The Evolution of Modern Medicine
by William Osler
Hypertext Meanings and Commentaries
from the Encyclopedia of the Self
by Mark Zimmerman

THE EVOLUTION OF MODERN MEDICINE

A SERIES OF LECTURES DELIVERED
AT YALE UNIVERSITY ON THE SILLIMAN
FOUNDATION IN APRIL, 1913

by WILLIAM OSLER

THE SILLIMAN FOUNDATION

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

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

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

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

PREFACE

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

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

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

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

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

F.H.G.

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

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

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

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

CHAPTER I

INTRODUCTION

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

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

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

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

[*] II Chronicles xvi, 12.

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

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

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

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

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

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

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

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

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

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

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

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

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

ORIGIN OF MEDICINE

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

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

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

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

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

[2] Lucas-Championniere: Trepanation neolithique, Paris, 1912.

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

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

EGYPTIAN MEDICINE

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

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

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

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

[5] Maspero: Life in Ancient Egypt and Assyria, London, 1891, p.
119.

[6] Maspero: Life in Ancient Egypt and Assyria, London, 1891, p.
118.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[12] The History of Herodotus, Blakesley's ed., Bk. II, 84.

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

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

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

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

ASSYRIAN AND BABYLONIAN MEDICINE

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

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

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

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

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

[15] Morris Jastrow: loc. cit., p. 122.

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

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

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

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

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

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

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

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

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

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

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

[19] Ibid., pp. 257-258.

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

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

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

[21] Pliny: Natural History, Bk. XVIII, Chap. XXV, Sect. 57.

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

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

Some of the laws of the code may be quoted:

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

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

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

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

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

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

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

HEBREW MEDICINE

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

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

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

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

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

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

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

CHINESE AND JAPANESE MEDICINE

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

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

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

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

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

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

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

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

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

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

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

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

[28] See Y. Fujikawa, Geschichte der Medizin in Japan, Tokyo,
1911.

CHAPTER II

GREEK MEDICINE

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

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

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

* * * * *

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

[Bk. III.--Translated by D. A. Slater.]

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

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

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

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

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

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

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

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

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

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

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

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

[3] Gomperz: Greek Thinkers, Vol. I, p. 276.

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

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

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

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

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

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

[5] Poetical Works of Matthew Arnold, Macmillan & Co., 1898, p.
440.

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

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

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

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

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

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

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

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

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

[8a] J Oehler: Janus, Harlem, 1909, XIV, 4; 111.

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

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

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

ASKLEPIOS

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

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

[11] Louis Dyer: Studies of the Gods in Greece, 1891, p. 221.

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

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

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

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

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

[13] Caton: Temples and Ritual of Asklepios, 2d ed., London,
1900.

[14] Max Neuburger: History of Medicine, English translation,
Oxford, 1910, p. 94.

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

[15] Caton: Temples and Ritual of Asklepios, 2d ed., London,
1900.

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

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

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

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

[17] Ibid.

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

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

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

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

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

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

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

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

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

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

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

HIPPOCRATES AND THE HIPPOCRATIC WRITINGS

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

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

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

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

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

[21] Oxford. Clarendon Press, 2d ed., 1911.

[22] Gomperz: Greek Thinkers, Vol. I, p. 281.

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

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

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

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

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

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

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

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

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

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

[23] Littre: OEuvres d'Hippocrate, Vol. IV, pp. 641-642.

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

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

[24] Gomperz: Greek Thinkers, Vol. I, p. 296.

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

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

[26] Thomas Phaer: Regiment of Life, London, 1546.

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

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

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

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

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

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

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

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

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

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

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

[30] W. R. Halliday: Greek Divination, London, Macmillan & Co.,
1913.

ALEXANDRIAN SCHOOL

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

[31a] Galen: De usu partium, VII, Chaps. 8-9.

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

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

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

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

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

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

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

GALEN

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

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

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

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

[32] Allbutt: British Medical Journal, London, 1909, ii, 1449;
1515; 1598.

[33] Fischer, Jena, 1909.

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

[34] Bk. VIII, Chap. VII.

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

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

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

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

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

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

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

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

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

CHAPTER III

MEDIAEVAL MEDICINE

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

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

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

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

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

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

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

SOUTH ITALIAN SCHOOL

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

[3] H. O. Taylor: The Mediaeval Mind, Vol. I, p. 251.

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

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

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

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

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

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

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

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

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

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

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

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

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

BYZANTINE MEDICINE

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

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

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

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

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

ARABIAN MEDICINE

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

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

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

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

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

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

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

[10] Leclerc: Histoire de la medecine arabe, Tome I, p. 139.

