1832), physician to Louis XVIII, who wrote a famous history of
anatomy and surgery; and Vicq d'Azyr (1748-1794), known equally well
for his labors in the department of anatomy, especially of the brain,
nervous system,{224} and the vocal organs. Bichat (already mentioned)
would deserve to be placed at the head of French anatomists were it not
for his superior rank in clinical medicine.
The founder of pathological anatomy as a science was Morgagni, born
in 1682, in Forli, Italy,--a pupil of Valsalva, and, at the age
of nineteen, the assistant of the latter. It was not until his
seventy-ninth year, after he had published several works, that he
allowed his famous work on pathological anatomy to appear. This is the
historical classic, De Seclibus et Causis Morborum, published in Venice
in 1761. Its famous author did not cease work, even when he became
blind, and to him we owe the maxim that observations should be "weighed,
not counted." He was very versatile, and well informed in all branches
of science and literature, and possessed a remarkable memory; likewise
was the first to devote attention extensively and thoroughly to the
anatomical products of common diseases, since, before his time, little
had been regarded but rare discoveries in the body. He also called
attention to the important bearing which the history of the disease has
toward its products, and found his discoveries of advantage, even when
they were unable to promote the cure of disease, because of the light
which they threw upon physiology and normal anatomy, and because they
prevented incurable patients from being continually tormented with drugs
intended to cure them; also because pathological investigations
alone could settle disputes in diagnosis and matters of honor among
physicians. He died in 1772.
Morgagni's legitimate successors in Great Britain were Baillie
( 1761-1823), a son of John Hunter's sister, and Sir Everard
Home,--Hunter's brother-in-law,--who became professor in the Royal
College of Surgeons, and was intrusted by Hunter with the work of
describing his collection. Home, however, in a most discreditable
way, burned several volumes of Hunter's own descriptions, in order to
appropriate to himself the sole credit of the work. He has{225} gone
down to fame especially because of his book on the prostate.
One of the most notable events in the history of medicine was the
introduction of the systematic practice of _preventive inoculation
against small-pox_. It is so generally taught that this is entirely due
to the efforts of Jenner--or, rather, we are so often allowed to
think it, without being taught otherwise--that the measure deserves
an historical sketch. The communication of the natural disease to
the healthy, in order to afford protection,--or, in other words, the
communication of small-pox to prevent the same,--reaches back into
antiquity. It is mentioned in the Sanscrit Yedas as performed by
Brahmins, who employed pus procured from small-pox vesicles a year
before. They rubbed the place selected for operation until the skin was
red, then scratched with a sharp instrument, and laid upon it cotton
soaked in the variolous pus, moistened with water from the sacred
Ganges. Along with this measure they insisted upon careful hygienic
regulations, to which, in large measure, their good results were due.
Among the Chinese was practiced what was known as "pock-sowing," and
ten centuries before Christ the Celestials introduced into the nasal
cavities of young children pledgets of cotton saturated with variolous
pus. The Arabians inoculated with needles, and so did the Circassians,
while in North Africa incisions were made between the fingers, and among
some of the negroes inoculation was performed in or upon the nose. In
Constantinople, under the Greeks, the custom had long been naturalized,
and was practiced by old women, instructed in the art, who regarded it
as a revelation of Saint Mary. The first accounts of this practice were
given to the Royal Society by Timoni, a physician of Constantinople, in
1714. The actual introduction of the practice into the West, however,
was due to Lady Mary Wortley Montagu, who died in 1762, and who was wife
of the English Ambassador to the Porte in 1717. She had{226} her son
inoculated in Constantinople, by Maitland, and on her return to London,
in 1721, her daughter also was inoculated. During the same years
experiments were undertaken by Maitland upon criminals, and, as
these turned out favorably, the Prince of Wales and his sisters were
inoculated by Mead. The practice was then more or less speedily adopted
on this side of the Atlantic, but suffered occasional severe blows,
because of unfortunate cases here and there, such as never can be
avoided. The clergy, especially, using the Scripture, as designing men
can always do, became warm opponents of the practice, and stigmatized
it as an atrocious invasion of the divine prerogative. Nevertheless, in
1746 the Bishop of Worcester recommended it from the pulpit, established
houses for inoculation, and thus made it again popular. In Germany it
was generally favored, and a little later came into vogue in France
and Italy. In 1757 Robert Sutton, near London, professed to have made
fifteen thousand inoculations without a single fatal case; he kept
his patients on a strict diet for nine days, then inoculated with the
smallest possible quantity of virus. The operation was not prohibited in
England until the year 1840, although it involved much greater dangers
than vaccination with cow-pox.
The first inoculation with cow-pox seems to have been performed in
1774: by a farmer of Gloucester, named Jesty, though the pioneer in
the extensive and general introduction of this method was Edward
Jenner (1749-1823), of Berkeley, in Gloucestershire, who, therefore, is
generally known as the "Father of Vaccination." The son of a clergyman,
he began early the study of medicine and surgery, and during his
apprenticeship received from a milkmaid information of the protective
power of cow-pox against variola, as established by popular observation.
(Sutton and others had proved that inoculation of _sheep_-pox was not
efficient.) This communication so struck Jenner as a means of affording
protection to the whole human race{227} that the subject never
afterward left his mind. In 1770 he became a pupil of John Hunter, and
when he communicated to him this idea the great surgeon said: "Do not
think; investigate!" Accordingly he went to Berkeley and performed the
little operation which has made him famous; and from 1778 until 1788 he
communicated to Sir Everard Home such observations as he had made. But
the first vaccination was performed in 1796, upon a boy, with matter
from the hand of a maid who had contracted cow-pox in milking.
In 1798 he published his memorable work, and afterward removed
to London. He died full of fame and honor, in his native place,
having-received rewards from the government amounting to one hundred and
fifty thousand dollars, besides being made an honorary citizen of the
city of London. The subsequent wide-spread practice of the method, and
the formation of societies{228} for the promotion of vaccination are
matters of recent history.
The first vaccinations in the United States were performed by Doctor
Waterhouse, Professor of Medicine in Harvard College, in 1800, upon four
of his own children. The transmission of humanized virus through the
system of the cow, and its subsequent employment in vaccination of human
beings, was first practiced by Troja (1747-1827), of Naples, shortly
after the introduction of human vaccination; but in 1810 this was
prohibited in Italy. Compulsory vaccination was first extensively
introduced in Germany in 1807; in England it was first legalized in
1827. The occasional temporary character of the protection thus afforded
was first taught by Elsâsser in 1814. Schoenlein was the first to call
attention to the distinction between variola and varioloid.
Another matter in which the eighteenth century witnessed great reform
was the _treatment of the insane_, which continued in very bad condition
until toward the close of the century, when a movement for improvement
began. From and after this lunatics were liberated from their fetters
and from the hands of brutal keepers, and regarded as actually ill,
while so-called schools of psychiatry were founded. While the first
impulse in this direction was given by Lorry, the true reformer was
Pinel, already mentioned, who did away with corporeal punishment and
abuse, separated the insane from convicts, limited the employment of
drugs and especially venesection, placed the unfortunates in special
institutions under the charge of physicians, and classified patients
according to their symptoms. Yet, in spite of his humane teachings,
lunatics were found incarcerated in cages in some of the French cities
as late as 1834. Pinel was followed by Esquirol (1772-1840), who in 1818
established the first clinic for mental diseases.
It is well known what a conspicuous part _public baths_ played in the
social life of the ancient Greeks and Romans, but{229} the first
public resort for sea-bathing was established in Germany in 1794. The
cold-water epoch of this century, however, began with the researches
of Hahn (16961773), a Silesian, who introduced a systematic and almost
exclusive hydrotherapeutic method. The modern method of using cold
water as an antipyretic agent was first employed in England, in 1797,
by Currie, who originally was an American merchant. In France the method
found little sympathy, but it made its way even to Spain later, where it
was adopted by the famous Sangrado, who is well known to readers of _Gil
Blas_.
CHAPTER IX.
_The Age of Renovation (continued).--The Eighteenth Century; General
of Surgeons, 1800; the Josephinum, 1785.--The Nineteenth Century.
Realistic Reaction Against Previous Idealism. Influence of Comte, of
Claude Bernard, and of Charles Darwin, 1809-1882. Influence Exerted by
Other Sciences.--Theory of Excitement: Roeschlaub.--Stimolo and
Contrast imolo: Rasori, 1762-1837.--Homoeopathy: Hahnemann,
1753-1843.--Isop-athy, Electrohomoeopathy of Mattei.--Cranioscopy, or
Phrenology: Gall and Spurzheim.--The Physiological Theory: Broussais,
1772-1838.--Paris Pathological School: Cruveilhier, 1791-1873. Andral,
1797-1876. Louis, 17871872. Magendie, 1783-1855. Trousseau, 1801-1866.
Claude Bernard, 1813-1878.--British Medicine: Bell and Hall, Travers,
1783-1858.--Germany, School of Natural Philosophy: Johannes Müller,
1801-1858.--School of Natural History: Schônlein, 1763-1874.--New Vienna
School: Rokitansky, 1804-1878. Skoda, 1805-1881._
That the{230} eighteenth century, up to its close, was the golden age
of medicine, is due to the prevalence during that period of a strong
idealistic undertone, as a result of which any learned occupation caused
the scholar to be held in higher esteem than is the case even to-day.
Medicine was then regarded as _a conscientious vocation_ and not as a
mere business or trade; indeed, general scientific knowledge more widely
prevailed among the better class of the profession, and there was
much less of that one-sided, narrow education that obtains to-day. The
profession, moreover, was not overcrowded; physicians were neither too
few nor too numerous, consequently their social position was higher.
Again, the relations between doctor and patient were more intimate, most
practitioners being of the type described as "family physicians," and
those possessed of the doctorate degree ranked among the gentry rather
than as artisans. They were, for the most part, fully devoted to their
calling; moreover, the State took greater care to protect the people,
so that it became dangerous for strolling vagabonds and imposters to
attempt to trifle with human life and excite the vulgar to the prejudice
of scientific knowledge.
The{231} pursuit of anatomical studies was now facilitated, despite the
fact that students were frequently compelled to take long journeys
in order to obtain the "material" therefor. In the early part of the
century so great was the lack of dissecting material that the great
Haller while in Paris was compelled to purloin his cadavers, and
ultimately, on discovery of this fact, to fly for his life; Hoffmann was
only able to make twenty dissections during twenty-four years; even
in the middle of the century there was only one dissection annually in
Halle; up to 1712 there had been only three dissections in a score
of years--though now subjects can be had there in abundance at a
ridiculously low figure; cadavers were extremely scarce in Vienna as
late as 1765; and for a long time the only places in London where the
study of anatomy could be legally pursued were the College of Physicians
and the College of Surgeons, and the trouble that hampered John Hunter
in this direction is historical. The crime of "Burking" became known in
Hunter's day. Murder was committed, and the victim sold for purposes of
dissection--for at this time, as "body-snatching" was a necessity, those
that purchased cadavers asked few questions, and the fees paid were, of
course, high.
The first clinical institution in Austria was organized in Vienna, in
1754, by Van Swieten, though there was an "ambulatory clinic"
(out-patient department) in Prague nine years before. During the
century, however, hospitals were everywhere in bad condition. In the
Hôtel-Dieu, at Paris, several patients--even as many as six--were
sometimes put in the same bed; the convalescent and the dying found
themselves thus associated; in Vienna the Allgemeines Krankenhaus was
composed of seventeen hospitals that subsequently were amalgamated into
one. In London numerous hospitals were founded, and as the medical staff
of each became eminent they attracted numerous pupils; but later it
became necessary to relieve the hospital wards, and private institutions
for instruction were established by popular{232} teachers, the most
celebrated being the "Windmill Street School of Anatomy," founded by
William Hunter about 1770, and the private school of Sir William
Blizzard, which, established in 1780, developed, five years later, into
the London Hospital Medical School.
While few, if any, of the lectures were compulsory, particularly in the
natural sciences, even more attention than now was bestowed upon the
accessory branches; botany, chemistry, and natural history were the
recreation of many students and physicians. Pupils enjoyed the privilege
of studying what they pleased--as they do practically to-day in the
Portuguese University of Coimbra,--and professors exercised to the
utmost their individuality in teaching. In Spain natural sciences found
no admission, and even so late as 1770 no instruction in these branches
was given, as they were regarded as dangerous to the purity of the
faith; mineralogy for mining purposes was an exception, for even the
most faithful Catholic needs money.
At the universities medical students were not permitted to go out
without their scholastic cloaks,--a regulation that still obtains in
Spain. That the number of students has enormously multiplied may be seen
from the fact that the little University of Giessen, with scarcely any
medical school at all, has always more students than had Halle in the
days of the famous Hoffmann. In the middle of the last century Würzburg
had at one time but _three_ medical students, while to-day it has in the
neighborhood of five hundred. Even then it was complained that, on
account of the number of students, there was an educated proletariat
arising, and in 1791 it was proposed, in Austria, that the rush for
study should be repressed.
Among the Continental students the revels and bad behavior of past
centuries were not to any great extent corrected; fights and debauchery
were very common, and all sorts of orgies and bacchanals prevailed.
The professors were, in large measure, independent of the State, and a
single{233} individual often represented a number of branches now taught
by special chairs. When indisposed to lecture, they simply posted upon
the blackboard: "_Hodie non legitur_," and this was the end of the
matter. In 1777 Vienna had one hundred and forty-seven medical teachers,
and in Germany there were two to every thirty-nine students. That in
the last century one man often accomplished more than a great number
of average teachers do to-day is amply demonstrated by the lives of
Boerhaave, Haller, and others. Then, too, the Latin tongue was generally
employed for purposes of instruction, though surgeons, for the most
part, lectured in the vernacular; Cullen, in 1770, was the first in
Great Britain to deliver purely medical lectures in English; and as the
clergy gradually retired from the ranks of the profession, Latin more
and more fell into disuse. Strange to say, as the clerical influence
waned, the Jews began to enter medicine, the movement beginning about
1791, in France, under the promulgation of "civil equality" ideas;
previously the Hebrews had been an almost universally suppressed people,
and in Berlin were permitted to enter and leave the city by only one
gate, and were forbidden to learn or write pure German, in consequence
whereof their dialect was an Hebraic-Teutonic jargon, that even to-day
prevails in some portions of western Europe. Educated Jews were few in
number, since attendance upon universities was ordinarily denied them,
although long before they had been admitted at Salamanca, Toledo,
Salernum, and Montpellier. In Austria the prohibition was not removed
until 1789, and even then, so bitter was the prejudice against the
Semitic race, the clergy vigorously protested. It was the same clerical
body that, in 1667, protested with the greatest vehemence against
allowing Hebrew physicians to pass through the gates of Wurtemburg
without paying toll, declaring that it was "better to die with Christ
than be cured by Jews, who were aided by the devil."
Professors{234} were often attached to the courts of their various
sovereigns, and at one time the French court possessed a faculty of
forty-eight physicians, surgeons, and apothecaries, the first two
physicians being required to attend every morning when the king arose;
hence originated the titles, still known in Germany, of "Hofrath" and
"Geheimrath."
Medical fees, as a rule, were very small, though there were exceptional
instances in which enormous sums were bestowed: Joseph II, of Austria,
gave Guerin, who was summoned from Paris in consultation, an honorarium
of 171,000 marks and made him a baronet. Taking all things into
consideration, the income of the average practitioner in the eighteenth
century would be in the neighborhood of $1000, which, however, was
equivalent to three times that amount to-day. Fothergill, whose highest
income in a single year was $25,000, bequeathed to the poor of London
$1,000,000; Sir Astley Cooper had a yearly income of from $75,000 to
$100,000, but it may be remembered that his practice during the first
year netted him just $26, and that it was four years later before his
income reached the sum of $500.
The physician of the last century was, at least, on occasions of moment,
very different from other men, and to be recognized by his dress. A cap
was placed upon his head when he graduated, in recognition of the fact
that physicians at an earlier period belonged to the learned or clerical
profession; and in later life he wore a purplish or scarlet cloak (to
distinguish him from lawyers, whose professional color was yellow,
and from theologians, who then, as now, sported the sombre black).
The regulation full-dress costume of the English physician of the last
century demanded a well-powdered wig, silk coat, knee breeches with
stockings, buckled shoes, lace ruffles, cap, and goldheaded cane, to
which, in cold weather, was added a muff--to preserve his delicacy of
touch.
Surgeons{235} were still strictly separated from physicians, even in
education; nor were they esteemed as equal in rank, until the French
Revolution brought about the doctrine of civil equality; perhaps this
is one reason why this branch of the medical art made less conspicuous
progress until recent times. The change was brought about, in France, by
the abolition of eighteen universities and fifteen colleges of medicine,
the Royal Society of Medicine (founded in 1776), and the Academy of
Surgery (founded in 1731); but by this abolition charlatanism acquired
such speedy control that the arrangement was soon abandoned. Thus it
came about that surgical instruction was given in special institutions
or in the universities, and the conditions of instruction finally
improved. When the College of St. Come was abolished in 1753 the Société
de Chirurgie, founded in 1731, became the Académie de Chirurgie; and,
when the French Academy was formed in 1795, the Académie was merged into
its medical department. The École Pratique, where Desault and Chopart
taught, was established in 1750 for the practical education of surgeons.
In England the Royal College of Surgeons was not incorporated until
1800. In Austria, in 1785, the Josephinum was opened by Joseph II,
who also erected permanent military hospitals in Prague, Brünn, Milan,
Mantua, Pesth, Olmütz, etc.; he also created the "Joseph's Akademie" in
order to educate military surgeons and thus overcome the defects of
army surgery; the Josephinum unquestionably exerted great influence in
elevating the social and military position of army surgeons and attained
historical importance after Brambilla compelled the recognition of
surgeons as social equals of other members of the medical profession. As
the result of these improvements, the various armies of Europe were soon
furnished with better medical officers. Prior to this, too, the field
hospitals had been as badly mismanaged as their civil prototypes, and
the substitution, in 1793, of movable hospitals, as suggested at{236}
the close of the sixteenth century by Henry IV, of France, was scarcely
an improvement. The whole system suffered from perpetuation of the dual
and distinct functions of the physician and the surgeon, to destroy
which was a part of the design of the Josephinum. How unpleasant was the
position of the army surgeon up to this date may be inferred from the
fact that in 1758 one was subjected to corporeal punishment at the
command of his colonel, and that a general upon his death-bed could
leave orders that fifty blows be given each of his medical staff in case
the post-mortem disproved the diagnosis.
In Austria, at the beginning of the Seven Years' War, all military
surgeons of the Protestant faith were compelled to become Catholics
or leave the service. The condition of the wounded soldiers was as
deplorable as can well be imagined; but upon this subject I cannot
dwell.
The tendency of the nineteenth century seems to be a continuation, and,
perhaps, in some respects, an exaggeration, of the condition obtaining
in France during the previous century; in other words, the world has
become practically an enormous school of pathological anatomy and
diagnosis,--a school inaugurated by Bichat, as representing so-called
scientific or exact medicine. Philosophically this has been a century
of reaction against the idealism of the preceding age; it places the
individual, rather than the idea, in the foregound. The mutual influence
of medicine, philosophy, and the natural sciences is less conspicuous
now than formerly. Recent philosophers who have exercised the greatest
influence are: Schelling, who held to the equality of the real and the
ideal; Hegel, whose supreme principle was absolute reason, of which
religion was regarded as a representation; Hartmann, whose philosophy of
the "unconscious" depends largely upon the results of natural sciences,
embraces Darwinism, and is, in many respects, an extension and
completion of Schopenhauer's{237} pessimism and doctrine of the soul.
But one who has exercised still more influence upon our profession
is Comte, whose positivism contrasted strongly with the idealism and
atheism of Schelling, and who required only this of philosophy,--namely,
that it should work out the general ideas and results of other sciences;
his most important follower was Claude Bernard, and upon these two
the whole exact school of France is based. But the most influential
philosophic doctrines of this or any other century have been those
emanating from Charles Darwin, Herbert Spencer, Ernst Haeckel, Alfred
Wallace, and their contemporaries and followers. Darwin (1809-1882) was
the grandson of Erasmus Darwin, already mentioned, and his _Variation of
Animals and Plants Under Domes-tication, Origin of Species, and Descent
of Man_ have found a place in all modern languages. The system known
by his name is the pure science of nature, is founded upon scientific
investigation, and by its merits alone has found almost universal
acceptance; it has been added to and further elucidated by the efforts
of Haeckel and Spencer.
When it is declared that medicine of the present is influenced by no
system, it is speedily found, on critical analysis, that this is an
error. It necessarily follows the realistic and materialistic as readily
as it did the teachings and doctrines of natural philosophy; and, in
consequence, "medical thought," so called, is just as one-sided to-day
as at any time in the history of the art. The watchword of to-day,
natural specific tendency, veils, but does not take away, its
philosophic principles, and so our ridicule of earlier medical systems
is quite unjustifiable. A modern historian aptly remarks that the
medicine of the present "embraces nothing but a theorem of investigation
by the senses."
Discoveries in botany, the result of better knowledge of natural history
and more accurate habits of study, have influenced{238} modern progress
not a little; have led to better classification and broader knowledge.
The natural system of de Candolle (1778-1841) of Geneva, and of
Endlicher, of Vienna, called into existence the so-called natural
historical school of medicine; the researches into plant-cells by
Schleiden and Baumgartner, and the almost contemporaneous discovery of
animal cells by Schwann became, in course of time, the origin of recent
cellular pathology; then came microscopic botany, and the influence of
the lower fungi in the production of fermentation and putrefaction.
Similarly too, the laws of physics have been shown to have an
inseparable connection with anatomy and physiology, and their study has
become a most important aid in the experimental researches of
to-day; through Helmholz they brought in the ophthalmoscope; thermal
electricity, for the discovery of which medicine is indebted to Seebeck;
a better knowledge of optics, thanks to Fraunhofer, who was equally
expert in electricity; spectrum analysis, invented by Kirchhoff; and
the varied efforts of Faraday, Graham Bell, Thomas Alva Edison, and
Daguerre, the latter better known for his invention of photography.
Finally, medicine is immeasurably indebted to Tyndall and Huxley for
their teaching of the correlation and conservation of energy.
Chemistry also has performed its share, and, as applied to physiology,
is a discovery almost wholly within the present century. The new
nomenclature serves a practical purpose in that it is now possible to
portray chemical combinations and isomerism in a graphic, and at least,
semi-comprehensive way. Among the chemists may be specially mentioned
Bertholet, whose laws are as well known as they are succinct; Humboldt;
Berzelius; Dumas; Chevreuil, who recently died at the age of almost one
hundred years; Magendie; Orfila, the toxicologist; Gmelin, eminent
in physiological chemistry; Rose, perfecter of organic analysis;
Wohler,{239} who first made organic alkaloids; Bunsen; Sir Humphry Davy;
Marsh; Faraday; Graham; Young, who first showed the industrial value of
coal; and Gay-Lussac.
