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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..d7b82bc --- /dev/null +++ b/.gitattributes @@ -0,0 +1,4 @@ +*.txt text eol=lf +*.htm text eol=lf +*.html text eol=lf +*.md text eol=lf diff --git a/LICENSE.txt b/LICENSE.txt new file mode 100644 index 0000000..6312041 --- /dev/null +++ b/LICENSE.txt @@ -0,0 +1,11 @@ +This eBook, including all associated images, markup, improvements, +metadata, and any other content or labor, has been confirmed to be +in the PUBLIC DOMAIN IN THE UNITED STATES. + +Procedures for determining public domain status are described in +the "Copyright How-To" at https://www.gutenberg.org. + +No investigation has been made concerning possible copyrights in +jurisdictions other than the United States. Anyone seeking to utilize +this eBook outside of the United States should confirm copyright +status under the laws that apply to them. diff --git a/README.md b/README.md new file mode 100644 index 0000000..eb16fde --- /dev/null +++ b/README.md @@ -0,0 +1,2 @@ +Project Gutenberg (https://www.gutenberg.org) public repository for +eBook #67833 (https://www.gutenberg.org/ebooks/67833) diff --git a/old/67833-0.txt b/old/67833-0.txt deleted file mode 100644 index d207610..0000000 --- a/old/67833-0.txt +++ /dev/null @@ -1,22448 +0,0 @@ -The Project Gutenberg eBook of The growth of medicine from the -earliest times to about 1800, by Albert Henry Buck - -This eBook is for the use of anyone anywhere in the United States and -most other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms -of the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you -will have to check the laws of the country where you are located before -using this eBook. - -Title: The growth of medicine from the earliest times to about 1800 - -Author: Albert Henry Buck - -Release Date: April 14, 2022 [eBook #67833] - -Language: English - -Produced by: Turgut Dincer, Karin Spence and the Online Distributed - Proofreading Team at https://www.pgdp.net (This file was - produced from images generously made available by The - Internet Archive) - -*** START OF THE PROJECT GUTENBERG EBOOK THE GROWTH OF MEDICINE FROM -THE EARLIEST TIMES TO ABOUT 1800 *** - - - - - - THE GROWTH OF MEDICINE - FROM THE EARLIEST TIMES TO ABOUT 1800 - - - - - PUBLISHED ON THE FOUNDATION - - ESTABLISHED IN MEMORY OF - - WILLIAM CHAUNCEY WILLIAMS - - OF THE CLASS OF 1822, YALE MEDICAL SCHOOL - - AND OF - - WILLIAM COOK WILLIAMS - - OF THE CLASS OF 1850, YALE MEDICAL SCHOOL - - - - - THE GROWTH OF MEDICINE - - FROM THE EARLIEST TIMES - TO ABOUT 1800 - - - BY - - ALBERT H. BUCK, B.A., M.D. - - _Formerly Clinical Professor of Diseases of the Ear, Columbia - University, New York--Consulting Aural Surgeon, - New York Eye and Ear Infirmary; etc._ - - - [Illustration] - - - NEW HAVEN: YALE UNIVERSITY PRESS - LONDON: HUMPHREY MILFORD - OXFORD UNIVERSITY PRESS - MDCCCCXVII - - - - - COPYRIGHT, 1917 - BY YALE UNIVERSITY PRESS - - First published, February, 1917 - - - - - THE WILLIAMS MEMORIAL PUBLICATION FUND - - -The present volume is the first work published by the Yale University -Press on the Williams Memorial Publication Fund. This Foundation -was established June 15, 1916, by a gift made to Yale University by -Dr. George C. F. Williams, of Hartford, a member of the Class of -1878, Yale School of Medicine, where three generations of his family -studied--his father, William Cook Williams, in the Class of 1850, and -his grandfather, William Chauncey Williams, in the Class of 1822. - - - - - PREFACE - - -Very few persons will challenge the truth of the statement that in the -United States and Canada there are not many physicians who possess -even a slight knowledge concerning the manner in which the science -of medicine has attained its present power as an agency for good, or -concerning the men who played the chief parts in bringing about this -great result. Up to the present time no blame may justly be attached to -any individuals or to any educational institutions for this prevailing -lack of knowledge, and for two very good reasons, _viz._: first, -in a newly settled country, in which the population grows by leaps and -bounds through the influx of foreign immigrants, the training of young -men for the degree of M.D. must necessarily be almost entirely of a -practical character, and consequently the teaching of such a subject -as the history of medicine would be quite out of place; and, second, -the treatises on this subject which are purchasable by English-speaking -physicians are of rather too scientific a character to appeal either -to the undergraduate or to the busy practitioner. The first of the -reasons named, it may now safely be assumed, is rapidly losing its -validity, if indeed it has not already ceased entirely to afford a -legitimate excuse for neglecting the study of this branch of medical -science. On the other hand, the second reason mentioned is still in -force,--so far at least as the present writer knows,--and, if such be -the case, it certainly cannot fail to act as a deterrent influence of -great potency. Here, then, is my apology for attempting to prepare an -account of the history of medicine which shall present the essential -facts truthfully and with a sufficient degree of attractiveness to -win the continuing interest of the reader; which shall place before -him, and especially before those who are just at the threshold of -their professional career, word pictures of those physicians of past -ages whose lives may safely be taken as models worthy to be copied; -and which shall describe, so far as I am able to do this, the methods -which they employed to advance the science of medicine, to gain genuine -professional success, and to merit the enduring esteem of later -generations of physicians. If my efforts prove successful in producing -this kind of history it is fair to expect that, in a comparatively -short time, those physicians whose interest may have been aroused by -the perusal of this less complete and more popular work, will demand -something of a more exhaustive character--a book, for example, like the -admirable history which Max Neuburger, of Vienna, is now publishing, -and of which two volumes have already issued from the press (the -first in 1906 and the second in 1911).[1] It is to this work and the -excellent history written by the late Dr. Haeser, of Breslau, that I -am chiefly indebted for the information supplied in these pages; and -I therefore desire to make special mention here of this indebtedness. -The other sources from which I have been an occasional borrower are -all mentioned in the “List of Authorities Consulted.” Footnotes and -cross-references in the text interfere greatly with one’s pleasure in -reading a book, and I have therefore not hesitated to introduce them -sparingly. - -It gives me a special pleasure to call attention here to the -far-sighted generosity displayed by the founder of The Williams -Memorial Fund in making it practicable henceforth for the Yale -University Press to accept for publication medical treatises which -deal with the historical and scientific questions of this branch of -knowledge, but which for sound business reasons cannot be published on -a merely commercial basis. - -And I have the further pleasure of expressing my real appreciation -of the skill with which the University Press has solved the problems -of a suitable size and style of type for this volume, and of the -sound advice which it has given with regard to the extent to which -the effectiveness of the book may be increased by the introduction of -pictorial illustrations. - -To my friend, Lawrence F. Abbott, of New York, I am deeply indebted for -the valuable assistance which he has rendered me throughout the entire -progress of this work. Indeed, without this assistance, I doubt whether -I should have had the courage to remain at my post to the very end. - - ALBERT H. BUCK. -Cornwall, N. Y., December 29, 1916. - - - - - CONTENTS - - - PART I. ANCIENT MEDICINE - - PAGE - - Preface ix - - Chapter I. Development of the Science and Art of Medicine 3 - - Chapter II. Oriental Medicine 11 - - Chapter III. Oriental Medicine (continued) 25 - - Chapter IV. Greek Medicine at the Dawn of History 46 - - Chapter V. The Significance of the Serpent in the Statues - and Votive Offerings Exposed to View in the - Aesculapian Temples 62 - - Chapter VI. The Beginnings of a Rational System of Medicine - in Greece 67 - - Chapter VII. Hippocrates the Great 81 - - Chapter VIII. Brief Extracts from Some of the Hippocratic - Writings 89 - - Chapter IX. The State of Greek Medicine after the Events - of the Peloponnesian War; the Founding of Alexandria - in Egypt, at the Mouth of the Nile; and the Development - of Different Sects in Medicine 96 - - Chapter X. Erasistratus and Herophilus, the Two Great - Leaders in Medicine at Alexandria; the Founding of - New Sects 104 - - Chapter XI. Asclepiades, the Introducer of Greek Medicine - into Rome 116 - - Chapter XII. The State of Medicine at Rome after the Death - of Asclepiades; the Founding of the School of the - Methodists 129 - - Chapter XIII. The Further History of Methodism at Rome, - and the Development of Two New Sects, viz., the - Pneumatists and the Eclectics.--A General Survey of - the Subject of Sects in Medicine 138 - - Chapter XIV. Well-known Medical Authors of the Early - Centuries of the Christian Era 151 - - Chapter XV. Claudius Galen 160 - - Chapter XVI. The Influence of Christianity upon the - Evolution of Medicine 179 - - - PART II. MEDIAEVAL MEDICINE - - Chapter XVII. The Condition of Medicine at Byzantium - during the Early Part of the Middle Ages 191 - - Chapter XVIII. Beginning of the Arab Renaissance under the - Caliphs of Bagdad 203 - - Chapter XIX. Further Advance of the Arab Renaissance - during the Ninth and Succeeding Centuries of the - Christian Era 212 - - Chapter XX. Hospitals and Monasteries in the Middle Ages 235 - - Chapter XXI. Medical Instruction at Salerno, Italy, in the - Middle Ages 243 - - Chapter XXII. Early Evidences of the Influence of the - Renaissance upon the Progress of Medicine in Western - Europe 259 - - Chapter XXIII. Further Progress of Medicine and Surgery - in Western Europe during the Thirteenth, Fourteenth - and a Part of the Fifteenth Centuries 269 - - Chapter XXIV. During the Latter Half of the Middle Ages - Surgery Assumes the Most Prominent Place in the - Advance of Medical Science 292 - - Chapter XXV. Brief History of the Allied Sciences--Pharmacy, - Chemistry and Balneotherapeutics 315 - - - PART III. MEDICINE DURING THE RENAISSANCE - - Chapter XXVI. Important Events that Preceded the - Renaissance--Early Attempts to Dissect the Human Body 327 - - Chapter XXVII. The Founders of Human Anatomy and Physiology 340 - - Chapter XXVIII. Further Details Concerning the Advance in - Our Knowledge of Anatomy.--Dissecting Made a Part of - the Regular Training of a Medical Student.--Iatrochemists - and Iatrophysicists.--The Employment of Latin in - Lecturing and Writing on Medical Topics 355 - - Chapter XXIX. The Contributions Made by Different Men - during the Renaissance, and More particularly by - William Harvey of England, to Our Knowledge of the - Circulation of the Blood, Lymph and Chyle 371 - - Chapter XXX. Advances Made in Internal Medicine and in - the Collateral Branches of Botany, Pharmacology, - Chemistry and Pathological Anatomy 387 - - Chapter XXXI. Chemistry and Experimental Pharmacology 398 - - Chapter XXXII. Some of the Leaders in Medicine in Italy, - France and England during the Sixteenth and - Seventeenth Centuries 411 - - Chapter XXXIII. The Three Leading Physicians of Germany - during the Latter Half of the Seventeenth Century: - Franz de le Boë Sylvius, Friedrich Hoffmann and Georg - Ernst Stahl 426 - - Chapter XXXIV. Hermann Boerhaave of Leyden, Holland, one - of the Most Distinguished Physicians of the Seventeenth - Century 438 - - Chapter XXXV. General Remarks on the Development of - Surgery in Europe during the Fifteenth and Sixteenth - Centuries 446 - - Chapter XXXVI. Surgery in Germany and Switzerland during - the Fifteenth and Sixteenth Centuries 454 - - Chapter XXXVII. The Development of Surgery in Italy during - the Renaissance 472 - - Chapter XXXVIII. The Development of Surgery in Spain and - Portugal during the Renaissance 484 - - Chapter XXXIX. The Development of Surgery in France during - the Renaissance.--Pierre Franco 490 - - Chapter XL. The Development of Surgery in France - (continued).--Ambroise Paré 499 - - Chapter XLI. Surgery in Great Britain during the Sixteenth - and Seventeenth Centuries 516 - - Chapter XLII. Reforms Instituted by the Italian Surgeon - Magati in the Treatment of Wounds.--Final Ending of - the Feud between the Surgeons and the Physicians of - Paris.--Revival of Interest in the Science of - Obstetrics 529 - - Chapter XLIII. The First Appearance of Syphilis in Europe - as an Epidemic Disease.--Medical Journalism.--The - Beginnings of a Modern Pharmacopoeia.--Itinerant - Lithotomists 542 - - List of the More Important Authorities Consulted 557 - - General Index 563 - - - - - LIST OF ILLUSTRATIONS - - - Fig. 1. View of the Temple of Aesculapius on the Island - of Cos _facing page_ 52 - - Fig. 2. Bird’s-eye View of the Temple of Aesculapius and - Associated Buildings on the Island of Cos - _facing page_ 54 - - Fig. 3. Ground Plan of the Asclepieion on the Island of Cos - _facing page_ 55 - - Fig. 4. Ancient Statue of the God Aesculapius in the Berlin - Museum _facing page_ 62 - - Fig. 5. Head of the Marble Statue of the God Aesculapius in - the Naples Museum _facing page_ 62 - - Fig. 6. Bas-relief of Aesculapius, Accompanied by Women and - Children, in the Presence of an Enormous Serpent - _facing page_ 68 - - Fig. 7. Female Bust Showing Cancer of One Breast - _facing page_ 68 - - Fig. 8. Paralysis of the Left Facial Nerve _facing page_ 70 - - Fig. 9. The Oldest Known Pictorial Representation of a - Formal Dissection of the Human Body _facing page_ 280 - - Fig. 10. The Manner of Giving Public Instruction in Medicine - during the Middle Ages 281 - - Fig. 11. Henri de Mondeville _facing page_ 288 - - Fig. 12. One of the Wards in the Hôtel-Dieu of Paris - _facing page_ 304 - - Fig. 13. The Physician, the Surgeon and the Pharmacist - _facing page_ 306 - - Fig. 14. Andreas Vesalius _facing page_ 344 - - Fig. 15. William Harvey _facing page_ 380 - - Fig. 16. “The Lovesick Maiden” _facing page_ 412 - - Fig. 17. Thomas Sydenham _facing page_ 418 - - Fig. 18. Consultation by Three Physicians upon a Case of - Wound in the Chest 457 - - Fig. 19. Barber Surgeon (_Wundarzt_) Extracting an Arrow - from a Wounded Soldier’s Chest while the Battle - is Still in Progress 461 - - Fig. 20. Amputation of the Leg 463 - - Fig. 21. The Manner in Which the So-called Tagliacotian - Operation for Repairing a Defective Nose Should - be Carried Out 480 - - Fig. 22. Pierre Franco’s Forceps for Crushing Calculi in - the Urinary Bladder 497 - - Figs. 23–24. Forceps Devised in 1552 by Ambroise Paré for - Drawing Out the Cut Ends of Arteries after the - Amputation of a Limb, and Holding Them while - the Ligature is Being Applied 512 - - Fig. 25. Ambroise Paré the Famous French Surgeon of the - Sixteenth Century _facing page_ 514 - - Fig. 26. Frère Jacques de Beaulieu _facing page_ 550 - - Fig. 27. Jean Baseilhac, commonly Known in France as Frère - Côme _facing page_ 552 - - Fig. 28. Concealed Lithotome Invented by Frère Côme in 1748 553 - - - - - PART I - - ANCIENT MEDICINE - - - - - CHAPTER I - - DEVELOPMENT OF THE SCIENCE AND ART OF MEDICINE - - -Friedlaender says that “in the temple of history, now hoary with age, -medicine also possesses its own chapel, not an accidental addition to -the edifice but a large and important part of the noble building.” In -this chapel is preserved the record of the efforts made by man, through -the ages, to maintain his body in good condition, to restore it to -health when it has become affected by disease or damaged by violence, -and to ward off the various maladies to which it is liable. It is a -record, therefore, in which every practitioner of medicine should -take a deep interest. Rokitansky, the famous pathologist of Vienna, -expressed the same idea very tersely when he said: “Those about to -study medicine and the younger physicians should light their torches at -the fires of the ancients.” Members of the medical profession, however, -are not the only persons in the community who take an interest in the -origin and growth of the science of medicine and the art of healing -the diseased or damaged body; the educated layman is but little less -interested than the physician, being ever ready to learn all he can -about the progress of a branch of knowledge which so profoundly affects -his welfare. But hitherto the only sources of information available for -those who are not familiar with French or German have been treatises -of so technical a character that even physicians have shown relatively -little disposition to read them. - -The science of medicine developed slowly from very humble beginnings, -and for this earliest period the historian has no records of any kind -which may be utilized for his guidance. It is reasonably certain, -furthermore, that this prehistoric period lasted for a very long time, -probably several thousand years; and when, finally, some light on the -subject appeared, it was found to emanate from several widely separated -regions--_e.g._, from India, Mesopotamia, Egypt and Greece. Then, -after the lapse of additional hundreds or even thousands of years, -there was inaugurated the practice of making written records of all -important events, and, among others, of the different diseases which -affect mankind, of the means employed for curing them or for relieving -the effects which they produce, and of the men who distinguished -themselves in the practice of this art. While the “science of the -spade” and that of deciphering the writing of the papyri, monuments -and tablets thus brought to light, have already during the last half -century greatly altered our ideas with regard to ancient medicine, -there are good reasons for believing that much additional information -upon this subject may be looked for in the not distant future. It is -plain, therefore, that a history of the primitive period of medicine, -if written to-day, may have to be modified to-morrow in some important -respects. On the other hand, the facts relating to the later periods -are now so well established that a fair-minded writer should experience -no serious difficulty in judging correctly with regard to their value -and with regard to the claims of the different men to be honored for -the part which each has played in bringing the science and art of -medicine to their present high state of completeness and efficiency. - -The subdivision of the history of medicine into separate periods -is certainly desirable, provided it be found practicable to assign -reasonably well-defined limits to the periods chosen. But, when the -attempt is made to establish such subdivisions, one soon discovers that -the boundaries pass so gradually the one into the other at certain -points, or else overlap so conspicuously at other points, that one -hesitates to adopt any fixed plan of classification. Of the four -schemes which I have examined--viz., those of Daremberg, of Aschoff, -of Neuburger, and of Pagel--that of Neuburger seems to me to be the -best. That which has been adopted, however, in the preparation of the -present outline sketch combines some of the features of both the Pagel -and the Neuburger schemes. - -_Periods in the History of Medicine._--There are nine more or less -distinctly defined periods in the history of medicine, to wit:-- - -FIRST EPOCH: _Primitive medicine_.--This period extends through -prehistoric ages to a date which differs for different parts of the -world. The duration of this period, in any case, is to be reckoned by -thousands of years. - -SECOND EPOCH: _The medicine of the East_--that is, of the cultivated -oriental races of whose history we possess only a very fragmentary -knowledge. - -THIRD EPOCH: _The medicine of the classical period of antiquity_--the -pre-Hippocratic period of Greek medicine. - -FOURTH EPOCH: _The medicine of the Hippocratic writings_--the most -flourishing period of Greek medicine. - -FIFTH EPOCH: _The medicine of the period during which the centre of -greatest intellectual activity was located at Alexandria, Egypt_. - -SIXTH EPOCH: _The medicine of Galen_--an author whose teachings exerted -a preponderating influence upon the thought and practice of physicians -in every part of the civilized world up to the seventeenth century of -the Christian era. This period is also characterized by the gradual -diminution of the influence of Greek medicine. - -SEVENTH EPOCH: _The medicine of the Middle Ages_--a period which -includes a large part of the preceding epoch. Its most characteristic -feature is the important part played by the Arabs in moulding the -teachings and practice of the medical men of that time (ninth to -fifteenth century). - -EIGHTH EPOCH (fifteenth and sixteenth centuries): _The medicine of the -Renaissance period_--characterized chiefly by the adoption of the only -effective method of studying the anatomy of man--the actual dissection -of human bodies. - -NINTH EPOCH (from the beginning of the seventeenth century to the -present time): _Modern medicine_.--This epoch may with advantage be -divided into two periods--the first extending to about the year 1775, -soon after which time Jenner began his important work on the subject -of vaccination; and the second to the present time. No attempt will be -made in the following account to cover this second period. - -_The Beginnings of Medicine._--In the early period of man’s existence -upon this earth he must have possessed an exceedingly small stock of -knowledge with regard to the maintenance of his body in health and with -regard to the means which he should adopt in order to restore it to a -normal condition after it had been injured by violence or impaired in -its working machinery by disease. With the progress of time, utilizing -his powers of observation and his reasoning faculty, he slowly made -additions to his stock of facts of this nature. Thus, for example, he -gradually learned that cold, under certain circumstances, is competent -to produce pain in the chest, shortness of breath, active secretion of -mucus, etc., and his instinct led him, when he became affected in this -manner, to crave the local application of heat as a means of affording -relief from these distressing symptoms. Again, when he used certain -plants as food he could scarcely fail to note the facts that some of -them produced a refreshing or cooling effect, that others induced a -sensation of warmth, and finally that others still, by reason of their -poisonous properties, did actual harm. Sooner or later, such phenomena -as nausea, vomiting and diarrhoea would also be attributed by him to -their true causes. In due course of time his friends and neighbors, -having made similar observations and having tried various remedial -procedures for the relief of their bodily ills, would come together and -compare with him their several experiences; and so eventually the fact -would be brought out that the particular method adopted by one of their -number for the relief of certain symptoms had proved more effective -than any of the others. Thus gradually this isolated community or tribe -of men must have learned how to treat, more or less successfully, the -simpler ills to which they were liable. - -Lucien Le Clerc quotes from the Arab historian Ebn Abi Ossaïbiah the -following account of the manner in which bloodletting probably first -came to be adopted as a remedial measure:-- - - Let us suppose that in the earliest period of man’s history - somebody experienced the need of the medical art. He may, for - example, have felt a general sense of heaviness in his body - (plethora), associated perhaps with redness of the eyes, and - he probably did not know what he should do in order to obtain - relief from these sensations. Then, when his trouble was at its - worst, his nose began to bleed, and the bleeding continued until - he experienced decided relief from his discomfort. In this way - he learned an important fact, and cherished it in his memory. - - On a later occasion he experienced once more the same sense of - heaviness, and he lost no time in scratching the interior of his - nose in order to provoke a return of the bleeding. The nosebleed - thus excited again gave him entire relief from the unpleasant - sensations, and upon the first convenient occasion he told his - children and all his relatives about the successful results - obtained from this curative procedure. Little by little this - simple act, which was a first step in the healing art, developed - into the intelligently and skilfully performed operation of - venesection. - -Primitive man also increased his stock of knowledge in the healing art -by reading attentively the book of nature,--_i.e._, by observing -how animals, when ill, eat the leaves or stems of certain plants and -thus obtain relief from their disorders. The virtues of a species of -origanum, as an antidote for poisoning from the bite of a snake, were -revealed, it is asserted, by the observation that turtles, when bitten -by one of these reptiles, immediately seek for the plant in question -and, after feeding upon it, experience no perceptible ill effects from -the poisonous bite. The natives of India ascribe the discovery of the -remarkable virtues of snakeroot (the bitter root of the ophiorrhiza -Mungos) as an antidote for poisoning by the bite of a snake, to the -ichneumon, a small animal of the rat species. The instinctive desire -to escape pain taught man, as it does the lower animals, to keep a -fractured limb at rest, thus giving the separated ends of the bone -an opportunity to reunite; after which the limb eventually becomes -as strong as it ever was. Simple as this mode of acquiring useful -medical knowledge may appear to us moderns, there are good reasons -for believing that hundreds of years must have elapsed before the -accumulated stock of such experiences became really considerable. -On the other hand, it is reasonable to suppose that this growth in -medical knowledge took place more rapidly in certain tribes or races -than in others, and that when, under the action of wars, the inferior -men became tributary to those of greater intellectual powers, they -acquired, through contact with their conquerors, additional knowledge -at a much more rapid rate. One great hindrance, however, stood in the -way of such progress. I refer to the deeply rooted belief, entertained -by man in this primitive period of his existence, in the agency of -malevolent spirits (demons) in the production of disease,--a belief -which continued to exist for many thousands of years. Out of such a -belief developed the necessity of discovering some practical method -of appeasing the evil spirits and of thus obtaining the desired cure -of the ills of the body. Usually some member of the tribe who had -displayed special skill in the treatment of disease, and who at the -same time was liberally endowed with the qualities which characterize -the charlatan, was chosen to be the priest or “medicine man.” It was -his duty to employ measures suitable for expelling the demon from the -patient’s body and for restoring the latter to health. Possessing -great influence, as these superstitious people believed he did, with -the unseen gods, such a physician-priest must have discouraged all -efforts to increase the stock of genuine medical knowledge; for such -an increase would necessarily mean a diminution of his own power and -influence. - -In what must still be termed the age of primitive medicine, but -undoubtedly at an advanced stage of that epoch, there were performed -surgical operations which imply a remarkable advance in the invention -of cutting instruments and in the knowledge of the location and nature -of certain comparatively rare diseases, and at the same time great -courage and wonderful enterprise on the part of those early physicians. -As evidence of the correctness of these statements the fact may be -mentioned that trepanned skulls belonging to the neolithic period have -been dug up in various parts of the world--in most of the countries -of Europe, in Algiers, in the Canary Islands, and in both North and -South America. From a careful study of these skulls it has been learned -that the individuals upon whom such severe surgical work had been -done--sometimes as often as three separate times--recovered from the -operation. The instruments used were made of sharpened flint (saws or -chisels). Pain in the head, spasms or convulsions, and mental disorders -are suggested by Neuburger as the indications which probably led to -the performance of the trepanning. This author also makes the further -statement that the ancient Egyptians employed knives made of flint for -opening the dead bodies which they were about to embalm and for the -operation of circumcision. Recent excavations have thrown additional -light upon the state of medical knowledge during this neolithic -age. Thus, there have been found specimens of anchylosed joints, of -fractured bones, of flint arrow heads lodged in different parts of -the skeleton, of rhachitis, of caries and necrosis of bone, etc. The -following quotation is taken from the printed report of a lecture -recently delivered in London by Dr. F. M. Sandwith, Consulting Surgeon -to the Khedive of Egypt. Speaking of certain excavations made in the -Nubian Desert and of the oldest surgical implements yet discovered, he -says:-- - - In one place a graveyard was found, and here were remains of - bodies with fractured limbs that had been set with bark splints. - One was a right thigh bone that had been broken, and was still - held in position by a workmanlike splint and bandages. All the - knots were true reef-knots, and the wrappings showed how the - strips of palm-fibre cloth were set just as a good surgeon would - set them in these days so as to use the full strength of the - fabric. - -Among the most ancient remedies may be mentioned talismans, amulets -and medicine stones, which were furnished--presumably at a price--by -the physician-priests, and which were believed to afford the wearers -protection against evil spirits (the “evil eye,” for example). Various -objects were used for this purpose, and among them the following -deserve to be mentioned: disks of bone removed with the aid of a -trephine from the skull of a dead human body and worn with a string -around the neck; the teeth of different animals; bones of the weasel; -cats’ claws; the lower jaw of a squirrel; the trachea of some bird; one -of the vertebrae of an adder, etc. And where these measures failed, -the priests resorted to incantations, religious dances, and the -beating of drums or the rattling of dried gourds filled with pebbles. -Primitive races of men inhabiting the most widely separated parts of -the earth appear to have adopted means almost identical with those -just described for driving away evil spirits. The holding of these -superstitious beliefs is one of the most extraordinary characteristics -of the human race. It played an important part throughout the classical -period of Greek and Roman civilization, and also during the Middle -Ages. Christianity undoubtedly was a most potent agency in hastening -the eradication of the feeling, but even this great power has not yet -sufficed entirely to do away with superstition; for traces of this -weakness may still easily be detected in some of the men and women with -whom we daily come in contact. - - - - - CHAPTER II - - ORIENTAL MEDICINE - - -The researches of the scholar working in combination with the engineer -have unearthed--more particularly in Mesopotamia, in Egypt and in -Greece--evidences of an ancient medical science far advanced beyond -that briefly described in the preceding chapter. These evidences relate -to nations that flourished as far back as four thousand years B. C. -While they are very fragmentary and cover historical events which -are often separated from one another by long periods of time, these -data nevertheless suffice to give one a fairly good idea of the then -prevailing state of medical knowledge. Both Pagel and Neuburger adopt -the plan of discussing these different nationalities separately, and I -shall follow their example. - -_Medicine in Mesopotamia._--As appears from the most recent -investigations the Sumerians were the first occupants of the region -lying between the Euphrates and the Tigris rivers. It was from them -that their Semitic conquerors, the Babylonians and the Assyrians, -received a civilization which, already about 4000 B. C., had -reached a wonderful degree of development. The canalization of the -low-lying lands of that region, the organization of a religious and -civil government of a most efficient type, the invention first of -picture-writing and then of the cuneiform characters, the cultivation -of the arts and natural sciences and especially of astronomy and -mathematics to a high degree of perfection,--these are among the things -which were accomplished by this very clever race of men. In addition, -however, to these useful activities the Babylonians developed and -cultivated diligently the science of astrology--that is, the science -of predicting human events (such as the death of the king, the -occurrence of the plague or of war, etc.) from various telluric and -cosmic phenomena--an eclipse of the sun, peculiarities of the weather, -the condition of vegetation, etc. The deeply rooted love of the human -race for the supernatural--a characteristic to which I have already -briefly referred--facilitated the development of this harmful practice, -and kept it alive through many succeeding centuries. Walter Scott, in -his romance entitled Quentin Durward, gives an admirable portrait of -a typical astrologer whom Louis XI. of France maintained at his court -during a part of the seventeenth century. - -While in other parts of the Orient the science of medicine, as -already stated at the beginning of this chapter, made a noteworthy -advance beyond the conditions observed among the primitive races, in -Mesopotamia this science, which was far more important to the welfare -of its inhabitants than all the other branches of knowledge combined, -received very little attention and consequently made only insignificant -advances. The British Museum has in its possession several thousand -tablets which were dug up from the ruins of Nineveh and which represent -a part of the library of the Assyrian King, Assurbanipal (668–626 B. -C.). Translations of the text of only a very few of these tablets have -thus far been published, and from these, which embody the greater -part of our knowledge of Assyrian medicine, it appears that, for the -present at least, the estimate recorded above must stand. A few new -facts, however, have been brought to light, and they appear to be of -sufficient importance to merit brief consideration here. - -In the first place, Herodotus, who visited Babylon about 300 B. C., has -this to say in relation to the state of medicine in that city:-- - - The following custom seems to me the wisest of their - institutions next to the one lately praised. They have no - physicians, but, when a man is ill, they lay him in the public - square, and the passers-by come up to him, and if they have - ever had his disease themselves or have known any one who has - suffered from it, they give him advice, recommending him to do - whatever they found good in their own case, or in the case - known to them; and no one is allowed to pass the sick man in - silence without asking him what his ailment is.[2] - -The Babylonians held some rather strange beliefs regarding the -construction of the human body and the manner in which its functions -are performed. The living being, as they maintained, is composed of -soul and body. The intellect has its seat in the heart, the liver -serving as the central organ for the blood, which they considered to be -the true life principle. They divided this fluid into two kinds--blood -of the daytime (bright arterial) and that of the night (dark venous). -Although the blood was held by them to be the basis of life, they -evidently attached a certain value to respiration, for one of their -prayers begins with these words: “God, my creator, lead me by the -hand; guide the breath of my mouth.” Disease was always looked upon as -something (usually personified as a demon) that entered the body from -without and that consequently had to be expelled. There were special -demons for the different diseases. Thus, Asakku brought fever to the -head, Namtar threatened life with the plague, and Utukku attacked the -throat, Alu the breast, Gallu the hand, Rabisu the skin, and so on. The -most dreaded demons were the spirits of the dead. Special amulets were -employed as protective remedies. Prayer formulae were also used. Here -is one among several that I find mentioned in Neuburger’s treatise:-- - - Wicked Consumption, villainous Consumption, Consumption which - never leaves a man, Consumption which cannot be driven away, - Consumption which cannot be induced to leave, Bad Consumption, - in the name of Heaven be placated, in the name of Earth I - conjure thee! - -The genuine remedial agents employed in Babylonia were of a most -varied nature: a mixture of honey and syrup of dates; medicinal herbs -of different kinds for internal administration; bloodletting; the use -of cups for drawing blood to the surface of the body; warm baths and -cold shower baths; rubbing oil over the body; medicated clysters; the -use of various salves; the use of secret remedies which were composed -of various ingredients and which bore such names as “the Sun God’s -remedy,” “the dog’s tongue,” “the skin of the yellow snake,” “the -medicine brought from the mountain of the human race,” etc. - -Some of the predictions made by the Babylonian astrologers are of -sufficient interest to be placed on record. Here are a few examples:-- - - If the west wind is blowing when the new moon is first seen, - there is likely to be an unusual amount of illness during that - month. - - If Venus approaches the constellation of Cancer, there will be - respect for law and prosperity in the land; those who are ill - will recover, and pregnant women will have easy confinements. - - If Mercury makes its appearance on the fifteenth day of the - month, there will be corpses in the land. And again, if the - constellation of Cancer is obscured, a destructive demon will - take possession of the land, and there will be corpses. - - If Jupiter and the other planets stand opposite one another, - some calamity will overtake the land. If Mars and Jupiter come - into conjunction, there will be deaths among the cattle. - - If an eclipse of the Sun take place on the twenty-eighth day - of the month Ijar, the king will have a long reign; but, if it - take place on the twenty-ninth day of the month, there will be - corpses on the first day of the following month. - - If there should be thunder during the month of Tisri, a spirit - of enmity will prevail in the land; and if it should rain during - that month, both men and cattle will fall ill. - -Besides these predictions, which were based upon phenomena connected -with the movements of the stars and the conditions of the weather, -there were others which the people themselves were competent to make -without the aid of the professional astrologer or the official priest. -Such, for example, are the following “omens”:-- - - If a woman gives birth to a child the right ear of which is - lacking, long will be the reign of the prince of that land. - - If a woman gives birth to a child both of whose ears are - lacking, sadness will come upon the land and it will lose some - of its importance. - - If a woman gives birth to a child whose face resembles the beak - of a bird, there will surely be peace in the land. - - If a woman gives birth to a child the right hand of which lacks - fingers, the sovereign of that country will be taken prisoner by - his enemies. - -The keen interest taken by the priests in the matter of predicting the -outcome of various diseases led in due time to their making records -of the nature, symptoms and progress of the latter. Although this -practice was inaugurated purely for the purpose of enabling them to -foretell with greater accuracy the probable issue of any given malady, -it nevertheless served also to establish on a firm basis the custom -of keeping records of the case-histories. Only one thing more was now -needed to render this practice the first step in a genuine advance of -medical knowledge; but this step could not be made in Babylonia, where -priestcraft and superstition had struck such deep roots in the public -life. It was only in free Greece, and at a time in its history when -the spirit of Hippocrates exerted an overpowering influence over the -minds of men, that the separation of the functions of the physician -from those of the priest became possible and was in due time effected. -(Neuburger.) - -Before closing this very incomplete account of the state of medical -knowledge in Babylonia, it will be well to mention some of the items of -the law laid down by Hammurabi (circa 2200 B. C.) for the guidance of -the physicians of that land with regard to the remuneration which they -should receive. At the same time I shall make no attempt to reconcile -the statement of Herodotus (given on page 12) with the wording of -this law, which distinctly recognizes the existence of physicians in -Mesopotamia. Possibly the conditions in Nineveh in the fourth century -B. C. were different from what they had been eighteen centuries earlier. - - If a physician makes a deep cut with an operating knife of - bronze and effects a cure, or if with such a knife he opens a - tumor and thus avoids damaging the patient’s eye, he shall - receive as his reward 10 shekels of silver. If the patient is - an emancipated slave, the fee shall be reduced to 5 shekels. In - the case of a slave the master to whom he belongs shall pay the - physician 2 shekels. - - If a physician makes a deep wound with an operating knife of - bronze and the patient dies, or if he opens a tumor with such a - knife and the patient’s eye is thereby destroyed, the operator - shall be punished by having his hands cut off. - - If a physician, in operating upon the slave of a freedman, makes - a deep wound with an operating knife of bronze and thus kills - the patient, he shall give the owner a slave in exchange for the - one killed. And if, in opening a tumor with such a knife, the - physician destroys the slave’s eye, he shall pay to the latter’s - owner one-half the slave’s value. - - If a physician effects the healing of a broken bone or cures a - disease of the intestines, he shall receive from the patient a - fee of 5 shekels of silver.[3] - -It would be difficult to imagine anything better adapted to arrest the -development of medical knowledge in a nation than the promulgation of a -law like that ascribed to Hammurabi; and one cannot be surprised at the -statement made by Herodotus, eighteen centuries later, “that there were -no physicians in Babylon.” Foolhardy, indeed, would be the man who, for -the sake of earning a possible reward of six shekels of silver, would -be willing to risk the danger of having both his hands cut off; and yet -every conscientious and faithful practitioner of medicine in Babylon at -the time mentioned must necessarily have been obliged to run this risk. - -_Medicine in Ancient Egypt._--Of the sources of information with -regard to the knowledge of medicine possessed by the ancient Egyptians -the most important are the following: Homer’s Odyssey; Herodotus; -Diodorus; Clemens of Alexandria; Pliny’s Natural History; Dioscorides; -the Papyrus Ebers; the Papyrus Brugsch; and the Papyrus Birch, in the -British Museum. Then, in addition to these sources, there are the -inscriptions found in recent times on the walls of the temples and -the pictures painted on the wrappings of mummies, from both of which -considerable information with regard to various therapeutic procedures -and to the details of the process of embalming has been derived. Some -of this information extends back to about 3000 B. C. The healing art -was at that time entirely in the hands of the temple priests, who -formed an organized body with a sort of physician-in-chief at its head. -Two of these--Athotis and Tosorthos--attained such a high standing and -possessed such influence that they were chosen Kings of Egypt. The -practice of obstetrics was entrusted to the care of women who had been -trained to this work and who acknowledged the authority of a skilled -head-nurse of their own sex. The patients who had received treatment -for their ailments at one or other of the temples presented to these -institutions gifts in the form of sculptured or painted representations -of the diseased or injured parts of the body. In these and in other -ways medicine and pharmacy received contributions which were of no mean -value. Botanical gardens were established at various places in Egypt -and were cultivated with care. Chemistry--a name which derives its -origin from a word in the Egyptian language--also made considerable -progress as a science. On the other hand, the knowledge of the -structure and functions of the different parts of the human body was -very imperfect and remained unchanged for many centuries. This would -probably not have been the case if the work of preparing the bodies -for the process of embalming had not been entrusted entirely to mere -menials, men who had no interest in anything but the mechanical part of -their occupation. - -According to the statement of Clemens of Alexandria[4] the Egyptian -science of medicine is set forth in the last six of the forty-two -hermetic books, which were composed, according to the prevailing -belief, by the god Thot or Thoüt (= Hermes of the Greeks). The first -one of these six books is devoted to the anatomy of the human body, -the second one to the diseases to which it is liable, the third to -surgery, the fourth to remedial agents, the fifth to the diseases of -the eye, and the sixth to diseases of women. As to the remedial agents, -Neuburger says that it has not been found practicable to identify more -than a very few of the Egyptian drugs enumerated by Dioscorides. Homer, -who wrote at least five hundred years B. C., has something to say on -this subject in the Odyssey.[5] His words are as follows:-- - - Such drugs Jove’s daughter owned, with skill prepar’d, - And of prime virtue, by the wife of Thone, - Aegyptian Polydamna, given her. - For Aegypt teems with drugs, yielding no few - Which, mingled with the drink, are good, and many - Of baneful juice, and enemies to life. - There every man in skill medicinal - Excels; for they are sons of Pason[6] all. - -A physician of the present age, on reading the histories of the -ancient Egyptians, Greeks and other oriental nations, finds it almost -impossible to realize that many of the characters designated as gods -and goddesses, possibly all of them, were not mythological persons, as -they would have been termed only a few years ago, but real human beings -like ourselves. Such, for example, was the opinion of Cicero who, when -asked why these people were spoken of as gods, gave the following -reply:[7] “It was a well-established custom among the ancients to deify -those who had rendered to their fellow men important services, as -Hercules, Castor and Pollux, Aesculapius, Bacchus and many others had -done.” And I find that those modern authors of the history of medicine -whose works I have consulted, are quite ready to accept even the gods -called by the Egyptians Osiris (or Serapis), Isis, and Thoüt (or -Hermes) as genuine historical personages. Such a belief receives some -degree of confirmation from the following inscriptions which, according -to the authority of Le Clerc,[8] were found engraved upon two columns -discovered in the city of Nyoa, in Arabia:-- - - (On the first column): My father is Cronos, the youngest of - all the gods. I am King Osiris, who have visited with my - armies every country on the face of the earth--the remotest - inhabitable parts of India, the regions lying beneath the Bear, - the neighborhood of the sources of the Danube, and the shores - of the Ocean. I am the oldest son of Cronos, the scion of a - fine and noble race. I am related to the day. There is no part - of the earth which I have not visited, and I have filled the - entire universe with my benefits. (On the second column): I - am Isis, Queen of all this country, and I have been taught by - Thoüt. There is nobody who has the power to loosen what I shall - bind. I am the oldest daughter of Cronos, the youngest of the - gods. I am the wife and at the same time the sister of King - Osiris. To me is due the credit of having been the first to - teach men agriculture. I am the mother of King Horus. I shine in - the dog-star. It is I who built the city of Bubastis. Farewell, - Egypt, my native land. - -The discovery of the art of medicine, says Le Clerc, was attributed to -Osiris and Isis, and they were also credited with having taught it to -Aesculapius. - -At the cities of On (Heliopolis), Sais, Memphis and Thebes were located -the most celebrated of the Egyptian temples, which were dedicated -not merely to the worship of their numerous gods, but also to the -dissemination of knowledge of various kinds and to the care of the -sick and maimed. In a word, they were--like the Aesculapian temples at -Trikka, Epidaurus and Cos, of which some account will be given farther -on--both hospitals for the treatment of disease and schools for the -training of physicians. The chief priest of the temple bore also the -title of the “physician-in-chief,” and exercised the prerogatives of -a chief magistrate. Under this system medical knowledge advanced to -a certain stage and then made no further progress. The preponderance -of the priestly (_i.e._, the superstitious) influence was too -pronounced to permit anything like real progress. - -The papyrus Ebers makes mention of a number of diseases, and among them -the following may be noted: abdominal affections (probably dysentery), -intestinal worms, inflammations in the region of the anus, hemorrhoids, -painful disorders at the pit of the stomach, diseases of the heart, -pains in the head, urinary affections, dyspepsia, swellings in the -region of the neck, angina, a form of disease of the liver, about -thirty different affections of the eyes, diseases of the hair, diseases -of the skin, diseases of women, diseases of children, affections of the -nose, ears and teeth, tumors, abscesses and ulcers. - -In the matter of diagnosis the Egyptian physicians not only employed -inspection and palpation, but were in the habit of examining the urine. -A statement made in the papyrus Ebers is good ground for the belief -that they also employed auscultation to some extent. - -Therapeutics constituted beyond all question the strongest part of -Egyptian medicine. As might be expected from the strange mixture of the -priest and the medical man in every physician, the remedial measures -commonly employed consisted in part of prayers and incantations, and -in part of rational procedures and the use of drugs. Among the latter -class of remedies the following deserve to be mentioned: emetics, -cathartics and clysters. Bloodletting, sudorifics, diuretics and -substances which cause sneezing were also often employed in Egypt. To -produce vomiting the favorite agents were the copper salts and oxymel -of squills. Castor oil disguised in beer was given as an aperient. -Pomegranate was the drug preferred for the expulsion of worms. -Mandragora and opium were also employed as remedies. Foreign drugs -were largely imported by the Phoenicians, and in their successful -campaigns against Asiatic nations the Egyptians learned much about -the use of these rarer remedies. The different forms in which the -Egyptians administered their remedies included potions, electuaries, -gums to be chewed but not swallowed, gargles, snuffs, inhalations, -salves, plasters, poultices, injections, suppositories, clysters and -fumigations. The physicians, in their practice, were subjected to very -strict rules regarding the amount of the doses to be given and the -manner of administering the different remedies, and consequently they -received no encouragement to indulge in any individuality of action. -The prescriptions were written in very much the same manner as are -those of to-day; that is, they contained the fundamental or important -drugs, certain accessory materials, and something which was intended -merely to correct the unpleasant taste of the mixture. In comparison -with those commonly written at a somewhat later period these ancient -prescriptions were of a very simple character. - -Up to the present time the researches of the archaeologists have thrown -comparatively little light on the surgery of the ancient Egyptians. -The facts already ascertained, however, are sufficient to warrant the -statement that they had reached a degree of knowledge and skill in -this department of medicine well in advance of that reached by any of -their contemporaries. They performed the operations of circumcision -and castration, and they removed tumors, and their eye surgeons were -especially renowned for the work which they accomplished in their -special department. Their skill in manufacturing surgical instruments -is amply revealed in the specimens--instruments for cupping, knives, -hooks, forceps of different kinds, metal sounds and probes, etc.--which -have been dug up at the various sites of ancient ruins. They must also -have possessed considerable manual skill, for without it they could -not, in embalming a corpse, have removed the entire brain from the -skull with a long hook, by way of the nasal passages, and at the same -time have left the form of the face undisturbed. - -From Joachim’s German translation of the papyrus Ebers,[9] as quoted by -Neuburger, I copy the following passages:-- - - If thou findest, in some part of the surface of a patient’s - body, a tumor due to a collection of pus, and dost observe - that at one well-defined spot it rises up into a noticeable - prominence, of rounded form, thou should’st say to thyself: This - is a collection of pus, which is forming among the tissues; I - will treat the disease with the knife.... If thou findest, in - the throat of a patient, a small tumor containing pus, and dost - observe that it presents at one point a well-defined prominence - like a wart, thou may’st conclude that pus is collecting at - this point.... If thou findest, in a patient’s throat, a fatty - growth which resembles an abscess, but which yields a peculiar - sensation of softness under the pressure of the finger, say to - thyself: this man has a fatty tumor in his throat; I will treat - the disease with the knife, but at the same time I will be - careful to avoid the blood-vessels. - -These short extracts will suffice to show that the Egyptian physicians -of that early period--at least 1550 B. C.--reasoned about pathological -lesions in very much the same manner as a physician of to-day would -reason. In this same ancient papyrus, however, foolish as well as -sensible statements appear. Thus, for example, mention is made on the -one hand of the fact that, in order to give a certain remedy to an -infant, it is sufficient to administer it to the nurse who suckles the -child (a proceeding which is not uncommon in our own day); and then, -in another part of the text, it is stated that “if, on the day of its -birth, the infant does not cry, it will surely live; but, if it says -‘ba,’ it will die.” - -In matters relating to personal hygiene the ancient Egyptians often -displayed a remarkable degree of common sense. They maintained, for -example, that the majority of diseases are due to the taking of -food in excessive quantity; and, in harmony with this belief, they -introduced the custom of devoting three days out of every thirty to -the taking of emetics and clysters. Perhaps it was to this custom -that they owed their good health,--a fact to which both Herodotus and -Diodorus testify. In principle this practice agrees with that adopted -by modern physicians, who omit the emetics and substitute for the -clysters the drinking of certain mineral waters during a limited period -of the summer season and under the very agreeable surroundings of a -comfortable hotel at Carlsbad, Ems, Wiesbaden or Saratoga. While the -monthly plan of purging the system of harmful elements must certainly -have been the more effective of the two, it cannot for a moment be -doubted that exceedingly few moderns would be willing to subject -themselves to such a régime. - -In still other ways the ancient Egyptians displayed a most intelligent -respect for every measure that tended to promote the general health of -the community. They took care, for example, to prevent the entrance -of decomposing materials into the soil and the ground water; priests -skilled in work of this character made careful inspections of all meats -that were to be used for food; stress was laid upon the importance of -keeping the dwelling houses clean; the people were taught the value -of bathing the body frequently, of cultivating gymnastic exercises, -of clothing themselves suitably, and of employing the right sort of -diet. At a still later period of their history they adopted the custom -of drinking only water that had been either boiled or filtered. A -particular kind of beer, the gift of their first king, Osiris, was -the favorite beverage of the people. It was made from barley and -doubtless possessed intoxicating properties, as is suggested by one -of the papyrus texts in which the following charge is brought against -a student: “Thou hast abandoned thy books and art devoting thyself to -idle pleasures, going from one beer-house to another. Thou smellest so -strongly of beer that men avoid thee.” - -A large proportion of the sources of information regarding the medicine -of the ancient Egyptians have been brought to light during recent -years, but so many gaps in the series still remain unfilled that it is -not possible to furnish more than a disconnected and very imperfect -account. Archaeological investigations, however, are being conducted -with vigor and new discoveries are reported almost every month. There -are therefore good reasons for hoping that, in the course of the next -few years, much additional light will be shed on the mode of life and -accomplishments of these pioneers of civilization, who, before they -passed out of history, succeeded in attaining the highest degree of -cultivation in the science and art of medicine that had up to that -time been attained by any other nation. One thing is certain, says -Neuburger, they exerted a powerful influence upon the beginning of -medicine in Greece and upon the social hygiene of the Jewish people, -and therefore upon the human race at large. - - - - - CHAPTER III - - ORIENTAL MEDICINE (Continued) - - -_The Medicine of the Ancient Persians._--After Cyrus the Great had -put an end to Babylon as a power among the nations the Persians became -the leaders in all the affairs not merely of Asia Minor but also of -the entire country from India to the shores of the Mediterranean; in -fact, they eventually also gained control of the land of the Pharaohs. -Notwithstanding the completeness of the political power which they -possessed over these conquered races, they permitted them to retain -their respective religions and even their individual languages; -as evidence of the correctness of which last statement the modern -discovery of inscriptions written in the three principal tongues may be -mentioned. The remarkable degree of general culture which existed at -Babylon at the time of the Persian conquest, and which the Sumerians -and Semites had originally introduced, was left undisturbed by the -political change. - -So far as we possess any knowledge regarding the medicine of the -ancient Persians, this information has been derived, according to -Neuburger, from the Zend-Avesta--one of the ancient religious writings -preserved by the Parsees. It furnishes comparatively few facts of -special interest to physicians. In the main, the practice of medicine -must have differed very little from that employed by the earliest -Babylonian physicians, and briefly described on pages 11–16. There are -one or two additional matters, however, which deserve to be mentioned -here. It was maintained, for example, that the touching of a corpse -produced a special contamination, a belief which interfered most -seriously with the study of anatomy, and therefore prevented any -real advance in medical knowledge. Then, again, the ancient Persians -appear to have taken comparatively little interest in surgery, for it -is said that King Darius I. was obliged, when he needed treatment for -a badly sprained ankle, to send for a Greek physician. Finally, there -may be found in Herodotus the following statement, which shows that the -Persians had learned something of value, in practical hygiene, from -their neighbors, the Egyptians:-- - - The Great King (Cyrus), when he goes to the wars, is always - supplied with provisions carefully prepared at home, and with - cattle of his own. Water, too, from the river Choaspes, which - flows by Susa, is taken with him for his drink, as that is the - only water which the kings of Persia taste. Wherever he travels, - he is attended by a number of four-wheeled cars drawn by mules, - in which the Choaspes water, ready boiled for use, and stored in - flagons of silver, is moved with him from place to place.[10] - -Neuburger makes the remark that the ancient Persians are entitled to -the gratitude of later generations for the valuable service which they -rendered the science of medicine, inasmuch as, during the dynasty of -the Sassanide princes (fifth century A. D.) and at a time when European -culture was hastening to its destruction, they gave shelter both to -classical culture in general and to the medical knowledge of the -Greeks, and then afterward handed it over to the conquering Arabs, who -passed it on to our forefathers. - -_The Medicine of the Old Testament._--There are no medical -writings which give any information concerning the science and art of -medicine as possessed by the ancient Israelites, but the Bible contains -a number of passages that refer to matters which belong in the domain -of medicine, and more particularly in that of social hygiene. The -mosaic laws were framed with a view to the good of the Jewish people -as a whole, and were directed to such matters as the prevention and -suppression of epidemic diseases, the combating venereal affections -and prostitution, the care of the skin, the systematizing of work, -the regulation of sexual life, the intellectual cultivation of the -race, the provision of suitable clothing, dwellings and food, the use -of baths, etc. Many of these laws--like those, for example, which -prescribe rest on the Sabbath day, circumcision, abstinence from eating -the flesh of the pig, the isolation of persons affected with leprosy, -the observation of hygienic rules in camp life, etc.--testify to a -remarkably high degree of the power to reason correctly; and, when -considered in the light of modern science, they seem to justify the -prediction made in Deuteronomy iv., 6. A similar prediction (supposed -to be spoken by God from Mount Sinai) is made in Exodus xix., 6: “And -ye shall be unto me a kingdom of priests, and an holy nation.” That a -large part of the credit given to Moses for the wisdom displayed in -these sanitary laws really belongs to the Egyptians is shown by the -text of Acts vii., 22: “And Moses was learned in all the wisdom of the -Egyptians, and was mighty in words and in deeds.” - -As regards the manner in which the Israelites treated the diseases -which afflicted them the Bible furnishes ample proof of the fact -that they placed their chief reliance upon prayers, sacrifices, and -offerings at their temples, and made comparatively small use of -medicinal agents, dietetic measures, and external applications. The -favorable effect of David’s harp-playing upon the melancholia of King -Saul furnishes the only instance, to be found in the Bible, of the -curative value of music in certain mental disorders. - -The story of Naaman (2 Kings v.) deserves to be mentioned briefly here. -He was captain of the host of the King of Syria (about 894 B. C.) and -a man of valor, highly esteemed by his master, but he was--according -to the Bible statement--a leper. Learning casually that there was -in Samaria a prophet who might be able to cure his disease, he put -a large sum of money into his sack and departed for that country. -“So Naaman came with his horses and with his chariot, and stood at -the door of the house of Elisha. And Elisha sent a messenger unto -him, saying, Go and wash in Jordan seven times, and thy flesh shall -come again to thee, and thou shalt be clean.” Naaman, at first much -displeased with the advice given to him by Elisha, and especially by -the very informal manner in which it had been communicated to him, -finally decided to follow the prophet’s instructions. “Then went he -down, and dipped himself seven times in Jordan, ... and his flesh came -again like unto the flesh of a little child, and he was clean. And he -returned to the man of God, ... and came, and stood before him; and -he said, Behold, now I know that there is no God in all the earth, -but in Israel: now therefore, I pray thee, take a blessing of thy -servant.” Elisha, however, refused persistently to accept any reward -for the advice which he had given. He simply said to Naaman: “Go in -peace.” Before he departed, however, Naaman expressed to Elisha the -hope that he would be pardoned if he yielded to the necessity of bowing -down to the god Rimmon on certain occasions--as, for example, when he -accompanied his master, the king, on his visits to the temple of that -god for the purposes of worship. From the evidence furnished by this -account, as given in the Old Testament, it is fair to assume that both -Naaman and the writer of the book of Kings believed that the cure had -been effected by supernatural means. The modern physician, however, -is not ready to accept such an interpretation of the manner in which -Naaman’s cure was effected, but prefers to believe that the supposed -leprosy was in reality some curable form of skin disease which to -the unprofessional eye appeared like the other malady. It might, for -example, have been an aggravated general eczema, dependent upon such -excesses of eating and drinking as a wealthy captain of the king’s host -would be likely to indulge in. And if this supposition is correct, one -cannot but admire the great practical wisdom of Elisha in advising -Naaman to take seven baths--one a day presumably--in the river Jordan, -a spot so far removed from his home that it would scarcely be possible -for him to obtain any but the simplest kind of diet during this -comparatively long period of time. - -An interesting case of snake-bite is briefly related in Acts xxviii., -3–6. It is stated that “when Paul (after being shipwrecked on the -Island of Melita) had gathered a bundle of sticks, and laid them on the -fire, there came a viper out of the heat, and fastened on his hand. And -when the barbarians saw the venomous beast hang on his hand, they said -among themselves, No doubt this man is a murderer, whom, though he hath -escaped the sea, yet vengeance suffereth not to live. And he shook off -the beast into the fire, and felt no harm. Howbeit they looked when he -should have swollen, or fallen down dead suddenly: but after they had -looked a great while, and saw no harm come to him, they changed their -minds, and said that he was a god.” This narrative is interesting in -several respects, but there is one feature that deserves to receive -special mention, viz., the fact that Paul experienced no harm from the -bite of a poisonous serpent--a wound which frequently proves fatal. -Inasmuch as the account distinctly states that the reptile “fastened on -his hand” and that “the barbarians saw the venomous beast hang on his -hand,” the conclusion is warranted that one or both of the creature’s -fangs had entered the hand by a curving route, and probably in such -a manner that the free end of each fang, from which the poison is -ejected, passed completely through the skin from within outward. When -the bite of a poisonous snake is of a character such as I have just -described,--and not a few of them have this character,--only a very -small quantity of the venom is lodged in the subcutaneous tissues, -where the larger blood- and lymph-channels lie, and as a consequence the -person bitten escapes serious harm. On the other hand, when the fangs -enter the flesh in a less decidedly curving direction, thus permitting -a greater quantity of the venom to reach and remain in the deep-lying -tissues, serious or even fatal results may be anticipated. The point, -then, which I desire to make is simply this: Paul’s escape from death -in this instance may perfectly well be ascribed to natural causes. - -The Israelites, at a certain stage of their history, appear to have -completely divorced the practice of medicine from the priestly -function. In one place, for example, it is stated that King Asa sought -relief from his ailment, not from Jehovah, but from the physicians. -Jeremiah expresses astonishment that not a single physician is to -be found in Gilead. May this not be interpreted as signifying that -regularly established physicians were at that time (595 B. C.) to be -found in some parts of Palestine? And, at a much earlier period (1500 -B. C.), Job calls his friends “physicians of no value” (Job xiii., -iv.). From these and a number of other statements in the Bible it seems -permissible to believe that, at a very early period of history, the -Jewish physicians occupied an entirely independent position. - -It would doubtless appear strange to most readers of this brief sketch -of the history of medicine if some reference were not made in this -place to Luke, the author of the gospel which bears his name and of -the Acts of the Apostles, and who was also the companion of Paul on -his journey to Rome and during a portion of the latter’s stay in that -city. Luke was a native of Antioch, in Syria, and not a Jew. He was -a physician and tradition says that he was also a painter. It is not -known where he received his medical training, but it is not at all -unlikely that he studied at Alexandria, in Egypt, where the greatest -facilities for such training, obtainable at that period, were to -be found. His style of writing shows plainly that he was a man of -considerable cultivation and endowed with a clear and logical mind; and -if he had not possessed a genial personality he would hardly have been -known as “the beloved physician”; nor could any other motive but those -of loyal, self-sacrificing friendship for his friend, and a desire to -promote the cause of Christianity, have led him to share with Paul the -dangers and discomforts of the journey to Rome. - -_The Medicine of India, China and Japan._--It would be too much -of a departure from the plan which is being followed in the writing of -this history to attempt to describe, even in the briefest manner, the -mode of development of the science and art of medicine in India, China -and Japan. Unquestionably the earlier physicians of these countries -made many valuable contributions to medical knowledge, but they were -made at such a period of time, or under such conditions, that they -could not have exerted an appreciable influence upon the development -of medicine in ancient Greece,--certainly no such influence as was -exerted by Assyria and Persia, and especially by Egypt. It therefore -seems permissible to speak of the medicine of these more remote -countries only incidentally, and not as an integral part of the series -of centres of learning which made the medicine of ancient Greece the -direct ancestor--if I may use such a term--of European medicine.[11] -In conformity with this idea it will be well to mention here briefly -a few of the more important facts relating to the achievements of the -physicians of the three countries named. - -The most celebrated medical authors in India were Caraka, Súsruta and -Vagbhata--“The ancient trinity,” as they were called. Caraka probably -lived during the early part of the Christian era, Súsruta during the -fifth century, and Vagbhata not later than during the seventh century -A. D. It is apparent, therefore, that none of the treatises written -by these authors could have exerted the slightest influence upon the -growth of medical knowledge in ancient Greece. - -The crudeness of many of the conceptions held by these Hindu physicians -concerning pathology is revealed in the following definition: -“Health is the expression of the normal composition of the three -elementary substances (air, mucus and bile) which play a vital -part in the machinery of the human body, and it is also dependent -upon the existence of normal quantitative relations between these -three substances; and when the latter are damaged, or when they are -abnormally increased or diminished, then disease of one kind or another -makes its appearance.”[12] - -Great stress was laid by the physicians as well as by the priests of -ancient India upon the observance of very elaborate rules respecting -the care of the person while in health and, very naturally, when a -patient became ill the physician in charge paid quite as much attention -to the employment of hygienic and dietetic measures in effecting the -desired cure as to the administering of drugs. - -The list of the commonly employed hygienic measures is too long for -reproduction in its entirety in this brief sketch, but an enumeration -of some of the more important items may prove interesting. In -estimating the value of these rules the reader should bear in mind -that they were intended for people living in a hot climate. Daily -bathing heads the list. Then follow: regulation of the bowels; rubbing -the teeth with fresh twigs of certain trees which possess astringent -properties, and also brushing them twice a day; rinsing the mouth with -appropriate washes; rubbing the eyes with salves; anointing the body -with perfumed oils; cutting the nails every five days, etc. Two meals -a day were prescribed--the first one between nine in the morning and -noon, and the second between seven and ten in the evening. “Only a -moderate amount of water should be drunk during the meal; drinking -water at the beginning of a meal delays digestion, while a copious -draught at the end produces obesity. After the meal the mouth should -be carefully cleansed and a short walk should be taken.” Among the -more important articles of food the following deserve to be mentioned: -rice, ripe fruit, the ordinary vegetables, ginger, garlic, salt, milk, -oil, melted butter, honey and sugar cane. If meat is eaten, preference -should be given to venison, wild fowl and the flesh of the buffalo. -The meat of the pig, and beef, as well as fish, are less conducive -to health. Gymnastic exercises in moderation are beneficial. Sleep -should be indulged in during the day only after some specially severe -exercise; at night it should not be extended beyond one hour before -sunrise. Bathing immediately after eating is harmful, and it is not to -be indulged in when one is affected with a cold, with a high fever, -with diarrhoea, or with some disease of the eyes or ears. A hot bath -or washing with warm water may be beneficial for the lower half of the -body, but for the upper half it is harmful. Sea bathing and cold baths -(preferably in the river Ganges) are beneficial. The clothing worn -should be clean; soiled garments are likely to produce skin diseases. -It is advisable to wear shoes, and an umbrella or a staff should be -carried. The wearing of garlands, finery, and jewels increases the -vital powers and keeps away evil spirits. The following are good -measures to adopt for the preservation of health: an emetic once a -week; a laxative once a month; and a bloodletting twice a year. All -the measures enumerated above were subject to modification according -to changes in the season, the locality, the weather, and various other -circumstances. - -In harmony with the extraordinary fruitfulness of the land the -pharmacopoeia of India is very rich. It is a remarkable fact that not -one of the numerous drugs mentioned in the official list is of European -origin. The great majority of them belong to the vegetable kingdom; -Caraka stating that he knew of 500 plants that possessed remedial -virtues, while Súsruta placed the number at 760. Then, too, the list -contains a goodly number of drugs which belong, some to the animal and -others to the mineral kingdom. It appears that the physicians of India -began using mineral substances, both externally and internally, at a -very early period of their history. Among such substances the following -may be mentioned: sulphate of copper, sulphate of iron, sulphate of -lead, oxide of lead, sulphur, arsenic, borax, alum, potash, chloride -of ammonium, gold, precious stones of different kinds, etc. The people -of India were skilled in chemical and pharmaceutical work. The drugs -were prepared by them in a great variety of ways--as, for instance, -extracts of the juices of plants, infusions, decoctions, electuaries, -mixtures, syrups, pills, pastes, powders, suppositories, collyria, -salves, etc. Practicing physicians carried with them a sort of portable -medicine chest, and they often collected, themselves, the medicinal -plants which they required. Súsruta gives instructions as to the spots -where certain plants are most likely to be found, and as to the seasons -when they should be gathered. Charlatanry and mysticism often played a -part in this business. Thus, it was maintained that drugs collected and -prepared by persons other than physicians did not produce the desired -effects. The fact that cosmetics (especially hair dyes), “elixirs of -life,” aphrodisiacs, poisons and antidotes for poisons, occupy the most -prominent place in the list of pharmaceutic preparations sold, casts -a glaring ray of light, as Neuburger states, on the degree of culture -among the people of ancient India. - -The list of separate maladies recognized by the physicians of the -latter country is inordinately long. There were 26 kinds of fevers, 13 -species of swellings of the lower abdomen, 20 different diseases due to -worms, 20 kinds of urinary diseases, 8 varieties of strangury, 5 kinds -of jaundice, 5 varieties of cough or asthma, 18 kinds of “leprosy,” 6 -kinds of abscesses, 76 different eye diseases, 28 affections of the -ear, 65 disorders of the mouth, 31 nasal affections, 18 diseases of -the throat, a large number of mental disorders, etc. It seems scarcely -necessary to remark that these so-called diseases were in reality -only groups of certain types of loosely related symptoms. The term -“leprosy,” for example, included, besides the disease which modern -physicians call by that name, a number of different affections of the -skin. It is worth noting here that diabetes mellitus, which is one -of the twenty different kinds of urinary diseases enumerated in the -classified list mentioned above, was first described by the physicians -of India, whose attention was directed to the disorder by observing -that flies and other insects were attracted to the urine of these -patients by reason of its sweetness. It is also an interesting fact -that occasionally these physicians, who, beyond a doubt, were keen -observers of symptoms, paid some attention to the anatomical features -of the individual cases. Thus, it is stated that the particular form of -swelling of the lower abdomen, to which they applied the name “splenic -belly,” is dependent upon “an enlarged spleen which distends the left -side, is as hard as a stone, and is arched like the back of a turtle”; -whereas they spoke of “an enlargement of the liver” when very much the -same conditions were observed on the right side of the abdomen. The -accuracy of their clinical observations is particularly noticeable in -their accounts of cases of consumption, apoplexy, epilepsy, hemicrania, -tetanus, rheumatism, venereal diseases, some affections of the skin, -and insanity. It was in their surgical technique, however, that -the physicians of ancient India were distinguished above all their -brethren of the neighboring oriental countries, and this superiority -they maintained for a very long time. Among the operations which they -performed the following may be mentioned: they removed tumors by -excising them, they opened abscesses by the use of the knife, they -employed scarifications (in inflammations of the throat) and made -punctures (in hydrocele and ascites), they passed probes into fistulae, -they extracted foreign bodies, and they employed needles armed with -hairs taken from the horsed tail or with thread composed of flax or -hemp. According to Súsruta their stock of instruments was composed of -101 blunt and 20 cutting instruments. Among those which were blunt -there were forceps of different sizes and forms, hooks, tubes, probes -or sounds, catheters, bougies, etc. They made use of the magnet -for drawing out foreign bodies of iron, and they applied cups for -therapeutic purposes. Their cutting instruments consisted of knives, -bistouris, lancets, scissors, trochars, needles, etc. Steel was the -metal of which they were made; for the people of India learned at a -very early period how to make steel. In suitable cases cauterization, -either with the actual cautery or with caustic potash, was a favorite -method of treatment with the surgeons of ancient India. “Burning with -the heated iron,” they taught, “is more effective than cauterization -with potash, inasmuch as it permanently cures diseases which may not be -cured by either drugs, surgical instruments, or chemical cauterizing -agents.” In cases of enlargement of the spleen they plunged red-hot -needles into the parenchyma of the organ, presumably through the -skin and other overlying tissues. There were fourteen different -kinds of surgical dressings; cotton, woolen, linen and silk being -the materials used for bandages, and strips of bamboo or some other -wood for splints. When the conditions permitted such a proceeding, -it was customary to sew up wounds of the head, face and windpipe. -Furthermore, it was the rule to perform all surgical operations at a -time when the constellations were favorable. Religious ceremonies were -performed both before the operation and after it was completed, and -it was also considered necessary that the operator should face the -west and the patient the east. Intoxication was employed as a means -of securing narcosis. Owing to their scrupulous cleanliness and the -minute attention which they paid to details, the surgeons of ancient -India obtained for a long time a much higher degree of success than -did the surgeons of other oriental nations. At the same time they were -not lacking in that degree of boldness which enables an operator--in -critical cases which probably without such prompt and radical action -would terminate fatally--to save life. For example, they did not -hesitate to open the abdominal cavity and to sew up a wound in the -intestines; they cut for stone in the bladder, employing for this -purpose the lateral method of operating; and they performed a great -variety of plastic operations. - -Some of their hygienic rules concerning pregnant and nursing women -are eminently practical; others would hardly be approved by modern -accoucheurs. Here are a few of these rules: During the period of a -woman’s pregnancy close attention should be paid to her diet, and -special care should be exercised by her to avoid excesses or errors -of any kind. When the ninth month is reached she should take up her -abode in the small cottage in which she is eventually to be confined--a -building erected with special religious ceremonies and thoroughly -fitted with everything that is likely to conduce to her comfort. At -the time of the actual confinement she should have with her four -female assistants, and all those measures, of either a religious or a -practical character, which have in view the hastening of the birth of -the infant, should be scrupulously carried out. If any delay in the -delivery of the after-birth occurs, the removal of the mass may be -promoted by the employment of well-directed pressure over the lower -part of the abdomen, by shaking the body, and also, if necessary, by -giving an emetic. The woman in childbed should not be allowed to get -up before the tenth day after her confinement, and for a period of -six weeks her diet should be most carefully watched. On the third day -the child should be put to the mother’s breast; up to that time it -should be given only honey and butter. If the mother, for any reason, -is not able to suckle the infant, a wet-nurse should be employed for -the purpose, but not until the physician shall have subjected her to -a most thorough examination and shall have instructed her minutely in -regard to her own diet. The subsequent care of the child was provided -for in the most particular manner: It was restricted to a carefully -planned diet; it was not allowed to sit or to lie except in certain -prescribed positions; its times for sleeping were strictly ordered; -it was permitted to amuse itself only in certain ways;--in brief, -everything was done according to strict rules, even special precautions -being taken to guard the child, during the first years of life, against -dangerous demons. Weaning began after the sixth month, and for a -certain length of time the child was fed largely on rice. In cases of -difficult labor and in their gynaecological practice the physicians of -ancient India did not manifest any special knowledge or skill. - -One of the instructions given to young physicians in India when they -were about to enter upon the practice of their profession, may be -of interest to the reader. It is worded as follows: “Let thy hair -and finger-nails be cut short, keep thy body clean, put on white -garments, wear shoes on thy feet, and carry a staff or umbrella in thy -hand. Thy demeanor should be humble, and thy heart pure and free from -deceitfulness.” The following proverb, although it originated in India, -is well worthy of acceptance in every part of the world: “When you are -ill the physician will be to you a father; when you have recovered from -your illness you will find him a friend; and when your health is fully -re-established he will act as your protector.” - -On a previous page the statement has been made that the science and -art of medicine developed in ancient Greece quite independently of -any influence that might have been exerted by the teachings of the -physicians of India. This statement should be somewhat modified, for it -is reasonable to suppose, although directly confirmatory evidence has -not yet been discovered, that, through the channels of trade between -the two countries, some knowledge of the doings of the physicians -of India must have reached the ears of their Greek brethren. On the -other hand, at a later period of history (after Alexander the Great -had invaded India), the relations between the two countries became -quite close and were kept up without a break for several hundred -years. During the earlier part of this later period, as appears from -the writings of Hippocrates, Dioscorides and Galen, various drugs and -methods of treatment employed by the physicians of India were adopted -by the practitioners of Greece. - -_Medicine of the Chinese and Japanese._--The isolation of China -with respect to those countries which were within comparatively easy -reach and in which there was a civilization that, already several -thousand years before the Christian era, had attained a remarkable -degree of development (India, Babylonia and Egypt, for example); her -blind belief in authority; her unwillingness to tolerate any influences -that seemed to emanate from foreigners; and her complete satisfaction -with her own methods of doing things, with her own beliefs, and with -her own natural and manufactured products,--these, it is generally -believed, were the most important factors in keeping this remarkable -nation in a state of immobility as regards at least some departments -of human knowledge and accomplishment. This is particularly true in -respect of the science and art of medicine. But China is at last -waking up from this lethargic state. A wonderful change has come over -her during the past twenty or thirty years, and she is now beginning -to realize that, with her millions of population and wonderful -natural resources, she has an important part to play in advancing the -civilization of the world. - -The preceding remarks must not be interpreted as signifying that, -during the long ages of the past, China has not been developing and -is not able at the present time to show a record of very creditable -work accomplished in many departments of human activity. In her early -history, many centuries ago, she accomplished great things, and all--so -far as we now know--without aid from neighboring nations; but there -came a time when all this creative activity ceased, and then, for long -periods of years, she appeared to rest satisfied with the advances -which she had already made, and to have no further ambition to add to -the stock of her possessions. - -Among the valuable things which should be credited to the Chinese -are the following: the discovery of the compass (about 1100 B. C.), -the making of porcelain, the invention of printing, the raising of -silkworms, the manufacture of glass and of paper, the successful dyeing -with purple, embroidering with gold, working in metals, the artistic -cutting of precious stones, enameling, the making of “India ink,” etc. -Furthermore, it is a fact most creditable to the Chinese that in no -other country in the world have scholars been held in such high esteem, -or assigned so high a rank, as they have been and still are in China. - -Chinese medicine possesses a very rich literature. The first medical -treatise, which deals with plants that possess medicinal virtues, is -ascribed to the Emperor Schin-Nung, who flourished about 2800 B. C. -This is the monarch who taught his people from which springs they -should drink, and who tested all the plants of his vast empire with -reference to their healing properties. According to the legend the -wall of his stomach was so thin that he could look through it and see -everything that was going on in the interior of that organ. In this way -he was able to carry on a large series of experiments upon himself in -regard to the action of different poisons and their antidotes. It is -also related that medical knowledge was still further advanced by the -yellow Emperor Hoang-Ti who lived about 2650 B. C., and who is credited -by the Chinese with having invented arithmetic and music. The treatise -called “Noi-King,” which deals with the subject of internal diseases -and gives a systematic account of human anatomy, is also credited -by the Chinese to this monarch; but Neuburger maintains that this -book, which is still in common use in China, is of much more recent -origin. There are several other medical treatises which deserve to be -mentioned. Such, for example, are the following: the celebrated book on -the pulse, written by Wang-Schu-Scho in the third century B. C.; two -very important books written by Cho-Chiyu-Kei--one bearing the title -“Schang-Han-Lun” (On Fevers) and the other that of “Kin-Kwéi” (Golden -Casket);--the different treatises written by Tschang-Ki (tenth century -A. D.) and published in the collection called “The Golden Mirror of -the Forefathers in Medicine” (I-Tsung-Kin-Kien); and, finally, the -very popular modern work (in forty volumes) entitled “The Trustworthy -Guide in the Science and Art of Medicine” (“Ching-Che-Chun-Ching”). Of -these forty volumes, seven are devoted to nosology, eight to pharmacy, -five to pathology, six to surgery, and the remainder to children’s and -women’s diseases. - -Anatomy, it appears, has never played other than a very insignificant -part in the Chinese system of medicine. This is not to be wondered -at when we remember that their religion makes the dissection of a -human body a sin worthy of punishment. No mutilated person, the -Chinese believed, would be permitted, upon reaching the domain of -the dead, to rejoin his ancestors. About the year 1700 A. D. the -Emperor Kang-Hi made the attempt to incorporate anatomy as a part -of the regular study of medicine in the Chinese Empire; his first -step being the authorization of P. Perennin, a Jesuit Father, to -translate Dionis’ work on anatomy into the Chinese. His efforts were, -however, unsuccessful, owing to the strong opposition offered by the -native physicians. And the attempts made during more recent times -to accomplish the desired reform by introducing copies of European -anatomical illustrations do not appear, as yet, to have produced any -appreciable impression. In very recent years, however, the medical -missionaries, sent out, if I am rightly informed, from the United -States, are giving excellent instruction in anatomy. - -Physiology, as taught by the Chinese, is something beyond the -comprehension of modern Europeans. Neuburger explains their views -in the following manner: “The cosmos is the product of the combined -action of two dissimilar forces--the male (Yâng) and the female (Yin). -When these forces work in harmony a state of equilibrium results.... -Matter consists of five elements, viz., wood, fire, earth, metal, and -water; and all things are composed of these elements. In sympathetic -relationship with these five elements stand the five planets (Jupiter, -Mars, Saturn, Venus, Mercury), the five different kinds of air (wind, -heat, moisture, dryness, cold), the five quarters of the globe (east, -south, west, north and the equator), the five periods of the year (in -addition to the four which we recognize, the Chinese make a fifth -period out of the last eighteen days of spring, summer, autumn and -winter), the five times of day, the five colors (green or blue, red, -yellow, white and black), the five musical tones, etc.... As in the -cosmos, so in man the two primeval forces--Yâng and Yin--underlie all -his vital processes. Thus, his body is made up of the five elements of -which all matter is composed, and health depends upon the maintenance -of a state of equilibrium between the male and the female forces, -etc.” After this brief exposition it seems unnecessary to devote any -further space to the consideration of the physiological doctrines of -the Chinese. - -With respect to the questions of diagnosis and prognosis it may be -stated that the Chinese attach great importance to the necessity of -making a most careful objective examination of the entire body; but, -when one investigates the precise manner in which this examination is -to be carried out, it soon appears that most of the details relate to -matters of a purely fanciful or mystical nature. The only steps of real -importance, according to them, are the examination of the patient’s -pulse and the inspection of his eyesight and his tongue. From the -examination of the pulse alone they believe it possible to diagnose -the nature and seat of the disease. To examine the pulse properly -is a complicated affair and can scarcely be carried out in actual -practice in less time than ten minutes; indeed, in certain cases the -physician may find it necessary to devote two or three hours to the -business. According to the Chinese scheme there are many different -kinds of pulse, and there are no less than thirty-seven different types -of condition presented by the tongue, each bearing its own special -pathological significance. - -Disease, so reads the Chinese doctrine, is a discord, a disturbance -of equilibrium, caused by the preponderance of one or the other of -the primeval forces (the male or the female). It manifests itself -in some disorder of the circulation of the vital air and the blood, -and eventually involves the organs of the body. Wind, cold, dryness, -moisture, the emotions and passions, poisons, and also evil spirits and -imaginary beasts are the causes of disease. - -No other nation, says Neuburger, has at its command such a large number -of remedial drugs; and it is also a fact, he adds, that the department -of therapeutics is that in which Chinese medicine has reached its -highest development. The steadfast belief that in nature there exists -a remedy for every human ill led the physicians of that country to -search diligently in all possible directions for vegetable and animal -and also, to some extent, mineral substances which might possess -remedial virtues. Although this search necessarily brought to notice -a lot of useless drugs, it cannot be denied that eventually it added a -considerable number of remedies which have proved useful to the medical -profession of the entire world. In this category belong the following: -rhubarb, pomegranate root as a cure for worms, camphor, aconite, -cannabis, iron (for the relief of anaemia), arsenic (for malarial and -skin diseases), sulphur and mercury (both of these for affections of -the skin), sodium sulphate, copper sulphate (as an emetic), alum, -sal ammoniac and musk (for nervous affections). Toward the middle -of the sixteenth century A. D. there was published, under the title -“Pen-Tsao-Kang-Mu,” a monumental work (fifty-two volumes) in which are -very fully described no fewer than 1800 remedies, mostly of a vegetable -nature. Prophylactic Inoculation with the pus from a small-pox pustule -was practised by the Chinese as long ago as during the eleventh century -A. D., “thus constituting a forerunner of our modern serum therapy.” -(Neuburger.) Vaccination was not introduced into China until during the -nineteenth century of the present era. It is a curious fact that, in -the choice of a remedy, the Chinese physicians attach a certain degree -of importance to the form and color of the drug, as symbols indicative -of the effect which they may be expected to produce. Thus, the red -blossoms of the hibiscus plant are believed to be more efficacious -than the white as an emmenagogue; saffron, being of a yellow color, -possesses the power to relieve jaundice; beans that have the shape of -a kidney should be prescribed in cases of renal disease; glow-worms -should form a part of all eye-washes, etc. - -The doses prescribed are very large, and the medicines are often put up -in an attractive form, with labels on which such descriptive titles as -these are written: “Powders of the Three very wise Men,” or “Powders -recommended by Five Distinguished Physicians”--titles which are -calculated to work upon the imagination of the patient. - -There are two methods of treatment which the Chinese physicians -are very fond of employing for the relief of a great variety of -diseases--viz., acupuncture and cauterization of the skin over the -seat of the malady by means of what are termed “moxae”--moxibustion. -Moxae are prepared by kneading together into a cone-shaped, tinder-like -mass the leaves of the artemisia vulgaris, then drying it thoroughly. -Such a mass is attached to the skin at the affected spot by simply -moistening the base of the cone, after which the apex is ignited. Some -physicians prefer to interpose a thin sheet of metal between the skin -and the base of the moxa. The manner in which these contrivances should -be used in the different diseases and the proper number to employ are -matters subject to fixed rules. In a strong individual, for example, -as many as fifty moxae may be used at a time. In affections of the -chest they were applied to the patient’s back, in diseases of the -stomach to the shoulders, and in venereal affections over the spinal -column. In acupuncture, which is a procedure invented by the Chinese, -slender needles of gold, silver or highly tempered steel, from 5 to 22 -centimetres (2 in.