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

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

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

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

[12] Withington: Medical History, London, 1894, pp. 151-152.

[13] Neuburger: History of Medicine, Vol. I, pp. 368-369.

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

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

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

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

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

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

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

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

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

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

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

[17] The Mediaeval Mind, Vol. I, p. 280.

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

[17a] Steinschneider: Virchow's Arch., Berl., 1867, xxxvii, 351.

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

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

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

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

THE RISE OF THE UNIVERSITIES

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

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

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

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

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

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

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

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

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

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

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

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

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

[20] Allbutt: Historical Relations of Medicine and Surgery,
London, Macmillan Co., 1905.

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

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

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

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

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

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

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

[22] Bibliotheca Chemica, 1906, Vol. I, p. 15.

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

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

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

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

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

MEDIAEVAL MEDICAL STUDIES

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

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

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

[25] Franklin: Recherches sur la Bibliotheque de la Faculte de
Medecine de Paris, 1864.

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

MEDIAEVAL PRACTICE

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

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

ASTROLOGY AND DIVINATION

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CHAPTER IV

THE RENAISSANCE AND THE RISE OF ANATOMY AND PHYSIOLOGY

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

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

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

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

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

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

[*] Cf. Osler: Thomas Linacre, Cambridge University Press,
1908.--Ed.

[2] Joannis Caii Britanni de libris suis, etc., 1570.

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

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

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

[3] Miall: The Early Naturalists, London, 1912.

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

PARACELSUS

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

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

[4] Fuller: The Holy and Profane State, Cambridge, 1642, p. 56.

Francis Bacon, too, says many hard things of him.[5]

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

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

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

[6] Robert Browning: Paracelsus, closing speech.

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

[7] Professor Sudhoff: Bibliographia Paracelsica, Berlin, 1894,
1899.

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

[9] Anna M. Stoddart: The Life of Paracelsus, London, John
Murray, 1911.

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

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

--Paracelsus, Browning.

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

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

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

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

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

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

[13 Geneva ed., 1658, Vol. I, p. 613.

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

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

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

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

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

[14] Robert Fludd, the Mystical Physician, British Medical
Journal, London, 1897, ii, 408.

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

[15] Rattray: Theatrum Sympatheticum, Norimberge, MDCLXII.

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

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

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

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

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

(Canto iii, xxiii.)

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

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

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

[18] Charleton: Of the Magnetic Cure of Wounds, London, 1650, p.
13.

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

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

VESALIUS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

HARVEY

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

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

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

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

[26] William Harvey: Prelectiones Anatomiae Universalis, London,
J. & A. Churchill, 1886.

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

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

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

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

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

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

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

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

[29] Ibid. p. 49.

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

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

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

[30] De Plantis, Lib I, cap. 2.

[*] Cesalpinus has also a definite statement of the circlewise
process.--Ed.

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

[32] Osler An Alabama Student and Other Biographical Essays,
Oxford, 1908, p. 295.

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

[33] Osler: An Alabama Student, etc., pp. 329-330.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CHAPTER V

THE RISE AND DEVELOPMENT OF MODERN MEDICINE

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

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

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

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

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

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

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

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

[4] Venice, 1761.

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

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

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

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

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

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

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

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

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

[7] Dictionary of National Biography, London, 1886, VII, 14-17.

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

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

[8] Edward Jenner: The Origin of the Vaccine Inoculation,
London, 1801.

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

[9] Jockmann: Pocken und Vaccinationlehre, 1913.

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

[10] Joseph Frank: Reise nach Paris [etc.], Wien, 1804-05.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

INTERNAL SECRETIONS

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

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

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

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

CHEMISTRY

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

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

CHAPTER VI

THE RISE OF PREVENTIVE MEDICINE

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

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

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

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

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

[2] Works of William Harvey, translated by Robert Willis, London,
1847, p. 532.

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

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

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

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

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

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

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

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

SANITATION

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

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

[3] Journal Linnaean Society, London, 1879, XIV, 304-311.

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

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

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

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

[5] Matthew Carey: A Short Account of the Malignant Fever,
Philadelphia, 1793.

[6] R. La Roche: Yellow Fever, 2 vols., Philadelphia, 1855.

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

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

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

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

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

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

[*] Figures for recent years supplied by editors.

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

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

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

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

[7a] Connecticut.

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

TUBERCULOSIS

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

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

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

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

(Daemon of the World, Pt. II.)

          The End

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