Upon medicine, zoology also, with comparative anatomy and physiology,
has had a wonderful influence; here may be noted the names of Cuvier,
Oken, Bilharz, Brehm, Wagner, Leuckart, Richard Owen, William Carpenter,
and last, but by no means least, Thomas Huxley.
But perhaps the most significant feature of the age has been the
wonderful development of scientific associations and the publication of
medical and scientific literature. Whether these have yet reached their
climax is perhaps an open question, but the consequent widening circle
of readers, as well as of writers, seems to imply that there will be for
a long time to come no lack of activity in this direction. In the United
States more than in any other country medical societies and associations
innumerable have sprung up, and to such a degree that (in the eastern
States at least) there are few counties that cannot boast of a medical
During the present century foreign universities have decreased in
number, partly owing to consolidations and partly by surrender of
charters; for instance, the old University of Ingolstadt was united
with that of Landshut, and in 1827 was removed to Munich; in 1816 the
University of Wurtemburg was united with that of Halle; the University
of Bonn was abolished in 1792, but revived in 1818. A few new
universities, like that of Zürich, have been founded. In the quaint
old town of Prague the old German university was, in 1883, divided, and
there now exist in that city two universities side by side, in one of
which German is spoken, in the other Bohemian.
It will thus be seen that the nineteenth century is essentially an era
of modern science, with whose dawn was sounded the death-knell of the
"demon of disease" and his twin{240} brother "visitation." In 1801 the
first experiment in steam-navigation took place upon the Thames. In 1807
the slave-trade in England was abolished by Parliament. The theological
part has entirely faded out of medicine; and the era of accurate
scientific experimentation which long since dawned, is now, so far as
we can see, at its height, since it is difficult to conceive of much
improvement upon its methods under existing conditions, or of greater
enthusiasm than has been already manifested.
Now, regarding some of the systems and theories of this age. The systems
of the past have been more or less long-lived,--as, for instance, those
of Dogmatism and of Galen,--while as we come closer to the present they
become more ephemeral. Those of the early part of the present century
took root in the soil of the eighteenth,--for instance, the so-called
_theory of excitement_ of Roeschlaub (1768-1835), which endeavored
to mold into one the Brunonian errors and the fancies of Schelling.
According to it, life depends upon irritability, but is inherent in the
organism as an independent feature; so it recognizes both irritability
and solidism, while Brown considered the former alone, adding, as an
after-thought, a chemical or qualitative potency (oxygen), in order to
account for alterations of quality. Roeschlaub inclined first toward
natural philosophy, then, owing to an inherent theological and polemical
bias (he was originally intended for the church), to mysticism and
theosophy; finally, with a courage almost unexampled, he upset all
his former teachings by admitting he was mistaken. To him was opposed
Hufeland, who wrote on the _Lengthening of Life_, was noted for a
warm and benevolent heart, and possessed no small penetration, as is
evidenced by his aphorism, "Successful treatment requires one-third
science and two-thirds '_savoir faire_.'"
_Stimolo_ and _contrastimolo_ were titles applied to a theory advanced
by Rasori (1762-1837), of Milan, that combined Methodism with Brunonism;
by Baas it is characterized{241} as a "genuine blot upon the human heart
beyond any other of the various systems." Long centuries of experience
and the conclusions of great and venerable minds may go for naught, as
Rasori abundantly demonstrated. The theories of Brown were then taught
as his own to his classes in Pavia, showing he was not above plagiarism;
his _stimolo_ corresponded to the sthenic diathesis devised by Brown,
while his system consisted of an endeavor to make a diagnosis by
watching the effects of drugs. Bleeding was held to be the best measure;
if it did the patient good, the sthenic diathesis was assumed; if it
made him worse, the asthenic was certain. He gave enormous doses of
powerful drugs--sixty grains of gamboge, and from two to three ounces of
saltpeter in a single day. Is it strange that homoeopathy or any other
heterodox system sprang up in the midst of such measures? It is an old
saying that there is no folly which will not secure a following; and,
strange to say, Rasori had a numerous and an eminent one.
As just intimated, Homoeopathy was the natural reaction against such
heroic measures; in the rebound the other extreme was reached, even to
practical therapeutic nihilism. Now, instead of venesection and drastic
medication, came the theories expounded by Hahnemann (1753-1843), which
_denied disease, admitting only symptoms_. This apostle of homoeopathy
was the son of a porcelain-painter in Meissen; he studied in Leipzig and
in Vienna, and later practiced in various cities, including Dresden and
Leipzig. "_Similia similibus curantur_" was not original with him, as it
long before had been formulated by Hippocrates, and later by Paracelsus.
Of the life and labors of Hahnemann, much might be told; but this is not
the time or place to go into the subject.
An offshoot of homoeopathy, which demands only the harshest criticism,
is Isopathy,--perhaps the filthiest theory ever invented,--according
to which like is to be cured by like,{242} and to such an extent that
small-pox is to be treated by variolous pus, tape-worm by the ingestion
of the proglottides, etc.
Another of the rankest of fraudulent outgrowths is the so-called
Electrohomceopathic system of Count Mattei, who prates of "red,"
"blue" and "green" electricity,--a theory that, in spite of its utter
idiocy, has attracted a considerable following and earned a fortune for
its chief promoter.
Another of the vagaries of the earlier portion of the present century,
and that still survives, in a weak way, is Cranioscopy, or Phrenology.
Gall expounded his doctrines at Vienna as early as 1796, but, being
expelled, went to Germany, where he was joined by Spurzheim, who, though
much{243} more of a student and scientist, accepted the doctrine of
the former with enthusiasm; and it was chiefly due to the efforts of
Spurzheim that phrenology was introduced into England, and later (1832)
into America. Gall assumed to locate twenty-seven different organs
alongside of each other in the brain, and held that external markings
on the skull were guides to the development of the various parts. Every
neophyte in anatomy knows how little foundation there is for such a
doctrine, but for a time it attracted great attention, and there
are to-day certain men and women who make their living out of this
imposition.
The Physiological Theory of Medicine was originated by Broussais
(1772-1838), and combined the views of Pinel and Bichat with the
"sympathetic" view of Hoffmann, the "concealed inflammation" of Stoll,
and the theory of inflammation held by Marcus. Broussais had been a
pupil of Bichat. In 1814 he began hospital teaching, and in 1831 was
made professor. Personally very vain, quick-tempered, even belligerent,
as a therapeutist he was a man of routine. He was, perhaps, best known
shortly before his death, when delivering lectures on phrenology.
According to him, life depends upon external irritation, produced
by heat, which excites new chemical processes, while these in turn
stimulate regeneration, assimilation, as well as contractility, and
sensibility. When the functions supported by heat cease, death ensues.
Health depends upon moderate action of external irritants; disease, upon
either their weakness or their extraordinary strength. He saw nothing
ontological about disease. In therapeutics he admitted the healing power
of Nature, but regarded the physician not as a minister, but as a lord
of Nature. Febrile and inflammatory diseases were all treated by the
withdrawal of nourishment, carried to the extreme. His most powerful
antiphlogistic treatment consisted in the application of leeches to the
abdomen,{244} and to robust individuals he applied from thirty to fifty
at once It is not, then, to be wondered at that, in consequence of his
so-called "hirudinomania," leeches became very scarce In the year 1833
forty-one million five hundred thousand leeches were imported into
France, while in 1824 one-twentieth of this number sufficed to supply
the demand. Even in cases of worms, the abdominal integument had to pay
its blood-tribute, particularly if enteritis prevailed. He only allowed
a spare diet of mucilaginous and acid drinks. In mercurial France and
Italy he gained numerous followers, but they were few and far between
in practical, hard-headed Germany and England. His best follower was
Bouillaud (1797-1881), who adopted the symptomatic nature of fever and
the sanguinary therapeutics of his master, but used the lancet more than
the leech. As the homoeopaths regard Hahnemann, so Bouillaud looked up
to Broussais as the Messiah of medicine and science, which, as Baas says
were "already greatly overstocked with Messiahs."
Contemporaneous with the school of Broussais, and its antagonist in all
respects, was the Paris School of Pathological Anatomy and Diagnosis,
which has given tone to all medical art. It made it the duty of the
physician to search for changes in the human body, to investigate the
local products of disease, and assigned to medicine the duty of removing
these products. The tendency of its teaching was to treat the patient
rather as a living cadaver than as a sentient being endowed with vital
forces, and the charge which Asclepiades once falsely made against
Hippocrates was revived upon new grounds. Kratzmann wrote some years
ago: "In France every one experiments on the sick, less to attain the
best method of cure than to enrich science with an interesting discovery
and to advance the accuracy of diagnosis by some new physical sign."
The seductiveness of this system promoted still more onesidedness, which
finally almost attained the belief that the science{245} of medicine
really originated in the Anatomical School of Paris.
The forerunners of this school were Bichat and Pinel, and its proper
founders were Corvisart, Dupuytren, and Laënnec. There was also Bayle,
who was first to apply the ear to the thorax in disease of the heart,
and thus became the predecessor of Laënnec and Chomel. He was the
godfather of typhoid fever, and from being a famous clinician became
later a great pathologist. The most celebrated adherent of the method,
however, was Cruveilhier (1791-1873), professor first in Montpellier and
then in Paris, who revived the Anatomical Society founded by Bichat,
and wrote his first essays as the result of Dupuytren's advice; finally,
there came from his pen the famous treatise on _Pathological Anatomy_,
with its magnificent plates,--a work begun in 1830 and not fully
completed until 1864. Like Morgagni, he associated general and
pathological anatomy with bedside observations; also established a class
of inflammations to which belong gangrene and atony, and a certain class
of neuroses and fevers, and endeavored to investigate the different
steps in the development of lesions, not simply their final products.
His teachings concerning pyæmia and phlebitis, which had been first
studied by John Hunter, excited great attention, and he even came to the
one-sided conclusion that "phlebitis rules the whole of pathology."
He was the first to observe that its suppurative form does not occur
primarily, but is secondary to coagulation of the blood.
The ablest representative of this school, and one who, perhaps, more
than any other man, made Paris a Mecca to which foreigners made their
pilgrimages, was Andral (1797-1876),--the son of a physician and the
most noted and indefatigable investigator and thinker of his time.
Between 1823 and 1840 were published the five volumes of his _Medical
Clinic_, which made him famous. He taught, in opposition to Broussais,
the existence of primary diseases{246} of the blood, the so-called
dyscrasiæ; made physiology subservient to pathology; was the creator of
the chemistry of the blood; and in therapeutics was wedded to emetics
and cathartics, ascribing little importance to abstraction of blood.
The first man to apply the Numerical Method to pathology, and who
brought about the downfall of Broussais, was Louis (1787-1872), who
had studied in Russia, but came to Paris while still a young man. He
expressed his principle in the following words: "As often as I have
formed an _a priori_ idea and had afterward opportunity to prove the
facts, I have invariably found that my idea was false. In pathology
as well as in therapeutics numerical analysis is a useful practice. By
numbers only can be obtained the frequency of conditions or this or that
symptom; by a definite enumeration alone is it possible to utilize the
special relations of age, sex, constitution of our patients, to settle
that this or that symptom occurs so often in one hundred or one thousand
cases." This system he applied to etiology, symptomatology, prognosis,
therapeutics, and pathological anatomy. He discarded blisters and
condemned large bleedings, but fell into other errors, carrying his
numerical method to an unjustifiable extreme.
Next to Andral and Louis should be mentioned Magendie (1783-1855),
Professor of General Pathology in the College de France, and physician
to the Hôtel-Dieu, who was a representative of the new French medicine,
and introduced experiments into both pathology and physiology; he was
the pioneer in experimental pharmacodynamics, which occupies itself
largely with alkalies, a large number of which he introduced into
practice. He was a solid humoralist in pathology, a most accurate
diagnostician, but (it is charged) "was too simple in therapeutics"! As
a result of his intravenous injections of putrefactive material, he had
the terms "pyæmia," "icliorrhæmia," and "metastasis" introduced into
Trousseau{247} (1801-1866), of Tours, also became professor in the Paris
Faculty, and rendered especial service in his studies of croup and the
employment therefor of tracheotomy, though his chief fame rests upon
his merit as a clinical teacher and the publication of clinical lectures
which are still models in every way of accurate, forcible teaching.
Claude Bernard (1813-1878) became the successor of Magendie, and even
more famous as an experimenter in pathology, physiology, and anatomy.
Originally a poet, he finally turned to medicine and science, and in
1869 became a member of the French Academy.
One of the results of the French fondness for pathological anatomy was
an outgrowth, unfortunate in some respects, of specialism, which made
its appearance early and spread to other countries, particularly to
Germany, so that to-day there is scarcely an organ in the body which
has not only its special student, but its special representative in
medicine. It would be of interest to go over some of the various organs
and count those who have become most renowned in the study of their
diseases, but that is beyond the scope of this volume.
As Baas says, England, after her excessive participation in the
iatrochemistrv and iatromechanics of the seventeenth century, with a
devotion that extended far into the eighteenth, seemed then to lose all
confidence in systems and schools of medicine, inasmuch as since that
time no system or so-called school has gained in Great Britain any large
or permanent band of followers; even Brunonianism did not succeed in
this respect. This form of conservatism is a characteristic of the
British race. But while schools have not risen, individuals have
formulated hypotheses or doctrines that at least attracted attention, if
not followers. For instance, John Mason Goode (1764-1827) formulated an
intricate nosological arrangement in his long-popular text-book entitled
_The Study of Medicine_, and{248} also arranged a classification of
diseases now almost forgotten.
In 1816 Sir Charles Bell (1774-1842) made the memorable discovery that
the posterior roots of the spinal nerves preside over sensation, and the
anterior over motion; and this attracted anew the attention of English
physicians to the nervous system, and was rewarded by the later
discovery of reflex action or reflex phenomena, communicated to the
Royal Society in 1863 by Marshall Hall. Both discoveries were important,
and both were duly rewarded by yet others.
Benjamin Travers (1783-1858) seems to have been greatly influenced by
the first of these discoveries, and led thereby to pay special attention
to what he termed "constitutional irritation"; his studies on this
subject are often quoted to-day, and are well worthy of perusal; he
understood by this term a process (in strong contrast with inflammation)
which subsides without hyperæmia and without plastic exudate, but which,
on the other hand, may occasion liquid products and result in neoplasms.
Contemporaries of Travers were: Abram Colles; John Cheyne (1777-1830),
of Dublin, who wrote on _Diseases of Children_ and described
"Cheyne-Stokes respiration." William Stokes (1804-1878), also of Dublin,
who distinguished himself in 1857 by a great work, entitled _A Treatise
on the Diagnosis and Treatment of Diseases of the Chest_; Robert Graves
(1797-1853), Professor of Medicine in the King's and Queen's College,
Dublin, who published clinical lectures of his own, besides many
clinical reports in connection with Stokes. Graves was one of the
first to oppose the "absolute diet" of the earlier physicians in the
management of febrile maladies, and requested that his epitaph should
have but one line--"He fed fevers!"
"The School of Natural Philosophy" was the title applied to a system
which, in Germany, ran parallel with that of Broussais, being the
legitimate outcome of the medical{249} philosophy of the eighteenth
century which had originated there, and also a revival of opposition
thereto on the side of realism. It led into speculative extremes, which
finally sobered down, because of the meaningless scholastic phrases
often introduced, and thus broke a path for the subsequent enthusiasm
in behalf of French positivism in medicine. Those who constituted this
school were, for the most part, men of importance, but were followed
by a number of imbecile representatives. Use was made of the abstract
doctrine of the philosophy of identity and the imponderables, such as
electricity, mechanical forces, and magnetism, contrasted with which
were the dimensions of matter and certain qualities, like sensibility,
irritability, etc. Perhaps the greatest influence of this teaching was
in the department of embryology and physiology, where Johannes Müller
displayed his remarkable activity. Among the most distinguished
representatives of the natural-philosophy school was Oken (1779-1851),
of Bavaria, who subsequently taught in Munich, Jena, and Zürich, and
published a large work on natural history, which did much for the
popularization of this science; he explained that the skull is made up
from a series of vertebræ; also discovered the Wolffian bodies, and was
such a power in his way that Agassiz characterized him not only as "a
master in the art of teaching," but as "a courageous and ruling spirit."
Others of this school were: von Walther (1782-1849), eminent as a
surgeon; Dollinger (1770-1841), of Bamberg, the distinguished leader
of the Old Catholics; Reil and Procliaska, anatomists; Troxler and
Schelling, philosophers and anatomists; Treviranus, the microscopist;
Malfatti, Kilian, Spindler; Schmidt, of Vienna; and others too numerous
to mention.
As a successor to the School of Natural Philosophy came the School
of Natural History (1831-1850). which made important concessions to
realism; its most prominent members were from South Germany. This school
was based{250} partially upon the philosophy of Nature, and expired
almost suddenly. One of its most eminent exponents was Krukenberg,
whose therapeutic creed was that "Physicians should be filled with
pious reverence toward Nature; the organism is a whole, and must be
contemplated in this sense; medical art is, undoubtedly, capable of
decisive action, but let us not mistake that in many cases its activity
is quite superfluous, in very many null and inadequate, and in many
injurious." This school was the expression of the turn medicine was
compelled to take in order to escape the after-effects of the one-sided,
ideal, systematizing tendency of the eighteenth century (whose final
outcome was natural philosophy), and to square itself with the realism
and positivism of the nineteenth.
Schonlein (1763-1874), of Bamberg, outlined a system that taught
pathological and anatomical revelations as concrete expressions of the
independent entity disease, whose relation to the organism is as that
of a parasite sojourning temporarily in it; he also constructed a
classification of diseases, something after the manner of the botanical
classification of de Candolle. One of his best-known pupils was Canstadt
(1807-1850), whose _Jahresbericht_ has preserved his name. Siebert,
of Jena, famous as a diagnostician, and Haeser, the medical historian,
belonged to this school.
An offshoot of the French school of pathological anatomy and diagnosis
was the so-called New Vienna School, which aided the French system in
obtaining high recognition in German medicine, and gained its first
influence from the labors of Wünderlich (1815-1857); next to whom should
be mentioned Baron von Rokitansky (1804-1878),--a Bohemian,--one of the
most famous men in modern times, and who exercised a profound influence,
even in foreign countries,--particularly in Italy and Russia. Von
Rokitansky worked for a long time in miserable quarters in Vienna, but
finally a magnificent building was{251} specially erected for him.
He was loaded with honors, and took his seat in the Austrian House of
Deputies. Two sons are well known in medicine to-day, and two more
have achieved reputation as singers,--a circumstance which the father
embodied in the _bon mot_ that "two of his sons howled and two of
them healed." He transplanted into Vienna the tendency of the earliest
pathologico-anatomical school, which captivated all by its novelty and
interest, and in the post-mortem room and the clinical-lecture room he
converted medicine in Germany to the realism of the nineteenth century.
He was, indeed, the Van Swieten of his time in his influence upon
educational affairs. His works are distinguished by simplicity,
clearness, and logical order. He performed more than thirty thousand
autopsies; for fourteen years he studied the defects of the septum of
the heart and the comparative anatomy of the uterus and genito-urinary
organs, yet paid little attention to the microscope or to applied
medicine. He was a pathologist, pure and simple.
A friend and co-laborer,--Skoda (1803-1881),--also a Bohemian, was
little, if any, less famous. In 1839 he gave to the world his famous
work on _Auscultation and Percussion_; in 1847 became professor at
Prague, and was the first man to lecture in German. In spite of his
bachelor peculiarities, his taciturnity, and his heedlessness, he was
very popular, and left a fortune,--quite in contrast to Rokitansky,
who died poor. His scientific merit was based upon the fact that he
overthrew the specific and pathognomonic arrangement of sounds, as
taught by the French, and substituted therefor a category, based upon
the physical constitution and shape of organs and tissues. He endeavored
to develop a strictly scientific system of physics out of the empirical
French doctrine of physical signs, and in his work on _Physical
Diagnosis_ he displayed an independent spirit, though as one who had
received his impulse from France. He was the first in Germany to insist
upon the merits{252} of Avenbrugger, and was the leading diagnostician
of his time of the new Vienna school. Skoda was the first for whom was
created, in Vienna, a specialty after the French model,--that is, a
special division for patients suffering from thoracic diseases. Great
as he was, we must yet lay it up against him that through his
influence,--first in Vienna and afterward throughout Germany,--practical
medicine degenerated into simple diagnosis, and that, by his
observations on the natural course of disease, undisturbed by
therapeutics, he became the founder and exponent of expectant or
nihilistic therapeutics,--the harbinger of a very cheerless period in
the history of medicine.
_Age of Transition (concluded).--New Vienna School (concluded):
von Hebra, 1816-1880. Czermak and Türck, Jager, Arlt, Gruber,
Politzer.--German School of Physiological Medicine:
Roser, 1817-1888.--School of Rational Medicine:
Henle, 1809-1855.--Pseudoparacelsism: Rademaclier,
1772-1849.--Hydrotherapcvtics: Priessnitz, 1799-1852.--Modern Vitalism:
Virchow.--Seminalism: Bouchut.--Parasitism and the Germ-theory: Davaine,
18111882. Pasteur, 1822-1895. Chauveau, 1827--. Klebs, 1834--. F.
J. Cohn, 1828--. Koch, 1843--. Lister, 1827--.--Advances in Physical
Diagnosis: Laënnec, 1781-1826. Piorry, 1794-1879.--Surgery: Delpeeli,
1772-1832. Stromeyer, 1804-1876. Sims, 1813-1883. Bozeman, 1825--.
McDowell, 1771-1830. Boyer, 1757-1853. Larrey, 1766-1842. Dupuy-tren,
1777-1835. Cloquet, 1790-1883. Civiale, 1792-1867. Vidal, 18031856.
Velpeau, 1795-1868. Malgaigne, 1806-1865. Nélaton, 1807-1874. Sir
Astley Cooper, 1748-1841. Brodie, 1783-1862. Guthrie, 1785-1856.
Syme, 1799-1870. Simpson, 1811-1870. Langenbeck, 1810-1887. Billroth,
1819-1894._
A few{253} of Skoda's more eminent colleagues deserve brief mention:
Oppolzer (1808-1871) was singularly gifted in diagnosis, popular, a
teacher of wide influence, and manifested in superlative degree the
characteristics that constitute a great physician; he wrote little,
but was for a long time Professor of Medicine at Prague. Von Hebra,
the elder (1816-1880), worked a complete revolution in dermatology, and
developed a classification based upon the pathological anatomy of
the skin. He instituted a new and independent line of therapeutics as
applied to this branch of our art, for which the medical world will ever
hold him in grateful remembrance. Sigmund and Zeissel during the
same period did much to clear up the problems of syphilis. To Czermak
(1828-1873) and TUrck (1807-1868) we are indebted (practically) for the
making a specialty of diseases of the nose and larynx; of like service
to ophthalmology were Jàger, Jaxtthal, Arlt, Stellwag von Carion,
Hasner, Mauthner, Fuchs, and von Reuss, while Gruber and Politzer did as
much for diseases of the ear.