-8¼ in.) in length, were forced through the stretched -skin to different depths (1¼ in.-1½ in.) and then driven farther inward -in a rotary direction by means of a small hammer. The needles, after -being allowed to remain in situ for a few minutes, were withdrawn, and -pressure was made with the hand over the small wounds, or a moxa was -burned over the spot. There are in all 388 places where acupuncture may -be performed, and a chart of the body, showing where these places are -located, has been prepared for the guidance of the Chinese physicians. -Neuburger calls attention to the fact that the latter dislike the sight -of blood, and that this is one of the reasons why acupuncture and the -use of moxae have grown to be such popular remedies. Bloodletting -is rarely employed by them; but dry cupping, on the contrary, is a -favorite procedure in certain maladies. Massage is generally performed -by old or blind women, and much attention is devoted to the “movement -cure,” which is said to have been invented about 2500 B. C. - -As may readily be imagined, the Chinese--owing to their dislike for the -sight of blood and also by reason of their ignorance of anatomy--have -not advanced, in surgery, beyond the most primitive state of that art. - -The science of public health is quite unknown in China. In a Chinese -treatise entitled “Long Life,” the following advice is given: “Always -rise early in the morning, take some breakfast before you leave your -residence, drink a little tea before eating, at the mid-day meal -partake of well-cooked but not too highly salted food, eat slowly, take -a nap of two hours after the meal, eat lightly at night, and, before -going to bed, rinse your mouth with tea and have the soles of your feet -rubbed until they are warm.” (Neuburger.) - -Up to the latter part of the nineteenth century of the present era, -Japan, so far as medical matters are concerned, differed in no -material respect from China. During the last fifty or sixty years, -however,--that is, since the visit of Commodore Perry, of the United -States Navy, to that country,--wonderful changes have taken place; and -now Japan, as a result of her determination to adopt the methods of -education, of utilizing steam and electric power, etc., has already -taken a leading place in the council of nations. The physicians, many -of whom received their training in the best schools of Europe and -the United States, are contributing to-day their full share toward -advancing the science of medicine. That China is following in the -footsteps of Japan is already plainly evident, and no intelligent -observer entertains the slightest doubt of her ultimately--probably at -no distant day--possessing a corps of medical men as well educated, -as efficient in the treatment of disease, and as practical in public -hygiene as their European and American confrères. During thousands -of years China has suffered severely from the blighting tyranny of -superstition, priestcraft and selfish bureaucracy, and, now that the -sunlight of truth and genuine liberty is beginning to search every nook -and cranny of that great country, we who have had the advantage of this -beneficent influence for so many scores of years truly rejoice over the -change that is taking place in China. - - - - - CHAPTER IV - - GREEK MEDICINE AT THE DAWN OF HISTORY - - -It is from Greece and from Greece alone, says Daremberg, that our -modern medicine derives its origin. - - It has come down to us, in a direct line, through the sheer - force of its inherent excellence, and with little or no aid from - outside sources. Harvey, Bichat and Broussais are as much the - legitimate heirs of Hippocrates, Herophilus, Galen, Berenger de - Carpi and Vesalius, as Hippocrates is the heir of Homer, and - as this divine singer of the anger of Achilles is himself the - product of a civilization that existed before his day and that - was in all probability the creation of Hindu influences. - -It is to the development of medical knowledge in Greece, therefore, -that our attention should next be directed, and more particularly to -that period which belongs to the dawn of history--the pre-Homeric -period. - -_The pre-Homeric Period of Medicine in Greece._--The poems of -Homer, the Iliad and the Odyssey, furnish us with the earliest and -almost the only written evidence of the state of medicine in Greece -during that period of time. They were probably written, according -to the authority of the Earl of Derby, somewhere about 800 B. C., -and modern investigations show that the siege of Troy, the theme -of the Iliad, occurred between the years 1194 and 1184 B. C. These -investigations also show that in this region, and especially in the -Island of Crete and in Mycenae on the neighboring mainland of Asia -Minor, at this time and probably several hundred years earlier, there -existed a high degree of civilization. Specimens of a written language, -for example, were found among the objects recovered from the ruins -of the palace of King Minos at Cnossus in Crete, but hitherto no -interpreter of this unknown language has been found. It is reasonable -to expect, however, that in due time these Minoan records will be -translated, that still other records belonging to this remote age -will be discovered, and that much valuable information regarding the -condition of medical knowledge in Greece during this long period -will then be revealed to us. Strange as it may appear, the classical -Greek writers seem to have possessed very little knowledge concerning -this highly developed civilization at Cnossus. And yet, if we stop -to consider the matter, their silence will appear less strange for -the following reasons. Some great calamity (war, an earthquake, or a -conflagration) must have destroyed many of the evidences of Minoan -civilization besides those which are now being brought to light; then, -also, several hundred years elapsed between the occurrence of this -disaster and the classical period of Greek culture; and, finally, there -is the fact that the knowledge of past historical events, when kept -alive simply by tradition, slowly vanishes, until finally it becomes -so vague as to possess very little value. The discoveries made in the -Island of Crete and at Mycenae were not known to Daremberg when he -wrote the lines quoted above, but he felt perfectly sure, from his -knowledge of the laws of development in general, that a product so -highly cultured as Homer could not have suddenly sprung into existence -out of the apparent darkness and ignorance of the centuries immediately -preceding his time. - -_The State of Medical Knowledge at the Time of the Siege of -Troy._--It is from Homer’s Iliad and Odyssey that our authoritative -knowledge of the most ancient Greek medicine is derived. In the former -work mention is made of Aesculapius and his two sons, Machaon and -Podalirius, both of whom accompanied Agamemnon and the Greek host in -their expedition against Troy. According to this author’s account they -served in the double capacity of surgeons to the army and valiant -leaders of troops. In order that the reader may judge for himself just -what is the nature of the evidence furnished by Homer with regard to -the medical knowledge of that period, it seems desirable to introduce -here a few of the more characteristic references which the poet makes -to spear, javelin and arrow wounds, to the injuries caused by fragments -of rocks hurled by the assailants, and to various remedial measures, -both surgical and medical, employed for the relief of the wounded or -sick warriors. There are at least one hundred such passages in the -Iliad alone, but the few which are here cited will serve as adequate -examples of Homer’s familiarity with anatomy and with some of the -methods of treating spear and arrow wounds,--a familiarity which -indicates that the poet must have had some medical training. - - Thus he; and not unmoved Machaon heard: - They through the crowd, and through the widespread host, - Together took their way; but when they came - Where fair-hair’d Menelaüs, wounded, stood, - Around him in a ring the best of Greece, - And in the midst the godlike chief himself, - From the close-fitting belt the shaft he drew, - With sharp return of pain; the sparkling belt - He loosen’d, and the doublet underneath, - And coat of mail, the work of Arm’rer’s hand. - But when the wound appeared in sight, where struck - The stinging arrow, from the clotted blood - He cleans’d it, and applied with skilful hand - The healing ointments, which, in friendly guise, - The learned Chiron to his father gave. - (Book IV. of the Iliad, Lines 221–259.) - - * * * * * - - He said: the spear, by Pallas guided, struck - Beside the nostril, underneath the eye; - Crashed through the teeth, and cutting through the tongue - Beneath the angle of the jaw came forth: - Down from the car he fell; and loudly rang - His glittering arms: aside the startled steeds - Sprang devious: from his limbs the spirit fled. - Down leaped Aeneas, spear and shield in hand, - Against the Greeks to guard the valiant dead; - And like a lion, fearless in his strength, - Around the corpse he stalk’d, this way and that, - His spear and buckler round before him held, - To all who dar’d approach him threatening death, - With fearful shouts; a rocky fragment then - Tydides lifted up, a mighty mass, - Which scarce two men could raise, as men are now: - But he, unaided, lifted it with ease. - With this he smote Aeneas near the groin, - Where the thigh bone, inserted in the hip, - Turns in the socket joint; the rugged mass - The socket crushed, and both the tendons broke, - And tore away the flesh: down on his knees, - Yet resting on his hand, the hero fell; - And o’er his eyes the shades of darkness spread. - (The Iliad, Book V., Lines 333–356.) - - * * * * * - - He said, and passing his supporting hand - Beneath his [Eurypylus’] breast, the wounded warrior led - Within the tent; th’ attendant saw, and spread - The ox-hide couch; then as he lay reclined, - Patroclus, with his dagger, from the thigh - Cut out the biting shaft; and from the wound - With tepid water cleans’d the clotted blood; - Then, pounded in his hands, a root applied - Astringent, anodyne, which all his pain - Allayed; the wound was dried, and stanch’d the blood. - (The Iliad, Book XI., Lines 958–967.) - - * * * * * - - But Jove-born Helen otherwise, meantime, - Employed, into the wine of which they drank - A drug infused, antidote to the pains - Of grief and anger, a most potent charm - For ills of every name.[13] Whoe’er his wine - So medicated drinks, he shall not pour - All day the tears down his wan cheeks, although - His father and his mother both were dead, - Nor even though his brother or his son - Had fallen in battle, and before his eyes. - (Book IV. of the Odyssey, Lines 275–284.) - -In former years and down almost to the present time, it was the custom -among English medical writers to speak of Aesculapius only as the -“God of Medicine,” thus conveying to the minds of many readers that -he was a mythological character, not a real personage. To-day, and -especially since Schliemann has demonstrated, by his excavations at -the site of ancient Troy, that Homer’s Iliad is not merely a beautiful -creation of his poetic fancy, but a narration of events that actually -occurred about 1200 B. C., it is quite generally acknowledged that -Aesculapius[14] is an historical character, an individual whose memory -should receive due honor from the physicians of modern times. Neither -Homer nor Pindar speaks of him as a god. In Athens he was publicly -deified in 420 B. C. - -When Daremberg, as quoted above, expressed the belief that Hippocrates -was the product of an earlier civilization, he undoubtedly gave due -weight to other circumstances beside those which are narrated in -Homer’s poems--circumstances, for example, which are referred to -casually by several of the classical Greek authors, and to which fresh -importance has been given by a number of recent discoveries. Thus, -there is an abundance of evidence showing that the Greeks, both before -and after Homer’s time, held the memory of Aesculapius in the very -highest honor. So great, as they believed, was his power over disease, -so wonderful were the cures which he accomplished, and so noble and -pure was his character, that they made him a god and erected temples -in his honor--not mere places where a barren worship might be carried -on, but veritable sanatoria--termed Asclepieia--where the extraordinary -healing powers of him whom they had made a god might be perpetuated -for the benefit of succeeding generations. While, on the one hand, -the ancient Greeks may have been full of superstitious beliefs, they -were at the same time as kindly disposed toward their fellow men, as -generous in their spending of money for this purpose, and as practical -in their selection of suitable methods as are the benefactors of to-day -all over the world. In course of time these so-called temples became -the prototypes of our hospitals, sanatoria and schools of medicine, -and it therefore seems only proper that they should here be described -somewhat in detail. - -_The so-called Aesculapian Temples and their Chief Purpose._--The -first of these temples, or Asclepieia, were established at Trikka, in -Thessaly; at Cnidus, on the coast of Caria in Asia Minor, opposite -Cos; at Epidaurus, in Argolis, Greece; at Cyrene on the northern -coast of Lybia, Africa, opposite the Island of Crete; at Crotona, -on the southeastern coast of Italy; and, finally, at Athens. It is -said that traces of as many as eighty of these Asclepieia have been -found in different parts of the ancient world. One of them, for -example, is known to have existed on the small island (Isola San -Bartolommeo) in the Tiber, at Rome. Their management was intrusted, in -the earlier years of their existence, to men who were descendants of -Aesculapius--i.e., the sons and grandsons of Machaon and Podalirius. -They were both priests and physicians, and are mentioned in history as -the Asclepiadae. With the progress of time it became necessary, as one -may readily understand, to intrust the temple service to individuals -who were not members of the family of Aesculapius. The original -Asclepiadae guarded as valuable secrets the methods of treatment and -the pharmaceutic formulae which had been handed down to them by the -head of the family. It was therefore natural, when these newly adopted -members were installed in office, that they should be made to promise, -under oath, not to “divulge these secrets to any but their own sons, -the sons of their teachers, or the pupils who were preparing themselves -to become regular physicians.” (Neuburger.) - -The divulging of these secrets, it may be assumed, would gradually -entail upon the organization of priest-physicians a serious money -loss. As will be seen further on, the oath known as “the Hippocratic -Oath” omits these mercenary features, and thus places the vocation of -physician upon a much higher level. - -It is an interesting fact, as noted by Hollaender, of Berlin, that -Homer does not make the slightest mention of temples dedicated to -Aesculapius; from which circumstance it may be inferred that a long -time--perhaps several hundred years--elapsed, after his death, before -his countrymen realized fully his greatness and the value of the -services which he had rendered in his rôle of physician. Of the temples -which were then built in his honor, all have long since fallen into -ruins, but in recent years excavations have been made at some of the -more important of these sites and under the guidance of competent -scholars, and as a result our knowledge of the state of medicine in -Greece between the time of Homer and the appearance of the Hippocratic -writings has been greatly enlarged. The facts revealed by these -excavations and the statements which are to be found in classical Greek -literature, but which previously did not receive all the consideration -that they deserved, have now been pieced together and we have thus -been furnished with a fairly satisfactory picture of the relations of -the different chambers and spaces in these temples, and with a more or -less complete account of the manner in which affairs were conducted by -those in charge. The following short description which is based on the -account recently published by Professor Meyer-Steineg of Jena, Germany, -will put the reader in possession of all the more important facts.[15] - - [Illustration: FIG. 1. VIEW OF THE TEMPLE OF AESCULAPIUS ON THE - ISLAND OF COS. - - As it must have appeared to the traveler, in the third century - B. C., on his approach by sea to the port of that island. - - Reconstitution based upon recent photographs and upon surveys by - Herzog (_Koische Forschungen_, 1904). - - (Courtesy of Prof. Dr. Meyer-Steineg, of Jena, Germany.)] - -There were two principal types of Asclepieia--one, like that of -Epidaurus, in Argolis, which occupied an inland situation, that had -clearly been chosen from religious motives alone, viz., because it was -believed, in accordance with an ancient tradition, that at this spot -Aesculapius had been born--and a second, like that of Cos, on the -island of the same name in the Aegean Sea, which situation without -doubt had been chosen chiefly because the locality was exceptionally -healthful. Of the first of these two types of temples, the sites of -both of which have been most carefully studied, very little need -be said in this brief sketch. The purely medical aspects of this -Asclepieion, to which at the height of its celebrity crowds flocked -from all parts of Greece, are of minor interest. The temple and its -accessory buildings, which appear to have been very extensive, were -located in a narrow valley, not far distant from the seaside village -which still to-day bears the name of Epidaurus. Then, also, the -locality is deficient in one important respect--it has an insufficient -supply of good drinking water; and, finally, it is only slightly -elevated above the sea-level. Dr. Meyer-Steineg remarks that the -patients who visited this temple must have owed whatever benefit they -derived from the visit to other influences than those of a purely -medical or hygienic character. Doubtless suggestion played an important -part in any relief which they may have obtained, and the so-called -temple-sleep was also doubtless a very effective factor in this -direction. The Asclepieion at Cos, on the other hand, occupied a most -healthful position on the northern slope of the ridge of mountains -which extends throughout the entire length of the island and attains a -maximum height of about 3000 feet. (See Fig. 1.) - -It now remains for me to describe, as best I may within the limited -space which is at my command, the results of the excavations and -surveys that have been made in recent years on the Island of Cos. -Professor Meyer-Steineg’s article on this subject[16] is the source -from which I have derived the information contained in the following -account. - -The temple and its associated buildings stood at an elevation of -three hundred feet above the sea-level and at a distance of a little -more than two miles from the city of Cos. The heights behind the -temple were in former times covered with forests and afforded ample -protection against the debilitating and much-dreaded south wind. A -brook of considerable size and of very pure water passed through the -temple grounds; the spring (Burinna) from which it took its origin -being located about 300 feet higher up on the side of the mountain. -Not far off, in the same neighborhood, is a mineral spring, the water -from which contains both iron and sulphur. All the physical conditions -of this site were, therefore, very favorable to the restoration of -both mental and bodily health. Professor Meyer-Steineg declares that -it is scarcely possible to determine accurately the age of the Cos -Asclepieion,--_i.e._, of the structures which the present ruins -represent,--but he believes that some of them date no farther back than -the third century B. C., at which time extensive structural alterations -were made.[17] Then, at a still later date (first century A. D.), in -consequence of the damage done by an earthquake, C. Stertinius Xenophon -(at the instigation of the Roman Emperor Claudius, whose private -physician he was) carried out some very radical changes. Not only were -the separate buildings well supplied with running water, but even many -of the individual rooms (of which there were a large number) were -equipped with the same conveniences. Hydropathy evidently formed an -important part of the treatment in the reconstructed temple. (See Fig. -2.) - -As has been shown above, the climate, the freedom from disturbing -factors of all kinds, the existence at that spot of a plentiful supply -of pure water, the character of the structures composing the temple -group, and the widespread belief among the people that the Asclepiadae -were able, with the assistance of the god Aesculapius, to effect cures -which were obtainable nowhere else--all contributed to make the temple -at Cos one of the greatest sanatoria of ancient times. - - [Illustration: FIG. 2. BIRD’S-EYE VIEW OF THE TEMPLE OF AESCULAPIUS - AND ASSOCIATED BUILDINGS ON THE ISLAND OF COS. - - As they appeared in the third century B. C. - - (Copied by permission from a model made by Prof. Dr. - Meyer-Steineg for the Medico-historical Museum of the University - of Jena, Germany.)] - - [Illustration: FIG. 3. GROUND PLAN OF THE ASCLEPIEION ON THE ISLAND - OF COS. - - As Ascertained by the Researches of Dr. Herzog. - - The different structures are arranged as nearly as possible in - the same positions which they occupied in the third century, B. - C. - - _A_, main entrance to Asclepieion; _B_, _B_, - _B_, gallery, 6 metres broad, with colonnade on one side; - _C_, open space or court, on the southern side of which is - a structure composed of recesses provided each with a bathing - basin (_D_); _H_, staircase leading to intermediate - terrace; _a_, massive series of steps leading to the upper - terrace; _b_, _b_, _b_, broad gallery similar to - that shown on the lower terrace; _d_, the temple proper. - - (From Prof. Dr. Meyer-Steineg’s _Medizinisch-historische - Beiträge_.)] - -The buildings which constituted what is commonly termed the “Temple -of Aesculapius” at Cos were located on three artificially prepared -terraces. The principal entrance to the group, as the excavations -conducted quite recently by Herzog show, was on the lower terrace, -and faced north--that is, toward the sea. From this lower level a -broad staircase led to the second or intermediate terrace, which, in -turn, was connected with the upper one by means of a very broad and -massive series of steps. The southern limit of this upper terrace -ended abruptly at the slope of the mountain. The arrangement of the -buildings on the three different terraces may, in harmony with the -account given by Professor Meyer-Steineg, be briefly described as -follows: That which stood on the lower terrace occupied three sides -of a parallelogram (Fig. 3), the open part of which faced south. The -longer side of the building measured about 120 metres (390 feet) in -length, and the two shorter sides each 55 metres (180 feet). The -supply of running water in every part of this great building, which -appears to have been devoted mainly, if not entirely, to therapeutic -purposes, must have been most abundant. The source from which the -water came was the Burinna spring, situated higher up on the mountain -at a spot far beyond all possibility of contamination. It is not yet -clear, says Dr. Meyer-Steineg, whether or not there were any buildings -devoted to therapeutic purposes on the intermediate terrace. (Figs. -2 and 3.) On the other hand, the great halls, contained in the large -building which surrounded the temple on the upper terrace, appear to -correspond very closely to the rooms that constituted the main portion -of the building on the lower terrace, and it is therefore probable that -this upper building also served some useful purpose in the general -scheme of the Asclepieion. It is Herzog’s opinion--according to -Meyer-Steineg--that the central idea around which everything in this -assemblage of fine buildings revolved, was a clinic conducted by the -Asclepiadae. The means chiefly employed at first for the restoration -of health were such simple agents as sunlight, pure air, pure drinking -water, dietetic measures, massage, physical exercise, etc., and yet, -when the patient’s condition seemed to require their use, there was no -hesitation in resorting to the rational employment of drugs, and even -surgical operations were performed. The numerous instruments which Dr. -Meyer-Steineg collected at the site of the ruins when he visited Cos in -1910, furnish ample corroborative evidence of the correctness of this -last statement. - -Not the least important part which this famous Asclepieion played in -the history of medicine was the splendid opportunity which it afforded -to those who were preparing themselves to engage in the practice of -the healing art, for acquiring the necessary familiarity with the -different diseases and for learning how they should be treated. - -The manner of conducting the preliminary treatment was probably not -the same in every particular in all the different Asclepieia, and yet -in the main the plan of procedure followed in Epidaurus, in Cos and in -Athens undoubtedly resembled closely that which Pagel furnishes in his -_Geschichte der Medizin_. It may be briefly described as follows:-- - -In the first place, moribund persons, the unclean, and women about to -be confined were not admitted into the temple enclosure. The management -of the latter class of patients was left entirely to women nurses, and, -when it became evident that a person was likely to die, the individual -was thereafter cared for outside the enclosure.[18] In short, -everything possible was done to keep out of sight all such objects as -might produce an unpleasant impression upon applicants for treatment. -After preliminary bathing and dieting, the patient was conducted into -the temple enclosure and encouraged to make offerings and to pray to -the god Aesculapius, an imposing statue of whom in marble was one of -the first things that confronted him. As he was led about by the priest -or an attendant, his imagination was wrought upon by the sight of -numerous votive offerings exposed to view on the walls or columns of -the buildings, by the singing of hymns in adoration of the god, and by -the reading of the records of earlier cases inscribed on tablets or on -the columns. After his mind had thus been worked upon, he was asked to -furnish to the priest a detailed history of his own case and to submit -to some sort of physical examination. As a final and most important -step in this first stage of the treatment he was subjected to what was -termed “the temple-sleep,” during which the suggestion of the proper -remedies to be employed was supposed to be communicated to him by the -god himself. - -In our day it is difficult to understand how persons of a fair degree -of intelligence could for so long a period have continued to believe -in the efficacious interference of the deified Aesculapius in their -behalf. But that this belief really did exist is well known, and it was -only after the lapse of many centuries that the faith of the public -began to weaken, doubtless through the influence of several factors. -Perhaps the most important of these was the discovery of an increasing -number of instances of humbuggery or trickery, of which the officiating -priests, in some of the temples, had been guilty. The satirical writer, -Aristophanes, who flourished in Athens about 400 B. C., describes an -incident of this nature in his play entitled “Ploutos.” The following -extracts furnish an account of the doings observed by the slave Karion -on the occasion of his passing a night in the temple enclosure at -Athens:-- - - The Scene throughout is laid at Athens, in front of the - house of Chremulos. - - * * * * * - - _Blepsidemos_: Ought n’t we then to bring in some doctor? - - _Chremulos_: Prythee, what doctor is there now in the city? - For their pay is no longer anything worth, nor their art. - - _Blep._: Let us cast about. - - _Chrem._: Nay, there is not one. - - _Blep._: I believe there is not. - - _Chrem._: Nay, by Zeus, the best plan is to do what I have - been long preparing--(to conduct him [Ploutos]) to the temple of - Asklepios [and] make him lie down [there]. - - * * * * * - - _Chrem._: Karion, my man, you must bring out the bedclothes - and lead Ploutos himself in the usual way, and carry everything - else that is ready within. - - (_Exeunt omnes._) - - * * * * * - - _Chorus of Farmers._ What is the matter, Oh thou best - friend of--thyself? For you seem to have come as a messenger of - some good news. - - _Karion._[19] My master has fared most prosperously, or - rather Ploutos himself. For, instead of being a blind man, he - has been made to see again, and his pupils are clear-sighted, as - he has met with a kindly friend in Asklepios the Healer. - - _Chorus._ You give me reason for joy, reason for shouts of - triumph. - - _Karion._ Ye have reason to rejoice whether ye wish it or - not. - - _Chorus._ I will shout aloud for Asklepios of the goodly - children, the great light to mortals. - - * * * * * - - _Karion._ Well, as soon as ever we came to the god, - leading a man then, indeed, most miserable, but now blessed and - fortunate, if any other is so, first we led him to the sea, and - then we bathed him. - - _Wife of Chremulos._ By Zeus, then the old man was - fortunate, bathing in the cold sea. - - _Karion._ Then we went to the sacred enclosure of the god. - And when on the altar the cakes and offerings were dedicated - by the flame of murky Hephaistos, we laid down Ploutos, as was - proper; and each of us made up from little odds and ends a bed - for himself. - - _Wife._ Then were there certain others beside yourselves - wanting the god? - - _Karion._ Yes, Neokleides, for one, and he is blind; but - in stealing has far overshot those who can see; and there were - many others with all sorts of ailments. But when the minister of - the deity put out the lights and told us to go to sleep and said - that we were to keep silent, if any of us perceived a noise, we - all lay down in an orderly manner. And I was unable to sleep, - for my attention was arrested by a certain pitcher of porridge - a little way off from the head of a certain old woman, and I - strangely desired to creep over to that pitcher. Then I looked - up and saw the priest making a clean sweep of the cakes and - dried figs from the sacred table. After this he went round all - the altars in a circle to see if any cakes were left anywhere. - Then he consecrated them into a certain wallet; and I, believing - that there was great holiness in this proceeding, rise up to go - to the pitcher of porridge. - - _Wife._ Oh you most miserable of men, were you not afraid - of the god? - - _Karion._ Yes; by the gods I was afraid lest he with his - fillets should reach the pitcher before me; for the priest - had already given me a lesson. But, as soon as ever the old - woman perceived the noise I made, she lifted up her hand over - the pitcher (to protect it). Then I hissed and seized (her - hand) by the teeth as if I were a reddish-brown snake. But - she at once drew back her hand again and lay down peacefully, - rolling herself up. And then I at once gulped down a lot of the - porridge; and then, when I was full, I jumped up again. - - _Wife._ And didn’t the god come up to you? - - _Karion._ Not up to that time. After this I at once - covered myself up, being afraid; but he made a complete circuit - examining all the ailments in a most orderly fashion; and then a - slave set by him a little mortar and box of stone. - - _Wife._ Of stone? - - _Karion._ No, by Zeus, certainly not,--at least, not the - box. - - _Wife._ To the deuce with you, how did you see since you - say you were covered up? - - _Karion._ Through my old cloak; for, by Zeus, it had holes - not a few. First of all, he took in hand to pound a plaster - for Neokleides, and he threw in three cloves of Tenian garlic. - Then he bruised them in the mortar, mixing therewith the acid - juice of the fig-tree and squill; then, having diluted it with - Sphettian vinegar, he turned his eyelids inside out that he - might feel more pain, and then applied the mixture. But he, - squalling and bawling, jumped up and was running away, when the - god said with a laugh:--“Sit down there now, smeared with thy - plaster, that I may stop thee from going to the Assembly, having - for once a real excuse.” - - _Wife._ What a patriot and sage the god is! - - _Karion._ After that he sat down by the side of Ploutos, - and first he touched his head, and then, taking a clean towel, - he wiped his eyelids all round, and Panakeia covered his head - and all his face with a cloth of purple dye; and the god then - whistled. Thereupon two snakes of monstrous size darted forth - from the temple. - - _Wife._ Dear Gods! - - _Karion._ And these two (snakes) having quietly glided - under the crimson cloth, licked his eyelids all around, - methought. And before you could drink ten cups of wine, my - mistress, Ploutos stood up and was able to see: and I clapped - my hands with delight and awoke my master. And the god suddenly - took himself off from our view with the snakes into the temple. - -If one examines carefully the facts connected with the Aesculapian -temple treatment, so far as they are known to us, one cannot fail -to be impressed with their strong resemblance to what has been the -experience of similar semi-religious movements in more recent times, -not only in European countries but also in the United States. In all -of them there may be found a kernel of true religious belief, and no -candid observer can deny the fact that many persons have been benefited -thereby both in body and in mind. But, sooner or later, the method -has fallen into disrepute, either because it was employed in the vain -hope that it might accomplish a cure which surgical means alone could -effect, or else because unscrupulous persons, taking advantage of the -credulousness of those associated with the movement, utilized it for -their own selfish advantage. - - - - - CHAPTER V - - THE SIGNIFICANCE OF THE SERPENT IN THE STATUES AND VOTIVE - OFFERINGS EXPOSED TO VIEW IN THE AESCULAPIAN TEMPLES - - -Almost every important gallery of sculpture in Europe possesses at -least one marble statue of Aesculapius, and in the majority of these -the god is represented as a middle-aged or elderly man of powerful -frame, having a full head of hair and full beard, and clothed only -with the pallium or mantle, which is so placed as to leave the right -shoulder and a large part of the chest uncovered. He holds in his -right hand a knotted staff around which, in many of the statues, is -coiled a serpent whose head approaches very closely to the hand. The -expression of the god’s countenance is strikingly peaceful and serene, -yet without any evidence of weakness. In not a few instances other -animals are represented alongside the statue, usually at the god’s -feet--as, for example, the cock, the owl, the eagle, the hawk or the -ram--and occasionally his daughter Hygieia is shown at his side feeding -the serpent. The cock is the symbol of watchfulness--a physician should -be vigilant; the owl symbolizes his need of clear-sightedness and of -readiness to care for his patients in the night as well as during the -day; the eagle has a penetrating eye and it is the emblem of long -life--a benefit which the healing art is capable of procuring; the hawk -was the bird consecrated to Isis, Queen of Egypt, who was believed by -the Egyptians to have been highly skilled in medicine; and the ram -is the symbol of dreams and divination. Pliny says that the patients -who were brought to the temple of Aesculapius were made to lie down -at night wrapped in the skin of a ram, in order that they might -have divine dreams. The presence of the serpent in nearly all of the -statues of Aesculapius is explained in a variety of ways. Some say -that this reptile, which sheds his skin once a year, is emblematic of -the sick person’s need to acquire a new body, or at least cast off -his old skin in the same manner as does the snake. Others consider -the serpent as merely the symbol of wisdom, as it is admittedly the -shrewdest and most cunning of all animals. In a few instances it is -represented as drinking from a receptacle held in the hand of Hygieia. -Perhaps the sculptor’s intention here was to show that the serpent, -although the wisest of all animals, believed that he might add to -his stock of wisdom by drinking from the fountain under the control -of Aesculapius, thus conveying the impression that the wisdom of the -latter was greater than his own. But all these interpretations are too -subtle for the uneducated mind to appreciate at a glance. They fail -also to satisfy our preconceived ideas of what such a statue should -be--viz., a memorial of the godlike character of Aesculapius and of -the priceless benefits which he conferred upon his fellow men, and, -at the same time, an object which, when first contemplated by one -who is ill, would at once evoke in that person feelings of perfect -confidence in the ability and the willingness of the god represented -by the statue to effect a cure. Some, perhaps even a majority, of the -statues thus far recovered from the ruins of the different Aesculapian -temples certainly fail to arouse any such sentiments in the minds of -ordinary observers; but there are others which do in some measure -accomplish this, and among the number the statue which may be seen in -the Berlin Museum and of which a photographic copy (Fig. 4) is here -reproduced, should certainly be included. The head of the god is less -imposing and the expression less kindly than are these features in -some of the other statues (see, for example, Fig. 5), but, to offset -this, the serpent represented in the latter is of the non-poisonous -variety.[20] The addition of such a harmless creature to the figure -representing the god contributes nothing to the power of the statue -as a whole to impress the people--_i.e._, the uneducated masses, -as, for example, the peasants, etc. On the other hand, the significance -of the poisonous snake in a statue of this character will be readily -appreciated if one considers the fact that in ancient times, as it is -even to-day in India, the loss of life caused by the bites of poisonous -snakes was enormous. In the presence of such a fact, therefore, it -would be difficult for a sculptor who was desirous of emphasizing -the extraordinary healing powers of his hero to accomplish this -more effectively than by embodying in his statue, along with other -impressive features, such characters as would show him to have gained -the mastery over that terribly fatal malady--the bite of the viper -and of the still more deadly serpents of India and parts of Africa. -Although we possess no facts which would warrant the statement that -Aesculapius had been particularly successful in the treatment of this -form of poisoning, these temple statues furnish indirect proof of a -strong character that his healing power in this direction had been -very great,--so great, indeed, as to have been largely instrumental -in winning for him the appellation of a god. Such a striking object, -especially when its more important features were commented upon by -the priest who accompanied the patient on his or her first tour of -inspection of temple wonders, could scarcely have failed to produce a -very deep impression upon the imagination. - - [Illustration: FIG. 4. ANCIENT STATUE OF THE GOD AESCULAPIUS IN THE - BERLIN MUSEUM. - - (From Holländer’s _Plastik und Medizin_, with the author’s - permission.)] - - [Illustration: FIG. 5. - - HEAD OF THE MARBLE STATUE OF THE GOD AESCULAPIUS IN THE NAPLES - MUSEUM.] - -In the illustration which has here been reproduced (Fig. 4), a viper, -as clearly shown by the shape of his head and neck and by the unusual -length of the jaw, has twined himself about the staff and is close -to the god’s hand, so close that in an instant’s time the fatal bite -might readily be inflicted. But Aesculapius shows by his countenance, -by the unconcerned manner in which he allows his right hand to remain -near the serpent’s head, and by the easy pose of his whole body, that -he is not at all concerned about the danger which appears to threaten -his life. In the estimation of the ancient Greeks this fearlessness was -undoubtedly attributed to the supernatural power which they believed -Aesculapius to possess over dangerous serpents as well as over diseases -of all kinds. - -So far as now appears, all the statues of the god that have been dug -up in Greece or its nearest colonies represent the serpent as of -the size commonly observed in that part of the world. Hollaender, -however, furnishes (on page 118 of his work) an illustration which -represents--as he believes--the god Aesculapius in the presence of -an enormous snake, evidently a python. (Fig. 6.) As this variety of -serpent is not to be found in Greece, or indeed at any point further -north than the Mediterranean coast of Africa, it is fair to assume -that the bas-relief which depicts this scene must have been made for -exhibition in an Asclepieion located at Cyrene or at the relatively -near city of Alexandria, where patients, who were more or less familiar -with this serpent and realized its power of crushing people to death, -would have occasion to witness this suggestive work of art. And, -furthermore, as if it were for the express purpose of emphasizing the -great protective power of the god, the sculptor has introduced, on one -side of the scene, the figures of three women, two young children and -a lamb. The women nearest to the monster have folded their arms and do -not manifest the least sign of fear. The children also appear to be -unaware of the presence of a deadly danger. In short, the proximity of -the god Aesculapius has instilled into the minds of these human beings -the most complete sense of fearlessness; he himself, as in the case -of the statue of Aesculapius shown in Fig. 4, exhibiting a complete -absence of fear in the presence of the dangerous monster. Neither death -by poisoning nor death by constriction has any terrors for him to whom -the patient is about to appeal for relief from disease. - -That pythons were a terror in former times to the people who inhabited -the coast regions near Cyrene is evident from a statement which -Aristotle makes in his History of Animals (Book VIII., Chapter -xxviii.). It reads as follows:-- - - In Libya (Africa) the serpents, as has been already remarked, - are very large. For some persons say that, as they sailed along - the coast, they saw the bones of many oxen, and that it was - evident to them that they had been devoured by the serpents. - And, as the ships passed on, the serpents attacked the triremes, - and some of them threw themselves upon one of the triremes and - overturned it. - - - - - CHAPTER VI - - THE BEGINNINGS OF A RATIONAL SYSTEM OF MEDICINE IN GREECE - - -With the lapse of time the religious and mystical features of the -treatment carried on at the Asclepieia gave place, more and more, -to rational methods, and eventually--it is scarcely possible to -mention a date, but probably not many years before the Hippocratic -period--these institutions became centres for the spread of medical -knowledge of the most practical kind. This is particularly true of the -Asclepieion at Cos, where Hippocrates is believed to have received -his medical training. It is interesting to note that the mystical -features of the temple treatment--features which certainly did not -originate with Aesculapius himself or with his sons, Machaon and -Podalirius--eventually proved powerless to stay the slow but sure -advance of sound medical knowledge. Even during the period when these -false elements seemed to be most strongly rooted in the temple methods, -there were forces at work which in due time deprived them of much of -their pernicious power. This result was inevitable, for an organization -which, in order to prosper in its work of doing good to humanity, -depended upon the natural superstitiousness of the people, could not -possibly thrive for an indefinite length of time. That the evil results -did not develop sooner than they did simply shows how powerful and -stubborn is the force of superstition. In the absence of trustworthy -historical evidence, hypothetical statements only can be brought -forward, but there can scarcely be any doubt but that a genuine belief -in the power of Aesculapius (deified) to cure disease and restore -health persisted for centuries. - -The custom of recording the case histories on tablets or on the -columns of the temple,--for at this period writing was in general -use,--and also that of dedicating to the god images which represented -(sometimes with a remarkable degree of truthfulness) the pathological -condition for which the patient sought relief, contributed very greatly -to the substitution of sound learning for religious mysticism and -poorly concealed humbuggery. - -Among the interesting objects which may be seen at the Museum of the -History of Medicine in Jena, Germany, there are several of these -terra-cotta images (votive offerings) representing pathological -conditions; and among them the writer noticed more particularly one -which reproduced faithfully, though in diminutive size, the appearances -presented by cancer of the female breast. (Fig. 7.) There were also a -very carefully modeled statuette of the trunk of a woman affected with -ascites, and an admirable representation of a case of facial paralysis. -(Fig. 8.) These objects were obtained by Professor Meyer-Steineg on the -occasion of a recent visit to the ruins of the temple of Cos and other -similar ruins in Greece and Asia Minor. The British Museum possesses -many objects of the same character. - - [Illustration: FIG. 6. BAS-RELIEF OF AESCULAPIUS, ACCOMPANIED BY - WOMEN AND CHILDREN, IN THE PRESENCE OF AN ENORMOUS SERPENT. - - The original is in the National Museum at Athens.] - - [Illustration: FIG. 7. FEMALE BUST SHOWING CANCER OF ONE BREAST. - - (Courtesy of Prof. Dr. Meyer-Steineg, of Jena, Germany.)] - -It is not known at what precise date the _iatreia_, or small -private hospitals, first made their appearance, but it was about the -time when the religious character of the therapeutic work done in -the Asclepieia gave place to treatment of a more distinctly medical -character. Then, in addition to these _iatreia_, there were -schools for gladiators and institutions in which gymnastic exercises -were zealously cultivated; and in these places there was a frequent -demand for advice in regard to questions of diet, and for surgical -aid in the setting of broken bones, the reducing of dislocations, -and the curing of bruises and sprains. As may readily be understood, -the Asclepieia could not furnish the sort of professional aid which -these institutions needed, and thus a further stimulus was given to -the complete separation of the two kinds of medical practice--that -connected with the temple and that conducted by outside physicians. - -In Plato’s “Republic” (Book III., Chapter 15) mention is made of a -certain Herodicus (of Selymbria; about 450 B. C.) who effected many -cures by a method of treatment which combined athletic exercises -with dieting. He gained considerable celebrity in this way, and is -undoubtedly entitled to the credit of having been the first to call -serious attention to the value of this plan of treating certain -maladies. But, unfortunately, he made use of it in not a few instances -where it proved harmful rather than beneficial to the patient, and thus -brought discredit upon the method. - -Already previous to the time at which the changes mentioned above -took place, there had occurred still other changes in the character -and practice of medicine. The business of cutting for stone in the -bladder, for example, had been left entirely in the hands of men who -made a specialty of this branch of medicine--men who might truthfully -be called medical artisans. Then there was another class of men who -devoted their energies to collecting medicinal roots and plants. -They were a necessity to physicians, and constituted the first -representatives of the modern apothecary. Still another change in the -status of the Greek physicians had been slowly developing throughout -this pre-Hippocratic period, a change which tended more and more to -make them men of self-reliance and of considerable importance in their -respective communities, and which indicated very clearly that they were -steadily growing in skill and breadth of knowledge. As evidence of the -correctness of this statement it is sufficient to mention the fact that -Greek physicians had established so good a reputation that they were -frequently called to see important cases at a great distance--in Egypt, -in Persia, etc. But before further consideration is given to this -subject of the development of the Greek physician during the period -immediately preceding the appearance of the Hippocratic writings, -it seems advisable to say a few words concerning the facilities for -medical instruction which were available at that time. - -_Medical Instruction in Connection with the Asclepieia._-- -It does not appear clearly in any of the published descriptions -of these ancient Greek sanatoria just what were the relations -between the priests and the men who utilized all this rich clinical -material--records of all sorts of diseases, and the means (other -than religious) employed in treating them, pictures or plastic -reproductions of the visible pathological lesions, etc.--for the -purpose of instructing the younger men who contemplated engaging in the -practice of medicine. The modern teachers of the art know very well how -difficult is the task of combining in a satisfactory manner these two -things--the safeguarding of the patient’s interests and the utilization -of their maladies as object lessons for men who are preparing to cure -or relieve the bodily ills of those who may at some future moment need -their professional services. To them, therefore, it would be a matter -of very great interest to learn how this difficult problem had been -solved nearly twenty-five hundred years ago. But, unfortunately, no -satisfactory data upon which a trustworthy account might be founded -are obtainable, and we are obliged to fall back upon such aid as our -imagination may furnish. From Puschmann’s work on medical teaching in -ancient times the following statement relating to the subject has been -taken:-- - - The priests in the Aesculapian temples were not, as is generally - assumed, physicians in the ordinary sense. They may have - acquired some knowledge of the art, and they may even in some - instances have been regularly trained physicians, but the - important fact remains that they wished it to be understood that - the treatment carried out in the temple was in accordance with - revelations made to them by the god Aesculapius, and not the - mere fruit of human knowledge. Consequently the intervention - of regular physicians in the temple management of the sick - must have appeared to them quite superfluous. For this reason, - therefore, it is not likely that there existed, on the part of - either the temple priests or the physicians, any feeling of - animosity or opposition. It is more likely that the contrary - was the case, for the evidence shows that the physicians--the - Asclepiadae--paid most humble reverence to the sacred relics - of Aesculapius, and placed the most implicit confidence in the - opinions which he was supposed to give in desperate cases. - - [Illustration: FIG. 8. PARALYSIS OF THE LEFT FACIAL NERVE. - - (Courtesy of Prof. Dr. Meyer-Steineg, _Jenaer - medizinisch-historische Beiträge_, Heft 2, 1912.)] - -While Puschmann does not say to what period in the history of these -temples his statement applies, it is safe to assume that he had in -mind only the earlier stages. When the systematic teachings of medical -pupils began, those physicians who gave the instruction--viz., the -Asclepiadae who were not at the same time priests--took up their abode -somewhere in the neighborhood of the temple. Thus, medical schools were -formed at different places, those of Rhodes, Crotone, Cyrene, Cos and -Cnidus attaining the greatest celebrity. The pupil paid a fee for his -instruction, and when his training was believed to be completed he was -admitted into the association or brotherhood of the Asclepiadae upon -taking the following oath, which for ages past has been known as “The -Hippocratic Oath,” but which is now believed to have been formulated -long before the time of Hippocrates:-- - - - THE HIPPOCRATIC OATH - - I swear by Apollo the Physician and Aesculapius, and Hygieia and - Panacea and all the gods and all the goddesses--and I make them - my judges--that this mine oath and this my written engagement I - will fulfil as far as power and discernment shall be mine. - - Him who taught me this art I will esteem even as I do my - parents; he shall partake of my livelihood, and, if in want, - shall share my goods. I will regard his issue as my brothers and - will teach them this art without fee or written engagement if - they shall wish to learn it. - - I will give instruction by precept, by discourse, and in all - other ways, to my own sons, to those of him who taught me, to - disciples bound by written engagements and sworn according to - medical law, and to no other person. - - So far as power and discernment shall be mine, I will carry out - regimen for the benefit of the sick and will keep them from harm - and wrong. To none will I give a deadly drug even if solicited, - nor offer counsel to such an end; likewise to no woman will I - give a destructive suppository; but guiltless and hallowed will - I keep my life and mine art. I will cut no one whatever for the - stone, but will give way to those who work at this practice. - - Into whatsoever houses I shall enter I will go for the benefit - of the sick, holding aloof from all voluntary wrong and - corruption, including venereal acts upon the bodies of females - and males whether free or slaves. Whatsoever in my practice or - not in my practice I shall see or hear amid the lives of men - which ought not to be noised abroad--as to this I will keep - silence, holding such things unfitting to be spoken. - - And now if I shall fulfil this oath and break it not, may the - fruits of life and of art be mine, may I be honored of all men - for all time; the opposite if I shall transgress and be forsworn. - - (Translated from the Greek by the late John G. Curtis, M.D., of - New York.) - -While at first, according to Puschmann, many physicians did not belong -to the Aesculapian Brotherhood, there came a time when all were known -as Asclepiadae. - -_Influence of the Schools of Philosophy on the Growth of Medical -Knowledge._--About the beginning of the sixth century B. C. there -developed, in Greece and its colonies, schools of philosophy which -exerted a most excellent influence upon the growth of medicine. The -first of these was the one known as the Ionian School, whose founders -and chief representatives were Thales, of Miletus in Ionia (born in -640, died in 548 B. C.), and his pupils Anaximander and Anaximenes. -The guiding principle of these men was to study natural phenomena and -to learn, if possible, their causes and the laws of their action. -Physiology, therefore, became one of their special studies, and -thus they contributed to the laying of one of the most important -foundation-stones of medicine. Thanks to the good quality of the work -of instruction that had thus far been carried on at Cos, Cnidus, and -other Asclepieia, medicine had by this time reached a sufficient -degree of development for its devotees to derive a full measure of -benefit from the new teaching of the philosophers. Well grounded in the -observation of disease in its different forms and modes of behavior, -and also familiarized with the ordinary methods of treatment, these -physicians needed to be shown a new route along which they might -advance to greater heights of knowledge, and they also needed to be -stimulated to further endeavor. The introduction of the new school -accomplished both of these purposes. It taught the men of the older -organizations that they must make much greater use of their reasoning -powers than they had hitherto done, and at the same time, through -the creation of a group of rival physicians, it supplied them with -the required stimulus. Another important school of philosophy was -that known as the Eleatic School, which flourished at Elea, in Lower -Italy, its leaders being natives of that city. The most prominent men -connected with this school were Parmenides (born about 540 B. C.) and -Xenophanes of Colophon, in Asia Minor, whose contributions to mental -science formed the basis of Plato’s metaphysics. - -The period roughly embraced between the years 500 and 300 B. -C. represents the most brilliant age of Greek intellectual and -artistic activity. During this time there came into prominence such -philosophers, historians, poets, physicians, artists and generals of -armies as had never before been marshaled in historic array in so -rapid succession. Even at this late day the names of these great men -are almost household words--such names, for example, as Pythagoras, -Alcmaeon, Anaxagoras, Aristotle, Plato, Socrates, Sophocles, -Aeschylus, Euripides, Aristophanes, Pindar, Xenophon, Demosthenes, -Democedes, Hippocrates the Great, Phidias, Praxiteles, Zeuxis, -Apelles, Darius I., Alexander the Great, and many others of almost -equal celebrity. During the centuries immediately preceding this -golden age of Greek history, there seem to have been very few men of -great merit in any of the branches of learning or in the fields of -war or art, but this impression is certainly false. It is doubtless -to be explained by the fact that large quantities of documentary -evidence relating to these years have been entirely lost. Daniel Le -Clerc, for instance, states[21] that, of the separate histories of -the descendants of Aesculapius which were written by Eratosthenes, -Pherecydes, Apollodorus, Arius of Tarsus and Polyanthus of Cyrene, -not one has come down to our time. If, then, in the single department -of medicine, the destruction of documentary evidence was as great as -is here represented, how enormous must have been the loss of precious -historical materials in all the departments of human activity taken -together. We may, therefore, safely assume that this golden age, which -lasted only about two hundred years, represents simply the culmination -of an even longer period of slow but steady development, a period of -creditable though perhaps less brilliant achievements. - -Of the names mentioned above there are several that belong to men who -were in various ways connected with the early history of medicine. -Pythagoras, for example, is said to have been one of the first among -the Greek philosophers to exert a strong and double impression upon -the medical teaching of that period. He was born in the Island of -Samos, near the coast of Asia Minor, about the year 575 B. C. After -spending several years in Egypt for purposes of study, and probably -visiting Babylon, at that time a great centre of learning and of -artistic cultivation, he established at Crotona, in the south of Italy, -a school[22] where natural philosophy, mathematics, acoustics, etc., -were taught. He also devoted some attention to anatomy, to embryology, -to physiology and to therapeutics. According to his views of what -constituted hygienic living a man should accustom himself to a diet -of the simplest character, without meat. Pythagoras was a believer in -the Chaldean doctrine that the uneven numbers possess a more important -significance than the even, and that the number seven in particular -has a special relationship to the phenomena of certain diseases; the -crisis frequently falling on the seventh, fourteenth, or twenty-first -day. Galen, it is said, expressed surprise that a man as sensible and -learned as Pythagoras should have paid any attention to such trifles. -Not a few of the disciples of Pythagoras were physicians, and when -the brotherhood (if such it may be called) broke up, as it did in the -fifth century B. C., these men traveled about from one Grecian city to -another; from which fact they were given the name of “periodeuts” or -ambulant physicians. Crotona was also celebrated as the birthplace of -Milo, the athlete. - -Democedes, who was a contemporary of Pythagoras, but not one of his -disciples, was a native of Crotona. Dion Cassius, the author of a Roman -history, ranks him and Hippocrates as the two most eminent physicians -of antiquity. Daremberg, who derived his facts from the works of -Herodotus, gives the following account of the adventures of Democedes:-- - - Being unable to bear any longer the frequent anger and harsh - treatment of his father, Calliphon, Democedes left Crotona, - and settled in practice at Aegina, on the Saronic Gulf, not - far from Athens. Almost from the very start he attained marked - success, and already in the second year of his residence in - Aegina he was made the recipient of a pension of one talent - (equal to about £240, or $1200,) out of the public treasury. - During the following year he was induced, by the offer of a - larger pension (100 minae, or about $3000,) to settle in Athens; - and, a year later, he accepted a still larger remuneration from - Polycrates, the tyrant of Samos. Having accompanied the latter - on a trip to Sardis, the capital of Lydia, in Asia Minor, he - fell a prisoner into the hands of the governor of that city, - and was made by him a slave. Not long afterward Darius gained - possession of this governor’s or satrap’s property, including - all his slaves; and thus, despite all his efforts to conceal - his profession through fear that a knowledge of it on the part - of the king might prolong his bondage indefinitely, Democedes - was unable to do so. The discovery came about in the following - manner. During a hunting trip Darius broke his ankle. He called - to his assistance the court physicians, who were esteemed the - most skilful that could be found in all Egypt, but they failed - to give him relief. By the violence of their manipulations - they rather made matters worse. For seven days and nights his - sufferings were so great that he was unable to obtain any sleep. - Finally, on the eighth day, one of the court attendants having - told Darius that there was a Greek physician among the slaves, - Democedes was sent for, and he appeared before the king clad in - rags and with chains on his ankles. When asked whether he knew - anything about medicine he denied such knowledge, being fearful - that the discovery of the truth about himself would stand in - the way of his ever getting back to Greece. Darius, perceiving - that he was dissimulating, ordered the attendants to fetch the - whips and pinchers. Whereupon Democedes made up his mind that - he had better confess the truth. He accordingly told the king - that, while not possessing a thorough knowledge of the healing - art, long association with a physician had familiarized him - more or less with the subject. The king then asked him to take - charge of the case. Democedes, following the treatment adopted - by the Greek physicians in similar conditions, applied soothing - remedies and soon succeeded in procuring sleep for the suffering - king. Eventually he obtained a complete cure, and Darius, who - had made up his mind that he would never again be able to use - his limb, was naturally delighted with the result. He loaded - Democedes with gifts, and, being charmed with his conversation, - made him sit at the royal table and did everything possible to - render court life attractive; but liberty was denied him, which - was the one thing that Democedes most ardently desired. The only - use which the latter made of the great influence which he had - obtained over Darius was to save the Egyptian physicians from - the death by crucifixion which the king had decided to inflict - upon them for their lack of skill. - - The means of escape finally presented themselves to Democedes - in a most unexpected manner. Atossa, who was the wife of Darius - and also the daughter of Cyrus, was afflicted with a swelling of - the breast which developed into an abscess and began to burrow - into the neighboring tissues. After, for a time, concealing - the trouble through a sense of false modesty, she made up her - mind to consult Democedes. He had the good fortune to cure her - of this malady in a relatively short time. As preparations - were then being made to send a number of spies to Greece with - instructions to examine the coast carefully for the purpose - of determining at what points the defenses were sufficiently - weak to render an attack by the Persians reasonably sure of - success, Democedes asked permission of Darius to accompany these - men as their guide. His request was granted; and, as soon as - the expedition reached Tarentum in Calabria, he delivered the - Persian spies into the hands of Aristophilides, the king of that - country, and then fled in all haste to Crotona, his native city. - Shortly afterward these Persians, having been set at liberty by - Aristophilides, made the attempt to capture Democedes and carry - him off by main force, but the citizens of Crotona thwarted - the attempt and compelled the men to return to Asia. Democedes - then married the daughter of Milo, the athlete, and history - furnishes no information regarding the subsequent career of this - extraordinary man. - -Daremberg calls attention to certain excellent proverbs which may be -found in the writings of the Greek poets and which are of some interest -to physicians. The following may serve as examples of those most widely -known:--[23] - - Joy is the best physician for fatigue. - (Pindar, 522–442 B. C.) - - The good physician is he who knows how to employ the right - remedies at the proper time; the poor one, he who, in the - presence of a serious illness, loses his courage, becomes - flustered, and is unable to devise any helpful method of - treatment. - (Aeschylus, 525–456 B. C.) - - Physician, heal thyself. - (Euripides, 400–406 B. C.) - -Advice given to Phaedra by her nurse:-- - - If thou hast some ailment which thou dost not care to reveal to - men, here are women who are competent to treat the condition - properly. - (Euripides.) - - Sleep is the physician of pain, - and - Death is the supreme healer of maladies. - (Sophocles, 495–406 B. C.) - -In Plato’s writings there are to be found a few passages in which this -philosopher gives his views in regard to certain matters that are not -without interest to modern physicians. The following extracts are of -this nature:-- - - There is not then, my friend, any office among the whole - inhabitants of the city peculiar to the woman, considered as a - woman, nor to the man, considered as a man; but the geniuses - are indiscriminately diffused through both: the woman is - naturally fitted for sharing in all offices, and so is the man; - but in all the woman is weaker than the man. - - Perfectly so. - - Shall we then commit everything to the care of the men, and - nothing to the care of the women? - - How shall we do so? - - It is therefore, I imagine, as we say, that one woman, too, is - fitted by natural genius for being a physician, and another is - not; one is naturally a musician, and another is not. - - (From “The Republic” of Plato, translated by Spens.) - - But tell me with reference to him who, accurately speaking, is - a physician, whom you now mentioned, whether he is a gainer of - money or one who taketh care of the sick? and speak of him who - is really a physician. - - One who taketh care, said he, of the sick. - - * * * * * - - Why then, said I, no physician as far as he is a physician, - considers what is advantageous for the physician, nor enjoins - it, but what is advantageous for the sick; for it hath been - agreed that the accurate physician is one who taketh care of - sick bodies, and not an amasser of wealth. Hath it not been - agreed? - - He assented. - (Plato, 428–547 B. C., translated by Spens.) - -But Plato’s knowledge of human anatomy and physiology was very crude -and in some instances decidedly fanciful. In corroboration of this -statement the following extract from the “Timaeus” may be quoted:-- - - And on this account, fearing to defile the Divine nature more - than was absolutely necessary, they [the junior gods] lodged - man’s mortal portion separately from the Divine, in a different - receptacle of the body; forming the head and breast and placing - the neck between, as an isthmus and limit to separate the two - extremes. - - In the breast, indeed, and what is called the thorax, they - seated the mortal part of the soul. And as one part of it was - naturally better, and another worse, they formed the cavity of - the thorax into two divisions (resembling the separate dwellings - of our men and women), placing the midriff as a partition - between them. That part of the soul, therefore, which partakes - of fortitude and spirit and loves contention they seated - nearer the head between the midriff and the neck; as it is the - business of the reason to unite with it in forcibly repressing - the desires, whenever they will not obey the mandate and word - issuing from the citadel above. - - The heart, which is the head and principle of the veins as well - as the fountain of the blood that impetuously circulates through - all the members, they placed in a kind of sentry-house, that, in - case of any outburst of anger, being informed by the reason of - any evil committed in its members, owing either to some foreign - cause, or else internal passions, it (the heart) might transmit - through all its channels the threatenings and exhortations of - reason, so as once more to reduce the body to perfect obedience, - and so permit what is the best within us to maintain supreme - command. - - But as the gods foreknew, with respect to the palpitation of - the heart under the dread of danger and the excitement of - passion, that all such swellings of the inflamed spirit would - be produced by fire, they formed the lungs to be a sort of - protection thereto; first of all, soft and bloodless, and next - internally provided with cavities perforated like a sponge, in - order to cool the breath which they receive, and give the heart - easy respiration and repose in its excessive heat. On this - account, then, they led the channels of the windpipe into the - lungs, which they placed like a soft cushion round the heart, in - order that when anger rises in it to an extreme height it might - fall on some yielding substance, and, so getting cool, yield - cheerfully and with less trouble to the authority of reason. - (Plato’s “Timaeus,” translated by Henry Davis.) - -Alcmaeon, Empedocles, Diogenes of Apollonia, Anaxagoras and Pausanias, -whose names are mentioned above in the list of eminent men who -flourished during the golden age of Greek history, are entitled to -further consideration. Alcmaeon of Crotona was a contemporary and -disciple of Pythagoras. He was specially devoted to the study of -anatomy and physiology, and is credited with the distinction of -having been the first person to dissect animals for the purpose of -learning the formation of the different parts of their bodies. With the -exception of a few fragments that are to be found scattered throughout -ancient medical literature, Alcmaeon’s writings have all been lost. -The discovery of the optic nerve is credited to him, and Neuburger -states that he deserves still greater credit for having been the first -to declare that the brain is the central organ of all intellectual -activity. - -Of all the disciples of Pythagoras, Empedocles attained the greatest -celebrity. He flourished about 444 B. C., his residence being at -Agrigentum, in Sicily. Much of his reputation appears to have been -due to the mystery which surrounded many of his actions. He was even -reputed to have brought again to life persons who were believed to be -dead. His works were all in verse, but only fragments have come down -to us. He placed the seat of hearing in the labyrinth of the temporal -bone. His death occurred in Peloponnesus at the age of sixty, as the -result of an accident. - -Anaxagoras was born at Clazomenae, in Ionia, 500 B. C. He was the -teacher of Euripides, the Athenian poet, and Pericles, the greatest of -Athenian statesmen. He and his contemporary, Diogenes of Apollonia, in -Crete, devoted a great deal of attention to the study of anatomy. They -dissected animals and made some genuine discoveries; Anaxagoras noting -the existence of the lateral ventricles of the brain, and Diogenes -furnishing a description--very erroneous, it is true--of the vascular -system of the body. Puschmann says that, according to Aristotle, -the philosophers of that period considered the study of man and his -diseases the most important one to which they could devote their time -and thoughts. Many of them indeed had been educated as physicians, and -not a few were actual practitioners of medicine. - - - - - CHAPTER VII - - HIPPOCRATES THE GREAT - - -Hippocrates was born in 460 B. C. in the city of Cos, on the island of -the same name. Both his father and grandfather were eminent physicians, -descendants of Aesculapius. On his mother’s side he traced his descent -from Hercules. The famous painter, Apelles, also hailed from the city -of Cos. To distinguish Hippocrates from an earlier individual of the -same name he was called Hippocrates II., or the Great. He is said to -have received his first instruction in medicine at the school of the -Asclepiadae in his native city, but his frequently repeated and very -favorable comments on the teachings of the Cnidian school[24] have -led some to believe that he may have received a part of his medical -training at the latter institution. At a later period of his life his -popularity as a teacher of medicine, in the school of the Asclepiadae -at Cos, attracted many pupils to that city. In accordance with a custom -which prevailed among the physicians of ancient Greece, Hippocrates, -at the beginning of his career, spent quite a long time in Athens, and -then traveled about, from one city to another, in the character of a -periodeutic or itinerant physician. In this way, as he himself reports -in some of his writings, he visited Thessaly, Thrace, the Island of -Thasos, Scythia, the countries bordering on the Black Sea, and even -Northern Egypt. Owing largely to domestic troubles he left his home in -Cos, during the latter part of his career, and removed to Thessaly. -He died about 370 B. C. at Larissa, at an advanced age. Soranus of -Ephesus, the celebrated obstetrician, reported that in his time (second -century A. D.) the tomb of Hippocrates was still standing, and that -it had been taken possession of by a swarm of bees whose honey was -far-famed for its efficacy in curing ulcers of the mouth in children. - -Among the pupils of Hippocrates were his two sons, Draco and Thessalus, -and his son-in-law, Polybus. Thessalus, in the capacity of a military -surgeon, accompanied Alcibiades on his expedition to Sicily, and -later in his career he served as private physician to Archelaus, King -of Macedonia. It is also believed that a number of the writings in -the Hippocratic collection are from his pen. On the other hand, it -is a well-established fact that Polybus is the author of a few of -these treatises. When Hippocrates gave up the work of teaching, his -son-in-law, who was at that time engaged in private practice in Cos, -was chosen his successor in the school. - -Among the many anecdotes which are related of Hippocrates, there is one -which may with propriety be repeated here:-- - - On the occasion of a visit to Abdera, in the northern part of - Thrace, Hippocrates was requested to examine into the mental - condition of the philosopher Democritus, who was thought by - his narrow-minded countrymen to be insane. Hippocrates found - him deeply engrossed in the study of natural philosophy and - asked him what he was doing. Democritus replied that he was - investigating the foolishness of men. Whereupon Hippocrates - reported that he considered Democritus the wisest of men. - (Pagel.) - -No better evidence of the true greatness of a man can be furnished than -that which is afforded by the praise of his contemporaries in the same -rank or walk of life; and when the appreciation comes from such men as -Plato and Aristotle, it constitutes an absolute guarantee that it is -well and honestly earned. To Hippocrates belongs the singular honor -of having won unstinted praise from both of these great philosophers, -Aristotle giving him the title of “Hippocrates the Great,” and Plato -comparing him to those famous sculptors, Polyclytus and Phidias. His -writings and those of the members of his family who were associated -with him in the work of promoting a knowledge of medicine were most -carefully preserved by his successors. When the Ptolemies began to -establish libraries at Alexandria, Egypt (285 B. C.), and manifested -a decided readiness to purchase the works of the most celebrated -authors, copies of the Hippocratic writings were among those which -found their way to that city. This eagerness on the part of the Kings -of Egypt to purchase books or manuscripts stimulated unscrupulous -persons to attribute to celebrated authors not a few of these works -which they offered for sale. The librarians, whose duty it was to -guard against such frauds, were not sufficiently well informed to -prevent them; and thus there were accepted, as genuine productions, -a few books which could not possibly have been written by those to -whom they were attributed. The collection of Hippocratic writings -did not escape this fate, and the evil was also further aggravated -by the fact that copyists and incompetent editors made all sorts of -emendations and additions on their own responsibility. Thus, it is -not surprising that a collection which originally contained only the -writings of Hippocrates and his immediate family, should in course of -time have become expanded, not only by such alterations as have just -been described, but also by the addition of entire works that had -been written by others. At the beginning of the third century B. C., -the Ptolemies appointed a committee of learned men in Alexandria to -examine carefully the treatises reputed to be the work of Hippocrates -and to make a collection of those which appeared to them to be -genuine. They performed this task to the best of their ability, but -the result showed that they lacked the necessary critical powers; and -consequently during the past 2000 years repeated attempts have been -made to do what they failed to accomplish, but these efforts have only -succeeded in part. The French edition prepared by Émile Littré, the -distinguished member of the French Academy of Medicine, and published -in the years 1839–1861, was, until quite recently, universally -accepted as embodying the best results of modern research and criticism -with regard to this difficult question. But since 1861 other scholars -have been busily engaged in perfecting the text of the Hippocratic -writings, and their criticisms and suggestions have made it possible to -publish a German version of this great work which is of more practical -value to physicians than that of Littré, which forms a series of ten -large volumes and is no longer easy to obtain. On the other hand, the -German version by Robert Fuchs (Munich, 1895–1900), in three volumes -of moderate size, while in no respect inferior to the famous French -translation, is superior to it in several particulars: it is better -adapted to the needs of the ordinary practitioner of medicine, it -embodies the results of the excellent critical work done since 1861 -(e.g., by Ermerins of Utrecht, Daremberg of France, and Ilberg and -Kühlewein of Germany), and it costs very much less than its French -predecessor and rival. - -As regards the question of authenticity of the treatises contained in -the work known as “The Hippocratic Writings” the most important thing -to be determined is, not whether this or that book or chapter in the -collection was really written by Hippocrates, but whether the work in -its totality gives a correct and fairly complete picture of the best -medical thought and practice of the period during which Hippocrates -lived; and to this question a decided answer in the affirmative may be -given. As to the broad question of authenticity, Max Neuburger, the -distinguished Viennese author of the latest and most authoritative -history of medicine, thus expresses himself:-- - - Notwithstanding the extremely small quantity of evidence which - the so-called “Hippocratic Writings” themselves furnish as to - who were the writers of the individual treatises and as to what - Hippocrates himself actually did or thought; and although it - is true that portions of the collection often contradict one - another both in regard to questions of theory and also in regard - to methods of treatment, one fact stands out conspicuously, - viz., that the peculiar character of these writings both as a - collection and taken separately, not only gives them a unique - position in medical literature, but reveals plainly that - they owe their origin directly or indirectly to the powerful - influence of a single commanding personality. - -As to the manner of teaching medicine, the Hippocratic writings show -that, at the time which is here under consideration, the mystical -features had almost completely disappeared. The science was now taught -by regular instructors, who agreed for a stipulated fee to take charge -of the pupil’s entire training from the beginning to the end of the -course. Candidates who were in delicate health were discouraged from -entering upon the career of a physician, and those who had completed -the regular course of instruction were sent out into the world equipped -with certain general principles for their future guidance in actual -practice. Some of these bear a close resemblance to the principles of -a similar nature which had been established at a much earlier period -in India. For example, the importance of cleanliness of the person is -strongly emphasized. Reticence, as well as courtesy, is classed as one -of the virtues of a good physician. - - He who acts hastily and does not take sufficient time for - consideration is sure to be criticised unfavorably. If he breaks - out too readily into laughter he will be thought uncultivated. - -In another of the Hippocratic writings the physician is urged not to -indulge in too much small talk, but to confine his conversation as much -as possible to matters relating to the treatment of the disorder. - - In his business dealings the physician, like a genuine - philosopher, should not display a greed for money, he should - assume a modest and dignified attitude, he should appear quiet - and calm, and his speech should be simple and straightforward - and free from all superstition. - -For their knowledge of human anatomy the physicians of that period -were obliged to depend on the dissection of animals. Specimens of -human bones were of course easily accessible, and consequently the -descriptions which are given of these structures are quite accurate, -even as regards many of the finer details. - -It would be a very difficult matter to furnish here, within a limited -space, a reasonably clear exposition of the views held by Hippocrates -with regard to human physiology and pathology. Empedocles, a Greek -physician and high priest of Agrigentum, in Sicily, who was born about -490 B. C., founded a system of philosophy on the theory that the -universe is made up of four elements--fire, air, earth and water; and -he maintained that fire is the essence of life, the other elements -forming the basis of matter. It was upon this system that Hippocrates -founded his own theories of life, death and disease, but he disagreed -with Empedocles in regard to the manner in which the four elements -are united, his own belief being that they form together a genuine -mixture, whereas Empedocles maintains that their union represents -merely a mechanical aggregation of separate atoms. He also held that -these original four elements, to which he gave the names of heat, -cold, dryness and moisture, were represented in the human body by the -following four cardinal fluids or “juices”: blood, mucus or phlegm, -black bile and yellow bile.[25] He maintained, further, that when these -elements are mingled harmoniously so as to produce a state of perfect -equilibrium, health resulted; but that when some deficiency of one or -more of them, or some lack of harmony between them in other respects, -occurs, disease is produced. At a later date, a fifth element--wind or -air (pneuma)--was added to the other four; and when Hippocrates was -unable to account satisfactorily for certain phenomena of disease, he -was wont to refer the phenomenon observed to divine interference. - -This brief exposition of the physiological and pathological views -held by Hippocrates, incomplete and superficial as it is, will have -to suffice. Those who wish to acquire a more profound knowledge of -the subject should consult some of the larger treatises like those of -Daremberg, of Max Neuburger, and of Pagel, as well as the sections -devoted to these subjects in the French (Littré) and the German (Fuchs) -versions of the Hippocratic writings. At every step in such a study, -the modern physician will encounter ideas and individual terms which he -will have great difficulty in comprehending; and later on, as he reads -the sections which deal with the more practical matters of the medical -art, he will be astonished to find that Hippocrates was a most acute -and trustworthy observer of the phenomena of disease, a remarkably -clear writer, and a standard-bearer of very high aims. - -In the examination and treatment of the sick the physicians of -ancient Greece were highly trained. They paid very close attention -to the patient’s account of his symptoms, but it was to the physical -examination of the diseased body that they attached the greatest -importance. They noted with extreme care the color and other -peculiarities of the skin and mucous membranes, the condition of the -abdomen, and the shape and movements of the thorax; they tested the -patient’s temperature by placing the hand upon the body; and all -the excretions were subjected to the closest scrutiny. By means of -palpation they were able to determine not only the size of the liver -and spleen, but also the changes which occur in the form of these -organs in the course of certain diseases. They utilized succussion -both as an aid to diagnosis and as a means of favoring the breaking -through of pus into the bronchial tubes. They were familiar with the -pleuritic friction sound and with the finest râles, which they compared -to the creaking of leather or “the noise of boiling vinegar.” In -their descriptions of these sounds it is distinctly stated that the -examiner’s ear was kept tightly pressed against the patient’s chest. - -In speaking of the accounts of individual diseases which appear in the -Hippocratic writings, Puschmann says that they are evidently based -on cases actually observed in practice, and that they are admirably -written. It is in the laws which they have laid down with regard to -the treatment of disease, however, that the Hippocratic writers have -gained their chief distinction, a distinction which will belong to them -through all time. - - The physician should be the handy man of Nature, and he should - strive to aid and to imitate her efforts to effect a cure. - His first care should be to remove, so far as is possible, - the causes of the disease; and then, in the conduct of the - treatment, he should keep in view at all times the special - circumstances of the case, giving closer attention to the - patient than to the disease itself. In short, he should aim at - being useful, or at least he should be careful not to do any - harm. - - - - - CHAPTER VIII - - BRIEF EXTRACTS FROM SOME OF THE HIPPOCRATIC WRITINGS - - -The statements which have thus far been made in these pages with regard -to Hippocrates are only of a general character, and it may therefore -be interesting for the reader to have placed before him a few selected -extracts from the writings which have formed the basis of these -statements. The English text here used is a translation of the German -version of Robert Fuchs, to which reference has already been made. -It would have been a pleasure to use for this purpose the admirable -English translation of Frederick Adams, published in 1849 under the -auspices of the Sydenham Society of Great Britain; but, unfortunately, -this version contains only a part of the Hippocratic writings, and, -besides, this writer did not at that time have the advantage of -consulting the French and German versions which have been published -since 1849. - -It seems almost unnecessary to state here, by way of preface, that the -small amount of space which may properly be devoted to these extracts -renders it necessary to present many of them in a very fragmentary -and disconnected form, merely enough text being furnished to give the -reader some slight idea both of the manner in which Hippocrates and -those associated with him handled certain medical topics, and also of -the views which they entertained with regard to the same subjects. - - - BRIEF EXTRACTS FROM SOME OF THE HIPPOCRATIC WRITINGS - - _Aphorisms._--I.--1. Life is short, art is long, the right - moment lasts but an instant,[26] experience is often deceptive, - a correct judgment is hard to reach. - - 6. For the most serious ills extreme measures cautiously - employed are the best. - - 8. When an illness has reached its acme the lightest diet must - be prescribed. - - 11. During the exacerbations nourishment should be withheld, for - at these times the giving of food is harmful; and in illnesses - which are characterized by periodic paroxysms it is also best - not to give food during the paroxysms. - - 13. Old people bear fasting very well, and the same is almost - true of persons of mature age; but young individuals do not bear - abstinence from food so well, and this is particularly the case - with children, especially with those of a lively disposition. - - 24. In acute illnesses laxative remedies should rarely be - administered, and then only in the early stage of the malady and - with great caution. - - II.--2. When sleep puts an end to delirium it is a good sign. - - 3. When either sleep or wakefulness oversteps the proper limit - it is harmful. - - 5. Causeless depression is an indication of some disorder. - - 19. In acute diseases the prognosis as regards either death or - recovery, is very uncertain. - - 44. Corpulent persons are more likely than those who are slender - to die a quick death. - - V.--7. When epileptic attacks occur before the age of puberty, - a change for the better may be looked for; but if the disease - makes its first appearance when the individual has already - reached his twenty-fifth year, he may be expected to carry the - affliction with him to the time of his death. - - 9. Consumption most commonly attacks persons who are between the - ages of eighteen and thirty-five. - - 14. When a consumptive person has attacks of diarrhoea, a fatal - issue may be anticipated. - - VII.--1. If in the course of an acute illness the extremities - grow cold, it is an unfavorable sign. - - 14. If, after a blow upon the head, stupefaction or delirium - manifests itself, the outlook is bad. - -[The total number of the aphorisms is 422.] - - _The Book of Prognoses._--1. I believe that it is best - for a physician to acquire a certain degree of practice in the - power to predict how the disease is likely to terminate; for if, - when he is in the presence of his patient, he is able to state, - not only what is going to take place in the future course of - the malady, but also certain other facts which relate to the - past behavior of the attack, but which were omitted from the - account given to him of the previous history of the case, he - will impress the patient with the belief that he is thoroughly - familiar with the disease from which the latter is suffering, - and that consequently he is a physician in whose knowledge and - skill he can place entire confidence. Then, besides, he will be - the gainer in another respect: his knowledge of what is likely - to be the subsequent course of any given disease will enable - him to treat it in the most effective manner. The ability to - restore all his patients to health would of course be a greater - power than that of correctly predicting the future behavior - of a malady in any particular case. This ability, however, is - clearly unattainable. One patient dies by reason of the severity - of the disease itself, even before the physician is called in; - a second one, shortly after the latter’s visit; and a third - lingers on for a day or two after the doctor’s arrival, dying - before the latter’s art has had time to produce a beneficial - effect in hindering the advance of the malady. The observation - of these different events should enable the physician to become - acquainted with the nature of the diseases observed, and--more - particularly--to learn to what extent, in individual instances, - they manifest a strength greater than the patient’s power of - resistance. At the same time, he must not forget that in many - cases divine interference plays a part in directing the course - of the disease. And thus, if he pays heed to all these things, - the physician will merit the confidence of his patients and will - gain the reputation of being a clever and skilful practitioner. - - IV.--It is better when the physician, upon the occasion of his - first visit, finds the patient lying upon one side, with his - hands, neck and thighs slightly flexed, and the entire body - placed in a perfectly natural position, like that which a man - assumes in bed when he is in a state of health. It is not so - well when the physician finds the patient lying upon his back, - with his hands, neck and thighs extended. But if the latter - is found curled up and sliding down toward the foot of the - bed, this is an unfavorable sign. Finally, if he is found with - rather cold feet projecting from under the bedclothes, and with - his arms outstretched and his neck and thighs exposed, his - condition may be considered dangerous, for this attitude of the - body betokens an agitated state of the mind. If the patient - sleeps with his mouth constantly open, lying upon his back and - with his thighs strongly flexed and widely separated, it may be - assumed that death is near at hand. If he lies upon his belly - when it is known that he was not in the habit of sleeping in - this manner before he was taken ill, the inference is warranted - either that he is delirious or that he is suffering from pain in - the lower part of his abdomen. Finally, if the patient shows an - inclination to maintain a sitting posture while the malady is - still in an active stage, this feature must be looked upon as a - grave symptom and especially so in inflammation of the lungs. - - XIV.--Pus that has a whitish color and a uniform consistency, - that is smooth and free from clumps, and the odor of which is - only slightly unpleasant, is the least harmful. On the other - hand, a pus which possesses the opposite characteristics is very - dangerous. - - XL.--Severe pain in the ear, if associated with a persistent - fever is dangerous, for the patient may become delirious and die. - -[There are 47 chapters in the Book of Prognoses; in addition, there -are 740 separate sections in the Coan Prognoses (_Praenotiones -Coacae_).] - - _The Epidemic Diseases._--VI.--4. The wife of Agasis - had already as a young girl been troubled with shortness of - breath. After she had reached womanhood, and soon after she had - given birth to a child, she lifted a heavy weight. Immediately - she heard, as she believed, a noise in her chest, and on the - following day she experienced some difficulty in breathing and a - certain amount of pain in her right hip. These two symptoms were - so related to each other that, whenever the pain in the hip made - its appearance, she immediately became conscious that she was - short of breath, and, vice versa, whenever the pain ceased, she - found that her breathing became easier. Her expectoration was - of a foamy character and of a rather bright color, but, after - it had been allowed to stand for a short time, it looked like - diluted biliary matter that had been vomited. The pain in the - hip troubled her chiefly when she performed manual work. She was - advised to abstain from eating garlic, pork, mutton, and beef, - and not to call loudly or to get excited while she was engaged - in work. - - VII.--7. The wife of Polycrates became feverish during the - summer season, and about the time of the dog star. In the - morning her breathing was somewhat embarrassed, but after - mid-day it became more difficult and at the same time more - rapid. From the very beginning of the illness she had a cough - and expectorated purulent masses. In the throat and along the - course of the trachea one could hear a hoarse whistling sound. - The patient’s face had a healthy color, and over the two halves - of the jaw there was some redness, not of a deep hue but rather - fresh and bright. A little later her voice also became hoarse, - she began to show some emaciation, raw spots developed over - the fleshy parts of her hips, and the surface of the body grew - more moist than it had been before. On the seventieth day the - outward evidences of fever became much less noticeable, but the - respiration grew more rapid; and from that day to the time of - her death, five or six days later, she was obliged to remain in - a sitting posture. Toward the end the tracheal râle grew louder, - and dangerous sweats occurred, but the patient never lost her - expression of intelligence. - - _Fractures._--II.--9. In the human body the foot, like the - hand, is composed of a number of small bones. As they are not - easily broken it may safely be assumed, when such a case of - fracture comes under observation, that some pointed or unusually - heavy object had caused the lesion, and that the surrounding - soft parts must necessarily have been injured at the same time. - (Injuries of this nature will be discussed in a later section.) - But if any part of this bony framework is pushed out of its - natural position--whether this take place in one of the toes, - or in one of the tarsal bones, it makes no difference--the - dislocated part should be forced back into position in the - manner recommended in section XXIV. In its essential features - the treatment consists in the employment of wax plaster, - compresses, and bandages, exactly the same as is done in the - treatment of fractures of the long bones, but without splints. - The same rules hold good with regard to the degree of pressure - to be applied, and every third day the dressings should be - renewed. On each occasion of such renewal the patient should be - questioned with regard to the sensations which he feels after - the bandages have been applied, and if necessary they should be - readjusted in accordance with the nature of the answers which - he gives. The great majority of these injuries heal completely - in twenty days. The exceptional cases are those in which the - fracture] involves a bone that stands in immediate relation - with the bones of the leg. It is advisable, however, that the - patient should remain in bed during the period mentioned; for, - in not a few instances, the persons thus affected, failing to - appreciate the gravity of the injury, walk about before the - parts have really healed; and then, for an indefinite period - of time, they are frequently reminded in a painful manner of - the injury which they received. There is nothing astonishing in - this when the fact is recalled to mind that the feet support the - entire weight of the body. - -[Forty-eight chapters or sections, some of them of considerable length, -are devoted to the subject of fractures. The authorities are almost -unanimous in stating that this portion of the so-called Hippocratic -writings was written by Hippocrates himself. Malgaigne and Petrequin, -two of the most competent French writers on questions relating to -surgery, declare that the treatises written by Hippocrates on fractures -and dislocations (the two forming in reality one continuous treatise) -are the best and most complete books ever written by a physician.] - - _Wounds of the Head._--10. The physician should, first of - all, before touching the patient’s head, inspect carefully the - wound and surrounding parts. After noting whether the injury - has been inflicted upon a strong or a weak portion of the head, - he should ascertain whether the hair has been cut by the fall - or the blow, and whether portions of it have penetrated into - the wound. In the latter event he should express his fear that - the skull at this point has been laid bare and has perhaps even - received some material injury. He should make this statement - before he has touched or probed the wound. Then afterward he - should proceed to a physical examination of the injured parts, - in order that he may learn positively whether the overlying soft - tissues have or have not been separated from the bone. If simple - inspection reveals the fact that the skull has been laid bare, - well and good; but, if the real condition is not thus revealed, - he should not hesitate to employ the probe. If he finds that the - soft parts have been separated from the bone and that the latter - has been more or less injured, he should continue this more - minute exploration until he shall have ascertained to just what - extent and in what manner the skull has been injured, and what - measures are required to remedy the damage; in brief, he should - make the diagnosis. At the same time, however, he should not - neglect to question the patient very closely about the manner - in which the wound was inflicted, for in this way he may be - able to infer the existence of a contusion, or even a fracture - of the skull, of which no material evidences are discoverable. - Important information may also be gathered by passing the hand - over the seat of injury in the bone,--information which the - employment of the probe is not competent to convey. - -[Twenty-one additional chapters are devoted to wounds of the head, -every possible phase of the subject being handled by Hippocrates in the -most careful and thorough manner.] - - - - - CHAPTER IX - - THE STATE OF GREEK MEDICINE AFTER THE EVENTS OF THE - PELOPONNESIAN WAR; THE FOUNDING OF ALEXANDRIA IN EGYPT, AT THE - MOUTH OF THE NILE; AND THE DEVELOPMENT OF DIFFERENT SECTS IN - MEDICINE - - -Up to the time when war broke out between Sparta and Athens (431 B. -C.), the latter city had for many years easily held the supremacy, not -merely in everything relating to the science and art of medicine, but -also in all other branches of learning and especially in the arts of -sculpture, painting and architecture. At the time named above came the -beginning of her downfall. For a period of about twenty-one years she -struggled against disasters of all sorts. - -_The Plague at Athens, the first Recorded in History._--Shortly -after the war began--a war engendered by the bitter jealousy of Sparta -over the ever increasing ascendancy of her rival--the latter city was -visited by a devastating plague, the first European pestilence that -has been recorded in history. Thucydides, who wrote the history of the -Peloponnesian War, gives a most lucid description of this plague of -Athens, from which I shall copy certain portions. - - It first began, it is said, in the parts of Ethiopia above - Egypt, and thence descended into Egypt and Libya and into most - of the King’s country. Suddenly falling upon Athens, it first - attacked the population in Piraeus,--which was the occasion - of their saying that the Peloponnesians had poisoned the - reservoirs, there being as yet no wells there,--and afterward - appeared in the upper city, when the deaths became much more - frequent. All speculation as to its origin and its causes, if - causes can be found adequate to produce so great a disturbance, - I leave to other writers, whether lay or professional; for - myself, I shall simply set down its nature, and explain the - symptoms by which perhaps it may be recognized by the student, - if it should ever break out again. This I can the better do, - as I had the disease myself, and watched its operation in - the case of others.... People in good health were all of a - sudden attacked by violent heats in the head and redness and - inflammation in the eyes, the inward parts, such as the throat - or tongue, becoming bloody and emitting an unnatural and fetid - breath. These symptoms were followed by sneezing and hoarseness, - after which the pain soon reached the chest, and produced a hard - cough. When it fixed in the stomach, it upset it; and discharges - of bile of every kind named by physicians ensued, accompanied - by very great distress. In most cases, also, an ineffectual - retching followed, producing violent spasms, which in some - cases ceased soon after, in others much later. Externally the - body was not very hot to the touch, nor pale in its appearance, - but reddish, livid, and breaking out into small pustules and - ulcers. But internally it burned so that the patient could not - bear to have on him clothing or linen even of the very lightest - description; or indeed to be otherwise than stark naked. What - they would have liked best would have been to throw themselves - into cold water; as indeed was done by some of the neglected - sick, who plunged into the rain-tanks in their agonies of - unquenchable thirst; though it made no difference whether they - drank little or much. Besides this, the miserable feeling of not - being able to rest or sleep never ceased to torment them. The - body meanwhile did not waste away so long as the distemper was - at its height, but held out to a marvel against its ravages; - so that when they succumbed, as in most cases, on the seventh - or eighth day to the internal inflammation, they had still - some strength in them. But if they passed this stage, and the - disease descended further into the bowels, inducing a violent - ulceration there accompanied by severe diarrhoea, this brought - on a weakness which was generally fatal. For the disorder first - settled in the head, ran its course from thence through the - whole of the body, and, even where it did not prove mortal, it - still left its mark on the extremities; ... some, too, escaped - with the loss of their eyes.... Some died in neglect, others in - the midst of every attention. No remedy was found that could be - used as a specific; for what did good in one case, did harm in - another.... Such was the nature of the calamity, and heavily - did it weigh on the Athenians; death raging within the city and - devastation without. - (Translation of Richard Crawley; Dent & Sons, London.) - -_Athens Ceases to be the Centre of Medical Learning._--It is safe -to assume that one by one the more prominent of the physicians who -had survived the events which have just been narrated, must have left -Athens and taken up their abode in the various cities of Asia Minor -and the neighboring islands, in Sicily, in Italy, etc. Hippocrates, -who was thirty years old at the time when the plague broke out in -Athens, appears not to have witnessed it. He practiced his profession -and taught medicine in his native city; then he spent a certain number -of years in traveling about as a peripatetic physician; and finally -settled for the remainder of his life in Thessaly. But the length of -each of these periods of his professional life is not mentioned by any -of the authorities. About forty years after the death of Hippocrates, -Alexander the Great had already nearly completed his series of -brilliant conquests, and was taking steps to found a city, or rather, a -university, in which medicine was to take an organized shape as one of -the great departments of human learning. - -It may be well at this point, however, to interrupt this narrative -of the regular course of events for the purpose of considering very -briefly how far the physicians of that period had advanced toward -gaining a permanent and honorable position in their respective -communities. - -_The Degree of Esteem in which Physicians Were Held by Their Fellow -Citizens and by the Governing Authorities During the Centuries -Immediately Preceding the Christian Era._--We have at our command -very little direct evidence bearing upon the question of the esteem in -which physicians were held three hundred years B. C. by the communities -in which they practiced their profession. We know positively that -the kings and princes of that period fully appreciated the value of -the services which were rendered to them by the physicians (commonly -Greeks) whom they employed. In the event of war they took with them -men who were skilled both in surgery and in the treatment of the -ordinary ills of the body. One of the sons of Hippocrates, for example, -served for some time in this capacity, and he is credited with the -statement that “the physician who wishes to obtain the best training -in surgery should enter the service of the army.” There were eight -surgeons officially connected with the “ten thousand” whom Xenophon -led back to Greece after the famous campaign in Asia Minor. The -army of Alexander the Great was accompanied by the most celebrated -surgeons of that period. Upon a bronze tablet found at Idalium, on -the Island of Cyprus, there is an inscription which dates back to the -fifth century B. C., and which commemorates the merits of a physician -named Onasilos, who, aided by his pupils, rendered valuable services, -without any remuneration, during one of the wars of the Greeks; and in -recognition of these services, the Government had bestowed upon him a -stipend and had exempted him from taxation. It is further known that -the Athenians lavishly heaped honors upon Hippocrates, initiating him -at public expense into the mysteries of the Eleusinia, giving him a -crown of gold, and distinguishing him in still other ways. These facts -show how highly the rulers of that day appreciated the services of a -competent physician; but, up to a comparatively recent date, it has -not been so easy to demonstrate what was his position in the esteem -of the community at large. The discovery, not many years ago, of two -inscriptions in Greek throw a certain amount of light upon this very -point. One of these, which bears the date of 388 B. C., states that -its purpose is to commemorate the fact that the physician Euenor, who -had been intrusted by the people with the work of supervising the -preparation of all the drugs intended for use in the public hospital, -had not only fulfilled his duty but had in addition spent large sums of -his own money in the accomplishment of this work. Another inscription, -which was unearthed in the Island of Carpathus, between Crete and -Rhodes, and which is believed to date back to the end of the fourth -or the beginning of the third century B. C., reads (in a somewhat -abbreviated form) as follows: “In view of the fact that, for more -than twenty years, Menocritus, the son of Metrodorus of Samos, has -devoted himself with much zeal and self-sacrifice to the duties of his -position as parish physician, living all this time in rather narrow -circumstances and not asking any pay for his services, we, the citizens -of Brycontium, have resolved to erect in his honor, in the temple of -Neptune, a marble column bearing an inscription that shall set forth -these facts, to crown him with a wreath of gold, and to announce -publicly, at the Aesculapian games, this our decision.” As apropos -of this subject I may be permitted to quote the following words from -Plato’s “The Republic” (Book 1, Chap. 18): “Will you call the medicinal -the mercenary art, if, in performing a cure, one earns a reward? No, -said he.” - -_The Founding of Alexandria._--Alexander the Great, after subduing -the Persians and the cities of Phoenicia, marched into Egypt and -founded (331 B. C.), at the mouth of the Nile, the city of Alexandria. -In October of the same year he crossed the Euphrates and the Tigris -and defeated, for the second time, the Persian hosts under Darius. -Alexander was now the conqueror of Asia. During the following eight -years he laid his plans most carefully for the consolidation of his -great empire, the capital of which was to have been Babylon; but, -while he was thus making provision for the welfare of his numerous -subjects, who were of widely different tastes and aspirations, he -succumbed (323 B. C.) to a severe attack of malarial fever, aggravated -by an excessive indulgence in wine on the occasion of some festivity. -In the meantime Alexandria was developing rapidly into a great centre -of learning in all the departments of human knowledge. The Ptolemies, -beginning with Ptolemy Soter, who reigned over Egypt from 323 to 285 -B. C., contributed greatly to this result. For a period of about 250 -years Alexandria remained the centre around which revolved all that was -best in the domains of medicine, philosophy, geometry, mathematics, -history, etc. Money was spent lavishly in collecting the writings of -all those authors who had distinguished themselves in these different -fields of learning, and no pains were spared to secure correct -versions of the different works; the septuagint version of the books of -the Old Testament of the Bible being a conspicuous example of what the -Ptolemies accomplished in this direction during the third century B. -C. Every possible facility was offered at the same time for the giving -and receiving of instruction; and thus, with the immense library as a -foundation of priceless value, the Museum at Alexandria became in every -material respect a great university, the first one of which history -gives us any fairly satisfactory information. Several years after -the Museum library was established a second one of somewhat smaller -proportions was organized in the Serapeum (Temple of Serapis). The -example set by the Ptolemies was followed by Attalus, King of Pergamum -in Mysia, Asia Minor (241 B. C.), and, before many years had elapsed, -the great library of that city almost rivaled those of the Museum and -Serapeum at Alexandria. It was the competition between these two royal -collectors of books that led to the issuing of a decree that no more -papyrus was to be exported from Egypt, and thus there was provided the -stimulus which led to the discovery or invention of a new and better -material on which books might be written--viz., Pergamentum (our -parchment), a word coined from the name of the city in which it was -invented. - -_The Development of Different Sects or Schools of Medicine._--Up -to the time of the death of Hippocrates medicine maintained the -character of a single organized and harmonious body; but, when this -great physician had disappeared from the scene and was no longer -there to guide the further development of medical science and to keep -his followers working shoulder to shoulder with a single spirit and -purpose, this hitherto homogeneous body split up into sects or schools, -each of which had some favorite doctrine the promulgation of which -seemed to each group of adherents to be of great importance. There -were at first two such principal groups, viz., the Dogmatics and the -Empirics. The former was composed of those who laid great stress upon -speculation or theorizing,--that is, upon the use of the reasoning -power,--and the latter of men who maintained that actual experience was -the only thing of any serious value. The respective leaders of these -two groups or sects were Plato and Aristotle. - -In Raphael’s celebrated painting, “The School of Athens,” these two -heroes of philosophy are represented standing side by side--Plato with -his right hand elevated and pointing toward heaven, while Aristotle is -looking distinctly at the earth. Pictorially, the tendencies of the two -schools of philosophy could not have been better represented. Plato’s -genius had taken its flight heavenward and was contemplating earthly -things from this point of vantage; his method being to ignore system -and to look at everything with the eyes of purest love. “Delightfully -poetic, but thoroughly unprofitable speculation as to what constitutes -scientific truth and perfected morality!” (Friedlaender.) - -Aristotle, whose father was a physician and a descendant of -Aesculapius, was the hero and guiding spirit of those who based their -philosophy on experience, on ascertained facts. Like his celebrated -pupil, Alexander the Great, who brought whole nations under his sway, -he too was a conqueror in every field of human knowledge. His ideas -ruled supreme over the minds of men for thousands of years and to-day, -although many of them are no longer accepted as valid, Aristotle -himself is universally held to have been the greatest thinker and -investigator who has ever lived upon this earth. (In chapter XIII. I -shall have occasion to say something further regarding the Dogmatics -and the Empirics.) - -Out of the teachings of Plato and Aristotle developed two schools of -philosophy that exerted, in course of time, a great influence upon -the minds of men and upon the growth of medical science. The schools -referred to are the Epicureans and the Stoics. Epicurus (242–270 B. -C.), who gave his name to the first of these, taught that the highest -good was happiness. - - The happiness he taught his followers to seek was not sensual - enjoyment, but peace of mind as the result of the cultivation - of all the virtues. According to the teaching of his school - virtue should be practiced _because_ it leads to happiness; - whereas the Stoics taught that virtue should be cultivated for - her own sake, irrespective of the happiness it will ensure. Zeno - (circa 370–260 B. C.), the founder of the Stoic philosophy, - taught an ethical system according to which virtue consists in - absolute judgment, absolute mastery of desire, absolute control - of the soul over pain, and absolute justice. The keynote of the - system is _duty_, as that of Epicureanism is pleasure. (Sir - William Smith.) - -In addition to the sects named above, there was still another known -as the Older Dogmatic School, which was composed of men who had -been the direct followers of the great master, but who, forgetting -altogether the practical teachings of Hippocrates with regard to -the importance of experience, gave themselves up to all sorts of -hypotheses and theories. Among the names of the earliest followers of -this school one is astonished to find those of Thessalus and Draco, -the sons of Hippocrates, as well as the name of Polybus, the latter’s -son-in-law. Diocles of Carystos and Praxagoras of Cos, two of the most -distinguished men of that period, were also among the earliest members -of this dogmatic school. Diocles, who was one of the Asclepiadae, owed -his celebrity in part to his contributions to our knowledge of anatomy -and in part to the work which he had done in other departments of -medicine. Unfortunately, all of these writings have been lost with the -exception of a few fragments which came to light toward the middle of -the nineteenth century. Praxagoras was also one of the Asclepiadae. He -was distinguished, as has already been stated on an earlier page, by -the fact that he--and not Aristotle, as is sometimes stated--was first -to recognize the difference between arteries and veins, and also by -the further fact that he called attention to the practical value of -the pulse as an indication, in certain diseases, of the tone of the -patient’s bodily condition or vitality. - - - - - CHAPTER X - - ERASISTRATUS AND HEROPHILUS, THE TWO GREAT LEADERS IN MEDICINE - AT ALEXANDRIA; THE FOUNDING OF NEW SECTS - - -Two of the most celebrated physicians of that period (305–280 B. C.) -were Erasistratus and Herophilus, both of whom were distinguished -as the founders of schools or sects of medicine at Alexandria. They -had received their early training as physicians from Chrysippus, a -widely known Stoic philosopher, who, according to Albert von Haller, -had taught at the school of Cnidus and had also written on medical -topics; and, among the other teachers, it is stated that Anaxagoras -of Cos had instructed Herophilus, and that Metrodorus, the son-in-law -of Aristotle, had performed the same service for Erasistratus. So far -as fundamental principles are concerned, the schools founded by these -two physicians at Alexandria differed very little from each other, and -the men themselves also gained their distinction in very much the same -branches of medical knowledge, both of them having made a number of -original discoveries in anatomy and both of them having become eminent -practitioners. - -Herophilus was born at Chalcedon, a Greek city on the Propontus, -nearly opposite to Byzantium. We possess no knowledge whatever -regarding the earlier years of his career, notwithstanding the fact -that no fewer than four different men devoted their energies to the -writing of his biography. The books themselves have been either lost -or destroyed. Herophilus showed a decided leaning toward the study -of anatomy, and his contributions to this branch of medicine are -among the earliest which we possess. Herophilus strove to supply one -of the most conspicuous deficiencies in the Hippocratic system of -medicine, viz., inadequate knowledge of the nervous system; and to -this end he conducted a series of the most careful investigations, -as a result of which he was successful in establishing several facts -previously unknown. He described the membranes of the brain, the -choroid plexus, the venous sinuses, the structure which bears his -name,--the torcular Herophili,--the cerebral ventricles, and the -calamus scriptorius; he traced the course of the nerve trunks for some -distance from their origin in the brain and spinal cord; and it was he -who established the fact that two different sets of nerves exist--one -for conveying sensations to the brain and the other for producing -motion. In addition, he investigated the corpus vitreum, the retina, -the optic nerve, etc. He also called attention to the peculiar mode -of construction of the duodenum, and to the fact that the walls of -the arteries are thicker than those of the veins. Some idea of the -accurate manner in which he carried on his anatomical researches may be -gained from the fact that he noted the circumstance that the left vena -spermatica occasionally originates in the vena renalis. - -Herophilus also gained distinction in the practical branches of -medicine. According to Puschmann he laid the foundations for a -scientific sphygmography. Thus he distinguished several varieties -of pulse in accordance with the differences which he noted in its -strength, regularity, degree of fulness, and rate of speed. He also -must have had considerable experience in surgery, as is shown by his -remark that a dislocation of the thigh, owing to the tearing of the -ligamentum teres which necessarily accompanies such a dislocation, is -likely to occur again in the same individual. In his writings relating -to the practice of medicine, Herophilus upheld the principle that -experience alone should be our guide, as theoretical considerations are -not to be trusted. He is also credited with having said, in response to -the question, Whom do you consider the best physician? “Him who knows -how to distinguish what is attainable from what is unattainable.” - -Erasistratus, the contemporary of Herophilus and his associate in the -work of establishing at Alexandria a great anatomical and clinical -medical school, was a native of Julis, in the Island of Ceos, not far -from the coast of Attica. In the earlier part of his professional -career he spent some time at the Court of Seleucus, the founder of the -Syrian monarchy (312–280 B. C.). This monarch, who had been one of -Alexander the Great’s distinguished generals, consigned the government -of the eastern part of his vast kingdom to his son Antiochus. The -latter fell ill about this time, and the most distinguished physicians -of the Court were then called in to determine what was the nature of -his malady and to decide upon the proper treatment. The patient grew -more and more languid, showed complete indifference to all that took -place about him, and steadily lost flesh. Erasistratus, who was one of -the physicians summoned, observed his behavior very closely and soon -noted the fact that, whenever Stratonice, his young and attractive -stepmother, entered the sick room, Antiochus became agitated; his face -being flushed, his voice subdued, his pulse more rapid, and his eyes -brighter, all of which signs of excitement disappeared when Stratonice -left the room. From these phenomena this shrewd observer drew the -inference that the patient was deeply but hopelessly in love with his -father’s second wife. Accordingly he informed Seleucus that his son’s -illness was simply the result of having lost his heart to one who was -unable to return his affection. Seleucus, who was much astonished, -asked with deep interest who was the lady. “My wife,” replied -Erasistratus, without an instant’s hesitation. “But tell me then,” -asked Seleucus, “would you be willing to cause the death of my son, -who is so very dear to me, by refusing to give up your wife to him?” -“Would you, yourself, my lord, under similar circumstances,” replied -the physician, “be willing to give up Stratonice to the Prince, if it -had been she with whom he had fallen in love?” Seleucus having already -vowed that he would not hesitate for a moment to do so, Erasistratus -declared the whole truth to him, and of course there was nothing left -for the King but to keep his word. History fails to state whether or -not the lady made any objection to the transfer. As Antiochus lived -to reign for many years after the murder of his father, it is safe to -assume that he recovered his health. - -This brief tale, the truth of which is not disputed by any of the -authorities, reveals Erasistratus to have been a clever diagnostician, -to have possessed a profound knowledge of human nature, and to have -been a man of exceptional courage; in short, he was a physician -admirably fitted to act as the founder and leader of one of the two -great medical schools of Alexandria. The following account may suffice -to convey some idea of his career after he became established at the -latter city. - -At the beginning of his residence in Alexandria, Erasistratus, like -his great rival Herophilus, devoted his energies to anatomical and -physiological researches. These two men evidently realized to the full -how important it was to medicine, if it were to make a substantial -advance beyond the point to which Hippocrates and his followers had -already carried it, that a more complete understanding of the structure -and working of the human body should be obtained; and their efforts -in this direction were greatly aided by the enlightened views of the -kings of Egypt, the Ptolemies, who did everything in their power to -furnish these two investigators with all the human dissecting material -they could use to advantage. They even went so far as to allow them -the privilege of utilizing, for scientific purposes, the living bodies -of imprisoned criminals, “in order that they might in this way learn -the location, color, shape, size, construction, hardness, softness, -smoothness, nature of external surface, protuberances and recesses of -the individual organs during life.” The defense which they offered for -permitting such vivisections was this: “It is permissible to sacrifice -the lives of a few criminals if many worthy persons may thereby be -permanently benefited in health, or have their lives prolonged.” -(Puschmann.) Those who were opposed to such examinations upon human -beings expressed their disapproval in the following terms: “This -practice is not only cruel, but useless, and at the same time it -derogates from the dignity of the healing art, which is intended to -be a blessing and not a source of pain to man; for those in whom the -abdominal cavity is first opened and then the diaphragm divided, die -before it is possible to make the scientific examination ‘during life’ -which constitutes, as it is claimed, the justification for the entire -procedure.” (Puschmann.) - -As regards the work done by Erasistratus in the departments of anatomy -and physiology, the following statement may be made: He threw a great -deal of additional light upon the structure of the lacteals, the valves -of the heart, the brain, the nerves, and several other portions of the -body; and he assigned to the pneuma, or breath,--of which he assumed -that two kinds exist,--the most important rôle in the mechanism of -life. According to the description given by Galen and reported by Le -Clerc, the phenomena to which Erasistratus refers take place somewhat -as follows: “When the thorax or chest expands, the lungs also undergo -dilatation and fill themselves with air. This air, entering first by -way of the trachea, ultimately reaches the anastomosing terminals of -the bronchial tubes, from which locality the heart, by the act of -dilatation, draws it into itself, and then, immediately afterward -contracting, sends it, by way of the great artery (the Aorta), to every -part of the body.” When it is considered that at this remote period -of time nothing was known about oxygen and carbon dioxide, nor about -the power of these elements to pass freely through a thin membrane -(exosmosis and endosmosis), no surprise will be felt that Erasistratus -carried the physiology of respiration no farther than he did. On the -contrary, it is remarkable that he was able to describe so correctly -this complicated process. In fact, none of his successors, up to the -time when Harvey’s great discovery was announced, was able to furnish -a better description. The physiology of gastric digestion was another -of the problems concerning which Erasistratus held views that were -different from those commonly accepted by the physicians of that time. -The stomach, he maintained, first retracts when portions of food are -introduced and then contracts in such a manner as to break them up into -smaller and smaller fragments; this process taking the place of that -of “coction,” as taught by Hippocrates. The resulting chyle passes -from the stomach into the liver and is deposited in those spots where -the finer branches of the vena cava and the terminal twigs of the -channels which lead into the gall-bladder come together. Here the chyle -breaks up into two portions, one of which--viz., that which contains -biliary elements--gains an entrance into the channels that lead to the -gall-bladder, while the other, which is composed of elements suitable -for making pure blood, finds its way into the ramifications of the -vena cava. While holding these views about the mode of transformation -of gastric chyle into the bile and pure blood, Erasistratus did not -hesitate to confess that he was unable to say whether bile was produced -within the body or whether it already existed in the food that was -taken into the stomach. - -As regards the treatment of disease Erasistratus held certain views -which were decidedly at variance with those maintained by the majority -of his associates. Thus, for example, Straton, a distinguished disciple -of this master, praises him for having banished bloodletting from the -list of remedial measures, and adds that he can testify to the fact -that Erasistratus had, by other means, cured all the diseases in which -the ancients commonly employed bloodletting as the chief remedial -agent. His favorite substitutes for the latter procedure were fasting, -dieting, physical exercise, and--in cases of hemorrhage--placing -ligatures around the arms and legs. Caelius Aurelianus is authority for -the statement that, in certain very exceptional cases, Erasistratus did -resort to bloodletting. Another of the latter’s tenets was his strong -objection to the employment of purgatives and composite remedies. On -the other hand, he appears to have attached considerable importance -to the employment of chicory in the treatment of all disorders of the -abdominal organs. One of the evidences of his preference for this -drug is to be found in the care which he takes in describing how the -plant should be prepared for remedial purposes. “Boil a bunch of the -plant in water until the mass is thoroughly cooked; then cast it into -a fresh supply of boiling water (to drive out still more of its bitter -quality); and finally, upon removing it from the boiling water, place -it for conservation in a receptacle containing oil. When it is required -for use add a small quantity of weak vinegar.” Galen, in commenting -jocosely upon the stress which Erasistratus lays upon these details, -makes the remark: “As if our domestics did not know how to cook a bunch -of chicory!” - -Speaking of the effects produced by venom when one is bitten by a -poisonous snake, Erasistratus remarks that “from the effects which the -poison introduced in this manner produces, we may derive a general -indication as to how a cure may be obtained. The poison, it will be -noted, destroys very quickly the parts with which it comes in contact, -and then, by spreading throughout the body, causes death. The thing to -do, therefore, is to draw it as quickly as possible out of the body -and thus arrest its further spread. To this end the wound should first -be enlarged and its sides scarified; then, after it has been sucked, -a cupping glass should be applied over it; and, finally, it should be -cauterized.” - -Erasistratus cultivated surgery as well as the other branches of -medicine. He was a bold operator, as may be inferred from the fact -that, in cases of scirrhus or other variety of tumor of the liver, he -did not hesitate to incise the skin and overlying integuments, and -then, after the peritoneal cavity had been opened, to apply directly to -the seat of the disease such medicaments as seemed to him appropriate. -On the other hand, he did not approve of _paracentesis abdominis_ -in cases of dropsical effusion, as a means of evacuating the fluid -accumulated in the peritoneal cavity. - -It appears that the disciples and successors of Herophilus and -Erasistratus soon abandoned the exact methods which these two great -masters had inaugurated and which, in a comparatively short time, had -produced such admirable results, and then they fell back into the -less arduous, the easy-going ways of speculation. Only a very few had -sufficient strength of character to walk in the older pathway, and -among the number were some who left Alexandria and established schools -in the other cities--as, for example, Zeuxis, who organized a new -centre of medical teaching at Laodicea, in the interior of Asia Minor, -and Hikesios, who founded another school at Smyrna, on the seacoast of -Lydia. It is not strange, therefore, that before many years had elapsed -the two original schools at Alexandria died a natural death. As Pliny -aptly writes, “It was so much more comfortable to sit on the benches -of the schools and have learning poured into your ears than to wander -daily through the desert outside in search of other nourishing plants.” -As a further result of this deadness of the schools at Alexandria (that -is, of the sect of the Dogmatics) the more serious-minded physicians -espoused with eagerness the side of the Empirics--a sect which -developed about this time, but which did not, it must be confessed, -hold out much hope of solving the physiological and pathological -problems of the day, but which nevertheless satisfied in some measure -their needs as practitioners. - -Philinus of Cos (286 B. C.) was looked upon as the founder of the -school of the Empirics, and among its most distinguished disciples -were: Serapion of Alexandria (279 B. C.), Glaucias, Apollonius -Biblas, and--perhaps the most celebrated of them all--Herakleides of -Tarentum (242 B. C.), who did such excellent work in the department -of pharmacology. It was he, for example, who defined more precisely -than had been done by any one of his predecessors the proper manner -of employing opium. In addition, he wrote a commentary on the -Hippocratic works and also separate treatises on medical, surgical -and pharmaceutical topics. In the latter category belongs his book -entitled “A Military Pharmacopoeia.” Last of all, Apollonius Mus, a -distinguished follower of Herophilus, deserves to be mentioned because -it was he who perfected the preparation of castor oil. At a still later -date (158 B. C.) Zopyrus proved himself to be a most worthy successor -to Herakleides. It was he who first classified drugs according to the -effects which they produce, and he also invented or discovered the -preparation named “ambrosia,” a general antidote for poisons of all -kinds. Kings and princes were, at that period, in constant fear of -being poisoned, and so it came about that those who were skilled in the -knowledge and preparation of drugs were greatly stimulated by their -royal patrons to find efficient antidotes. It is narrated that Attalus -Philometer, King of Pergamum, the native city of the famous physician -Galen, and Mithridates Eupator, King of Pontus, cultivated poisonous -plants in their gardens and tried the effects of the poisons distilled -from them on criminals. They also encouraged in every possible way -the preparation of antidotes; and thus was compounded a mixture which -even to-day is still known by the name of “_Mithridaticum_.” For -centuries it was a very popular remedy for poisoning by snake-bite. Le -Clerc states that one of the first things that the great Roman general -Pompey did, after conquering Mithridates and gaining possession of his -palace (about 64 B. C.), was to have a careful search made for the -recipe of this famous antidote. Upon finding it he was surprised to -learn what simple ingredients it was composed of--viz., “20 leaves of -rue, a pinch of salt, two nuts, and two dried figs.” The theriacum, -which one hundred years later was modeled after the Mithridaticum, -contained a great deal of honey and a large number of unimportant -drugs, introduced--as Pliny claims--“to magnify the importance of the -apothecary’s art, rather than to increase the curative effects of the -remedy.” - -The scepticism which already at that period had begun to take -possession of many of the best minds manifested itself in the form of -a disbelief in the possibility of discovering full scientific truth, -and men therefore taught the doctrine that the human understanding -is not capable of attaining anything higher than probability. The -acceptance of such a doctrine naturally acted as a powerful hindrance -to all further original research. And so the Empirics neglected the -study of anatomy and physiology as something quite superfluous and -unprofitable. They gave no further thought to the causes of disease, -and were quite satisfied simply to observe its manifestations, to -investigate the factors which appeared to bring it into a state of -activity, and to search for the means of effecting a cure. In carrying -on work of this character, they of course derived help, not only from -their own experience, but also from that of others--which latter became -in time a matter of history. When they encountered new experiences -and were unable to supply a satisfactory explanation they resorted -to a third method--that of reasoning by analogy. Upon this triple -support--one’s own individual experience, the experience of others -stored up in the form of history, and reasoning by analogy--rested the -entire structure of empiricism. - -Strange as it may at first appear, the science of medicine from this -time onward made no further conspicuous progress until the middle of -the seventeenth century of the present era. In certain branches of -practical medicine--as, for example, pharmacology, obstetrics and -general surgery, and also in certain special departments--the Empirics -made a number of material additions to our knowledge; but in all -essential particulars the medical science taught throughout this period -of about two thousand years varied but little from that taught at -Alexandria one hundred or two hundred years before the birth of Christ. -This extraordinary phenomenon of almost complete arrest of development -for so long a period of time should not excite surprise, for something -of a similar nature has certainly occurred in other departments of -human knowledge. - -The further history of the medical sects which flourished under the -Ptolemies and for a short time afterward, when Alexandria became -a colony of the Roman Empire, need not detain us long. Daremberg -furnishes a chronological chart of the physicians who played a more -or less prominent part in the work of these sects, and from this -it appears that they numbered thirty-four in all--ten followers of -Herophilus, fourteen of Erasistratus, and ten Empirics. Callamachur -and Bacchius, who belonged to the first of these groups, deserve to be -mentioned because they were its most distinguished members and because -they were the first physicians who wrote commentaries on the writings -of Hippocrates. In the sect of the Empirics the next in importance -after Philinus of Cos is Serapion of Alexandria. Mantias, another -disciple of Herophilus, gained considerable reputation from the fact -that he was the first to collect together into a single treatise the -different pharmaceutical formulae that were then in general use. He was -also an authoritative writer on surgical topics. - -_Certain Branches of Medical Work Begin to Assume more Distinctly -the Character of Specialties._--At the time of Hippocrates there -were no specialists, or at least none who received any sort of official -recognition from the general body of physicians; and yet, there were, -even then, a few practitioners who devoted themselves preferably to -the treatment of certain maladies, like the affections of the eye and -the teeth; and, beside these, there were undoubtedly, in the larger -communities, men who were ready and competent to undertake the more -serious surgical operations. But even these men, as appears from the -language of the so-called Hippocratic oath, could not honorably perform -an operation for stone in the bladder; this particular work having been -left from time immemorial entirely in the hands of the lithotomists, a -class of men who performed no other kind of surgery and who, in fact, -were considered outside the pale of the medical profession--merely -surgical artisans. - -During the Alexandrian period the attitude of the best physicians with -reference to specialization in medical practice evidently underwent -a change,--not a very marked one, it is true, but yet sufficient -in degree to attract some attention. We read, for example, that a -certain Demetrius of Apamea, a follower of Herophilus, was skilled -as an obstetrician and was also a clever diagnostician; that Andreas -of Carystus, another disciple of Herophilus and the physician upon -whose authority the incredible story of the burning of the Cnidian -archives by Hippocrates was spread abroad, was considered at this -time an expert in the science of obstetrics; that, toward the end of -the period (first century B. C.), Alexander Philalethes, a disciple -of Herophilus and well known as an author of treatises on the pulse -and on the doctrines taught by different physicians of that period, -acquired widespread celebrity as a gynaecologist; that Straton, a -disciple of Erasistratus, had gained considerable distinction as a -gynaecologist; and, finally, that two physicians--Gaius of Naples and -Demosthenes of Marseilles (Massilia)--were widely celebrated for their -skilfulness in the treatment of eye diseases. The latter was also a -successful author, for his treatise on ophthalmology retained its -popularity down to the Middle Ages. All these men, it should be noted, -were directly and indirectly connected with the work at Alexandria, and -were physicians of some degree of prominence. It is fair to assume, -therefore, that specialization in medical practice had by this time -become an accepted fact and was certainly not frowned upon by those in -authority. The result is entirely in accord with what might be expected -from a body of physicians as enlightened as were the men gathered -together at Alexandria during the centuries immediately preceding and -that immediately following the birth of Christ; but many additional -centuries were yet to elapse before anything like the well-defined -specialism of modern times was to become an established fact. - - - - - CHAPTER XI - - ASCLEPIADES, THE INTRODUCER OF GREEK MEDICINE INTO ROME - - -The seventh Ptolemy, Ptolemy Euergetes or Physcon, whose reign lasted -from 146 to 117 B. C., drove all men of learning away from Alexandria -and closed the famous schools in that city. It was only a few years -after these events, and at a time when that city was fast losing its -supremacy as the great centre of medical learning,[27] that there -appeared at Rome a Greek philosopher and physician who was destined to -become the founder of a new set of medical ideas and of a new kind of -medical practice. Being a man of general cultivation and attractive -personality, and not afraid to encounter the prejudices and ill will -which almost always greet a foreigner when he first establishes himself -in a strange country and among a people of a different race, he soon -overcame those obstacles and was eventually successful in making Rome -the starting-point and centre of the best medical thought and practice -of that period of the world’s history. To understand clearly, however, -the character of the work which Asclepiades accomplished in the city -which was soon to be the capital of the world as then known, it is -desirable that a brief account should be given of the condition of -medical affairs in Rome at the time of his arrival. - -_The Practice of Medicine at Rome During the Century Immediately -Preceding the Christian Era._--Foreigners were not encouraged to -settle in Rome until toward the latter part of the second century B. -C., and consequently the treatment of the sick in that city maintained -its distinctly Roman character for an unusually long time. In the -households of the better classes the head of the family commonly -prescribed for any illness which might befall its members. In not a few -instances one of the slaves--who was known as a _servus medicus_, -and who might perfectly well have been a regularly educated Greek -physician--took charge of the patient in place of the master of the -house. A book of domestic remedies was the usual source of information -from which the latter derived his knowledge of therapeutics. Marcus -Porcius Cato, the distinguished Roman censor (234–149 B. C.), was the -author of one of the most popular of these books of recipes. The text -of this work has come down to our time. There were, at this period, -no regularly established physicians and no such thing as a medical -practice. For several hundred years the Romans were almost constantly -at war with the neighboring tribes or nations, and this life of -outdoor exposure and active exercise kept them free from the numerous -and very varied bodily ills of the later generations. This state of -society alone was quite sufficient to prevent the thoroughly trained -physicians of Greece and Alexandria from settling in Rome. But there -were still other forces at work which greatly delayed their taking -such a step, viz., the unwillingness on the part of the authorities -to grant to foreigners the rights of citizenship, and the very strong -prejudice which the Roman aristocracy cherished with regard to the -Greek nation. Some idea of the strength of the latter feeling may -be gathered from the letter which Cato the Censor, perhaps the most -influential citizen of Rome at that time, wrote to his son Marcus. -Daremberg gives the following quotation from this epistle: “The Greeks -are a perverse and unteachable race. Believe that an oracle is speaking -to you when I say--Every time that the Greeks bring to us some branch -of knowledge they will not fail to corrupt our manners; and it will -be far worse for us if they should send us their physicians, for they -have bound themselves by an oath to kill all Barbarians by the aid of -medicine--and they have the insolence to reckon us also as Barbarians. -Remember that I have forbidden you to call in a physician.” Daremberg -adds: “The old man Cato must have been very simple-minded to believe -for a moment that physicians would be such egregious fools as willingly -to kill the patients from whom they derive their support.” But even -this strong prejudice on the part of the Roman aristocracy had to -give way in course of time to forces of a much stronger character. -During the second century B. C., the Romans, no longer fearing the -encroachments of their warlike neighbors and having overcome all danger -of an invasion on the part of their once powerful Carthaginian foe, -entered upon a career of conquest. The capture of an ever increasing -number of cities and towns in Greece, Asia Minor, Egypt and Africa -brought great wealth to Rome, and, with it, increasing luxury, an -increase in the prevalence and variety of diseases, and an increased -need of men who were competent to deal successfully with such diseases. -The physicians who first attempted to meet this need were men of an -inferior stamp, to whom the situation appeared simply to afford an -excellent opportunity for making money; and very naturally they failed -to gain the respect and confidence of the better citizens. At a later -date Julius Caesar, who was, at that time, Consul (about 90 B. C.), -extended the right of citizenship to all foreign physicians who were -practicing in Rome, and thus was removed one of the greatest obstacles -which prevented the better class of Greek medical men from settling in -that city. - -More than a hundred years before the time of which I am speaking -(_i.e._, about 218 B. C.), a Greek physician named Archagathus had -the courage to take up his abode in Rome. He was the son of Lysanias, -a native of Peloponnesus. At first he appeared to gain the favor of -the community in which he practiced, for they bought and placed at his -disposal a shop, or office, in the cross-way of Acilius, and gave him -the name of _vulnerarius_--healer of wounds. Later, however, they -disliked his rather too free use of the knife and the actual cautery, -and thereafter he was spoken of as the _carnifex_, or executioner. -Medicine was thus brought into disrepute and we hear nothing further -about physicians in Rome for more than a century--that is, until about -90 B. C., when Asclepiades,[28] a native of the city of Prusa, Bithynia -(northwest part of Asia Minor), made his appearance in that city. At -first he taught rhetoric, but, finding this occupation unprofitable, he -began the practice of medicine. Pliny says that he acquired a knowledge -of this art through the studies which he carried on after his arrival -in the city of Rome, but Neuburger makes the statement that he began -the study of rhetoric, philosophy and medicine in his youth and then -spent some time in perfecting his knowledge at Parion, a city of Mysia -on the Hellespont, at Athens, and probably also at Alexandria. - -As a practitioner Asclepiades appears to have met with unusual success. -He was well educated and possessed of agreeable manners, and was the -friend as well as the physician of Cicero, one of the most polished -men of whom history furnishes us any knowledge. He was also on terms -of intimacy with Atticus and other eminent citizens of Rome. The -possession of such friends was more than sufficient to render him one -of the favored and prosperous physicians of his day in that city. As -Meyer-Steineg aptly says, “he owed not a little of his success to the -happy manner in which the scientist, the clever physician, and--to -a slight degree--the charlatan were combined in his character.” The -following anecdote which is told of him by Lucius Apuleius shows, on -the one hand, that he possessed remarkably keen powers of observation, -and, on the other, that there were some grounds for the charge that his -behavior was at times somewhat theatrical in character:-- - - One day, as Asclepiades was returning to the city, from his - place in the country, he observed the approach of a long funeral - procession. Desiring to learn whether the deceased was a person - of his acquaintance, and also in the hope of perhaps gaining - other information of a professional nature, he approached as - nearly as possible to the bier. The face of the corpse was - anointed with sweet-smelling ointments over which spices had - been sprinkled; but, notwithstanding this, he was able to detect - certain signs which led him to suspect that the man might not - yet be dead; and accordingly he examined the body very closely - and thus satisfied himself that such was indeed the fact. - Whereupon he called aloud that the man was still alive, and - told the bearers to extinguish the torches, to carry away the - materials for the pyre, and to remove the funeral feast from - the grave to a table. Some at once objected to the carrying - out of these measures and made sarcastic remarks about the - healing art--probably because they were already in possession - of the man’s estate, and were afraid that they might have to - give it up. The more influential ones, however, insisted that - the physician’s words should be heeded. Then Asclepiades, - notwithstanding the opposition which was made by the relatives, - succeeded in securing a brief delay, during which he had the - supposed corpse removed to his own house. Restorative measures - were employed, respiration was re-established, and the man was - brought back to life. At the succeeding festivities unlimited - praise was bestowed upon the wise physician. - -Whether this tale, which I have copied from Neuburger, is true or -not, it seems to fit in well with the bold and independent character -of Asclepiades as it is revealed to us by the different writers of -the history of medicine. In his comment upon this narrative the -distinguished Viennese historian makes the remark that Asclepiades -was very conceited, and--like most reformers--showed a disposition to -ignore the work accomplished by his predecessors. He also expresses the -belief that Asclepiades possessed a leaning toward the methods of the -charlatan; the episode just narrated revealing a love for theatrical -display in his professional activity. On the other hand, in the further -course of the chapter which he devotes to this famous Roman physician, -Neuburger gives fuller recognition to the value of the services which -he rendered to medicine, and thus, in the light of these services, one -is justified in overlooking any little weaknesses of character which he -may have displayed. Perhaps the most important of the services which -Asclepiades rendered was that of having introduced Greek medicine into -Rome--an important connecting link in the transmission of medical -knowledge from Greece to Modern Europe. - -_The Views of Asclepiades with Regard to Physiology and -Pathology._--The human body, according to the philosophy of -Asclepiades, is composed of atoms--that is, small bodies which are -invisible, have no definable quality, are in continual motion, through -mutual pressure undergo modifications in form, and break up into -innumerable smaller fragments or particles that differ both in size -and in shape. The arrangement of these small bodies is such that -intercommunicating spaces or pores are left between them, and through -these channels flows a sap or juice containing larger and smaller -particles; the larger ones composed of blood, and the smaller of vapor -or heat. Health, according to Asclepiades, is that state in which the -primitive atoms are properly distributed or placed and the flow of the -juices in the pores takes place normally. When, however, the flow is -arrested and the primitive atoms are disordered in their relations to -each other and to the pores, or when the elements composing the fluid -contents of the latter become mixed, disease results. Alterations in -the pores themselves, as contradistinguished from the fluid contained -within them, may also cause disease. Farther on, when the proper time -arrives for considering the sect of the Methodists, I shall have -occasion to discuss this subject again, and particularly that part -of it which relates to pathology. In the meantime, however, I cannot -resist the impulse to say a few words about the remarkable insight -possessed by Asclepiades into the manner of construction of the human -body, as manifested by this very brief but very significant anatomical -and physiological description. Upon a first reading one might easily -get the impression that Asclepiades has reference to only one kind or -system of “pores” or channels--viz., such as serve for the circulation -of tissue juices alone. But, upon a closer scrutiny of the text, one -finds some warrant for suspecting that he had in mind more than one -system of such channels; for he states distinctly that the fluid -circulating in these pores contains larger particles composed of blood -and smaller ones which consist of vapor (_spiritus_) or heat. The -question suggests itself: Could a man who had no knowledge of Harvey’s -discovery, who did not possess a microscope, and who at the same time -believed--as did all the ancients--that air circulated in the arteries -and blood in the veins, come any nearer to the actual truth than did -Asclepiades? His description needs very few alterations and additions -to make it fit correctly the system of terminal arterio-venous channels -known to-day as arterioles and capillaries. - -_Methods of Treatment Adopted by Asclepiades._--The prevailing -methods of treating diseases in Rome were not approved by Asclepiades, -and he lost no opportunity of giving expression to this disapproval. -In the first place, he protested vigorously against the practice -of prescribing on every possible occasion purgatives and remedies -capable of producing vomiting. He had a decided preference for gentler -measures, his idea being that a physician should cure his patients -_tuto, celeriter, et jucunde_--safely, quickly and agreeably. Le -Clerc adds that this is a fine sentiment, but that its realization -in actual practice is something which most physicians find it very -difficult to attain. Asclepiades condemned strongly the employment of -magical remedies, a practice which was still much in use at that time -in Rome, although it was already less common than it had previously -been. Cato’s collection of household remedies contains a short list -of some of these appeals to man’s superstition.