An indirect offshoot of the new Vienna school is the so-called
"Physiological Medicine," founded by Eoser (1817-1888),{254} of
Stuttgart (late Professor of Surgery in Marburg), seconded by Griesinger
and Wunderlich. Their views were directed against the symptomatologists
and idealists, and particularly against the School of Natural History,
the claim being that physiology must include vital phenomena, while from
the morbid portions of these phenomena the special science should
be formed as an artificial, yet practical, division of knowledge.
'Wunderlich's book of therapeutics was for a long time the best guide
in this direction, inasmuch as it left to individual thought and
judgment--the Hippocratic method of investigation--the determination of
value and demand. Another offshoot, that differs but little from this
save in definition, is the "School of Rational Medicine," originated by
Pfeufer (1806-1869) and Henle (1809-1855), and which, since 1841,
has been represented by a special journal. While Wunderlich claimed
pathology to be the physiology of the sick, Henle considered this
questionable and made no distinction at all between the physiology of
the healthy and that of the ill. The language of the followers of this
school contrasted strongly with that emanating from other schools, and
for a time was confident and ingeniously triumphant; nevertheless, it
did not forget philosophical speculation, and Hegel may now be regarded
as indirectly the godfather of rational medicine.
The vagaries of Paracelsus led indirectly, though positively, to the
foundation of Homoeopathy, and likewise originated the doctrine that
bears the name of Rademacher (1772-1849). It is curious that this
pseudoparacelsic system should spring up alongside of the Vienna school,
its teachings being the classification of diseases by their therapy,
Rademacher's followers possessed three universal remedies,--"cubic niter
(nitrate of sodium), copper, and iron,"--and also three primary diseases
that must take their titles from the three universal medicaments.
In spite of the admission that these diseases were unknown, it was
boldly{255} asserted they were with certainty to be cured by the three
chief remedies. The three primary diseases, "sodic nitrate, copper, and
iron diseases," do not necessarily remain as such, as they may throw
some organ "into a condition of sympathy, and thus it results that iron
disease may express itself in the form of consumption, delirium tremens,
etc., while a copper disease may appear as worms, paralysis, jaundice,
etc." Besides universal diseases and universal remedies there were
diseases of organs, to be diagnosed by the efficacy of organ remedies;
thus, abdominal diseases must be relieved by corresponding "abdominal
remedies," head diseases with "head remedies," chest diseases with
"chest remedies," etc. Also for each particular viscus there must be a
special remedy. What is the most surprising about this absurd doctrine
is that it found followers, some even quite capable in their way.
Now, too, reappeared the Hydrotherapeutic System--the great apostle
of which was Priessnitz (1799-1852)--based upon gross views of humoral
pathology, according to which a disease entity was to be expelled in the
form of sweat, eruption, etc. Poultices, cold packs, and cold baths were
the principal therapeutic measures. Winternitz has made hydrotherapy
popular and, in a measure, effective in the management of certain
maladies.
Rudolph Virchow in 1858 instituted the doctrine or theory known as
"Modern Vitalism," which, in fact, was borrowed from natural scientific
medicine, and distinguished from the vitalism of the previous century in
that it breaks up the old vital force, which was supposed to be either
distributed throughout the entire body or located in a few organs, into
an indefinite number of associate vital forces working harmoniously, and
assigns to them all the final elementary principles without microscopic
seat. "Every animal principle has a sum of vital unities, each of which
bears all the characteristics of life. The characteristics and unity
of life cannot be found in any determinate{256} point of a higher
organism,--e.g., in the brain,--but only in the definite, ever-recurring
arrangement of each element present; hence it results that the
composition of a large body amounts to a kind of social arrangement,
in which each one of the movements of individual existence is dependent
upon the others, but in such a way that each element has a special
activity of its own, and that each, although it receives the impulse
to its own activity from other parts, still itself performs its
own functions." This is nothing but another way of expressing the
cell-doctrine, to which many medical men are now committed, which means
that all bodies are built up of cells and that each cell has a unity and
a purpose of its own.
In 1677 Sir Robert Hooke discovered plant-cells; later Schwann
discovered animal cells and Robert Brown cell-nuclei; but it remained
for Virchow to supply the gap which had risen between anatomical
knowledge and medical theory; that is, to supply a "cellular pathology,"
since which time the cell has assumed the rôle which the fibre occupied
in the theories of the seventeenth and eighteenth centuries. Time alone
can decide as to the ultimate validity of this theory, which has in
certain circles been most enthusiastically received. One of its weakest
aspects is, perhaps, that the so-called intercellular substance plays
an uncertain and unsatisfactory part. An important feature in which the
cellular pathology differs from other systems, and particularly from the
old humoral pathology, is in the doctrine that the blood itself is not
the proper and original cause of dyscrasiæ, and probably not the cause
of continuous alteration of the tissues; that these dyscrasiæ arise
because the blood is not an independent structure, but dependent upon
the condition of the patient in consequence of its continuous conveyance
of the noxious material from all parts of the body,--the blood is,
therefore, merely the medium for the production of the dyscrasia.
This theory has made several peculiar, new, and symptomatic or
morphological{257} forms of disease, such as leukæmia, leucocytosis,
etc. Virchow also cleared up the old and obscure ideas regarding pyæmia,
and proved that an absorption of pus into the blood, which the name
implies, is quite impossible; likewise, that pyæmia is inseparable from
thrombotic processes.
Virchow was born in Pomerania in 1821, and in 1849, he distinguished
himself by attaining the highest grade in the career of the learned,--a
professorship, which he first held in Würzburg. During earlier years his
residence and labors were largely the result of necessities arising from
political views, for on account of these he was long denied a residence
in Berlin. A personal friend, now old, once an _interne_ in the great
Julius Spital, in Würzburg, at the time{258} when Virchow taught there,
tells me a light was burning every night in Virchow's room until 3
a.m., and yet the professor was always out at work by 7. It was by such
intense application that he arrived at his present position at the very
top of the professional ladder; but very few men have the physique and
constitution to stand such arduous study. In 1856 he assumed the chair
of Pathological Anatomy in Berlin, and introduced microscopical anatomy,
to which Rokitansky had not given sufficient attention. Virchow was
a former pupil of Johannes Muller, famous as a physiologist and
pathologist, and his views to-day are often tinged by the doctrines
acquired from this great teacher. He is also a great admirer of Harvey,
whose picture, at least for a long time, was the only one permitted to
hang in his study. His first edition of _Cellular Pathology_ appeared in
1858; the colossal work on _Tumors_ in 1866, in which he carried out
the division of morbid growths originally adopted by Johannes Müller in
1838, classifying them according to their microscopical elements. He is
also scarcely more celebrated for his teachings and labors than for the
number of famous pupils brought up under his influence, among whom may
be mentioned Leyden, Recklinghausen, Cohnheim, Waldeyer, Kuhne, and
Rindfieisch. As a result of his labors has arisen in Germany what has
been called the "Medical School of Natural Sciences," that seeks, by
means of pathological anatomy and microscopy, experimental physiology
and pathology, and the other applied methods, to make of medicine
an exact science; and to it belong such men as Zienissen, Gerhardt,
Notlniagel, Liebermeis-ter, Senator, Erb, Vogel, and others. An offshoot
from this is the so-called "Munich Clinical School," to which belong von
Buhl, Pettonkofer, Seitz, and Oertel.
The splitting up of medicine into specialties, and the increase of its
subordinate branches into schools.--so called,--resulted in great danger
to the unity of medical science.
A return{259} to the methods which combine science and practice--the
so-called clinical-practical method--is again sought by men who have
established the well-known _Zeitschrift fur Klinische Medicin_, under
the management of Frerichs and Leyden,--a journal which has already done
a great deal of good.
The versatile Bouchut, of Paris, has recently published a theory,--the
so-called "Seminalism,"--for which the claim is made that he grants
nothing to hypothesis, and everything to observation; its characteristic
is that this new theory is also vitalistic,--in fact, the French have
scarcely ever brought forth any other than vitalistic theories. Borden
and Barthez, during the previous century, created the first French
theory, which was followed out by Bichat, and later by Bouchut, who, as
a matter of fact, owes much to Bichat. Bouchut teaches that beasts
have an intelligence of instinct, and men one of abstraction; no beast
oversteps the limits of animal thought, which is separated by an abyss
from the productive thought of men; there is a proper kingdom of man, in
accordance with his special nature; also, that the vital forces of
men and of beasts are entirely different from each other, and that the
principle of physical identity remains in the bodies of each, since the
constantly renewed mass is formed in exact accordance with the original
plans; in all the changes of his elements man is identical with man; all
internal and external causes of disease modify, more or less, the vital
force and its impressibility in the fluids or at some point in the
economy, either increasing it or diminishing it. This theory, published
in. 1873, claimed "in the abstraction of its promise and completeness
of its conclusions to yield to none of its predecessors." Yet, even
in France, the task of transforming medicine into a natural and exact
science is far from being a _fait accompli_.
The most recent theories of disease are the result of microscopical
study of germs,--the germ-theory, in fact,--and{260} stand in the
closest possible relation with the doctrine of spontaneous generation,
fermentation, miasm, and contagion. In 1838 Ehrenberg regarded infusoria
as animals, but Dujardin in 1841 expressed doubts, and Perty in 1852
affirmed that most forms classified as infusoria should be assigned to
the vegetable kingdom, where, a little later, Naegeli relegated
them. The correctness of this conclusion was proved by Cohn, who also
perfected a classification. This particular form of investigation began
in the twenties of the present century and assumed its present direction
in the thirties and forties. Gaspard, in 1823, renewed the experiments
of Haller, and injected into the veins of animals, not alone putrescent
material, but the blood of other creatures suffering from the effect
of such injections. Bassi, in 1835, discovered the cause of silk-worm
disease, thereby giving special impulse to the theory of parasitism, and
this was quickly followed by evidence of the existence of both vegetable
and animal exciters of disease. Schoenlein, in 1839, demonstrated the
fungus of favus; Vogel discovered the Oïdium albicans in 1840; Goodsir,
the _Sarcina ventriculi_, in 1841; but the greatest influence upon
the development of the parasitic, or germ-theory was the sequel to the
discovery of the anthrax bacillus, by Davaine in 1850. In 1837 Latour
and Schwann demonstrated that the cells, which were known even to
Leeuwenhoeck, were actually vegetable forms, and Schulze had already
pointed out that fermentation of fluids could only occur in the presence
of extremely minute vegetable organisms; Chevreuil next showed that
animal solids remained free from decomposition when protected from the
access of germs; and in 1857 Pasteur demonstrated that fermentation and
putrefaction were caused, not by chemical forms, as Liebig had taught,
but simply by the agency of lower organisms, which he divided into
aerobes and anaerobes; while in 1868 Chauveau queried as to whether
morbific elements resided in the formed elements of germs or in their
fluid{261} constituents. Thus the theory of _contagium vivum_, for which
Henle contended as early as 1821, was not forgotten. In Germany Klebs
and Hueter became the prominent champions of this theory; Hallier had
designated his so-called "Microsporon septicum," and introduced a method
of fractional cultures. The views of Klebs were opposed by Billroth, who
contended for his "phlogistic ferment" and "_Coccobacteria septica_,"
upon which he wrote an elaborate and extensively illustrated treatise;
he also at that time opposed the specific character of the lower
organisms as disease agents. Hallier's _microsporon_ was refuted by
Cohn, who studied and classified the various fungi, and distinguished
between the pathogenic and the septicogenic,--that is, those which
produced disease and those which produced ordinary putrefaction. Then
came the experimental evidence of Davaine and Koch, who demonstrated the
development of bacteria from spores. It is hardly necessary to discuss
this theory further, but I may mention the labors of Panum and of
Brieger, who deeply investigated the poisons produced by bacteria, to
which are given the general titles of ptomaines and toxins.
It would be unjust, however, did I not mention the name of Lister in
connection with the inestimable benefit that has accrued to surgery
from the practical application of the theory of infection to wounds,--a
measure that brought about an entire revolution in surgery and surgical
technique, and an entire reversal of the statistics of operations;
where thousands formerly died, thousands now live, their lives being
indirectly due to the labors of this one man and his following.
I will add that it is necessary to realize the difference between life
and death to appreciate the changes that have been brought about during
the last score of years. Much that in former years was unjustifiable has
become both justifiable and feasible; to-day patients, as a matter of
course, live after operations which, so recently as when I was{262}
a student, were considered impossible, or if performed exposed the
operator to the charge of manslaughter.
I have spoken of the impulse which came from Avenbrugger's invention of
percussion, which was greatly extended through the translation of his
work by Corvisart (1755-1821); the latter also excelled as a clinical
teacher and pathological anatomist, and had much to do with the
education of others of his _confrères_ whose names are lustrous in
history. Among the most celebrated was Laënnec (1781-1826), who, though
brought up among most trying surroundings, early manifested a zeal for
medicine. He became a field-surgeon in the French army soon after the
Reign of Terror, and pushed his classical and medical studies with
restless zeal. In 1815 his first experiments were made with the
stethoscope, the invention of which was due to accident: in order
to hear the sounds of the heart more clearly, lie one day applied a
cylindrical roll of paper, and then immediately constructed the whole
form of the stethoscope upon the principle now everywhere resorted to.
In 1819 he published his work on Mediate Auscultation,--a treatise on
prognosis in disease of the lungs and heart, based principally upon this
new aid to investigation. The treatise was speedily translated into
all the languages of Europe. After enjoying a large practice Laënnec
succumbed to ill health at the early age of forty-five. He seems to have
had but slight appreciation of his own services to medicine, and to have
prided himself rather on his skill in riding horseback. Honor and fame,
however, followed closely upon the publication of his well-known work,
and the manuals of physical diagnosis which now find frequent mention
in book catalogues, and come from various and wide sources are the
legitimate outcome of Avenbrugger's and of Laënncc's pioneer treatises.
A versatile French writer who devoted especial attention to medical
nomenclature was Piorry (1794-1879), to whom we are{263} indebted
for the pleximeter. The double stethoscope, a legitimate extension of
Laënnec's simple instrument, was invented by Cammann, of New York, and
can justly be claimed for American medicine. Other methods of physical
examination--like spirometry, chest measurement, and study of expired
air--have been introduced since 1846. The ophthalmoscope, which has been
of such sterling service, and is based upon the simplest of principles,
was the invention of the famous Helmholtz, but just deceased. The
principle of endoscopy,--the illumination and visual examination of
the various cavities of the human body,--the various specula, the
spectroscope, the sphygmograph, the more accurate record of physical
sounds, the application of electricity, and the employment of
thermometry represent a few of the strides in the medical science of
the present century, thereby aiding and perfecting the art of diagnosis,
which, in turn, must ever necessarily form the basis for all rational
treatment. Let no one complain that we are still so far from certainty
in every case; the wonder is that so much has been discovered in so
short a space of time.
Wonderful as have been these advances, the greatest achievements have
accrued to the department of surgery, which Chamisso terms "the _seeing_
portion of the healing art." The sixteenth century opened the way
for checking of haemorrhages; the seventeenth accomplished great
simplifications and improvement in the way of dressing wounds; the
eighteenth gave a refining and elevating tendency to the study of
applied practice, and raised surgery to a level with other branches
of science; and now the nineteenth century has, toward its close, made
surgery as nearly, perhaps, as it ever can be, an exact science, to
which every other branch of science has been made contributory. The
chain-saw, invented in 1806 by Jeffery, alone gave an impetus to
resection, which was cultivated especially in Germany; to resection was
added osteotomy by Heine{264} and Maver; this, in turn, was succeeded
by the so-called subcutaneous osteotomy of Langenbeck in 1854; Stromeyer
introduced subcutaneous tenotomy in 1831, which was a very pronounced
advance on all that had gone before; then came the introduction of
anæsthesia, by which were made possible operations that had been beyond
human endurance; by the introduction of the rubber bandage by Esmarch in
1873 bloodless methods were made possible. Pain and haemorrhage, the
two greatest enemies of the conscientious surgeon, being thus almost
annihilated, there was left but an apparently theoretical limit to
what the surgeon might accomplish. Orthopaedic surgery, introduced
by Delpech, was unknown prior to 1816; it was first practiced
systematically by Stromeyer and popularized in France by Guerin.
Operations on nerves were studied as special methods by Schuh, Wernher,
and Nussbaum. Jobert and Simon abroad, and Sims and Emmet in the United
States, by their studies of fistulæ peculiar to the genito-urinary
tract in females, have conferred inestimable benefits upon suffering
womanhood. So late as 1839 Vidal declared there did not exist in the
history of surgery a single well-authenticated case of complete cure of
vesicovaginal tear.
It is not my intention to more than barely refer to the living surgeons
of to-day, or those who have but very recently passed away from us; but
it would be an injustice to overlook Bernhard von Langenbeck and Theodor
Billroth. The former, born in 1810 and deceased in 1887, was for a
time a teacher of physiology, but subsequently became successor of
Dieffenbach in the University of Berlin. The influence he exerted upon
surgery in Germany and (since the decline of French precedence) upon
surgery all over the world, has perhaps been greater than that of any
one man since Dupuytren's time. He it was that introduced into surgical
technique and surgical pathology the experimental method of which
Johannes Müller was the great{265} exponent; indeed, the relatively high
importance which pathology is given to-day in every surgical curriculum
is due more to his labors than to those of any other one man. Genial,
learned, indefatigable, he was the ideal accomplished teacher. It would
be impossible in any short _résumé_ of his life and labors to do justice
to so distinguished a man, to whom the profession owes so much. Perhaps
the highest testimonial that could be given would be the enumeration of
the men who were ever and always his enthusiastic admirers. Langenbeck
was the founder of the German Congress of Surgeons, and for many years
its president, and the permanent home this association has built for
itself in Berlin bears his name; the surgical journal he founded has
now passed its fiftieth volume, and is today the first periodical of its
class in any country or language.
Theodor{266} Billroth, who only within a few years joined the great
silent majority, was for many years the surgical sun of Austro-Hungary,
around whom revolved all the other lights of the profession in the
empire. He was as expert with the microscope as with the knife, and
equally great with both. Although his great and elaborate work on
_Coccobacteria Septica_ is now obsolete, it nevertheless marked an era
in surgical pathology, as does also his textbook on the same subject,
which reached fifteen editions and has been widely translated. He it was
who made the first resection of the larynx and of the stomach, and to
him we are indebted for many other daring operations. It was the fame of
this teacher that in recent years led young Americans to Vienna, and he
set the example in every way for a constantly growing number of students
whose names are, or ere long will be, famous. Billroth was born, in
1819,{267} in Bergen, and succeeded Schuh in Vienna, after having
taught most acceptably at Zürich. What he was to his teacher,
Langenbeck, such are the younger German surgeons, like Czerny,
Gussenbauer, Mikulicz, and others, to _him_.
Here may be recalled the pride with which Americans greet the name of
McDowell, who performed the first ovariotomy, and prepared the way for a
branch of abdominal surgery the results of which have fairly astonished
There is much to be said also for certain measures, such as the
introduction into surgery of plaster of Paris, by Larrey; of starched
bandages, by Seutin; of absorbable material for ligatures and sutures,
the latter from animal sources. Finally, antiseptic--or, better,
aseptic--methods of operating and caring for injuries and wounds have
worked a revolution in methods and results that is, perhaps, the most
important known to medical history.
At the beginning of the present century the French appeared to lead
in matters surgical, and were distinguished by dexterity in operating,
fertility of invention, accuracy of observation, and clearness of
clinical teaching. The foundation of this reputation was laid by
Desault, and upon it his successors continued to build. From his school
descended the barber-surgeon Boyer (1757-1833), who became the first
surgeon and trusted adviser of Napoleon, and was by him created a baron.
He was the author of a work, in eleven volumes, which has survived many
editions and translations, and therein he laid especial stress upon
after-treatment. Richerand (1779-1840), like Boyer, was made a baron,
and was a professor in Paris; but his character suffered from his
overweening ambition and vanity; he was wont to exhibit most unpleasant
personal traits; nevertheless his surgical ability entitles him to front
rank among his contemporaries. The third surgeon honored with the rank
of baron was Larrey (1766-1842), surgeonin-chief{268} to the Grand Army,
and whom Napoleon I called the most virtuous of men. In 1792 he joined
the Army of the Rhine, and was the physician of the so-called "flying
ambulance" for twenty-two years. He was present in sixty great battles
(including that of Waterloo) and four hundred engagements, and was three
times wounded. His memoirs and monographs on subjects connected with
military surgery cause him to be often quoted even at the present day.
It is recorded that he performed two hundred amputations in a single
dav; during the march through Russia he had at one time in Smolensk ten
thousand men to care for in one hospital. A wonderful organizer, he was
idolized by the soldiers, and seems to have been held in nearly the same
esteem as his great prototype. Ambroise Paré.
The most famous French surgeon of this century,--equally celebrated as
a diagnostician, as an operator, and as a teacher,--was Baron Dupuytren
(1777-1835). As a child he had been stolen, on account of his eminent
beauty. His early life was one of poverty and want. He zealously devoted
himself to anatomy and physiology as foundations for successful work
in surgery and ultimately secured a private practice that embraced all
France, and, when visiting other countries, was received like a prince.
For years he devoted three hours daily to didactic lectures. He died,
leaving a fortune of several millions of francs; he even offered to the
exiled Charles of England a million francs as a trifling recompense for
his misfortune. He was known as "The Xapoleon of Surgery,"--a title
well earned, yet one which drew upon him the enmity of many of his
contemporaries, particularly as he seemed inclined to persecute all who
dared to tread in his path.
His death resulted from empyema, for which he declined operation,
preferring, as he said, "to die at the hands of God, rather than man."
The first truly scientific practitioner of orthopædic surgery in France
was Delpech (1777-1832). of Toulouse, who{269} was likewise the pioneer
in subcutaneous tenotomy of the tendo Achillis and in autoplastic
operations. At his own expense he erected a large orthopaedic institute
in Montpellier, and his death occurred while on his way to pay a visit
to this institution, both he and his coachman being shot by an insane
patient upon whom he had operated.
Dupuytren's successor in the Hôtel-Dieu was Roux (1780-1854), who earned
specific reputation as a dextrous and rapid operator; his labors in
constructive and plastic surgery were extraordinary. The first to
apply physical investigation to surgery was Lisfranc (1790-1847),--best
remembered, perhaps, in connection with amputation of the foot. Marjolin
(1770-1850) was a teacher of eminence, as were also Sanson (1790-1841)
and Cloquet (1790-1883), though the latter is better remembered for his
works on anatomy than for his exploits in surgery. Civialc (1792-1867)
is chiefly famous for revamping the operation of lithotrity, for, though
a lithotrite had been invented by d'Etoilles, Civiale was the first
actual operator, for which he was fiercely opposed by Larrey, Sanson,
Velpeau, and others; he lived to see his rivals confounded and
lithotrity accepted as a legitimate surgical procedure. Amussat
(1796-1856) reinvented torsion of arteries for the repression of
haemorrhage, for, although this measure had been suggested by the
ancients, it was held to be suitable only for very small vessels; he
never held a professorship, yet at his residence were gathered so-called
"conferences" that were attended by the most eminent medical men of the
time; he is specially known in connection with the operation for opening
the colon in the lumbar region. Pravaz was a surgeon of Lyons,
whose name has been perpetuated by the small syringe--the original
hypodermatic--which he devised. Vidal (1803-1856), of Cassis, made
a reputation by his work on _Surgery_, in five volumes, which was
extensively translated and reprinted throughout Europe. Jobert de
Lamballe{270} (1799-1867) rose from abject poverty to a professorship
and a seat in the Académie; he is particularly remembered for his
achievements in plastic operations. Velpeau (1795-1868) in 1834 became
the successor of Boyer; popular as a teacher, and an author of great
fertility, he devoted attention alike to surgery and midwifery; his
_Operative Surgery_, in three volumes, and a treatise on _Diseases of
the Mammary Gland_ are still classics. Gerdy (1797-1856), like Velpeau,
was the son of poverty-stricken parents; in 1833 he became a professor,
and wrote extensively on bandages, dressings, and on operation for the
radical cure of hernia. Bonnet (1802-1858) rendered great service
to surgery by his researches upon diseases of the joints. Malgaigne
(1806-1865), made Professor of Operative Surgery in Paris in 1865,
devoted great attention to surgical anatomy, operative and experimental
surgery, and especially to fractures and dislocations,--his work on
fractures is met with on many book-shelves to-day. Nélaton (1807-1874)
was surgeon to Emperor Napoleon III, and, though he wrote little, became
peculiarly eminent as a practitioner; his ingenious probe, tipped
with porcelain, by means of which he located a bullet in the foot of
Garibaldi, is well known. He devoted special attention to tuberculosis
of bones and joints, being, perhaps, further instigated thereto by the
case of the Prince Imperial; his treatise on this subject forms most
acceptable reading to-day, and he taught the existence of osseous
tuberculosis long before such was recognized in either Great Britain,
Germany, or the United States.
Were I to refer to living contemporaries of many of the celebrities just
mentioned, I should speak with special reverence and esteem of Péan,
Verneuil, and Oilier, who are to-day the greatest surgeons in France;
but with their lives and labors any one may easily acquaint himself from
sources which are at the command of all.
I pass now to the Italians, who, since Scarpa's time, have{271} never
made any very decided impression upon surgery, although there are many
most excellent practitioners of the art in Italy; the best known are
Porta (1800-1875), Vanzetta (born in 1809), and Rizzoli (who died in
1880); lliberi, Tizzoni, Loreta, Durante, and others are, perhaps,
equally entitled to mention.
Since the time of Gimbernat there have been no surgeons in Spain whose
services have been sufficiently important to rouse special attention
away from their native peninsula. The Spaniards are well educated, and
well equipped for practice, but do not appear as great originators nor
experimenters; doubtless because their medical schools and universities
long since lost prestige, owing to clerical and Inquisitorial
interference; nevertheless, Spanish medical literature has kept well
abreast with that of other countries.
In Great Britain the example of John Hunter, during the eighteenth
century, produced results of the greatest importance; advances were made
simultaneously in physiology and pathology which the Anglo-Saxon races
have been quick to utilize. While, perhaps, more conservative and less
inventive than the French, the surgeons of England have ever been in the
front rank, and quite early they gave great attention to careful local
dietetic and hygienic measures, of which Continental surgeons were, and
are, too often neglectful. English surgeons, too, while they have been
specialists, have never been quite so narrow in their respective fields
as the Continental surgeons, and it has always been rare to find one who
was not also a good general practitioner; the immense advantages which
this added knowledge confers must be apparent. The most celebrated
representative of British surgery of this century was the son of a
clergyman,--Sir Astley Cooper, born in Norfolk in 1748, but subsequently
a resident of London. During youth he resolutely compressed the bleeding
limb of a playmate who was the victim of an accident, so that time was
gained for the arrival of a surgeon, who then tied the{272} vessel;
this decided his future calling, and he pursued his studies in London,
Edinburgh, and on the Continent. In 1791 he settled down to private
practice, which soon yielded him an income in excess of £20,000
($100,000), for his day the equivalent of thrice that amount at present.
At the age of seventy-three he succumbed to a longstanding asthma.
He was a somewhat voluminous writer, and his works on fractures,
dislocations, and diseases of the breast are by no means obsolete. His
motto was: "First observe, and then think." Exceptionally endowed
with all the graces of person, he became one of the most popular and
influential men of his day; withal, he was always zealous for his
profession, never unoccupied, and charitable to a high degree. Of his
boldness we have evidence in the fact that in 1817 he tied the abdominal
aorta, being the first to undertake this surgical feat.
A colleague{273} of Cooper's at St. Thomas's Hospital was Travers,
already spoken of in connection with irritation. Tyrrel, a nephew of
Cooper, was a well-known surgeon, particularly in diseases of the eye.
Others of the same name were: Samuel Cooper (1781-1848), who wrote a
voluminous treatise on practical surgery; Bransby Cooper (1792-1853),
Sir Astley's nephew and adopted son, who was well known, and who
achieved an eminence that is only dimmed by that of his uncle.
Sir Benjamin Brodie (1783-1862) was distinguished as a special
investigator and a soft-tissue operator, of whom it is said that,
basing his actions upon his statistics, the older he became, the less
frequently he operated. His bestknown writings concern diseases of the
joints. Guthrie (1785-1856), a man of noble characteristics, was the
friend and{274} companion of Wellington, whom he accompanied in all his
campaigns. Although well known as a lithotomist, his fame rests chiefly
upon studies and writings in the domain of military surgery. A colleague
of his in the Westminster Hospital, Sir William Lawrence (1783-1867),
was surgeon to the queen, highly esteemed as a dextrous operator, and an
authority on ruptures and on operative surgery. John Lizars (1783-1861)
was a pupil of John Bell, and distinguished himself as a bold operator
and fertile writer; early in the century he treated chronic
hydrocephalus by operation. Robert Liston (1794-1847) was another
remarkable surgeon and a wonderful operator. Sir Charles Bell
(1774-1842) has already been mentioned for his researches on the nerves,
and he also wrote on operative surgery, and is somewhat famed for his
opposition to venesection.
In Edinburgh James Syme (1799-1870) secured great reputation both by
his dexterity as an operator--which is spoken of by his own pupils as
marvelous--and by his introduction of resection into general practice.
Sir James Y. Simpson (1811-1870) aided to make the Edinburgh school
famous by his researches into the domain of both surgery and obstetrics.
Though the inventor of acupressure, his name will forever be associated
with the introduction of chloroform. Professor Dunn says that, u after
seeing the terrible agony of a poor Highland woman under amputation of
the breast, Simpson left the class-room and went straight to Parliament
House to seek work as a solicitor's clerk. But on second thought he
returned to the study of medicine, asking: 'Can anything be done to
make operations less painful?' The ultimate result was the discovery
of chloroform, and so the suffering of one became the occasion of the
deliverance of many. Upon his advocacy of chloroform in obstetrics he
had to defend himself against most vehement attacks of both Scotch and
English clergymen, who affected to regard such procedure as a crime that
transgressed the will of the Deity; but he successfully confounded{275}
these assailants with their own weapons, proving himself their more than
equal in knowledge of Scripture lore.
Many other British surgeons, living and dead, deserve most honorable
mention, but time and space will not permit. I cannot, however, pass by
without mentioning Curling, Annandale, Chiene, Cheyne, Macewen,
Ogston, Jonathan Hutchinson, Sir James Paget, Christopher Heath, Thomas
Langmore, Savory, Holden, Holmes, Adams, Sir Joseph Lister, and Sir
Prescott Hewitt, of the value of whose labors I have already tried to
speak; Sir William Ferguson, of whom it is said that he had the eagle's
eye, a lion's heart, and a lady's hand; John Bowman, best known for his
work in ophthalmic surgery; Sir Henry Thompson, the eminent lithotomist
and lithotritist; and Sir Spencer Wells, Keith, Lawson Tait, and
Bantock, whose names are inseparable from the history of abdominal
surgery. And what can be said of the young men who are being trained in
the methods and practice of their predecessors--trained not only in the
direction of manual dexterity, but in experimental science, to which
they make the former subservient'? All honor to these scions of Great
Britain's surgical art, who have astonished the world with their
consummate ability! I would that time permitted recapitulation of the
work accomplished in late years by the present generation of men in
London, Edinburgh, and other medical centres; but the scope of these
chapters does not cover this ground.
CHAPTER XI.
HISTORY OF MEDICINE IN AMERICA.
_The Colonial Physicians. Medical Study under Preceptors. Inoculation
against Small-pox. Military Surgery during the Revolutionary War.
Earliest Medical Teaching and Teachers in this Country. The First
Medical Schools. Benjamin Rush. 1745-1813. The First Medical Journals.
Brief List of the Best-Known American Physicians and Surgeons._
The{276} history of medicine in America commences with the early
struggles of the physicians in the American colonies. One Dr. Wootton
came to Virginia in 1607 as Surgeon-General of the London Company. The
following year Dr. Russell was with Captain Smith in his exploration of
Chesapeake Bay. Neither of these men stayed long in the country, since,
in 1609, Captain Smith, after being wounded, was compelled to return to
England for treatment, for lack of medical aid.
When, in 1626. Peter Minuit _purchased the island of Manhattan for the
sum of twenty-four dollars_, there was probably no physician there at
the time. Undoubtedly the first physician, in what is now New York, was
Lamontagne,--a Huguenot, who arrived in 1637, and who seems to have been
a man of great capability for his time. It would appear that men of no
little eminence left the Old World for the New during the early days
of the American colonies, and that the medical services which the early
colonists received were on a par with those received by those whom they
left behind in their old homes. During the seventeenth century a number
of reputable physicians emigrated to this country, among them Dr. John
Clark, of Boston, in 1638, whose son and grandson followed him in his
profession and became prominent in their chosen calling. In 1644 came
Dr. Child, a graduate of Padua, who seems to have been a man of great
A number of younger Americans also went abroad to{277} study,--Leyden,
Paris, Padua, and the British universities being those most eagerly
sought. In Virginia, so early as 1619, the Colonial Assembly discussed
the erection of a university or college. In 1637 a public college was
established in Cambridge, and in 1638 the Rev. John Harvard left to
it his library and half his fortune, after which it was called Harvard
College. William and Mary College was chartered in Virginia in 1693.
Probably the first lectures in anatomy given in this countrv were those
of Giles Firman, which were given previous to 1647 at Harvard College.
It was in this early day that arose the custom, continued until very
recently, of studying medicine with a preceptor. This was necessary at
that time, and until comparatively recently, because of the scarcity of
institutions of learning and the expense connected with an education.
The form of apprenticeship was often gone through with for a term of
years varying from three to seven, during which time the young student
performed the most menial duties, had very meagre opportunity for
anatomical study, and acquired his knowledge rather by contact with and
absorption from his preceptor than in any other way. In this method
of teaching the personal element was so pronounced that everything, in
fact, depended upon the preceptor, save what natural talent and industry
might accomplish, With such meagre opportunities the means for doing
were equally scant. Nevertheless, emergency made many of these early
American practitioners self-reliant and competent to treat, according to
the knowledge of that day, the various accidents then so common. In
1636 the Assembly of Virginia passed a fee-bill for surgeons and
apothecaries, fees, however, being often paid in tobacco, powder, lead,
wampum, etc. Not a few combined ministry of the body and the soul, and
a number of eminent physicians were also preachers of more or less
renown,--among them John Rogers, John Fisk, and others.
Probably{278} the only medical work published in America during the
seventeenth century was _A Brief Rule to Guide the Common People of
New England how to Treat Them-selves and Others in the Small-pocks or
Measels_. This was printed and sold in 1677, by John Foster, of Boston.
It was printed upon one side of a single sheet in double columns, and
described both of these diseases as due to the blood endeavoring to
recover a new form and state.
The old English distinction between physician and surgeon was for many
years quite generally preserved, but could not persist, because of the
different conditions under which men practiced. During this century,
also, a number of midwives made excellent practitioners,--among them
the wife of Dr. Fuller, one of the _May Flower_ pilgrims. Those colonial
days, however, seem to have been free from the ravages of itinerant
specialists and charlatans, who so abundantly infested Europe at the
time. It is also to the everlasting credit of the American profession
that it took no part in the horrible delusions and scandalous
transactions connected with the Salem witchcraft.
By the beginning of the eighteenth century the population of the United
States was about three hundred thousand whites; by the end of the
century it had increased to a total of about four millions. During this
century a larger proportion of educated medical men came from abroad
and settled in various parts of the country, while the Colonial and the
Revolutionary Wars offered ample opportunity for the development
and study of military medicine and surgery. Commerce between the two
continents increased; communication became more free, and the people of
the Old World and the New were constantly brought into closer relation.
The most lively medical controversy of the century was, probably, that
excited over the introduction of vaccination against small-pox. In
previous sketches I have had to intimate that the greatest enemy of
the medical profession in time past has been the clergy. In this{279}
particular instance, however, it was to the Rev. Cotton Mather, of
Boston, that the profession is largely indebted for the favor with
which the new method was received in this country. In 1721 he called the
attention of various American physicians to the method, then in vogue in
Turkey, of inoculation with virus from the active disease. Dr. Boylston,
of Brookline, Mass., who settled in Boston, corresponded with members
of the British Royal Society and finally determined to put the method
to actual proof. In 1721 he inoculated his own son with the virus of
natural small-pox, and within the next year had inoculated two hundred
and forty-seven persons, of whom about two per cent, died of the
disease; while, of nearly six thousand persons attacked by the disease
in the natural way, more than fourteen per cent. died. In spite of this,
the man and the method were violently attacked by the people and the
profession, and found their warmest defenders among the ranks of the
clergy. Benjamin Franklin, then only sixteen years of age, joined with
the rabble in opposing the inoculation method. Boylston was threatened
with hanging, and had even to hide himself for a time, he died in 1766.
After the great discovery of Edward Jenner societies were formed for the
promotion of vaccination all over the world. The earliest vaccination
in the United States was performed by Dr. Waterhouse (born 1754, died
1846), who operated upon four of his own children in 1800.
It was during the eighteenth century that a number of our best-known
educational institutions were founded in the different colonies,--among
them, Yale College, in 1701; Princeton (College of New Jersey), in 1746;
University of Pennsylvania, in 1749; Columbia (King's College), in
1754; and others, only a little less known. In most of these latter were
established medical departments, but the method of apprenticing students
to physicians was still in general observance, no preliminary education
whatever, as a rule, being demanded. In 1766, however{280}, the
New Jersey Medical Society ordained that no student be taken as
an apprentice by any member of the society unless he had competent
knowledge of Latin and some initiation in the Greek. About the middle of
the century Drs. Bard and Middleton, in New York, and Dr. Cadwallader,
in Philadelphia, began giving lectures in anatomy, while at Newport,
Rhode Island, Dr. William Hunter, between 1754 and 1756,--a near
relative of the famous Hunters of London, and a pupil of the elder
Monro,--gave a course of lectures on human and comparative anatomy. Dr.
William Shippen. Jr. (1736-1808),--a student of John Hunter's,--returned
in 1762 to America, and gave his first course of lectures on anatomy and
midwifery during the years immediately following. His lectures led to
the formation of a Medical Department of the College of Philadelphia,
in 1765, in which lectures were continued regularly until the winter of
1775, when the{281} War of the Revolution interfered. In July of 1776
Shippen was made Chief-Physician of the Continental Army, and in
the following year was elected by the Provincial Congress
Director-in-General of army hospitals. During the latter years of the
war he returned to Philadelphia each winter, and delivered a course
of lectures, shortened by the necessities of the case. Thus he was the
first public teacher of midwifery in this country. He was ably seconded
in his work by Dr. John Morgan (1735-1789),--also a pupil of Hunter and
Monro, who received a prominent army appointment in 1775, but who, two
years later, was unfortunately dismissed on charges{282} subsequently
proved false. Shippen and Morgan were for some time the only professors
in the Medical Department of the College of Philadelphia. In 1768
Kuhn--a pupil of Linnæus--was made Professor of Materia Medica and
Botany; and Benjamin Bush, a year later, was given the Chair of
Chemistry. The commencement of this institution occurred in 1768, when
the degree of M.B. was given to seventeen graduates. In 1779 political
reasons led to the abolition of the College of Philadelphia, the
University of Pennsylvania taking its place. Ten years later the former
institution was restored, and in 1791 the two institutions were united.
The present Medical Department of the University of Pennsylvania is,
therefore, the legitimate continuation of the first medical school in
The Medical Department of King's College, New York, now Columbia
College, was organized in 1767, by Clossey, an Irishman; Middleton,
a Scotchman; James Smith, a graduate of Leyden; Tenant, an alumnus of
Princeton College; and Bard, who was by far the most eminent of the
group, a Philadelphian by birth, who had studied under the best masters
in England.
The Medical Department of Harvard University was organized in 1783. Most
prominent in connection with it was Dr. John Warren, the first teacher
of anatomy and surgery, and the founder of a family of eminent medical
men, whose descendant, Dr. J. Collins Warren, is to-day an occupant
of the chair of surgery in the same school. The Medical Department of
Dartmouth College was organized in 1798 by Dr. Nathan Smith,--a man of
great energy and unusual versatility.
While these medical colleges were developing their strength the medical
profession were not idle, and institutions and libraries sprang up in
various places. The Pennsylvania Hospital, for instance, founded in
1762, is to be credited with the oldest medical library in this country,
many{283} of its volumes having been selected especially for it by
Louis, of Paris, and the famous Lettsom, of London. It now contains
nearly fifteen thousand volumes. The library of the New York Hospital,
not quite so large, was founded in 1776; that of the College of
Physicians, in Philadelphia, in 1788. The profession of New Jersey
organized the State Medical Society in 1765. In 1781 was founded the
Massachusetts Medical Society. In 1787 arose the College of Physicians
of Philadelphia.
In 1789 the profession of Maryland organized the so-called Medical
and Chirurgical Faculty of Maryland, constituting thereby the same
organization as the societies of other States. Before the close of the
century, Delaware, New Hampshire, and South Carolina had also
organized societies. In the larger cities extensive hospitals were also
founded,--the Pennsylvania Hospital, in Philadelphia, in 1751, inside
of which the first clinical instruction in this country was given by Dr.
Thomas Bond. The New York Hospital began in 1769, simultaneously with
the organization of the Medical Department of King's College. The first
insane-asylum in America was built at Williamsburgh, Va., in 1773,
although the charter of the Pennsylvania Hospital, dated 1751, provided
for the care of lunatics, though not at that time in a separate
institution.
The most conspicuous medical character of the century in American
history was undoubtedly Benjamin Rush (1745-1813). He was one of
Shippen's earliest students in anatomy, studied widely abroad, was
a member of the Continental Congress, and one of the signers of the
Declaration of Independence. After him is named Rush Medical College of
Chicago. He was an extensive writer on a variety of subjects, not only
professional, but political, philosophical, etc. He recognized but two
kinds of remedies,--stimulants and depressants,--and held it to be
the principal duty of the physician to decide as to which were most
advisable in a given case. He called calomel the "Samson"{284} of the
materia medica, and his opponents contended that he was right, since it
had undoubtedly slain its thousands. As an accurate observer of disease,
he was correct and exact, and his descriptions are to-day both classic
The study of practical anatomy lias always been carried on in this
country under great disadvantages. At first only the bodies of executed
criminals were sparingly furnished.
In 1788, in New York, occurred the celebrated "doctor's mob," which
attested the vehemence of public objection to dissection, and which for
two days defied the control of all the authorities. Secret dissections
had been practiced in Harvard College so early as 1771, but the practice
was against the law even for sixty years later in Massachusetts.
Physiology, as such, was not taught in any medical school in this
country during the century, and experimental{285} physiology was
practically unknown. Surgery was eagerly studied, especially during war
times, and Dr. John Jones (1729-1791), of the King's College School,
was, perhaps, the most eminent of the surgeons of his day. Others who
vied with him were William Shippen, Jr., the first teacher of surgery in
the College of Philadelphia; John Warren, of Boston; Richard Bayley, of
Connecticut; Baynham, of Virginia; and McKnight, of New York.
The position of midwifery during the earlier years of the country may
be, perhaps, understood by the following extract from the _New York
Weekly Post-Boy_, of July, 1745:--
"Last night died, in the prime of life, to the almost universal regret
and sorrow of this city, Mr. John du Puy, M.D., man-midwife," etc.
The first practitioner of obstetrics in New England was Dr. Lloyd
(1723-1810), a pupil of Hunter and Smelley; while Dr. Shippen, in
Philadelphia, endeavored to organize a school for the instruction of
midwives, in which, however, he met with insuperable difficulties.
The first attempt to regulate practice in colonial times was an act
passed by the General Assembly of 1760, providing for at least a form of
examination in physic and surgery, registration, etc. The first medical
journal to appear in the United States appeared about 1790. It was
entitled _A Journal of the Practice of Medicine and Surgery and Pharmacy
in the Military Hospitals of France_, consisting merely of translations
from the French journals of military medicine. The first real American
medical journal was the _Medical Repository_, begun in 1797 and
discontinued in 1824.
The present century, now drawing to its close, saw in its earlier half
the rise of a large number of American physicians and surgeons who have
made their names illustrious for all time by their teachings, their
writings, and their invention and originality. While it is, of course,
invidious to{286} select names, the following certainly deserve
honorable mention in this list, without the slightest disrespect or
intentional slight to many others whose names must be omitted for want
of space.