[29] In addition to -the remedial measures mentioned above, Asclepiades placed his chief -dependence on the following: abstinence from meat; the employment of -wine under certain well-defined circumstances; massage and frictions; -baths of different kinds (it is said that he devised a great variety); -walking; driving and being carried about in the open air in a litter -or in a boat on a quiet river or in the protected harbor. One of his -remedies in the case of sleeplessness consisted in having the patient -placed in a suspended couch which could easily be rocked from side to -side. As all these measures were agreeable and could at the same time -easily be employed by almost everybody, they met with general favor, -and in consequence Asclepiades was looked upon by the Romans as “a -person sent from heaven.” As a rule, he recommended the drinking of -simple water, but in certain cases (to be mentioned farther on) he did -not hesitate to advise the taking of wine in moderation. He advocated -tracheotomy, in cases of inflammation of the throat, in preference to -the then prevailing practice--both very painful and quite difficult to -carry out--of introducing a tube of some kind as a means of opening a -passage for the entrance of air into the lungs. - -Le Clerc quotes Galen as authority for the statement that Asclepiades, -who never hesitated for an instant to criticise the different -therapeutic procedures of his predecessors, did not go so far as to -condemn wholly the practice of bloodletting. Indeed, he was quite ready -to employ it in the treatment of painful affections because, as he -claimed, the pain was caused “by the retention of the larger particles -or atoms in the pores or channels of the tissues, and hence--as -these particles were composed of blood--bloodletting was the only -remedy capable of setting them free.” Thus, he resorted to bleeding -in pleurisy, because this affection is characterized by pain; but he -abstained from employing the remedy in “peripneumonia” or “inflammation -of the lung,” because in most cases it is not accompanied by pain; -and he also did not approve of its employment in inflammation of the -brain (_phrenitis_). On the other hand, he advocated bleeding -in epilepsy and all forms of disease in which convulsions occurred, -and he also advocated it in cases of hemorrhage of every description. -Quinsy sore throat was another malady in which he drew blood freely -from the veins of the arm, of the temple and even of the tongue; and -in addition, when the disease was severe, he scarified the skin at -suitable spots and applied cups to the part. In all these measures -his purpose was “to open the pores”; and when this treatment failed -he incised the tonsils or the uvula, and even, as a last resort, -performed laryngotomy or tracheotomy. In cases of dropsy he employed -_paracentesis abdominis_,--that is, he made a very small opening -in the abdominal wall to serve as an outlet for the fluid contained in -the peritoneal cavity. From these facts it is evident that Asclepiades -did not always abide by his rule not to use any but very gentle -remedies. - -Asclepiades showed, in his manner of treating still other pathological -conditions, how different was his practice from that of his -predecessors. In the first place, he was very partial, as has already -been stated, to such extremely mild forms of physical exercise in -the open air as one can obtain from driving or from being carried -in a litter or a boat. He prescribed these measures, not merely for -convalescents but also for those, for example, who were still in the -midst of an active fever. His idea was, that by means of such very -gentle forms of exercise the pores would become less clogged and -would permit the juices of the body to flow more freely. In cases of -dropsy, also, he was in the habit of employing friction for precisely -the same purpose. He even used this remedy in cases of inflammation -of the brain, in the expectation that he might thereby induce sleep -for these patients. Indeed, this subject of frictions was one on which -Asclepiades wrote at greater length than on any other remedial agent. - -It is a surprising fact that, in common with Erasistratus, he taught -the doctrine that physical exercise was not at all necessary to persons -in normal health. At the same time he approved of it, when carefully -graded, for those who were affected with bodily ills of a certain -nature. - -Wine was another remedy which Asclepiades was fond of prescribing -in all sorts of maladies, but his rules in regard to the manner in -which it should be employed were quite different from those adopted -by his contemporaries. A few illustrations will suffice to show the -different conditions for which he was wont to advocate the taking of -wine: He gave it, for example,--though probably much diluted with -water--to patients affected with fever, but only after the stage of -greatest activity had been passed. Strange as it may appear to-day, -he was rather in favor of giving to patients ill with inflammation of -the brain (_phrenitis_) wine in sufficient quantity to produce -intoxication; his belief being that he could in this way induce -drowsiness and eventually sleep--a thing so desirable for those -affected with that disease. Further, he instructed sufferers from -catarrh to drink twice or three times as much wine as they usually -drank, in consequence of which instructions the patients found it -necessary to dilute their wine with water to a less degree than -usual--that is, to such a degree that the proportion would be one-half -of each; thus showing, as Le Clerc remarks, how sober the ancients -must have been when they were in perfect health. They probably--he -adds--drank their wine ordinarily in the proportion of five-sixths -water to one-sixth wine, or, at most, three-quarters water to -one-quarter wine. - -In some cases Asclepiades prescribed the drinking of wine (particularly -the wine of Cos) to which sea-water had been added; his idea being -that the addition of salt would enable the wine to penetrate farther -into the tissues and thus open the pores more freely. This idea of -added salt was not original with him, for Pliny states that in certain -parts of Greece it was customary to place casks filled with new wine -in the sea and to leave them there for some time. The wine, it was -claimed, was rendered by this procedure mature and pleasanter to drink. -They called wine thus treated “Thalassite wine” (from the Greek word -“thalassa,” sea). In cases of jaundice he occasionally recommended the -drinking of plain sea-water, whereby the bowels were stimulated to act -more freely. Under ordinary circumstances he employed, for the relief -of constipation, clysters, but he was sparing in their use. - -The remedial measures enumerated above, together with dieting, are -those upon which Asclepiades chiefly relied in his practice. In acute -diseases he made very little use of drugs that were to be taken -internally, but in maladies of a chronic character he employed them -quite freely. Gargles, poultices and inunctions are mentioned among the -external remedies which he often prescribed. - -_Further Particulars Regarding the Life and Career of -Asclepiades._--Le Clerc furnishes a number of details which throw -additional light upon the career of Asclepiades. During the latter’s -lifetime his professional reputation was very great. Lucius Apuleius, -the famous Roman satirist and rhetorician, and a contemporary of -Asclepiades, calls him the Prince of Physicians, second only to -Hippocrates the Great; Scribonius Largus, a Roman physician and writer, -who flourished during the reigns of the Roman emperors Tiberius and -Claudius (37–54 A. D.), speaks of him as a great medical author; Sextus -Empiricus, a writer remarkable for his learning and acumen, who lived -in the first half of the third century A. D., calls him a physician of -unrivaled skill; and Celsus, who is termed the Cicero of physicians, -on account of the purity of his Latin, holds him in high esteem as a -medical authority. His fame as a physician had spread to Asia Minor, -for we are told that Mithridates, King of Pontus, who reigned from 120 -B. C. to 63 B. C., and who was a man of great ability and great energy, -invited him to take up his residence at his court; but Asclepiades -refused. Perhaps a still stronger evidence of his real worth as a man -is to be found in the fact that he was the physician and personal -friend of Cicero. - -Notwithstanding these strongly favorable estimates of the ability -of Asclepiades there were not a few men, and they too men of great -authority, who were indisposed to give him so conspicuous a place in -the temple of fame. Galen, for example, while admitting that he was a -very eloquent physician, maintained that he was a sophist, given to -quibbling, and disposed to contradict everybody. Caelius Aurelianus, a -contemporary of Galen and the author of the most important practical -treatise on Methodism that has come down to our time, appears to have -held the same opinion as Galen with regard to Asclepiades. The complete -disappearance of all the writings of the latter author makes it -impossible for us at the present time to form an independent judgment -as to the merits of these conflicting estimates of the man’s character. -Galen was a great admirer of Hippocrates and it is very likely that he -took offense at the failure of Asclepiades to accept all the teachings -and therapeutic methods of his hero. As to the reasons which led -Caelius Aurelianus to agree with the estimate made by Galen, we know -absolutely nothing. - -Toward the middle of the seventeenth century there was discovered at -Rome, not far from the Capena gate, a portrait bust in white marble -of Asclepiades. It was probably executed by a Greek sculptor residing -in Rome, for, if the work had been done in Greece, the face would -have been represented with a beard, as are the heads of Hippocrates, -Soranus and other celebrated physicians of antiquity. The absence of -the beard, furthermore, shows--according to the opinion of antiquarian -experts--that the bust must have been sculptured before the time of the -Emperor Claudius (41–54 A. D.), as he was the first of the Caesars to -wear a beard. This bust, which is a little larger than life-size, is -at present--if I am rightly informed--in the Capitoline Museum at Rome. - -Asclepiades lived to a great age. In descending, one day, a flight of -steps he fell and received injuries from which he died. - - - - - CHAPTER XII - - THE STATE OF MEDICINE AT ROME AFTER THE DEATH OF ASCLEPIADES; - THE FOUNDING OF THE SCHOOL OF THE METHODISTS - - -In summing up the effects which were produced by the teaching and -practice of Asclepiades upon the science and art of medicine, Dr. -Meyer-Steineg makes the remark that the wide and ready acceptance of -both depended largely upon the personal character of the man, upon the -manner in which he carried out the measures which he advocated, and -upon the fact that the Romans happened at that period of their history -to be ready to respond favorably to such new doctrines and therapeutic -methods; but that, as soon as his strong personality had ceased to -exert its influence, as it did after he had passed the active period -of his life, and also because Rome did not at that moment possess any -physicians who were sufficiently endowed with his medical gifts and -sagacity to perpetuate his art, both it and his doctrines began to lose -ground. Nevertheless, as this writer states, Asclepiades had already -succeeded admirably in preparing the way for a further development of -the healing art, and for this valuable service full credit should be -given him. - -Not long after the death of Asclepiades, Antonius Musa,[30] the -personal physician of the Emperor Augustus, succeeded, by means of -hydrotherapy, in curing his royal patient of a protracted gouty or -rheumatic affection from which he had been a sufferer; and, as a mark -of gratitude for the cure which he had effected, the Emperor raised -him to the rank of a noble (about the year 10 A. D.), erected a statue -in his honor in the temple of Aesculapius, and at the same time issued -a decree that from that time forward the physicians who practiced in -Rome should be exempted from taxation and from certain other civic -burdens. These privileges, which were afterward confirmed by Vespasian -(70–79 A. D.) and also by Antoninus Pius (138–161 A. D.),[31] were of -great advantage to the medical profession as a whole. Julius Caesar -(100–44 B. C.), it will be remembered, had already (about half a -century earlier) bestowed Roman Citizenship upon the physicians who -practiced their profession in that city. Thus, at the time of which -we are now speaking, the medical men of Rome occupied the enviable -position of being on an equality with their fellow citizens of the -better class, a position which made it attractive for young men of -ability and of good social standing to enter the profession. - -Among the numerous followers of Asclepiades the most distinguished -was undoubtedly Themison of Laodicea, a city of Phrygia, Asia Minor, -who flourished about the middle of the first century B. C. When he -was well advanced in years he wrote a medical treatise in which he -developed a system of pathology and therapeutics that was accepted as -the professional creed of the sect known as “Methodists.” Starting -from the doctrine of pores and primitive atoms taught by Asclepiades, -he laid great stress upon the idea that in disease all the alterations -which take place in the tissues may be classed in one or the other of -these two categories--a relaxation (_laxum_) or a contraction -(_strictum_) of the parts. To these two categories, which the -Methodists termed “communities,” and which were the only ones at first -accepted as a part of their creed, a third was soon added, viz., that -condition in which both relaxed and contracted states appear side by -side, although not necessarily both of them developed to the same -degree; and to this third category or “community” they applied the -term “_mixtum_.” The ideas which are here stated in a somewhat -crude and imperfect manner owing to my lack of knowledge of all the -facts, constitute the basis of the pathology of the “Methodists”--a -pathology which held its own in the domain of medicine during a period -of four hundred years, and which--in contradistinction to the humoral -pathology of Hippocrates--is justly entitled to the name of “solidist -pathology.” This doctrine, as might be expected, underwent certain -modifications during this long period of time, but they were not -serious enough to alter materially the fundamental form of the teaching -as it has here been described. - -Themison and his followers, like their distinguished predecessor, -Asclepiades, possessed something more than a mere glimmering of the -truth in pathology as we know it to-day; and this idea suggests -the further thought that Morgagni, Rokitansky, Lebert, Virchow and -perhaps others whose names do not now occur to me, could scarcely have -developed a better pathology if they had lived during these first -centuries of the Christian era--a period of time when public sentiment -did not permit postmortem examinations, when Harvey’s discovery was not -even dreamed of, when the microscope was unknown, and when experimental -pathology was an impossibility. Many centuries had still to elapse -before medicine could gain that freedom of action, that rich equipment -of tools, and that stock of accumulated knowledge which enable her in -these days to make such giant strides forward as we have witnessed -during the past twenty or thirty years. - -The question will naturally arise, How did the Methodists decide, in -the presence of an actual case of illness, which one of these abnormal -states (the laxum, the strictum, or the mixtum) was the condition -that called for medical treatment? The answer which they gave to this -question was, that the condition of the different secretions and the -dejections furnished the principal indication as to what particular -part or organ of the body was ailing, and also as to what was the -nature of the morbid change or process that produced the malady. When, -for example, the secretion from an organ or part was excessive, they -inferred that the pores of such a part were relaxed and distended, -thus permitting an increased flow; and when the secretion was less -than it should be, they decided that the pores were contracted. The -_status mixtus_ had reference to those cases in which a condition -of relaxation was observed in one part of the body, while that of -contraction was noted in another. - -Neuburger mentions the fact that the Methodists were somewhat arbitrary -in their classification of the different diseases, most of the acute -maladies being placed by them under the heading _Status strictus_, -while they assigned the majority of the chronic affections to the -category of _Status laxus_. - -The effect of the tendency of the Methodists to classify and simplify -all the departments of medicine was not wholly beneficial. It conveyed -to many the impression that medicine might readily be learned in the -course of a few months, and thus offered the temptation to inferior -men to choose the career of physician; and yet, on the other hand, -it infused into the art the essentially Roman characteristics of -orderliness, simplicity and efficiency. Anatomy, for example, was -studied only so far as a knowledge of this department of medicine was -necessary to render the physician familiar with the location, general -character and relations of the different organs. There was one field, -however, in which the adherents of this school displayed a high degree -of excellence, viz., in their descriptions of disease; and this is -especially true of those written by Caelius Aurelianus (fourth century -A. D.), whose manner of handling the subject of differential diagnosis -is far more thorough and satisfactory than that of any of the medical -authors who preceded him. - -In their treatment of disease, the Methodists were largely guided by -the principle of _contraria contrariis_,--_i.e._, in those -cases in which, to the best of their belief, a _status laxus_ -existed, they administered astringents, in the hope of thereby bringing -the parts back more nearly to a contracted condition; and, _vice -versa_, when the diagnosis of _status strictus_ was made, they -gave a relaxing medicine. The terms “laxatives” and “astringents,” -which are still applied to many drugs, were originated by the -Methodists. Bloodletting, for example, was one of the remedies which -they used for producing relaxation, and an astringent was employed -when a contrary effect was desired. In the list of relaxing remedial -agents (aside from bloodletting) were placed the following: warm -baths, poultices, inunctions with warm oil, vapor baths, fasting and a -restricted diet, diuretics (very carefully watched and employed only in -exceptional cases), emetics, diaphoretics and laxatives. The following -agents, on the other hand, were classed as contracting, astringent and -tonic remedies: washing with cold water, cold baths, the application of -cloths dipped in cold water, living in cold air, strengthening diet, -wine, vinegar, alum, narcotics, etc. Themison, it should be added, is -the first one among the ancient writers to mention the use of leeches -as a means of extracting blood. It does not follow from this, however, -that he was the discoverer of this method of local bloodletting; for it -is highly probable that this procedure had been in common use for many -years previous to his time. - -Themison, as I have before stated, was an old man when he laid the -foundations for Methodism, and it is not probable that it attained -much importance as a sect until several years after his death. Then -Thessalus, a native of Tralles, a flourishing commercial city of Asia -Minor, and a man who had received his medical training in one of the -Greek schools, materially added to the body of doctrines held by this -sect, and at the same time rendered them more acceptable to physicians -generally. He was of humble birth, the son of a wool carder, and his -education had been rather neglected; but he nevertheless managed, by -his own efforts and in no small degree by the unlimited self-confidence -(Galen calls it impudence) which he possessed, to push his way to -the top of the ladder.[32] He acquired a large fortune during the -reign of Nero (54–68 A. D.) and apparently succeeded in persuading -this monarch that he was a great physician. Here are some facts which -appear to justify Galen’s dislike for Thessalus: In a letter to Nero -the latter writes: “I have founded a new medical sect, the only -genuine one in existence. I was forced to do so because the physicians -who preceded me had failed to discover anything that is likely to -promote health or to drive away disease; even Hippocrates himself -having laid down doctrines which are positively harmful.” His vanity, -according to Le Clerc, reached such a pitch that he called himself the -“conqueror of physicians.”[33] Pliny corroborates the latter statement -in the following words: “When he assumed the title of ‘conqueror of -physicians,’ a title which was engraved, according to his instructions, -on his tomb in the Appian Way.” Notwithstanding his unbounded conceit, -Thessalus appears to have made several important improvements in the -doctrines of the Methodists. He is also, as it appears, entitled to the -credit of having been the first to inaugurate the practice of giving -systematic instruction at the bedside; thus establishing for all time a -most valuable precedent for the guidance of his successors. - - “He was an excellent practitioner and an original thinker.... - He was also a prolific writer, as is shown by the number and - variety of treatises which--as we are assured by Caelius - Aurelianus--were composed by him.” The same authority speaks of - him as “a leader among our chiefs,” thus affording good evidence - of the degree of esteem in which he was held by the members - of his own school. The fact that pupils came in throngs to be - taught by him shows clearly how thoroughly he understood the - needs of the physicians of Rome. (Meyer-Steineg.) - -Thessalus, notwithstanding his declaration that medicine might readily -be taught in six months, wrote a larger number of treatises on -professional topics than any student of medicine could possibly read -and digest in the course of two or three years. They filled several -large volumes, but not one of them is known to exist to-day. He wrote -at great length, as we are assured, on the subject of surgery, a -subject in which he took an active interest. He taught that ulcers, no -matter in what part of the body they may be located, require the same -kind of treatment. - - If an ulcer is excavated, it is necessary to bring about a - filling-up of the excavation; if its surface is on a level with - the surrounding skin, the aim should be to make it cicatrize; - if the growth of new tissue is excessive, the redundant portion - should be destroyed by burning with caustic; and, finally, if - the ulcer is of recent development and bleeds readily, the - attempt should be made, by approximating the edges, to effect an - immediate healing. - -In the treatment of chronic ulcers which show little or no disposition -to heal, and which, when they do finally heal, are very prone to break -open afresh, Thessalus urges the great importance of ascertaining, if -possible, the cause or causes of this behavior. If it be found that -the trouble is due to some weakness or abnormal predisposition of -the part in which the ulcer is located, or that the condition of the -entire body is probably the real cause of the trouble, he recommends -the employment of “metasyncritic remedies”--that is, remedial measures -which effect a marked change in the individual’s vital processes -throughout the body, and also such as exert an alterative effect upon -the ulcer itself. Among the measures of the first class he enumerates -the following: Various forms of physical exercise; alternately -increasing and diminishing the amount of nourishment taken; and perhaps -the taking of an emetic at the very commencement of the treatment. -As to the second class of measures--those needed to bring about a -change in the ulcer itself--he makes the following recommendations: -Remove from the diseased tissues as much as will restore the parts, -as nearly as possible, to the condition of a healthy wound, and then -adopt the treatment suited for the latter condition. In cases in which -the ulcer heals and then subsequently breaks open again, it will -sometimes be found beneficial to apply in the neighborhood a plaster -containing an irritating substance like mustard, the effect of which -is often to change the disposition of the parts. In actual practice he -recommends that the local measures should be employed first, and then, -if they fail to accomplish the desired purpose, the physician should -have recourse to those enumerated in the first class--the strictly -metasyncritic remedies. - -It is rather difficult to believe that a man so full of conceit and so -unjust in his criticisms of his predecessors as Thessalus clearly was, -could be capable of formulating such a concise statement of the nature -of chronic ulcers and such a practical rule for their proper treatment. -His development of the idea of “metasyncrisis”--or renovation of the -body (_recorporatio_), as Caelius Aurelianus translates the -word--seems to have been original with Thessalus.[34] The Methodists, -it should be added, deserve special credit for having been the first -to introduce and carry into effect the systematic treatment of chronic -diseases; and, as a general proposition, it may be said that their -treatment of all forms of disease was thoroughly practical, free from -all tendency to resort to magical methods, and based largely on the -employment of such hygienic measures as the use of baths of different -kinds (hydrotherapy), massage, moderate outdoor exercise, passive -movements, sea voyages, fasting, regulation of the diet, etc. One -of the favorite practices--of which Thessalus was said to have been -the originator--was to begin the treatment of almost all maladies by -prescribing an abstinence from all food for a period of three full -days. When I come to speak of Soranus and Caelius Aurelianus I shall -probably have occasion to give further details regarding the methods of -treatment employed by the Methodists. - -As a system, says Neuburger, Methodism was not capable of inaugurating -any fundamental advances in medicine; the most that it was able -to accomplish was to broaden and otherwise improve the domain of -therapeutics, and some of its wiser members were diligent in collecting -and sifting critically a large number of valuable experiences, which -were then courteously registered by them to the credit of the sect. - - - - - CHAPTER XIII - - THE FURTHER HISTORY OF METHODISM AT ROME, AND THE DEVELOPMENT - OF TWO NEW SECTS, VIZ., THE PNEUMATISTS AND THE ECLECTICS.--A - GENERAL SURVEY OF THE SUBJECT OF SECTS IN MEDICINE - - -Among the Methodists there were many physicians who attained more -or less distinction during their professional career, but only two -of them, beside those whose contributions to medical knowledge have -already been mentioned in these pages, gained sufficient celebrity to -justify me in devoting some additional space to the description of the -work which they accomplished. Soranus, of Ephesus on the coast of Asia -Minor, and Caelius Aurelianus, of Sicca in the north of Africa, are the -physicians to whom I have reference. - -It was Soranus, says Le Clerc, who gave the finishing touches to -the system of the Methodists, and the work which he did was of such -excellence that he may with justice be called the ablest and most -skilful of all the members of that school. Caelius calls him “a chief -among the leaders of our sect.” He received his medical training at -Alexandria and came to Rome about the year 100 A. D. His professional -career covered the period corresponding to the reigns of Trajan and -Hadrian (98–138 A. D.). He is known to posterity chiefly through -his two treatises--one on obstetrics and gynaecology and the other -on acute and chronic diseases. The first of these treatises, in the -original Greek, was rediscovered in 1838 by Reinhold Dietz, Professor -of Medicine in the University of Königsberg, Prussia, and a German -translation of the work (by Lüneberg and Huber) was published in Munich -in 1894. Moschion, who was probably a pupil of Soranus, wrote a popular -treatise on the same subject for the use of midwives, and in this book -he has reproduced much of the material which is to be found in the work -of his master. The treatise written by Caelius Aurelianus on acute and -chronic diseases is admitted by him to be founded on that which Soranus -wrote on the same subject. In fact, as Daremberg states, the work of -the former represents almost a translation (into Latin) of Soranus’ -treatise. The sources just named are the principal ones from which our -knowledge of this author is derived. - -Soranus was a prolific writer; the treatises which he wrote and which -deal with a great variety of subjects, number thirty in all. The -majority of these works, however, have been lost. He had many followers -and his influence upon medical science was very great, not simply -during his lifetime, but also for several centuries after his death. -He commanded the respect and confidence of the opponents of Methodism -as well as of the members of his own sect. One of his most pronounced -traits of character was his readiness to condemn, on every possible -occasion, superstitious practices, such as the employment of amulets, -magnets, etc. He was also a very persistent and earnest advocate of -the gentler and more rational obstetric methods. For example, he -disapproved of the reckless employment of remedies for hastening the -expulsion of the foetus, of the practice of succussion (which was -carried out by the aid of a ladder), of making the pregnant woman run -up and down stairs, of a resort to rough mechanical procedures for -extracting the placenta, etc. The following quotation from one of -Soranus’ treatises (Gynaeciorum, Lib. I., cap. 19) reveals clearly what -sort of a man and physician he was:-- - - There is a disagreement; for some reject destructive practices, - calling to witness Hippocrates, who says, “I will give nothing - whatever destructive” and deeming it the special province of - medicine to guard and preserve what nature generates. Another - party maintains the same view, but makes this distinction, - viz.: that the fruit of conception is not to be destroyed at - will because of adultery or of care for beauty, but is to be - destroyed to avert danger impending at parturition, if the - uterus be small and cannot subserve the perfecting of the fruit, - or have hard swellings and cracks at its mouth, or if some - similar condition prevail. This party says the same thing about - preventing conception, and with it I agree. - - (Translated from the Greek by the late John G. Curtis, M.D., of - New York.) - -Soranus was not only a great obstetrician,--admitted by all the -authorities to have been the greatest in ancient times,--he was also -in high repute for the work which he did in other departments of -medicine--in gynaecology, for example, in the instruction of midwives, -in the management of children’s diseases, in the diagnosis and -treatment of both acute and chronic diseases, in surgery, etc. While in -general he adhered to the fundamental teachings of the Methodists, he -did not hesitate to depart from the beaten pathway of that sect in his -explanations of certain pathological conditions; for he was more of a -clinical observer than a sectarian, and it was probably his independent -manner of thinking that gave the sect new vigor and thus enabled it to -live on through such a long period of time. Galen, who was not at all -disposed to speak favorably of the Methodists, says that he tried a -number of the remedies recommended by Soranus and found them good. - -Caelius Aurelianus probably flourished during the third century A. D. -The different authorities, however, do not agree as to the limits of -the period during which he lived; some saying that his career antedated -that of Galen, while others claim that he came upon the scene after -the death of the latter, which occurred early in the third century A. -D. His chief merit appears to have been that, through his translation -of the writings of Soranus into Latin, he placed within reach of the -physicians of Rome the teachings of that admirable diagnostician and -therapeutist; for it must be remembered that the great majority of the -Roman medical men were not able to read Greek. On the other hand, -Caelius Aurelianus, who was himself a thoroughly practical physician, -deserves considerable credit for having enriched the text of his book -with many very appropriate examples (chiefly with regard to questions -of diagnosis) drawn from his own personal experience, which must -have been extensive. During the Middle Ages, as we are informed by -Friedlaender, this work furnished the chief source from which the monks -derived their knowledge about diseases and their proper treatment. -The Latin in which the book is written is described by nearly all the -authorities as barbaric. - -_The Pneumatists._--Methodism had been established only a very -few years when Athenaeus of Attalia, a city on the coast of Pamphylia, -Asia Minor, founded (about 50 A. D.) a new sect--that of “Pneumatism.” -He was not the discoverer of the “pneuma” or “vital spirit,” for that -had already been admitted by the earlier schools of philosophy as a -fifth primary creative element, supplementary to the four well-known -substances--fire, air, earth and water. He believed that heat, cold, -moisture and dryness (the primary qualities of these four bodies) -were not the veritable elements of living beings. Heat and cold, he -maintained, were “efficient causes” and moisture and dryness “material -causes.” To these he added “spirit” as a fifth element; and he taught -that this spirit enters into the formation of all bodies and preserves -them in what may be termed their natural state. It was from the -Stoics, more particularly, that Athenaeus borrowed this belief, and -it was the latter fact, as Le Clerc says, which led Galen to speak of -Chrysippus--one of the most famous of the Stoics--as “the Father of the -Sect of the Pneumatists.” - -In his application of the doctrine of Pneumatism to the science of -medicine, Athenaeus maintained that the majority of diseases owed their -origin to some disturbance or disorder of the spirit; but it is almost -impossible to understand, from the scanty data which have come down -to us, what Athenaeus really meant by the term “spirit,” and by the -expression “disorder of the spirit.” - - From the definition which he gives of the word “pulse” one - is justified in drawing the conclusion that he considered - the spirit to be an actual substance, capable of undergoing, - to a greater or less degree, such changes as expansion and - contraction. The same obscurity of meaning is encountered when - one endeavors to discover how the new doctrine affected the - practice of medicine. (Le Clerc.) - -In view of all these circumstances it is not at all surprising that -Pneumatism was not very popular with the physicians of Rome, and -that, after a brief period had elapsed, many of the adherents of -this doctrine abandoned it and gave their preference to the more -practical teachings of the Methodists. Meyer-Steineg goes so far as to -remark that, to all intents and purposes, such a thing as a sect of -Pneumatists did not exist. - -The most prominent of the disciples of Athenaeus were Theodorus, -Agathinus, Herodotus, Magnus and Archigenes. - -Haller speaks of Theodorus as the inventor of a remedy which, as he -claimed, cures all cases of poisoning. - -_The Eclectics._--Agathinus, a native of Sparta, was the teacher -of Herodotus and Archigenes. His chief distinction is to be found -in the fact that he gave to the offshoot from the school of the -Pneumatists the name of “Eclectics,”[35] his object being, as we are -assured by Neuburger, to bring the three sects (Pneumatists, Empirics -and Methodists) into closer union. - -Herodotus--who, it is perhaps desirable to state, is a different person -from the famous historical writer of the same name--lived during the -latter part of the first century A. D., and was more closely allied to -the Methodists than to the Pneumatists. It appears from the text of a -fragment of one of his treatises that he wrote a description of the -disease now called small-pox and directed attention to its contagious -character. - -Magnus, a native of Ephesus in Asia Minor, is reported to have been -the writer of a collection of letters on medical topics and also of a -history of the discoveries made in medicine subsequently to the time of -Themison. - -Archigenes, the fifth member of this group of Pneumatists, was born -in Apamea, Syria, and lived in Rome under the reigns of Trajan -(98–117 A. D.) and Hadrian (117–138 A. D.). Le Clerc speaks of him as -belonging to the Eclectics rather than to the Pneumatists. This is -a matter, however, of small importance, as the sects were, at that -period, very much mixed. The poet Juvenal, who was a contemporary -of Archigenes, refers to him briefly as a physician who had a large -practice; and the historian Suidas says that he wrote a great deal -about physics as well as about medicine. That he was esteemed highly -as an authority in practical surgery is shown by the fact that Galen, -when he discusses surgical topics, makes frequent quotations from -the writings of Archigenes. Only fragments of the latter, however, -have come down to our time. His popularity as a practitioner was very -great; notwithstanding which he managed to write several treatises -on a variety of topics--on the pulse, on feverish diseases, on the -different types of fevers, on local affections, on the diagnosis and -treatment of acute and chronic maladies, on the right moment when -surgical operations should be performed, on drugs, and on therapeutic -procedures in general. He applied ligatures to blood-vessels and also -arrested further bleeding from them by passing needles through the -adjacent parts in such a manner as to exert pressure upon the vessel (a -procedure which is termed “acupressure”); he operated for the removal -of both mammary and uterine cancers; he employed the red-hot cautery -iron for the arrest of hemorrhage and also for the relief of coxalgia, -and he was familiar with the use of the vaginal speculum. - -Antyllus, another prominent surgeon of that period, joined the -Methodists at a considerably later date. He was also the author -of an excellent treatise on surgery, the greater part of which, -unfortunately, has been lost or destroyed. - -Aretaeus of Cappadocia, a district of Asia Minor, lived during the -second century A. D. He was a man of very broad culture. From the -fact that he assigned an important rôle to the pneuma, he is usually -classed among the Pneumatists. He does not appear, however, to have -taken a very active interest in the doctrines of that school, and both -Le Clerc and Daremberg seem disposed to call him an Eclectic, and we -may therefore rank him as one of the independent physicians of that -period. It is doubtful whether he ever practiced in Rome. His two -treatises--one on the causes and means of identifying acute and chronic -diseases, and the other on the treatment of these diseases--are written -in Greek, and are characterized by the clearness and simplicity of his -descriptions, which very closely resemble those of Hippocrates, and by -the soundness of the advice which he gives in regard to the methods -of treatment.[36] In his conceptions of what a physician should aim -to be, Aretaeus maintained a very high standard. Some of his views -regarding human physiology and pathology are given here very briefly: -Respiration serves the purpose of cooling the warmth of the heart, and -the lungs are therefore prompted by the latter organ to draw cool air -into their cavities; digestion takes place not only in the stomach -but also in the intestinal canal, and owes its origin to warmth; the -cerebral nerves, close to the spot from which they originate, cross -from one side to the other, and by the aid of this fact paralysis on -one side of the body may be explained. Aretaeus has gained considerable -fame, says Puschmann, from his description of the “Syriac ulcer,” the -picture of which he draws agreeing perfectly with what is known to-day -as pharyngeal diphtheria. In various places throughout his writings -he displays a thorough knowledge of normal anatomy--as, for example, -when he describes the ramifications of the vena portae and gall-ducts -of the liver. He was also well informed in matters belonging to the -domain of pathology, for he gives admirable descriptions of many of -the diseases--for example, pleurisy with empyema, pneumonia, pulmonary -consumption, cerebral apoplexy, paraplegia, tetanus, epilepsy, diabetes -mellitus, gout, etc. From the character of these descriptions one is -strongly tempted to believe that he must have made a certain number of -postmortem examinations. - -According to Neuburger, Aretaeus enters very fully into details -when he discusses the subject of diagnosis; his statements in one -place warranting the belief that he even auscultated the heart. His -methods of treatment were based largely upon his own experience and -were generally of a simple character. He attached great importance, -for example, to a very careful regulation of the diet, muscular -exercise, massage, etc., and his employment of remedies was confined -to a very small number of such drugs as exert a mild action. When the -case, however, was of such a character as to call for more vigorous -interference, he did not hesitate to resort to the use of opium, -emetics, cathartics, venesection, blistering, the red-hot cautery iron, -etc. - -Rufus, a native of Ephesus, a city of Asia Minor, about thirty-five -miles from Smyrna, is reckoned by most authorities among the Eclectics; -in other words, he was an independent, or one who adopted from the -teachings of the different sects such doctrines as met with his -approval, but who, at the same time, did not care to pose as the -disciple of any one of them. He received his medical training at -Alexandria, but it is not known where he practiced his profession. -Almost no details concerning his life or his professional career have -come down to our time. It is simply known that he flourished during -the reign of the Emperor Trajan (98–117 A. D.). Ebn Ali, an Arabian -physician and author, says that he was the leading medical authority -of his time and that his works were highly esteemed by Galen. His -treatise on anatomy (entitled “The Names of the Different Parts of the -Human Body”), which is one of the few that have escaped destruction, -is described as a treatise which was written for students, and which -possesses great value for the history of anatomical nomenclature. The -same authority says that Rufus was the first to describe the chiasma, -that he came very near establishing the existence of two different -kinds of nerves--motor and sensory--and that he attributed the control -of all bodily functions to the nervous system. He also states that he -was one of the first to furnish a description of the oriental bubonic -plague. Some idea of Rufus’ style of writing may be gathered from the -following quotations which have been taken from his short treatise -entitled “The Questioning of Patients”:--[37] - - It is necessary to question the patient, for by so doing one - may gather more exact information concerning the nature of the - malady, and will then be able to treat it more intelligently. - In this way also one may learn whether the patient’s mind is - in a normal or an excited state, and whether any change has - taken place in his physical strength. Some idea regarding the - nature and seat of the disease is usually obtained from such - questioning. If, for example, the patient answers clearly and to - the point, and does not hesitate; if his memory does not play - him false; if his speech is not thick or indistinct; if, being a - well-bred man, he gives his responses in a polite and cultivated - manner; or if, in the case of a person who is naturally timid, - the answers reflect this timidity, then you may feel confident - that your patient’s mind is not affected. But if, on the other - hand, you ask him about one thing and he gives you a reply about - something entirely different; if, as he talks, he appears to - forget what he was talking about; if he has a trembling tongue - the movements of which are also uncertain; and, finally, if from - a certain state of mind he passes rapidly to one of a totally - different character,--all these changes are evidences that the - brain is beginning to be affected.... If the patient speaks - distinctly and with a fairly strong voice, and is able to tell - his story without stopping from time to time in order to rest, - the inference is warranted that his physical strength is not - materially affected.... - -The following quotation is from his treatise on gout:-- - - If the patient complains that one of his joints is painful, he - should be asked whether or not the part has received a blow. If - he replies that it has not, then (you may infer that the pain - is due to gout and) you should forthwith put him on a suitable - diet, order a clyster and bleed him at a spot not far (from the - seat of the pain).... The withdrawal of nourishment is ordered - for the purpose of arresting any further formation of new blood - and thus preventing the joints from growing more sluggish in - their movements. The clyster is ordered because we believe that - it is beneficial (in this condition) to evacuate the bowels. - The bleeding will be found useful, but to a less degree in - the lower than in the upper limbs.... One must be careful not - to assume that the patient is cured when he has been entirely - relieved of his pain, because with the lapse of time fresh - attacks are liable to occur; this disease, like certain other - affections, possesses a periodic character.... Therefore it is - well, immediately after the bloodletting, to employ friction, to - get rid of the excess of moisture in the body by some laborious - form of exercise, to take such articles of food as are easily - digested,--in brief, to aim chiefly at reducing as much as - possible the moisture of the body. - -One cannot but feel a keen regret that so few of the writings of this -thoroughly practical and highly educated physician should have come -down to our time. So far as I am able to learn, Rufus wrote no fewer -than 102 treatises, all of which, with the exception of the seven -about to be mentioned (together with a number of fragments preserved -by different writers of antiquity) have either disappeared or been -destroyed. The titles of the treatises which have been preserved are as -follows: (1) Diseases of the Kidneys and Bladder; (2) On Satyriasis and -Gonorrhoea; (3) Purgatives; (4) The Names of the Different Parts of the -Human Body; (5) On the Questioning of Patients; (6) On the Pulse; (7) -On Gout. - -_A General Survey of the Subject of Sects in Medicine._--During -the sixth century B. C.,--that is, about two hundred years before -the formation of the more distinctly medical sects of which mention -was made in Chapter IX.,--Pythagoras of Samos and his disciples put -forward certain beliefs or doctrines with regard to the mode of -action of some of the functions or vital processes of the human body, -and all those who accepted these teachings as affording a true and -satisfactory explanation of the phenomena in question constituted what -is generally termed a school or sect. Some of these individuals were -physicians--that is, men who undertook to cure or at least to relieve -those who were ill; but probably the majority were simply philosophers, -mere “lovers of wisdom,” who by studying problems of this nature sought -to satisfy their longing for a more perfect knowledge of the truth -respecting the various phenomena of life. - -A few years later, Heraclitus of Ephesus, who, like Pythagoras, was -both a philosopher and a practicing physician, taught the doctrine that -all things owe their origin to fire. One is not at all surprised to -learn that he had relatively few followers, for history tells us that -he was both a misanthrope and a slanderer of the medical profession, -as shown by the following saying which is attributed to him: “Next to -physicians the grammarians are the biggest fools in the world.” - -Hippocrates attached much importance to the value of experience and -to the necessity of studying disease at the bedside; at the same time -he upheld what is commonly known by the name of humoral pathology--a -doctrine which refers all maladies to some abnormal change in the -humors or fluid portions of the body. His writings also show that he -made full use of the reasoning power. The followers of this great -physician did not form a sect in the ordinary sense of the term; they -were his adherents simply because he was an able diagnostician, a -successful teacher, an excellent therapeutist, a skilful surgeon, a man -of very high moral character,--in short, a great physician. Every sect -which developed in the centuries following his death contained a goodly -proportion of Hippocratists. - -Nearly two centuries after the active period of the professional life -of Hippocrates, Erasistratus and Herophilus gathered about themselves -in Alexandria (about 280 B. C.) large groups of followers, who held for -their respective teachers a degree of esteem which amounted, according -to Galen, almost to veneration. As there was little or no antagonism -or lack of harmony between the doctrines taught by these physicians, -the two groups cannot properly be classified among the sects. In -fact, it would be more correct to say that Erasistratus and Herophilus -contributed facts of permanent value to our stock of knowledge rather -than doctrines which might prove highly popular for a few scores of -years, but which would probably in due course of time be set aside as -no longer of value. - -The four most characteristic types of sects in medicine were the -following: the Dogmatists--or Rationalists, as Daremberg calls them -in one place; their great rivals, the Empirics; the Methodists; and -the Eclectics. The oldest sect, the Dogmatists, did not come into -prominence until after the medical schools at Alexandria had already -been in operation for a long time. The development of the rival sect of -the Empirics at this late period brought with it endless discussions -regarding the merits of their respective teachings, and thus both of -them gained a degree of prominence which seems to us moderns to have -been out of all proportion to the importance of the subject-matters -discussed. The Dogmatists, says one writer, insisted that it is just as -necessary to be acquainted with the “hidden causes” of disease as with -those which are plainly recognizable, and that it is only by aid of the -reasoning power that we gain some knowledge of this class of causes. -They claimed that, while a knowledge of anatomy is of very great -service to the surgeon, it usually renders this service through the aid -of the reasoning power; as when, in the performance of a lithotomy, the -operator selects the fleshy (_i.e._, vascular) neck of the bladder -as the spot in which to make the opening with the knife, in preference -to the base of the organ, which is chiefly membranous in structure and -therefore less likely to heal solidly. - -The plausible but rather shallow response made by the Empirics to -the arguments advanced by their rivals consisted in quoting certain -maxims, as, for example: “The farmer and the helmsman do not acquire -knowledge of their respective occupations from discussions, but from -actual practice”; “It is not of vital importance to know what are the -causes of the different diseases, but what remedies are competent to -cure them”; and “Diseases are not cured by eloquence, but by remedial -agents.” - -Among the comments made by Celsus with regard to the differences which -distinguished the Dogmatists from the Empirics we find the following -statement: “The two sects employed the same remedies and pursued very -much the same course of treatment, but their reasonings about such -matters were different.” - -Modern physicians will, at first thought, be disposed to wonder how men -as clever as many of these physicians were could have split up into -separate and more or less antagonistic sects because of such apparently -trivial differences of opinion. It must be remembered, however, that -these men were groping in comparative darkness whenever they tried to -advance their knowledge of pathology, and that in this imperfect light -many things seemed of much greater importance than they appeared to be -in the brighter light of later centuries. It is only fair, therefore, -to withhold criticism and to ask ourselves whether this strong desire -on the part of those men to advance their knowledge of pathology--a -desire which manifested itself in the formation of sects--was not in -reality an evidence of the great vitality of Greek medicine on Roman -soil in those early centuries. - -The remarks made above with regard to the Dogmatists and the Empirics -apply in a general manner to the sects known as the Methodists and the -Eclectics, a sufficiently full account of which has been given in the -preceding chapter.[38] - - - - - CHAPTER XIV - - WELL-KNOWN MEDICAL AUTHORS OF THE EARLY CENTURIES - OF THE CHRISTIAN ERA - - -There were four men who were not especially identified with any of the -sects described in the preceding chapters, and yet who occupied, as -authors of medical treatises, very prominent places in the history of -medicine of the period or epoch which we have just been considering. -They are Celsus, Scribonius Largus, Pliny the Elder and Dioscorides. -These men lived during the first and second centuries A. D. and they -therefore all belong strictly to the period which is designated in our -scheme as the fourth epoch. I shall give here brief sketches of all of -these writers and of their works. While Caelius Aurelianus, another -important medical author, belonged to a much later period, I shall, for -reasons of convenience, describe in the same chapter with the others -the part which he played in the evolution of medicine. - -Aulus Cornelius Celsus, called by some the Latin Hippocrates and by -others the Cicero of physicians because of the correctness and elegance -of his Latin and the clear manner in which he puts his thoughts into -words, flourished during the reign of the Emperor Augustus (27 B. -C.-14 A. D.). The date and place of his birth are not known, but it is -generally believed that he was born and received his education at Rome. -The great work which he wrote and upon which he must have been engaged -the larger part of his lifetime was a sort of cyclopaedia, which -bore the title “_Artium libri_,” and in which each department -of knowledge was represented by a separate treatise. It is said that -five books were devoted to agriculture, seven to rhetoric, eight to -medicine, etc.; but all of these treatises, excepting those relating -to the latter science, have been lost or destroyed. It is not certainly -known to which of the professions Celsus belonged, but the very skilful -and judicious manner in which he has culled all that is best from the -medical treatises published before his time, the remarkable knowledge -of technical details which he displays in every part of his own work, -and the fine tone of medical thought which pervades these eight -books, almost compel the conclusion that the author was a very clever -clinician, although probably not a physician who practiced for a money -reward. In no other published treatise is a more perfect picture of the -medical practice of antiquity to be found than that which Celsus gives -us in his work “_De arte medica libri octo_.” - -It is not an easy matter to select, from a treatise of several hundred -pages in length, one or two passages of such a character that they may -be accepted as fairly representing the author’s manner of dealing with -medical and surgical questions of practical interest. The two given -below are translations from Védrènes’ version (Paris, 1876), and they -deal, the one with venesection and the other with the proper manner of -arresting hemorrhage from a wound. Both the passages quoted represent -only fragments, as sufficient space for more extensive extracts is not -available. - - _Book II., Chapter X._--_Bloodletting from a - Vein._--Incising a vein for the purpose of drawing blood from - it, is not a new procedure; but it is certainly a new thing to - resort to bloodletting in almost all diseases. Again, it is an - ancient custom to employ bloodletting in young subjects and in - women who are not pregnant, but it is a new thing to perform - this operation on infants and aged individuals, and on women - approaching the period of confinement. It was the idea of the - ancients that persons at the two extremes of life were not able - to support this sort of treatment, and they were convinced that - a pregnant woman, if subjected to the operation of bloodletting, - would almost surely be confined before the completion of her - time. Since then, however, experience has shown that there is - no fixed rule about this matter, and that a physician should - preferably regulate his course in accordance with observations - of a different nature. The determining factor, for instance, - is neither the age nor the pregnant state of the patient, but - rather the degree of physical strength. In the case of a youth - who is feeble, or of a delicate woman (aside from the question - of pregnancy), it would be wrong to draw blood, for it would be - robbing them of what little strength they possessed. But, in the - case of a vigorous child, a robust old man, or a pregnant woman - who is in good health, one need not hesitate to resort to this - procedure. Nevertheless, there may arise, in connection with the - operation of venesection, a number of questions which are quite - likely to puzzle an inexperienced physician and perhaps lead him - into error. For example, infants and old people possess as a - rule diminished vigor, and the woman who is about to be confined - needs all her strength for the period following delivery, both - for herself and for the nourishing of the child. But the mere - fact that one must give some thought to questions of this nature - and must exercise prudence does not justify the immediate - rejection of a method of treatment like that of venesection. For - is it not the very essence of our art, not merely to consider - the factors of age and the pregnant state, but also to form an - estimate of that other and more important factor, viz., the - patient’s strength,--be that patient an infant, an aged person, - or a woman advanced in pregnancy,--and then to decide whether - it is, or is not, great enough to bear the loss of blood? - In deciding a question of this kind it will be necessary to - distinguish between real vigor and obesity, between thinness and - feebleness, etc. - - * * * * * - - Venesection is an easy operation for a physician who has already - familiarized himself with the manner of performing it, but - for one who is ignorant of these details it may prove very - difficult. It is necessary, for example, to bear in mind that - the artery and vein are united and that they are accompanied - by nerves; and, further, that the injuring of the latter - will induce spasms and violent pains. On the other hand, it - must also not be forgotten that an artery once opened has no - disposition to close, nor does it heal, and that sometimes the - blood escapes in an impetuous manner. If, perchance, the vein - is cut transversely, the edges of the opening contract and no - more blood escapes. Again, if the scalpel is plunged into the - parts timidly, the skin alone will be divided and the vein will - not be opened. In some cases this vessel is so hidden from - sight that the physician may experience difficulty in bringing - it into view. Thus it will be seen that there are several - circumstances which may render this operation difficult for an - ignorant or inexperienced physician. The vein should be incised - in a longitudinal direction, midway between its two sides. The - moment the blood gushes from the opening its color and general - appearance should be carefully noted, etc. - - _Book V., Chapter XXVI._--_The Proper Manner of Arresting - Hemorrhage from a Wound._--If there is fear that there - may be bleeding, one should fill the wound with dry lint, - place over it a sponge wrung out of cold water, and press - upon it with the hand. If the bleeding still continues, it is - advisable to change the stuffing of lint somewhat frequently; - and, if this step proves ineffective, then lint moistened with - vinegar may be tried, for this liquid acts energetically in - arresting hemorrhage. Some physicians, indeed, actually pour - it into the wound. There is a strong objection, however, to - the use of an agent which, like vinegar, arrests the bleeding - too completely--viz., that it is apt to set up afterwards an - intense inflammation of the parts. The same reasoning applies - with even greater force to the employment of corrosives and - caustics, which produce an eschar. Despite the effectiveness - of most of these in arresting hemorrhage, their use should be - discouraged.... Finally, if the bleeding continues it will be - necessary to grasp the vessel from which the blood is escaping, - to ligature it in two places close to the wound, and then to - divide the vessel between the two ligatures, in order that - it may retract (both of the new orifices having already been - closed by the ligatures). If the circumstances are such that the - plan just recommended cannot be carried out, it will then be - advisable to apply the red-hot cautery to the bleeding vessel. - When a rather free hemorrhage occurs at a part of the body where - there are no nerve trunks and no muscles,--as on the forehead or - at the top of the head,--the simplest plan is to apply a cup at - some little distance from the source of the bleeding and thus - divert the current of the blood from the spot affected. - -And to these two longer extracts may be added a third:-- - - From these considerations the inference is warranted that a - physician cannot possibly give proper attention to a large - number of patients. (Book III., Chapter IV.) - -Celsus’ treatise was ignored by physicians for many centuries, but -it was considered by the monks, in the Middle Ages, a valuable -guide in the treatment of disease; and it was probably owing to -this circumstance, says Védrènes, that the book did not altogether -disappear. It was not until the year 1443 that Thomas de Sazanne, -afterward Pope Nicholas V., discovered a copy of the work in the church -of Saint Ambrosius, at Milan, but it was only in 1478 that the book was -printed for the first time (at Florence). Then, as if to make up for -the long neglect to which it had been subjected, no fewer than sixty -Latin editions were issued during the two succeeding centuries; and, -in addition, it was eventually translated into every modern European -language. - -Scribonius Largus, a Roman physician who lived during the reigns -of Tiberius and Claudius (14–54 A. D.), owes his celebrity to the -fact that he wrote and published (in 47 A. D.) a book containing a -collection of the best medical formulae and popular recipes known at -that time. He appears to have had a large private practice and to have -spent a considerable portion of his professional life in the service -of the army. He accompanied the Emperor Claudius, for example, in his -campaign against Britain (43 A. D.), and the book which he wrote, and -which has just been mentioned, was dedicated by him to that emperor. -According to Neuburger, Scribonius is to be credited with having been -the first to describe correctly the proper manner of obtaining the drug -known as opium, and also the first to recommend, in the treatment of -severe headaches, the employment of electric shocks as communicated by -the fish called the “electric ray.” - -Medical practice at that period, says Le Clerc, was divided among three -kinds of practitioners--those who treated their cases exclusively by -dietetic measures, those who effected cures by surgical means, and -those who took charge only of such patients as required chiefly the -employment of external remedies. But Scribonius Largus insists that -such a division was more theoretical than real, as no one of these -classes could get along without the cooperation of the others. - -C. Plinius Secundus, commonly called Pliny the Elder, was born near the -beginning of the first century of the Christian era, either at Verona -or at Como in the north of Italy, and settled in Rome at an early -period of his life. At the beginning of his career he served for some -time in the army in Germany, and upon his return to Rome practiced as -a pleader. Subsequently he held various official positions which gave -him the opportunity of visiting other countries of Europe. He perished -at Stabiae (near the modern Castellamare, on the Gulf of Naples) in 79 -A. D., at the age of fifty-six years, while watching the eruption of -Vesuvius, which overwhelmed Herculaneum and Pompeii. He was in command -of the Roman fleet at the time. - -Pliny was indefatigable as a writer and as a gatherer of knowledge of -all sorts, and he and Celsus are well named the Encyclopaedists. He -is said to have written twenty books on the war with the Germans, an -unknown number on rhetoric and grammar, and thirty-seven on natural -history. The latter books alone have come down to our time. Pliny’s -nephew, who is known as Pliny the Younger, and who edited the great -work of his uncle on natural history, furnishes us, in a letter -addressed to the historian Tacitus, with some interesting details -regarding the elder Pliny’s manner of life. It appears from this -account, that the latter read almost incessantly. During his meals and -while he was taking his bath, an attendant read aloud to him. He also -took his books with him on his travels and was always accompanied by -a person who could write rapidly under dictation. He continued this -practice upon his return to Rome and dictated to his amanuensis even -while he was being carried about in a sedan chair. Books 20–27 of his -great work on natural history are devoted to the subject of remedial -agents belonging to the vegetable kingdom, books 28–32 deal with those -which belong to the animal kingdom, and books 33–37 treat of mineralogy -with special reference to medicine, painting and sculpture. Pliny was a -compiler and not an original investigator. Some idea of the popularity -of his treatise on natural history may be gathered from the fact that -it was the second book to be printed after the invention of printing, -the Bible being the first. Another interesting fact connected with -Pliny’s treatise is mentioned by Neuburger, viz., that the use of -hyoscyamus and belladonna as agents capable of dilating the pupils, -owed its origin to the discovery (by C. Himly, in 1800) of a place in -the text (Book XXV., 92) where it is stated that the juice of the plant -Anagallis was rubbed into the eyes before the operation for cataract -was undertaken. - -According to Pliny (Book XXXI., Chapter VI.), the ancients employed -mineral waters extensively in the form of baths, and they also -occasionally used them as internal remedies. Galen, too, mentions the -fact that these waters were in demand in the spring or autumn for -purgative purposes. - -In Book XXXIX., 8, 3, Pliny--as quoted by Védrènes--makes the following -remarks:-- - - Very few Romans have shown an active interest in medical - affairs, and those few speedily found it necessary to pass - themselves off as Greeks. For it is a well-known fact that those - physicians who, without being able to speak Greek, attempted to - build up a practice in Rome, failed to gain the confidence of - their patients, even of those who were not at all familiar with - that language.... When one’s health is the question at issue the - readiness to place confidence in a medical adviser is apt to - diminish in proportion as one’s knowledge of the man increases. - Indeed, medicine is the only art in which one is quite ready - at first to put faith in almost anybody who calls himself a - physician, and that too, despite the acknowledged fact that in - no other circumstances of life is an imposture more fraught with - danger. - -English versions of Pliny’s Natural History and of Pliny the Younger’s -Letters have been published in what is known as Bohn’s Libraries. - -Pedanius Dioscorides, a native of Anazarba, a small Greek town near -Tarsus in Cilicia, lived about the middle of the first century A. D. -(during the reigns of Nero and Vespasian). From his earliest youth he -took a great interest in botany, and, after reaching manhood, traveled -extensively in the wake of different Roman armies, for the sole purpose -of studying by direct observation the plants of different countries -and of verifying the medicinal virtues which each one was reputed to -possess. In this way he visited, in turn, Greece, Italy, Asia Minor -and perhaps also the southern portion of France (the Narbonaise). He -collected great quantities of specimens of every kind of drug--animal -and mineral substances as well as objects belonging to the vegetable -kingdom; and, wherever it was possible to do so, he wrote memoranda of -the traditions of the natives with regard to the uses and medicinal -effects of these different drugs. After he had completed all these -researches and had gathered together all this vast mass of materials, -he wrote his famous treatise on materia medica--“the most complete, -the best considered, and the most useful work of its kind to be found -anywhere to-day.” (Galen.) It is from this treatise, therefore, says -Dezeimeris, that one can derive the most satisfactory idea of the -early Greek materia medica; but at the same time, he adds, it is not -a book in which will be found a detailed account of the manner in -which the practitioners of that period employed the remedies which he -describes. The same authority calls attention to the great difficulty -which modern physicians often experience in their attempts to identify -the drugs which Dioscorides describes. Le Clerc calls attention to -the fact that the physicians who were contemporaries of Dioscorides -were not in the habit of employing either iron or antimony (called by -them _stibium_) internally. Apparently they had not yet learned -that these substances possess properties which exert a curative action -in certain diseases. On the other hand, he mentions the manner of -extracting quicksilver, by chemical means, from cinnabar [red sulphide -of mercury], the steps required for preparing acetate of lead, and the -proper way of making lime water. - -The work to which reference has been made above was published by -Dioscorides about the year 77 A. D. It is the earliest pharmacological -treatise that has come down to our time, and for many succeeding -centuries it served as the authoritative guide in all questions -relating to drugs. The first printed edition of the Greek original -appeared in Venice in 1499, but a still earlier Latin version was -issued in 1478. According to Pagel the best edition (in Latin and -fully illustrated) is that of Pietro Andrea Mattioli, which was printed -in Venice in 1554. Neuburger commends highly the German version by J. -Berendes. (Stuttgart, 1902.) - -Of Caelius Aurelianus we possess no biographical details beyond the -facts that he was a native of Sicca in Numidia, Africa, and that he -lived toward the end of the fourth or during the first part of the -fifth century of the present era. He was the author of several works, -all but one of which, however, have been lost. The single treatise -which has come down to our time treats of acute and chronic diseases, -and is spoken of by Daremberg as being virtually a translation of -one of the lost writings of Soranus. This book, says Haeser in his -History of Medicine, is the most important source from which our -knowledge of Methodism is derived; and Neuburger not only agrees with -this statement, but adds that the treatise of Caelius Aurelianus -played a most important part, toward the end of the Middle Ages, in -the evolution of medicine. Up to the present time no translation of -this work into any modern language has been published, but Neuburger -furnishes a very full analysis of its important parts. In two places, -as appears from this analysis, Caelius Aurelianus mentions--among -the signs and symptoms of certain affections of the respiratory -apparatus--phenomena which show beyond a doubt that he (or Soranus) was -familiar with auscultation of the chest. The words which he uses are -these:-- - -“_Stridor vel sonitus interius resonans aut sibilans in ea parte quae -patitur,” and “sibilatus vehemens atque asper in ultimo etiam pectoris -resonans stridor._” - - - - - CHAPTER XV - - CLAUDIUS GALEN - - -During the centuries immediately preceding the Christian era, Greek -medicine was represented by a collection of treatises which had been -written by Hippocrates and his followers on anatomical, physiological, -pathological, therapeutical and ethical subjects, and which constituted -a fairly complete but not always easily intelligible system. As -time went on, however, and especially as new and useful facts were -constantly being added to the existing stock of medical knowledge, -the more thoughtful physicians began to feel that the system, which -up to that day had proved acceptable, needed to be perfected in a -number of respects; and accordingly, as a result of this feeling of -dissatisfaction, and also as an expression of the prevailing desire -for a more perfect knowledge of the truth, there developed, as has -been stated in the preceding chapters, a number of different medical -sects. When Galen first appeared in the field as a physician of unusual -promise, these various sects were all still in a thriving condition. -The Methodists, in particular, were very popular. Galen did not favor -any special sect, but in his writings he made it manifest that he -attached more importance to the teachings of Hippocrates than to those -of any other author. “It was Hippocrates,” he said, “who laid the real -foundations of the science of medicine.” It is therefore not surprising -that Galen should have devoted so much time to the writing of elaborate -commentaries on the works of Hippocrates. The service which he thus -rendered to medicine, says Daremberg, was of very great value. But -Galen, notwithstanding his great admiration for Hippocrates, did not -hesitate to criticise a number of his teachings, and especially those -which, as he believed, were not stated with sufficient clearness. -Valuable as was the service rendered to medicine by the writing of -these commentaries, there still remained an urgent need for a service -of a different and much more difficult kind, viz., that of welding -together into a single clearly written and easily intelligible system -of medicine, all that was good in the Hippocratic writings and in the -disconnected and at times antagonistic teachings of the sects. To -accomplish this successfully required the services of a man endowed -with mental gifts of a most exceptional character--complete knowledge -of medicine in all its departments, a mind thoroughly trained in -philosophy, the power to express his thoughts in simple language, -and an independence and fairness of judgment which would render him -indifferent to the petty interests of the sects. Claudius Galen, as -subsequent events showed, possessed these very gifts in a high degree, -and he devoted the better part of his reasonably long lifetime to the -accomplishment of this much-needed work. How greatly it was needed at -that particular period of time, nobody then knew or could even suspect. -It soon appeared, however, that all the vaunted civilization of the -Graeco-Roman world--much of it of the purest gold and a great deal -of the basest alloy--was to be swept so completely off the face of -the earth that, for thirteen hundred or more years, almost no thought -whatever could possibly be given to the science and art of medicine. -Fortunate, most fortunate it was, therefore, that, before this wave -of destruction reached Rome, all the best part of Greek medical -literature--for such it was in truth--had been gathered together and -carefully systematized by Galen and stowed away in the recesses and -chambers of remotely situated monasteries and churches by clear-sighted -monks for the benefit of later generations of physicians. - -_Brief Biographical Sketch._--Claudius Galen was born in Pergamum, -an important Greek city of Asia Minor, about the year 131 A. D., under -the reign of the Emperor Hadrian. His father, whose name was Nicon, -was a man of ample means, well informed in philosophy, astronomy and -geometry, and most liberal in providing for the thorough education of -his son in every branch of useful knowledge. In two or three places -in his writings Galen speaks of his father in terms of affection. On -the other hand, he does not hesitate to state in the plainest language -possible that his mother was a veritable Xanthippe. In her moments of -bad temper she would not only shout and scream in a violent manner, but -would sometimes go so far as to bite her serving-maids. Pergamum, at -the time of which I am writing, offered unusually good opportunities -for studying disease. Its Asclepieion, which was built during Galen’s -boyhood, had already become one of the famous temples of Asia Minor, -and the sick and maimed flocked to it in large numbers. Then, in -addition, the city was well equipped with able physicians, who appear, -according to Neuburger, to have been on very friendly terms with the -priests of the temple. It was under the guidance of such men that -Galen--at the early age of seventeen, and after a careful training in -philosophy, mathematics, etc.--began the study of medicine. He speaks -with special interest and respect of one of his instructors, a certain -Quintus, who had the reputation of being an excellent anatomist and at -the same time one of the most distinguished practitioners of that day. -Another anatomist, Styrus, was also one of Galen’s teachers. - -On the death of his father Galen left his home and devoted the -succeeding nine years to visiting all the different cities in which -he believed he might gain some additional knowledge in medicine and -surgery. A large part of this long period was spent in Alexandria, -which still retained much of its importance as a home of all the -sciences. On attaining his twenty-eighth year he left that city and -returned to Pergamum, evidently with the purpose of establishing -himself there in the regular practice of his profession. Through -the influence of the temple officials, and especially of the High -Priest, Galen received the appointment of physician to the gladiators, -a position which he held with credit for a period of four years, -and which afforded him excellent opportunities for cultivating his -knowledge of surgery. It was while he was serving in this capacity -that he devised and put into practice a method of saturating the -dressings (in cases of severe wounds) with red wine, for the purpose -of preventing the development of inflammation in the parts affected; -and the success which he thus obtained was so great that not one of the -gladiators intrusted to his care died from his wounds. History does -not state the precise manner in which Galen carried out his method of -utilizing wine in the dressing of wounds, and we are therefore unable -to determine just how much credit he was entitled to receive for this -crude but apparently effective means of securing local antisepsis. -It is clear, however, that Galen’s treatment could only have been a -modification of a much older method, for Jesus, in his answer to a -question put to him by a lawyer, said: “But a certain Samaritan, as he -journeyed, came where he (the injured man) was: and when he saw him, -he had compassion on him, and went to him, and bound up his wounds, -pouring in oil and wine, and set him on his own beast, ...” (St. Luke -x., 33, 34). - -At the end of four years there broke out in Pergamum a riot which -rendered residence there, at least for a certain length of time, -undesirable. Accordingly Galen, who was now thirty-two years old, -and who was probably glad of an excuse for leaving a place where a -physician of his education and talents had so few opportunities for -gaining distinction, decided to visit Rome, and--if circumstances -appeared to favor the plan--to settle there. His first impressions -after arriving in that metropolis were favorable to the plan of -establishing himself there permanently, but at the end of a few years -he became conscious of the growing hostility of those practitioners -who had been for a longer time than he well established in that city. -This hostility increased as he rose in favor and esteem with people -of position and influence. He had treated skilfully and with success -Eudemus, a peripatetic philosopher of great celebrity, for a quartan -fever. He had also cured the wife of Boëthus (a patrician who belonged -to the consular class) of a serious illness and had received as an -expression of appreciation a gift of four hundred pieces of gold. He -had won the friendship and esteem of such men as Sergius Paulus, the -Praetor; of Barbaras, the uncle of the Emperor Lucius; and of Severus, -who was at that time Consul, but who later became Emperor. These very -influential men took an active interest in Galen’s scientific work, -having been invited by him on more than one occasion to witness his -dissections of apes,--dissections which he made for the particular -purpose of demonstrating the organs of respiration and of the voice. -All these facts soon became known to Galen’s rivals and probably helped -to fan the spark of their envy into a flame; but it is very doubtful -whether he was justified in saying that the ill feeling thus engendered -threatened to end in some act of personal violence, for which reason -he decided to leave Rome and return to Pergamum. His secret manner -of departure, without taking leave of anybody, and the fact that the -Plague was just at that time rapidly approaching Rome, justify the -belief, says Neuburger, that it was not fear of personal violence at -the hands of his jealous rivals that drove Galen away so mysteriously -from the city in which, in the short space of four or five years, -he had won so great professional success, but an unwillingness to -face his duty, which was, to remain and aid in the approaching fight -against the great destroyer--the Plague. If Galen had been a simple -physician, one of the great body of medical practitioners in Rome, no -one would be disposed to question the justice of the criticism which -the distinguished Viennese historian makes of his decision to abandon -that city at the moment of her distress and peril. But, as a matter -of fact, Galen was not a practitioner of medicine in the full sense -of that term. He treated cases of illness because in no other way -would it be possible for him to acquire the necessary familiarity with -disease; but, almost from the very beginning, he seems to have fully -realized that he was destined to devote his time and his energies to -a very different kind of professional work,--work which was urgently -needed, which promised to be of very great value to medical science, -and which probably no other physician then living was competent to do -effectively. Furthermore, he was himself profoundly conscious that the -work in question constituted the main object of his life. His own words -(see his statement with reference to Archigenes, on page 174) show -this plainly, and the huge mass of medical treatises which he wrote -reveal in the most unmistakable manner with what untiring persistency -he pursued the path which he believed it was his duty to follow. It -being assumed, then, that such were the motives which actuated Galen, -was it a mistake on his part to conclude that duty did not require him -to remain in Rome? The question is a difficult one to answer, and I do -not feel called upon to decide it. We do not, however, brand a general -in the army a coward because he endeavors to protect himself as much -as possible from danger during a battle, that he may be able, to the -very end, to direct the soldiers under his command. Similarly, was not -Galen justified in avoiding every risk which was likely to imperil the -performance of duties which were of far greater value to medicine and -to humanity at large than that of acting as a mere soldier in the ranks -of medical men? - -It seems a great pity that one of the most inspiring figures in the -history of medicine should be represented to posterity with such a -blemish upon his character, and I have therefore ventured to suggest a -possible defense of Galen’s action. - -Not very long after he had returned to Pergamum, Galen was summoned -by the Emperors Marcus Aurelius and Lucius Verus, who were then with -the army at Aquileia, a few miles north of the present Trieste, to -join them at that city; and he was, of course, obliged to obey. A -fresh outbreak of the Plague had occurred and there had already been -many fatal cases among the troops. It was therefore decided by the -emperors, almost immediately after Galen’s arrival, to return to Rome -with a part of the army. A start was accordingly made, and the company -had already advanced some distance on their way, when Lucius Verus -died. This unexpected event greatly increased the difficulties of -the return journey, as it was deemed necessary to carry the remains -of the deceased Emperor back to the imperial city. Thus Galen found -himself once more settled in Rome, this time in the capacity of private -physician to the Emperor Marcus Aurelius and his sons Commodus and -Sextus. The position was extremely well adapted to the needs of Galen, -who, from that time forward, for a period of several years, had at his -disposal ample time for writing and for conducting his experimental -work in anatomy and physiology, a privilege of which he appears to have -made excellent use. He lived to be seventy years of age, his death -occurring during the latter part of the reign of Severus, or at the -beginning of that of Caracalla (about 201 A. D.). - -All Galen’s critics agree that he possessed his full share of -peculiarities,--not to call them by the harsher name of faults. He was -constantly ready, for example, to praise his own doings and sayings, -and he rarely lost an opportunity of holding up the physicians of Rome -to ridicule and contempt. He was specially bitter in his criticisms of -Methodism and its adherents--“the donkeys of Thessalus,” as he called -them. At the same time, no other physician of ancient or modern times -has manifested to an equal degree such extraordinary industry as a -writer and original investigator in a great variety of departments of -knowledge. Although many of his works have been lost,[39] those which -have come down to our time are still very numerous--“a sufficient -number,” says Neuburger, “to constitute a library by themselves.” I -give here a few of the titles of these works, in order that the reader -may get at least some idea of the great variety of medical topics which -Galen has discussed in his writings. The more complete list furnished -by Daniel Le Clerc contains nearly two hundred titles, and yet even -this is believed to fall short of the actual number. - - - SELECTED LIST OF THE WORKS OF GALEN RELATING TO - MEDICINE. (FROM LE CLERC.) - - Explanation of some of the Ancient Terms Employed by Hippocrates. - - On the Establishment of the Art of Medicine. - - Definitions of Medical Terms. - - On the Different Sects in Medicine. - - Discourse against the Empirics. - - On the Importance, for a Physician, of a Thorough training in - Philosophy. - - The Physician; or Introduction to Medicine. - - The Elements, as taught by Hippocrates. (2 books.) - - The Different Temperaments. (3 books.) - - On the Nature of Man; Commentaries on two Books of Hippocrates. - (2 books.) - - The Humors. - - Do the Arteries Normally contain Blood? - - On Black Bile. - - On the Bones. (For Students in anatomy.) - - Dissection of the Vocal Organs. - - The Anatomy of the Eyes. - - Dissection of the Veins and Arteries. - - Dissection of the Nerves. - - On the Utility of the Different parts of the Body. (17 books.) - - On the Natural Faculties. (3 books.) - - The Sentiments of Hippocrates and of Plato. (9 books.) - - The Organ of Smell. - - The Movements of the Muscles. (2 books.) - - The Physiology of Respiration. - - On Obesity. - - On the Maintenance of Health. (6 books.) - - The Characteristics of Different Foods. (3 books.) - - Precepts regarding the Diet best suited to the Four Different - Seasons and to Each of the Twelve Months of the Year. - - On the Manner of Living best suited to those who Wish to - Preserve their Health. (3 books.) - - On Habit. - - On the Differences between Diseases. - - On the Causes of Diseases. - - On Marasmus or Consumption. - - On the Different Kinds of Fevers. (2 books.) - - On Thirst. - - On the Parts of the Body Affected. (6 books.) - - The Diseases of Women. - - The Different Kinds of Pulse. (16 books.) - - The Different Kinds of Urine. - - On Critical Days. (3 books.) - - Commentaries on the Treatises of Hippocrates. (39 books.) - - On the Manner of Treating Different Maladies. (17 books.) - - On Venesection. (3 books.) - - On the Use of Cups, Leeches and Scarifications. - - On Purgatives. (3 books.) - - On Colic. - - On Jaundice. - - On Gout. - - On Stone in the Bladder. - - Etc. - -The numerous works of Galen, says Pagel, constitute a complete and -very satisfactory encyclopaedia of medicine. The most available -edition of his works in Greek is that of Karl Gottlob Kühn of Leipzig -(1821–1828; 22 Vols. of about 1000 pages each). There is scarcely a -department which this great physician has not treated quite fully. But, -unfortunately, the translations into modern languages are relatively -few, and they cover only small portions of the entire work. That -of Daremberg, entitled “_Oeuvres anatomiques, physiologiques et -médicales de Galien, etc._” (Paris, 1854–1857; 2 Vols.), is in every -way most satisfactory, and it is from this source that I have made a -few extracts--just sufficient to give the reader some idea of Galen’s -style of writing and of his competency to deal with such subjects as -human anatomy and physiology. To attempt anything like a complete -exposition of his views regarding pathology, therapeutics, hygiene, -etc., would necessitate my devoting more space to this part of the -history of medicine than I can afford to give. To those who desire to -obtain more ample information about Galen’s views regarding pathology -and therapeutics I would recommend a study of Daremberg’s admirable -work and a perusal of the careful analysis made by Neuburger of certain -portions of Galen’s text. - -_Galen’s Contributions to Anatomy and Physiology._--At the -period of time about which I am now writing, and for many centuries -afterward, there existed among all classes of the community a very -strong prejudice against dissecting human corpses. And even Galen -himself appears to have shared this prejudice, for, in spite of his -intense eagerness to gain a more perfect knowledge of human anatomy, he -apparently did not dare to undertake any such investigation, even when -a favorable opportunity for so doing presented itself, as it did on the -occasion to which he refers in the following brief extract taken from -one of his treatises:-- - - A carelessly constructed sepulchre on the banks of a river had - been undermined during a season of flood, and the corpse thus - set free had floated down stream a short distance, until it - finally lodged on the shore of a small cove. Passing near by I - had the opportunity of inspecting this corpse. The fleshy parts - had already disappeared to a great extent through the process - of decomposition, but the bones were still held together by - their fibrous connections. The picture presented to the eye was - that of a human skeleton specially prepared for the instruction - of young physicians. On another occasion, a few steps from the - main road, I came across the dead body of a robber who had been - killed by the traveler whose money he had attempted to steal. - The peasants of that neighborhood were not willing to bury the - corpse of such a bad man, and they accordingly allowed it to - remain at the spot where it was first discovered. In the course - of the following two days, as might be expected, the vultures - removed every particle of flesh from the bones, so that, when - I saw what remained of the body, the only thing visible was a - nicely cleaned skeleton. - (Le Clerc: _Histoire de la Médecine_, p. 711.) - -Here were two excellent opportunities for gaining the additional -knowledge of human anatomy which Galen so much desired, but he -evidently was not at all disposed to avail himself of them--doubtless -because his mind was deeply imbued with the feeling that any such -interference on his part would be a sacrilegious act. Under the -circumstances, therefore, there was nothing left for him to do but -to utilize animals for purposes of dissection, and more particularly -apes, whose anatomy very closely resembles that of the human being. -Several of Galen’s books on anatomy have come down to our time, but -quite a number of others have been lost. From those which we possess, -and especially from the one entitled “Anatomical Administrations,” -it is permissible to conclude that he was a most skilful dissector -and an extremely close and careful observer, and that he was very -particular to set down the results of his observations in admirably -clear language. Indeed, Le Clerc assures us that Vesalius, the great -Flemish anatomist of the sixteenth century, bestowed high praise upon -Galen’s anatomical descriptions; and that, too, notwithstanding the -fact that the latter sometimes erred in his statements regarding the -similarity between certain parts observed in dissections of an animal -and the corresponding parts in man. In one of his treatises[40] Galen -states distinctly that the arteries contain blood. In another he gives -a remarkably full and accurate description of the nervous system, -including the brain, spinal cord, and many of the nerves. - - He describes the optic nerve, the oculo-motorius and - trochlearis, the different ramifications of the trigeminus, the - acusticus and facialis, the vagus and glossopharyngeus, the - nerves of the pharynx and larynx, the sympatheticus (with the - accompanying ganglia), and the radial, ulnar, median, crural and - ischiatic nerves. (Puschmann.) - -Although it is true that certain important anatomical and physiological -facts are found recorded for the first time in the works of Galen, -this must not be accepted as evidence that Galen himself is the real -discoverer of these facts. The most that can be claimed for him is that -he is the first writer to bring the facts in question to the knowledge -of us moderns. When the ancient books that have been lost are once -more brought to light, as they very well may be at any time, we shall -be able, perhaps, to give credit where credit is due. But there is one -department in which Galen did experimental work of an entirely original -character and for which he deserves unstinted praise. I refer to the -experiments which he made concerning the physiology of the brain and -spinal cord. They are related in the following extract, which has been -translated from the account given by Neuburger (_op. cit._, Vol. -I., p. 380):-- - - The brain itself is not sensitive; it expands and contracts - synchronously with the respiratory movements, the purpose of - which action is to drive the pneuma from the cavities of that - organ into the nerves. The function of the meninges is to hold - the parts firmly together and to unite the blood-vessels. - Pressure upon the brain causes stupor. An injury of the tissues - surrounding the fourth ventricle or of those which constitute - the beginning of the spinal cord produces death. The seat of - the soul is in the substance of the brain, and not in its - membranes. The spinal cord serves as a conductor of sensation - and of motor impulses, and it also plays the part of a brain - for those structures of the body which lie below the head. - It gives off nerves like streamlets. Division of the spinal - cord longitudinally in its median axis does not give rise to - paralysis. Transverse division, on the other hand, causes - symmetrical paralyses. If the cord is divided between the third - and fourth cervical vertebrae, respiration is arrested, and - if the division is made between the cervical and the thoracic - portions of the spinal column, the animal breathes with the aid - only of its diaphragm and of the upper muscles of the trunk of - the body. Division of the recurrent nerves produces aphonia; if - the fifth cervical nerve is divided, the scapular muscles on - the corresponding side will be paralyzed. Galen considers the - ganglia to be organs for reinforcing the energy of the nerves. - The fact that both cerebral and spinal-cord nerve-filaments - enter into the composition of the sympathetic nerve explains the - extraordinary sensitiveness of the abdominal organs. - -When we consider that these experiments are the first of their kind -of which history makes mention, that they were carried out nearly -seventeen hundred years ago, and that--so far as we know--they sprang -entirely from the brain of the experimenter, we may well express -unlimited admiration for Claudius Galen. - -Daniel Le Clerc says that Galen’s principal treatise on human -physiology, entitled “Utility of the Different Parts of the Human -Body,” constitutes a _chef-d’oeuvre_ which has challenged the -admiration of physicians and philosophers in all ages. Christians, -however, he adds, are particularly gratified to learn from this work -that “Galen, although classed as a Pagan, unhesitatingly recognizes -that it was an all-wise, an all-powerful, an all-good God who created -man and all the other animals.” Further on, Le Clerc refers to another -statement which was made by Galen and which will be found on page 261 -of Daremberg’s version. It reads as follows:-- - - If I were to spend any more time in talking about such - brutes--by which term he designates men who cannot appreciate - the wisdom of God in distributing the different parts of the - body in the manner in which He has done this--I should justly - incur the blame of sensible persons. They would accuse me of - desecrating the account which I am writing, an account which is - intended as a hymn of sincere praise of the Creator of man. I - believe that true piety consists, not in sacrificing numberless - hecatombs nor in burning unlimited quantities of incense and a - thousand perfumes, but in first searching out and then making - known to my fellow men how great are the wisdom, the power, and - the goodness of the Creator. - -Galen’s work on “The Utility of the Different Parts of the Human Body” -is composed of seventeen books, all of which exist to-day in a complete -state. Taken together they form, as may be seen by the following list -of contents, a remarkably complete treatise on physiology. Books I. and -II. are devoted to the hand, forearm and arm (105 pages); Book III. to -the thigh, leg and foot (62 pages); Books IV. and V. to the alimentary -organs and their accessories (101 pages); Book VI. to the respiratory -organs (78 pages); Book VII. to the organs of the voice (67 pages); -Book VIII. to the head, the encephalon and the organs of special sense -(45 pages); Book IX. to the cranium, the encephalon and the cranial -nerves (38 pages); Book X. to the eyes and their accessories (45 -pages); Book XI. to the face and more particularly the jaws (55 pages); -Book XII. to the neck and the rest of the spinal column (46 pages); -Book XIII. to the shoulder and the structure of the spinal column in -detail (40 pages); Books XIV. and XV. to the genital organs and the -parts in which the foetus develops (70 pages); Book XVI. to the nerves, -arteries and veins (43 pages); and Book XVII. Epilogue (11 pages). - -There are very few modern text books in which the author treats the -subject in as exhaustive a manner as Galen has done in these seventeen -books. As may readily be imagined from the great number and length -of his writings, he often wanders off into side issues and thus lays -himself open to the charge of being a diffuse writer. At the same -time he cannot be accused of dullness, for in reading Daremberg’s -version one is seldom tempted to omit any of the text, and his style -is interesting. The following brief extracts, to which should be added -that given on a previous page, may be taken as fair samples of his -manner of treating questions in the department of physiology:-- - - _Reasons why the Alae Nasi are Cartilaginous and why they may - be Moved by Voluntary Muscular Action._--We have already - explained in some measure the reasons why the alae nasi should - be composed of cartilage and why it should be possible for the - animal to move them at will.[41] It is an established fact that - the movements of these parts are competent to aid in no small - degree the somewhat forcible inspirations and expirations. This - is the reason why the alae are constructed in such a manner as - to be easily movable. They are made of cartilage because this - substance is hard to fracture or to tear apart. The placing - of these alar movements under the control of the will, and - not under that of some other bodily force (like the arterial - impulse, for example), is certainly an excellent arrangement; - and, if one does not appreciate this without any further - explanation, it must be because my previous reasonings about - such matters have fallen upon inattentive ears. - - (Translated from Book XI., Chapter XVII., of Daremberg’s French - version of Galen’s works.) - -Another brief extract may be given here. It forms a part of the chapter -relating to the action of the sigmoid valves of the pulmonary artery, -etc., and merits special attention because it furnishes additional -evidence of the correctness of Daremberg’s statement that Galen was -the leader of the most advanced school of experimentation:-- - - The more strongly the thorax, in its exertion of a compressing - force, tends to drive the blood (out of the heart), the more - tightly do these membranes (the sigmoid valves) close the - opening. Invested in a circular manner from within outward, - extending throughout the entire circumference of the interior - of the vessel, these membranous valves are, each one of them, - so accurately patterned and so perfectly fitted that when they - are put upon the stretch by the column of blood, they constitute - a single large membrane which closes (watertight) the orifice. - Pushed back by the return flow of the blood, they fall back - against the inner surface of the vein, and permit an easy - passage of the blood through the amply dilated orifice (which - they, an instant before, closed so perfectly). - - (Translated from Book VI., Chapter XI., of Daremberg’s French - version of the works of Galen.) - -In his comments upon the account of the sigmoid valves which I have -just quoted, Daremberg says that the description of these structures -given by Erasistratus at least four hundred years earlier is admitted -by Galen to be so correct that it would scarcely be possible to furnish -a better one. - -_Galen’s Remarks upon the Subject of Diagnosis._--In the treatise -entitled “On the parts of the Body Affected” (Book II., Chapter X.) -Galen gives the following advice with regard to the method which it is -desirable to adopt when one wishes to ascertain which part or organ is -affected, what is the nature of the disease there located, and whether -it is primary in its nature or secondary to some affection of earlier -development:-- - - It should have been the special duty of Archigenes, who - appeared on the scene next in order after a series of the most - illustrious physicians,[42] to infuse more light into medical - teaching. Unfortunately, he did the very opposite; for we who - have grown old in the exercise of the art (and should therefore - find it easy to comprehend what is written about medicine), are - at times unable to understand what he says. Such being the true - state of affairs, I now propose to undertake what Archigenes - failed to accomplish. I shall commence by indicating in a - general way what is the proper method to adopt when one wishes - to ascertain in what part or organ the disease is located and - how one should proceed when it is proposed to teach the method - to others. This method may be stated in the following terms:-- - - In the first place, the part should be carefully examined in - order that we may ascertain whether it presents any signs of - special value as indicating the nature of the disease. In the - next place, it is important in such an examination to know - beforehand what are the particular signs which belong to each - of the diseases that may affect the part or organ in question, - and also whether these signs vary according to the particular - section of the organ involved. In inflammation of the lung, - for example, there are: difficulty in breathing (dyspnoea) and - great general distress (malaise), the patient being obliged to - remain in a sitting posture (orthopnoea)--all of which are signs - indicating the possibility of suffocation. Furthermore, the - air expired from the infected lung is sensibly hot, especially - if the inflammation is of the erysipelatous variety, and, as - a consequence, the patient shows a disposition to draw long - breaths, knowing that the cold air which he thus draws into - his lungs will afford him some measure of relief. The sputa - expectorated when he coughs are differently colored; some - being red, yellowish, or of a rusty appearance, while others - are almost black, livid, or frothy. The patient also often - experiences the sensation of a heavy weight in his chest, - together with more or less pain, which seems to be located - deep down in that region and which shoots backward into his - spinal column or forward toward the sternum. Add to these - manifestations a high fever and a pulse such as we have already - described on another page, and you will have.... - - (Translated from Daremberg’s French version of Galen’s works.) - -It has been said that Galen possessed more than the ordinary share of -vanity with regard to his cleverness as a diagnostician; and certainly -some of the accounts which he gives, in his clinical and scientific -treatises, of his own experiences, seem to bear out this accusation. -One hesitates to expose the weak spots in the character of one of the -really great men of antiquity lest such exposure may convey a wrong -impression; at the same time it would be an error to represent him as -a man entirely free from the foibles common to humanity,--even to the -best and wisest of men. I therefore repeat here Galen’s own account of -a professional visit which he made to a brother physician whose malady -presented to himself and to his friends many obscure features. - - Upon the occasion of my first visit to Rome I completely won the - admiration of the philosopher Glaucon by the diagnosis which I - made in the case of one of his friends. Meeting me one day in - the street he shook hands with me and said: “I have just come - from the house of a sick man, and I wish that you would visit - him with me. He is a Sicilian physician, the same person with - whom I was walking when you met me the other day.” “What is the - matter with him?” I asked. Then coming nearer to me he said, - in the frankest manner possible: “Gorgias and Apelas told me - yesterday that you had made some diagnoses and prognoses which - looked to them more like acts of divination than products of the - medical art pure and simple. I would therefore like very much to - see some proof, not of your knowledge but of this extraordinary - art which you are said to possess.” At this very moment we - reached the entrance of the patient’s house, and so, to my - regret, I was prevented from having any further conversation - with him on the subject and from explaining to him how the - element of good luck often renders it possible for a physician - to give, as it were off-hand, diagnoses and prognoses of this - exceptional character. Just as we were approaching the first - door, after entering the house, we met a servant who had in his - hand a basin which he had brought from the sick room and which - he was on his way to empty upon the dung heap. As we passed - him I appeared not to pay any attention to the contents of the - basin, but at a mere glance I perceived that they consisted of a - thin sanio-sanguinolent fluid, in which floated excrementitious - masses that resembled shreds of flesh--an unmistakable evidence - of disease of the liver. Glaucon and I, not a word having been - spoken by either of us, passed on into the patient’s room. When - I put out my hand to feel of the latter’s pulse, he called my - attention to the fact that he had just had a stool, and that, - owing to the circumstance of his having gotten out of bed, his - pulse might be accelerated. It was in fact somewhat more rapid - than it should be, but I attributed this to the existence of - an inflammation. Then, observing upon the window sill a vessel - containing a mixture of hyssop and honey and water, I made up - my mind that the patient, who was himself a physician, believed - that the malady from which he was suffering was a pleurisy; the - pain which he experienced on the right side in the region of - the false ribs (and which is also associated with inflammation - of the liver) confirming him in this belief, and thus inducing - him to order for the relief of the slight accompanying cough - the mixture to which I have just called attention. It was then - that the idea came into my mind that, as fortune had thrown the - opportunity in my way, I would avail myself of it to enhance - my reputation in Glaucon’s estimation. Accordingly, placing my - hand on the patient’s right side over the false rib, I remarked: - “This is the spot where the disease is located.” He, supposing - that I must have gained this knowledge by simply feeling his - pulse, replied with a look which plainly expressed admiration - mingled with astonishment, that I was entirely right. “And”--I - added simply to increase his astonishment--“you will doubtless - admit that at long intervals you feel impelled to indulge in - a shallow, dry cough, unaccompanied by any expectoration.” As - luck would have it, he coughed in just this manner almost before - I had got the words out of my mouth. At this Glaucon, who had - hitherto not spoken a word, broke out into a volley of praises. - “Do not imagine,” I replied, “that what you have observed - represents the utmost of which medical art is capable in the - matter of fathoming the mysteries of disease in a living person. - There still remain one or two other symptoms to which I will - direct your attention.” Turning then to the patient I remarked: - “When you draw a longer breath you feel a more marked pain, do - you not, in the region which I indicated; and with this pain - there is associated a sense of weight in the hypochondrium?” - At these words the patient expressed his astonishment and - admiration in the strongest possible terms. I wanted to go a - step farther and announce to my audience still another symptom - which is sometimes observed in the more serious maladies of the - liver (scirrhus, for example), but I was afraid that I might - compromise the laudation which had been bestowed upon me. It - then occurred to me that I might safely make the announcement - if I put it somewhat in the form of a prognosis. So I remarked - to the patient: “You will probably soon experience, if you have - not already done so, a sensation of something pulling upon the - right clavicle.” He admitted that he had already noticed this - symptom. “Then I will give just one more evidence of this power - of divination which you believe that I possess. You, yourself, - before I arrived on the scene, had made up your mind that your - ailment was an attack of pleurisy, etc.” - - Glaucon’s confidence in me and in the medical art, after this - episode, was unbounded. - -Thirty or forty years elapsed after Galen’s death before the Profession -began to realize how great an authority he had become in all matters -relating to medicine; not perhaps among the majority of physicians, but -among the better educated and those more given to reasoning about the -various problems in physiology and pathology. Then came the invasion -of Rome by the Barbarians, and with it the scattering of nearly all -those who were at the time practicing medicine in that great city. -This was the beginning of the long period known as the Middle Ages, -a period during which, so far as Italy and Gaul were concerned, the -science of medicine made no advance whatever. The physicians living -in a precarious manner in the towns, and the monks who practiced -medicine in the country districts, took very little interest, as may -readily be imagined, in the achievements of Galen. Through all those -years they clung to the doctrines of the Methodists, as revealed to -them in the work of Caelius Aurelianus, the favorite medical treatise -of that period. It was only during the latter part of the Middle Ages -that Galen’s teachings began once more to be appreciated at their true -value; and, as time went on, they gained a stronger and stronger hold -on the minds of medical men, until finally they held undisputed sway. -Friedlaender, speaking of medicine in those dark times, uses these -words: “Galen’s colossal personality loomed up throughout that long -night as a brilliant guiding star to light the intricate pathways of -medicine.” - - - - - CHAPTER XVI - - THE INFLUENCE OF CHRISTIANITY UPON THE EVOLUTION OF MEDICINE - - -The religion established by Jesus Christ in Judea during the early part -of the first century remained confined within the limits of that region -for a number of years, but already during the latter half of that -period groups of Christians were to be found in every part of the Roman -Empire, and in certain localities the membership of the new church had -increased so greatly in numbers as to excite the alarm and hostility -of the temple priests and of the governing officials. Persecutions, -especially in the city of Rome and at the instigation of Nero, became -more and more frequent and more and more pitiless, but they failed -utterly to destroy the new religion, so firmly was it rooted in the -followers of Jesus Christ. As a matter of fact its spread was checked -for only a few years, and then its adherents increased in numbers more -rapidly than ever. Neuburger, in his “History of Medicine,” makes the -following quotation from the account which Dionysius of Alexandria -gives of the great plague that occurred during the third century A. D.: - - The majority of our brethren in their love for their neighbors - did not spare themselves, but acted as a unit in their efforts - to assist. They visited the sick without the slightest fear and - gave them the very best of care, for the sake of Christ.... - Among the non-Christians, however, the very opposite was true. - As soon as any of their number fell ill they pushed them to one - side, even those who were dearest to them, and, before they were - more than half-dead, they threw them out into the street and - took no care to bury the dead bodies. - -Such an example of self-sacrifice and humanity--and there must have -been very many similar examples--could not possibly have failed to make -a profound impression upon the community at large. Daniel Le Clerc says -that three physicians suffered martyrdom for their Christian faith -during the reigns of the Emperors Marcus Aurelius, Lucius Verus and -Commodus. They were Papila (of Pergamum), Alexander (of Lyons) and -Sanctus (a contemporary of Galen), whose death was of a particularly -cruel character. Credit should also be given to Christianity, says -the same writer, for having established the rule that every community -should assume the expense and responsibility of caring for its own -poor and sick. This was a step of the greatest importance; and, at -a still later period, when Christianity became largely an affair of -the state, a complete hospital organization was effected, with the -bishop as the chief officer and, under him, deacons and deaconesses. -Such well-organized institutions proved to be of the greatest possible -benefit to the advance of medical science. They were the worthy -successors of those more ancient hospitals, the Aesculapian temples, -which were first established by the Greeks in the pre-Hippocratic age, -and they have continued in an unbroken chain from the institutions of -those primitive times to the thoroughly well-equipped hospitals of the -present day. - -In 330 A. D. the new capital of the Roman Empire was established -in Byzantium, afterward called Constantinople, and Rome, which for -hundreds of years had been the metropolis of the world and the source -from which a large part of Roman history had emanated, was given a -subordinate position. Then followed, in 410 A. D., the conquest of the -latter city by the Visigoths, a horde of uneducated Barbarians who had -felt the might of Rome in previous years, and who now doubtless took -immense satisfaction in humiliating her and in destroying her valuable -possessions. There are good reasons for believing that, when the -Emperor Constantine established his residence in Byzantium, the leading -physicians of Rome followed him; and it is not likely that many of -those who, for one reason or another, preferred to remain in the old -capital, continued to do so after it became known that the Barbarians -were approaching the city. But the migration of these physicians to the -new capital did not mean a renewal there of the scientific activity -which had characterized the growth of Greek medicine in Rome during -the first two centuries of the Christian Era. It is probable that -the fugitives, being obliged to travel with the smallest amount of -baggage possible, left the major part of their books and papyrus rolls -behind, hoping, no doubt, that they might be able at some later date -to recover them. But the favorable occasion never arrived, and thus a -great deal of valuable medical literature entirely disappeared. The -loss, however, might have been even more serious than it was if the -Christian church had not already (during the third century) begun to -establish monasteries in secluded and inaccessible spots. It was to -these institutions that not only books of a religious character, but -also those relating to the science of medicine, were transported for -safe keeping during the early Middle Ages. Farther on, I shall have -occasion to refer to this subject again and to discuss more fully -certain other benefits which accrued to medical science from these -monastic institutions. - -But while, on the one hand, the Christian church through the -instrumentality of the monasteries was lending its aid to the -preservation of the sources of medical knowledge, it was, on the other, -doing its best to arrest all further evolution of that branch of -science; not consciously, it must be admitted, but through a mistaken -sense of its duty to God. Thus it came about that the Emperor Justinian -I. (527–567 A. D.), acting under the narrow-minded advice of his -ecclesiastical counsellors, closed the medical schools at Athens and -Alexandria and at the same time withdrew the regular allowance of money -which up to that time had been paid to the state physicians and to -special scholars. A few years later, however (_i.e._, in the early -part of the seventh century A. D.), some of the more highly educated -physicians of Alexandria got together and made the attempt to organize -a school of medicine in that city. A course of lectures was planned -and sixteen of Galen’s works, carefully chosen for the purpose, were -made the basis of the new course of instruction. The books selected -were first carefully edited and simplified, and then commentaries -were added in order that in their final shape these treatises might -be better suited to the uses of students. The invasion of Alexandria -by the Arabs, however, soon put an effectual stop to this promising -attempt to revive Greek medicine. - -In this brief sketch I have thus far mentioned only the more direct -effects produced by the new religion upon the evolution of medicine. -The indirect effects, however, were also in some cases of very great -importance. At the beginning of her history there developed in the -Christian church, among her chief men, a strong disposition to quarrel -over dogmas. To apply the term quarrelsomeness to this tendency may -easily convey a wrong impression. It was, more strictly speaking, a -highly developed conscientiousness on the part of men whose minds were -deeply imbued with the idea that they were rendering God a service by -keeping what they believed to be the true and only religion free from -errors of all kinds. It took many centuries to impress the leaders -of the church with the fact that the religion of Jesus Christ, like -the science of medicine or the natural sciences, was capable of -development to an almost indefinite extent; and it is owing to our -appreciation of this important fact that we moderns look with so much -more lenient eyes upon the distressing, not to say cruel, events -of mediaeval ecclesiastical history. At the time of which I am now -writing, however, it was considered highly unchristian--especially -for one holding authority in the church--to believe otherwise than -as her doctrines taught; and accordingly, in the early part of the -fifth century A. D., Nestorius, the Patriarch of Constantinople, was -deposed from his high office by a Council of the church and imprisoned -because he was unwilling to teach the doctrine of the miraculous birth -of Jesus Christ. Those who accepted the view held by Nestorius--and -they eventually became a very numerous and a very influential body of -Christians--were driven out of Constantinople and compelled to seek -homes in distant places. This affords, perhaps, an explanation of the -fact that, during the eighth century A. D., many Nestorian Christians -were found living in the eastern part of Syria and in Persia; and it -seems fair to assume that these Christian communities represented -to some extent the direct successors of those Nestorians who had -taken refuge in this remote corner of Asia Minor three hundred years -earlier. Furthermore, it is highly probable that there were Christian -communities in this region several centuries before the Nestorians -arrived, for it is believed that the Apostles James and Thomas visited -Persia and the northeastern part of Syria in the course of their work -as evangelists. It is not known, though, how many of the descendants of -these earlier Christians adopted the peculiar beliefs of the Nestorian -refugees. - -And here it should be stated that the facts which have thus far -been mentioned are not the only ones that throw some light upon the -relationship subsisting between Christianity and the spread of medical -knowledge to Western Europe. Those which remain to be considered -are of two kinds, viz., facts relating to the origin of the Arabic -Renaissance, and facts which show that the Christian church, from the -fourth century onward, was contributing not a little, through the -establishment of the great monastic orders, such as the Benedictines, -the Dominicans, and the Franciscans, to the preservation if not to the -further evolution of Graeco-Roman medical knowledge. I shall reserve -for consideration in a later chapter this particular part of the -history of medicine; and in the meantime I shall endeavor to describe -the events which preceded and rendered possible the active study of -Greek medicine on the part of the followers of Mohammed. - -So far as history furnishes us with any information on the subject, the -Nestorians who lived in Persia, Syria and Mesopotamia were Christians -of a remarkably liberal type. They appear to have been an unusually -peaceable people, for not only were they kindly disposed toward one -another, but they seem to have been on the best of terms with their -Jewish neighbors, who, like themselves, were eager after knowledge. -Already at a very early period there existed at Djondisabour--a -town which had been founded in the Province of Khorassan, in the -northeastern part of Persia, about the year 260 A. D., by Sapor II., -King of that country--a school in which the medicine of Hippocrates -was taught. Freind, in his “History of Physick” (London, 1727), -says that about the year 272 A. D. the Emperor Aurelian (Lucius -Domitius Aurelianus), as a compliment to his daughter, who was the -wife of the King of Persia, sent to Djondisabour, the city in which -she resided, several Greek physicians; and Abulpharagius, the Arab -historian (thirteenth century), intimates that these were the men -who conducted the teaching in the newly established medical school. -Another possibility suggests itself. After the death of Alexander the -Great in Babylon (323 B. C.), from malarial fever, it is not unlikely -that some of the numerous Greek physicians who accompanied the army in -an official character, and who, we are warranted in believing, were -exceptionally well educated, decided not to remain in that unhealthy -district, but to settle in some of the neighboring towns (_e.g._, -Nisibis in the hill country to the north of Babylon, or Sura to the -east of the river Tigris); and that these men also contributed their -share toward the planting and perpetuation of Greek medicine in this -district of the Orient. However, the salient fact in this period of -the history of medicine is this: When Almansur, the Caliph of Bagdad -(712 to 775 A. D.), made up his mind to introduce Greek medicine into -his kingdom and looked around for the ways and means of accomplishing -this, he found at the city of Djondisabour men who were not only well -versed in Greek medicine, but who at the same time were so thoroughly -grounded in all departments of scholarship that they could at once -begin the work of translating the writings of Hippocrates and other -classical medical authors into Arabic, the language of the Mohammedans. -But at this stage of affairs the existence of a serious obstacle was -discovered. The writings which it was proposed to translate were not -immediately obtainable, and it therefore became necessary to institute -without delay a vigorous search for the books required. In order that -the reader may appreciate fully the difficulties which Almansur had to -overcome, in this matter of a scarcity of Greek originals, it seems -best to pause at this point, and to review briefly some of the facts -which bear upon the question at issue. - -_The Wholesale Destruction of Medical Literature during the Early -Centuries of the Christian Era._--The invasion of Rome in 410 A. D. -was one of the first events which entailed a serious loss of the Greek -medical books that had been accumulating for several centuries in that -city. Fortunately, not a few of these works were rescued in time by -the church authorities and deposited for safe keeping in the various -monasteries scattered all over the Roman Empire. A still more serious -destruction of books occurred about the year 638 A. D., when Amrou, a -famous Arabian warrior, captured Alexandria and--under the instructions -of his master, Omar ben Khattab--destroyed the greater part of the -contents of the famous libraries located in that city. The narrative of -this event, as told by Lucien Le Clerc, is as follows:-- - - John the Grammarian,[43] who was living at that time in - Alexandria, held the following conversation with Amrou on a - certain occasion: “You have inspected all the edifices of - Alexandria, and have sequestrated all their contents. I have no - objections to your appropriating everything that may be of use - to you; there are certain things, however, which you may not - wish to possess, but which are highly prized by us.” - - “What are those objects?” inquired Amrou. - - “The works on philosophy, which are contained in the public - libraries,” John replied. - - “I can do nothing about them without a special order from the - Prince of Believers, Omar ben Khattab,” was the answer given by - Amrou. - - John’s wish having in the meantime been conveyed by the General - to Omar, the latter sent this reply:-- - - “As to the books of which you speak, I have this to say. If - their contents agree with what is written in the word of God, - the books are of no use to us, the Holy Writ being sufficient - for our guidance. But if they are at variance with God’s word, - then surely they should be destroyed.” - - Amrou therefore ordered all the books to be sent to the bathing - establishments of Alexandria, to be used as fuel in heating - the baths. So great was the number of books contained in the - libraries that it took six months to consume them all. (Sismondi - questions the correctness of this account.) - -While the invasion of Rome by the Barbarians in the fifth century -and the capture of Alexandria by the Arabs in the early part of the -seventh gave rise to an enormous loss of valuable books relating to -medicine and philosophy in general, these were by no means the only -occasions when books were probably destroyed in great quantities. Wars -were frequent in those days and towns were constantly being sacked. -Everywhere throughout the East the modern traveler encounters the ruins -of large cities, and in those cities--the centres, as they were, of -wealth and culture--there must have been large collections of books. It -is not at all strange, therefore, that when the Caliph Almansur made -a serious beginning of the work which was to convert the Arabs into -rivals of the ancient Greeks, he should have found a great scarcity of -medical works which, after being translated, were to serve as manuals -of instruction. However, his ambition was very great, his wealth almost -inexhaustible, and his associates eager to aid him in realizing the -_renaissance_ which he had planned for his people; and, as will -appear later on, he and those who aided him eventually succeeded in -overcoming this apparently insurmountable obstacle. - -Among the medical books which, upon the approach of the Goths, -were carried from Rome and other cities to different monasteries -for safe keeping there must have been very few that were written -in Latin, and yet these were the only ones from which the monks -individually could derive any benefit. Several centuries later, when -all the monasteries of Italy and the East were visited by those who -were searching eagerly for original manuscript copies of the Greek -medical writers,--Hippocrates, Soranus, Rufus of Ephesus, Aretaeus, -Dioscorides, Galen,--it was found that such copies existed in a number -of these institutions, thus showing that the monks had been actuated by -unselfish and far-seeing loyalty to the best interests of mankind when -they rescued these particular treasures from the hands of the enemy. -They themselves could make no use of them, being unable to read Greek, -but they knew their priceless value to medical science. - -The Latin treatises which they had also rescued, and of which they made -excellent use during the succeeding centuries, were those of Celsus, -Scribonius Largus, Pliny the Elder (to a slight degree only) and -Caelius Aurelianus. - - - - - PART II - - MEDIAEVAL MEDICINE - - - - - CHAPTER XVII - - THE CONDITION OF MEDICINE AT BYZANTIUM DURING THE - EARLY PART OF THE MIDDLE AGES - - -The Byzantine period of the history of medicine begins about the middle -of the fourth century A. D. and retains some degree of importance up to -or perhaps a little beyond the beginning of the eighth century. During -this period of nearly four centuries there appeared on the scene five -physicians whose writings form a very creditable part of the late Greek -medical literature. The names of these authors are: Oribasius, Aëtius, -Alexander of Tralles, Theodore Priscianus and Paulus Aegineta. - -_Oribasius._--The first physician named in this list, Oribasius, -was born about the year 325 A. D. in Pergamum, an important city -of Asia Minor and the birthplace of Galen. He received his medical -training at Alexandria, settled in Constantinople (the new name given -to Byzantium), and soon afterward became the personal physician of -the Emperor Julian the Apostate, the nephew of Constantine the Great. -Subsequently he was appointed Quaestor of Constantinople, but, upon -the death of Julian (363 A. D.) and the accession of Valens and -Valentinianus to power, his property was confiscated and he himself was -obliged to take refuge among the Ostrogoths, who dwelt on the shores of -the Black Sea. These people received him with open arms, and he soon -acquired great influence among them. After a time, however, he was -recalled to Constantinople and all his former privileges were once more -granted to him. He died about the year 403 A. D. - -Despite his duties as a practicing physician of the very highest -rank--duties which he could not wholly set aside when he accepted the -office of Quaestor of Constantinople--and despite the necessity of -devoting considerable time to the work which this non-medical official -position entailed, Oribasius, like Pliny, appears to have been a most -energetic contributor to medical literature. We possess to-day, for -example, a large part of the medical cyclopaedia (72 books) which he -prepared at the command of the Emperor Julian, and which--even in its -incomplete state--contains very full information regarding anatomy, -physiology, surgery, pathology and pharmacology. Although the work -is simply a compilation, its present value is great, for it contains -numerous extracts from earlier and contemporary treatises, many of -which have entirely disappeared,--treatises of which we should have had -no knowledge whatever if Oribasius had not introduced numerous extracts -from them into his cyclopaedia. - -About the year 390 A. D., when Oribasius was already an old man, he -published (in nine books) a “Synopsis” of the larger work, chiefly -for the benefit of his son Eustathios, who was at that time studying -medicine. Surgery is omitted from this work, as that branch of medicine -was assumed to belong entirely to specialists. At a still later date -(about 395 A. D.), Oribasius published a third work (in four books) -entitled “Euporista,” which was intended chiefly for the use of -laymen. The subject-matter of this treatise consists of diet, hygiene -and general therapeutics. Neuburger speaks well of all three of the -published works of Oribasius, and furnishes a fairly full analysis of -the contents of each one. - -Bussemaker and Daremberg have published, in six volumes (Paris, -1856–1876), an excellent French version of the works of Oribasius. - -_Priscianus._--Theodorus Priscianus lived during the latter part -of the fourth and the first part of the fifth century of the present -era. Very little is known about his professional career beyond the -facts that he was a pupil of Vindicianus, a distinguished physician -who lived during the reign of the Emperor Valentinianus I. at -Constantinople (364–375 A. D.), and that subsequently he was chosen -the private physician of the Emperor Gratianus (375–383 A. D.). The -treatise which he composed, and which bore the title of “Euporiston,” -was originally written in Greek, but was afterward translated by -its author into Latin. An excellent German version of the work by -Meyer-Steineg was published in Jena in 1909. As the book was intended -by Priscianus to serve chiefly as a guide to practitioners of the -art, it contains practically nothing about anatomy and physiology. -In his pathology he follows closely the teachings of the Methodists; -his first question, in the presence of a case of illness, being: “Do -the symptoms point to a condition of _strictum_ rather than to -one of _laxum_, or _vice versa_?” “In his treatment,” says -Meyer-Steineg, “Priscianus follows very closely the rule that every -patient, no matter what may be the disease with which he is affected, -should first undergo a certain amount of general treatment.” In his -choice of remedies Priscianus invariably gives the preference to those -agents which are of a simple character and easy to obtain. On the other -hand, he does not hesitate to admit that he sometimes employs certain -magical remedies, as is shown by the following quotation taken from -Book IV., Chapter I., section 4:-- - - If a person wears, during the waning of the moon, a wreath - of polygonum on his head, he will obtain relief from his - headache.... If one drinks of the water from which an ox has - just drank, he will be relieved of the pain in his head.... If - a loadstone be held upon the head it will draw out the hidden - pain, and the same effect may be obtained by rubbing over the - forehead a swallow’s nest thoroughly mixed with vinegar. - -In Book I, paragraph 2, Priscianus draws a picture of the rude -and uncivilized behavior of the practitioners of his day in the -sick-room. The following are his words as translated from the German of -Meyer-Steineg:-- - - As the patient lies on his bed prostrated by the severity of - the disease, there quickly comes into the room a crowd of us - physicians. No feeling of sympathy for the sick man have we, - nor do we realize how impotent we all are in the presence of - these forces of nature. Instead, we struggle to the utmost of - our ability to obtain charge of the case; one depending for - success on his powers of persuasion, a second on the strength - of the arguments which he is able to bring forward, a third on - his readiness to agree with everything that is said, and the - fourth on his skill in contradicting the opinion of everybody - else. And, as this quarrel goes on, the patient continues to lie - there in a state of exhaustion. “For shame!” Nature seems to - say, “you men are an ungrateful lot! You do not even permit the - patient to die quietly; you simply kill him. And then, moreover, - you accuse me of not furnishing sufficient means of effecting a - cure. Illness is certainly a painful affair, but I have provided - plenty of remedies. Poisons, I admit, are hidden in some of the - plants, but the healing agents which may be extracted from them - are much more numerous. Away, then, with your angry disputes and - your self-glorifying chatter; for in these are not to be found - the remedial agents which I have bestowed upon man, but rather - in the powerful forces which reside in the seeds, fruits, plants - and other objects which I have created in his interests.” - -_Aëtius._--Aëtius was a native of Amida, in Mesopotamia, and -he lived during the early part of the sixth century A. D., under -the Emperor Justinian I. He studied medicine at Alexandria and then -settled in Constantinople, where he was appointed to the double office -of private physician to the emperor and commanding officer of his -body-guard (_Comes obsequii_),--an arrangement which made it -practicable for the emperor to have his physician near his person on -all possible occasions. Almost nothing is known about the subsequent -private life and professional career of Aëtius beyond the facts that -he was a Christian and that he wrote a treatise on medicine in sixteen -books, which together form a large volume. The work, says Le Clerc, is -almost entirely a compilation from the treatises of earlier writers -on medicine and surgery; the best parts of the book being those which -relate to the pathology and treatment of internal diseases, to materia -medica, and to ophthalmology. The Christianity of Aëtius, like that of -Alexander of Tralles, and other physicians of a later period, appears -to have permitted a belief in magical remedies. For example, Aëtius -gives formulae containing the names of the Saviour and the Holy Martyrs -for exorcising certain maladies, and he recommends the employment of -amulets. The subject of baths is treated by him quite thoroughly, and -he lays stress upon the importance of physical exercise as a means of -maintaining one’s health. Freind, the author of an English history of -medicine which was very popular in its day,[44] quotes the following -remedy for gout from the treatise of Aëtius:-- - - In September to drink milk; - in October to eat garlick; - in November to abstain from bathing; - in December not to eat cabbage; - in January to take a glass of pure wine in the morning; - in February to eat no beet; - in March to mix sweet things both in eatables and drinkables; - in April not to eat horseradish; - nor in May the fish called Polypus; - in June to drink cold water;--and so on through the remainder of - the year. - -At the end of the French version of “_Les Oeuvres de Rufus -d’Éphèse_” (translated from the Greek by Daremberg and Ruelle) -will be found fragments of some of the books of Aëtius; in 1899 J. -Hirschberg translated into German Book VII. (eye diseases) of the -same author; and, two years later (1901) Max Wegscheider published a -German version of Book XVI. (obstetrics and gynaecology). No other -translations of the writings of Aëtius into either French, German or -English are--so far as I am able to learn--available. - -_Alexander of Tralles._--Alexander of Tralles, a city of Lydia, -in Asia Minor, was born about 525 A. D. His father Stephanus was -highly esteemed as a practicing physician, and his four brothers, -all of them older than himself, were men of distinction in their -several callings; Anthemius, the oldest, being one of the greatest -mathematicians and mechanicians of his day and the man to whom the -Emperor Justinian intrusted the rebuilding of the church of St. -Sophia in Constantinople;[45] Metrodorus, a celebrated grammarian and -the honored teacher of the youth belonging to the highest circles -of that metropolis; Olympius, a leading authority in jurisprudence; -and Dioscorus, a prominent physician in his native city. Alexander -received his first instruction in medicine from his father, but he -obtained his real training from a physician who was the father of his -most intimate friend Cosmas, and who, throughout Alexander’s entire -subsequent career, proved most helpful in advancing his interests. At -first he traveled extensively, visiting in succession--probably in -the capacity of a military surgeon--Italy, Northern Africa, Gaul and -Spain. Afterward, he settled permanently at Rome and practiced medicine -there during the remainder of a long life. Puschmann, the translator -of his writings, seems disposed to believe that he was both a teacher -and a practitioner of medicine during his residence in that city. When -he became too old to bear the heavy burdens of medical practice, he -wrote an account of his life,--a life which was rich in professional -experience,--and thus built for himself “a monument more striking and -more durable than the splendid temple erected by his eldest brother.” -(Meyer, quoted by Puschmann.) - -Various circumstances justify the conclusion that Alexander of Tralles -was a Christian. His style of writing is simple and direct, and he -states his views with a degree of modesty which wins for him at once -the sympathy and confidence of his readers. He gives full and generous -recognition to the great physicians who lived and wrote before his -time, and more especially to Hippocrates. On the other hand, he does -not hesitate, when he believes that he is right, to put forward views -which are in direct antagonism with those of even so great an authority -as Galen. In the domain of therapeutics, says Puschmann, Alexander was -decidedly superior to Galen. His teachings are based on experience -gained in actual practice, whereas Galen was very often disposed to -trust to considerations of a theoretical nature; for he was chiefly -interested in establishing the pathology of the different diseases and -in opening up new territories in medicine in which the human mind might -display its activity. - -The twelve books of which the treatise of Alexander of Tralles -consists, were printed in the original Greek for the first time in -1548, by Robert Étienne, the celebrated printer of Francis I., King of -France. The last and most perfect edition of the Greek text is that -of the late Dr. Theodore Puschmann, which was published in Vienna -in 1878 (two Vols.). It contains, in addition to the Greek version, -a careful analysis of the twelve individual books, and an admirable -German translation of the entire work. It is from the latter that the -following brief extracts (translated into English) are taken:-- - - _Introduction to the writings of Alexander of - Tralles._--Upon a certain occasion, my dearest Cosmas, thou - didst urge me to publish my rich experiences in the domain of - practical medicine, and I am now gladly complying with thy wish, - for I feel under deep obligations to both thyself and thy father - for the kindness which you have shown to me on every possible - occasion in the past. Thy father was always a most helpful - patron to me, not only in my practice, but also in all other - relations of life. And thou also, even when thou wert living - abroad, stood staunchly by me through all the trials which I - experienced and the severe blows dealt me by Fate. For these - reasons I will now in my old age, when it is no longer possible - for me to endure the labor and worries of practice, do as thou - desirest, and will write a book in which shall be set forth the - experience which I have gained during my long service in the - treatment of disease. I hope that many of those who read what - is here written, with minds free from jealousy, will experience - real pleasure in noting the well-founded and scientific - character of the rules which I have laid down and the brevity - and preciseness of my descriptions. For I have done my very best - always to employ simple words, in order that everybody may find - it easy to understand my book. - - _Some Magical Remedies or Amulets Recommended by Alexander - of Tralles, as Effective in the Treatment of Colic._--The - Thracians remove the heart from a lark while the bird is still - alive, and wear it, prepared as an amulet, on the left thigh. - - Procure a little of the dung of a wolf, preferably some which - contains small bits of bone, and pack it in a tube which the - patient may easily wear as an amulet on his right arm, thigh, or - hip during the attack. He must be very careful, however, not to - allow the parts around the seat of the pain to come in contact - with the earth or with the water of a bath. This amulet is, in - my experience, an unfailing remedy, and almost all physicians of - any celebrity have commended its virtues. - - Remove the nipple-like projection from the caecum of a young - pig, mix myrrh with it, wrap it in the skin of a wolf or dog, - and instruct the patient to wear it as an amulet during the - waning of the moon. Striking effects may be looked for from this - remedy. - - Let the design of Hercules throttling a lion be engraved upon a - Median stone, and then instruct the patient to wear it on his - finger after it has been properly set in a ring of gold. - - Take an iron ring and have the hoop made eight-sided. Then - engrave upon the eighth side these words: “Flee, flee, oh - Gaul! the lark has sought thee out.” On the under surface of - the head or seal of the ring engrave the letters J. C., thus: - [illustration] I have often made use of this amulet; and, while - I should consider it wrong to keep silence about a remedial - agent of such extraordinary efficacy in cases of colic, I - feel bound to say that it should not be recommended to the - first comer, but only to believers and to those individuals - who know how to guard it carefully. The Great Hippocrates, - with remarkable insight, gave the advice that things which are - holy should be intrusted only to those who are of a religious - character, and should be withheld from the profane. As regards - the ring, however, the patient must be careful, before wearing - it, to have a sketch made of it on either the seventeenth or the - twenty-first day of the moon. - -Alexander has been severely criticised for his advocacy of the -employment of amulets in the treatment of diseases; but he defends -himself against such criticism by saying that physicians owe it as a -duty to their patients to study carefully what he calls the hidden -forces of nature, and to pay unprejudiced attention to the effects -produced by amulets and other magical remedies. He reminds his critics -that Galen and other eminent medical authorities have insisted that -a place be given to this class of agents in the list of authorized -remedies; and he adds that Galen further emphasizes the duty of the -physician to employ them when other measures fail, or when the patients -themselves frankly confess that they have faith in their efficacy and -therefore wish them to be tried. Alexander also makes the statement -that Galen, after treating for a long time all reports about the -beneficial results obtained from the employment of magical measures -as old women’s tales, had finally decided that these benefits were at -times marvelous and should be accepted as genuine by physicians even if -they are unable to explain them. - -How much Alexander of Tralles really believed in these supernatural -agents, or to what extent he relied upon their effect in influencing -the imagination, we may not know; but his was an age of superstition, -and the conditions governing society at that time were very different -from those which control the world at the present day. - -_Paulus Aegineta._--Paulus Aegineta[46] was born in the Island of -Aegina, not far from Athens, in the early part of the seventh century -A. D., and practiced medicine in Alexandria, Egypt. He is known to us -as the author of a compend of medicine which was very popular during -a long period of time, especially among the Arabs, who, as early as -two hundred years after his death, translated his work from the Greek -into their own language. At a still later period it was also translated -into Latin, the two best versions in this language which we now possess -being those of Guintherus Andernacus (Paris, 1532) and of J. Cornarius -(Basel, 1556). There is also an English translation by F. Adams (“The -Seven Books of Paulus Aegineta,” London, 1845–1847), which is favorably -spoken of by Neuburger, and which is apparently at the present time -the only existing version of the work of Paulus of Aegina in a modern -European language; for the French translation by René Briau (“_La -Chirurgie de Paul d’Égine_,” Paris, 1855) comprises only Book VI. - -The contents of the entire work are as follows: _Book -I._--Dietetics of Pregnant Women and of Children; Children’s -Diseases; Massage, Gymnastics, Sexual Hygiene, Bathing, etc.; _Book -II._--General Pathology, the Doctrine of Fevers, Semeiology; _Book -III._--Diseases of the Hair, Diseases of the Brain and Nerves, -Diseases of the Eyes, Ears, Nose, Mouth, Teeth and Face; _Book -IV._--Leprosy, Skin Diseases, Inflammations, Swellings, Tumors, -Wounds, Ulcers, Fistulae, Hemorrhage, Worms, Affections of the Joints, -etc.; _Book V._--Toxicology; _Book VI._--Surgery; _Book -VII._--Materia Medica. - -To furnish even a very superficial analysis of the contents of this -treatise would call for more space than can well be given up here -to such a purpose. I shall therefore simply mention a few points of -special interest to which Neuburger calls attention in the course -of his very full analysis of the work. He states, for example, that -Paulus mentions several instances in which patients affected with lung -disease, coughed up calculi or small stone-like masses. He also states -that the same author was familiar with the fact that in the course of -“phthisis,” the pus may find its way into the bladder and there cause -ulceration [in other words, that pus containing tubercle baccilli -may flow down by way of the ureters and cause tuberculous ulceration -of the bladder]. Paulus’ theory regarding the origin of gout, adds -Neuburger, is quite remarkable for that early period. He maintains, for -example, that in persons who lead a rather inactive life and who are -often affected with digestive disorders, there is produced, through the -inadequate power of the tissues of the body to assimilate the excess -of nutriment brought to them, a _materies morbi_ which is drawn -first to the parts that are weakest or least capable of resistance (the -joints, for example) and then also to other structures, as the liver, -spleen, throat, ears and teeth. These ideas--let it be remembered--were -set down in writing in 650 A. D. - -At the beginning of his analysis of Book VI., Neuburger makes this -remark: “Although the description given by Paulus of the surgery of -the ancients is based upon the writings of Hippocrates and Galen, as -well as upon those of Leonides, Soranus and Antyllus, one finds at -every step ample evidence that the writer possessed both independence -of judgment and the manual skill which belongs to a physician who is -familiar with surgical work.” He calls particular attention to the -section (No. 88) which deals with the manner of removing the heads of -arrows from wounds, and he gives special praise to Paulus for his most -instructive account of the diagnostic signs to be looked for in a case -of suspected wounding of a vital organ. He is extremely thorough, says -Neuburger, in his teachings about fractures and dislocations, and he -not infrequently differs from the views expressed by his predecessors. - -In the section devoted to gynaecological operations Paulus makes it -perfectly clear that he was in the habit of using a speculum of a very -practical form. Here are his words:-- - - ... and, while the operator is holding the instrument in - position, an assistant turns the screw until the blades of the - instrument have been separated to the distance desired. - -In other chapters of Book VI., Paulus furnishes most interesting and -minute descriptions of a great variety of operations in general surgery -and also in obstetrics, ophthalmology, otology and rhinology. Those who -desire to learn further details about these surgical matters should -consult the English version mentioned on a previous page. - -It is not at all unlikely that at some future day it will be found -desirable--by reason of the discovery of the treatises which they -are known to have written, but which have been lost--to add to this -short list of ancient medical authors the names of the following men -who are frequently quoted by them in their works: Antyllus, who made -some really valuable additions to our knowledge of the proper manner -of treating aneurysms, and who must have been a surgeon of great -resourcefulness; Leonides, the Alexandrian, who lived about the time of -Galen, and who appears to have been highly considered for his practical -common sense in the choice of surgical measures; Hesychios of Byzantium -and his distinguished son, Jacobus Psychrestus, who was highly spoken -of by his contemporaries (fifth century A. D.), in whose honor a -public statue was erected (Haller), and to whom is attributed the -saying: “A good physician should either decline at the start to take -charge of a patient, or else he should not leave him until he shall -have brought about some measure of improvement”; finally, Heliodorus, -and perhaps a few others who are less well known. - - - - - CHAPTER XVIII - - BEGINNING OF THE ARAB RENAISSANCE UNDER THE CALIPHS OF BAGDAD - - -Toward the end of the sixth century A. D. the prospects for the -perpetuation and further evolution of Greek medicine looked decidedly -dark. In Rome and in the larger Italian towns of the Roman Empire, -physicians were doubtless still to be found, but they must have led -very precarious lives and they certainly could not have had any leisure -or opportunity for scientific work. In these earlier years of the -Middle Ages the monks conducted the larger part of whatever medical -practice was required in the districts in which the monasteries were -located. In Byzantium, also, the outlook at this period of Roman -history was very unfavorable; and nowhere else, as a matter of fact, -would it have been possible for the casual observer to discover any -signs that indicated the approach of a revival in the study of the -sciences. And yet, even at that seemingly darkest moment in the history -of medicine, there were forces at work which would soon revive these -precious seeds of Greek knowledge, and, after transplanting them to -a richer soil, cause them to produce even better fruit and in larger -quantities than ever before. - -The rulers under whose auspices the first steps in the great Arab -Renaissance were taken, belonged to what is known as the Abbaside -Dynasty, the founder of which was Abbas (566–652 A. D.), the uncle of -Mohammed. His descendants ruled as Caliphs of Bagdad, on the eastern -bank of the Tigris, for many centuries (from 750 A. D. onward).[47] -Almansur, the second Caliph of this dynasty, felt a very strong desire -that his people, the Arabs, should acquire knowledge of all the useful -branches of learning, and more especially of medicine and philosophy; -and accordingly, as the Greeks were then universally admitted to be -the only nation which possessed that knowledge, and as scarcely any -scientific books written in the Arabic language existed at that early -date, he directed all his efforts to the finding of Greek originals and -of the men qualified to translate them into Arabic. Already as early -as the sixth century A. D., Sergius, a Christian of Ras el Ain, had -translated a considerable number of Greek treatises into the Syrian -tongue, but his work was found to be of an inferior character, and for -this reason could not be utilized to any great extent in the present -undertaking. Honein (ninth century), one of the most eminent scholars -of the Arabic Renaissance, revised a few of these translations and -thus rendered them of some service; but by far the larger part of this -gigantic task of creating Arabic versions of the classical works of -Greek literature, was performed during the ninth century, a period -during which the reign of the Arabs extended from the Ganges on the -east to the Atlantic on the west. By the end of the eighth century -the work of translating had advanced only to the point of producing a -single treatise on medicine and a few relating to alchemy; but before -the ninth was completed, the Arabs had in their possession, in the form -of translations, nearly all the scientific literature of Greece, and, -more than this, they could boast that not a few men belonging to their -own nation had already become celebrated as scientists of the very -first rank. - -The medical school at Djondisabour[48] at the time (765 A. D.) when -the Caliph Almansur decided to carry out the ambitious scheme which -he had been meditating, was practically under the control of a family -of Nestorian Christians. A large hospital formed the nucleus of the -institution and furnished all the material needed for familiarizing the -student with the different diseases and injuries commonly encountered -in that part of the world and with the methods of treatment which, as -long experience had shown, offered the best chances of affording relief -or effecting a cure. It was a clinical school of a most practical type, -and at the head of it was George Bakhtichou, who had been recommended -to Almansur as the physician best fitted to take responsible charge of -the new work which was then about to begin. George Bakhtichou was not -the organizer of the school at Djondisabour, but simply its head at -the time of which I am now speaking. Medicine had been taught there, -it appears, since the early part of the seventh century A. D. The -languages commonly spoken in that town were the Syrian, the Arabian -and the Persian, and probably only a few persons understood Greek. The -Caliph believed that, as the first and most important step in the new -work, medical text books, translations of the works of the best Greek -physicians, should be provided with as little loss of time as possible, -and George Bakhtichou agreed with this opinion entirely. The latter, -therefore, upon the urgent invitation of the Caliph, left the hospital -at Djondisabour in the charge of his son, Bakhtichou ben Djordis, and -went to Bagdad in company with two of his pupils, Ibrahim and Issa ben -Chalata. He was well received at Court, partly because he displayed a -readiness to further the Caliph’s educational plans, and partly also -because he was promptly successful in relieving him of a distressing -dyspepsia. Not long after he had arrived in Bagdad, however, he was -himself taken ill and was obliged to return to Djondisabour. Before -his departure the Caliph presented him with a gift of 10,000 pieces of -gold. Issa ben Chalata, one of the two pupils whom George Bakhtichou -had brought with him to Bagdad, was left behind to look after the -Caliph’s health. He proved faithless to his trust, however; and, as -soon as it was discovered that he was selling his supposed influence -with the Caliph, he was not only dismissed in disgrace but all his -property was confiscated. After this disagreeable experience the Caliph -did his best to induce George to return to Court, but the latter was -then unable to travel, owing to the injuries which he had received -from an accidental fall. His pupil Ibrahim went to Bagdad in his place. - -It is known that George Bakhtichou personally took an active part in -the work of translating Greek medical treatises into Arabic, but it has -not yet been ascertained which books in particular were assigned to his -care in the distribution of the different tasks. Ossaibiah, the Arabian -historian, makes the statement that the work of translating Greek -medical treatises was entirely under the control and guidance of George -Bakhtichou; and in the “Continens” of Rhazes frequent mention is made -of the latter’s name. All of which confirms the belief that, at the -beginning of the Arabic Renaissance, George Bakhtichou was in reality -the head and front of the movement, so far at least as medicine was -concerned. When he became too old and infirm to continue his attendance -at the Djondisabour hospital, he intrusted the management of that -institution to Issa ben Thaherbakht, who was one of his best pupils. He -died in 771 A. D. - -In 786 A. D., Haroun Alraschid succeeded to the caliphate; and not long -afterward, on the occasion of some temporary illness, he requested -Bakhtichou ben Djordis, the son of George and his successor in the work -of translating from the Greek, to consult with the regularly appointed -physicians of the Court in regard to the nature and proper treatment of -his malady. The consultation took place at the appointed time, and one -of the Caliph’s physicians, thinking that he might catch Bakhtichou in -a trap, submitted to him a specimen of urine which purported to come -from the Caliph, but which in reality had been obtained from a beast of -burden. Alraschid, who knew of the deception, asked:-- - -“What remedy would you administer to the person from whom this urine -came?” - -Bakhtichou, who had been clever enough to recognize the true character -of the specimen, replied promptly: “Some oats, your Majesty.” - -The Caliph laughed heartily over the episode, loaded George’s son -with presents, and appointed him the chief of all his physicians,--the -first instance among the Arabians, it is said, of the appointment of an -Archiater. - -Bakhtichou ben Djordis was the author of a collection of short medical -treatises, and he also wrote, for the special use of his son Gabriel, a -medical “remembrancer.” He was as highly esteemed by the Arabs as his -father had been before him. The date of his death is not known. - -Gabriel, the son of Bakhtichou and a grandson of the famous George -Bakhtichou, was the most distinguished member of this remarkable -family of physicians. In the year 792 A. D., five years after the -consultation mentioned above had taken place, Gabriel was sent by his -father to give medical advice to Jafar, the son of the Grand Vizier. -The treatment which he recommended proved to be entirely successful, -and, pleased with the result, Jafar soon afterward had an opportunity -to speak to Haroun Alraschid of Gabriel as the physician best fitted to -effect a cure in the case of his own favorite wife, who, in a fit of -yawning, had dislocated her shoulder. The Arabian physician had tried -friction, different sorts of ointments, and manipulations of every -imaginable kind, but all in vain. The dislocation still persisted. -When Gabriel arrived on the scene he told the Caliph that he could -bring the shoulder back into place provided no offense would be taken -at the means which he was about to employ. Alraschid gave the desired -promise and Gabriel made a movement as if he were about to lift up the -bedclothes. Instantly the patient, through a natural sense of modesty, -stretched out her dislocated arm to keep the bed-covering in place. -“There! she is cured!” exclaimed Gabriel, and such indeed was the -truth. The sudden movement of the limb had reduced the dislocation.--It -only remains for me to add that the sum of 500,000 drachmae[49] was -paid to Gabriel by Haroun Alraschid for his successful treatment. - -Some surprise having been expressed by the Caliph’s relatives that -he should display such extravagant generosity toward a Christian, he -replied: “The fate of the empire is bound up in my fate, and my life is -in the hands of Gabriel.” - -Gabriel Bakhtichou died in the early part of the ninth century, not -long after the Caliph El Mâmoun had started on his expedition against -the Greeks (828 A. D.). He was the author of several medical treatises, -and, like his famous grandfather, George Bakhtichou, he did everything -in his power to promote the work of translating from the Greek -into the Arabic. Gabriel’s brother, also named George, and his son -Bakhtichou ben Djabriel were both of them physicians of considerable -distinction. The latter accompanied El Mâmoun on his expedition against -the Greeks. It is a fact worth noting here, that throughout this war -the Caliph never for a moment lost sight of the great national scheme -of education which his predecessor Almansur had inaugurated and which -was still engaging the time and best efforts of many scholars and -copyists in Bagdad. Whenever he captured a city he insisted upon the -delivery to him of whatever copies of scientific treatises its citizens -might possess. But even these extraordinary methods of securing the -books which they needed did not satisfy the Arabs, their eagerness -to accumulate as many text books as possible being insatiable. -Accordingly, from time to time, one of the translators--some member -of the Bakhtichou family, for example--would be sent to the different -cities of Syria and Persia to search out and get possession of as -many Greek manuscripts as possible. Thus, Honein is reported to have -said: “I have not been able to procure a complete copy of Galen’s -‘Demonstration.’ Gabriel endeavored to find a copy, but did not -succeed; and I myself hunted through Irak, Syria, Palestine and Egypt, -but was at last only partially successful. I found one-half of the text -in Damascus.” - -The work of translation was kept up with unremitting zeal until the -middle of the ninth century (reigns of El Ouatocq and of Moutaouakkel). - -Among the physicians who received their training at the Djondisabour -medical school the Bakhtichous were not the only ones who attained -considerable distinction. John Mesué the Elder,[50] for example, -who was a Nestorian Christian and the son of an apothecary, became -more famous than any member of that family. He not only did his full -share of the translating, but he was also a prolific author and a -very faithful and efficient teacher, Galen’s writings furnishing the -basis of his lectures. He lived to be about eighty years of age, his -death occurring in 857 A. D. Most of his writings have been lost. Of -the twenty or more which have come down to our time those bearing the -following titles deserve to receive special mention:-- - - Book of Fevers. - On the Different kinds of Food and Drink. - On Venesection and Scarifications. - On Tubercular Leprosy. - On Abnormal Prominence of the Abdomen. - On Purgative Remedies. - On Baths. - On the Regulation of Diet. - On Poisons and Poisoning. - On Vertigo. - On the Treatment of Sterility. - On Dentifrices and Gargles. - -Sabour ben Sahl, whose death occurred in 869 A. D., was also connected -with the hospital at Djondisabour. He was distinguished on account -of his special knowledge of the properties of simple drugs and their -combinations. He was also the author of the exhaustive formulary -known as _Acrabadin Kebir_--probably the first one of its kind, -says Le Clerc, of which history makes any mention. This formulary or -dispensatory--of which a large and a small edition existed--was in -general use in all the hospitals, physicians’ offices, etc., of that -time. - -Still another most distinguished physician and author of medical -treatises received his training at the Djondisabour school--viz., -John, son of Serapion (or Serapion the Elder, as he is commonly -called). He lived about the middle of the ninth century of the -Christian era and wrote entirely in the Syrian language, but at a later -date his works were all translated into Arabic. The smaller of his two -most important treatises, and at the same time the one which appears -to have attracted the most attention, was called the Kounnach. About -the middle of the twelfth century A. D. it was translated into Latin by -Gerard of Cremona, and named by him _Breviarium_; a still later -translation received the name of _Practica_. The first part of -this smaller treatise (the Breviarium or the Practica) is divided into -six books, the titles of which are as follows:-- - - 1. On Nodosities, Ophiasis, and Alopecia. - 2. On the Falling Out of the Eyelashes. - 3. On the Mild Form of Tinea, the form which resembles Favus. - 4. Scaly Affections of the Head and of Other Parts of the Skin. - 5. Lice of the Head and of the Body. - 6. Headache caused by Exposure to the Sun; and other forms of - Cephalalgia. - -Salmouïh ben Bayan, a Christian, was the last one of the pupils of the -Djondisabour school who attained considerable celebrity as a physician. -When the Caliph Motassem came to the throne in 833 A. D., he appointed -Salmouïh his personal physician and soon became very much attached -to him; leaning upon him more and more for advice in all sorts of -troubles. Salmouïh was the author of several medical treatises, but -they have all been lost, not even their titles are now known to us. -When dying (early in 840 A. D.), he sent word to the Caliph not to -put his entire trust in the medical judgment of Mesué if he should -find it necessary to call upon the latter for advice in the event of a -serious attack of illness. This celebrated physician was universally -admitted to be most learned in everything relating to medicine, but -there were many of his professional brethren--and Salmouïh was among -the number--who did not esteem him so highly as a practitioner. “The -most important thing in medicine,” said the latter, “is to appreciate -correctly the intensity of the disease, and that is something which -Mesué, with all his learning, is not able to do.” However, despite the -death-bed warning given by Salmouïh to Motassem, this ruler died less -than two years later from the effects of the treatment which Mesué -the Elder, who had been called in to prescribe for his Highness, had -ordered. - -In addition to the pupils already mentioned there are a few others who, -according to the testimony of Le Clerc, reflected some credit upon the -institution in which they acquired their medical training. But enough -has already been said, I believe, to establish the fact that, in this -remote Persian province of Khorassan (to the west of the country known -to-day as Afghanistan), there existed during the eighth and ninth -centuries of the present era a most efficient medical school, which was -entirely managed by Nestorian Christians, and which sent out into the -world trained physicians of the very highest type. - - - - - CHAPTER XIX - - FURTHER ADVANCE OF THE ARAB RENAISSANCE DURING THE NINTH AND - SUCCEEDING CENTURIES OF THE CHRISTIAN ERA - - -During the latter part of the eighth century the Arab Renaissance, so -far at least as the science of medicine was concerned, was controlled -and kept in vigorous life almost entirely by physicians who were -connected with the school at Djondisabour--one might almost say, by -physicians who were members of the Bakhtichou family. To this family, -therefore, belongs the chief credit for the admirable results attained -during this, the first stage of the Renaissance. But during the ninth -century A. D. men who had not received their professional training -at this famous school came to the fore and gave a fresh and a more -vigorous impulse to the work than their predecessors had given. Under -the Bakhtichous the translating had been well started, and in addition -a few original medical treatises had been written in the Arabic -language. During the period which followed, however, the translating -and copying became more active than before, and, in addition, several -really valuable treatises were produced by men who wrote in Arabic, -and who were--if not racially Arabs--at least the adopted sons of that -nation. Of these men none stands out more prominently than Honein, who, -according to Le Clerc, “accomplished a marvellous amount of work of -the most varied character and of a very high degree of excellence, and -that too despite many obstacles. While he was not the originator of the -Renaissance in the East, he took the most active part in keeping it up.” - -Honein, who may rightly be considered as having at least inaugurated -the second stage of the Arab Renaissance, was born in 809 A. D. at -Hira, where his father Isaac, a Christian Arab, conducted a pharmacy. -The inhabitants of this town were known to be somewhat lacking in -cultivation, and it was therefore not surprising that, when Honein -went to Bagdad and presented himself to John, the son of Mesué, as one -who wished to become his pupil, his request was promptly declined on -the general ground that the people of Hira had not received sufficient -education to warrant any one of their number in undertaking the study -of medicine. This decision was of course a great disappointment to -Honein, but it disturbed him only for a short time. Soon afterward he -went to Greece where he worked hard to perfect himself in the knowledge -of the Greek language. Then, after a residence of two years in that -country, he returned to Bagdad, taking with him a considerable supply -of Greek books. His next step was directed toward gaining a better -knowledge of Arabic, and with this object in view he spent some time -in Bassora, a town which was situated not far to the south of Bagdad, -and which possessed good educational facilities. While residing there -he devoted a certain portion of his time to the translation of Galen’s -treatise on anatomy; and he was accordingly prepared, upon his return -to Bagdad, to submit to John, the son of Mesué, and to Gabriel, the son -of Bakhtichou (who by that time was well advanced in years), a specimen -of the work upon which he had been engaged. Both of these men were -greatly pleased with the excellence of the translation, and encouraged -Honein to go on with the work. El Mâmoun (the second son of Haroun -Alraschid), who was the then reigning Caliph, engaged his services both -as a translator of Greek writings (into Syriac as well as Arabic) and -as a reviser of the translations which had been made by others, and he -paid him most generously for these services. According to Le Clerc, -the amount of literary work done by Honein was simply prodigious. -He translated large portions of the treatises of Galen, Oribasius -and Paulus Aegineta, as well as several of the works of Aristotle -and of Plato, of the mathematicians and astronomers, and also of the -philosophers; and in addition he wrote a large number of original -treatises--such, for example, as a complete set of commentaries on the -writings of Hippocrates, a practical work on the diseases of the eyes, -etc. - -The following account of Honein’s experience at the Court of the Caliph -Moutaouakkel (middle of the ninth century A. D.) furnishes some insight -into his character:-- - - The Caliph, who had heard of the great learning, ability, and - industry of Honein, but who had at the same time feared that he - might be in secret communication with the Greeks, decided to - subject him to a test that would reveal how far he was venal. - Accordingly he sent for him, clothed him in robes of honor, gave - him 50,000 drachmae, and then said: - - “I wish that thou wouldst prepare for me a secret combination of - drugs which will enable me to get rid of one of my enemies.” - - Honein replied: “I have no knowledge of any but salutary - remedies, and it never occurred to me that the Prince of - Believers might ask me to furnish those of a different kind. - However, if it be the wish of your Majesty, I will see what I - can do; but I shall require plenty of time.” - - After waiting in vain for the desired preparation and finding - that even threats failed to accomplish anything the Caliph put - Honein in prison. Then, at the end of a year, which interval - the latter had employed diligently in the work of translating, - Moutaouakkel gave orders for the prisoner to be brought into - his presence. Before this was done, however, a heap of objects - of value was placed on one side of the room and instruments of - torture on the other. When Honein was brought in, the Caliph - said to him: “Time is passing, and my wishes have not yet been - gratified. If thou art now ready to obey my behest, these - treasures and many others in addition shall be thine. But, if - thou continuest to refuse, I will subject thee to tortures and - will finally put thee to death.” - - “I have already told the Prince of Believers,” replied Honein, - “that my knowledge is limited to the preparation of salutary - remedies.” - - Whereupon the Caliph said: “Have no fear! I simply wished to - test thee! But tell me, what are the reasons upon which thy - refusal is based?” - - “There are two reasons,” replied Honein: “my religion and my - profession. The first teaches us to do good to our enemies; - and the second, not to do any harm to the human race. Every - physician has registered an oath that he will never administer a - poison.” - - “Those are two excellent laws,” remarked the Caliph; and he - proceeded to load Honein with presents. - -Among those who were associated with Honein in his work of translating -Greek medical books into Arabic there are three whose names also -deserve to be remembered. They are: his son Isaac; his nephew Hobeïch; -and a Christian Greek named Costa ben Luca, whose residence was at -Baalbek. To men of the present time all these names of oriental -physicians are, as a rule, mere meaningless words, conveying no idea -of an important relationship to the evolution of medicine. During the -ninth and tenth centuries of the present era, however, and indeed -for many years subsequent to that time, they were accorded by the -physicians of that period almost as much honor for the part which they -took in furthering the revival of medicine among the Arabs as was given -to Honein himself. It seems therefore appropriate that at least a brief -account of the lives of these men and of the work which they did should -be given here. - -Isaac received his education from his father Honein, and soon after -reaching manhood he was set to work translating from the Greek into -both Syrian and Arabic--two sister languages. He was a man of great -intelligence, and was thought by many to be the equal of his father -in the knowledge of Greek, Syriac and Arabic. He also had, like his -father, the good fortune to find favor with the rulers of that period. -He died in 912 A. D. as the result of a stroke of cerebral apoplexy. -In addition to his translations he wrote original treatises on the -following topics:-- - - Simple Medicaments. - Origins of Medicine. - Correctives of Purgative Remedies. - Treatment by Cutting Instruments. - The means of Preserving the Health and the Memory. - -Hobeïch was the son of Honein’s sister. The date of his birth is not -known. He received his training in the languages from his uncle, and -in the course of time became associated with the latter in the work -of translating. Eventually he reached his uncle’s high standard of -scholarship, and the text of his translations was from that time forth -accepted without any revision. The Caliph Moutaouakkel appointed him -Court Physician, and the immediate successors of this Caliph retained -him in the same position. His death occurred during the second half of -the ninth century of the Christian era. - -Hobeïch translated the “Oath of Hippocrates” and a large number of the -more important of Galen’s treatises. In addition, he left to posterity -several original writings. Quotations from these are to be found in the -works of Rhazes, of Ebn el Beithar, and of Serapion the Younger, and -they reveal two important facts: first, that Hobeïch was an excellent -practicing physician; and, second, that the Arabs had already at this -comparatively early date begun to gather their medical information -from other sources than the Greek treatises. The following drugs, for -example, are described by Hobeïch in the quotations just mentioned, and -yet they do not appear to have been known to the Greek medical writers: -Turbith, Convolvulus of the Nile, Nux Vomica, Colocynth, Croton -Tiglium, Aloes and Myrobolans. - -Costa, the son of Luca, was a Christian Greek from Baalbek, in Syria. -The dates of his birth and death are not known, but it is believed that -he lived during the first half of the tenth century of the present era. -He was an excellent Greek and Arabic scholar and was also familiar with -the Syriac language. His translations were esteemed equal to those -of Honein. After spending some time in Greece he settled in Irak, a -province of Persia, and devoted himself to the translation of the books -which he had brought with him from Greece. At a later period of his -life he removed to Armenia, a country which lies to the north of Irak, -between it and the Black Sea, and it was during his residence there -that he wrote a number of treatises. It was in Armenia, also, so far as -may be judged from the accounts which we possess, that his death took -place. As an evidence of the fact that he was highly esteemed by his -contemporaries, his biographer states that a cupola was built over his -tomb. - -Among the medical works which he translated from the Greek the -following are the only ones of special importance: The Aphorisms of -Hippocrates, and Galen’s commentaries upon them. - -The ninth century, the period during which the major portion of the -work described in the preceding part of this chapter was accomplished, -is considered by Lucien Le Clerc the most remarkable in the worlds -history. He speaks of it in the following terms:-- - - Its greatness is emphasized by the fact that, except in this one - corner of the globe, everything was in a state of decadence.... - Great as is the credit due the Abbaside Dynasty and its - ministers, still greater is our admiration for the Arab nation - on account of the eagerness with which it met the wishes of its - rulers and also because it pursued resolutely, and despite all - the obstacles (political and religious) which were placed in - its way, the course laid down for it to follow.... The Arabs - also knew how to choose men who were really eminent and to - rescue them from lives which otherwise would probably have been - sterile; they claimed the inheritance of Greek science; and they - revealed to the world that they were worthy of this inheritance. - -Some idea of the completeness of the list of Greek medical works which -the Arabs translated may be gained from the fact that Galen’s writings -are more complete in the Arabic than they are in the Greek, the -language in which they were originally composed. - -With Costa the second stage in the Arab Renaissance came to an end. -All the work accomplished at Bagdad up to this period in our history -received its inspiration from the different Caliphs belonging to -the Abbaside Dynasty. But now the political conditions in the East -underwent a change, and other Arabian dynasties, each in its turn, -gained control of the power previously wielded by Almansur, Haroun -Alraschid and their successors. Fortunately, all of these new rulers -seem to have been favorably inclined toward the revival of literature, -and consequently the Arabs continued to take an active part in the -advance of medical knowledge during the tenth and eleventh centuries. -Bagdad, however, ceased to be the centre of all this intellectual -activity, and eventually Cordova in Spain almost rivaled the capital -of ancient Greece in the eagerness with which she sought to increase -her stores of books, and in her readiness to honor scholars. By this -time the Arabs controlled, not only Persia and Arabia, but also Egypt, -Palestine, Syria, Marseilles, the coast of Asia Minor, Greece, Sicily, -the northern part of Africa and Spain. Owing to the limited space at my -command I shall be obliged to confine my account to the more salient -features of the progress made during this later or third stage of the -Arab Renaissance. - -Already as early as toward the end of the ninth century the number of -physicians in the East had increased so greatly, and the territory -where well-educated medical men were to be found had broadened to -such an extent, that I shall now be obliged, in order to maintain -some approach to chronological order in my account of the evolution -of medical science, to treat the subject according to countries. If -the men who stand out foremost in this third stage of the scientific -renaissance are not in every instance Arabs or Persians or Syrians, I -may at least claim that they are the product, directly or indirectly, -of the great Arab movement. The countries in which their best work was -done are the following: Persia (apart from Bagdad and its immediate -neighborhood), Egypt, Magreb (the modern Algiers and Tunis), Fez -and Spain. But, before I consider the progress of medicine in these -different parts of the Orient, I should say at least a few words about -the events which characterized the cessation of literary work at -Bagdad. As might be expected, that city, after the Greek medical and -scientific treatises had all been translated into Arabic, gradually -lost its pre-eminence as a centre of learning, and new centres -developed in other cities throughout the vast Musulman Empire. It must -not be inferred, however, that this change was wholly or even largely -due to the cessation of literary work. Other factors contributed to -this result, viz.: the decadence of the caliphate and the fact that -the caliphs themselves appeared to lose their interest in promoting -the sciences actively. It was not until during the tenth century that -any further interest in the advancement of medical science was taken -by those in authority at Bagdad. Then the Emir Adhad Eddoula built a -splendid hospital, and organized it on the basis of several separate -services--one for fever cases, another for accidental injuries, a third -for ophthalmic cases, and so on. Twenty-four physicians, who had been -selected because of their special aptitude for some particular class of -medical work, were appointed to take charge of the different services; -and it is interesting to note that nearly all of these men bear Arab -names. Nevertheless, for a still further period of many years, says Le -Clerc, there continued to be as many Christian as Mohammedan physicians -in Bagdad. - -In the tenth century other hospitals were established in Bagdad. Thus, -in 914 A. D., the Vizir Ali ben Issa founded one which he endowed -in the most liberal manner. This Vizir must have been a most humane -person, for, when the physician-in-charge wrote to him for further -instructions regarding the course which he should pursue with respect -to people of different religions, the Vizir replied: “Use the fund for -the benefit of all classes alike, and be sure to remember the animals.” - -_Persia._--Rhazes, whose full name is Abou Beer Mohammed ben -Zakarya, is generally admitted to have been the most illustrious of -Persia’s physicians, and probably the most distinguished representative -of Arab medical learning. He was born at Raj, in the Province of -Khorassan, about 850 A. D. After he had received his professional -training at Bagdad, he settled at Raj and was soon afterward appointed -director of the local hospital. At a later date he was placed in -charge of the hospital at Bagdad, but before many months had elapsed -he returned to Raj, his native town, and here he spent most of the -remaining years of his long life. The date of his death is stated by -Haeser as either 923 or 932 A. D., but Le Clerc mentions only the -latter date. - -Rhazes was a very hard worker and was highly esteemed by his fellow -countrymen, who called him the Arabian Galen. The total number of -writings which he left behind him at the time of his death was -237, most of them dealing with medical subjects. A few of them, -however, were devoted to the discussion of chemical, anatomical and -philosophical questions. To-day we possess only 36 of the treatises -written by Rhazes, and of this number only six have been printed in -Latin. His greatest work, as all critics admit, is that which is -commonly known as the “Continens” (or “El Haouy”). In this work, which -is divided into twenty-two books, Rhazes gives in a condensed form the -views entertained by all his predecessors regarding the more important -questions in medical science, and then adds thereto the conclusions -which his own experience has led him to form. - -He also wrote a second treatise (in ten books) which was esteemed -by the physicians of that and later periods almost as highly as -the Continens. It was called the “Mansoury,” and its contents are -distributed as follows: I., Anatomy; II., the Different Temperaments; -III., Alimentary Substances and Drugs; IV., Hygiene; V., Cosmetics; -VI., the Regimen to be adopted in Traveling; VII., Surgery; VIII., -Poisons; IX., Maladies in General; X., Fevers. - -A third treatise of considerable importance is that which is devoted -by Rhazes to the description and treatment of small-pox and measles. -So far as is known at the present time this is the first treatise that -has been written on these diseases, and its celebrity rests, not only -upon this circumstance, but also upon the facts that its author is -evidently familiar with the different types of small-pox and with the -characteristic features which distinguish this disease from measles. -Freind, in commenting upon this treatise, says that Rhazes assigned -for small-pox a cause “entirely new in physick, a sort of an _innate -contagion_. This is a _ferment_ in the blood, like that in -must, which purifies itself sooner or later by throwing off the peccant -matter at the glands of the skin; an hypothesis since applied, though -upon very slight grounds, to feavers in general by many moderns.” From -this account it is fair to conclude that Rhazes, in the tenth century -of the Christian era, as clearly suspected the germ origin of certain -febrile diseases as Liebermeister did toward the end of the nineteenth, -or as Fracastoro did in the sixteenth. And one cannot help exclaiming: -How many centuries had to elapse, and what an immense amount of other -facts had still to be discovered--facts in anatomy, in physiology, in -chemistry, in optics, etc.