John R. Cox (1773-1864), an early student of Benjamin Rush, filled the
chair of Materia Medica and Pharmacy in the University of Pennsylvania,
and published the _American Dispensatory_ in 1806. Caspar Wistar
(1761-1818) was the author of a _System of Anatomy_,--held in great
favor in his day as a text-book. Nathaniel Chapman (1780-1853) was
Professor of Theory and Practice in the University of Pennsylvania until
1850. John Eberle held the similar chair of the Jefferson School from
1825-1831. The former wrote on _Materia Medica and Therapeutics_, the
latter on the _Practice of Medicine_, both works being exceedingly
popular. John W. Francis (1789-1861) taught{287} obstetrics in the
College of Physicians and Surgeons from 1826-1830. Franklin Bache
(1792-1864) was one of the authors of the _Dispensatory of the United
States of America_, published in conjunction with George B. Wood, who
was Professor of Materia Medica in the University of Pennsylvania, and
who wrote also extensively on his chosen subject in monographs and large
Robley Dunglison (1789-1869) taught for a number of years in the
University of Virginia, but removed later to the Jefferson School in
Philadelphia. He was a man of great industry and versatility, and
wrote on a variety of subjects, his best-known work being his _Medical
Dictionary._
W. E. Horner (1793-1853) taught anatomy and histology in the University
of Pennsylvania, and will long be remembered for his researches in these
branches. John W. Draper (1811-1882) made himself eminent as well by
his researches in photography{288} and in general science, as by the
publication of his treatise on _Human Physiology_, which first appeared
in 1853. Better known as physiologist was John C. Dalton (18251889),
whose text-book is to-day studied in many colleges and who first
introduced the method of vivisectional classroom demonstrations in our
own school here in Buffalo.
Alonzo Clark (1807-1887) was one of the most eminent teachers of
medicine that this country has produced. Austin Flint (1812-1886)
was also a famous teacher of medicine in New York, who made his first
reputation in the then small school in Buffalo.
His text-book on _Practice_ is the most popular American work on the
subject that has ever appeared, and is still in general use. William P.
Dewees (1768-1841){289} was the author of a treatise upon _Diseases of
Children_, which reached a tenth edition and which rivaled the similar
treatise of John Forsyth Meigs. The best-known teacher of dermatology
and venereal diseases was Freeman J. Bumstead (1826-1879), author of the
most popular work upon the latter subject that has been issued from the
medical press. He wras professor of these diseases at the College of
Physicians in New York. His text-book vied with that produced by William
H. Van Buren (1819-1883), who, in connection with Dr. Keyes (still
living), wrote a treatise upon the _Surgical Diseases of the
Genito-Urinary Organs_, including syphilis, which has been, since its
appearance, exceedingly popular with the medical profession.
Among the best-known neurologists and alienists of the century since
Benjamin Rush wrote his _Inquiries and Observations upon Diseases of the
Mind_ (1812){290} was Dr. Isaac Ray, who, in 1838. published a work upon
the medical jurisprudence of insanity.
Dr. Brigham ( 1798-1849) was superintendent of the Utica Insane-asylum
for some years before his death; and Dr. Kirkbride, who died in 1883,
had been superintendent of the Philadelphia Asylum for over forty years.
Dr. John P. Gray followed Brigham as superintendent of the Utica Asylum,
where he remained for thirty-two years, and founded the _Journal of
Insanity_.
The first independent writer upon diseases of the eye was Dr. Frick
(1793-1870), of Maryland. As illustrating how little our present
specialties were then separated, it is worth while to remark that Dr.
Edward Delafield (1794-1875), who, in 1826. was Professor of Obstetrics
and Diseases of Women and Children in the College of Physicians and
Surgeons, New York, delivered at the same time a special course of
lectures upon diseases of the eye. The first man in the United States
to make these diseases his exclusive specialty was Dr. Williams
(1822-1888), of Cincinnati.
It would be very wrong, in this connection, to omit the mention of the
name of Oliver Wendell Holmes, the genial "Autocrat of the Breakfast
Table," but recently dead at a ripe old age, who used to say that he was
"seventy years young." who was for a long time Professor of Anatomy at
Harvard Medical College, but who was much more widely known and
endeared to the English-speaking public by his beautiful poems and most
attractive prose writings.--who, as author of the _Chambered Nautilus_,
for instance, will be remembered so long as the English language has
a literature and is read, he rendered a great service to the medical
profession by first calling attention to the contagiousness of puerperal
fever. Of his prose writings, his medical essays--entitled _Currents and
Counter-currents_--make perhaps the most delightful reading.
Not{291} a few Americans deserve special mention as surgeons and
surgical teachers of eminence during the past hundred years. Without
being invidious, there must, nevertheless, be mentioned John Collins
Warren (1778-1856), first Professor of Anatomy and Surgery in the
Harvard School, under whose auspices ether was first administered for
the purpose of surgical anæsthesia, and who was the founder, in 1828, of
the _Boston Medical and Surgical Journal_. He wrote an extensive
treatise upon tumors, and, it is stated, first successfully tapped the
pericardium.
Philip S. Physick (1768-1837), a pupil of Hunter, has been spoken of as
the "father of American surgery," which he taught in the University
of Pennsylvania. He was a tremendous worker, but wrote very little. He
employed animal ligatures made of buckskin. John Syng Dorsey (1783-1818)
was a nephew of Physick; taught anatomy in{292} the University of
Pennsylvania; wrote a treatise on surgery, which was the second surgical
text-book published in this country, and was the first in the United
States to tie the external iliac artery. He died at the age of
thirty-five, at a time when he was giving promise of exceeding eminence.
Nathan Smith taught in Dartmouth, Yale, and Bowdoin Colleges, and 'was
considered the best man of his day in New England.
To him is justly due the great honor of having performed the first
rational and deliberate ovariotomy, which he did in 1809, his patient
living for thirty-two years. The operation was performed without an
anæsthetic, and considering the circumstances under which it was carried
out has shed a lustre upon his name and brain which nothing can ever
dim. By this performance he became practically the father of modern
abdominal surgery, and to him Americans and{293} Europeans alike are
delighted to render all the honor that is his due.
Perhaps the most eminent surgeon of the country was Valentine Mott
(1785-1865), a pupil of Cooper and Bell, who taught in the College of
Physicians and Surgeons, New York, until 1840, and in the University
Medical School until 1860. He was a man of exceeding boldness and
brilliancy, whose operations were performed at a time when anaesthesia
was unknown, or was in its infancy, and who probably did more work in
the surgery of the vascular system than any other surgeon who has ever
lived. He was the first to tie the arteria innominata,--in 1818. As
Gross wrote of him, he had a record of one hundred and thirty-eight
ligations of various large arteries,--a record probably never equaled.
He was also the first to do a successful extirpation of the clavicle for
tumor,--an operation which at that time was considered very formidable.
Though not a great writer himself, he is best known among students
as the translator and editor of Velpeau's large work upon operative
Dr. George McClellan (1796-1847) was the founder of the Jefferson
Medical School, and its first Professor of Surgery. He was followed
later by Dr. Thomas D. Mutter, who left his surgical museum to the
College of Physicians of Philadelphia and endowed a lectureship there.
J. K. Rodger, of New York; John Rhea Barton, of Philadelphia; William
Gibson, of Philadelphia; Gurdon Buck, of New York; Willard Parker, of
New York; Frank H. Hamilton, of New York, who made his reputation while
teaching in our Buffalo school, author of a most popular and valuable
treatise upon fractures and dislocations; and Henry B. Sands, of New
York, were men of greatest prominence during the middle and latter
portion of the present century, each of whom has contributed in his
way either to the science or to the literature of surgery. The most
prominent figure in American surgery of the past forty{294} years was
Samuel D. Gross, of Philadelphia, professor in the Jefferson School,
to which he moved from Kentucky, where he laid the foundation for his
attainments and reputation.
He was an early writer upon surgical pathology and anatomy, but is best
known for his elaborate _System of Surgery_, in two large volumes, which
has survived several editions and is still most highly esteemed. Among
others who ought to be mentioned are Nathan R. Smith, of Baltimore,
the inventor of the anterior splint; Paul F. Eve, of Nashville; John
T. Hodgen, of St. Louis; Daniel{295} Brainard, of Chicago, and his
successor, Moses Gunn; Alden March, of Albany; Henry J. Bigelow, of
Boston, who performed the first excision of the hip in this country, in
1852, and who invented the method of crushing and removing stone from
the bladder at a single operation, known as litholapaxy; and D. Hayes
Agnew, of Philadelphia, who finished, before his death, a large and
elaborate treatise on surgery, in three thick volumes.
Of obstetricians and gynaecologists America has had no lack, and, in
fact, the United States may almost be said to be the first home of
gynaecology. Dr. Bard was the first Professor of Midwifery in King's
College, now Columbia, New York, and the author of the first work upon
the subject published in this country. In Philadelphia, Dr. Thomas C.
James (1756-1835) was the first distinct teacher of obstetrics, his
chair falling later to Dewees, already mentioned, who wrote extensively
on midwifery and the diseases of children and of women. The same chair
in the University of Pennsylvania was filled later by Hugh L. Hodge
(1796-1873), a man of great originality and independence, who published
a most elaborate and beautiful work upon his branch, which will always
remain a classic. Charles D. Meigs, professor in the Jefferson School,
Philadelphia, was the first to direct attention to thrombosis as a
cause of sudden death in childbirth. He wrote both on gynaecology
and midwifery. Bedford, of Baltimore, was another popular teacher
and writer, with whom deserves to be mentioned William H. By ford, of
Chicago, who wrote on both obstetrics and gynaecology.
Gynaecology owes much to the efforts of American schools and
practitioners. The first successful attempt of McDowell's, already
alluded to, was imitated by Nathan Smith in 1821; and during the next
forty years thirty-six ovariotomies had been performed by eighteen
different surgeons,{296} with a record of twenty-one recoveries.
Probably the most prominent passed figure in American gynaecology is
J. Marion Sims (1813-1883), born in the South, where he invented his
well-known speculum in 1852, whose introduction marked an epoch in
the treatment of the pelvic diseases of women. It was also in South
Carolina, among poor negro patients, that he perfected his method of
plastic operations in the vagina for the relief of vesical fistulæ,
which he later demonstrated in Paris to the astonishment of incredulous
Parisian surgeons, who had almost uniformly failed in their attempts,
and which he later successfully and brilliantly performed in all the
capitals of Europe, where, as in this country, he enjoyed the greatest
reputation. He was the founder of the great Woman's Hospital in New
York, in 1855, an institution from which has proceeded more good
gynæcological teaching than from any similar institution in the world
Other ovariotomists{297} and gynaecologists of great merit were John
L. Atlee, and his brother Washington Atlee, of Pennsylvania; Dunlap, of
Springfield, Ohio; Peaslee, of New York, who wrote the first American
treatise on ovarian tumors; Kimball, of Lowell, Massachusetts; and D. H.
Agnew, of Philadelphia, who is, perhaps, yet better known as a general
surgeon because of his _magnum opus_,--his _Treatise on Surgery_, in
three large volumes, already mentioned.
After{298} this brief _résumé_ of the names and achievements of the
best-known American physicians and surgeons no longer living, it remains
only to say a few words with regard to the general character of their
work and attainments. It certainly was the case, during the earlier
and middle portions of this century, that men had much to gain, beside
addition to their vernacular, by study in foreign countries. Edinburgh
and London were, at first, the centres to which men flocked; during the
middle of the century they gathered in Paris, attracted by such men as
Broussais, Velpeau, and others; after which the tide of travel turned
toward Germany, where the government does more for the education of
medical men and the furnishing of distinct opportunities than is done in
any other part of the world. But, thanks to the influence of the foreign
schools and the receptivity and natural quickness of the American mind,
we have reached a point in this country when it is no longer necessary
for American students to visit the foreign centres for this purpose,
advantageous as these may be in many respects. The only feature in which
we are yet lacking is the matter of government aid and the government
control of medical institutions, by which better opportunities may be
afforded for pathological study. Aside from this, and the centralization
of cases which government control permits, it may be said that the
Americans are in all respects as good practitioners as--and in most
respects better than--their foreign colleagues. They evince more of
humanity, more of real interest and care in their patients, and more
consideration for their comfort and welfare; while, in all that pertains
to fertility of invention, to originality of performance, and accuracy
of work, they, as a rule, excel. Divested of glamour, American surgery,
both general and special, is ahead of most of that which one can see
abroad, and the therapeutics of the American profession certainly
surpass those of any other nationality. No one need feel, then, that it
is necessary to go abroad for any{299} purpose, unless it may be that
polish and wide range of general information that necessarily come from
travel and observation among other nations and peoples. In practical
medicine, then, as in practical living, America leads the world.
CHAPTER XII.
THE HISTORY OF ANÆSTHESIA.
_Anaesthesia and Analgesia. Drugs Possessing Narcotic Properties in use
since Prehistoric Times. Mandragora; Hemp; Hasheesh. Sulphuric Ether and
the Men Concerned in its Introduction as an Anaesthetic--Long, Jackson,
Wells, and Morton. Morton's First Public Demonstration of the Value of
Ether. Morton Entitled to the Credit of its Introduction. Chloroform and
Sir James Simpson. Cocaine and Karl Roller._
It is{300} not, perhaps, generally understood that we owe the term
_anaesthesia_ and the adjective _anaesthetic_ to the genius of Dr.
Oliver Wendell Holmes, who suggested their use to Dr. Morton. The term
_anaesthesia_ is applied to the artificial loss or deprivation of
all sensation, which may be either local or general. It should be
distinguished from _analgesia_, which means simply freedom from pain,
consciousness being retained. In this respect local anaesthesia is
really local analgesia, although the terms are confused in this regard.
Anaesthesia, in its present sense, is truly a modern discovery, which
is to be credited to the United States. In its less restricted
sense, however, it is a condition brought about by numerous
drugs,--intoxicants, narcotics, etc.,--some of which have been more or
less in use for centuries. Anaesthesia is also a condition which may be
produced in the hypnotic sleep,--a fact well recognized by the ancients,
although the attention of scientific men was scarcely drawn to the fact
until the days of the notorious Mesmer. The substances which may produce
loss of consciousness may be taken intentionally or unintentionally,
and maybe taken into the stomach, beneath the skin, or, when gaseous,
through the lungs, in which absorption of the same into the blood is
very speedy. It is not at all unlikely that the curious effects ascribed
to some of the ancient oracles were due{301} to the inhalation of gases
arising from natural springs or produced from other sources.
The most common source of narcotic drugs has always been the vegetable
kingdom; and the peculiar effects of the juices or other ingredients of
the poppy, henbane, deadly-nightshade, Indian hemp, mandragora, etc.,
have been sung in poetry, rehearsed in prose, and known from almost
prehistoric time. Ulysses and his companions were stupefied by
_nepenthe_; a draught of vinegar and myrrh, or gall, was offered to
Christ upon the cross, as it often was to malefactors; and Herodotus
speaks of a peculiar habit of the Scythians, who produced some
stupefying vapor,--probably from the seed of the hemp. From Biblical
times, at least, the most common narcotic seems to have been alcohol in
some of its numerous combinations. Furthermore, the effect of hemlock
has been celebrated since the days of Socrates, who was permitted to
drink it in order to soothe himself during his last hour.
Mandragora seems to have had a great reputation in times past,--so much
so that it is probable that more than one substance was included under
this term. Apuleius, who lived about a century later than Pliny, wrote:
"If any one is to have a member mutilated, burned, or sawed, let him
drink half an ounce of mandragora with wine, and let him sleep till the
member is cut away, without any pain or sensation." Among the Chinese
and the Indians similar drugs seem to have been in frequent use,
especially the _bhang_, ordinarily known as _hasheesh_. In many parts of
the East something of this kind was administered to condemned criminals,
as well as those compelled to undergo rude operations. It is said, also,
that mild intoxication was produced among the fanatics of the East for
the purpose of firing them to the point of heroic deeds, as it is
also said that among the Druids the practice prevailed of partially
stupefying the novitiates before initiating them into the most sacred
and secret rites of their cult.
Guy{302} de Chauliac was almost the only surgical writer of previous
centuries who has referred to agents for the relief of pain, although
during and before his time it was customary to give something to those
about to undergo torture, by which to deaden their sensibility; and,
though in the fables of all lands and all times something has always
figured to which was ascribed the power of making people oblivious to
pain or to the peculiarities of their situation, it is very difficult
to learn just what, if any, particular composition was referred to or
deserved such mention. There is allusion to something of the kind in
_Romeo and Juliet_; again, in _Cymbeline_; and in one of Middleton's
tragedies, published in 1567, entitled _Women Beware Women_, occurs this
passage:--
"I'll imitate the pities of old surgeons
To this lost limb, who, ere they show their art,
Cast one asleep, then cut the diseased part."
Larrey, in his military campaigns, noticed the effect of cold in
diminishing sensitiveness, and suggested that cold might be made a
useful local anæsthetic. Many surgeons used to operate upon patients
under the influence of alcoholic narcotization. It was in 1776 that
Mesmer arrived in Paris and became the exponent of so-called "animal
magnetism,"--later termed "mesmerism," now known as hypnotism,--under
the influence of which he reduced to the state of unconsciousness of
pain (i.e., analgesia, as well as the more complete condition,
anæsthesia) a number of patients, who were operated upon without feeling
the slightest suffering.
But, in spite of the earnest attempts of humane surgeons in various
parts of the world, no agent had been discovered which was proven safe
and generally effectual, up to the time, for instance, of Velpeau, who
in 1839 wrote: "To escape pain in surgical operations is a chimera which
we are not permitted to look for in our time."
The substance known as sulphuric ether has been known{303} since
the thirteenth century, when, as it appears, Raymond Lulli made
certain--perhaps ambiguous--references to it. In 1540 it was known as
the sweet oil of vitriol. It was not called an ether until 1730, when
Godfrey spoke of it as such. It was frequently referred to during
the last century by various writers, and the first reference to its
inhalation seems to have been published in 1795 by Pearson. In a work
by Beddoes, on Factitious Airs, published at Bristol, in 1796, is a
statement that "Ether in pectoral catarrh gives almost immediate relief,
both to the oppression and pain in the chest." Beddoes also states
that after inhaling two spoonfuls he soon fell asleep. Later it was in
somewhat general use internally for mitigating the pains of colic. By
1812 it was often inhaled for experiment or diversion, its peculiar
exhilarating effects being generally known. So it is, perhaps, not
strange that so soon as it was definitely recommended for purposes
of surgical anæsthesia, a number of claimants for the honor of its
discovery should quickly arise.
It was the same with nitrous-oxide gas, which had been knowrn for
a number of years, and which was repeatedly used for the purpose of
anæsthesia before the introduction of ether for the same purpose.
Chloroform was discovered in the year 1831 by Guthrie, of Sackett's
Harbor, New York, and about the same time by Soubeiran, in France, and
Liebig, in Germany. But, although before the profession for sixteen
years, it was not recommended for the same purpose as sulphuric ether
until 1847, and then by Doctor--later, Sir--James Simpson.
For all practical purposes we may limit further consideration of the
history of anæsthesia to these three substances, and mainly to the
consideration of the introduction and adoption of ether, which displaced
nitrous oxide, preceded chloroform, and has held its own to the present
day as the anaesthetic in most general use, although in{304} many
respects inferior to chloroform. But the glamour of history pertains
mostly to ether, because of the peculiar difficulties and incidents
attending its production.
For the honor of its discovery there are four claimants:--Crawford
W. Long, of Danielsville, Ga.; Charles T. Jackson, of Plymouth,
Mass.,--both physicians; Horace Wells, of Hartford, Vt., and William T.
G. Morton, of Charleston, Mass.,--both dentists. It is only fair to each
of these four men to consider briefly the merits of the claims made for
each, while at the same time attributing the final success of the new
agent to the happy accidents which permitted Morton to make a public
demonstration of its power in the Massachusetts General Hospital, before
such eminent men as Warren, Bigelow, and others, by whose influence and
reputation the agent was at once received upon its merits. This was on
the sixteenth of October, 1846,--a year which deserves to be memorable
in the history of medicine.
Crawford Long graduated, in 1839, from the medical department of the
University of Pennsylvania, and settled in Jefferson, Georgia, where
it seems to have been a common thing to have what was known as "ether
frolics," during which the exhilarating effects of the inhalation of
the drug were matters of common sport and amusement at various small
gatherings. Long himself frequently inhaled the drug and often felt its
benumbing effects. It is stated that it finally occurred to him to give
it a trial in a surgical operation, and that, in May of 1842, he removed
a small tumor from the neck of a patient thus anaesthetized and without
any pain. Owing to the sparseness of the population and the lack of
dissemination of medical knowledge in those days, no public report
was made of these operations, which produced nothing more than local
town-talk. A young student of Long's, named Wilhite, kept a negro boy
under the influence of ether for some time, to Long's surprise. Long
lived one hundred and thirty{305} miles from any railroad, and the
first published account of his operations appeared in 1849, which was
suggested by an account of Morton's work, which he had read in the
editorials of the _Medical Examiner_ for December, 1846. Long died in
1878, the unfortunate controversy in which the four claimants already
mentioned participated being not yet concluded. Nevertheless, there is
every reason to think that he is entitled to the credit of having
first anaesthetized a patient with sulphuric ether for the purpose of
producing insensibility to pain.
Horace Wells began the study of dentistry in 1834, in Boston, and later
opened an office in Hartford, Connecticut. He seems to have been a young
man of great ingenuity, continually making new instruments and devising
new experiments. To him is to be credited the first operation ever
performed without pain by the use of nitrous-oxide gas. In 1844 a Dr.
Colton delivered a lecture in Hartford upon the subject of this gas.
A young man who inhaled it, and became excited, ran against some
furniture, badly bruising himself, but made no complaint of pain.
Wells, noticing this, said to a by-stander that he believed that one,
by inhaling a sufficient quantity, could have a tooth extracted or a leg
amputated without pain. The following day he inhaled the gas himself and
had a tooth extracted by a Dr. Higgs. Wells remained unconscious for a
little while, and, on recovering consciousness, cried out: "A new era in
tooth-pulling! It did not hurt me as much as the prick of a pin! It is
the greatest discovery ever made!"
He at once began the manufacture and use of the gas, which became quite
general in that locality. His attention was also called to the action of
the vapor of ether, which Dr. Marcy, a physician of Hartford, suggested
to him to try as a substitute for gas; but Wells, finding it more
difficult to administer, discontinued it and confined himself to the use
of nitrous oxide. A month later Dr. Marcy gave{306} ether to a sailor
for a small operation, the man feeling no pain. These experiences of
Wells and Marcy occurred two years after Long's work with ether, each
being in total ignorance of the experiments of the other.
In 1845 Wells visited Boston for the purpose of introducing nitrous
oxide as an anaesthetic, and called upon his fellow-dentist and old
partner, Morton, among others. He was discouraged, with his lack of
success, returned to Hartford, and continued the frequent use of gas for
a couple of years longer, but met with no encouragement in introducing
it for general surgical purposes, on account of prejudice and fear upon
the part of physicians and surgeons. Wells died in January, 1848, a few
days before the Medical Society of Paris passed a resolution that to him
is due all the honor of having first discovered and successfully
applied the use of vapors or gases whereby surgical operations could
be performed without pain. There stands to-day in Hartford the monument
erected by the city and the State, with the following inscription:--
"Horace Wells, who discovered anæsthesia, November, 1844."