--before it became possible to convert this -suspicion, this simple product of the reasoning faculty, into an actual -demonstration of the truth in pathology! - -Among the Arabian physicians of the eleventh century Avicenna is -certainly one who should be placed in the first rank. He was born in -980 A. D. at Afschena, a village in the Province of Khorassan, Persia, -and spent his youth in Bokhara, where his father held some high office -under the Government. His great intellectual capacity was revealed at -an early age. It is said, for example, that already before he was ten -years old he had committed the entire Koran to memory; and it is added, -further, that when he was only seventeen years old he had already -acquired such knowledge of medicine that he was invited to take part -in a consultation regarding some malady with which the Emir Nuch ben -Mansur was affected. The advice which he gave on this occasion was -followed, and in the sequel it proved so good that he was granted, as -a reward, unrestricted access to the royal library,--a privilege which -he utilized to the very best advantage. When his father died Avicenna -came into possession of a large fortune, which enabled him to indulge -in a great deal of traveling. In this way he visited one Persian Court -after another throughout a period of several years. Finally, during a -residence at Hamadan, the Prince Schems ed-Daula, whom Avicenna had -successfully treated for some malady, made him his Vizir. While he -held this office he managed, without neglecting his official duties, -to continue his scientific studies; but he was not able entirely to -keep out of political intrigues, and as a consequence his life was for -a short time in some danger. He was confined for several months in a -fortress, from which, however, he managed eventually to make his escape -to the Court of Ibn Kakujah, in Ispahan. He resided in that city during -the following fourteen years, and it was there that he wrote his two -principal works--the famous medical treatise known as the “Canon,” and -the equally celebrated cyclopaedic work on philosophy. Worn out by -his incessant and most exhausting literary labors and by his excesses -in other directions, Avicenna died in June, 1037 A. D., while he was -accompanying the Emir on his expedition to Hamadan. His tomb may still -be seen in the latter city. - -Neuburger, from whose excellent History of Medicine the preceding -details have been gleaned, makes the statement that the treatise in -which Avicenna’s clinical experience was recorded has not come down to -our time, and that, consequently, we lack the means of estimating just -how great a physician--just how close a clinical observer and how wise -a practitioner--he really was. So far, however, as may be judged from -the evidence furnished by the Canon, Avicenna was not the equal, in all -practical matters relating to medicine, of Haly Abbas and of Rhazes. -He was perhaps too much inclined to “look at bedside phenomena through -the spectacles of preconceived theories.” In brief, he was, first and -foremost, a philosopher, and only in a subordinate degree a physician, -although a most excellent one. In Book III., where he discusses certain -surgical procedures, statements are made which justify the belief that -Avicenna was acquainted with intubation of the larynx. - -Le Clerc mentions six other Persians who, during the tenth century of -the present era, gained more or less distinction as physicians. In the -following paragraphs brief notices are given of each of these men. - -Eben el Khammar, born in 942 A. D., was a Christian and an excellent -practitioner. He was well versed in the science of medicine and a -writer of some importance. Date of death unknown. - -Abou Sahl el Messihy, who was also a Christian, was a contemporary and -intimate friend of Avicenna. He died in 1000 A. D. He was the author -of a complete and very useful summary of medicine, entitled “Kitab el -Meya”; and the Arab historian Ossaibiah speaks in terms of admiration -of another treatise which he wrote and which bears the title, -“Exposition of God’s wisdom as Manifested in the Creation of Man.” - -Abou Soleiman Essedjestany, commonly called “El Mantaky.” The dates -of his birth and death are not known. He wrote a number of treatises, -and--among others--one on “The Organization of the Human Faculties.” - -Aboul Hassan Ahmed Etthabary, a native of Thabaristan, in the Province -of Khorassan. He was employed as a physician by the Emir Rokn eddoula -ben Bouïh, and is known as the author of a compendium of medicine -entitled: “Hippocratic Methods of Treatment.” He died in 970 A. D. - -El Comry was one of the most eminent medical practitioners of his time, -and was in high favor with the royal household. He wrote a compendium -of medicine which bears the title “R’any ou Many,” and he was also -the author of a treatise on the causes of disease. His death occurred -toward the end of the tenth century of the Christian era. - -Alfaraby, who is highly commended by Avicenna, should be classed among -the philosophers rather than among the physicians. He died in 950 A. D. - -The sixth Persian physician of some distinction mentioned by Le Clerc -is Ali ben el Abbas--usually spoken of as Haly Abbas. The dates of his -birth and death are not stated by any of the authorities, but it is -known that he was a native of Ahouaz, a small town on the Karun river, -to the southeast of Bagdad, and that he was still living in 994 A. D. -Haly Abbas, it is claimed, was the first medical writer who ventured to -prepare a complete and systematically arranged Practice of Medicine. -He gave it the title of Al-Maleky--“The Royal Book,”--and dedicated -it to the Emir Adhad-ad-Daula, whose private physician he was. It is -a much smaller treatise than the “Continens” of Rhazes, and somewhat -more complete than the same author’s shorter work--the “Mansoury.” It -covers the entire field of medicine and is distinguished by its very -practical character. It was first translated into Latin in 1127 A. D. - -Haly Abbas, in one of his treatises, speaks of Hippocrates in the -following terms: “Hippocrates, who is the prince of the medical art and -the first physician who ever wrote a book on this art, is the author of -many treatises on all sorts of medical topics.... But he writes in such -a very concise manner that much of what he says is obscure, and as a -consequence the reader, if he wishes to understand him, is obliged to -seek the aid of a commentary.” - -_Egypt._--The dynasty of the Fatimides--the descendants of Fatima -(the daughter of Mohammed) and of Ismael, a great-grandson of Ali, the -fourth of Mohammed’s successors--reigned over Egypt for nearly two -centuries (10th to 12th of the present era), and they showed toward -the scientists the same spirit of generosity that had been manifested -toward them by the Abbasides in the earlier part of their reign. In 970 -A. D. Moëz Eddoula drove out the reigning family, assumed the title of -Caliph, and founded the city of Cairo. In 972 he built the celebrated -mosque Al Azhar and constructed, as a sort of annex to it, a school, a -veritable university, where ultimately all the sciences were taught. -It throve vigorously, and students flocked to it in great numbers from -all quarters of the Moslem empire. During the eleventh and twelfth -centuries Egypt was once more, as it had been in the palmy days of -Alexandria, the home of many excellent and vigorous institutions of -learning. Among the physicians, however, who received their education -in medicine at Cairo during this long period, there was not one who -attained great eminence. - -At the end of the eleventh century the Crusaders, under the leadership -of Godfrey de Bouillon and others, made their first serious attack -on Palestine and Syria, and from that time onward, for about two -centuries, they and the different armies sent out successively -from Europe carried on almost constant warfare, which Michaud the -distinguished French historian (about 1800 A. D.) calls the product -of a pious delirium. Wars of religion are the most savage and pitiless -of all wars, says Le Clerc, and this was emphatically true of those -waged by the Crusaders. On the other hand, says the same writer, “the -tolerance exhibited at that period by the Arabs in religious matters -is a well-attested fact, and it owes its origin to the circumstance -that their scientific education was conducted by Christians. Of -Saladin’s fifteen physicians two-thirds were either Jews or Christians. -Cultivation and good training were the characteristics of the Arabs -at that period of their history, whereas fanaticism and brute force -were the distinguishing features of the European soldiers. Several -hundred thousand adventurers first ravaged Europe and then pounced -upon Asia. At Antioch Godfrey de Bouillon committed all sorts of -excesses, and then, when he had taken Jerusalem, he massacred 70,000 -of its inhabitants--Jews and Musulmans. Eighty years later, Saladin -retook Jerusalem; and, with the exception of a comparatively small -number, he allowed all of his captives to go free. His brother, Malek -el Adel, paid the ransom of 2000 of the prisoners. Contrast these -fruits of civilization with the barbarism of the European conquerors -under Godfrey de Bouillon. Another result of the Crusades was this: -The Franks lost a good deal of their savagery through contact with the -Arabs. At a still later period Western Europe drew a large part of her -supplies of knowledge from Spain--_i.e._, from the Musulmans.” - -_Syria._--In the thirteenth century Damascus, the capital of -Syria, assumed considerable importance as a centre of medical activity. -Bagdad and Cairo had by this time lost the greater part of their -attractiveness for those who wished to perfect their knowledge of -the healing art, and the vandalism of the so-called Soldiers of the -Cross had put an end for many years to come to all hopes of making -Constantinople once more the home of scientific or artistic effort. -There was one branch of medical practice, however, in which the Cairo -physicians excelled all others--that, namely, of ophthalmology. This is -explained by the well-known fact that at all periods of her history -Egypt has been afflicted with ophthalmias to a much greater degree than -any of the other countries of the Mediterranean basin. The great wealth -accumulated in Damascus, the large number of hospitals which were -located in the city, and the attractiveness of the town as a place of -residence undoubtedly had much to do with the fact that it attained at -this period so great popularity as a centre of medical activity. - -_Spain._--During the tenth century of the present era the Moslem -reign in Spain flourished greatly under the two enlightened rulers -of the Ommiade Dynasty--Abdurrahman Ennasser and Hakem, and medicine -shared fully in this prosperity. During Abdurrahman’s reign the Emperor -Romanus at Constantinople sent an embassy to Cordova in Spain, and -among the gifts which they took with them for the Prince, was a copy -of the treatise of Dioscorides in the original Greek, illustrated by -marvelously beautiful paintings of the different medicinal plants. -But there was nobody in Cordova at that time who could read Greek. -Accordingly, Abdurrahman begged the Emperor to send him a man who was -familiar with both the Greek and the Latin tongues, and it was in -answer to this request that the monk Nicholas was sent to Cordova (951 -A. D.). Working in conjunction with several of the most distinguished -physicians of that city he succeeded in identifying nearly all of the -plants mentioned by Dioscorides. - -Among the physicians of Arab, Persian or Jewish extraction who, during -the eleventh and twelfth centuries, practiced their profession in Spain -and attained considerable celebrity, the following deserve to receive -special mention here: Abulcasis, Avenzoar, Averroes and Maimonides. - -_Abulcasis._--Abulcasis is universally credited with being the -greatest surgeon of whom the Arabs may rightfully boast. He was born -at Zahra near Cordova in 936 A. D., and his death occurred 1013 A. -D. Quite early in his professional career (before he had reached his -twenty-fifth year) he was appointed one of Abdurrahman’s private -physicians. Although he owes his reputation chiefly to the treatises -which he wrote on surgery Abulcasis was also the author of several -medical works. He published a collection of all his writings under the -title of “The Tesrif,” which is divided into thirty parts or books, -and which--according to Lucien Le Clerc--constitutes a veritable -encyclopaedia. During the course of the twelfth century Gerard of -Cremona translated into Latin the part relating to surgery; it is not -known at what time or by whom the remainder of the collection was -translated. The author’s name in the Latin edition is given, not as -Abulcasis, but as Alsaharavius. - -During the lifetime of Abulcasis his writings, and especially his work -on surgery, were not very highly appreciated in Spain. This was largely -due to the fact that the Mohammedan inhabitants of that country did not -look upon surgery with any degree of favor. The Arabs of the East held -Abulcasis in much greater honor. Guy de Chauliac, the famous French -surgeon of the fourteenth century, in his treatise on surgery, quotes -Abulcasis no less than two hundred times. Le Clerc, in the course -of his remarks upon the value of the surgical treatise written by -Abulcasis, says: “This book will always be considered, in the history -of medicine, to represent the first formal and distinct scientific -treatise on surgery.” At the same time, the prevailing testimony makes -it appear that the book contains only a small portion of original -matter, a large part of its substance having been borrowed from the -work of the Greek author, Paulus Aegineta. Its chief merit consists in -the orderly and very clear manner in which the facts are presented, and -doubtless the popularity of the book was materially increased by the -fact that many of the instruments required for the different operations -were illustrated pictorially. - -Lucien Le Clerc has published (Paris, 1861) a French translation of -Abulcasis’ Treatise on Surgery, and on page 71 of this version the -following statement will be found:-- - - ... you may also introduce into the cannula a specially adapted - piston in copper, or a stylet the end of which is armed with - cotton. Then fill the cannula with oil or some other suitable - fluid, introduce into one end the stylet armed with cotton, and - push it onward until the liquid enters the ear. - -Edouard Nicaise, commenting on these words in his version of Guy de -Chauliac’s _La Grande Chirurgie_ (page 690), says that they -constitute the first reference, thus far discovered in medical -literature, to the use of the instrument known as a syringe. - -_Avenzoar._--Avenzoar was born in Seville, in the southern part -of Spain, during the latter part of the eleventh century. The exact -date is not known. His father was a physician of some distinction, and -his son also attained considerable eminence in the same profession. -According to Neuburger, Avenzoar died, at an advanced age, in 1162 A. -D., and was buried in Seville. - -It is said that in actual practice Avenzoar, who was a man of some -wealth, confined himself to consultation work. He considered it beneath -the dignity of a physician to prepare drugs, to apply leeches, or -to perform certain surgical operations--as, for example, lithotomy; -but Le Clerc seems disposed to believe that Avenzoar did not adopt -this view until after he had become somewhat celebrated and had -accumulated a fortune. Neuburger ranks him next to Rhazes as a clinical -observer and a practitioner of sound common sense, and he speaks of -his great medical work, the Teïssir, as a treatise that abounds in -most interesting histories of cases of disease. Among these will be -found the account of an attack of mediastinitis which occurred in -his own person, and which ended in suppuration that found a vent for -its products by way of one of the bronchi.[51] As this disease is of -rare occurrence, and as Freind’s account of the attack is presumably -a translation of the original report in Arabic made by Avenzoar, its -reproduction here may be interesting. I shall take the liberty of -modernizing the text very slightly and of abbreviating it in one or two -places. - - I felt some pain in the region of the mediastinum (the membrane - which divides the thorax in the middle) while I was on a - journey. As it increased a cough developed, and I observed - that my pulse was very hard and that I had an acute fever. On - the fourth night I took away a pint of blood, but this gave me - very little relief. Being obliged to travel all day I was much - fatigued when I retired at night, and I fell asleep. During my - sleep the bandage on the arm came off, and when I awoke I found - the bed deluged with blood and my strength greatly exhausted. - The next day I began to cough up a sanious matter, and my mind - wandered at times. Gradually all the symptoms subsided and I - recovered my health. Although I partook of large quantities of - barley water, I believe that my recovery was not due to this, - but rather to the great loss of blood which I had experienced. - -Freind adds that “Avenzoar not only takes notice of an abscess in the -mediastinum, but in the pericardium likewise; which I don’t find had -been described or even observed by any of the Greeks or Arabians: and -there is no doubt but this membrane and the mediastinum to which it -is contiguous, are subject, as well as the pleura and lungs, to an -inflammation.” - -It is one of the distinguishing features of Avenzoar’s character that, -in his writings, he does not hesitate to differ from his predecessors -whenever he believes that their views are erroneous. - -_Averroes._--Averroes was one of Avenzoar’s most distinguished -pupils. Indeed, the latter’s famous work, the Teïssir, is dedicated to -Averroes. Thanks to the distinguished French historian and philosopher, -Ernest Renan, our knowledge of Averroes has been greatly expanded since -1852. Averroes was born at Cordova in 1126 A. D. His father and his -grandfather had both held the office of Cadhi (Alcalde, in Spanish), -and were therefore people of importance in that city. His studies were -confined at first largely to philosophy, and when he reached mature -age he gained a great reputation as the commentator and interpreter of -the writings of Aristotle. Still later in life much of his attention -was devoted to medicine, and he wrote a book which bears the title -“Kitab al-kullidschat” (General principles of Medicine). Among the -physicians of the later Middle Ages this work was commonly spoken of as -the “Colliget” (from kullidschat), and was almost as highly esteemed as -the Canon of Avicenna. The idea of writing a treatise on the individual -diseases was first entertained, among Arabian physicians, by Averroes; -but on reflection he abandoned the idea, and, instead, urged Avenzoar, -his friend and former instructor, to undertake the work in his place. -It was in this way that the Teïssir--the finest work on the practice of -medicine produced by an Arab writer--came to be written. - -The topics treated in the “Colliget” are distributed throughout the -seven books in the following manner:-- - - Book I. Anatomy. - Book II. Health (Physiology). - Book III. Diseases. - Book IV. Signs or Symptoms. - Book V. Remedial agents and Foods. - Book VI. The Preservation of Health. - Book VII. The Treatment of Diseases. - -Neuburger speaks of the “Colliget” as a fine piece of philosophical -writing, but adds that it is not at all suited to the needs of the -practical physician. Indeed, he doubts whether any person who has not -received a thorough training in natural philosophy--the philosophy of -Aristotle--would be able to follow the author intelligently. - -_Maimonides._--Maimonides, who is ranked by Le Clerc as the -greatest Jew, after Moses, of whom the history of that nation makes -mention, was born at Cordova, Spain, in 1135 A. D. In early youth -his teachers were his father and a disciple of Ebn Badja. At the age -of thirteen, and from that time until he had reached his thirtieth -year, he was obliged under the pressure of circumstances, to profess, -at least outwardly, the faith of Islam. Death or banishment was -the only alternative. During the intervening period of seventeen -years he devoted himself exclusively to his studies. In 1160 A. D. -he accompanied his family to Fez, Morocco, and five years later he -settled at Fostath, near Cairo, Egypt. As a means of gaining his -livelihood he engaged in the business of trafficking in precious -stones, continuing his studies at the same time and carrying on a -certain amount of medical practice. Not long afterward he gained the -favor of the Vizir El Fadhl Beissâny, the friend of Saladin, Sultan of -Egypt and Syria, and was by him appointed one of the Court physicians. -This enabled him to give up entirely his commercial business. He -prospered in the practice of medicine and was very highly esteemed in -the community in which he lived. His death occurred in 1204 A. D. - -Among the books which he wrote (generally in Arabic) on medical -subjects, the following deserve to receive special mention:-- - - I. Commentary on the Aphorisms of Hippocrates. - - II. A work known as “Aphorisms of Maimonides” (borrowed partly - from Hippocrates and partly from Galen). - - III. Résumé of the writings of Galen. - - IV. A letter relating to the subject of personal hygiene. - - V.-IX. Treatises on asthma; on hemorrhoids; on venoms and - poisons in general; on drugs; and on forbidden articles - of diet. - - X. A translation of one of Avicenna’s works. - -Neuburger speaks in very favorable terms of the medical writings of -Maimonides, and adds that he also wrote a treatise which bears the -title: “Guide to Those in Perplexity”--a work which aims to reconcile -reason and faith. The book has been translated into French by Munk; and -the treatise on poisons has also been translated into the same language -by J. M. Rabbinowicz (Paris, 1867). - -Speaking of the remarkable manner in which philosophy and medicine had -flourished in Spain during the tenth and eleventh centuries, under the -reigns of Haken II. and his successors, Ernest Renan says: - - The love of science and of things beautiful had established, - in that privileged corner of the world, a degree of tolerance - that can scarcely be matched in modern times. Christians, Jews, - Musulmans all spoke the same language, sang the same poems, and - took part in the same literary and scientific studies. All the - barriers which commonly separate men were thrown down, and all - worked with equal zeal in behalf of our common civilization. - -With the death of Averroes (1198 A. D.), however, Arab philosophy lost -its last representative, and the Koran resumed its full authority over -freedom of thought. In the succeeding period of decadence (thirteenth -century of the Christian era) there were no physicians of first -importance, at least in Spain and Persia; and even in Egypt and Syria, -over which reigned at this time the enlightened family of Saladin, -the leading physicians were not of the same calibre as the men whose -names I have just mentioned. Bagdad and Cordova had by this time become -cities of less importance than Damascus, and botany and ophthalmology -were esteemed of greater value in the scheme of medical education -than at any previous time. It will not appear strange, however, -that medicine should have stood still during this later part of the -Middle Ages if we bear in mind the fact that warfare was then such a -frequently occurring event that nobody had either time or inclination -for scientific studies. The invasions of the Mongolians and the -Crusaders were most disturbing factors. - -During the twelfth century of the present era there were--so we are -assured by Le Clerc--women physicians among the Arabs in Spain. It is -said, for example, that Abou Bekr, a distinguished medical practitioner -of that period, had a sister who was well trained in medicine, and that -it was she who acted as midwife at all the confinements of the wives of -the Caliph Almansur. After her death her niece officiated in the same -capacity in her place. There can scarcely be any reasonable doubt that, -almost from time immemorial, women as well as men have taken active -part in the practice of medicine. - -According to Puschmann, Spain possessed, during the twelfth century of -the Christian era, seventy public libraries and seventeen institutions -for instruction in the higher branches of learning. Among the residents -of the city of Cordova there were, during the same period, no fewer -than one hundred and fifty authors; and the smaller cities of Almeria, -Murcia and Malaga could each claim proportionally an equally large -number, viz., fifty-two, sixty-one and fifty-three. - -_The Effects of the Arab Renaissance as a Whole upon the Evolution of -Medicine._--Although the series of events which I have endeavored -to sketch here in brief outlines reveals an extraordinary degree of -zeal and persistence on the part of the Arab rulers and their subjects -to endow the nation with the knowledge and skill of their models, -the Greeks, the final results gained, at least so far as they relate -to the evolution of medicine as a whole, were not very great. The -movement lasted for five or six centuries, but nevertheless only a few -relatively unimportant facts were added by the Arabs to the stock of -knowledge which was possessed at the time of Galen’s death. Alhazen’s -brilliant researches in the eleventh century of our era in optics (more -particularly with reference to refraction) paved the way for a more -perfect knowledge, in modern times, of the physiology of vision; Geber, -who lived during the eighth century of the Christian era, and who is -spoken of by Le Clerc as “occupying the same place in the history of -chemistry that Hippocrates does in the history of medicine,” laid the -foundations of that important branch of science; Abulcasis discovered -the Medina worm (_dracunculus Medinensis_) and wrote an excellent -description of the pathological effects which it produces when it -lodges under the skin of a man’s leg; and, finally, our pharmacopoeia -was enriched, during these centuries, by the addition to it of a number -of new drugs and pharmaceutical preparations. These are among the more -important contributions which the Arabs made to the general stock of -medical knowledge. On the other hand, they contributed, in an indirect -manner, to the advance of the science of medicine. From the thirteenth -century onward, for a long period, the Latin language was destined to -serve as the vehicle by means of which all scientific knowledge was -to be spread abroad in the countries which are now known as Italy, -Spain, France, Switzerland, Germany, Belgium and Holland, and therefore -an immense amount of translating had to be done before the works of -Hippocrates, Galen and other Greek medical authors could be brought -within reach of the physicians of these different countries. At that -late date it was by no means always feasible to get possession of an -original copy of one of these classical treatises, and consequently in -such cases it became necessary to employ an Arabic version in the place -of the Greek original. It was in this indirect manner, therefore, that -the Mohammedan Renaissance contributed most effectively in advancing -the development of medical science in general. - -One cannot dismiss the subject of Arabic medicine without calling -attention once more to the spectacle which this remarkable Renaissance -offers--that of an entire nation deliberately working to educate itself -up to the level of such intellectual and artistic giants as the ancient -Greeks; a work which continued with unabated zeal throughout several -centuries in spite of obstacles and discouragements, and which never -ceased for a moment. It is a spectacle without parallel in the world’s -history. - - - - - CHAPTER XX - - HOSPITALS AND MONASTERIES IN THE MIDDLE AGES - - -Long before the Christian era it was the practice among the Greeks -to make suitable provision for those who, by reason of poverty or -illness, were unable to provide for their own wants or to secure the -services of a physician. Their slaves, for example, were sent, when -overtaken with illness, or when they had become too feeble to work, to -what was termed _Xenodochia_--institutions where they received -kindly care and such medical treatment as was necessary. (Mommsen.) In -strong contrast with this humane practice stands the action of those -wealthy Roman property owners who, adopting the course recommended by -Cato, the famous censor (96–46 B. C.), “sold their slaves when they -became old and feeble or ill, as they would old iron, or oxen that -can no longer be utilized for work.” This cruel practice not only -continued throughout a period of nearly three centuries, but apparently -became more and more common, for we are told that the Emperor Claudius -(268–270 A. D.) was obliged, in order to mitigate the evil, to issue a -decree that, when a slave was driven out of the house by his owner, he -should be declared free. - -_Hospitals and Other Kindred Institutions._--Toward the end of the -fourth century of the present era the first hospital was established in -Rome by the widow Fabiola, a member of the distinguished Fabian family, -and her example induced other wealthy Roman ladies to found similar -institutions. But already several years before this time the influence -of Christianity had made itself felt so strongly in the eastern branch -of the Roman Empire that the Emperor Julian, who had previously been -among its most bitter opponents, was forced to say, in one of his -letters:-- - - Now we can see what it is that makes these Christians such - powerful enemies of our gods; it is the brotherly love which - they manifest toward strangers and toward the sick and the poor, - the thoughtful manner in which they care for the dead, and the - purity of their own lives. - -Moved by these considerations, he decided forthwith to erect hospitals -in all the cities of the empire. We do not know whether he acted upon -this resolution or not, but it is a matter of record that St. Basil, -Bishop of Caesarea (370–379 A. D.), founded in that city, which is -about thirty miles distant from Jerusalem, a settlement composed of -numerous dwellings that were devoted to the use of the poor and the -sick. This institution was managed in an admirable manner, a special -corps of physicians and nurses being assigned to the duty of caring for -its inmates. At Edessa, the capital of Northern Mesopotamia, another -hospital was founded in 375 A. D. The date of the establishment of the -celebrated hospital at Djondisabour in Persia, of which mention is made -elsewhere (see page 204 _et seq._), is not known. About the middle -of the sixth century of the present era, Childebert I., King of the -Franks and son of Clovis, founded at Lyons, France, the Hôtel-Dieu, a -hospital which has afforded shelter and comfort to thousands of human -beings during the past fourteen hundred years, and which is in active -operation at the present time; a hospital, too, which has served as a -training school for a long line of distinguished physicians, surgeons -and gynaecologists. It is an interesting fact that Childebert intrusted -the management of this great institution to laymen (instead of the -ecclesiastical powers). Finally, toward the end of the sixth century, -Bishop Masona founded in Merida, Spain, a hospital in which Jews, -slaves and freemen were received and treated on the same footing; and -he laid down the rule that one-half of the moneys and other gifts -received by the church was to be devoted to the maintenance of this -institution. The list of hospitals and other charitable organizations -which were established in these early centuries is very long, and it -reveals the fact that in every known land there existed, throughout -these years, a strong wish to give aid and comfort to the poor, the -sick and the helpless. The Musulmans appear to have been as zealous -as the Christians in promoting works of this kind; for the records -show that in Bagdad, Cairo, Damascus, Cordova and many of the other -cities which were under their control, they provided ample hospital -accommodations. Indeed, one of the largest and most perfectly equipped -institutions of this character of which the history of the Middle -Ages furnishes any record, was that planned and constructed at Cairo, -Egypt, in 1283 A. D., by the Sultan El Mansur Gilavun. While it was -building, the workmen employed were not permitted to engage in any -undertaking for private citizens, and the Sultan himself never failed -to visit the spot every day during the progress of the work. The site -chosen was that of one of the royal palaces, and in tearing down this -structure, in order to make room for the new building, the workmen -brought to light a large chest filled with gold and precious stones, -the value of which was sufficient to pay the entire expense of erecting -the hospital. Upon the completion of the building and the equipment -of its spacious wards in the most perfect manner possible, the Sultan -expressed himself in the following terms:-- - - I have founded this institution for people of my own class - and for those who occupy an humbler station in life--for the - king and for the servant, for the common soldier and for the - Emir, for the rich man and for the poor, for the freeman and - for the slave, for men and also for women. I have made ample - provision for all the remedial agents that may be required, for - physicians, and for everything else that may prove useful in any - form of illness.... - -One of the characteristic features in the management of this hospital, -says Le Clerc, was the custom of giving to each of the poorer inmates, -when he left the institution, five pieces of gold, in order that he -might be spared the necessity of undertaking immediately work of an -exhausting character. - -_Monasteries in Their Relation to Medicine._--While at first -these institutions were designed chiefly as places of refuge from -the turmoil of the world and from the violence of frequent warfare, -it became evident in the course of time that the evils incident to -such a secluded and self-centered life hindered rather than promoted -the development of those particular virtues which Jesus Christ urged -his followers to cultivate. This experience led to the adoption of -a different kind of cloister life; and so it came about, as stated -by Neuburger, that in 529 A. D. Benedictus of Nursia founded, at an -isolated spot high up on the slope of Monte Cassino, in Campania, -Italy, the now famous parent monastery of the Benedictine Order. -According to the original regulations of this order, the monks were -obliged to perform every day a certain amount of manual labor as well -as devotional exercises. Nine years later Cassiodorus, who had for -a long period been a sort of Secretary of State under Theodoric the -Great and his successors, became a monk, and, from that time to the -day of his death, “devoted all his energies to the service of God -and the advancement of science.” He secured a house not far from the -Benedictine monastery on Monte Cassino, gathered together there a -considerable library, and made it a rule of the place that the copying -of original codices (the majority of them theological) constituted -the most useful and honorable form of manual labor. A few years -later, this smaller establishment was made a part of the monastery at -Monte Cassino, and the rule just mentioned was thereafter adopted by -the enlarged institution. But the care of the sick, the feeble, and -children was the particular work which Benedictus, the founder of this -institution, had most at heart. Cassiodorus went even farther and urged -upon the brethren the desirability of studying the healing art and of -utilizing, for this purpose, the works of ancient medical authors. - - Learn all you can, he said, about the characteristics of - different plants and about the methods of preparing medicinal - mixtures, but set all your hopes upon the Lord who is the - preserver of our lives. In your search for knowledge about - drugs consult the herbarium of Dioscorides, who has described - and pictured the different herbs with great accuracy. Afterward - read Latin translations of the works written by Hippocrates and - by Galen, particularly the latter’s treatise on therapeutics, - the one which he addresses to the philosopher Glaucon; and, in - addition, study the work of Caelius Aurelianus on the practice - of medicine, that of Hippocrates on medicinal plants and methods - of treatment, and some of the other writings on medicine which - you will find in my library and which I have left behind me for - the benefit of my brethren in this institution. - -The advice given by Cassiodorus was heeded, not only by those to whom -it was addressed, but also by many succeeding generations of monks. -Even at the present time, says Neuburger, the books which Cassiodorus -recommended are still to be found, either in the form of original -manuscript copies or in that of translations, in the library of the -parent institution. Furthermore, when it is remembered how large a -number of affiliated Benedictine monasteries were established in -different parts of Europe, it will readily be appreciated that the good -accomplished by the advice which Cassiodorus gave must have been very -great. - -Among the later abbots of Monte Cassino there were three who attained -considerable distinction as physicians. They were Bertharius, who wrote -two treatises on medical topics; Alphanus II., Archbishop of Salerno, -who was celebrated both as a physician and as a poet; and Desiderius -(1027–1087 A. D.), who was skilled, not only in medicine, but also in -jurisprudence, and who was elected Pope under the title of Victor III. -The monastery attained the height of its celebrity at the time when -Constantinus the African became one of its regular members. Although -Constantinus was a native Arab (born at Carthage about 1018 A. D.), -he became converted to Christianity quite early in life. It is said -that he was a great traveler as well as a great scholar, and that he -devoted several years to visiting foreign lands--Babylonia, India, -Egypt and Ethiopia. It was in this way that he became so well versed in -the languages of the East. Upon visiting Spain as a fugitive from his -native city, he took with him several of the works of Hippocrates and -Galen, and in course of time translated them into Latin. Finally, he -accepted the position of secretary to Robert Guiscard, the first Norman -Duke of Calabria and Apulia, who appears to have selected Salerno as -his place of residence. At the same time he became one of the teachers -at the medical school of that city, and served in this capacity for a -certain length of time; but, at the end of a few years, he was formally -accepted by the Abbot Desiderius as a member of the Monte Cassino -community, and it was here that he did the larger part of his literary -work. His death occurred in 1087 A. D., the same year in which the -Abbot Desiderius--or, rather, Pope Victor III.--died. - -Constantinus was a prodigious worker, but it is doubtful whether he did -anything of an original character. Not a few of the treatises which -were, at that time, credited to him as original productions, are now -known--thanks largely to the researches of the great French historian -and linguist, Daremberg--to be simply translations from the Arabic. - -It is believed by some authorities that at Monte Cassino medicine was -taught to laymen as well as to those who were preparing to become -members of the Benedictine Order of monks. It is not likely, however, -that this was done to any great extent, as much better facilities for -acquiring knowledge of medicine were available at Salerno in the near -neighborhood. - -In some parts of Gaul, in the early Middle Ages, physicians received -very little consideration; indeed, to us moderns it seems strange -that any one should have possessed sufficient courage to accept -the responsibility of prescribing for a member of one of the royal -families. It is related by Neuburger, on the authority of Gregory of -Tours’ History of the Franks, that when Austrichildis, the wife of King -Guntram (sixth century A. D.), was ill with the plague and perceived -that her death was near at hand, she sent for her husband and extracted -from him a promise that he would behead the two physicians, Nicolaus -and Donatus, who had treated her and whose prescriptions had failed to -effect a cure. Her wish was carried out, in order--as the statement -reads--“that her Majesty might not enter the Realm of the Dead entirely -alone.” Many centuries later, however, when civilization had certainly -advanced far beyond the stage which it had reached in Gaul in the sixth -century of the present era, there were instances in which able and -conscientious physicians were subjected to equally cruel treatment for -their failure to effect a cure. - -It was at about this same period, as is amply verified by the -statements made by Bishop Gregory of Tours, that faith in the power of -saintly relics to heal diseases became almost universal. So great was -the effect produced upon the minds of the people by the public display -of these objects--bones of saints, portions of their grave-stones, -etc.--that a large number of marvelous cures were reported as the -result of such displays; and doubtless--so great is the power of -suggestion over the human mind--many of these reports were true. A -century later (673–735 A. D.), the Venerable Bede, author of the famous -work entitled “Ecclesiastical History of the English Nation,” gave, in -the course of his narrative, an account of a case of aphasia in which -“a remarkable cure was effected”; and, although he mentions a course -of “systematic exercises in speaking” as the means used to effect that -cure, he attributes it to supernatural causes and not to the practical -treatment adopted. He also describes some of the epidemics of his time, -and gives most interesting though brief accounts of the methods of -treatment employed by the priests and the monks. - -During the ninth and tenth centuries, as we learn from the very full -descriptions given by Neuburger in his History of Medicine, much zeal -was manifested by the monks at St. Gall in Switzerland, at Reichenau in -Saxony, and at Fulda, in Hesse Nassau, in the study of the different -branches of knowledge, medicine included. The following are the names -of those monks who attained the greatest distinction in this work: -Hrabanus Maurus, Abbot of the Fulda Monastery, afterward Archbishop -of Mayence, and the author of an encyclopaedia in which the science of -medicine receives quite full consideration; and Walahfrid Strabo, a -pupil of Maurus, Abbot of Reichenau, and the author of a treatise in -verse on medicinal plants. - - - - - CHAPTER XXI - - MEDICAL INSTRUCTION AT SALERNO, ITALY, IN THE MIDDLE AGES - - -The date of origin of the Medical School at Salerno is not known, -but such evidence as we possess shows without a doubt that already -in the earliest part of the Middle Ages some sort of facilities for -studying medicine were provided in that little town--the _Civitas -Hippocratica_, as it was called at a later period. It seems to -be the general impression, says Daremberg, that during those early -centuries only ignorance and superstition prevailed in Italy and Gaul; -in other words, that all desire for scientific research had vanished, -and that there no longer existed such a thing as the regular practice -of medicine. This impression, he adds, is erroneous. History shows -that schools modeled after those established by the Merovingian and -Carlovingian kings (448–639 A. D.), existed up to as recent a date as -the middle of the seventh century, and that subsequently the bishops -organized the teaching in such a manner that it should be entirely -under their control. As time went on, however, the schools assumed a -more public character, although the actual teaching was still carried -on in the cloisters and church edifices. It is well known, furthermore, -that the chief of the Ostrogoths, Visigoths and Lombards--the so-called -Barbarians, who at that time occupied these parts of Europe as -conquerors--showed themselves on many an occasion to be the enlightened -protectors of public instruction and the enthusiastic admirers of -classical literature and science. - - At Milan there is preserved a manuscript which furnishes - satisfactory proof that the writings of Hippocrates and Galen - were made the subject of public teaching at Ravenna toward - the end of the eighth century of the present era.... And the - transcribing of medical manuscripts was known to be carried - on at the Monastery of St. Gall, in Switzerland, during the - eighth century.... It is plain, therefore, that throughout - those extensive regions which previously had formed a part of - the Roman Empire, but which during the Middle Ages were under - the dominion of Barbarian kings, there was never an entire lack - of physicians, or of medical knowledge, or of facilities for - teaching medicine. (Daremberg.) - -In the light of these statements it is easy to believe that the -original development of the Medical School at Salerno was a perfectly -natural event like that of the founding of any of the medical -schools of a more recent date. The remarkably healthy and singularly -attractive character of the spot where the town of Salerno is located; -the proximity of mineral springs; the comparatively short distance -which separated it from such important centres of population as -Naples and the cities of the Island of Sicily, and from the famous -Benedictine Monasteries at La Cava, Beneventum and Monte Cassino; and -the circumstance that a Ducal Court was established there--all these -are facts which amply explain both why a medical school was founded -here rather than at some other spot, and why physicians of exceptional -ability were easily induced to make the place their home. At no time -in the history of the school, it is important to state, do the church -authorities appear to have been in control of its affairs. At most, -one or two of the monks seem to have taken part in the teaching for -limited periods of time; but in its main characteristics the school -may truthfully be described as an institution created and managed -by physicians for the advancement of medical science and the best -interests of the profession as a whole.[52] - -The organization of hospitals and their utilization for purposes of -clinical instruction must have been the most important events which -followed next in order. It is only upon this assumption that we can -satisfactorily explain why, for many years in succession, physicians -traveled all the way from France, Germany and England to Salerno. They -were eager to gain additional knowledge of medicine, and clinical -instruction afforded the only sure way of obtaining it; but instruction -of this kind was nowhere else to be obtained at that remote period, and -consequently men of this earnest and ambitious stamp were compelled to -make the long journey and to incur the expense and the risk incident to -such a trip. As a further evidence of the value which the physicians of -the later Middle Ages set upon the writings of the teachers at Salerno, -the fact deserves to be mentioned that, toward the end of the twelfth -century and all through the thirteenth and fourteenth centuries, these -works were frequently quoted. - -But the ability and learning of the Salerno physicians were highly -appreciated by the public at large as well as by their confrères in -other lands; for many people of wealth and of high social standing -visited Salerno for the purpose of consulting them. Among the number -were Adalberon, Bishop of Verdun, France, who journeyed thither in 984 -A. D., but failed to obtain the relief which he required; Desiderius, -the Abbot of Monte Cassino; Bohemund, the son of Duke Robert Guiscard; -and William the Conqueror, afterward King of England. The two last -named remained for some time in Salerno, in order to secure needed -treatment for the wounds which they had received in battle. - -Toward the end of the tenth, or at the beginning of the eleventh, -century the teaching of medicine at Salerno began to assume the -character of regularly organized work. The names of the men and women -who conducted it--for there were women as well as men in the corps of -teachers--are mentioned in various contemporaneous documents which have -come down to our time. They are as follows: Petroncellus, Gariopuntus, -Alphanus, Bartholomaeus, Cophon, Trotula, John and Matthew Platearius, -Abella, Mercuriade, Costanza Calenda, Rebecca Guarna, Afflacius, -Maurus, Musandinus and many others. According to Puschmann, the list -of physicians who, during the existence of the Medical School at -Salerno,--a period of nearly one thousand years,--acted as teachers -in the institution, comprised no less than 340 names. The presence -of several women among the instructors of this school, and the great -esteem in which they were held by the men of that time, both for their -ability as practitioners and for the excellence of the treatises which -they wrote, furnish strong confirmation of the statement which Plato -makes in his work entitled “The Republic,” and which I have already -quoted in one of the earlier chapters, viz.: “For women have as -pronounced an aptitude as men for the profession of medicine.” And, if -further evidence of the correctness of Plato’s opinion were needed, the -success attained by women physicians during the past thirty or forty -years in the United States of America might be cited. - -To the general statement made above I may with advantage add a few -details regarding both the individual physicians at Salerno and the -books which they wrote. During recent years, thanks to the researches -of Henschel, de Renzi and Piero Giacosa, our knowledge of these matters -has been greatly enlarged. In 1837 Henschel found, in the library -at Breslau, Germany, a manuscript collection of Salerno medical -treatises (“Compendium Salernitanum”) dating back as far as the latter -part of the twelfth century of the present era. De Renzi, working -in association with Daremberg and Baudry de Balzac, succeeded in -collecting from the different libraries of Italy quite a large number -of additional Salerno treatises, all of which have since been published -under the title “_Collectio Salernitana, ossia documenti inediti e -trattati di medicina appartenenti alla scuola medica Salernitana_” -(5 vols., Naples, 1852–1859). Finally, Piero Giacosa has added to this -stock of Salerno writings by the publication (Turin, 1901) of a work -which bears the title “_Magistri Salernitani nondum editi etc._” -Beside the treatises to be found in these three collections there is -one other which, according to Neuburger, contributed more than all the -others combined to the fame of the Medical School of Salerno. The title -of this extraordinary work is: “_Regimen sanitatis Salernitanum_.” - -The Salernian writings, it appears, may readily be divided into two -groups--those of the earlier and those of the later epoch of this -famous school. The treatises which belong to the older epoch are -written in the degraded Latin of the Middle Ages, and seem to have -been composed entirely for didactic purposes. In the main they are -compilations of still earlier Graeco-Latin works, but here and there, -especially in the parts which relate to therapeutics, evidences of a -certain measure of originality are discoverable. The pathology adopted -shows a hodge-podge of the humoral doctrine and that of the Methodists. - -The chief representative of this early epoch is Gariopontus (first -half of the eleventh century), whose treatise on special pathology -and therapeutics--entitled “_Passionarius_”--was very popular -for a long period of years. Next in order comes Petroncellus, whose -“_Practica_” calls for no special comment. Of the works of -Alphanus, John Platearius (the elder) and Cophon (the elder), we -possess only fragments. Trotula, who lived about 1059 A. D. and was -believed to be the wife of John Platearius I., attained greater -celebrity than any of those just mentioned. She was related to Roger -I., Count of Sicily, and was therefore probably of Norman extraction, -and she was considered by her contemporaries to be very learned -(“_sapiens matrona_”).[53] Her writings, which are quite numerous, -are frequently quoted by later authors, this being especially true of -her work on diseases of women. The four other women who took an active -and creditable part in the work of the Salerno Medical School also -wrote treatises on various subjects: Abella, on “Black Bile”, (written -in verse); Mercuriade, on “Pestilential Fever,” and also on “The -Treatment of Wounds”; and Rebecca Guarna, on “Fevers.” In the case of -Costanza Calenda, the daughter of the Dean of the medical school and -a woman remarkable for her wisdom as well as for her great beauty, no -record of the treatises which she wrote appears to have been preserved. - -The later epoch of the literature created by the Medical School of -Salerno begins about the year 1100 of the present era, after the Latin -translations and compilations made by Constantinus the African had -taught the physicians who were then at the head of affairs something -about the medicine of the Arabs, and had, at the same time, through -the latter medium, brought to their attention afresh the teachings -and practice of the ancient Greeks.[54] Among the works of the latter -character--works which in their Latin dress proved most valuable to the -Salerno physicians--are the following: “The Aphorisms of Hippocrates”; -“Galen’s _Ars Parva_” (_Mikrotechne_); and the same author’s -“Commentaries on the Hippocratic Writings.” - -John Afflacius, a monk who lived during the latter half of the eleventh -century of the present era, was one of the pupils of Constantinus. His -treatise “On Fevers,” according to Neuburger, contains ample evidence -of the author’s ability as a clinical observer. - -Something still remains to be said concerning Bartholomaeus, Cophon -the Younger, John Platearius the Younger and Archimathaeus. They -have already been mentioned in the list of authors whose writings -contributed materially to the celebrity of the Medical School of -Salerno, and it is now only necessary to furnish a few particulars -with regard to their lives and the nature of the work which they -accomplished. - -Bartholomaeus wrote a treatise (entitled “_Practica_”) on the -practice of medicine as taught by Hippocrates, Galen, Constantinus and -the Greek physicians. Its enduring popularity is evidenced by the facts -that it was translated at an early period into several languages and -that portions of its text are often quoted by later authors. The book -contains ample evidence that its author was a very close observer and -a physician who strove to make accurate diagnoses. - -Cophon the Younger (about 1100 A. D.) was the author of two works: a -treatise on anatomy which bore the title “_Anatomia Porci_,” and -one on the practice of medicine (“_Practica_”). The ancients, it -is stated, selected a pig for purposes of anatomical study “because its -internal organs present a very close resemblance to those of the human -being.” Both books are written in a clear and simple style. - -John Platearius the Younger was the author of a work on internal -medicine (“_Practica Brevis_”) and also of one on the subject of -urine (“_Regulae Urinarum_”). - -Archimathaeus wrote and published three treatises: one on “Urines,” -another on practical medicine (“_Practica_”), and the third -on “The Demeanor which a Physician should Observe when he Visits a -Sick Person” (“_De Aventu Medici_”). The latter treatise, says -Neuburger, is “a mixture of piety, artlessness, and slyness; but it -furnishes a capital picture of the carefully regulated behavior of the -mediaeval physician at the patient’s bedside, of the manner in which he -conducted his examination of the case, and of his intercourse with the -household as well as with the sick person.” - -In addition to the treatises referred to above,--treatises which are -known to have been written by the authors to whom I have credited -them,--the _Collectio Salernitana_ contains several of which the -authorship is not known. One of these, which bears the title “_De -Aegritudinum Curatione_,” is reputed to furnish a better account -of the special pathology and therapeutics taught at the Medical -School of Salerno during the height of its celebrity than is to be -found in any of the other treatises. In one part of the book--that, -namely, in which local affections are discussed--the anonymous author -gives in succession the opinions held by the seven leading teachers -of the school (Platearius II., Cophon II., Petronius, Afflacius, -Bartholomaeus, Ferrarius and Trotula) with regard to each one of a -certain number of local diseases; thus enabling the reader to obtain a -very fair idea of what was the condition of medical science at Salerno -during the twelfth century of the present era. - -The famous didactic poem known as the “School of Salerno” (_Schola -Salernitana_) and also as the “Code of Health of the School of -Salerno” (_Regimen Sanitatis Salernitanum_), was composed -originally about 1100 A. D. It was clearly intended in the first -instance for the guidance of laymen in matters relating to diet, the -conservation of health and the prevention of disease; but from time to -time, as the years rolled on, there were added to it several sections -which changed materially the character of the poem. From a mere code of -health it became eventually a fairly complete cyclopaedia of medicine -in versified form; the number of the verses having increased fully -tenfold during this long period. The poem, in its latest state, is -arranged in ten principal sections, as follows: Hygiene (8 chapters); -materia medica (4 chapters); anatomy (4 chapters); physiology (9 -chapters); etiology (3 chapters); significance of different signs (24 -chapters); pathology (8 chapters); therapeutics (22 chapters); nosology -(20 chapters); and the practice of medicine as actually experienced (5 -chapters). - -The work has been translated into nearly every modern language, and, -according to an estimate which was made in 1857, there are in existence -no fewer than 240 different editions. The most recent of these is the -French translation made by Meaux Saint-Marc and published by him (2d -edition) in Paris in 1880. There are two English versions--that by -A. Croke (Oxford, 1830), and the more recent one by John Ordronaux -(Philadelphia, 1871). - -Some authorities make the statement that the poem was written -originally for the guidance of Robert, the son of William the -Conqueror; but Neuburger says that the dedication of the work to this -prince is lacking in many of the original manuscript copies and that -in some instances the word “Francorum” is to be found in the place -of “Anglorum”; for which reason he believes that the introduction -of a dedication was made long after the poem had been written. It -will probably appear strange to most readers that the author of the -“_Regimen Sanitatis_” (or “_Flos Medicinae_,” as it was -sometimes called) should have written his text in the form of verse -rather than in that of prose. He himself states briefly, at the end -of the poem,[55] some of the reasons why he preferred to adopt this -course. Rhythm, he maintains, makes it easy to say a great deal in a -few words; besides which, it facilitates by its novelty the memorizing -of new facts, and also enables one quickly to recall to mind those -which have been learned at some previous time. His judgment seems -to have been entirely correct, for the book proved to be immensely -popular, and retained its popularity throughout an extraordinarily long -period of time. Furthermore, as already stated, it accomplished a great -deal toward enhancing the reputation of the Salerno School of Medicine. -When we consider how difficult it must have been in those days for -students of medicine to memorize facts which were stored in books that -were very costly and oftentimes not obtainable at any price, we cease -to wonder at the great popularity of this miniature cyclopaedia in -leonine verse.[56] Here were to be found, at one-fourth or one-tenth -the price of any similar book written in prose, all the essentials -(anatomy, physiology, pathology, etc.) required by the candidate for -medical honors; and if, perchance, he possessed a good memory, he -might, without a very great mental effort, transfer the entire poem to -his own private storehouse of facts. - -A few extracts from this remarkable piece of medical literature are -given below, in the belief that many of our readers will find them of -interest. - - ORIGINAL TEXT DR. JOHN ORDRONAUX’S TRANSLATION - - Si vis incolumen, si vis te If thou to health and vigor wouldst - vivere sanum, attain, - Curas tolle graves, irasci Shun weighty cares--all anger deem - crede profanum, profane, - Parce mero, coenato parum; From heavy suppers and much sit - non tibi vanum wine abstain. - Surgere post epulas; somnum Nor trivial count it, after pompous - fuge meridianum; fare, - Ne mictum retine, ne comprime To rise from table and to take the - fortiter anum. air. - Haec bene si serves, tu longo Shun idle, noonday slumber, nor - tempore vives. delay - The urgent calls of Nature to obey. - - _Conditiones Necessariae Medico._ _Demeanor Necessary For the - Physician._ - - Clemens accedat medicus cum Let doctors call in clothing fine - vesta polita; arrayed, - Luceat in digitis splendida With sparkling jewels on their - gemma suis. hands displayed; - Si fieri valeat, quadrupes And, if their means allow, let - sibi sit pretiosus; there be had, - Ejus et ornatus splendidus To ride, a showy, rich-attired pad. - atque decens. - Ornatu nitido conabere carior For when well dressed and looking - esse, over-nice, - Splendidus ornatus plurima You may presume to charge a higher - dona dabit price, - Viliter inductus munus sibi Since patients always pay those - vile parabit, doctors best, - Nam pauper medicus vilia Who make their calls in finest - dona capit. clothing dressed, - While such as go about in simple - frieze, - Must put up with the meanest grade - of fees; - For thus it is, poor doctors - everywhere - Get but the smallest pittance for - their share. - -At Salerno the anatomical demonstration made, apparently only once a -year, for the benefit of the students, consisted in exposing to view -the abdominal viscera of the pig and commenting upon the features -which distinguish them from the same organs in the human body. In the -“_Regimen Sanitatis_” only eight lines of text are devoted to -anatomy. - -In section IV., which relates to physiology, the text is more -instructive and entertaining, but still--as compared with the splendid -work accomplished by Galen--extremely incomplete and superficial. - -In the early part of the twelfth century, Nicolaus Praepositus[57] -composed, at the request of his colleagues in the school of Salerno, -an “Antidotarium”--that is, a collection of formulae for combining -together, in a single pharmaceutical preparation, various drugs, both -those commonly employed in that part of Europe and others which were -then known only to the Arabian physicians. This book of formulae, -containing as it did descriptions of the effects which might be -expected from the different preparations, and furnishing instructions -with regard to the proper mode of employing them, served its purpose -admirably, not only in Salerno but throughout Europe, at least -during the Middle Ages. All the pharmacopoeias of a later date were -based upon his “Antidotarium,” and indirectly upon the still earlier -celebrated treatises written by Matthew Platearius and bearing the -titles “_Glossae_” and “_Circa instans_” (also that of “_De -simplici medicina_”). The most remarkable item, however, which -is to be found in the Antidotarium is that in which mention is made -of the use of soporific sponges (“_spongia soporifera_”), for -anaesthetizing purposes by means of inhalations, in certain surgical -procedures. (Neuburger.) They were made by impregnating the sponges -thoroughly with the juices of narcotic plants (opium, hyoscyamus, -mandragora, lactuca, cicuta, etc.), drying them, and putting them aside -until they were actually needed. Then the sponge was saturated for -about an hour with hot water or steamed, after which it was applied -over the patient’s nostrils and held there until the inhalation of the -fumes had induced sleep. - -Another Salernian treatise worth mentioning is that written by Peter -Musandinus, under the title “On Foods and Beverages suitable for -Persons affected with a Fever.” This writer, who was one of the -teachers at the school of Salerno about the middle of the twelfth -century, says that great attention was paid in his time to the -preparation of foods in such a manner as to tempt the appetite of -people who were ill. He speaks of a meat extract which is prepared -from the flesh of the chicken, and also recommends that a soup -made by boiling a fowl in rose water be given to patients who are -affected with diarrhoea. He even goes so far as to lay stress upon -the importance of serving food to a sick person in dishes which are -pleasing to the eye. Apropos of the subject of foods that are easily -digestible and therefore suitable for invalids I may mention how Meaux -Saint-Marc translates or interprets the line in the “Regimen Sanitatis -Salernitanum” which reads _O fluvialis anas, quanta dulcedine -manas!_ His version may be rendered into English thus: - -“Oh wood-duck, how gently doth thy soft flesh glide over the internal -surface of the stomach!” - -Toward the end of the twelfth century (1180 A. D.) there was published -at Salerno a work on surgery--the oldest treatise on this subject -that is known to have been written in Italy during the Middle Ages. -It is now called “Roger’s Practice of Surgery,” but originally it was -spoken of (in accordance with a custom quite common in those days) as -“_Post mundi fabricam_,” which are the first three words of the -text. This book is of a very practical character and is written in a -simple, straightforward style. While it contains the usual amount of -traditional knowledge about surgical matters, it gives at the same time -the results of the personal experience of Roger, of his teachers, and -of his associates. As published in the “_Collectio Salernitana_” -the work represents, not the treatise as it was originally written, -but a revision made by Rolando of Parma. It is divided into four -parts or books, the topics treated in which comprise most of those -usually discussed in works on surgery. Under the heading “Wounds of -the Intestine,” in Book III., there occurs this most remarkable piece -of advice, viz., “to insert into the intestinal canal a small tubular -piece of elder and then to stitch the raw edges of the bowel together -over it.” - -Another treatise on surgery, entitled “_Chirurgia Jamati_,” -was published at Salerno before the end of the twelfth century. Its -authorship is attributed to Jamerius, and in many respects it resembles -closely the treatise of Roger. - -The “_Regimen Sanitatis_” was not, it appears, the only treatise -on medicine which was published at that period in the form of a poem. -Gilles de Corbeil (Petrus Aegidius Corboliensis), who had received -his professional training at the school of Salerno and was afterward -appointed the personal physician of King Philip Augustus in Paris -(1180–1223 A. D.), wrote versified treatises on these two groups of -topics--“The pulse, the urine, and the beneficial characteristics of -composite remedies,” and “The signs and symptoms of the different -maladies.” Both of these treatises were received everywhere throughout -Europe with great favor and they maintained their popularity for a -period of over four centuries. A French translation (by C. Vieillard) -of the treatise on urology was published in Paris in 1903. An edition -of the “_De signis et symptomatibus aegritudinum_” was printed in -Leipzig in 1907. The following five lines are quoted by Neuburger; and -they certainly display the remarkable gift possessed by Aegidius for -condensing a large amount of information into a very small space:-- - - - DE CONDITIONIBUS URINAE - - _Quale, quid, aut quid in hoc, quantum, quotiens, ubi, quando,_ - _Aetas, natura, sexus, labor, ira, diaeta,_ - _Cura, fames, motus, lavacrum, cibus, unctio, potus,_ - _Debent artifici certa ratione notari,_ - _Si cupit urinae judex consultus haberi._ - -To translate this into easily comprehensible English prose would -certainly require the employment of at least five times as many words. - -Another physician who received a part of his training at Salerno and -who is mentioned by Neuburger as “The greatest eye surgeon of the -Middle Ages,” is Benevenutus Grapheus (twelfth century), a native of -Jerusalem, and probably of Jewish parentage. He wrote a practical -treatise (“_Practica oculorum_”) which had a wide circulation, and -which has been translated into Provençal, French and English. - -Toward the end of the thirteenth century the famous Medical School -of Salerno began to show signs of decadence. Various circumstances -were responsible for this change. In the first place, its career of -great usefulness had already covered a period of about seven hundred -years, and--according to the law affecting all things human--its -time of decrepitude was already more than due. Then, in the next -place, vigorous rivals were beginning to appear in different parts -of Europe,--at Bologna, at Montpellier and at Paris,--and these new -schools must have attracted large numbers of students who otherwise -would have frequented the University of Salerno for the educational -facilities which they required. Commercialism--if such a term may be -employed to characterize the action of those who were not willing -to undergo the entire course of training required for obtaining the -full privileges belonging to a physician--may perhaps also be named -as one of the influences which contributed to the slow breaking up of -the school. That this force had already begun to exert some effect -upon the management of the institution may be inferred from the fact -that in 1140 A. D., Roger, King of Sicily and Naples, promulgated -the law that nobody would be permitted to practice medicine in his -kingdom until he should have satisfied the royal authorities that he -was properly qualified to undertake such practice. The establishment -of such a law surely indicated that the number of those who were -incompetent to assume the responsibilities of a practitioner of -medicine was alarmingly on the increase; and, after it had gone into -effect, many must have been deterred from choosing a medical career, -and perhaps others have been diverted to schools which were located -in countries where the laws were more lax. In 1240 A. D. the Roman -Emperor Frederic II., who was also King of Sicily, made it a law that -the course of medical studies at Salerno should cover a period of -five years. All these factors taken together would seem to have been -sufficient slowly to diminish the popularity of this celebrated school. -But to these there were added, in the latter half of the thirteenth -century,--if we may believe Puschmann,--two new factors, which exerted -a powerful influence in destroying all hope of further regeneration, -viz., the establishment of a university at Naples, in 1258 A. D., by -Manfred, King of Sicily, and the narrow and illiberal spirit in which -the Church, by this time in almost full control of the education at -Salerno, managed the medical school. - -During the following four centuries the University of Salerno--for -during the thirteenth century it became a university in fact, if not -in name--retrograded steadily, until finally the French Government, on -November 29, 1811, officially put an end to its existence. The traveler -who to-day visits Salerno, in the hope of seeing some remains of the -oldest medical school in Europe, will find there only a collection of -squalid buildings which serve as dwellings for the poorer classes, a -dirty and uncomfortable inn, and shops of nearly the same dimensions -as those which once lined the narrow streets of Pompeii. As he gazes, -however, at the superb view presented by the Gulf of Salerno he may -readily, by an effort of the imagination, reconstruct the picture of -the famous “Hippocratic City” as it was when William the Conqueror and -other distinguished persons visited it nearly a thousand years ago. - -Neuburger, in his review of the career of the Salerno Medical School, -sums up its contributions to the science of medicine in about these -terms: Those who taught at Salerno were the first physicians in the -Christian part of Western Europe who procured for medicine a home in -which scientific considerations alone prevailed, where the Church -exercised no control whatever, and where all the different branches of -the science were favored to an equal degree. They devoted their best -energies, by oral teaching and by their writings, to the single object -of communicating practical knowledge of the healing art to all who -desired to obtain it; and, by the admirable example of their own lives, -they furnished a high standard for the guidance of those who wished to -reflect honor upon the name of physician. - - - - - CHAPTER XXII - - EARLY EVIDENCES OF THE INFLUENCE OF THE RENAISSANCE UPON THE - PROGRESS OF MEDICINE IN WESTERN EUROPE - - -In previous chapters we have seen how the Arabs, inspired with an -extraordinary zeal for acquiring knowledge of the different sciences, -devoted time and money freely, throughout a period of several -centuries, to the accomplishment of this purpose. They were fired -with ambition to become a great nation, and their studies of the -world’s history taught them that the ancient Greeks had accumulated -in their literature vast stores of the very knowledge which they were -so anxious to acquire. Accordingly all their energies were directed -toward converting these stores from the Greek into their own language, -the Arabic. This widespread eagerness of the nation, at a given period -of its history, to improve itself intellectually is spoken of as the -Arabic Renaissance, and, at the time which I am now about to consider, -the movement had practically come to a standstill. A short time, -however, before this occurred, the physicians of Italy and of the more -northerly countries of Western Europe began to show a similar desire -to add to their medical literature; and their first step, like that -of the Arabs four or five centuries earlier, was directed to the work -of translating Arabic medical treatises into debased Latin, which was -the language commonly employed by the learned during the Middle Ages. -The knowledge which they desired to acquire could not at that time be -obtained in any other way, for nobody was acquainted with the Greek -language, and, besides, Greek originals had not yet been brought into -Western Europe. These first evidences of the Renaissance in that part -of the world were not confined to physicians; they were to be found -in every walk of life. The development of the movement reminds one of -what takes place near the sea coast, where a period of heat and calm is -suddenly broken by the appearance of a few gentle puffs of wind, which -are quickly succeeded by the full force of a steady and refreshing -sea-breeze. In like manner feeble indications of the coming movement -appeared in Italy, France, Germany and even England, and these were -soon followed by unmistakable evidences that a genuine Renaissance of -widespread proportions had begun. It was as if a great awakening had -taken place among the nations which had for centuries lain dormant; -an awakening which was followed by a desire to lay aside the trivial -pursuits in which they had so far been engaged, and to attain those -results which were, later on, to excite the wonder and admiration -of the world. Such were, for example, the development of the art of -printing with movable types; the discovery of America; the production -of such clever painters, sculptors, engravers, workers in metal, -etc., as Michael Angelo, Raphael, Albrecht Dürer, Benvenuto Cellini, -Rembrandt, and literally scores of others of nearly equal merit; the -development of a Shakespeare, a Milton and a Dante in the field of -literature; the production of a Luther, a man who had the courage to -protest against evil practices which had crept into the Christian -church. And medicine, as I have already stated, felt the influence -of the approaching Renaissance, and responded to it by efforts which -had for their object the acquisition of such knowledge as might be -furnished by translations from Arabic treatises. Constantinus, the -African, of whom mention has been made on a previous page, seems to -have been the first person (toward the end of the eleventh century) who -did any work of this kind; but his associates in Salerno do not appear -to have valued these translations very highly, or else, perhaps, they -were not yet prepared to give serious consideration to works which were -new to them. In the twelfth century, as will now be seen, the attitude -of the physicians of Western Europe underwent a change. - -The city of Toledo, in Spain, was richly stocked with the manuscript -treasures of Arabic literature at the time (1085 A. D.) when it fell -into the hands of the Christians. One of the earliest scholars to -engage in the work of translating these treasures into Latin was -Gerard of Cremona, in Lombardy, who lived during the twelfth century -(1114–1187 A. D.). He spent most of his lifetime in Toledo, “learning -and teaching, reading and translating.” (Neuburger.) Among the medical -works which he translated from the Arabic the most important are the -following: Several of the writings of Hippocrates and Galen; the -Breviarium of Serapion; several of the writings of Rhazes and of Isaac -Judaeus; the treatise on surgery by Abulcasis; the Canon of Avicenna, -etc. This stimulated many others to follow in the footsteps of Gerard -of Cremona; and thus, during the thirteenth century, a number of works -of importance were translated in addition to those already mentioned. -Such, for example, were the “Colliget” of Averroes by Bonacosa, a Jew -(1255) of Padua; the “_Teïssir_” of Avenzoar, and the “Dietetics” -of Maimonides by John of Capua, a Jewish convert to Christianity -(1262–1278); the “_De veribus cordis_” of Avicenna by Arnaldus -of Villanova (about 1282); the treatise “_De simplicibus_” of -Serapion the Younger, and the “_Liber servitoris_” of Abulcasis, -by Simon Januensis; and many others. This wave of keen interest in -the writings of Arabic physicians and in the Arabic versions of Greek -medical authors soon reached Languedoc in France, and then passed over -from there into Italy. For a long time the Salerno physicians resisted -its influence, but they finally yielded to it, as the leaders in the -schools of Bologna, Naples, Montpellier and Paris had already done. -It was at Palermo, in Sicily, however, that the movement received its -greatest impetus. Frederick II., at that time King of Sicily, and a -ruler who was most tolerant in religious matters, had at his Court an -entire staff of Arabic physicians, philosophers, astrologers and poets; -and, in addition, he kept a number of learned Christians and Jews -constantly busy translating Arabic works into Latin. The most widely -known member of the latter group was Michael Scotus (or Scottus), -who at one time had been a teacher in the Medical School of Salerno. -Among the books which he translated while he was at Palermo there were -several of Aristotle’s treatises, more particularly those which dealt -with psychological topics and with natural history. Frederick not -only did everything in his power to promote the work of translating, -he also took pains to distribute copies of the Latin versions, when -completed, among the universities of Western Europe. His son, Manfred, -who succeeded him on the throne, seems to have been almost as much -interested in the work as his father had been. It was from him, for -example, that the University of Paris received a set of the Aristotle -volumes in Latin. When Charles I., King of Naples (1265–1285 A. D.), -conquered Sicily he