William T. G. Morton was born in 1819, and, after failing in business
in Boston, in 1840 went to Baltimore and studied dentistry. In 1841 he
entered the office of Horace Wells, above alluded to, as assistant, and
in 1842 became his partner, after having introduced a new kind of
solder for fixation of artificial teeth to gold plates. In 1843 this
partnership was dissolved, Wells moving to Hartford, while Morton, in
1844, entered the office of Dr. C. P. Jackson as a medical student,
matriculating in the Harvard School, but never graduating. After Wells's
visit to Boston, during which he tried to introduce "laughing gas,"
Morton and he had numerous interviews, especially with regard to this
gas. Morton was not well versed in chemistry, and sought the advice of
his medical preceptor, Jackson, with regard to its manufacture. Asking
why{307} Morton wished to make it and being told the reason, Jackson
suggested the use of' sulphuric ether, just as Marcy had suggested its
use to Wells, saying that it was easy to procure, safe in employment,
and equally productive of results. He also stated that the students at
Cambridge College often inhaled ether for amusement.
On the evening of the same day, September 30, 1846, Morton administered
ether for the extraction of a tooth, the patient stating that he had
felt no pain. On the following day he visited the office of a well-known
patent lawyer for the purpose of securing letters patent upon his
supposed discovery. This lawyer, learning of Jackson's connection with
the subject, took time to consider the matter, consulted with Jackson,
and came to the conclusion that the patent must be a joint affair,
neither one having exclusive right to claim it. But Jackson,{308}
fearing the censure of the Massachusetts Medical Society should his name
be connected with the patent, and Morton--as a dentist--having no such
fine scruples, it was agreed that the patent should be made out in the
names of both, but that Jackson was to at once assign his interest
to Morton; in return for which he was to receive a ten per cent,
commission. Meantime Morton called upon Warren, one of the surgeons in
the Massachusetts General Hospital, who promised his co-operation and
sent him an invitation to test his invention in the hospital on October
16. 1846. The clinic-room was filled when Morton placed the patient
under the influence of his _letheon_, as he had named it; after which
Warren removed a tumor from the neck of a young man, and as it appeared,
without pain.
Upon the following day another operation was performed upon a young
woman, with the same happy result, while on November 7th an amputation
was made, entirely painlessly. At this time Morton endeavored to
disguise the odor of the substance he was using by aromatic oils. It was
not until the staff of the Massachusetts General Hospital declined to
use an agent whose composition was kept secret that Morton revealed
publicly the fact that this was nothing but sulphuric ether disguised
by aromatics. From a report of the Commissioner of Patents, published a
little later, the following paragraph is taken, the report being in the
nature of a commentary upon the discovery:--
It has been known for many years that the vapor of sulphuric ether,
when freely inhaled, would intoxicate to the same extent as alcohol when
taken into the stomach.
The fact has stood, further, upon the pages of science for many years
that the inhalation of sulphuric ether was productive of "temporary
narcotic stimulant effects."
After the issuance of letters patent Morton began selling office-rights,
such being the custom then, as now, among the dental profession, who are
much more commercial in{310} their proclivities than their brethren of
the medical profession. The result was an almost endless litigation,
with the development of the greatest personal animosity and rivalry
between Jackson and Morton, as well as the friends and descendants of
the other claimants. Morton wrecked his fortune and ruined his health in
his efforts to get substantial recognition and remuneration from the
United States Government; and the history of his repeated attempts to
interest Congress and the various officials of the government, from the
president down, is instructive, but far from pleasing, reading. In these
attempts he practically failed, and died from an illness contracted
through exposure, after maddening disappointment, although he had been
the recipient of numerous honors and some small pecuniary recognition
from societies and individuals. Morton died in 1868. In reviewing the
history of his life and labors there is much to justify the inscription
upon the monument erected to his memory at Mount Auburn Cemetery,
Boston:--
"_Inventor and revealer of anæsthetic inhalation, before-whom in all
time surgery was agony, and by whom pain in surgery was averted and
annulled; since whom science has controlled pain_."
Charles T. Jackson graduated at Harvard Medical College in 1829. after
having led an already eventful career as geologist and mineralogist. He
spent several years abroad, meeting many of the most distinguished
men upon the Continent and displaying, in many ways, a great deal
of scientific talent and mechanical ingenuity. In 1835 he opened, in
Boston, the first laboratory for teaching analytical chemistry in the
United States. A year later he was made State Geologist of Maine, and
spent three years in this capacity. He also did a great deal of work
upon the State geological surveys of Rhode Island, New Hampshire,
and New York, while he was the first to call attention to the mineral
resources of the southern shore of Lake Superior, where, in 1845. he
opened up copper{311} and iron mines. In 1846 and 1847 he became deeply
interested in the subject and discovery of anaesthesia, and after the
successful introduction of ether by Morton, in the Massachusetts General
Hospital, set up the claim that it was he who had suggested it to
Morton. In a pamphlet, published a little later, he states: "In the year
1837 I discovered that ether-vapor was superior to alcohol as a remedy
for the strangling and toxic effects of chlorine-gas after inhalations
for that purpose in my laboratory." He then relates how he administered
the vapor to himself for the relief of the irritation produced by
inhaling chlorine, and describes his sensations upon going to sleep
and awakening. This claim in its entirety was a great surprise to
both Morton and Wells, and led to a most unseemly discussion, which
degenerated into a downright professional fight. After the death of
Wells, Jackson and Morton both claimed that nitrous-oxide gas was not an
anaesthetic, and that insensibility to pain could not be produced by it,
in consequence of which the use of the gas was quite discontinued. It
became, then, simply a question of priority as to the administration of
ether for relief of pain during surgical operations. Wells being dead,
this brought Long into the conflict. Jackson visited Europe again, and
presented his claim before numerous societies in such a way as to be
recognized abroad as the discoverer of anaesthesia. The relative merits
of the whole controversy appear to have been pretty well summed up in
a memorial sent to the Senate and House of Representatives by several
hundred members of the Massachusetts Medical Society, which contains the
following paragraph:--"The undersigned hereby testify to your honorable
bodies that, in their opinion, William T. G. Morton _first proved_ to
the world that ether would produce insensibility to the pain of surgical
operations, and that it could be used with safety. In their opinion, his
fellow-men owe a debt to him for this knowledge."
In{312} the Public Garden in Boston there has been erected a monument
to the memory of the discoverer of ether, the donor being, at the time,
unable to mention the individual to whom it should be dedicated. Upon
one face is this inscription:--
"_To commemorate the discovery that the inhaling of ether causes
insensibility to pain, first proven to the world at the Massachusetts
General Hospital, in Boston, October, 1846_."
Upon another face are these words:--
"_In gratitude for the relief of human suffering by the inhaling of
ether a citizen of Boston has erected this monument, A.D. 1867_.
_The gift of Thomas Lee_."
Morton's untimely death, largely due to disappointment and, as he
thought, to persecution, has been already mentioned. In 1873 Jackson's
mind became deranged, and he died in an asylum in 1880.
Sir James Paget has summed up the relative claims of our four
contestants in an article entitled "Escape from Pain," published in the
_Nineteenth Century_ for December, 1879. He says: "While Long waited and
Wells turned back and Jackson was thinking, and those to whom they had
talked were neither acting nor thinking, Morton, the practical man,
went to work and worked resolutely. He gave ether successfully in severe
surgical operations, he loudly proclaimed his deeds, and he compelled
mankind to hear him." As Dr. Morton's son, Dr. W. J. Morton, of New
York, says, when writing of his father's claim: "Men used steam to
propel boats before Fulton, electricity to convey messages before Morse,
vaccine-virus to avert small-pox before Jenner, and ether to annul pain
before Morton."
So much for ether. I have already stated that chloroform was discovered
by Guthrie in 1831. But, though discovered in this country, it was first
introduced as an anæsthetic agent in Scotland, by Simpson, who, in
1847, at the age of thirty-six, began to direct his attention to the
discovery{313} of some means of alleviating pain during childbirth,
having a very large obstetric practice. Simpson was not satisfied
with sulphuric ether, because of its strong and disagreeable odor,
and inquired of his friend Waldie, Master of Apothecaries' Hall, of
Liverpool, if he knew of nothing likely to be a satisfactory substitute.
Waldie, acquainted with the chemical composition of chloric ether,
suggested that chloroform be prepared from it and used. Simpson
experimented with this in 1847, and established its anaesthetic
properties, which he made known through a paper read on November 10th of
the same year. It was arranged that upon the 13th of the month a public
test should be made at the Royal Infirmary; but Simpson, who was to
administer the chloroform, was unavoidably detained. Accordingly the
operation was performed as of yore, without an anaesthetic, and during
its performance the patient died upon the table. Had this death taken
place during the employment of chloroform, it would have been the
death-blow of that substance as an anaesthetic. The first public trial
took place two days later, the test proving a great success. Simpson
goes down in history, then, not as the discoverer of anaesthesia, but as
the one who introduced chloroform for anaesthetic purposes. He died in
1870, and upon his bust in Westminster Abbey is this inscription:--
"To whose genius and benevolence the world owes the blessings
derived from the use of chloroform for the relief of suffering."
It is a bit of most interesting medical history that after Simpson's
announcement of his discovery he was violently and vehemently opposed
by the Scottish clergy, who reviled him for endeavoring to relieve the
pains of childbirth, basing their opposition upon the primeval curse:
"In sorrow shalt thou bring forth children." And the beautiful ease with
which Simpson refuted this childish sophistry must ever be memorable;
for with one short argument he silenced his opponents and turned upon
them the{314} ridicule of the entire profession. For he reminded
them that the first operation recorded in history was performed under
anaesthesia, since, when God created Eve from one of Adam's ribs, he
"caused a deep sleep to fall upon Adam."
Cocaine is now such a universally recognized local anaesthetic that
there is the best of reason for referring to it here--the more so
because it affords another opportunity to do honor to a discoverer who
has rendered a most important service not only to our profession, but to
the world in general.
The principal active constituent of coca-leaves was discovered about
1860 by Niemann, and called by him cocaine. It is an alkaloid which
combines with various acids in the formation of salts. It has the
quality of benumbing raw and mucous surfaces, for which purpose it was
applied first in 1862 by Schroff and in 1868 by Moreno. In 1880 Van
Aurap hinted that this property might some day be utilized. Karl Koller
logically concluded from what was known about it that this anaesthetic
property could be taken advantage of for work about the eye, and made
a series of experiments upon the lower animals, by which he established
its efficiency and made a brilliant discovery. He reported his
experiments to the Congress of German Oculists, at Heidelberg, in 1884.
News of this was transmitted with great rapidity, and within a few weeks
the substance was used all over the world. Its use spread rapidly to
other branches of surgery, and cocaine local anaesthesia became
quickly an accomplished fact. More time was required to point out its
disagreeable possibilities, its toxic properties, and the like, but it
now has an assured and most important place among anæsthetic agents, and
has been of the greatest use to probably ten per cent, of the civilized
world. To Koller is entirely due the credit of establishing its
remarkable properties.
The{315} writer makes no apology here for having introduced two distinct
chapters,--one upon the history of antiseptic surgery, the other upon
the history of anæsthesia. First of all, they are the two grandest
medical discoveries of all time; and, secondly, they are of Anglo-Saxon
origin,--the one British, the other American. To the introduction of
anaesthetics and antiseptics is due a complete revolution of earlier
methods, complete reversal of mortuary statistics, and the complete
relief of pain during surgical operations; in other words, to these two
discoveries the human race owes more of the prolongation of life and
relief of suffering than can ever be estimated or formulated in words.
What an everlasting disgrace it is that, while to the great murderers of
mankind, men like Napoleon in modern times and his counterparts in all
times, the world ever does honor, erects imposing monuments and writes
volumes of encomiums and flattering histories, the men to whom the world
is so vastly more indebted for all that pertains to life and comfort
are scarcely ever mentioned save in medical history, while the world
at large is even ignorant of their names. For this reason, if for
none other, these chapters find an appropriate place in a work of this
Those interested in a somewhat more elaborate presentation of this
subject may find it in an anniversary address delivered by the writer on
October 16, 1896 (the semicentennial of Morton's public demonstration),
in the Medical School of the University of Buffalo, and published in the
_Buffalo Medical Journal_ of November, 1896.
CHAPTER XIII.
THE HISTORY OF ANTISEPSIS.
_Sepsis, Asepsis, and Antisepsis. The Germ-theory of Disease.
Gay-Lussac's Researches. Schwann. Tyndall. Pasteur. Davaine. Lord Lister
and his Epoch-making Revolution in Surgical Methods. Modifications of
his Earlier Technique without Change in Underlying Principles, which
Still Remain Unshaken. Changes Effected in Consequence. Comparison of
Old and Modern Statistics._
Modern{316} surgery, and, in no small degree, modern treatment of all
disease, have been so completely modified from previous methods by the
introduction of the so-called antiseptic system that it seems to be only
right to devote some time in such a work as this to a _résumé_ of
the history of the doctrines and experiments which have led to the
perfection, as it would seem, of modern methods.
The adjective "septic" comes from the Greek word "sepsis," which is
often transferred to the English, and which means "putrefaction," or
that which is putrid, or undergoing decomposition. From this word
are formed two others,--namely, "aseptic" and "antiseptic,"--the one
implying the exclusion of all causes of putrefaction and complete
freedom from it, the other referring to methods employed to antidote the
effect or counteract the influence of the agencies which produce sepsis
or destroy them while still within the living body. By general usage the
term "antiseptic" has been construed as the more comprehensive; hence,
the modern method is usually spoken of as "antiseptic surgery," and
hence the title above: "The History of Antisepsis."
The principle underlying the resort to antiseptic methods is summed
up in the expression, now so generally received,--the "germ-theory" of
disease. It refers, in general, to the so-called zymotic, or infectious,
diseases, whose manifestations are protean, which are all communicable
by one means{317} or another, but which are not all necessarily
contagious; some of which, being not at all amenable to surgical
treatment, are regarded as "medical" diseases, while others, which occur
mostly in connection with surgical cases, or which lead to conditions
requiring surgical relief, are usually spoken of as "surgical" diseases.
As excellent and only too common examples of these zymotic diseases may
be mentioned tetanus, erysipelas, puerperal fever, typhoid fever, and
those varied conditions which are generally grouped under the term
"blood poisoning." Those which most concern the surgeon, and those in
which most remarkable relief has been obtained are erysipelas and the
various forms of blood poisoning. These, in their varied manifestations,
have, until recently, been literally the terror of surgeons, and in
military hospitals, for instance, have been the cause of more deaths
than have ever resulted from wounds directly upon the battle-field.
In civil hospitals, as well as in general and private practice, the
mortality from these diseases was, until twenty-five years ago, simply
frightful; while frequently, and over wide areas of territory, endemics
and epidemics of puerperal fever would result in the death of almost
every lying-in woman. In consequence of this terrible death-rate
surgeons were afraid to operate, and certain classes of operations,
especially those on the abdomen and joints, were never performed, except
under most exacting circumstances. But few of the present generation can
actually realize the completeness of the changes brought about by the
adoption of the germ-theory, and the practical effect of its use as a
working basis for combating disease.
While no intelligent student at present denies that the infectious
diseases--of which the above named are but a very few--are the result
of the introduction into the body, from without, of minute living
organisms, for the most part vegetable,--thus constituting them in
reality, as they are often called, _parasitic_ diseases,--but few are so
familiar with{318} the history of modern discovery as to appreciate the
basis upon which it has been demonstrated. The proof of the germ origin
of disease is the legitimate outcome of the discovery of the actual
causes of fermentation and putrefaction.
Aside from the crude and often wild notions which have appeared here
and there in literature of previous centuries, about the first accurate
investigations bearing upon this subject were with reference to the
cause of alcoholic fermentation. About the beginning of this century
Appert published a monograph upon the Art of Preserving Animal and
Vegetable Substances, which consisted in placing them in closely corked
or stoppered bottles, and exposing these to the temperature of boiling
water. Gay-Lussac, the celebrated chemist, noticed that so soon as these
vessels were opened, particularly if much exposed to air, their contents
began to at once ferment or putrefy. This led to investigations into
the production of alcohol, and the antiseptic effect of pure oxygen-gas;
from which he concluded that oxvgen is necessary at the commencement
of the process, but not throughout its continuance. Some thirty years
later, Schwann, by the use of the microscope, then reasonably developed,
discovered in fermenting substances numerous very minute globular
bodies, which had the power of reproduction, and which were present in
juices or fluids undergoing alcoholic fermentation, but not in others,
and which he concluded to be the exciting cause. Schwann also discovered
that if, in vessels sealed by Appert's method, lie allowed air which
had been previously heated to come in contact with the fluids, no change
resulted; from which it was evident that it was something other than
the gaseous elements of the air which provoked fermentation. Schwann's
investigations were corroborated, in 1843, by Helmholtz.
Schwann's results were contested by Liebig, one of the most eminent
chemists of his time, who proposed a very different{319} theory,
ascribing putrefaction to the absence of oxygen and to the upsetting of
molecular arrangements. He believed that non-nitrogenous substances
did not spontaneously undergo putrefaction when pure, but they must
be brought into contact with some substance already undergoing change,
which latter was called a _ferment_, and which converted the oxygen
of the air into carbonic acid. According to him, the ferment was some
material undergoing decomposition.
The next researches on this subject were those of Schroeder and Dusch,
in 1854 who studied the question whether filtration of air would prevent
the fermentation of boiled fluids to which such filtered air might
have access. The material used for filtration was cotton-wool; and they
showed that air filtered through it was deprived of the agencies which
produce fermentation. Then came Pasteur, who repeated the experiments of
his predecessors and elaborated and confirmed them. He also found that
it was not necessary to filter the air of its contained particles,
but that if it were simply left undisturbed until these had settled by
gravity, it might then be brought in contact with putrescible substances
without causing any putrefaction.
In 1870, in a lecture upon haze and dust, Tyndall demonstrated
beautifully and in public the presence of countless particles in the
air, as well as that these were the agencies operating to produce
undesirable changes in organic substances. Both Pasteur and Tyndall,
as well as others, showed, as did also Lister, that heat as well as
filtration was sufficient to render these particles innocuous. As the
result of these and numerous other experiments, by various observers,
which there is no time here to recount, it was gradually and irrefutably
established that the gases of the air, _per se_, are powerless to cause
fermentation or putrefaction in boiled fluids or tissues, or in material
germ-free when exposed. It was sufficient, in order to so purify{320}
the air, to either previously heat it or filter it through cotton-wool
or through fluids inimical to germ-life, while the boiling of
organic material or its subjection to the boiling heat of water was
sufficient to destroy all germ-activity in it at the time, or, as we
say now, to sterilize it.
In this way, and even before any minute and systematic study of
bacteria,--i.e., before the inauguration of bacteriology as a separate
department of scientific study,--it was practically established that the
agencies which produce putrefactive changes or fermentation were minute
particles which were ever present in almost every substance, and that by
heat or something corresponding to filtration it was possible to remove
them or destroy their activity.
So much had been established without reference to the etiology of
disease. In order now to study the germ-theory of disease as applied
to man we must go back a little, neglecting the vagaries or the
pure conjectures of the ancients, to the era of pure philosophic
speculation,--perhaps to the days of Needham and Buffon.--to the middle
of the previous century, when scientists and naturalists began to
discuss the so-called spontaneous generation of life; for it is well
known that fluids, like milk and others, abound with life after a few
days of exposure; and it was supposed that the living organisms it
contained had a spontaneous origin. This question of the spontaneous
beginning of minute living forms was agitated for a century, or
practically until Tyndall and Pasteur gave it its death-blow by
their accurate and convincing demonstrations. There was no lark of
experimentation, but there was lack of exact knowledge and of accurate
deduction from facts observed. The bacteria--which at that time
were usually spoken of as "monads" and "vibriones," because of their
spontaneous motion--were found under varying circumstances, which,
not being scientifically inquired into, led thinking men into a most
perplexing condition{321} of mind. The two most ardent recent advocates
of spontaneous generation were Bastian, of England, who wrote an
elaborate treatise upon the subject, and Jeffries Wyman, of Cambridge,
Mass., who gave it the benefit of all his influence. But, under the
influence of blows dealt from the side of the physical laboratory by
Tyndall, and from that of the biologists by Pasteur, the theory was
weakened and effectually killed, so that to-day no one thinks of such
a thing. On the contrary, life seems to be inevitably the gift of a
preceding organism; and while the real origin of life is as unknown
to-day as ever, there is not a single fact in the possession of
scientists now justifying the view that life can have a spontaneous
origin. Moreover the researches of Pasteur and others into alcoholic
fermentation and the rôle played by the minute yeast-plant, and
the early researches of Pasteur, Davaine, and Koch into the rôle of
micro-organisms in producing disease in animals, and the scientific and
elaborate study of bacteria and vegetable molds, inaugurated by Cohn and
continued by many others, have as their legitimate outcome the creation
of bacteriology as a science, and the establishment of the fact that
the real condition in the so-called infectious diseases is one of
fermentative or putrefactive alterations in the fluids and tissues of
the living body, corresponding in minutiæ to the changes produced
in saccharine fluids by the yeast-plant, or in decomposing animal
or vegetable matter by the many known bacteria which are capable of
producing such changes. To put it in another way, disease is simply an
expression of the fact that these minute organisms, which are visible
only under high powers of the microscope and which reproduce their kind
with astonishing rapidity, gaining access to the surface or interior of
the body, begin there to thrive and multiply, taking up from the living
animal material for their own nourishment, thus robbing their host of
that upon which his tissues must live, while at the same time, as the
result of their activity, they produce{322} various substances which,
so far as they are concerned, are excretory in nature, and many of which
are extremely poisonous to the animal organism which harbors them. Such
a disease as puerperal fever, for instance, is simply an expression
of the fact that within the living human body there is going on active
putrefactive action by which the internal cells are being destroyed.
this destruction being progressive and often far-reaching; and that, as
the result of their presence in the still living body, the noxious
or toxic excretory materials of which they get rid are absorbed, in
consequence of which such varying symptoms as nausea, fever, purging,
vomiting, delirium, and many other symptoms are produced, the objective
evidence of their local activity being the actual destruction of
tissues, as is seen in cases of abscess, phlegmonous erysipelas, etc.
The condition known everywhere as gangrene, when moist and offensive,
is nothing but the putrefaction of tissues _en masse_ which are not yet
detached or separated from the living body of which they but recently
formed a living part.
Experiments with organic material outside the body have amply
demonstrated that such putrefactive processes can be checked by certain
precautions--such as filtration of air, heat, etc. It remained for
the genius of Lister to show how similar processes of putrefaction
and exclusion of germs could be made serviceable for the prevention of
disease in the human race. To Lister, then, is due the credit of having
originated the antiseptic system and brought about a condition long
yearned for by surgeons throughout the world, but never previously
attained. What a revolution he wrought by his masterly researches can be
appreciated only when one compares the impunity with which surgeons now
perform operations which, in the previous era were regarded as
absolutley unjustifiable--a conclusion amply warranted by the statistics
of that era.
Great as the credit due to Lister, it is equally desirable to state
that his work was, for the most part, based upon Lister's, the{323}
researches of Tyndall, Pasteur, and Koch, which had established the germ
nature of the terrible infectious diseases and the germicidal effect of
filtration, of heat, and of certain other substances and methods which
permitted of the development of his own system.
The antiseptic method, as it has since been known, was naturally at
first crude, although its scientific basis has never been shaken; and
that it has been since, in large measure, modified, and that surgeons
now resort to little, if any, of the paraphernalia which first made it
such a formal proceeding, in no regard shake the scientific nature
of its foundation, but rather have tended ever to corroborate it and
establish it more and more firmly. Lister began with the supposition
that the air contains the germs which are most active and pernicious
in producing disease. It has been since learned that air-contact is,
perhaps, least of all to{324} be dreaded. We, however, recognize the
germs as always the efficient agents, though we have since learned that
other sources of contamination are much more to be dreaded than air.
It had been the custom, up to Lister's time, to observe usually the
ordinary forms of cleanliness, but, not appreciating the multitude of
germs which lurk in and about the skin, it had not been customary to
scour and prepare it as we have learned to do since Lister's day. The
ligatures and instruments which were used and the dressings which were
applied, as well as the sponges used during the operation, usually went
through the ordinary forms of cleansing; and yet Lister's investigations
showed the utter inadequacy of such preparation. His most important
object-lesson, however, was that everything that came in contact with
fresh or bleeding tissues might carry infectious material (i.e.,
germs), unless it had itself been thoroughly freed from their
presence. Accordingly, the system taught the accurate preparation of
everything.--from the skin of the patient, which was to be carefully
cleansed and shaven, to the hands of the operator, which were to be
scrupulously scrubbed, as well as those of every assistant who might
handle or touch any of the instruments or dressing materials. It
included, also, the careful preparation of sponges, sutures, and
ligature materials, all of which were kept protected from air-contact
and in antiseptic solutions until the moment of their use. The dressing
materials were impregnated with substances like carbolic acid, which had
been proven to be germicidal; and impermeable material, like oiled silk,
was used to cover the surgical dressing, in order that fluids which
might leak through should not come in contact with the air, which might
permit of their putrefaction, while, at the same time, air from without
could have no access to the deeper parts thus protected.
The original method of Lister was very elaborate, and included also the
dissemination throughout the air of the operating-room{325} of a vapor
of carbolic acid, which was disagreeable, sometimes almost fatal, to
operators and bystanders alike,--its use being based upon the notion
that the air was the substance most to be dreaded. The instruments were
placed in strong antiseptic solutions, usually carbolic, which were
pungent and irritating to the hands of all that came in contact with
them. So thoroughly and ubiquitously were antiseptic materials employed
that it was soon learned that they were of themselves rather injurious
to the best interests of the patients upon whom they were employed.
Their use, of course, was contingent upon the notion, then everywhere
prevalent, that powerful substances must be used in order to counteract
the activity of the much-dreaded germs.
In the course of time, however, it was learned that the air was not so
much to be dreaded as had been supposed, and that even if it came in
contact with raw tissues infection did not certainly follow. It was
found also that the antiseptic solutions which had been so freely used
for irrigating or drenching the parts during an operation were by no
means essential, and that tissues often healed better which had not been
subjected to so much irritation. It was learned further that it was not
necessary to impregnate dressings with these same solutions, providing,
in the first place, they were carefully sterilized by the application
of heat, which in time came to be used for the purpose of sterilizing
everything not injuriously affected by it. In consequence, then, all
dressing material, silk ligatures, instruments, nail-brushes, etc., were
subjected to live steam or to boiling water for twenty minutes or more,
which was demonstrated to be completely effective in the destruction
of all organic or bacterial life. This, of itself, was a very great
simplification of the antiseptic method. It was also demonstrated that
the vital fluids of the animal body had of themselves great germicidal
power, and that the strong antiseptic fluids previously used tended
rather to impair{326} this power than to enhance it. Accordingly, fluids
for irrigation came to be used only when there was some noxious material
to be washed away. It was found that fresh wounds healed most kindly
when least irritated by applications of any kind, providing only that
nothing came in contact with them which could infect them. And, in this
way, as well as by resort to simpler rather than complicated procedures,
there was gradually substituted for the so-called _anti_septic method
that which is now everywhere recognized, and always practiced, when
possible,--i.e., the aseptic method. This simply means that it is very
much better to exclude germs than to permit of their access and then try
to kill them after they have lodged. The aseptic method is, therefore,
now in vogue, and among the best operators always the so-called _dry_
method of operating, which means that, so far as possible, nothing not
absolutely needed at the moment should come in contact with the field
of operation. This has been, in many respects, a great advance over
the older antiseptic method, though based upon absolutely the same
recognition of causes, being only an improvement in technique.
The benefits of Lister's studies, and of that which has grown out of
them, are simply incalculable. The surgical infections which, thirty
years ago, were the dread of all operating surgeons, have practically
disappeared from civil and military hospitals. I esteem myself fortunate
in this,--that I have been a living witness of the benefit of change
from the old to the new, since when I began my work, in 1876 (over
twenty years ago), as a hospital _interne_, in one of the largest
hospitals in this country, it happened that during my first winter's
experience,--with but one or two exceptions,--every patient operated
upon in that hospital, and that by men who were esteemed the peers of
any one in their day, died of blood poisoning, while I myself nearly
perished from the same disease. This was in an absolutely new building,
where expenditure had been lavish; one whose{327} walls were not reeking
with germs, as is the case yet in many of the old and well-established
institutions. With the introduction of the antiseptic method, during the
two years following, this frightful mortality was reduced to the average
of the day, and in the same institution to-day is done as good work as
that seen anywhere. The same was true without exception in the great
hospitals of the Old World; and in Paris, where, thirty years ago,
famous surgeons would go from one end of the building to the other,
handling one patient after another without ever washing their hands,
and where erysipelas and contagion of various kinds were thoroughly
distributed, as it were, impartially, now the successors of these
very same men, employing modern methods, get results which challenge
comparison.
The world has seen few extensive wars since the introduction of the
antiseptic system; but, in such as have occurred, its incalculable value
in military hospitals has been amply demonstrated. The modern soldier is
now taught how to make a prompt occlusive and antiseptic dressing of the
wound which he may receive upon the battle-field, which, from the
moment of its attention, continues to be treated according to the same
enlightened method after he reaches the field-hospital, or when sent to
the rear; so that men now receive extensive injuries to joints and to
viscera, which previously were either promptly fatal, or fatal within a
few days from erysipelas and hospital gangrene, from which they recover
with useful--often with nearly perfect--limb or function of part
restored.
The military hospital of to-day is, therefore, robbed of the terrors
which used to make it almost a charnel-house; hospital gangrene,
the special dread of active army-surgeons in time past, has almost
disappeared from the category of known diseases, and one of the greatest
dangers menacing the modern soldier has been removed from modern
civilized life. The method has met with universal adoption among
all{328} civilized races and peoples, and all this through the energy
and talent of the originator, now Sir Joseph Lister.
With the recognition of the germ nature of so many acute diseases has
come also systematic study of the use of antiseptics internally; and,
while no such exceeding satisfaction has resulted from labors in this
direction, we have, nevertheless, learned that most of the infectious
diseases of the alimentary canal--for example, cholera, typhoid,
etc.--are well attacked by means of antiseptics administered internally;
that many of the conditions that depress and annoy are due to the
presence of germs in the alimentary canal and the urinary system, and
are best combated by means which shall remove these agencies, if not
destroy them. It has been learned, also, that many forms of skin disease
are parasitic, and that these are only successfully treated by the
employment of antiseptics externally.
And so the recognition of the germ nature of infectious diseases and
the germicidal properties of certain substances, now spoken of as
antiseptics, have kept pace, the one with the other; and in consequence
the world has reached a period in its medical history never even dreamed
of by our forefathers, when the infectious diseases have been shown
to be practically preventable and, to a large extent, curable by the
employment of drugs directed especially against their exciting cause.
What the years to come may have in the way of further discovery in this
direction, we may not foresee. So far as one can at present see ahead,
the next advances must be in the direction either of means which
shall fortify the human organism against the inroads of bacteria, or
disease-germs, or else in the discovery of substances, such as we do
not yet know, which shall be at the same time poisonous to the germs
and innocuous to the patient, to whom they may be administered in doses
sufficient for their purpose. Any material possessing these properties
would be an ideal antiseptic for internal purposes. At present we only
approach our ideal, but are very{329} far from its active realization.
In no way would mankind be more greatly benefited than by the
prosecution of studies which may lead to satisfactory results in either
of these directions.
CHAPTER XIV.
AN EPITOME OF THE HISTORY OF DENTISTRY.
_Rude Dentistry of Prehistoric Times. Early Instruments for Extraction
Made of Lead. Dentistry on the Same Low Plane as Medicine during the
First Half of the Christian Era. Dentistry Taught at the School
of Salernum. Progress of the Art on the Continent. Prosthesis and
Substitutes for Human Teeth. Introduction of Porcelain for Artificial
Teeth; of Metal and of Vulcanized Rubber for Plates; of Plaster for
Impressions. From being a Trade, Dentistry is now a Profession, in which
Americans lead the World. Statistics._
The{330} following is a _synopsis of an address_ delivered at the
opening of the session of the Dental Department of the University of
Buffalo, in October, 1895. It is appended here because it is certainly
apropos of the topics herein considered, the colloquial form being
retained.
Called upon at short notice to welcome you here, and to offer remarks of
general professional interest, it occurs to me to be retrospective
for awhile and to consider the steps by which that which was once
an exceedingly crude art has been developed until now it is an exact
science. In other words, I would invite your attention, for a time, to
the history of dentistry. At a time even before our combined art and
science had a definite history we find that gold was used among the
Egyptians for the purpose both of filling teeth and of supporting and
directing them. In the bodies of many Egyptian mummies, especially of
the higher class, there have been found teeth filled with gold or with
wood which was covered with gold. It is known, also, that the Hindoos
and Egyptians inserted artificial teeth and that some of these were made
of wood, often covered with gold, and held in place by gold or silver
bands and wires. Herodotus, who traveled so extensively in Egypt and
wrote most entertainingly of his travels, has noted the division of
medicine among the Egyptians into special branches and the existence of
physicians, each of whom{331} applied himself to one disease and not to
more. "Some," said he, "are for the eyes, others for the head, _others
for the teeth_, and others for internal disorders."
It is known, also, that about 300 B.C. Erasistratus deposited in the
temple of the Delphian Apollo an _odontogogue_, or tooth-forceps, made
of _lead_, intimating thereby that only those teeth should be drawn
which were loose enough to be extracted with such an instrument.
Celsus, who was a contemporary of Christ and of Cæsar, was the first to
recommend the use of a file within the mouth for the purpose of removing
irritating edges and points of teeth. He also recommended bursting
hollow teeth by putting into them pepper-corns, which should absorb
moisture, swell, and thus break the teeth in pieces. He also recommended
to take particular pains to try to shake or manipulate teeth loose
before extracting them.
Galen, about 150 A.D., taught that teeth were true bones and that the
canine teeth should be called "eye" teeth, because they were supplied by
a branch of the optic nerve. Aëtius, 300 A.D., apparently discovered the
foramina at the roots of the teeth through which the nerves enter.
In Rome false teeth and sets of teeth constructed of ivory and fastened
with gold wire existed as early as the Laws of the XII Tables, and
before the days of Roman civilization it is known that the Etruscans
were skilled in manipulation of gold within the mouth, while your dean
has described and has, I believe, in his possession beautiful examples
of Etruscan work of this kind.
Among the Arabs, after the Arabian domination of the then civilized
world, attention was paid to the teeth, although this was considered a
very inferior part of the physician's work. Among these Arabians
much later, and in spite of their study of Greek writers and their
translations from the Greek, there may still be met such passages
as{332} this from Garriopontus, 1045 A.D.: "On the island of Delphi a
painful molar tooth, which was extracted by an inexperienced physician,
occasioned the death of a philosopher, for the marrow of the tooth,
which originates from the brain, ran down into the lungs and killed that
philosopher." For all that I know, this is the first record of a death
after extraction of a tooth. Albucassis, 1100 A.D., gave directions
for replacing lost teeth by natural or ivory substitutes. For centuries
extraction of teeth had been and was considered a critical and dangerous
operation, although itinerant quacks drew them without hesitation.
The Roman poets and satirists made many allusions, in their day, to the
teeth and to operations performed upon them.
During the Middle Ages the most celebrated medical school that the world
ever saw was founded at Saleraum, and was for several centuries the
headquarters to which resorted men who desired to study medicine and
patients from all parts of the world who desired to be cured of various
diseases. It was a favorite stopping-place for crusaders on their way
to and from the Orient, and history relates many interesting episodes
pertaining to such visits. Under the influence of this school dentistry
was more or less cultivated by those who practiced surgery. Bruno, of
Langoburo (about 1250), mentions various operations upon the teeth and
the antrum, although that was nearly four hundred years before Highmore
carefully described this cavity. Johannes Arculanus (Giovanni d'Arcoli),
in the fifteenth century, filled teeth with gold. I must digress for
a moment to speak of another suggestion of Arculanus's. You know that
quite recently the use of the magnet has once more come into vogue among
oculists for the removal of foreign particles of iron or steel from the
anterior chamber or the globe of the eye. It was Arculanus who, some
five hundred years ago, suggested extraction of iron splinters from the
eye by means of the _attraction of amber electrified by friction_. (For
School of Salernum{333} see page 72.)
During the sixteenth and seventeenth centuries the French surgeons,
especially Dionis and Verduc, made many practical contributions to
dentistry. In 1728 Fauchard wrote in Paris the first complete work on
dentistry,--_Le Chirurgien Dentiste, ou Traité des Dents_. Auzebi, of
Lyons, wrote another. Le Cluse first mentioned the English turnkey
for extraction. Jourdain introduced a number of new and appropriate
instruments and new forms of artificial teeth. Bourdet, dentist to the
king, made artificial palates. Porcelain teeth were first introduced in
France in 1774.
Among the Germans cosmetic dentistry, though still the favorite field of
charlatans, was greatly cultivated. Serré wrote a treatise on _Toothache
in the Fair Sex During Pregnancy_, but the first public dental clinic
in Germany was not established until 1855, by Professor Albrecht, and
in Vienna. It has been in Vienna, among the Germans, that dentistry
has been in time past most honored, and was taught when it was scarcely
recognized in the other German universities. Private dental institutions
were also first established in Vienna.
Of all the tooth-extracting instruments, the dental forceps in crude
form is the earliest, the first on record, perhaps, being that deposited
by Erasistratus in the Delphian temple, as already mentioned. For
hundreds of years these instruments scarcely changed in shape. It was
Garengeot who invented the _key_, early during the last century. Before
that, and for awhile, dentists who had abandoned the forceps used an
instrument known as _the pelican_,--said to much resemble the skid used
by lumbermen.
Before artificial (porcelain) teeth came into use the following
substitutes were employed, their estimated value being in accordance
with the order in which I name them:
Human{334} teeth, animal teeth, hippopotamus tusk and teeth,
elephant-ivory, and bone.
_Human Teeth_.--Transplantation of teeth was at one time very common.
After being inserted, they were held in place by pivots and ligatures,
springs, and upon bases. The pivot method also included the use
of screws. Ligatures for fastening teeth were made of silk-worm
gut,--which, now so common in surgery, was used for this purpose,
perhaps, two hundred years ago,--of gold wire, etc. The method by
ligatures is the earliest of all. Human teeth have always been more or
less expensive if fresh, few people being willing to part with sound
teeth except for a money consideration. In 1784 a Philadelphia dentist
offered, in an advertisement, two guineas each for sound front teeth.
_Animal Teeth_.--These were largely used, being held in place the same
way as above, the principal objection being that it was difficult, often
impossible, to match human with animal teeth. It was found, also, that
the latter decayed very much more easily.
_Hippopotamus-ivory_.--This was at one time very extensively used. It
was carved into the shape of the missing teeth, and was held upon a
base; or it was carved into shape as a base upon which to rest human
teeth. Most often it was used as a base for pivoting. Not infrequently a
block was carved out which represented gum, teeth, and all, and partial
dentures of this complex type were often so deftly fashioned as to
be very realistic, the part representing the gum being colored.
Unfortunately no dye nor color in the mouth could be made permanent.
_Elephant-ivory_.--This was used for the cheaper grades of work, being
less durable.
_Bone_.--Bone was still more objectionable, and was used for only the
cheapest work.
Artificial porcelain teeth were first introduced in France in 1774 and
in America in 1817. Those which were first made{335} were so large,
awkward, rough, and ill-fashioned, without attempt to represent the gum,
as to bear no comparison to the artistic products of to-day. They were
intended for the most part for attachment to ivory bases. The artificial
dentures made for George Washington were of this general character,
and, although they called forth his encomiums in a letter to his dentist
expressing his gratitude, they would pass for very shabby productions
today. One of the greatest advances in dentistry was the introduction of
gold bases as a substitute for the baseplates previously made of ivory
or bone. This is distinctly an American invention, and is to be credited
to Gardette, of Philadelphia, who produced the first bases of this kind
in 1787. Since then other metals have been used only because cheaper,
none having the valuable properties of gold.
Gutta-percha was introduced for this and various dental purposes in
England, in 1851, by Trueman. In 1851, too, came Goodyear's process of
vulcanizing, which the dental profession were at first slow to avail
themselves of, but which led, as its value was recognized later, to
expensive and almost endless litigation.
Another most valuable American invention was that of taking impressions
by the use of plaster. This was introduced about 1844-'45. This method
permitted the making of socket-plates, which, of itself, was a long step
in advance.
So much for a very brief epitome of some of the most interesting facts
in the history of dentistry. Did time permit, the matter would warrant
treatment at much greater length. But what now is to be said of the
condition of dentistry to-day? First of all, that it is no longer
relegated to charlatans and itinerants, but is studied, practiced, and
honored by men of the ablest minds and of the highest type. There is
to-day scarcely any branch of applied science which calls for greater
qualifications or for greater combination{336} of mental endowment and
manual dexterity than does dentistry. We, in New York, find ourselves
now in position where the State has assumed not only to regulate the
practice of dentistry, but even to pass upon the qualifications of those
who propose to study it. In the assumption of this task by the State
there is paid, perhaps, the greatest possible compliment to its dignity
and to its importance.
The great field of medicine is now altogether too vast, and the various
branches which pertain to it are too complex, to permit a mastery of
all its details by any one mind. The man does not live who to-day can be
considered _facile princeps_ in more than a few departments of medicine.
Life is too short to permit of it, and the study is altogether too
extensive. There is also a growing public demand for specialization
of work, and there is probably more excuse for the perpetuation of
dentistry as a specialty than for almost any other branch. Nevertheless,
it is necessary constantly to repress a tendency toward a failure to
comprehend the general principles underlying all medical specialties,
and it has been hard, at least until recently, to impress upon the men
of the dental profession that they were really only practicing a branch
of medicine, and that, in disregarding a general and comprehensive
knowledge of the fundamental branches, they were but poorly preparing
themselves for the practice of a dignified specialty. Certainly
dentistry makes as many demands for mechanical training, digital
dexterity, familiarity with the properties of materials, etc., as does.
surgery, and in some respects even more. Of course, to a certain extent
in these respects it is like a mechanical trade. The great trouble
with the dental profession, until very recent times, is that they have
regarded their work too much as a trade and not enough as a profession.
By taking the latter view of it the work is ennobled and their interest
for it cultivated. By taking the trade view of it they have lost those
finer features which{337} lift mechanical work out of the mere level of
a trade. Moreover, men in time past have been guilty of altogether too
much trades-union tactics, which are vehemently opposed to professional
ethics, and this has been another feature to degrade rather than elevate
This has been indeed a great misfortune, for men have been misled by the
need for cultivation of their hands, or their manual powers, and have
been persuaded away from a finer study of fundamental principles upon
which the whole practice of dentistry should be based. And so it has
happened that men have been so ambitious to become perfect operators
that they have neglected anatomy, physiology, chemistry, and pathology,
have even neglected odontology, sacrificing everything else to their
work as mere artificers.
If one scrutinizes the subject properly, there is no reason why there
should not grow up a class of men fitted to attend to any lesion of the
mouth or of the parts adjoining. In other words, there is no reason why
there is not more excuse for true oral surgeons than there is for any
other class of specialists, save possibly those who treat the eye. Aural
surgery, nasal surgery, pelvic surgery, rectal surgery, etc., are simply
voluntary limitations and applications of general surgery to special
parts; but he who attends to the teeth has to do so much work of a
character which the surgeon is not called upon to perform in any other
area, that I have always claimed the oral surgeon deserved a place, as
he had a field, by himself. Nevertheless, the knowledge which shall fit
a man for such work is not to be obtained in the ordinary dental course,
nor in three years of study, even under the best of auspices. The man
who would be an ideal oral surgeon must be not only generally familiar
with anatomy and physiology, but must thoroughly know the embryology of
the face and teeth, the physiology not alone of the organs of the
mouth, but of all the secreting glands and the chemistry of all their
secretions;{338} not only the anatomy of the cranium, but general
anatomy as well, and even comparative anatomy. He must be well informed
in the explanations of all the congenital defects met about the face
and mouth; he must be familiar not only with the ordinary principles
of pathology and bacteriology, but he will find in the fluids about the
mouth such a fertile opportunity for bacteriological study that, be he
ever so expert or erudite, he has still much left to investigate in
this direction. There is no disease-germ with which he can afford to
be unfamiliar, and, as any form of tumor may be found in or about the
mouth, he should be familiar with the entire subject of tumors and their
surgical treatment.
Then, again, he must be familiar not only with the physical properties
of metals and the various materials used in plastic dentistry, nor
expert alone in the operations about the teeth, but, inasmuch as he has
to cope with various wounds, injuries, and operations about the
soft parts, he must be thoroughly familiar with the principles of
wound-healing; with the causes of sepsis and the agents which produce
it, and the means of avoiding it; in other words, he must have a general
training in operative surgery, and, according to my ideal, which may
be high, he should be a man able to do almost any operation in surgery
before he limits himself to surgery of the mouth. Unless he have this
ability, he will not do such operation as well as a general surgeon can,
because the underlying principles are the same, and the latter will have
the greater command over them.