manifested considerable interest in continuing the -work of his predecessors, particularly as regards treatises relating -to medicine. Among the translators whom he employed for this work -was Farragut (in Arabic, Faradsch ben Salem), from Girgenti, a small -town on the south coast of Sicily, about sixty miles from Palermo. In -addition to several treatises of minor importance he translated into -Latin the colossal work of Rhazes--the “Continens.” Charles I. kept at -his Court not only expert translators, but also skilled illuminators; -and it was by them that the celebrated manuscript copy of this work -which is to-day in the _Bibliothèque Nationale_ at Paris, was -illustrated with miniatures, three of which are portraits of Farragut. -This particular copy of the “Continens” was completed in 1282 A. D. -Not a few of the translations made during this period, it should be -stated, are now very difficult to understand. In the first, place, the -Latin in which they are written is of the barbaric type (neo-Latin), -something quite different from that employed by Cicero, Tacitus and -other Roman authors of the classical period; and, in the next, it is -not infrequently evident that the translator himself did not clearly -apprehend the meaning of the original Arabic text. Despite all these -drawbacks, however, the placing of Latin versions of Arabic writings -within the reach of European physicians accomplished much good. Even -the imperfections to which reference has just been made probably -served to increase the eagerness of these men to gain access to the -real sources of Arabic learning--viz., the writings in the original -Greek. To anticipate a little, I may say here that this object was -not attained until after the lapse of about two more centuries--that -is, not until the scholars of Western Europe had learned to read the -Greek, and had also brought out from their hiding places in churches -and monasteries of the East the needed originals. At that period of the -world’s history centuries corresponded to decades as modern events are -recorded. - -One may gain some idea of the extent to which these Latin translations -of Arabic original treatises and of Arabic versions of Greek medical -works influenced the physicians of Western Europe, by consulting one -of the important medical treatises of the fourteenth century--that, -for example, of Guy de Chauliac (written 1363 A. D.). Edouard Nicaise, -the accomplished editor of this and several other mediaeval medical -treatises, has printed in his preface Joubert’s table showing just how -often Guy quotes each one of about four score earlier authors, and from -this analysis it appears that Abulcasis was quoted 175 times, Aristotle -62 times, Avicenna 661 times, Galen 890 times, Haly Abbas 149 times, -Mesué 61 times, Hippocrates 120 times, and Rhazes 161 times; or, to -state the facts somewhat differently, the quotations from treatises -introduced into Western Europe by the Arabs represent, in the present -instance, 70 per cent of all the quotations (2279 of a total of 3243) -made by this author. Another equally strong piece of evidence is that -afforded by Vincent de Beauvais’ encyclopaedia,--a work published -in Paris toward the middle of the thirteenth century,--in which the -parts relating to medicine appear to have been taken very largely from -treatises written by Arabic authors. (See statement on page 270.) There -can therefore be no reasonable doubt that the Arabs played a most -important part in the renaissance of medical learning which began a -century or two earlier, which already in the thirteenth century had -made great progress, and which very soon--as time is reckoned in the -calendar of all important world movements--was to culminate in that -still greater renaissance called “modern medicine.” - -During the later portion of the Middle Ages (thirteenth and fourteenth -centuries) there were four universities which possessed medical schools -of considerable importance--viz., those of Bologna and Padua in Italy, -and those of Montpellier and Paris in France. All of these seats of -learning, like the famous school at Salerno, developed so gradually -and from such modest beginnings that it is scarcely possible to assign -to any of them a date of origin. Medicine was taught at several other -places--as, for instance, at Oxford, England; at Naples, Vicenza, -Siena, Rome, Florence, Ferrara, Pisa and Pavia, in Italy; at Salamanca -and Lerida, in Spain; at Prague, in Bohemia; at Cologne, in Germany; -at Vienna, in Austria, etc. But the part which these smaller schools -played in the work of advancing our knowledge of medicine was certainly -of far less importance than that which fell to the lot of the four -institutions just mentioned. - -The University of Montpellier, if not the oldest of the four schools -mentioned, was apparently the first to attain some degree of -celebrity. It is known, for example, that the Archbishop of Lyons, -who was suffering at the time from some malady which the physicians -of that city were not able to cure, visited Montpellier 1153 A. D. -in the belief that he might there obtain the desired relief. John of -Salisbury, who lived during the latter half of the twelfth century and -who was considered one of the greatest scholars of his time, declared -that those who wished to acquire a satisfactory knowledge of medicine, -found that Salerno and Montpellier were the only places where the -desired instruction might be obtained. Gilles de Corbeil (mentioned -in the last chapter), Von der Aue, and other eminent men of the same -period spoke in equally favorable terms of the merits of Montpellier. -The celebrated monk, Caesarius of Heisterbach, calls the university of -that city “the headquarters of medical wisdom”; but at the same time -he expresses regret that the physicians of that school not only do not -believe in miraculous cures, but speak of them ironically. It was one -of the characteristics of the institution that the teachers, both the -medical and the philosophical, were, at a very early period, allowed -great freedom of thought and speech; but, as time went on, this liberty -became very much curtailed. During the thirteenth and fourteenth -centuries there were, it appears, many Jews among the students at -Montpellier, not merely in the department of medicine, but also in the -other departments of the university. - -The medical schools of Salerno and Montpellier seemed, at this early -period (thirteenth century), to possess more individuality than did the -similar organizations at Bologna, Padua and Paris; for limited periods -of time each of them in turn enjoyed a certain amount of fame by -reason of the fact that some teacher or writer of special distinction -happened then to be officially connected with the school. In other -words, it was the fame of the man and not of the school, that induced -students to visit Bologna or Padua, or Paris, during the thirteenth -and fourteenth centuries. At a somewhat later period (fifteenth -and sixteenth centuries) all three of these institutions stood out -prominently before the world as celebrated medical schools, with -distinctive characteristics. To be invited to occupy a chair in one of -these institutions conferred honorable distinction upon the incumbent -selected, and when I reach that period, farther on in this history, -I shall describe each one of the more important schools separately. -In dealing with the earlier epoch, however, it seems best to devote -our attention more particularly to individual physicians than to the -schools with which they may happen to be connected. - -Among the physicians belonging to the latter half of the thirteenth and -the first quarter of the fourteenth century there is one whose proper -place in the history of medicine is by no means easy to determine, and -who yet played a part of no small importance. This man was Pietro -d’Abano, or Petrus Aponensis, who was born at Abano, a small village -near Padua, 1250 A. D. Very little is known about his early youth, -but from this little we are warranted in drawing the conclusion that -his father, a notary, must have taken great pains to afford him every -possible educational advantage. He gave his son, for example, the -opportunity of studying Greek in Constantinople,--a thing of rare -occurrence in those early days,--and allowed him to remain there until -he had so far mastered the language that he was able to translate the -“_Problemata_” of Aristotle from the original text. Then, upon his -return home from Constantinople, he was sent to Paris for the purpose -of perfecting his knowledge of philosophy, mathematics and medicine. -After this thorough training for his life work, Pietro d’Abano began -teaching philosophy in Padua, and almost immediately he gained such -success that people spoke of him as “the great Lombard.” However, like -most of the men of that time who became conspicuous through their -intellectual attainments, Pietro d’Abano was soon accused by the -Dominicans of being a heretic and of cultivating the magician’s art. He -was able to parry this blow by making a journey to Rome and obtaining -from Pope Boniface VIII. a decree of absolution. About the same -time he began writing his two great works--the “_Conciliator_” -and the “Commentaries on Aristotle’s _Problemata_.” He did not -begin to teach medicine at the University of Padua until 1306, when -he was already fifty-six years of age. But his lectures, reflecting -as they did the depth and extent of his learning and the keenness of -his powers of analysis, were a source of great astonishment to his -contemporaries. It is reported by Neuburger, for example, that Gentile -da Foligno, one of the most distinguished professors in the Medical -School of Padua, happening to pass near the auditorium while Pietro -d’Abano was delivering his lecture, listened for a short time and then -exclaimed: “_Salve o santo tempio_”--“Hail to this time which has -brought forth such wonders!” With the increase of Pietro’s fame came -also a decided increase in the bitterness of the persecution carried -on against him by his ecclesiastical foes, largely due perhaps to his -open and courageous defense of the Averroism which they so much hated. -There is very little doubt that he would have been burned at the stake -about this time if the friendly disposition of the Popes and the mighty -influence possessed by the city of Padua had not shielded him from this -danger. In 1314 the newly founded school of Treviso invited Pietro -d’Abano to occupy the Chair of Medicine and Physics, and he accepted; -but he was taken ill and died during the following year. Shortly before -the occurrence of this event he was placed on trial for heresy by the -Inquisition, and the proceedings were continued even after his death. -Indeed, according to one account of this famous trial, not only was -the charge sustained, but the prescribed penalty was inflicted either -upon the disinterred corpse or upon an effigy of the condemned man. One -century later, the city of Padua erected a permanent memorial in Pietro -d’Abano’s honor. - -The principal work of this remarkable physician--viz., the -“_Conciliator differentiarium philosophorum et praecipue -medicorum_”--was first printed at Venice in 1471. (It is said to -be one of the earliest printed books known.) It was a most popular -treatise, as is shown by the fact that between the year last mentioned -and 1621 it passed through a number of editions. Of the other treatises -which he wrote--some seven or eight in all--it will be sufficient -to mention here that one alone to which reference has already been -made in the preceding account, viz., the work entitled “_Expositio -problematum Aristotelis_” (Mantua, 1475, and Paris, 1520). - -At this early period in the history of the Padua Medical School there -were one or two other men who attained a considerable degree of -celebrity for the excellence of the work which they did, either as -authors or as class-room teachers. A brief account of one of these, -Aegidius Corboliensis, has already been given on a preceding page, and -it seems only fair that I should furnish here similar brief accounts of -some of the others--Gentile da Foligno, Massilio and Galeazzo de St. -Sophia, Giacomo and Giovanni de’ Dondi, and Giacomo della Torre, from -Forli, all of whom contributed greatly to the steadily increasing fame -of the Padua School of Medicine; but, under the conditions which govern -the preparation of this brief history, I must reluctantly pass over -these names in silence. - - - - - CHAPTER XXIII - - FURTHER PROGRESS OF MEDICINE AND SURGERY IN WESTERN EUROPE - DURING THE THIRTEENTH, FOURTEENTH AND A PART OF THE FIFTEENTH - CENTURIES - - -Among the men who, during the thirteenth century, exerted more or -less influence upon the growth of medical knowledge there are three -who deserve to receive some consideration at our hands. They were not -physicians, but yet some of their writings deal with topics which -are closely related to the science of medicine. They are: Albert von -Bollstädt, a German who is generally known as Albertus Magnus, one of -the greatest scholastic philosophers of the Middle Ages; Vincent of -Beauvais (Vincentius Bellovacensis), a French Dominican monk, who was -reader to Louis IX., and who compiled a general encyclopaedia which -brought him great fame at that period; and Roger Bacon, an Englishman -who, by reason of the extraordinary extent of his knowledge and his -remarkable powers of observation, was given the name of “Doctor -mirabilis.” - -_Albertus Magnus._--Albertus Magnus was born at Lauingen, Swabia, -in 1193 A. D., obtained his education in Italy (at the University of -Padua, during the latter part of his stay), joined the Order of the -Dominicans on arriving at the age of thirty, and afterwards, throughout -his long life, devoted himself largely to teaching, particularly at -Paris and Cologne. He was a prolific writer and his works, particularly -those which treat of topics belonging to the domain of natural history, -were greatly appreciated. The effect, however, which they produced -upon a certain class of readers was to persuade them that he was a -great magician. The chief distinction of his writings lies in the -fact that they contain a large number of original observations which -he made during the course of his journeys afoot through Germany in -the character of Provincial of the Dominican Order. This habit of -exercising entire independence in the use of his reasoning powers -was something quite rare in those days. His observations were -directed chiefly to matters belonging to the domains of zoölogy, -botany, climatology, mineralogy, chemistry and physics. The following -significant advice, says Neuburger, is attributed to him: “As regards -the doctrines which relate to questions of belief and of morality, it -is the part of wisdom to attach greater authority to Saint Augustine -than to the philosophers; in matters belonging to the domain of -medicine put your chief trust in Galen and in Hippocrates; in natural -history, however, your best guide is Aristotle.” Neuburger adds that, -throughout the writings of Albertus Magnus, there appear interesting -statements relating to anatomy, physiology, psychology, and the plants -and minerals which may be used for remedial purposes. - -An edition of the writings of Albertus Magnus (21 folio volumes) was -published in Lyons by Petrus Jamy in 1651. The work was republished in -Paris in 1892 and following years. - -_Vincent of Beauvais._--Vincent of Beauvais, France, a Dominican -monk who lived during the first half of the thirteenth century and -was the tutor of Louis the Ninth’s children, devoted the major part -of his time to literary work. He wrote many theological treatises -and also edited a large encyclopaedia in which information is -furnished regarding everything that was known at that time. Several -hundred authors aided him in compiling this work, which is entitled -“_Speculum Majus_.” It is arranged in three parts, one of which -(“_Speculum Naturale_”) consists of 33 books that are divided -into 3740 chapters; and quite a number of the divisions are devoted -to topics relating to medicine. The authors, from whose writings this -medical information has been abstracted, are Hippocrates, Aristotle, -Dioscorides, Haly Abbas, Rhazes, Avicenna and several others--not to -mention the Church Fathers and other encyclopaedic writers connected -with the Church. The first printed edition of this great work appeared -toward the end of the fifteenth century (1473–1475 A. D.); the last, -or one of the last, in 1624. Lack of space will not permit me to give -any details concerning the works of a somewhat similar character -which were prepared, about the same time, by the English Franciscan -monk Bartholomaeus of Glanvilla (1260); by the Dominican, Thomas of -Cantimpré (1204–1280 A. D.), a pupil of Albertus Magnus; and by others. - -_Roger Bacon._--Roger Bacon was born about 1210 A. D. in -Ilchester, Somersetshire, England, and received his early training at -Oxford. When he was thirty years of age he went to Paris and, after -devoting himself assiduously for seven years to the study of various -branches of learning, he received the Doctor’s degree (1247). The -wish to acquire a thorough knowledge of whatever subject he undertook -to study constituted a prominent feature of his character. He was -fond of languages, but he had an even greater love for mathematics, -particularly in connection with astronomy, and for experimental work -in the department of chemistry. It is said that he expended a large -sum of money (£2000) upon these chemical investigations. He left -Paris in 1250, returned to England, and not long afterward joined the -Order of the Franciscans. Robert Grossetête, Bishop of Lincoln, and -the Franciscan monk Adam of Marisco--two men whom Neuburger describes -as theologians of a very liberal type--exercised a strong influence -upon Bacon at this period of his life. They confirmed him in the -belief that familiarity with the learned languages was an acquisition -greatly to be prized, and at the same time they gave him every -encouragement to pursue his researches in mathematics and in natural -history. For a certain length of time he was an instructor at Oxford, -but his views with regard to ecclesiastic and moral questions and -the discoveries which he made in physics (especially in optics) were -beyond the comprehension of his contemporaries, who did not hesitate to -pronounce them works of the Devil and to subject Bacon to all sorts of -punishments and deprivations. Fortunately for him and for the cause of -science the newly elected Pope, Clement IV. (1266), came to his rescue -in those dark days and granted him--under the promise of absolute -secrecy--permission to continue his researches without hindrance and to -perfect the plans which he had in mind for reforms of different kinds. -I cannot follow this pioneer of scientific research work, this man who -was several centuries ahead of the time in which he lived, through all -the vicissitudes of his interesting and extraordinarily fruitful life; -I may simply add that his death occurred about the year 1294; that -he left behind him many important treatises, only a small portion of -which have thus far been published,[58] and that from these alone one -is justified in classing Roger Bacon as one of the greatest thinkers -whom history has recorded. So far as is now known, he wrote very little -concerning medicine, and--strange to say--he seems to have attached -considerable importance to astrology; indeed, he went so far as to -blame the physicians of his day for their ignorance regarding this -science, “as a result of which they neglect the best part of medicine.” -In strange contrast with these views, which to-day we characterize as -foolishness, is Bacon’s famous dictum: “Experiment is a firmer and more -trustworthy basis of knowledge than argument”--a maxim which is the -guiding principle of modern medicine. - -The Medical School of Bologna.--The Medical School of Bologna first -began to assume a certain degree of prominence in the early part of -the thirteenth century, under the teaching of Thaddeus Alderotti--also -frequently called Thaddeus of Florence. - -_Thaddeus Alderotti._--Thaddeus Alderotti, who was born at -Florence, Italy, 1223 A. D., of humble parentage, began the study -of philosophy and medicine at Bologna only after he had reached -manhood; but he was such an earnest student and made such good use of -his opportunities that in 1260 he was chosen to serve as one of the -teachers in the school. Throughout a period of many years he filled -the office so acceptably that his colleagues bestowed upon him the -name of “Master of Physicians.” Before this time arrived, however, -his lack of funds was sorely felt, for he was obliged, in order to -support himself, to offer consecrated wax candles for sale at the -entrance of the church. He is reported to have been not merely a most -learned physician, but also a very successful practitioner. He was -called into consultation from all parts of the country, so highly -was his opinion valued by other physicians; and thus in due time he -accumulated a large fortune. His charges were by no means small. It is -related, for example, that Pope Honorius IV. sent for him to come to -Rome, and, after the treatment was completed, paid him a fee of 10,000 -gold pieces[59]--but not until after he had expressed surprise that -Thaddeus should have charged as much as 100 gold pieces per day for his -services. To this demurrer on the part of the Pope, Thaddeus replied -that the petty princes and even the simple nobles made no objection to -paying him 50 or more gold pieces per day. It is scarcely necessary to -add that the Holy Father did not wish to be outdone by his inferiors. - -Alderotti died 1303 A. D. - -Among the writings of Thaddeus Alderotti which have come down to our -time there are to be found a number of autobiographical references -which are not without interest. In one place, for example, he mentions -the fact that he occasionally walks in his sleep, and then proceeds -(in Latin) to discuss the phenomenon of sleep-walking as observed in -his own case. I give here a free translation of the text printed in -Neuburger’s History:-- - - The fourth question which suggests itself is this: Can the - senses during sleep come into active operation? Touching this - fourth question I reason thus: It appears as if, when one - is asleep, the senses must act, for a person may move about - without incurring any harm when he is in that state, as is - often observed in the case of those who, like myself, walk in - their sleep.... Furthermore, it has been remarked that these - people are able to harness a horse and then to ride the animal - safely,--acts which it is not possible to perform without the - aid of the senses. On the other hand, Aristotle maintains that - a man, when asleep, is not capable of using his senses. To this - I reply by conceding that during sleep a man certainly does not - perceive what is going on about him. Wherefore, if you answer me - by saying that the mere fact of a man’s ability to walk while - he is asleep furnishes conclusive evidence that he possesses - his senses, I reply that movements like that of walking are not - the result of an impression made upon the mind (“_impressio - imaginativa_”), but the product of a different mechanism, of - a nature which permits it to operate during sleep.... As to the - second point to which you call attention--that, namely, with - regard to the power of bridling and riding a horse while one is - asleep--I make this reply: These acts are performed as a result - of an impression made upon the mind through the working of the - imagination, and not as a direct consequence of any images - created upon the eye; for, if the sleep-walker happens to be in - a strange house when the impulse to walk seizes him, he will not - go to the stable. The route which he is sure to take will be one - with which he is familiar, as happened in the case of the blind - teacher who, unaccompanied by any person, walked habitually - through the streets of Bologna. And then, besides, I am able to - speak from personal experience, for in one of my sleep walks I - jumped down from an elevation about four feet above the ground - without awaking from my sleep.... When, in the course of one - of these walks, I am exposed to cold, or when I hear somebody - speaking near me, I refer these phenomena entirely to something - within myself, and I return to my bed. - -Of the four medical schools to which a brief reference was made on a -preceding page, that of Bologna was probably the first to attain a -certain degree of celebrity; and it owed this distinction very largely -to the work done by men who were primarily surgeons, viz.: Hugo of -Lucca; Theodoric, Hugo’s son; William of Saliceto; and possibly, to -a very slight extent, Roland of Parma, who spent only a part of his -professional life in Bologna. But there was one other who, while he was -not a surgeon, yet contributed very greatly to the fame of the Bologna -school and at the same time to the real advance in surgical knowledge -which characterized the work of the men whose names have just been -mentioned--viz., Mondino. These men, especially Mondino, cultivated -the study of anatomy much more earnestly than their rivals at Salerno -had ever done, and the surgical methods which they adopted were of -a more scientific character than those practiced by Roger. In the -treatment of wounds, for example, instead of striving to bring about -healing by the application of remedies which stimulate suppuration, -they favored the dry method; in which practice they were justified -not only by their own experience but also by Galen’s teaching: “A dry -state of the wound approaches more nearly to what may be considered -the normal condition, whereas a moist state is surely unhealthy.” -(_Methodi medend._, IV., 5.) As an offset to the latter authority -the Salerno surgeons quoted that particular aphorism of Hippocrates -(V., 67) which reads: “_Laxa bona, cruda vero mala._”--almost the -very opposite of Galen’s doctrine. Then again, the Bologna surgeons -effected improvements in other directions: They materially restricted -the use of the red-hot cautery iron, and they cast aside as useless -many of the complicated apparatuses which had previously been employed -in the treatment of fractures and dislocations. It is evident from -these facts that the Bologna surgeons were not, as were most of the -physicians of the twelfth and thirteenth centuries (Thaddeus of -Florence perhaps excepted), slavish followers of the ancients or even -of the more modern Arabs, but men who thought independently and who -were not afraid to use their own powers of observation. - -_Hugo of Lucca._--Hugo Borgognoni, more commonly called Hugo of -Lucca--was born in that city about the middle of the twelfth century, -served as municipal physician to the city of Bologna, accompanied -the Bolognese Crusaders on their expedition to Syria and Egypt, was -present at the siege of Damietta in 1219 A. D., and died a short time -before 1258, at the age of nearly one hundred. He acquired a great -reputation as a surgeon and brought up several sons who followed in -the same walk of life, among the number being Theodoric, who gained -even greater celebrity than his father in the domain of surgery. As -Hugo himself left no writings of any kind, we are largely dependent, -for a knowledge of his achievements, on the treatises which his son -Theodoric wrote. From this source we learn that Hugo recommended, for -use in surgical operations, the employment of narcotizing sponges like -those described on page 253, and was also an advocate of the plan of -treating wounds by the dry method (compresses soaked in wine over -which simple dressings were applied). In the treatment of empyema, of -abscesses, of penetrating wounds of the chest, and of both complicated -and simple wounds of the skull, he emphasized the wisdom of adopting -simple measures, of interfering with the parts as little as possible, -of abstaining from the use of the probe, and of observing strict -cleanliness. In cases of fracture of a rib it was his practice to -place the patient in a bath, and then, with fingers which had been -thoroughly oiled, to attempt the replacement of the separated ends of -the fractured bone. Neuburger regards Hugo of Lucca as the founder of -the Bologna School of Surgery. - -_Theodoric of Lucca_, known also as Bishop Theodoric, was born -1206 A. D. While still quite a young man he joined the recently -established order of preachers, and not long afterward was appointed -Almoner (_Poenitentiarius_)[60] to Pope Innocent IV. Eventually -he became Bishop of Cervia, near Ravenna. By special permission of -the Pope, he was able to complete the surgical training which he had -received from his father, Hugo of Lucca; and thus, while he still held -the office of Bishop, he practiced surgery to some extent in Bologna. -In course of time his practice became very extensive and also very -lucrative; as a result of which he was able to leave a large fortune to -various charitable institutions. The first printed edition of his work -on surgery appeared in Venice in 1498, and was followed by numerous -later issues. - -Theodoric, says Neuburger, was a most uncompromising advocate of the -dry method of treating wounds. His (Theodoric’s) words are these: “For -it is not necessary--as Roger and Roland have said, as most of their -disciples teach, and as almost all modern surgeons practice--to favor -the generation of pus in wounds. This doctrine is a very great error. -To follow such teaching is simply to put an obstacle in the way of -nature’s efforts, to prolong the diseased action, and to prohibit the -agglutination and final consolidation of the wound.”[61] - -In his enumeration of the different means that may be employed for -arresting hemorrhage, Theodoric mentions cauterization, tamponading, -the application of a ligature, and the complete division of the injured -blood-vessel. He attached great importance to the proper feeding of the -patient. In Book III., chapter 49, of his treatise on surgery, he gives -minute instructions with regard to the proper manner of employing a -salve made with quicksilver, and at the same time he mentions the fact -that he observed a flow of saliva as one of the results of its use. - -The expressions “healing by first intention” and “healing by second -intention” are encountered for the first time in the writings of -Brunus, a surgeon who practiced in the cities of Verona and Padua about -the middle of the thirteenth century, and who was a vigorous advocate -of the dry method of treating wounds. His two treatises (“_Chirurgia -magna_” and “_Chirurgia minor_”) were printed in Venice in -1546. Neuburger says that although a large part of the text in these -volumes consists of extracts from Galen, Avicenna, Hippocrates, -Abulcasis and other authorities, there are to be found at the same time -not a few observations of an original character. - -_William of Saliceto._--William of Saliceto (_Guglielmo da -Saliceto_) is accorded by Neuburger the honor of being Bologna’s -greatest surgeon--if not, indeed, the greatest surgeon of that period. -He was born in the early part of the thirteenth century and spent a -large portion of his professional life in Bologna, where he not only -practiced medicine but also acted in the capacity of a teacher of this -science. During the latter part of his career he lived in Verona, where -he held the position of Municipal Physician and Attending Physician of -the City Hospital. He died about the year 1280. - -Saliceto’s work on surgery is of a thoroughly practical character and -reveals the author to have been a born surgeon.[62] In addition to the -“_Cyrurgia_,” which was first printed in Piacenza 1476 A. D., he -wrote a treatise which bears the title “_Summa conservationis et -curationis_” (printed first in Piacenza in 1475). The “Surgery” -is divided into five books, preceded by a short chapter on general -methods, etc. Book I. is devoted to affections of the cranium, -eruptions on the head, eye diseases, ear diseases (snaring of ear -polypi), nasal polypi, abscesses in the axilla, affections of the -mammary gland, tumors in different parts of the body, venereal lesions -in the groin, and a long list of other surgical maladies. Book II. -describes wounds of all sorts, including those produced by arrows -(with reports of cases), penetrating wounds of the chest and abdomen -(with instructions about sewing both longitudinal and transverse -wounds of the intestine), etc. Under the head of penetrating wounds -of nerves (declared by the author to be very dangerous), Saliceto -recommends enlargement of the wound, the application of oil, and -the employment of opium or hyoscyamus to quiet the pain. Book III. -treats the subject of fractures and dislocations in a most thorough -manner. Mention is made of the crepitation noise heard in fractures -(_sonitus ossis fracti_) and a warning is given not to apply -the bandages too tightly and to be careful to change the dressings -every three or four days. The instructions given with regard to the -reduction of dislocations are said by Neuburger to be most sensible. -Book IV. contains such anatomical descriptions as may be helpful to -the practical surgeon. From these, however, it is evident that the -writer had never dissected the human cadaver. Book V. is devoted to -the subject of cauterizing and to the consideration of those remedial -agents which are commonly employed in surgery. The instruments used -for cauterizing purposes were made of different metals, gold or silver -being preferred for the more delicate ones, and brass and iron for the -others. Immediately after the cauterization it was customary to apply -butter, or the fat of some animal, or oil scented with roses, to the -burned part. - -Saliceto’s other treatise--the _Summa conservationis etc._--is -also divided into five books, which contain chapters devoted to all -the more important branches of internal medicine and to questions -of diet, of the physician’s behavior in the presence of a patient, -etc. Especially interesting are his remarks about the importance of -considering the psychological effect produced upon the patient by -such matters as the physician’s manner of feeling the pulse, his -carefulness to inquire about the patient’s various symptoms (how the -night was passed, what food and drink had been taken, etc.)--an effect -which oftentimes is “greater than that produced by instruments and -medicines.” In discussing the subject of prognosis, Saliceto makes the -remark that it is always proper for the physician to hold out to the -patient hope of recovery, although he urges at the same time the wisdom -of telling the whole truth to the friends of the patient. He also lays -great stress upon the importance of “not holding any conversation with -the lady of the house upon confidential matters.” Neuburger gives a -number of other extracts from this most interesting work; but I must -abstain from devoting any more space to this one mediaeval author, -whose manner of writing makes it difficult to realize that the treatise -which he has written belongs to the thirteenth century and not to a -very recent period. - -_Roland of Parma._--Roland, who was born in the city of Parma -and who spent a part of his life in Bologna, not only edited the work -of his teacher, Roger of Salerno, but also wrote a concise treatise -on surgery that is entitled “_Rolandina_.” Neuburger speaks -of this book as differing but little from Roger’s “_Practica -chirurgiae_.”[63] “It contains, however, the report of a case of -penetrating wound of the chest in which Roland showed not a little -courage by daring to cut off, flush with the skin, a portion of lung -tissue which happened to protrude from the wound, and then applying a -simple dressing.” - -The treatise known by the title “_Glossulae quatuor magistrorum super -chirurgiam Rogerii et Rolandi_” was written by an unknown author or -perhaps by several authors. It represents a collection of commentaries -on the works of the two who are mentioned in the title of the book, and -should probably be classed as a part of the literature of the Salerno -School of Medicine. - -_Mondino the Anatomist._--Mondino, who was the first physician, -after an interval of about fifteen hundred years, to revive the -practice of dissecting human bodies, was born at Bologna at about 1275 -A. D. He received his professional training at the medical school of -his native city and was given the degree of Doctor in 1290, at the age -of fifteen(!). Not long afterward he began to teach anatomy in the same -institution and continued to serve in this capacity up to the time -of his death in 1326. The physicians who aided him in his anatomical -researches were Ottone Agenio Lustrulano, his prosector, and a woman -named Alessandra Gilliani, from Perriceto. - -Mondino’s method of teaching anatomy was to deliver his lectures with -the dissected cadaver directly before him; that is, he demonstrated -the correctness of his statements as fast as he made them. (See Fig. -9.) Such a method was entirely new at the time and proved immensely -popular, attracting students to Bologna in large numbers. Partly in -this way and partly by means of the treatise on anatomy which he wrote -(“_Anatomia Mundini_”), he became the instructor of numerous -generations of physicians. His treatise remained the authoritative -guide in anatomy up to the middle of the sixteenth century. - - [Illustration: FIG. 9. THE OLDEST KNOWN PICTORIAL REPRESENTATION OF A - FORMAL DISSECTION OF THE HUMAN BODY. - - The original, which is in the library of the University of - Montpellier, France, appears in a manuscript copy of Guy de - Chauliac’s _Chirurgia magna_ (fourteenth century). Eugen - Holländer of Berlin, the author of _Die Medizin in der - klassischen Malerei_, has courteously given permission to - copy the reproduction. The many defects which appear in this - picture are due to the fact that the reproduction was taken - directly from the original miniature, now six hundred years old. - Holländer gives the following description of this interesting - scene: - - “In one of the rooms of the hospital a woman’s dead body is - lying upon a table. Alongside the bed in which she died a nun - is praying for her soul. Two physicians are busily engaged in - the work of dissecting the body. An instructor is reading out - of a book, for the benefit of the students who are crowding - into the room, such portions of the text as apply to the case - in hand, and at the same time he is directing their attention - to the uterus which one of the dissectors is lifting out of the - abdominal cavity. Owing to the defective state of the original - miniature it is not possible to state positively what part the - three women who stand near the head of the corpse are taking in - the scene, but it is not unlikely that they too are physicians, - especially as their presence on such an occasion would be quite - in harmony with the customs of that period of time.”] - -In one place in his “Anatomy” Mondino states explicitly that he -dissected two human cadavers in the month of January, 1315. This -statement renders it possible to fix the exact date when the -practice of making such dissections--which had been carried on for a -considerable period of time about 250 B. C.--was first resumed. If -one reflects upon the nature of the obstacles which in 1315 stood in -the way of a revival of this practice,--for example, the deep-seated -prejudice against it entertained by all classes of the community, and -the very strong opposition of the ecclesiastic authorities to what -they honestly believed to be a desecration of the human body,--one -will readily appreciate how great was the courage displayed by Mondino -when he almost openly undertook his first dissection. The subsequent -career of this famous teacher of anatomy justifies the belief that -his determination to take the course which he did was based upon -the profound conviction that the first step toward increasing the -scanty stock of knowledge possessed at that time with regard to the -structure of the human body in all its parts, must necessarily be one -in continuation of that which Erasistratus and his associates had taken -centuries earlier, but which had not been succeeded by a sufficient -number of other steps in the same direction. The series of discoveries -in anatomy, physiology and pathology which resulted from Mondino’s -courageous and intelligent act, form a part of the history of modern -medicine, and do not therefore call for consideration in this place. We -may simply add that much information of a very interesting character is -furnished by Neuburger (_op. cit._) with regard to the manner in -which Mondino and his immediate successors carried on their instruction -in anatomy from that time forward. - -The Medical School at Bologna, as may well be imagined, gained great -fame from the possession of such distinguished teachers as those -whose careers I have briefly sketched--Hugo and Theodoric of Lucca, -William of Saliceto, and Mondino; and it retained a large part of this -celebrity throughout the fourteenth and fifteenth centuries, despite -the appearance on the scene, toward the end of this time, of several -formidable claimants for high honors in the domain of medical research -and education--viz., the schools at Montpellier and Paris, in France, -and that of Padua, in Italy. - -_Lanfranchi and the Medical School of Paris._--According to -Edouard Nicaise[64] medicine was not taught publicly at Paris -previously to 1160 A. D. The teaching was carried on at that time -by associations of physicians, and it was only during the following -century (about 1250 A. D.) that something like a university was -established in that city. Up to the end of the sixteenth century (1595 -A. D.), during the reign of Henry IV., this institution remained under -the control of the Church. Its functions--so far at least as medicine -was concerned--were limited to the bestowing of degrees, for it -possessed at that time no organization of instructors and no permanent -quarters in which the teaching might be carried on systematically; a -church (see Fig. 10) or the Dean’s residence serving as the locality in -which the lectures were commonly delivered. - -During the middle part of the thirteenth century and for a long -time afterward, the practice of surgery, which was then of a rather -primitive type, was entirely in the hands of two classes of men--the -barbers and the so-called surgeons.[65] As time went on, the surgeons -began to feel the necessity of securing better protection for their -material interests, which were being more and more encroached upon by -the barbers--a class of men who were not privileged by the authorities -to include in their field of activities anything beyond hair-cutting, -shaving, cupping, the extraction of teeth, the application of -leeches, the incision of boils and perhaps one or two other simple -operations. For this reason, therefore, and also probably because -they too felt in some measure the effects of the Renaissance spirit -which was then abroad in the land, they organized themselves (1254 -A. D.) into an association which bore the name of “College of Saint -Cosmas” (_Collège de St. Côme_).[66] One of the early acts of -this association was to establish the rule that all applicants for -membership should pass successfully an examination as to their fitness -before they could be admitted. Very little is known about the doings of -the organization during the early years of its existence. Later, as we -shall see, it played a very important part in the history of medicine -in France. - - [Illustration: FIG. 10. THE MANNER OF GIVING PUBLIC INSTRUCTION IN - MEDICINE DURING THE MIDDLE AGES. - - (From Meaux Saint-Marc’s _L’École de Salerne_.) - - The present cut is evidently a modern copy of a much earlier - original.] - -From the account given by Nicaise it appears that no regular -instruction in anatomy was given in the University of Paris until after -the fourteenth century, and then only from three to five times a year, -when the body of a person who had been hung was publicly dissected. -“Such a dissection lasted seven days and was a veritable scientific -festival.” No official cliniques were held and the only way in which -the student of medicine could obtain some practical acquaintance with -disease and with the methods of treatment was by attaching himself to a -physician or a surgeon, or to a barber. - -From the preceding brief and very incomplete account the reader will, I -trust, be able to form some idea of the condition of affairs, medical -and surgical, in Paris at the time when Lanfranchi arrived in that city. - -Lanfranchi, says Neuburger, was born in Milan, Italy, and was -undoubtedly the most distinguished among the pupils of Saliceto at -Bologna. After leaving the medical school he practiced both medicine -and surgery for a certain length of time in his native city; but -finally, becoming involved in the quarrels between the Guelphs and -the Ghibellines, he--like many other Italian physicians--was obliged -to take refuge in France. In Lyons, which was his first place of -residence, he engaged for a short time in the practice of medicine and -also wrote his first treatise on surgery--“_Chirurgia Parva_.” -Then, after traveling from one place to another in the provinces, he -finally (1295 A. D.) settled permanently in Paris. In that city he very -soon acquired a large practice, and, at the same time, built up for -himself a great reputation as a teacher of medicine. The _Collège de -St. Côme_ elected him a member of that organization and profited -greatly from the fame which his teaching brought to the institution. -It is said that Jean Passavant, who was at that time the Dean of the -Medical Faculty of Paris, aided Lanfranchi in his work by every means -in his power. As a result Paris, during a considerable period of time, -was one of the few places in which genuine clinical instruction was -given to all those who desired to acquire a practical acquaintance -with disease. His larger treatise, the “_Chirurgia Magna_,” was -completed in 1296. It was dedicated to the King of France, Philip -IV., commonly called “_Phillippe le Bel_,” and its intrinsic -merits assured him a permanent reputation as a surgeon. This work, -which was translated years ago into English and has recently (1894) -been published by the “Early English Text Society,” under the title -“Lanfrank’s Science of Cirurgie,” consists of five separate fasciculi -or parts. A few extracts from the text of this celebrated work may -prove of interest to the reader. Not having access to the English -version just mentioned, I shall have to translate from the version -(partly Latin and partly German) supplied by Neuburger. - -Part I. of the _Chirurgia Parva_ mentions some of the -characteristics which a surgeon should possess. He should, for example, -have well-formed hands, with fingers that are long and slender; his -body should be strong and firm in its movements; his hands and fingers -should respond quickly to the workings of the mind; his mind should -be of a subtle type; in character he should not be over-bold, but -self-reliant and yet modest; he should have a good supply of common -sense; he should be well-informed not only in medicine, but also in all -the branches of philosophy; he should be a good logician; he should be -familiar with the writings of medical authors; he should be virtuous -and ethical; he should be trustworthy; he should not be avaricious nor -envious; ... and, finally, he should be thoroughly familiar with all -the diseases to which the human body is liable. In one place Lanfranchi -refers to the fact that exposure to the air favors the production of -pus in a wound. Among the methods which may be employed for arresting -hemorrhage he mentions digital compression and ligaturing of the -bleeding vessels. He recommends that a wounded individual should -abstain from wine and from an over-nutritious diet. No attempt, he -says, should be made to extirpate, with the knife or by means of the -actual cautery, an ulcerated cancer, unless it appears probable that -by such means complete destruction of the tumor may be effected. In -traumatic tetanus dependent upon an injury of a tendon or nerve trunk -he recommends complete division of the wounded structure. - -Part II. is devoted to the consideration of wounds of the different -parts of the body, taken in regular order from the head to the feet. -The descriptions, in each instance, are preceded by an adequate account -of the region affected. In his discussion of fractures of the skull he -speaks of the diagnostic value of the rough and jarring sound perceived -by the patient when the physician taps with a rod upon the injured -skull; and he also states that an aid to diagnosis may be derived from -the fact that a person whose skull is fractured experiences pain at the -seat of the injury when somebody passes the ends of his finger-nails -along a string which the patient holds suspended between his teeth.[67] -According to Neuburger the description which Lanfranchi gives of -the various symptoms observed in cases of fracture of the skull is -admirable. In the section relating to the treatment of such fractures -he warns against the tendency to resort too readily to the use of the -trephine, and expresses the belief that this instrument should be -employed only when the fractured bone is depressed or when there is -evidence of irritation of the dura mater. - -Part III. deals with skin diseases and various forms of tumors, -including those of the thyroid gland; and with diseases of the eye, -the ear and the nasal cavities; with the various kinds of hernia; with -renal and cystic calculi; with hemorrhoids, varicose veins, etc.; with -abdominal dropsy; and with still other affections. In bloodletting he -recommends the practice of opening the vein longitudinally. He is very -emphatic in his manner of insisting that medicine and surgery should -not be divorced, and that the operation of drawing blood should not be -intrusted to barbers. - -After the death or retirement of Lanfranchi during the first decade -of the fourteenth century, Paris appears to have played, at least for -a few years, a comparatively small part in the history of medical -teaching. Her rivals at Montpellier, in the south of France, and at -Bologna and Padua, in Italy, far outstripped her during this period. -There was one physician at Paris, however,--Henri de Mondeville,--who -would probably have proved a worthy successor of Lanfranchi if -circumstances had not seriously interfered with his acting the part of -a teacher. - -_Henri de Mondeville._--Henri de Mondeville, says Edouard -Nicaise, was born about 1260 A. D. in Normandy. In his native -village--Mondeville or Mandeville, or Amondaville, all of which names -are found in the manuscripts--he was known simply as Henri, but in the -outside world and in medical literature he is mentioned, in accordance -with the prevailing custom of that period, as Henri de Mondeville. -After studying medicine for a certain length of time in Paris and -Montpellier, he went to Italy and became the pupil of Theodoric of -Bologna. He is said to have been passionately fond of surgery, which -at that period was, in France, a much despised branch of medicine. In -Italy, on the contrary, such men as William of Saliceto, Hugo of Lucca, -Theodoric and Lanfranchi had raised surgery to a position of great -honor, and Henri de Mondeville cherished the hope that he also might be -able to accomplish the same result in France. Upon his return to Paris -he was chosen one of the physicians (there were four in all) of the -royal household, and from that time onward he was frequently obliged to -set aside, for longer or shorter periods, all his personal interests -(private practice, lecturing to medical students, hospital service at -Hôtel-Dieu, etc.) in order to attend the King or the Comte de Valois -on some military expedition. This sort of service, however, was by no -means time lost, for it afforded him the opportunity to acquire great -experience in the treatment of wounds, an experience which reveals -itself on almost every page of his treatise on surgery. And yet there -came a time (1312) when de Mondeville complained bitterly of these -interruptions, for which he received no pay and which interfered -seriously with his literary work. Despite these hindrances, he appears -to have made a fair degree of progress in the writing of his book, -for at the date last named he gave a public reading of the first two -sections “before a large and noble assemblage of medical students and -other distinguished personages.” The portrait of de Mondeville which -is here reproduced is a copy of the miniature which appears in one of -the manuscripts of his treatise that was prepared 1314 A. D., and is -now preserved in the _Bibliothèque Nationale_ at Paris. Nicaise -furnishes the following details regarding the original miniature. - - Inasmuch as the MS. bears the date 1314 the portrait must have - been painted while De Mondeville was still living. The master is - represented wearing a violet-colored gown, red stockings, and a - black skull-cap. He is thin, his beard is scanty and of a grey - color like the hair of his head, his features are finely cut, - and he appears to be a fairly tall man. So far as one may judge - from this portrait De Mondeville’s age was then about fifty. - -The date of his death is not known exactly, but it must have been -somewhere about 1320 A. D. - -Nicaise sums up de Mondeville’s personal history and his contributions -to the science of medicine somewhat as follows: He was a man of -warm impulses, who loved the truth and despised all shams. He never -hesitated to speak his opinion about others, the King himself not being -excluded from his criticisms. He was also quite frank in his exposures -of the ignorance of both nobles and members of the clergy. He was not -in the least degree superstitious. He remained unmarried throughout -life and seems to have entertained a slight disposition to find fault -with women, for he attacks somewhat violently their mode of life and -their extravagance, especially in the case of the women of Montpellier. -Although he possessed a great reputation and a very large clientele of -patients, he did not acquire a fortune. He is quoted as saying: “I was -obliged from the very first to work hard for a living.” Suppuration, -according to the view of de Mondeville, was not a necessary phenomenon -in the healing of wounds. - - [Illustration: FIG. 11. HENRI DE MONDEVILLE. - - (From Nicaise’s Version, Paris, 1893.) - - From a miniature at the head of a manuscript which bears the - date A. D. 1313, now preserved in the Bibliothèque Nationale at - Paris.] - -About the year 1316 the condition of de Mondeville’s health--he -probably had pulmonary tuberculosis--began to give him serious cause -for anxiety lest he might not live long enough to complete his book; -and, as a matter of fact, the treatise which we now possess shows -that his fears proved to be well grounded. The important subjects -of fractures, dislocations and hernia, for example, are mentioned -only casually. Those subjects, however, which he did discuss are -treated in a very clear and practical manner. Thus, for example, his -instructions with regard to the proper manner of treating wounds is -most satisfactory. Theodoric and he were the great champions of the -so-called dry treatment, which had been introduced at some remote -period of antiquity, but which apparently had not met with general -acceptance. Then, again, in his remarks on the subject of amputations, -he taught that the ligaturing of the severed arteries after the removal -of the amputated part, was universally recognized as the proper course -to adopt and should never be neglected. - -In Chapter VII. of the first section of his treatise, de Mondeville -gives a description of the anatomy of the heart and related -blood-vessels, and at the same time furnishes an unusually clear -account of the physiology of the circulation which was universally -accepted by the physicians of that period, as it had already been -by those of earlier centuries. It seems desirable to reproduce this -account here in order that it may serve for purposes of comparison with -that which Harvey was to give three centuries later. It is only by -making such a comparison that the physicians of our time can appreciate -the vast importance which attaches to Harvey’s wonderful discovery. De -Mondeville’s account, abbreviated wherever it seemed practicable to do -this, reads as follows:-- - - The heart is the most important of all the organs. It transmits - to the other members of the body vitalizing blood, heat and - spirit. Its muscular tissue, unlike ordinary muscle, is composed - of three kinds of fibres, and it is not under the control of - the will. It has the shape of a pineapple and is located in - the centre of the chest, like a prince in the middle of his - kingdom. Its lower extremity is directed somewhat to the left - of the chest, as we are assured by the Philosopher (Aristotle) - in his history of animals. There are two reasons why it points - toward the left: 1., in order that it may not press upon the - liver or be pressed upon by it; and 2., in order that it may not - communicate its heat to the left side (the cool side) of that - organ. - - It is important to note the fact that the heart is the only - structure which contains blood in its substance; in all the - other members of the body the blood is contained in the veins. - The base of the heart is situated at its highest point and - represents the broadest portion of the organ; it is attached to - the posterior wall of the chest by a few ligaments, than which - no stronger are to be found in any part of the body. These bands - do not touch the heart at any point except at the top, where - they take their origin; and their great strength is explained by - the fact that it is their duty to hold the heart firmly in its - proper position. - - The heart possesses two ventricles or cavities, of which the - left one--by reason of the natural position of the organ as a - whole--is a little higher than the right. Between these two - cavities there is placed a partition which in its turn contains - a small cavity--termed by some _the third ventricle_. - Above each of the larger ventricles there is a sort of - appendix--cartilaginous in structure, but flexible and at - the same time strong,--which contains a cavity and has some - resemblance to a cat’s ear. These structures, to which the - common people have given the name _auricles_, alternately - contract and dilate. The purpose for which they exist is to - serve as reservoirs for the blood and air that are needed for - the nourishment and cooling of the heart. - - To the right ventricle there comes a many-branched vein which - conducts to the heart a coarse, thick and warm blood destined - to nourish that organ. The portion of this abundant fluid which - is not needed for this purpose is then rendered less coarse and - thick by some subtle power possessed by the heart itself, after - which it is driven into the cavity that is located within the - partition wall which separates the ventricles the one from the - other. From this smaller cavity, this so-called third ventricle, - in which it receives additional heat and at the same time - undergoes further thinning as well as some kind of digestion and - purification, the blood passes on into the left ventricle and - there undergoes a further change--one which is characterized by - the development of that element which we call _spirit_, - something clearer, more subtle, more pure, more glorious than - any known substance in the human body, and therefore more nearly - allied in its nature to celestial things. This new element - forms a friendly and very appropriate link between the body and - the soul; it is the direct agent or instrument of the latter, - conveying to man the different faculties with which he may be - endowed. - - From the left ventricle of the heart, alongside its auricle, two - arteries are given off. One of them, which is only furnished - with one tunic (as in the case of a vein) and which is called - the _arteria venalis_ (pulmonary vein), carries to the - lungs the blood which they require for their nourishment, and - breaks up into many branches after entering these structures; - the other artery is provided with two tunics and is called - _the grand artery_ (the aorta). From the latter vessel - are given off the numberless arteries which are distributed - throughout the entire body--vessels which transport to every - organ and structure both the blood which they need for their - nourishment and the spirit required for their revivification. - When this spirit passes into the ventricles of the brain it is - subjected to a new species of digestion, which converts it into - the _spirit of the soul_. Similarly, when it enters the - liver it becomes _a nutritive spirit_; when it enters the - testicles, _a generative spirit_, and so on through all the - different organs. - - - - - CHAPTER XXIV - - DURING THE LATTER HALF OF THE MIDDLE AGES SURGERY ASSUMES THE - MOST PROMINENT PLACE IN THE ADVANCE OF MEDICAL SCIENCE - - -During the first half of the fourteenth century, as has been shown -in the preceding chapter, Henri de Mondeville was largely successful -in rendering Paris the most prominent centre of medical activity in -France, if not in Western Europe generally. His life, however, was -short, and his position as one of the leading surgeons of the French -Army subjected him to many and prolonged interruptions, for which -reasons he was not able to complete his excellent treatise on surgery. -No physician of the same intellectual capacity and of equally strong -character appears to have been living in Paris at the time of De -Mondeville’s death, and consequently the importance of that city as a -centre of medical education diminished rapidly after that event. On -the other hand, the Medical School at Montpellier in the southern part -of France began at about this period, under the influence of Arnold of -Villanova (probably a small town in Catalonia, Spain, in the diocese of -Valencia), to acquire importance. - -_Arnold of Villanova and the Medical School of -Montpellier._--Arnold of Villanova was born about 1240 A. D., of -humble parentage. He obtained his early education in a Dominican -cloister, and afterward devoted all his energies to the study of -languages (especially Hebrew), theology, philosophy, the natural -sciences (physics, alchemy), and medicine. Paris and Montpellier were -the principal cities in which he prosecuted those studies. Already as -early as the year 1270, Arnold had attained considerable celebrity -as a physician. Between the years 1289 and 1299 he appears to have -made his home in Montpellier, and to have been very actively engaged -both as a practicing physician and as a teacher of medicine. It was -in that city also that he wrote the more important of his numerous -medical treatises. At a later period of his life he appears largely -to have lost his interest in medicine, for in 1299 we find him acting -as an ambassador from the King of Aragon, whose private physician -he was, to the Court of Philippe le Bel, King of France, and deeply -entangled, during his stay in Paris, in disputes with the theologians -of that city respecting certain religious doctrines. He was also at -the same time busily engaged in championing various ecclesiastic -reforms which he was anxious to see inaugurated. His opponents haled -him before the tribunal of the Inquisition and succeeded in having him -cast into prison, where he remained until he expressed a willingness -to retract the obnoxious opinions which he had advanced. The same -tribunal pronounced his treatise “_De Adventu Antichristi_” to -be heretical. After these persecutions Arnold endeavored to procure -aid and comfort from Popes Boniface VIII. and Benedict XI. The former -was inclined in his favor, but Benedict manifested no disposition to -aid him. Boniface’s sentiments were doubtless influenced by the fact -that Arnold had treated him successfully for stone in the bladder; and -Neuburger incidentally states that, in the effecting of this cure, -not only medical and dietetic treatment had been employed, but also -two other measures--viz., the application of a bandage or truss which -encircled the loins snugly, and the wearing (by the patient) of a -magic seal ring upon which was engraved the effigy of a lion.[68] When -Pope Clement V. (1305–1315 A. D.) removed the papal seat from Rome -to Avignon, in France, Arnold was relieved from the charge of heresy -and reinstated in the respect of his contemporaries. He became the -trusted adviser of royalty, won the sympathy of Jayme II. and of his -brother, Frederic III., King of Sicily, for his broad-minded views -regarding religious matters, and was both hated and feared by his -enemies. According to trustworthy chronicles, Arnold of Villanova died -at sea in 1311, within sight of the coast of Genoa, while he was on a -voyage (probably from Sicily) to visit the Court of Clement V. In 1316 -the Inquisition pronounced most of his philosophical and theological -writings heretical, and ordered them to be destroyed. - -A complete collection of the medical writings of Arnold of Villanova, -so far at least as they were then known to exist, was printed at -Lyons, France, in 1586. It is said that many of the treatises which -this author wrote have been lost. Of those which have come down to our -time there are only three which call for any special comment--Arnold’s -“_Breviarium_,” a compendium of the practice of medicine; his -“_Commentary on the Regimen Salernitanum_,” the sales of which, -according to Neuburger, reached an enormous figure; and a work which -bears the title “_Parabolae medicationis secundum instinctum -veritatis aeternae, quae dicuntur a medicis regulae generales -curationis morborum_.” (Basel, 1560.) The latter treatise, which -might with propriety be given the simple title of “General Rules -regarding the Treatment of Diseases,” is dedicated (1300 A. D.) to -Philippe le Bel, King of France. It contains a number of chapters on -the principles of general pathology, and others on special pathology -and therapeutics, with relation both to internal diseases and to -those which particularly interest the surgeon. It also furnishes 345 -aphorisms, many of which embody truths of the highest importance and -reveal the author to have been a man of independent judgment, of wide -experience, and of a philosophical type of mind. - -In the “_Parabolae_” and the “_Breviarium_,” says Neuburger, -are to be found the most marked evidences of the knowledge and ability -which this great physician possessed. He then adds:-- - - Arnold attached much importance to hygiene and the proper - regulation of the diet as effective measures in preventing - diseases, and he formulated an admirable set of rules for - the ordering of one’s manner of living. In these he gives - prominence to the value of baths, to the importance of taking - a certain amount of physical exercise, and to the selection - of the right kinds of food. He also describes in detail how - wine may be utilized advantageously in cases of illness. As - regards the choice of remedies to be employed he says that the - physician should be guided by a very careful consideration - of the patient’s age, temperament, habits of living, etc.; - and, so long as there remains any doubt about the correctness - of the diagnosis, he should employ only mild and indifferent - remedies. The greatest care, he adds, should be exercised in the - preparation of the drugs that are to be administered, and one - should be very cautious about prescribing substances which have - not been sufficiently tried. - -Arnold’s writings are full of precepts which, like those quoted above, -show him to have been an excellent practitioner of medicine as well as -a man of sound common sense. And yet at the same time he appears to -have been more or less tainted with the prevailing belief in astrology, -in the efficacy of amulets (as in the case of Pope Boniface referred -to on a previous page), etc. His enemies gave him the reputation -of being a sorcerer upon whom the Devil had bestowed the power of -transmuting metals,--a reputation which undoubtedly was based upon the -fact that Arnold interested himself greatly in alchemistic processes, -often referring to them as closely resembling such organic phenomena -as generation, birth, growth, etc. But, in our judgment of the man, -we should be careful to remember that during the thirteenth century a -belief in alchemy, astrology, the efficacy of amulets, the influence -of supernatural agencies, etc., was almost universal. Even theologians -maintained that it was a sin for a practitioner of medicine to neglect -the influence of certain constellations. Indeed, there are even to-day, -not a few very sensible people in whose minds exists a lingering belief -in the interference of supernatural agencies in human affairs. - -The importance of the influence which Arnold of Villanova exerted upon -the progress of medical science, and more especially upon the fame of -the Medical School of Montpellier, should not be estimated exclusively -from the value of his writings nor from the character of the work -which he performed as an instructor in that school. In the thirteenth -and fourteenth centuries physicians as a class did not hold so high -a position socially in Western Europe as they were probably entitled -to hold, and consequently Arnold’s later career, in which he showed -himself to be a wise, broad-minded, and very able statesman and as -an enthusiastic champion of greater liberty of thought in the domain -of religion, must be looked upon as having aided very materially in -raising the profession of medicine to a higher rank and in adding éclat -to the School of Montpellier. - -_Contemporaries and Successors of Arnold of Villanova at -Montpellier._--During Arnold’s lifetime there does not appear to -have been another physician at Montpellier who could be compared with -him in professional ability or in general culture. There was one, -however, who attained considerable fame as a medical author, and who -certainly deserves at least a brief notice in this place--Bernard de -Gourdon, also known as Gordonius. - -Bernard de Gourdon[69] began teaching medicine in Montpellier in 1285 -A. D. He was the author of a treatise which bore the title “_Lilium -Medicinae_,” and which enjoyed an unusual degree of popularity for -a long period of time. The earliest printed edition appeared in Lyons -in 1474 and was followed by several others in 1491, 1550, 1559 and -1574. One of the latest editions is that of Frankfort, 1617. The book -was also translated into both French and Spanish. In his description -of the seven parts into which the book is divided, the author says, by -way of praising his own work: “In the lily there are many different -kinds of blossoms and in each one of these there are seven grains of a -golden character.” The book treats of fevers, poisonings, abscesses, -tumors, wounds and ulcers, of diseases of the liver, spleen, kidneys -and bladder, of affections of the eyes, and of numerous other topics. -The work as a whole, says Neuburger, lacks depth and thoroughness, -and reveals the author to be overfond of employing drugs, especially -in combination, and by no means free from a belief in the efficacy of -amulets and other supernatural remedies. It contains, however, one -or two references to matters of historical interest. For example, in -Chapter V., Part III., mention is made of spectacles. So far as now -appears, this is the first time that these useful contrivances are -referred to in medical literature; and the casual manner in which the -author speaks of them suggests the idea that they had already been -known for some time. Possibly Roger Bacon, who interested himself in -researches in the department of optics and who was a contemporary -of Gordonius, may have had something to do with the invention of -spectacles. - -At the ceremony of the marriage of the Duchess Juta of Austria to -Count Louis of Oettingen, at Vienna in 1319, Pietro Buonaparte, the -Podesta of Padua, created considerable excitement by wearing a pair of -spectacles which he had received a short time previously from Salvino -degli Armati of Florence, the reputed inventor of these contrivances. -It is not generally known that the printing of books in very large -and bold type during the latter part of the fifteenth and the early -part of the sixteenth centuries was done expressly for the benefit of -far-sighted readers--this defect in vision characterizing a very large -percentage of the learned men of that period. The great number of books -which, during those early days of the art of printing, were published -in this style, emphasizes the fact that the usefulness of spectacles -was not generally appreciated until after the lapse of many scores of -years. Being very expensive they were within the reach of only persons -of wealth, and, in addition, they were extremely difficult to obtain. -As late as during the year 1572, Augustus, Elector of Saxony, moved by -a strong wish to possess a pair of spectacles, despatched a special -messenger first to Leipzig and then to Augsburg with instructions to -purchase them for him at the great annual fair. This agent, however, -was unsuccessful in the attempt, and, accordingly, in the summer of -1574, he was instructed to ride on as far as Venice. But, on arriving -there, he was informed that no glasses would be ground before the -month of October. He was consequently obliged to remain in that city -until the autumn, at which time he sent word to his master that the -optician’s charge for the instrument would be 50 thalers (equivalent to -$250 at the present value of money). The Elector, it appears, was only -too glad to pay this sum for the coveted article. The first spectacles -made were equipped with only convex glasses, for the use of far-sighted -persons. It was not until about two hundred years later that the art of -grinding concave glasses for the relief of short-sighted individuals -was discovered. - -_Guy de Chauliac._--After the lapse of a few years there appeared -a man who was destined to add greatly to the fame of the Medical -School of Montpellier--not in the way in which Arnold of Villanova -had accomplished this result, but by the publication of the first -systematic treatise on surgery which was written in Western Europe -during the Middle Ages. This man was Guy de Chauliac, about whose early -life very little is known. He was born in the village of Chauliac, in -Auvergne, France, toward the end of the thirteenth century, his parents -being simple peasants; and during early boyhood he probably attended -the school connected with the village church. His medical studies were -begun at Toulouse and completed at Montpellier. But, at some time later -than 1326, he went to Bologna and perfected his knowledge of anatomy -under the guidance of Bertrucius, Mondino’s successor. After leaving -Bologna Guy visited Paris, arriving there subsequently to the deaths -of Lanfranchi, Pitard and Henri de Mondeville. Although he remained in -that great city only a short time, he appears to have formed a warm -friendship with several of the instructors in the medical school. - -About the year 1330 he took up his residence in Lyons. His appointment -to the position of Canon of Saint-Just, a church which is located in -that city, doubtless made it necessary for him to adopt this course. -And yet it is most improbable that he spent much of his time in Lyons, -for his other duties--his attendance at the Papal Court in Avignon, -as private physician to three Popes in succession, and the numerous -calls made upon him for professional advice and especially for surgical -assistance by people living at a long distance from Lyons--compelled -him repeatedly to absent himself from his home, sometimes for several -days at a time. In 1348 the plague visited Avignon and carried off -large numbers of people, the poet Petrarch’s Laura being one of -the victims. During that terrible epidemic Guy was most faithful -in his devotion to Clement VI. and to many others who needed his -professional services. In 1357 he was promoted by Innocent VI. to the -office of Provost of Saint-Just. In 1363 when--according to, his own -declaration--he was an old man, he wrote the treatise on surgery which -has rendered his name famous in the history of medicine. His death -occurred about July 23, 1368. - -Guy was not, as some writers have asserted, a professor of surgery in -the University of Montpellier; he was simply a physician who had won at -that institution the title of “Master in Medicine”--the highest grade -conferred by the university authorities, and one which necessarily -implied that the recipient had given a certain number of public -readings on medical topics. And yet in actual practice Guy manifested -a strong preference for the management of diseases which demanded -surgical treatment. His writings, furthermore, make it clear that he -had a strong affection for the institution in which he had been both a -student and in some measure an instructor. - -The book which Guy de Chauliac wrote, and which bears the title -“_La Grande Chirurgie_,” is described by Malgaigne,[70] one of -the most distinguished French surgeons of the nineteenth century, in -the following terms: “I do not hesitate to say that, with the single -exception of the book written by Hippocrates, there is not a work on -surgery, no matter in what language written, which ranks higher than, -or is even equal to, the magnificent treatise of Guy de Chauliac.” -Although most surgeons of the present day will scarcely assent to -praise of such an extravagant nature, they will undoubtedly agree -in according to this admirable author of the fourteenth century a -high place of honor in the Temple of Fame. Nicaise, the editor of the -most recent version of Guy de Chauliac’s treatise, speaks of him as -the “founder of didactic surgery.” From 1363 A. D., the date of its -first publication in manuscript, to 1478, a period of more than one -hundred years, Guy’s book was universally regarded as the authoritative -treatise on surgery. But this branch of medicine, it must not be -forgotten, was, at that period of the Middle Ages, held in very small -esteem by physicians generally, and therefore it is almost certain that -Guy received no encouragement whatever from any outside source. All -the greater credit, therefore, is due him for the admirable manner in -which he carried on the task which he had set before himself during the -last years of his life. Extraordinary as it appears to us to-day, the -Montpellier School of Medicine, toward the end of the fifteenth century -(that is, only a comparatively short time after Guy’s death), issued a -decree that thereafter their pupils were not to study nor to practice -surgery. From this and other well-authenticated facts it appears that -the prejudice which existed at that period among physicians against -surgery, was strong enough to render them blind to the reality that -it was through the instrumentality of this very branch of medical -activity that the school at Montpellier had gained such an increase -in celebrity. They were unable to dispossess their minds of the idea -that operative and all other surgical procedures were derogatory to the -dignity of the educated physician. - -Guy de Chauliac wrote his treatise originally in Latin--not the -Latin of the classical authors, but a Latin greatly deformed by the -introduction of French, Arabic and Provençal terms--barbaric Latin, -as it is often called. This language was commonly employed at the -University of Montpellier and at all other universities at that period; -but, as Nicaise states, the style of his writing is so concise, and at -the same time so intelligible, that it would scarcely be possible to -translate it into modern French without the loss of much of that which -constitutes the charm of the book. It was for the latter reason that -he decided to write his version of Guy’s treatise in old French--the -French of the thirteenth and fourteenth centuries. In order that our -readers, most of whom are doubtless more or less familiar with the -finished language of modern French literature, may see for themselves -to what extent the latter differs from its fourteenth century ancestor, -I shall introduce here a single paragraph of Nicaise’s text. I have -chosen it, more or less at random, from the admirable chapter which Guy -has written on wounds in general. - - Consequemment playes mortelles non necessairement, ains pour la - pluspart, sont petites playes, et superficielles és susdites - parties, et qui penetrent iusques à icelles et aux chefs - des muscles. La raison est, parce que si elles ne sont bien - traitées, il advient qu’on en meurt: et si sont bien traitées, - on en guerit: ainsi que i’ay veu de la partie posterieure du - cerveau, de laquelle sortit un peu de la substance du cerveau, - ce qui fut reconnu par l’offense de la mémoire, laquelle il - recouvra apres la curation. Ie ne dis pas toutesfois qu’on - vesquit, s’il en sortoit toute une cellule, comme Theodore - raconte d’un cellier. Aussi Galen ne dit pas, de deux blessez - qu’il vit guerir en Smyrne du vivant de son maistre Pelope, - qu’il en fust sorty de la substance de cerveau, ains seulement - que le cerveau avoit esté blessé: Ne, de celuy qu’il vist guery - en Smyrne (comme il recite au huitiesme de _l’Usage_), il - ne dit pas qu’il en sortit de la substance du cerveau, ains - qu’il fust blessé en l’un des ventricules gemeaux. Et avec ce - on pensoit qu’il fust guery par le vouloir de Dieu. Car si tous - deux eussent esté blessez, il n’eust gueres duré, comme il dit: - et de ce il conclud l’utilite de la duplication de quelques - instruments, ainsi qu’a esté dit cy dessus en l’anatomie. Et - tant de cettui-cy, que de ceux-là, la guerison rare est fort - rarement faite, comme il est dit au commentaire dessus allegué. - -There are many places in Guy’s treatise where his description of a -surgical condition, or of the proper measures to adopt for the relief -or cure of such condition, would doubtless prove interesting to our -readers, and would in any event aid them materially in forming an -independent judgment as to the man’s character in general and also -with regard to his qualifications as a surgeon. But all of these -descriptions, when rendered in their entirety into English, occupy much -space, and for this reason I shall be obliged to furnish here merely a -few extracts from some of the more interesting portions of the text. - -In the chapter which Guy devotes to wounds of nerves, cords and -ligaments--all of which structures were classed by him, as well as by -Galen, as belonging to the category of nerves--this author divides them -into punctured and incised wounds, bruises and concussions. As to the -first variety he says that they may be divided into closed punctured -and open punctured wounds. - - In the incised wounds two kinds may be distinguished: those in - which the nerve is incised in the direction of its length and - those in which the cut is made across the fibres. A further - subdivision is practicable, viz., into wounds accompanied by - more or less destruction of the substance of the nerve or its - envelopes, and those in which such loss has not occurred. Among - other differences worthy of mention are these: pain, spasmodic - phenomena, and abscess formation are present in certain cases - and absent in others. From all of which symptoms useful - indications as to the treatment needed may be deduced. - -In the section relating to the treatment of such traumatic affections -of nerves, Guy makes the remark that the measures called for are, for -the most part, the same as those required for wounds involving simply -the fleshy parts of the body. - - The element of pain, however, is one of the factors which - distinguish wounds of a nerve from ordinary flesh wounds, and - it may necessitate some slight modification of the treatment. - Aside from this, one of the first things that should be done is - to remove from the wound all foreign substances; after which - the edges of the cavity should be brought together and held - firmly in this position by appropriate means. Last of all, care - should be taken to protect the parts. These are the general - principles which are to guide the surgeon’s action. As to the - special details, they must depend upon the different conditions - presented by each individual case. Thus, for example, if we are - dealing with a punctured wound of a nerve, there will be no - edges of an excavation to bring together. - - If the object which produced the puncture is still lodged in the - tissues, it must, as a matter of course, be withdrawn. After - which, the further measures to be adopted may be enumerated - under the following heads: careful regulation of the manner of - living; removal from the system of all material which--attracted - to the wounded part by the pain--might there cause irritation or - inflammation; and protection of the body against any harm that - might come to it through the occurrence of convulsions. These - three measures are indicated for all wounds of nerves. But, in - the case of a punctured wound, still other procedures should be - employed, as will be discussed under a fourth head. - -The four heads mentioned by Guy may be briefly stated in the following -terms: I. The patient should be put upon a light and very simple diet; -and, in addition, he should be given a bed that is soft and humid -(“_humidus et mollis_”). His surroundings should be kept quiet, -and nothing should be permitted to disturb his peace of mind. II. To -protect his tissues from the injurious influence of any superfluous -matters of an irritating nature that may be circulating in the blood -(_i.e._, cacochyme), a vein on the opposite side of the body -should be opened and a certain amount of this fluid withdrawn. In -certain cases, furthermore, it may be well, in addition, to administer -an aperient remedy. III. If convulsions develop, the head, neck and the -entire back should be anointed with well-warmed linseed oil or common -(? olive) oil, as recommended by Galen. IV. Special measures should be -adopted for providing a free outlet for any pus that may form in the -deeper parts of the wound; and here again Galen recommends for this -purpose the employment of one of several medicinal preparations which -he enumerates. “But the more certain course,” Guy adds, “is to make an -opening in the skin either with the razor or with the actual cautery -(which latter, according to Henri de Mondeville, is the better plan of -the two), and then to apply some subtle drying remedy which possesses -the power to penetrate into the deepest recesses of the injured -nerve--for example, savin oil.” (Guy has a good deal more to say on the -subject of wounds of nerves, but the few extracts given above should -suffice.) - -It is now a well-known fact that Guy de Chauliac was in the habit of -treating fractures of the thigh by the employment of the weight and -pulley as means of keeping up a continuing extension of the damaged -limb. As his description of the method in question is very brief, it -may not seem out of place to reproduce it here. Translated into English -it reads as follows:-- - - As to the plan which I employ, it is this: After making fast - to the fractured thigh splints which extend down as far as the - feet, I reinforce the support which they give, either by placing - the limb in a box or by applying to its sides bundles of straw - (_appuyements_). [These are shown in the left-hand lower - corner of Fig. 12.] I then attach to the foot a mass of lead as - a weight, taking care to pass the cord which supports the lead - over a small pulley in such a manner that it shall pull upon the - leg in a longitudinal direction. And if it then be found that - there is not complete equality between the fractured limb and - its fellow as regards length, the discrepancy may be corrected - by gently pulling upon the former. Every nine days the limb - should be cautiously handled; and at the end of about fifty days - it will be found that firm union has taken place. - -One more remark seems to be called for in reference to the fact that -Guy de Chauliac, although he was avowedly a surgeon, managed to win -as great a reputation and as high a social position as was possessed -by any physician of that period. The medical practitioner, it will be -remembered, held himself, during the Middle Ages, and was universally -held, to be a much higher type of man than the surgeon. The relative -standing of the two is well shown in the accompanying sketch (Fig. -13), in which all the details (attitude, head gear, gown, etc.) have -evidently been carefully studied by the artist. Guy, however, through -the sheer force of his character, and also probably because he was -known to have won the highest medical honor (the grade of “Master of -Medicine”) which it was in the power of the university to confer, -pushed his way to the top, and held, for a period of twenty years, the -position of private physician to three Popes in succession--Clement -VI., Innocent VI. and Urban V. In other words, the prevailing -prejudices and jealousies were not sufficiently powerful to block the -triumphant career of this man of solid merit and high character. - - [Illustration: FIG. 12. ONE OF THE WARDS IN THE HÔTEL-DIEU OF PARIS. - - As it appeared in the sixteenth century. - - (From _Chirurgie de Pierre Franco_, edited by E. Nicaise, Paris, - 1895.)] - -_The State of Medicine and Surgery in Countries Other than Italy -and France During the Later Portion of the Middle Ages._--From the -account given by Neuburger it appears that the seeds planted by the -famous teachers of medicine and surgery in Italy and France during -the thirteenth and fourteenth centuries had begun to take root in -England and in the Low Countries to the north of France, and were -in fact already producing some good fruit in those lands. Thus, for -example, there have been handed down to our time the names of four -physicians who attained a certain degree of eminence in England during -the thirteenth and fourteenth centuries--Gilbertus Anglicus, John of -Gaddesden, John Mirfeld and John Arderne. - -_Gilbertus Anglicus_, who was the first English medical writer -to secure a certain degree of celebrity among the physicians of -continental Europe, wrote a compendium of medicine that was commonly -called the “_Laurea anglica_.” The book contains, along with some -good original observations and the records of his own experience, not a -few wearisome theoretical discussions; and at the same time it reveals -the fact that the author was inclined to favor remedial measures -of a superstitious nature. In the last chapter of his compendium, -however, he makes the very practical suggestion that distillation may -be resorted to when one desires to purify water that is contaminated. -Gilbertus, after obtaining his preliminary training in England -in the early part of the thirteenth century, visited some of the -leading schools on the continent, among others those of Salerno and -Montpellier, in which latter city he appears to have practiced medicine -for a certain length of time. - -_John of Gaddesden_, who is also spoken of as Johannes Anglicus, -was born about 1280 A. D. and died in 1361. He was therefore a -contemporary of Guy de Chauliac. He is said to have been a Fellow of -Merton College, Oxford, and to have held the positions of Prebendary -of St. Paul’s, London, and of private physician to the royal family. -He was also the author of a medical treatise which was generally known -by the title, “_Rosa Anglica_” (first printed in 1492). Neuburger -speaks of this book as being an imitation of Gourdon’s “_Lilium -Medicinae_,” but of a somewhat inferior grade, and he quotes two -or three passages which show that medicine was in a very low stage of -development in England at the beginning of the fourteenth century. -Gaddesden, for example, advises his confrères to adopt the rule of -always securing their honorarium before they undertake the treatment of -a sick person. In another part of the book he states that he treated -one of the sons of Edward II. for small-pox and secured excellent -results, not merely as regards the perfect restoration of his health, -but also as regards the complete prevention of any pitting of his face. -He attributes this success to the fact that he enveloped the patient in -a red cloth and took pains to have every object in the vicinity of the -bed draped in red.