When, then, this perhaps ideal man has become thoroughly familiar
with the principles of surgical anatomy, operative surgery, surgical
pathology, and bacteriology, in addition to the things already
mentioned, then, and not until then, may he and should he assume to
operate for harelip, cleft palate, cancer of the tongue, and various
other lesions in the parts about the mouth.
I{339} wish I could say and demonstrate more to impress upon you the
important bearing of modern surgical pathology to dentistry. Perhaps I
can give you no better illustrations than you can see in the studies
and writings of Prof. W. D. Miller, of Berlin, of whom I am proud to
say that he is an American, and that he is the only American occupying
a professorship in a German university. In his studies on the causes of
dental caries and upon the bacteria of the mouth he has identified and
named nearly a hundred species of the bacteria, many of which he has
shown to be the active causes of dental decay. He has done, then, for
dental pathology in this direction what other eminent observers have
done for the processes of suppuration and ulceration in other textures
and tissues, and has helped to show that they are all evidences of
pernicious germ activity. By his researches, also, upon inflammation in
elephant-tusks, and the results of injury, mainly by bullet wounds,
he has shown us that the phenomena attending these changes in dental
tissues are practically identical with those in bone. His researches
have done very much to explain the pathology of that common disease,
pyorrhoea alveolaris, which is known to be but one expression of local
infection, while the possibility of migration of infectious organisms
and of metastatic lesions in other parts of the body, having their
origin in infectious disease in or near the teeth, has been brilliantly
demonstrated by his interpretation of well-known clinical facts.
That American dentists are most highly regarded abroad is more than a
matter of every-day knowledge. It has got to be so now that a foreigner
will purchase instruments of American make, and then advertise himself
as an American dentist for the purpose of getting business,--a purpose
in which, as a rule, he is quite successful. But let me stop here to do
honor to another American dentist who is more highly honored abroad
than one ever can be at home, and of whom it might be said, perhaps,
that{340} he has had more friends among the royalty and nobility of
Europe than any other man of his time. This is Dr. Evans, who has lived
for years in Paris, who was the personal friend of Napoleon III and the
trusted guide and companion of the Empress Eugenie when she fled from
Paris. While it may be said of him that the qualities that made him so
universally popular were personal qualities, rather than professional
knowledge, it must be said in reply that it was his eminent professional
attainment which first brought him such influential friends.
But time presses, and I want, before closing, to say a little about
dentistry in America. It was about 1835 that Dr. Harris, then residing
in Baltimore, though born near Syracuse, conceived the modern idea
of the scope and practice of dentistry. He was ambitious to put the
dentists of his time upon a higher professional level, and to make of
dentistry a specialty in medicine. He applied to various medical schools
to found dental chairs, and to teach oral pathology along with dental
mechanics, as one of the branches of medicine, the graduating degree to
be M.D., as with other medical specialties. But the men of his time
were so short-sighted and of such constricted mental calibre, and the
dentists were so uneducated, that the Baltimore schools declined. He
therefore established a separate school, being forced to take this step.
This school was the Baltimore College of Dental Surgery, established in
1839,--the first in any country. The dentistry of that day was crude,
and its teaching was comparatively inefficient. It was not until six
years later that the next, the Cincinnati College of Dental Surgery was
organized,--in 1845. Then, in time, followed Philadelphia. But all these
colleges were separate institutions, teaching only those branches which
it was held necessary that a _dentist_ should know and having very
little of medicine in their curriculum. They conferred the degree of
D.D.S.
In 1868 Harvard University did what she ought to have{341} done at
the outset. She opened a dental department and began the teaching of
dentistry as a branch of medicine, establishing therefor a separate
degree,--D.M.D.,--_Den-tarioe Meclicince_ Doctor. In 1874 the University
of Michigan established a dental department, and a little later the
University of Pennsylvania did the same. These university schools gave
an immensely widened scope to the study, which was made broader with
each succeeding year.
There are now forty-five dental colleges in the United States. Forty
of these are members of the National Association of Dental Faculties,
organized for the purpose of securing uniformity in teaching and in
graduating men. Membership in this association is a certificate of high
standing and of comprehensive advantages.
Last year (1894) the number of students in dental colleges was 4979,
while the number of graduates was 1208. At present nearly all the States
have legislation governing the practice of dentistry, and often more
strict than that regulating the practice of medicine. In New York
the law places dentistry on precisely the same plane as
medicine,--prescribes the same qualifications for matriculation, the
same length of study, exactions for graduation, examination, etc. In
other words, the law is quite as strict regarding admission to dental
colleges as to medical. After 1897 at least a full high-school course
will be demanded for matriculation, and from now on we may look forward
to having a really educated dental profession.
Advances in other sciences, 153
Ægidius, 077
Æsclepiadæ, 011
Æsculapius, 007
Ætius, 049
Age of foundation, 012
Age of renovation, 012
Age of transition, 012
Agnew, D. Hayes, 295
Akenside, 213
Albiuus, 164
Albucassis, 063
Alchemists and charlatans, the, 187
Alchemy, 141
Alexander of Tralles, 050
Alexandria, library of, 031
school of, 032
Alkindus, 060
Ambulant physicians, 017
Amendment in medical affairs, 151
American teaching of to-dav, 298
Amphitheatres, dissecting, 111
Amussat, 269
Anæsthesia, history of, 300
Anatomic period, 012, 030
Anatomy and physiology of Galen, 039
Anatomy, chairs of, 111
Andral, 245
Andry, 177
Anel, 215
Animalculists, 183
Animism, 196
Animists, 183
Antiseptics, history of, 317
Antyllus, 051
Arabic period, 012, 057
review of the, 097
Archiaters, 053
Aretæus, 034
Argentier, John, 0146
Aristotle, 028
Arlt, 253
Arnold de Villeneuve, 088
Asclepiades of Bytlunia, 044
Aselli, 160
Astrology, 141
Astruc, 138, 214
Aubrey, 183
Auscultation, 262
Avenbrugger, Leopold, 210
Avenzoar, 064
Averroës, 064
Avicenna, 061
Bache, Franklin, 287
Baclitischua, 059
Bacon, Lord, 153
Bacon, Roger, 068
Baglivi, 162, 172
Baillie, 213, 224
Barba, 165
Barthez, 201
Bartholin, 161, 184
Barton, John Rhea, 293
Baseilliac, 214
Bayle, 245
Bell, Benjamin, 219
Bell, John, 219
Bell, Sir Charles, 219, 274
Bellini, 172
Benivieni, 114
Bernard, Claude. 247
Bernard the Provincial, 077
Bhang, 301
Bichat, 160, 162, 164, 208
Bienaise, 177
Bigelow, Henry J., 295
Bilguer, 215
Billroth, Theodor, 264
Blumenbach, 222
Boerhaave, 193
influence of, 168
Boerhaave's, clinics, 167
system of medicine, 194
theory of inflammation, 164
Bonnet, 270
Bordeu, 201
Borelli, 160, 172
Borri, 176
Botal, Leonard, 146
Boucliut, 259
Boyer, 267
Boylston, Dr., 279
Bouillaud, 244
Boulot, 177
Bourgeois, Louise, 166
Braid, Dr. James, 204
Braidism, 204
Brainard, Daniel, 295
Brasdor, 214
Brigham, 290
Brisseau, 178
Brissot, practice of bleeding by, 118
British surgeons, modern, 275
Brodie, Sir Benjamin, 273
Bronssais, 243
Brown, Dr. John, 200
Browne, Sir Thomas, 175
Brunner, 183
Brunonian doctrine, 205
Buck, Gurdon, 293
Bumstead, Freeman J., 289
Burking, 231
Cabalistic theory, 141
Cæsareau operation, 134
Camper, Peter, 219
Cardan, Jerome, 142
Cardinal powder, 165
Carion, Stellwag von, 253
Casserius, 162
Cataract, 178
Cathedral medical schools, 089
Cell, the term, 153
Cellular pathology, 256
Celsus, Cornelius, 036
Cesalpinus, 155
Chamberlain's obstetric forceps, 166
Chapman, Nathaniel, 286
Charitable institutions, ancient, 055
Chemical system of medicine, 169
Cheselden, 216
Cheyne, John, 248
Chinese, medicine of the, 005
Chiron, 007
Chloroform, discovery of, 303
Simpson's introduction, 313
Chopart, 314
Circulation, capillary, discovery of, 158
discovery of the, 155, 160
lesser, 112
failure to discover the, 113
Civiale, 269
Clark, Alonzo, 288
Classification of the history of medicine, 012
Clinical teaching, earliest systematic, 167
Cloquet, 269
Cnidus, Temple of Æsculapius at, 009
Cocaine, 314
Coction, doctrine of, 024
Colics, Abram, 248
Collot family of lithotomists, 177
Colonial physicians, 276
Columbus, 107, 155
Compass, invention of the, 099
Constantine the African, 074
Contrastimolo, 210
Cooper, Bransby, 273
Samuel, 273
Sir Astley, 271
Cornelius Agrippa, 139
Corpuscles of the blood, 158
Corvisart, 168
Cos, 019
Temple of Æsculapius at, 009
Cosmogony, Greek, 013
Countess's powder, 165
Cowper, 158, 182, 183
Cox, John R., 286
Crisis, doctrine of, 025
Cruveilhier, 245
Cullen, William, 198
Currie, 229
Czermak, 253
Dalton, John C., 288
Darwin, Charles, 237
Erasmus, 202
Daviel, 215
De Graaf, 183
De Haën, 200
De la Marche, Marguerite, 182
Delafield, Edward, 290
De Launay, 177
Delamotte, 166, 182
Delpech, 268
De Marque, 177
Denis, Jean Baptiste, 176
Denman, Thomas, 220
Dental surgery, the first college of, 341
Dentistry, ancient and mediaeval, 332
as a specialty of medicine, 337
in America, 341
of prehistoric times, 331
relation of, to modern surgical pathology, 340
Desault, P. J., 214, 267
Devanter, 166
Dewees, William P., 288
Diagnosis, exact methods in, 263
Dionis, Pierre, 177
Dissection, ceremonials previous to, 149
difficulties attending, 103
of human bodies, 32
Doctor's mob in New York, 284
Dodart, 172
Eberle, John, 286
Eclectics, 014, 046
Embalming, 003
Empedocles, 017
Empirics, 014
Engraving, 100
Engravings, first anatomical, 112
Epidanrus, Temple of Æsculapius at, 010
Erasistratus, 034
Erudite period, 013
Esquirol, 228
Ether, sulphuric, as an anæsthetic, 302
Eustachius, 107
Eve, Paul F., 291
Fabre, 164
Fabricius ab Aquapeiulente, 109
Fabricius Hildanus, 110, 178
Fallopius, 109
Faust, 100
Fermentation, the causes of, 319
Fernel, Jean, 115
Fidelis, on legal medicine, 167
Filkin, 217
First hospitals in United States, 283
First medical schools in the United States, 281
Flint, Austin, 288
Fothergill, John, 212
Francis, John W., 286
Frank, J. P., 212
Frère Come, 214
Frère Jacques, 177
Frick, 290
Fuchs, 253
Functions of the spinal nerves, discovery of the, 248
Gaddesden, John, 087
Galen, anatomy and physiology of, 039
Galen, Claudius, 036
Galen's, influence, 043
theories, 039
Gardiner, 199
Garengeot, 213
Gaub, 195
Gerard of Cremona, 090
Gerdy, 270
Germicides, internal use of, 329
Germ-theory of disease, 259
what it means, 323
Gibson, William, 263
Gilbert, of England, 087
Gimbernat, 215
Glisson, 163, 183
Goerter, 163
Goode, John Mason, 247
Goodwin, 160
Goursaud, 177
Graves, Robert, 248
Gray, John P., 290
Greece, medicine of, 016
Greek period, 012, 049
Gregory, 199
Griesinger, 254
Gross, Samuel P., 294
Guillemeau, Jacob, 131
Gunn, Moses, 295
Guthrie, 273
Guttenberg, 100
Guy de Chauliac, 093
Gymnasia, the, 018
Gymnasiarch, 018
Gymnast, 018
Hahn, 229
Hahnemann, 241
Haller, 160, 162, 163, 220
Ilaly-Abbas, 061
Hamilton, Frank H., 293
Harvey, Gideon, 175
J. William, 155
Hasheesh, 301
Hasner, 253
Havers, 183
Heberden, 212
Hebra, 253
Hebrews, medicine of the, 003
Heister, 215
Helvetius, 160
Henle, 254
Henri de Mondeville, 088
Herophilus, 033
Hessenfratz, 160
Heurne, Otto de, bedside instruction by, 167
Hewson, 161
Hiera sacra, 003
Highmore, 183
Hippocrates, 019
Hirudinomania, 244
Hoboken, 183
Hodgen, John T., 294
Hoffmann, Christopher Ludwig, 200
Hoffmann, Friedrich, 197
Hoffmann's dynamic system, 197
Holmes, Oliver Wendell, 290
Home, Sir Everard, 224
Homoeopathy, 241
Horner, W. E., 287
Hospitals and clinics, 231
Howard, John, 212
Hufeland, 240
Humanization of vaccine-virus, 228
Hunter, John, 164, 218
William, 218
Hunters' study of the lymphatic system, the, 161
Huxham, John, 212
Hydrotlierapeutic system, 255
Hydrotherapy, 229
Iatrocliemical system, 169
Iatroliptes, 018
Iatromechanical school, 171
Infarctus, doctrine of, 201
of botany on medicine, 237
of chemistry on medicine, 238
of Darwin and Spencer on medicine, 237
of Harvey's discovery, 159
of physics on medicine, 238
of the art of printing, 100
of the French Revolution, 191
of the Northern invaders, 071
of the occult sciences, 139
of the Salernian school, 081
of zoology on medicine, 238
Inoculation, against small-pox, in America, 279
Inoculation, preventive, against smallpox, 225
with cow-pox, the first, 226
Irritability of tissues, discovery of, 163
Isopathy, 241
Jackson, Charles T., 310
Jacobus Sylvius, 103
Jager, 253
Jaxtthal, 253
Jenner, Edward, 226
Jesuit powder, 165
Jews, prejudice against the, 233
John Actuarius, 066
John of Procida, 079
Joubert's Popular Errors, 147
Kampf, 201
Kepler, 162
Keyes, 289
Kirkbride, 290
Laennec, 262
Lamballe, Joubert de, 270
Lancisi's clinic, 168
Lanfranc, 091
Langenbeck, Bernhard von, 264
Larrey, 267
Lavoisier, 160, 191
Lawrence, Sir William, 274
Le Boe, 167, 169
Le Cat, 214
Le Dran, 213
Léonicenus, Nicholas, 101
Lettsom, 213
Leuwenhoek, 158
Levret's modification of obstetrical forceps, 166
Ligatures, first use of, in amputations, 127
Linacre, Thomas, 101
Linnæus, 191
Lisfrauc, 269
Lister, 261
Lister's, studies and methods, 325
work, benefits of, 327
Liston, Robert, 274
Lithotomy, lateral, inventor of, 177
Lizars, John, 271
Long, Crawford, 301
Lorry, 228
Louis, 216
Lymph, diseovery of the circulation of, 158
Machaon, 010
McClellan, George. 293
Me Dowell, Ephraim, 267, 292
Magati, 176
Magendie. 216
Magie, 111
Magnetism, animal, 203
Maimonides, 065
Maitre, Jean, 178
Malgaigne, 270
Malpighi, 158
Mandragora, 301
Marcellus Donatus, 115
March, Alden. 295
Marchetti, 158, 176
Mareschal, Georges, 178
Marinus, 042
Marjoliu, 269
Mascagni, 161
Mauriceau, 166, 182
Mauthner, 253
Mayow, 160
Mead, Richard, 213
Meclianico-dynamic system of medicine, 197
Meckel, 162
Medical, journals in the United States,
first, 285
jurisprudence, beginning of, 166
school of the natural sciences, 258
study under preceptors, 277
systems, promulgation of, 152
Medici puri, pretensions of, 189
Medicine, and surgery, approach of, 147
dogmatic school of, 013
Imperial school of, at Pekin, 006
physiological theory of, 243
of priesthood from, 147
Meiboni, 184
Meigs, John Forsyth, 289
Melainpus, 006
Mesmer, Frank, 203
Mesmerism, 203
Mesue, 060
Methodism, 013, 045
Microscope, 100
Midwifery during the seventeenth century, 182
Midwives, 165
Mondino, 092
Monro, Alexander, Sr., 216
Alexander, second and third, 216
Donald, 216
Monroes, the two, 164
Montpellier, the school of, 086
Morarnl, 213
Morel, 176
Morgagni, 224
Morton, Richard, 175
William T. G., 306
Mott, Valentine, 293
Muller, 222
Munich Clinical School, 258
Muralt, 180
Mutter, Thomas D., 293
Mystic period, 012
Natural history, the school of, 219
Natural philosophy, the school of, 249
Needham, 183
Nélaton, 270
Nepenthe, 301
New Vienna School, 250
Nitrous-oxide gas, 303
Nominalist, 069
Nuck, 183
Obstetrical forceps, invention of the, 166
Obstetricians and gynaecologists, American, 295
Obstetrics, development of, 166
Oken, 249
Ophthalmoscope, 263
Oppolzer, 253
Oribasins, 048
Orthopaedics, origin of name, 177
Ovariotomy, the first, 267
Pacchioni, 183
Palfyn's obstetrical forceps, 166
Paracelsus, 143
Paré, Ambroise, 123
Paré and the surgeons of St. Come, 131
Park, Henry, 217
Parker, Willard, 293
Paulas Ægineta, 051
Pecquet, 161
Percussion, invention of the art of, 210
Pergamos, library of, 030
Periodic physicians, 017
Peruvian bark, discovery of, 164
Petit, J. L., 213
Pen, 166
Peyer, 183
Peyronie, 213
Pfeufer, 254
Pharmacopolists, 054
Philosophic period, 012, 018
Phrenology, 163, 242
Physical examination, methods of, 263
Physick, Philip S., 291
Physiological medicine, 253
Pinel, 163, 196, 206, 228
Piorry, 262
Pitard, John, 092
Plater, Felix, 118
Plato, 027
Pleximeter, 263
Podalirius, 010
Porta, Giovanni Batista, 118
Portal, 223
Paul, 166, 182
Pott, Percival, 217
Pravaz, 269
Praxagoras, 027
Priessnitz, 255
Primitive period, 012
Pringle, Sir John, 212
Ptolemy Soter, 031
Purkinje, 222
Purmann, 180
Pythagoras, 015
Quesnay, 173, 214
Quintus, 042
Radcliffe, 213
Rademacher, 254
Rapid multiplication of scientific literature, 239
Rasori, 240
Rau, 180
Ray, Isaac, 290
Raymond Lulli, 087
Realism, 206
Realist, 069
Receptaculum chyli, discovery of, 161
Reflex action, discovery of, 248
Reform period, 013
Regulation of practice in colonial times, 285
Reil, 202
Religious orders and the sick, 095
Rembert Dodoens, 115
Reuss, 253
Rhazes, 060
Rhinoplasty, 176
Rhodes, Temple of Æsculapius at, 008
Richerand, 267
Richter, August Gottlieb, 216
Riolan, 128
Rivinius, 183
Rodger, J. K., 293
Roeschlaub, 240
Roger of Parma, 078
Roland of Parma, 078
Rolfink, 188
Rome during the Greek period, 053
Rokitansky, 250
Roser, 253
Rousset and the Cæsarean operation, 134
Roux, 269
Rufus of Ephesus, 042
Rush, Benjamin, 206, 283
Ruysch, 158
Sabatier, 214
Sacred period, 012
Salernum, school of, 072
Sandifort, 219
Sands, Henry B., 293
Sanson, 269
Santoro, 171
Santoro's thermometer, 171
Sauvage, 196
Saviard, 177
Scalpel, first use of, in dissecting, 112
Scarpa, 162, 215
Schaf hausen, 183
Schneider, 162, 184
School of rational medicine, 254
Scientific societies and journals, origin of, 151
Scultetus, 180
Seminalism, 259
Serapion, 060
Servetus, Michael, 112, 155
Severino, 119, 176
Shoeffer, 100
Shot wounds, the new teaching of Paré concerning, 132
Siegemundin, Justine, 182
Sigmund, 253
Simpson, Sir James Y., 274
Sims, J. Marion, 296
Skoda, 251
Smellie, William, 220
Smellie's modification of the obstetrical forceps, 166
Smith, Nathan R., 292
Societies and academies, foundation of, 235
Soemmering, 162, 222
Sol id ism, 198
Spontaneous generation of life disproven, 321
St. Come, College of, 92, 122
Stahl, 195
Stahl's pietistic system, 195
Steno, Nicholas, 159
Steno's duct, 159
Stethoscope, 262
Stimolo and contrastimolo, 240
Stoerck, 200
Stokes, William, 248
Stoll, 200
Student-life during the 15th and 16th centuries, 148
Surgery, achievements of, 263
reasons for neglect of, 120
Swammerdam, 153, 183
Sydenham, 152, 165, 173
Sylvius, 167
Syme, James, 274
Syphilis, wide-spread outbreak of, 136
Teeth, substitutes for human, 335
Telescope, invention of the, 099
Tenon, 215
Thaer, 199
Themison, 011
Theory of excitement, 210
Theosophy, 111
Thermometer, discovery of the, 171
Thoth, 002
Tourniquet, invention of, 176
Tourniquet, screw, invention of, 213
Transfusion of blood in man, the first, 176
Travers, Benjamin, 248, 273
Treatment of the insane, improvement in, 228
Troja, 228
Trotula, 079
Trousseau, 247
Türck, 253
Tyrrel, 273
Universities and royal scientific societies, 192
compulsory, 228
in the United States, the first, 279
the first, 227
Vagadasastir, 004
Valsalva, 176
Van Buren, William H., 289
Van Helmont, 168
Van Helmont's svstem of medicine, 168
Van Siebold, 216
Van Swieten, 168
Van Swieten and the Old Vienna School, 199
Velpeau, 270
Venesection, first account of, 010
revival of, 118
Verulam, Lord, 153
Vesalius, Andreas, 104
Vicq d'Azvr, 162, 164, 223
Vidal, 269
Vieussens, 162, 186
Virchow, Rudolph, 255
Vitalism, 201
modern, 255
Wainman, 217
Warren, John Collins, 291
Waterhouse, Dr., 279
Wells, Horace, 305
Werlhof, 211
Wharton, 183
White, Anthony, 216
Charles, 216
Wiehman, 211
William of Salicet, 091
Willis, Thomas, 163, 170
Winslow, 164, 223
Winternitz, 255
Wirsnng, 183
Wiseman, Richard, 180
Wistar. Caspar, 286
Wolf, 222
Wood, George R, 287
Wren, Sir Christopher. 182
Wunderlich, 250, 254
Zeissel, 253
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