[71] - -_John Mirfeld_, who lived during the second half of the fourteenth -century, completed his medical studies in Oxford, then entered -the Monastery of St. Bartholomew’s in London, and devoted himself -thenceforward to work in connection with the hospital belonging to that -institution. Among the books which he wrote there are a few that deal -with matters of interest to the physician. Such, for example, are a -glossary which bears the title “_Synonyma Bartholomaei_,” a work -called the “_Breviarium Bartholomaei_,” and a shorter treatise -on prognosis--the “_Speculum_.” None of these, however, possesses -any special importance. - - [Illustration: FIG. 13. THE PHYSICIAN, THE SURGEON AND THE - PHARMACIST. - - Reproduction of a miniature at the head of Guy de Chauliac’s - _La Grande Chirurgie_, edited by E. Nicaise, Paris, 1890.] - -_John Arderne_ was born in England 1307 A. D., probably obtained -his medical training in Montpellier, accompanied the English Army to -France in the character of a “Sergeant-Surgion,” and was present at the -battle of Crécy (1346 A. D.). During the succeeding twenty-four years -he practiced medicine in Wiltshire and Newark, and then settled for -the remainder of his life in London. Although his practice included -both internal diseases and those which required surgical treatment, the -great reputation which he acquired was based chiefly upon his success -in the latter field. Most of his writings, it appears, are still in the -form of manuscript. They deal chiefly with surgery and are accompanied -by drawings of the instruments which he employed. They possess one -feature which distinguishes them from the majority of medical writings -of the Middle Ages, viz., they abound in reports of cases observed and -treated by the author; and, furthermore, the methods of treatment which -he recommends are in most instances rational and of a relatively simple -nature. The only one of Arderne’s treatises which has been printed -is that relating to _fistula in ano_. It bears the title, “John -Arderne--Treatises of Fistula in Ano, Haemorrhoids, and Clysters; from -an early fifteenth-century manuscript translation,” and is edited by -D’Arcy Power, Early English Text Society, Original Series, 139; London -and Oxford, 1910. Arderne, we are told by Neuburger, puts forward two -claims: 1, that he succeeded in curing a large number of cases of anal -fistula, in proof of which he gives the names of the persons upon whom -he operated successfully, many of whom are high up in the social scale; -and, 2, that no other surgeon of whom he has any knowledge, either in -England or on the continent of Europe, is able to cure the disease. - -The three English physicians of whom I have here given very brief -accounts, can scarcely be said to compare favorably with those men -who, during the same period, brought fame to the medical schools of -Bologna, Padua, Montpellier and Paris; and this fact suggests the -question, Do these men really represent the best type of physicians who -lived in England during the fourteenth century? The great English poet -Chaucer, in his “Canterbury Tales” (written at about the same period -of time), furnishes us with a portrait of a man who appears to have -been well informed with regard to the earlier Greek and Arabian medical -authorities as well as with the leading physicians of his own time, -and who in addition was clever both in ascertaining the causes and -nature of his patients’ maladies and in prescribing for them the proper -remedies. As this physician’s name is not mentioned, we cannot be sure -that he was not one of the three to whom reference has just been made. -By the description given by the poet, who probably was personally -acquainted with the man whose portrait he draws, one is tempted to -believe that he was a physician of a higher type than any one of the -three named above. Chaucer’s account reads as follows:-- - - There was also a Doctor of Phisik, - In al this worlde was ther non him like - To speke of phisik and of surgerye; - For he was grounded in astronomye. - He kepte his pacient wondrously and we - In all houres by his magik natural. - Well coude he gesse the ascending of the star - Wherein his patientes fortunes settled were. - He knew the cause of every maladye, - Were it of cold, or hete, or moyst, or drye, - And where they engendered, and of what humour; - He was a very parfit practisour. - The cause once knowen and his right mesúre, - Anon he gaf the syke man his cure. - Ful redy hadde he his apothecaries, - To sende him drugges, and electuaries, - For eche of them made the other for to wynne; - Their friendshipe was not newe to begynne. - Wel knew he the old Esculapius, - And Discorides, and eek Rufus; - Old Ypocras, Haly and Galien; - Serapyon, Razis, and Avycen; - Averrois, Damascen, and Constantyn; - Bernard, and Gatisden, and Gilbertyn. - Of his diete mesuráble was he, - For it was of no superfluitee, - But of gret norishing and digestible. - -With the names of the three English physicians mentioned above, there -should be associated that of Jehan Yperman, who was born in Ypern, -Flanders, during the latter half of the thirteenth century, obtained -his professional training in Paris under Lanfranchi, and then, in -1303 or 1304, accepted the position of Physician to the Hospital of -Belle, a small Flemish town. In 1318 he settled permanently in Ypern, -his native city, and in a comparatively short time won completely the -confidence and esteem of his fellow townsmen through his attentiveness -to their wants when they were ill and through the great skill which he -manifested in his work as a surgeon. He died 1329 A. D. - -Yperman’s writings deal with both medical and surgical topics. Of -those which have been translated from the Latin into French are: “La -chirurgie de maitre J. Yperman,” Anvers, 1863; “Traité de médecine -pratique de maitre J. Yperman,” Anvers, 1863; and “Traité de médecine -pratique de maitre J. Yperman,” Anvers, 1867. A perusal of these -works, says Neuburger, easily convinces one that Yperman was not only -a skilful and clever surgeon, but also a physician of independent -judgment and wide experience. - -_Revival of the Practice of Dissecting Human Bodies._--It was in -Italy that dissecting was carried on during the fourteenth century more -vigorously than elsewhere in Europe. At first the only persons who made -such investigations for scientific purposes were individual physicians -or groups of physicians; and, in addition, they were obliged to carry -on the work in a secret manner--that is, by stealing from recently -dug graves the corpses which were necessary for such studies. It is -related, for example, that in 1319 one of the teachers in the Medical -School at Bologna and four of his pupils were brought before the Court -of Law under the charge of having clandestinely disinterred, for -purposes of dissection, the body of a man who had been hung for some -crime. At first the authorities merely winked at such transgressions, -but at the same time they made no attempts to have the law against -dissecting annulled or at least modified. Then, at a somewhat later -period, the conviction became general among the intelligent members -of the community that, unless work of this nature were officially -sanctioned, no real advance in the knowledge of human anatomy could -be made, and--what was probably of even greater importance in their -estimation--that Bologna might at the same time lose a good deal of its -superiority over its rivals as a centre of learning; and accordingly -it was found practicable to grant the desired sanction with many -modifying restrictions attached. Then, with the further lapse of time, -other medical schools fell into line and secured from the authorities -similar privileges for their teachers and pupils. Thus, in 1368, the -Senate of Venice authorized the medical school of that city to make a -public dissection of a human body once every year; and, eight years -later, the University of Montpellier acquired the same privilege. In -1391 John I. of Spain was equally generous in his treatment of the -Medical School at Lerida. After the opening of the fifteenth century -no further difficulties of a serious nature were experienced by the -teachers of anatomy in procuring at least some material for dissecting -purposes, and with each succeeding year such facilities steadily -increased. Unfortunately, however, there did not follow a corresponding -increase in the knowledge of human anatomy. As a matter of fact, it -was not until during the sixteenth century that any really valuable -work was accomplished in this branch of medicine. Guy de Chauliac, -in the first chapter of his treatise (“_La Grande Chirurgie_”), -gives the following description of the manner in which Bertrucius -taught anatomy in Bologna at the beginning of the fourteenth century, -and from this account it is easy to understand why the additions to -our stock of information in this department of medicine were so few -and so unimportant during this long period. The so-called dissecting, -it clearly appears, was in reality a not very profitable combination -of purely anatomical work of a primitive character and a search -for evidences of pathological changes. The clinical history of the -individual whose body was undergoing examination does not seem to have -played any part in the investigation. Here is De Chauliac’s account:-- - - After placing the dead body on a bench, my master proceeded with - his instructions, devoting thereto four separate sittings. At - the first of these he passed in review those parts or organs - which are concerned in nutrition; his reason for considering - them first being that they are the earliest to undergo - decomposition. At the second sitting he devoted himself to the - spiritual organs of the body; at the third, to the animal parts; - and at the fourth, to the extremities. Following the example - furnished by Galen in his commentary on the book entitled “The - Sects,” he maintained that there were nine things which should - be taken into consideration when one examines the different - parts of the body, to wit: their situation; their nature, - color, bulk, number, and shape; their connections or relations; - their actions and their utility; and the diseases which may - affect them. Conducted in this manner the study of anatomy, he - maintained, may prove helpful to the physician in recognizing - diseases, in making prognoses, and in selecting a suitable plan - for treatment. - -Puschmann, quoting from Hyrtl, says that when Professor Galeazzo di -Santa Sofia, who had been called from Padua to Vienna to fill the -Chair of Anatomy in the medical school of that city, made his first -public dissection of a human body (1404 A. D.) in the Bürgerspital, -the sittings covered a period of eight days; at the end of which time -he collected as much money as he could from those who had attended -the course, and turned it over to the treasurer of the Faculty. Then -followed a period of twelve years during which not a single public -dissection of a human body was made in Vienna. In 1440 the Faculty were -greatly rejoiced over the prospect of receiving from the authorities -the body of a criminal who was to be hung on a certain day; but, when -the time arrived and the body had actually been delivered to them, -they were grievously disappointed by the sudden coming to life of the -supposed corpse. Instead of dissecting him for the benefit of science, -the doctors bestirred themselves in the man’s behalf, obtained a pardon -in due form, and sent him back to his home in Bavaria under the escort -of the college janitor. Not very long afterward, however, he committed -a fresh crime, and this time was effectively hung. History does not -state whether the dissection then came off, or not. - -The Medical Faculty of the University of Tübingen established the rule -in 1497 that one human body should be publicly dissected every three -or four years; it being understood that during the progress of the -dissection the professor should read aloud to the class appropriate -portions of Mondino’s treatise on anatomy. The instruction in this -department of medical science was of the same general character in -all the other universities of Germany at that period. Anatomical -drawings, of a very crude type, were employed as substitutes for actual -dissection. - -At Padua, in Northern Italy, the science of medicine had already before -the end of the first half of the fifteenth century made a decided -advance, in proof of which several circumstances may be mentioned. In -the first place, the importance of the study of anatomy had by this -time become so generally recognized that no special difficulty appears -to have been encountered in securing the erection, in 1446, of an -anatomical theatre; and during this same period several physicians -connected with the medical school acquired considerable celebrity by -their publication of important treatises on topics belonging to the -domain of general pathology and therapeutics, and by the wide influence -which they exerted as teachers. Among the number of those who helped -in these ways to spread the fame of the Medical School of Padua may -be mentioned Hugo Benzi, Antonio Cermisone, Giovanni Savonarola and -Bartolommeo Montagnana. - -_Hugo Benzi_ (or Hugo of Siena) taught philosophy as well as -medicine in different institutions of learning--at Pavia, Piacenza, -Florence, Bologna, Parma, Padua and Perugia. His death probably -occurred at Ferrara about the year 1439. In addition to commentaries -on Hippocrates, Galen and Avicenna, he wrote several practical works -(“_Consilia_”) on such topics as periodical insanity, stomachic -vertigo, naso-pharyngeal polypi, epilepsy, lachrymal fistula, etc. - -_Antonio Cermisone_ was a native of Padua, became a teacher of -medicine first in Pavia and afterward in Padua, wrote several useful -treatises about various diseases, and finally died about 1441. - -_Giovanni Michele Savonarola_--the grandfather of the celebrated -Girolamo Savonarola, who was burned at the stake for heresy 1498 A. -D.--held the Chair of Medicine in Padua from about 1390 to 1462, and -also subsequently for a certain length of time in Ferrara. He was the -author of a number of treatises on practical medical topics--such, -for example, as fevers (first published in Venice in 1498), the art -of preparing simple and compound _aqua vitae_ (Basel, 1597), an -introduction to the practice of medicine (1553), the baths of Italy and -of the rest of the world (Venice, 1592), the different kinds of pulse, -etc. (Venice, 1497)--and he also wrote a large work covering the entire -field of medicine and modeled on the pattern of Avicenna’s “Canon.” -The book is divided into six parts, each of which is preceded by an -introduction that is devoted to the anatomico-physiological bearings -of that particular part; and here, in addition, there are to be found -scattered throughout the text references to surgical procedures. -Among the references of this character the following deserve to be -mentioned as worthy of some notice: the description of a speculum for -use in operations upon the interior of the nose; a reference to direct -laryngoscopy; the description of an instrument closely resembling the -well-known syringotome; the treatment of curvature of the spine by -mechanical means, etc. The book also reveals the fact that, already at -this period of the history of medicine (the middle of the fifteenth -century), physicians were beginning to take a more active part than -they had previously done in the management of confinement cases, which -as a rule were left entirely to the care of midwives. The records -also show that medical men were interesting themselves more and -more, as time went on, in sanitary science as applied to municipal -affairs. In most communities the need for such was indeed most urgent -at that time. The reforms of this nature were pushed with special -vigor in those parts of Italy which were governed by that enlightened -ruler of the Hohenstaufen family, Frederic II., King of Sicily and -Roman Emperor. The cultivation of personal hygiene was also pursued -very systematically during the later Middle Ages, the _Regimen -Salernitanum_ serving as the guide in such matters. - -Taken all together the conditions in the physician’s world were in -anything but a promising state toward the end of the fifteenth century; -but the dawn of better times, of modern medicine, was near at hand, -and already signs of its approach were beginning to be recognizable in -different parts of Western Europe. - - - - - CHAPTER XXV - - BRIEF HISTORY OF THE ALLIED SCIENCES--PHARMACY, CHEMISTRY AND - BALNEOTHERAPEUTICS - - -During the excavations carried on at the site of Pompeii, there were -discovered three houses which bore every appearance of having been -occupied by apothecaries. Among the objects found in these buildings -were: A bronze box equipped with the apparatus required for mixing -ointments; a few surgical instruments; several glass receptacles -which had evidently at some earlier period contained fluid or -semi-fluid pharmaceutical preparations, but which, at the time when -the excavations were made, presented merely a deposit of some solid -but easily friable substance at the bottom of the vessel; and quite -a variety of drugs in the form of pills, tablets, powders, etc. At -first, the impression prevailed that these must have been the houses -of apothecaries, but subsequently the discovery, in each instance, of -the house sign representing a snake with a pine cone in its mouth (the -symbol of Aesculapius) satisfied the authorities that these particular -buildings had belonged to physicians. Indeed, as a matter of fact, no -good reasons have thus far been found for believing that apothecaries, -in the modern acceptation of the term, existed in even the largest -cities of Greece and Italy until a much later date. - -_Pharmacy in Its Infancy._--All through the Hippocratic period and -during the years when Alexandria was at the height of its prosperity -as the great centre of medical activity, it was customary for the -physicians to prepare their own drugs. The same is true of the best -physicians belonging to the Augustan period; they were not willing to -put their trust in the drugs which had been prepared in the shops where -such things were usually sold. - -In the second century of the present era Galen gave the definition -that a remedial drug, or “Pharmakon,” was something which, when taken -into the living body, produces an alteration in its component tissues -or organs, whereas foods or nutrient elements simply cause an increase -of the parts. He attached great importance to such characteristics as -purity, freshness, care in handling, etc. It was his custom to prepare -with his own hands the different combinations of simple remedial agents -which he administered to his patients, and he kept these combinations, -as well as the simple drugs of the more costly kinds, carefully stored -in locked wooden boxes in a room which was devoted to this special -purpose and which was termed the “Apotheke.” Originally, therefore, -the “apothecary” was simply the person who had charge of this room -in which the drugs and spices were carefully “placed to one side” -(ἀπό, τίθημι) for safe keeping. At a later period, when the -caretaker became also the compounder of drugs, another word of a more -comprehensive significance--that of “pharmacist”--gradually supplanted -the term apothecary. - -There is another word, “antidote,” which has very materially changed -its significance during the lapse of centuries. Galen, for example, -employed this word as a synonym of pharmakon--a simple remedial agent, -and medical writers continued using the term in this sense during -the following thirteen or fourteen centuries. The word commonly -employed, by mediaeval physicians, to signify “pharmacopoeia,” was -“antidotarium.” In modern times the word “antidote” signifies only an -agent which neutralizes a poison. - -Galen took a very great interest in everything relating to the -subject of drugs, and sometimes made long journeys for the purpose -of securing certain plants or roots which he was unable to procure -near home or which he was very anxious to obtain in a more perfect -condition than was possible when they were purchased from the regular -dealers. “Simple remedies,” he declared, “are pure and unadulterated, -and produce effects in only one direction. It is the business of -pharmacology to combine drugs in such a manner--according to their -elementary qualities of heat, cold, moistness and dryness--as shall -render them effective in combating or overcoming the conditions which -exist in the different diseases.” Galen’s interest in pharmacology -materially aided the advance of medical science in other ways. He -systematized the existing knowledge of materia medica and infused some -measure of orderliness into the therapeutics of his day. The success -of his efforts in this direction did not become manifest until after -he had been dead about fifty years; but, if his ideas were slow in -meeting with general acceptance, they took such deep root in the minds -of physicians that to-day in Persia Galen’s system of therapeutics is -the only one generally received as authoritative. Although the facts do -not warrant our making the same statement with regard to Western and -Southern Europe, it is nevertheless true that our dispensatories still -continue to honor the memory of this great physician by bestowing the -name of “Galenical Preparations” on a large group of pharmaceutical -combinations. - -It is scarcely possible to state with any degree of positiveness at -what date pharmacists, in the modern sense of the term, came to be -recognized as constituting a separate and honorable class in every -well-organized community. It is known, however, that in Syria and -Persia, during the eighth and ninth centuries of the present era, not -a few of the leading physicians were the sons of apothecaries. Honein, -for example, of whose career I furnished a brief sketch in Chapter -XIX., was the son of an apothecary; and the careful manner in which he -was educated during his youth justifies the belief that his father must -have been a man of some cultivation and not at all like the general -average of that class of men of whom Galen speaks so disparagingly. But -even at that early period there certainly were individuals who were -skilled in the pharmaceutic art, for Berendes (_op. cit._) tells -us that Dioscorides (_circa_ 100 A. D.) describes minutely the -manner of preparing “Oisypum.” Oisypum is identical with the modern -“Lanolin” or “Lanolinum,” and is a pure fat of wool. Mention is made of -the preparation by four different authors of medical treatises during -the following sixteen centuries--viz., by Aëtius in the sixth, by -Paulus Aegineta in the seventh, by Nicolaus Myrepsus in the thirteenth, -and by Valerius Cordus in the seventeenth. Subsequently to the latter -date no further mention of the preparation is to be found in any of -the pharmacopoeias except the French Codex of the year 1758, in which -it is classed among the simple remedies under the title of “Oesipe.” -Finally Liebreich, toward the end of the nineteenth century, brought -the preparation once more into favor under the name of “lanolin.” The -fact that it remained in complete oblivion for such very long periods -of time is easily explained by the statement which Berendes makes: -“It was a troublesome ointment to manufacture, and consequently the -apothecaries disliked it and resorted to all sorts of falsifications.” - -With the advance of the Arab Renaissance pharmacy gradually became a -regular established occupation in every fairly large city in the East. -It is known, for example, that the first public apothecary shop in the -city of Bagdad was established during the eighth century of the present -era under the caliphate of Almansur; and about the same time, probably -a little earlier, there existed at Djondisabour a similar pharmacy in -connection with the school and hospital of the Bakhtichou family. The -training of an apothecary in those days was probably the same as that -of the physician. Originally pharmacists were called “Szandalani,” -probably because they dealt largely in sandal wood. - -The materia medica furnished by the Arab physician Rhazes in the -different works which he has written, is unusually rich in simple -elements, the majority of which are always drugs of a rather mild -action; Greece, Persia, Syria, East India and Egypt were the sources -from which they were derived. Beside the simple elements, Rhazes -mentions a number of composite preparations of drugs. As not a few -of the latter required very careful manipulation, it may safely be -inferred that the Arabian apothecaries of the ninth century had already -acquired considerable skill and experience in their special field of -work. - -At Salerno, during the first half of the twelfth century, pharmacy -began to assume a position of considerable importance. The work -which was prepared by Nicolaus Praepositus, and which was known as -an “Antidotarium,” furnished quite full information with regard to -the characters and therapeutic uses of nearly 150 different drugs. -According to Berendes this work served for several centuries as the -basis of later pharmacopoeias. One of its notable features is the -importance which the author attaches to the duty of weighing very -carefully each of the drugs that enter into the composition of a given -preparation, of gathering certain vegetable products at the right -season, and of paying strict attention to their quality and to the -manner of preserving them. - -In 1140 A. D., Roger, King of Naples and Sicily, promulgated a law -which defined what should be the proper relations between physicians -and apothecaries; and about one hundred years later (1241 A. D.) -Frederick II. amplified and gave greater precision to this law, thus -establishing what was practically an Institute of Apothecaries. The -following provisions constitute the essential features of the law:-- - - 1. The physician and the apothecary shall have no business - interests in common. - - 2. The physician shall not himself conduct an apothecary shop. - - 3. In each department of the kingdom two respectable men, - selected by the Faculty at Salerno, shall be assigned the duty - of furnishing sworn statements to the effect that all the - electuaries, syrups, and other preparations of drugs kept for - sale in a given apothecary shop, have been made according to the - established prescriptions and are offered for sale only in that - state. - - 4. In the case of those preparations which ordinarily do not - keep for a longer time than one year without spoiling, the price - at which they are to be sold shall be at the rate of 3 Tarreni - (about 30 cents) per ounce; while those which ordinarily remain - unchanged during a longer period, shall be valued at 6 Tarreni - per ounce. - -At the time which we are now considering, it was not the custom, owing -largely to the expensiveness of writing paper, to deliver to the -pharmacist a written prescription. Instead, the physician first gave -his instructions in person, and then, after he had seen the mixing and -other steps of the apothecary’s work properly performed, he carried the -preparation to the patient’s house. - -Long before the middle of the fifteenth century apothecaries had become -thoroughly well established throughout Central and Western Europe. -Among the statutes of the Medical Faculty of Erfurt, Germany, there has -been found one which dates back to the year 1412 and which says:-- - - The student of medicine, before he applies for the Bachelor’s - Degree, should spend one month in the spring of the year, in an - apothecary’s establishment, in order that he may familiarize - himself with the proper manner of preparing clysters, - suppositories, pessaries, syrups, electuaries and other things - necessary for a physician to know. - -The first work which was really worthy of being termed a treatise on -materia medica was published in 1447. It bore the title, “Compendium -Aromatariorum,” and was written by Saladin of Ascolo, the private -physician of Prince Antonio de Balza Ossino of Tarentum. Berendes says -that it was a work of much practical value. - -_The First Indications of the Beginning of Chemistry._--Up to a -comparatively recent date it has been customary to speak of Geber as -the first practical chemist and the first writer among the ancients -who appreciated the important part which chemistry was likely to take -in medicine and philosophy at no distant period of time. But to-day, -as appears from the researches made by M. Berthelot about 1893, we are -compelled to abandon the belief that such a person as Geber existed, -and shall have to adopt the more commonplace view that the science -of chemistry represents a gradual development from the much older -alchemy. We may define the latter branch of knowledge as the science -of transforming copper and brass into gold and silver. During the first -two or three centuries of the Christian era there existed a firm belief -that such a transformation had actually been accomplished, and in -confirmation of the correctness of this statement it may be said that -Zosimos of Panopolis, one of the leading philosophers of Alexandria -during the fourth century of the present era, and a man who was -considered by his contemporaries, as well as by all later alchemists, -to be perhaps the greatest authority in this branch of knowledge, -speaks in unmistakable terms in his cyclopaedic work on alchemy (28 -volumes), of a certain tincture which possesses the power of changing -silver into gold, and also of a “divine water” or fluid which is -capable of effecting many different transmutations. There can therefore -be no reasonable doubt that in the earlier centuries of the Middle Ages -the learned men of Alexandria accepted alchemy as a well-established -agency of great power. From the sixth century to the thirteenth this -science was cultivated with great assiduity by the Arabs in the -academies which they established in Cordova and other cities of Spain; -and it was from the latter region that the belief in alchemy spread to -all the countries of Western Europe, gradually gaining strength up to -perhaps the fifteenth century. - -It was during the thirteenth century that the so-called “philosophers’ -stone” came to be considered the most effective agent in transmuting -the baser metals into silver and gold, and there were not a few who -even believed that this as yet non-existent stone possessed the power -to increase longevity, to confer health, and to give a prosperous -issue to one’s undertakings. It was not the rabble, but the very -best and most highly educated men in the community who, during the -thirteenth century, took the most active interest in alchemy and the -philosophers’ stone. Arnold of Villanova, Raymund Lullus, Roger Bacon, -Albertus Magnus, and, to a lesser degree, the famous theologian Thomas -Aquinas were all believers in the art of the magician. And even more -extraordinary than this is the fact that in Germany men of this stamp -continued for two or three centuries longer to cherish a belief in the -reality of alchemistic processes. Even Martin Luther (1483–1546), the -great reformer, did not hesitate to express his approval of “the black -art,” as is shown by the following quotation from one of his writings:-- - - The art of alchemy is commendable and belongs in truth to - the philosophy of the ancient wise men, a fact which pleases - me greatly, not merely because of the intrinsic merits and - usefulness of the art in the matter of distillations of - vegetables and oily fluids and sublimation of metals, but also - because it serves as such a noble and beautiful symbol of the - resurrection of the dead at the last day of judgment. (Berendes.) - -Another celebrated character who dabbled in the black art was Johannes -Faust, who was born in 1485, obtained his degree of Bachelor of Arts at -the University of Heidelberg, and died in 1540 in Staufen in Breisgau. -Professor Scherer of Berlin says that “he was a great braggart, never -failed to create a sensation wherever he went, and had the conceit and -effrontery to pass himself off as a scientist among the learned men of -his day. He called himself the philosopher of philosophers, a second -Magus. He maintained that he was both a physician and an astrologer, -and claimed that he could restore the dead to life, and could predict -future events from a mere inspection of fire, air and water.” - -But although the persistent and wonderfully energetic activities of -the alchemists failed to find the philosophers’ stone, or to transmute -the baser metals into silver and gold, they placed in the hands of man -the key to a knowledge of chemistry, that branch of science which was -destined in later years to play such an important part in pharmacy, -in agriculture and in other industries. Thus we owe to alchemists the -discovery of many processes and the invention of many apparatus which -serve as the groundwork of modern chemistry. Some of the more important -of these are the following: The use of the spirit lamp; the invention -of tubular retorts; the production of potash and soda by burning -the hard deposit which collects in wine casks as well as various -marine plants; the oxidizing of certain metals (iron, lead, copper, -quicksilver and antimony); the making of metallic arsenic, of wine of -antimony, of sulphate of iron, of chloride of silver, of acetic acid -and of many other chemical products; the purification of metals by the -use of lead, etc. - -_Supplementary Data Relating to Balneotherapeutics._--I have -referred to this subject on several occasions in the course of the -earlier chapters of this history, but always without entering very much -into details. This policy was adopted, partly because the facts upon -which a satisfactory sketch of the growth of balneotherapeutics might -be based were not very numerous, and partly because of the necessity of -gaining space for more important matters. - -The principal facts to which I made reference were: First, that before -the Christian era the employment of baths in a variety of different -ways for therapeutic purposes was universal in the East; and, second, -that in the city of Rome during the centuries immediately following the -birth of Christ, facilities for this kind of treatment were provided -on a most lavish scale--as in the baths of Agrippa (27 A. D.), of -Titus (79 A. D.), of Caracalla (211 A. D.), and of Diocletian (302 A. -D.). I may now add that the warm springs of Aachen (Aix-la-Chapelle), -Baden-Baden and Wiesbaden, in Central Europe, and Bath, in England, -were known to the ancient Romans, and were utilized by them to some -extent for therapeutic purposes; but it was not until a much later -period that they and the less well-known springs of Schwalbach, -Driburg, Warmbrunn, Goeppingen and Gastein began to be actively -frequented for remedial purposes. By the beginning of the sixteenth -century it had become a very popular thing for sufferers from all sorts -of ailments to resort to these and other European springs. The history -of the therapeutic employment of mineral waters belongs, however, to -the period of modern medicine rather than to that which I have been -considering in the present volume. - - - - - PART III - - MEDICINE DURING THE RENAISSANCE - - - - - CHAPTER XXVI - - IMPORTANT EVENTS THAT PRECEDED THE RENAISSANCE--EARLY ATTEMPTS - TO DISSECT THE HUMAN BODY - - -_Important Events Immediately Preceding the Renaissance._--Three -hundred years before the Christian era Erasistratus and Herophilus -made, at Alexandria, Egypt, an attempt to develop a correct knowledge -of anatomy by means of dissections of human corpses, but the political -and religious conditions at that time were not favorable to scientific -work, and therefore the success attained was of a very restricted -character. Then, during the succeeding three or four centuries, this -early movement gradually died out, and no further contributions to -our knowledge of human anatomy were made until toward the end of the -second century of the present era, at which time Claudius Galen, a -man of giant intellect and tireless energy, did his best to supply -the anatomical knowledge so urgently needed. But the deeply rooted -prejudices of that age against dissections of the human body lay like -an insurmountable barrier across his path and forced him to confine his -efforts to the dissection of those animals whose bodily construction -resembled more or less closely that of man. Galen believed that the -anatomy which he thus evolved for the guidance of his professional -brethren would satisfy all their legitimate wants of this nature, -and he proceeded to build upon this faulty and unstable foundation -an equally faulty physiology. History records the extraordinary fact -that Galen’s belief in the sufficiency of his anatomy and physiology -for all the reasonable needs of physicians and surgeons was so well -grounded that during the following thirteen or fourteen centuries -nobody dared to cast the slightest suspicion upon the trustworthiness -of these foundations of the science of medicine. Then followed, during -the fourteenth and fifteenth centuries, an awakening which seemed to -affect all departments of human activity. This movement, which is -commonly termed the “Renaissance,” developed at first very slowly, and -reached a noteworthy degree of momentum only toward the middle of the -fifteenth century, about which time there occurred several events that -contributed greatly to strengthen and perpetuate the movement. Such -were, for example, the employment of gunpowder in the wars of Western -Europe; the invention of a method of manufacturing paper--a discovery -which led to the abandonment of the much more expensive parchment, and -prepared the way for the invention of printing in its different forms; -the taking of Constantinople by the Turks in 1453; the discovery of -America in 1492; and, finally, the Reformation inaugurated by Martin -Luther. Let us pass in review very briefly each of these events, in -order that we may the better appreciate how the science of medicine, -in the short space of time represented by a couple of centuries, made -a greater advance than it had previously made in the course of several -hundred years. - -The employment of gunpowder in warfare robbed the knight of the -protection which he had previously enjoyed from the wearing of metal -armor, and thenceforward his life was as much imperiled in battle -as was that of the foot-soldier, who was not permitted to protect -his person in this manner. Thus were the two upper classes of the -community, the nobles and the bourgeois, in any conflict which might -arise between them, placed more nearly upon a footing of equality. The -ultimate result showed itself in an increased importance, an increased -prosperity, of the middle class or _bourgeoisie_, from which the -physicians chiefly came. Indeed, feudalism from this time forward -rapidly ceased to exist. - -The discovery of paper, an excellent and relatively cheap substitute -for parchment, facilitated wonderfully the spread of knowledge. -Parchment, the material upon which books were written, was expensive -and was at times difficult to obtain; both of which circumstances -rendered books so costly that only a few physicians were able to -become the owners of the important standard medical works of that -period--such, for example, as the Hippocratic writings, Galen’s -treatises, the surgical manuals of de Mondeville and Guy de Chauliac, -the pharmacopoeia of Dioscorides, and still other books of lesser -value. And, if a satisfactory method of manufacturing paper had not -first been discovered, the benefits growing out of the invention of -printing in 1467 would have been far less than they actually proved to -be. Some idea of the magnitude of these benefits may be formed from the -following statement of facts. The demand for books, after the invention -of printing, became so great that the presses were kept almost -constantly busy. At first, according to the record furnished by Haeser, -Venice and Rome took the lead in supplying this great demand for books; -the former city printing 2978 and the latter 972 volumes between the -years 1467 and 1560; but, during a later period (1500–1536), Paris -outstripped Venice with a total of 3056 volumes, and Strassburg -advanced to the second place with a showing of 1021 volumes printed -during the same period of time. Thanks to the great diminution in the -market price of books that resulted from the two inventions named--the -manufacture of paper and the introduction of printing--almost every -physician in fairly prosperous circumstances was able at that period -to purchase the relatively few medical treatises which issued from the -presses; and, besides, new authors were thenceforth stimulated to put -their experiences into print. - -Among the very first medical books printed the following deserve to be -mentioned:-- - - (In Germany.) _Buch der Bündth-Erznei_, by Heinrich von - Volsprundt, 1460.--_Das buch der wund Artzeny. Handwirckung - der Cirurgia von Jyeronimo brunschwick_, 1508.--_Das - Feldtbuch der Wundtartzney_, by Hans von Gerssdorff, 1517. - - (In Italy.) _Avicennae opera, arabice_, 1473.--_Guillelmi - de Saliceto cyrurgia_, 1475. (A French translation was - published at Lyons in 1492.)--_Celsi de medicina liber_, - etc., 1478.--_Guidonis de Cauliaco cyrurgia_, 1490. (A - French version was printed in Lyons in 1498.) - - (In France.) _Christophori de Barzizus de febribum cognitione - et cura_, 1494.--_Bernard de Gourdon, traduction de son - “Lilium medicinae,”_ 1495. - -When Constantinople fell into the hands of the Turks in 1453, many of -its Greek inhabitants, and particularly those belonging to the more -highly educated classes, fled to Western Europe in order to escape from -the tyranny of the invaders. Not a few of these refugees brought with -them to Italy and France copies of the works of the classical Greek -authors, and on this account, as well as because of their willingness -to give instruction in their native tongue, they met with a cordial -welcome wherever they took up their new abodes. Their arrival in -Italy happened at a most propitious time, for the interest in Greek -literature was at that period just beginning to develop among Italian -scholars. Previously, Greek had been an almost unknown tongue in Italy. -Petrarch, for example, is reported to have said in 1360 that he did -not know of ten educated men in that country who understood Greek; and -there is no evidence to show that the number of such men increased -between 1360 and the time when the refugees from Constantinople -arrived. Many of the works of greatest importance to physicians--such, -for example, as the writings of Hippocrates, of Galen, of Rufus -of Ephesus, of Oribasius, of Alexander of Tralles, and of several -other classical medical authors of antiquity--were accessible (in -the original) only to those who were familiar with the Greek tongue. -Consequently the arrival of these refugees from Constantinople -constituted a most important event in the history of European medicine. - -The discovery of America by Christopher Columbus in 1492 owed its -origin in part to the restless spirit of adventure which was abroad -in Spain and Italy at that time, and also, in perhaps still larger -measure, to the hope of gain which might be expected to follow the -discovery of a shorter and more direct route to India. As regards the -attainment of the latter object, the great explorer failed, but his -discovery of a new continent resulted eventually in bringing great -wealth to the rulers of Spain, in stimulating maritime commerce, and in -broadening men’s views with regard to every phase of human activity. -The addition of a few new drugs to the pharmacopoeia was a further -result of some importance. Luther’s efforts to reform the government -and doctrines of the Church undoubtedly gave a great impetus to the -Renaissance and therefore to the growth of the science of medicine. -Men learned to use their reasoning powers with greater freedom, and as -a result our knowledge of the structure of the human body (anatomy) -and of the working of its complicated machinery, both in health -(physiology) and in disease (pathology), made astounding advances. And -it is to the consideration of these fundamental branches of medical -knowledge that we must now turn our attention. - -_Early Attempts to Dissect the Human Body._--Already as early as -during the first half of the fourteenth century physicians began to -appreciate the fact that further progress in the knowledge of medicine -was not to be attained otherwise than by a more profound study of human -anatomy than had been made up to that time; and they realized that it -was only by means of actual dissections that this more profound study -might be made. Various influences, however, co-operated to hinder such -study. In the first place, the people at large were thoroughly imbued -with the idea that dissecting a human corpse was an act of desecration, -and consequently it was by no means safe for a physician to do any -work of this character except in the most secret manner. Then, in -addition, it was commonly believed-and this belief persisted even up to -a comparatively recent date--that the bull which Pope Boniface VIII. -issued in 1300--and which declared that whoever dared to cut up a -human body or to boil it, would fall under the ban of the church--was -intended to cover dissections for purposes of anatomical study. The -recent investigations of Corradi, however, show (Haeser, p. 736 of the -third edition) that this bull was not intended to apply to dissections -for scientific purposes, but simply to put an end to the practice of -cutting up human corpses and boiling the separate sections in order to -obtain the bony framework in a condition suitable for transportation -from Palestine to Europe,--a practice which had grown to be very common -among the Crusaders. - -Mondinus’ “Anatomy,” which was published in 1314, reveals the fact -that, during the early part of the fourteenth century, several private -dissections were made. As might be expected, from the primitive -character of the illustrations that accompany the text of Mondinus’ -work, these dissections were carried out in a very imperfect manner, -for--to mention only a single example--this author admits that he made -no attempt to investigate the deeper structures of the ear, as such -an examination would necessitate the employment of violent measures, -“which would be a sinful act.” - -The archives of the Bolognese School of Medicine contain an item which -reveals the active interest taken in anatomy by the students of that -day. It reads as follows: “At Bologna, in 1319, several of the Masters -stole from a grave the corpse of a woman who had been buried two days -before, and then turned it over to Master Albertus to dissect in the -presence of a large number of students.” At the Medical School of -Montpellier, in the south of France, the Faculty obtained permission -in 1376 to dissect the corpse of an executed criminal once every -year; and the records show that the school actually availed itself of -this privilege in the years 1377, 1396 and 1446. Felix Platter, who -afterward became one of the most distinguished physicians of Basel, -Switzerland, pursued his early medical studies at the latter university -during the years 1552–1557; and, in the diary which he faithfully -kept during this period, he reveals in an interesting manner what -difficulties as well as dangers he experienced, first, in reaching -Montpellier from his home in the eastern part of Switzerland, and, -second, in obtaining greater opportunities for acquiring a genuine -knowledge of anatomy than the school itself afforded in its official -course. Although, owing to lack of space, I shall not be able to quote -in full the appropriate portions of this most interesting narrative, I -will furnish an abridged English translation of the story as it appears -in Platter’s journal or diary. In all its more important details the -account reads as follows:-- - - Our little party was composed of three persons, viz., Thomas - Schoepfius, the schoolmaster of St. Pierre; a Parisian by - the name of Robert who happened to be passing then through - Basel on his way to Geneva; and myself, a lad of sixteen. We - traveled on horseback and all three of us were armed with - rapiers. My outfit, which was handed to me by my father shortly - before our departure, consisted of two extra shirts and a few - pocket-handkerchiefs, wrapped up in a piece of waxed cloth. - In the matter of funds for the journey I received from my - father three crowns in silver and four gold pieces which, - for further security, he sewed into my vest. In addition, - he presented me with a rare piece of silver money which had - been issued by the Cardinal Mathieu Schiner, of the Canton de - Valais, who personally commanded the Swiss soldiers in their - successful combat with the troops of Louis the Twelfth, at - Marignan. It was a coin, therefore, which possessed considerable - historical value. My mother also bestowed upon me a gold coin (a - _couronne_). As a last injunction my father begged me not - to forget that, in order to procure the money which he had just - placed in my hands, as well as that which he had already paid - for my horse, he had been obliged to mortgage his property. - - We left the city at nine o’clock on the morning of Oct. 10th, - 1552, and at the same moment the news reached us that the Plague - had made its appearance in Basel. This was a most depressing - piece of intelligence, especially as we were already in great - fear that the army of the Emperor Charles the Fifth, which was - at that time on its way to the siege of Metz, would utterly - destroy our city. - - We arrived at Berne early on the morning of Oct. 12th, and, - after leaving our horses at the inn, The Falcon, lost no time - in visiting the objects of interest in that ancient city, not - forgetting the bear pit, in which there were at that time six - of these creatures. In the afternoon we resumed our journey - toward Fribourg, and very soon overtook a newly married couple. - As they were traveling on horseback like ourselves, and were - following the same route for a certain distance, we all agreed - to keep together. While passing along a shady part of the road - the bride’s dress became so firmly entangled in the branches of - an apple tree that, failing to stop the horse, she was left - suspended in the air by her skirts. I immediately dismounted and - helped her to regain her feet, to adjust her disordered dress, - and to resume her seat in the saddle. On arriving at Fribourg - we put up at the inn called _La Croix Blanche_, and soon - discovered that almost everybody in the town spoke French, a - language with which Thomas and I, who were Germans, were not - familiar; but, thanks to our companion Robert, the Parisian, we - experienced no difficulty whatever in making all our wants known - and in securing all the information that we desired. - - On the following day, Oct. 13th, it was raining hard when we - left Fribourg, and we were soon wet to the skin. After passing - through several small villages we stopped for refreshment at - an inn in the picturesque town of Romont, and at the same time - availed ourselves of the opportunity to have our clothes dried. - Then, having satisfied our appetites, we resumed our journey - in the direction of Lausanne; but we did not get very far on - our way before we discovered that Thomas had disappeared. We - were of course obliged to wait for him, and, by the time he had - rejoined the party, darkness and a thick fog combined to render - further progress very difficult, and we soon realized that we - had lost our way. We wandered up and down for some time without - encountering a barn or building of any kind in which we might - find shelter from the rain and secure a measure of protection - from the robbers who, according to common report, infested that - part of the country. Finally, however, we discovered a small - village; but, when we applied for a night’s lodging, not one - of the householders was willing to receive us. So we engaged - the services of a young peasant to act as our guide, and with - his assistance we finally reached a mean-looking inn in a - village called Mézières, which was composed of a few widely - scattered houses. We entered the tavern and found several - Savoyard peasants and some beggars seated at the long table of - the bar-room; they were engaged in eating roasted chestnuts and - black bread, which they washed down with copious draughts of a - liquor called _piquette_. They unceremoniously examined - our weapons and acted with great rudeness toward us in other - respects. The woman who kept the house said she had no other - room which she could place at our disposal, and our first - impulse therefore was to resume our journey immediately after we - had finished our meal of black bread and chestnuts; but, after - careful reflection, we came to the conclusion that such a course - might prove fraught with considerable danger. So we decided to - remain awake and watch for an opportunity to make our escape. - Very soon afterward these half-intoxicated men lay down on the - floor before the fire in the adjoining hall-way or vestibule - and fell into a sound sleep. Our guide then confessed to us - that, while at work in the stable, he had heard them planning - to waylay us on the highway at an early hour of the following - day. As soon, therefore, as we heard them all snoring lustily - we very quietly slipped out of the house. Our score having - already been paid earlier in the evening, and our horses having - been left saddled and bridled in the stable, we mounted and - took our departure by a road which led at first in a direction - different from that in which we were supposed to be traveling. - We experienced no further trouble on this part of our journey - and in due time reached Lausanne. When we told the people at the - inn about our experience at Mézières they replied that we might - consider ourselves most fortunate, as almost every day there - occurred, in the forest through which we had passed (_la Forêt - du Jorat_), a murder or some other deed of violence.[72] It - was plain, therefore, that we had had a narrow escape from death. - - In the further course of our journey along the north shore - of the lake we reached the city of Geneva on Oct. 15th. When - I called upon John Calvin, to whom my father had given me a - letter of introduction, he said to me: “My Felix, you arrive at - the right moment, for I am now able to give you an excellent - traveling companion for the remainder of your journey--_to - wit_, Dr. Michel Heronard, a native of Montpellier.” This Dr. - Heronard, as I learned subsequently, was a Protestant who played - a prominent part in the religious disorders which, a few years - later, greatly disturbed the peace of that city. - - On the 30th of October--just twenty days after we set out from - Basel--we entered the city of Montpellier, and I lost no time - in hunting up Laurent Catalan, the apothecary, at whose house I - expected to reside during my stay in that city. - -Platter had now, after a long and dangerous journey, reached one of the -three greatest medical schools of that period, and it was his hope -and expectation that he would here be able to acquire a correct and -intimate knowledge of human anatomy. He was already aware that this -knowledge could be satisfactorily obtained in only one way--that is, -by dissecting the human body; and accordingly he availed himself of -every possible opportunity, during the five years which he spent at -Montpellier, to accomplish this purpose. From the somewhat superficial -examination which I have made of the record furnished by the diary, -it appears that only five or six official lessons or demonstrations -were given by the professor of anatomy during the period of time -named; but--as every student of medicine knows--instruction of this -character is of relatively small value; and Platter himself seems to -have realized fully the truth of this statement, for during the second -year of his stay at Montpellier he joined a secret band of nocturnal -grave-robbers who were determined at all hazards to obtain the material -needed for self-instruction. The following brief description of one of -the raids made by this band of eager searchers after knowledge will -convey a good idea of the manner in which the work was conducted:-- - - Our first excursion of this kind was made on Dec. 11th, 1554. As - soon as it was really dark our fellow student Gallotus guided - us, along the road that leads to Nîmes, to the Augustinian - Monastery, which is situated about half-way between Castelnau - and the Verdanson brook. Here we were received by a monk called - Brother Bernard, a bold and determined fellow, who had disguised - himself for the business in hand. At midnight, after we had - partaken of food and drink, we started out, sword in hand, for - the cemetery which is located close to the church of Saint - Denis. Here we dug up with our hands a corpse which had been - interred that very day; and, having lifted it out of the pit by - means of ropes, and wrapped our cloaks around it, we carried the - body on two canes as far as Montpellier. Then, having concealed - our load close to the postern, alongside the city gateway, we - summoned the keeper and begged him to get us some wine, as - we were dying of thirst and very tired. While he was absent - in search of the wine three of our party slipped in through - the passage and carried the corpse safely to Gallotus’ house, - which was only a short distance from the gate. The gate-keeper - returned in due time with the wine, and did not appear to have - the slightest suspicion of the trick that we had played upon - him. It was now three o’clock in the morning. - -The control exercised by the authorities over the practice of -dissecting human corpses differed very appreciably at different dates -in different parts of Europe. Thus, for example, orders were issued to -the Italian bishops during the latter part of the fourteenth century to -put a stop to further dissections, and for a period of over one hundred -years these orders accomplished the purpose desired. On the other -hand, the Emperor Charles the Fourth adopted a more liberal course: -from the year 1348 on he permitted dissections of human corpses to be -made without hindrance in Prague, Bohemia, but his liberality in this -particular appears to have been of little use, for there is no evidence -to show that the knowledge of anatomy made any appreciable advance -anywhere in Europe until after the beginning of the sixteenth century. - -Gabriel Zerbi of Verona (1468–1505) published at Venice in 1502 the -first modern treatise on human anatomy that deserves to receive special -mention. Pagel speaks of it as containing fairly good descriptions of -different parts of the body. Zerbi held the Chair of Medicine, Logic -and Philosophy in the University of Padua, and lectured first in that -city, next at Bologna, and finally at Rome. One incident in his career -may prove of interest to the reader as showing the fearful risks to -which a practicing physician in those days was sometimes exposed. The -incident was of this nature:-- - - A wealthy pacha in Constantinople, failing to obtain relief from - his malady at the hands of the native Turkish doctors, summoned - an Italian physician from Venice. Zerbi, whom the ruling - Doge invited to accept the summons, sailed immediately for - Constantinople in company with his two sons who were mere lads. - The treatment which he inaugurated proved promptly successful, - and Zerbi, having been handsomely remunerated for his services, - was already on his way back to Venice when his ship was - overhauled by a swift-sailing caique on board of which were - the sons of his recent patient, who--as the story goes--had - celebrated his recovery by eating and drinking to excess. - This debauch promptly caused his death--probably by cerebral - apoplexy; but the sons were convinced that it was the result of - poison administered by Zerbi, and accordingly they lost no time - in starting out to capture the supposed murderer. Their first - act, on reaching the vessel which they were pursuing, was to - kill the younger of the two sons, in the presence of the father, - by sawing his body in two lengthwise. Then they killed Zerbi - himself in the same manner. - -Tiraboschi, the first historian of Italian literature (1731–1794), is -mentioned by Dezeimeris as his authority for this terrible tale. The -events here narrated occurred in 1505. - -At the beginning of the sixteenth century--the period with which our -history now has to deal--the only available knowledge of anatomy -was that which had been supplied by Galen in the third century of -the Christian era, and which had been handed down through all the -intervening centuries as something absolutely correct and not to be -challenged. But the time had arrived when men were no longer willing -to accept as truth the teachings of any individual until they had -subjected them afresh to the most searching investigations; and thus -it came about that a group of remarkably able men devoted all their -energies, during the greater part of the sixteenth century, to a very -critical study of human anatomy. As the work accomplished by these -men constitutes a very important chapter--perhaps the most important -chapter--in the history of medicine, I may be pardoned if I devote a -disproportionately large amount of space to the consideration of the -careers of the more prominent of these founders of modern anatomy, and -to an enumeration of the details of the work which they accomplished, -and which furnished the most complete verification of the truth stated -by Francis Bacon, Lord Verulam (1561–1626), in the following words -(_translation_):-- - - Man has no other means of getting at and revealing the truth - than by induction coupled with a never-tiring, unprejudiced - observation of nature and an imitation of her operations. - Actual facts must first be collected, and not created by a - process of speculation. - -One of the earliest and most thorough students of human anatomy was -Marc Antonio della Torre (1473–1506), who belonged to an honorable -family of Verona, several members of which had attained distinction -as physicians. He planned to publish a treatise on anatomy, and, with -this object in view, secured the assistance of Leonardo da Vinci -(1452–1515), the celebrated painter, architect and civil engineer, to -make life-size pictures of the parts which he had dissected with such -care. But, after the latter had completed many of the drawings which -were intended to serve as illustrations for the projected treatise, -Della Torre unexpectedly died, and the book was never finished. Quite -a number of the drawings, however, found their way to England, and for -many years past they have been carefully treasured at Windsor Castle -and in certain private collections. If Della Torre’s life had been -spared it is highly probable that his treatise on anatomy, equipped -with illustrations copied from this great artist’s drawings, would have -constituted a formidable rival of Vesalius’ famous work. - -Not long after this event it became the rule, among the leading -painters and sculptors of the Renaissance period, to pay a great deal -of attention to the study of human anatomy. The museums of Central and -Southern Italy contain quite a large number of anatomical drawings that -were made by Michael Angelo, by Raphael and by other great masters -of that period. Doubtless many of my readers recall seeing, in the -Cathedral of Milan, Marco Agrate’s (1562) extraordinary masterpiece, -in the form of a life-size black marble statue which represents Saint -Bartholomew standing erect, and carrying on one arm the folded skin of -his entire body. In this statue all the muscles and bony prominences -are modeled with perfect accuracy. It is a remarkable work of art. - - - - - CHAPTER XXVII - - THE FOUNDERS OF HUMAN ANATOMY AND PHYSIOLOGY - - -Among the earliest physicians of this period to inculcate the -importance of substituting a correct knowledge of anatomy for the -frequently incorrect descriptions that had been prepared by Galen and -handed down through the succeeding centuries, were the following: -Jacques DuBois of Paris (1478–1555), who was perhaps better known by -his latinized name of “Sylvius”; Guido Guidi (died in 1569), who was -also known as “Vidus Vidius”; and Winther of Andernach, a small city -on the Rhine. These three men, all of whom taught anatomy at Paris, -were commonly considered the best anatomists of that early period. -DuBois was further entitled to the credit of having been the first -physician to inject blood-vessels with a material that renders them -more easily visible, and also the first person in Paris to dissect a -human corpse. It was from these men that Vesalius, who afterward became -such a famous anatomist, received his first practical instruction in -this branch of medical science. Nothing further need be said here of -DuBois, but brief sketches of Guido Guidi and of Berengarius of Carpi, -another contemporary anatomist of considerable distinction, deserve to -find places in our history of this period. Vesalius’ facetious remark -that “Winther of Andernach never used a knife except for the purpose -of dissecting his food” absolves us from the duty of saying anything -further about his career as an anatomist. - -In 1542 Francis the First, King of France, gave a great impulse to the -study of medicine by calling Guido Guidi from Florence, Italy, to teach -that science in the _Collége de France_, an institution which -he had founded at Paris in 1530. Guidi, upon his arrival in Paris, -was at once most cordially received, both by those who were to be his -colleagues and by the King. Francis bestowed upon him a suitable gift, -appointed him to the position of First Physician (Archiater) at his -Court, and assured him that he would receive an ample salary during -his residence in the French metropolis. In 1547, after the death of -Francis the First, Guidi returned to his home in Florence, where Cosimo -dei Medici, at that time the head of the Florentine Republic and a -little later Grand Duke of Tuscany (Cosimo III.), made him his First -Physician and gave him the appointment of Professor of Philosophy in -the University of Pisa. Not long afterward Guidi was transferred to the -Chair of Medicine. He retained this position almost up to the time of -his death (May 26, 1569), and during this long period Cosimo bestowed -upon him various ecclesiastic honors, which not only increased his -social rank but added materially to his financial resources. - -Dezeimeris says that, while Guidi does not deserve to be placed, as -an anatomist, in the same rank with Vesalius and Fallopius,[73] he -merits full credit for the very important service which he rendered the -physicians of his day by placing within their reach translations of -certain Greek treatises relating to surgical topics--such treatises, -for example, as those of Hippocrates on ulcers, on wounds of the -head, on the joints and on fractures (with Galen’s comments), Galen’s -treatise on fasciae, and that of Oribasius on ligatures and other -surgical contrivances. - -Apart from his merits as a worker in the field of medical science, -Guidi occupies a creditable place in the history of medicine as a -fine type of the well-educated and kindly disposed physician, as the -following testimony given by Benvenuto Cellini, the distinguished -Florentine sculptor, shows:-- - - On the occasion of my visit to Paris I made the acquaintance - of Messer Guidi, and I wish to state in what a very friendly - manner I was received by that noble citizen of Florence and - excellent physician, the most virtuous, the most lovable, and - the most domestic man whom I have ever met. - -Guidi’s treatise on anatomy was first published at Venice (under the -editorship of his nephew) in 1611--_i.e._, forty-two years after -his death. His translations from the Greek treatises of Hippocrates, -Galen and Oribasius will be found in the work which bears the title -“_Collectio Chirurgica Parisina_,” Paris, 1544. - -Berengarius of Carpi (a small town in Northern Italy), who died in -1530, is pronounced by Kurt Sprengel a worthy predecessor of Vesalius. -He was Professor of Anatomy, first at Pavia and then at Bologna (from -1502 to 1527), and he is reported to have dissected more than one -hundred(!) cadavers during that period. Fallopius and Eustachius were -among his pupils, and it was their opinion that he did more than -anybody else to revive the interest in anatomical work. The famous -sculptor, Benvenuto Cellini (1500–1571), is authority for the statement -that Berengarius was not only an experienced anatomist and practicing -physician, but also a very skilful draughtsman; the three works which -he published being illustrated with a certain number of original -woodcuts that are not without interest both to the anatomist and to the -lover of art. - -Andreas Vesalius (1514–1564) was born at Brussels, of German parents -whose home was located at Wessels on the Rhine,--whence the name -“Vesalius.” His father was the apothecary of the Princess Margaretha, -Charles the Fifth’s aunt, and several of his ancestors had been -physicians of considerable distinction. At Louvain he received, in -early youth, a thorough training in the Latin, Greek and Arabic -languages and also in mathematics. When he was about eighteen years -of age, he visited Montpellier and afterward Paris, at which latter -city he received practical instruction in anatomy from the three -men whose names I have mentioned in the preceding paragraph--viz., -Guido Guidi, Jacques DuBois and Winther of Andernach. The instruction -in anatomy given in Paris at that period (about 1533) consisted -in interpretations of Galen’s teachings, in dissections of a few -animals, and in occasional demonstrations--which never lasted longer -than three days--of the easily accessible parts of a human cadaver. -Scanty as were these sources of information, Vesalius cultivated -them with the greatest zest. From time to time his teacher, DuBois, -noting the interest which his pupil took in anatomy, and recognizing -his fitness for imparting instruction, assigned to him the special -duty of rehearsing, in the auditorium, before his fellow students, -the essential facts of the day’s lecture. After war had been declared -between the Emperor Charles the Fifth and Francis the First, King of -France, Vesalius left Paris and returned to Louvain, where he began -lecturing on anatomy. These lectures constituted the very first attempt -at anything like systematic instruction in anatomy that is known -to have been made at that ancient university. It was while he was -engaged in this work that Vesalius, in order to become the possessor -of an entire human skeleton,--a thing of which he felt a very great -need,--ventured to remove from the gallows, outside the city, the -cadaver of a criminal. This, as Haeser declares, was an act of great -boldness and full of peril. - -The life of a military surgeon attached to the army of Charles the -Fifth, which was the life that Vesalius led during the following year -or two, was not sufficiently attractive to divert his mind seriously -from his favorite study; and it is therefore not surprising that -we find him, at the age of twenty-three, accepting from the Senate -at Venice the appointment of the professorship of anatomy at the -University of Padua. When he entered upon this new work Vesalius felt -considerable uncertainty as to the correctness of the anatomy which -he was then teaching, and it is therefore easy to understand why his -first three lectures were based entirely upon the teachings of Galen; -but, before he had finished the third one of the series, he made up his -mind that he would cut loose from the anatomy of the ape and confine -himself to that of the human subject, as was then being revealed to -him more and more perfectly from his own dissections. The stock of -knowledge which he had thus begun to accumulate, increased steadily -until, after seven years of teaching at Padua, Bologna and Pisa, at -each of which schools of medicine he gave courses in anatomy of seven -weeks’ duration, and after conducting the most painstaking dissections -of a number of human cadavers, he finally declared that he was ready to -publish his great treatise on anatomy. Some of his friends, foreseeing -clearly what a storm of protest the new book would arouse among the -followers of Galen, urged him to postpone for a time its publication; -but a few others agreed with him that it should be issued without -further delay. Accordingly Vesalius sent the manuscript of his work at -once to the printers at Basel, and the book was finally published in -June, 1543, before its author had attained his twenty-ninth year. Its -title was “_De corporis humani fabrica_,” and it was provided with -exceptionally fine pictorial illustrations, most of which were drawn, -as is generally believed, by John de Calcar, one of Titian’s pupils. A -second edition, superior in every respect to the first, was published -in 1555. In comparison with this great work the few treatises written -by Vesalius in later years are of minor importance. - -Vesalius may rightly be considered the founder of modern anatomy, -for he was the first to furnish correct information, based on actual -dissections of the human cadaver, respecting quite a large number of -the more important anatomical relations; and by this very act he won -the further credit of having dealt the first effective blow toward the -dethronement of Galen, the man who, next to Hippocrates,--probably even -more than Hippocrates,--had exercised, by his teachings in nearly every -department of medical science, almost despotic sway over physicians -for considerably more than one thousand years. At this distance of -time, it is hard to realize what a startling effect was produced by the -announcement of the discovery of so many errors in Galen’s scheme of -anatomy. Albert von Haller, the great authority on medical literature, -speaks of Vesalius’ book as an “immortal work”; and, although its title -would lead one to suppose that it deals only with the construction of -the human body, an examination of its contents reveals the fact that -it contains in addition quite full information regarding physiology and -pathological anatomy, as well as many details relating to comparative -anatomy. Perhaps the most marvelous thing about this book is the -fact that its author completed his work before he had reached his -twenty-eighth year. It may also interest the reader to learn that, -prior to 1914, the University of Louvain possessed a copy of Vesalius’ -great work printed on vellum and illustrated with many drawings in -colors; but I am unable to say whether this beautiful volume did or did -not escape destruction at the hands of the ruthless men who invaded -Belgium during the summer of that memorable year. - - [Illustration: FIG. 14. ANDREAS VESALIUS. - - (After the portrait by Van Calcar in the Royal College of - Surgeons, London.) - - Copied from the reproduction published in the _Nederlandsch - Tijdschrift voor Geneeskunde_, Jan. 2, 1915.] - -When the human mind has adjusted itself, in the course of years, to -consider certain beliefs and ideas as settled truths, it comes as a -painful shock to be told that these beliefs are erroneous and that -new ones must take their places. This is precisely what happened when -Vesalius’ book was first published. From one end of Europe to the -other there was a very great stir among the well-educated physicians; -the more liberal-minded being ready to accept at once the genuineness -of the new anatomy, whereas others,--and possibly they represented -the larger number,--acting under the influence of personal jealousy -or perhaps blinded by the belief that it was impious not to accept -without questioning the descriptions made by Galen, were scandalized -by the boldness of Vesalius in asserting that many of the statements -made by this great medical authority were incorrect. Jacques DuBois, -whose name has been mentioned by me on a previous page, was one of the -most bitter of Vesalius’ assailants. In a pamphlet which he published -in Paris in 1551 he even went so far as to speak of his late pupil as -“a crazy fool who is poisoning the air of Europe with his vaporings.” -On account of their former pleasant relations, and also because DuBois -was at that time an old man, Vesalius made no reply to these attacks; -but when Bartholomaeus Eustachius, Professor of Anatomy at Rome, one -of the most celebrated anatomists of that period, and a man of his own -age, entered the lists as the champion of Galen, Vesalius took up the -challenge, left the work upon which he was then engaged, and began a -tour of visits to the universities of Padua, Bologna and Pisa, for the -express purpose of disproving, by the aid of numerous dissections, -the statements made by his antagonists. Throughout this tour he was -received everywhere with enthusiasm, the older men among the teachers -of anatomy vying with the younger in manifesting the strength of their -approval. The entire journey, says Haeser, was from beginning to end -a series of the most brilliant triumphs. But, notwithstanding this -vindication, which most men would have accepted with the greatest -satisfaction, Vesalius returned to his home in Brussels only to find -that the bitter attacks made by his enemies had not ceased. This -depressed him greatly, for he was not philosophical enough to recognize -the facts that jealousy was at the bottom of this ill feeling toward -him, and also that sufficient time had not yet elapsed for the news -of his triumphant vindication to travel from Italy to Belgium. While -suffering from this fit of the blues he committed to the flames all his -books and manuscripts. These latter, it appears, contained not only -the fruits of many years of laborious anatomical and physiological -research, but also a large number of memoranda relating to pathological -anatomy. - -In 1556, complaints having reached the ears of Charles the Fifth to -the effect that the sin of dissecting human corpses was greatly on the -increase, this monarch decided to refer the question to the Theological -Faculty of the University of Salamanca, in the northwestern part of -Spain, for an authoritative opinion. The reply which these broad-minded -theologians sent to the Emperor was most satisfactory. It is reported -to have been expressed in the following words: “The dissection of -human cadavers serves a useful purpose and is therefore permissible to -Christians of the Catholic Church.” This decision did not of course -put an immediate end to the harsh criticisms and petty persecutions of -the bigots; but, as the years went by, it was noted that the work of -scientific research in human anatomy and physiology acquired greater -freedom of action, and it is fair to assume that this result was -largely due to the famous decision to which I have just referred. - -Shortly after Vesalius had retired, as stated above, from active -participation in anatomical research work, he was called by Charles the -Fifth to serve him in the capacity of private physician. During this -service, which lasted for several years, he visited, in company with -the Emperor, many of the principal cities of Europe; and then, when the -latter abdicated the throne of Spain,--for Charles was not only Emperor -of the Holy Roman Empire but also King of Spain,--Vesalius became the -private physician of Philip the Second, Charles’ son and successor on -the Spanish throne. This long period is largely a blank in the history -of Vesalius. Toward the end he got into trouble with the Inquisition -and was obliged, as a means of escaping the punishment of death, to -undertake a voyage to the Holy Sepulchre in Jerusalem. While he was -in that city he received an official invitation from the Senate at -Venice to fill the Chair of Anatomy at Padua. He then at once turned -his steps toward Italy, doubtless very happy over the prospect of once -more engaging in anatomical work; but he was shipwrecked on the coast -of the Island of Zante, October 2, 1564. Thirteen days later, before he -had completed his fiftieth year, he died from starvation and exposure. -A memorial tablet was placed in one of the neighboring churches on the -island, and in 1847 his Belgian compatriots erected a suitable monument -to his memory in the city of Brussels. - -Admirable as was Vesalius’ treatise on human anatomy, it was soon -discovered that it was deficient in certain particulars. Not a few of -the descriptions, for example, were incomplete, and there were also a -number of parts or organs for which no descriptions whatever had been -provided. Many of these deficiencies were supplied by contemporary -anatomists, nearly all of whom were Italians. First and foremost among -this secondary but yet very important group of laborers in the field of -original research work, the names of Fallopius and Eustachius deserve -to be mentioned. - -Gabriele Fallopius, who was born in Modena in 1523, was appointed to -the Chair of Anatomy at Ferrara when he was only twenty-four years -of age. Subsequently he taught at the University of Pisa. At the -time of his death in 1563 he was Professor of Anatomy, Surgery and -Botany at Padua. He made many important discoveries in anatomy, more -particularly in relation to foetal osteology and the distribution -of the blood-vessels. His work in the latter department is all the -more remarkable from the fact that it was accomplished at a time when -the art of injecting blood-vessels with some opaque material was -unknown in Italy. His name has been perpetuated in connection with -the Fallopian tube. As a man Fallopius was much liked because of his -kindly disposition and absence of conceit. The only treatise which he -published was that entitled “_Observationes anatomicae_,” Venice, -1561. - -Bartholomaeus Eustachius, born at San Severino, in the Marches of -Ancona, in the early part of the sixteenth century, was one of the most -distinguished physicians of his day. He taught anatomy at the famous -University of Sapienza at Rome, and devoted a great deal of time and -thought to the preparation of a large work which was to bear the title -“On the Dissensions and Controversies Relating to Anatomy”; but death -overtook him before he had completed this undertaking. It appears, -however, that in 1564--that is, ten years before he died--he published -a smaller work containing separate chapters on the kidneys, the organ -of hearing, the movements of the head, the vena azygos, the vena -profunda of the arm, and on certain questions relating to osteology; -and he introduced, as illustrations for the text, eight plates of -octavo size. These plates and thirty-eight others, which were to have -served as illustrations for the great work, were all completed as early -as during the year 1552. The artist Pini, who made the drawings that -served as the originals from which the plates were made, was related in -some degree to Eustachius, and upon the latter’s death the metal plates -became his property by inheritance. But nothing further was heard of -them until they were discovered, early in the eighteenth century, by -Lancisi, the Pope’s attending physician, in the possession of Pini’s -descendants. They were published for the first time in 1714. Haeser -says that these pictures are true to nature, but that in artistic merit -they are not equal to those which belong to the treatise published by -Vesalius. The name Eustachius is permanently connected with the channel -which leads from the tympanum to the nasal cavities--the Eustachian -tube. - -Only the briefest possible mention may here be made of those anatomists -who, following immediately in the footsteps of the three great leaders -mentioned above, played parts of greater or less importance in building -up the science of anatomy. Each one of them did creditable work in -correcting the errors made by their predecessors or in supplying -descriptions of structures or structural relations which these pioneers -had overlooked. Thus, long before the sixteenth century came to an end, -the gross anatomy of the human being had attained a large measure of -the completeness which it possesses to-day. The names of some of the -more prominent men among those to whom I have just referred are the -following: Giovanni Filippo Ingrassia, Matthaeus Realdus Columbus, -Julius Caesar Arantius, Constantius Varolius, Volcher Koyter and -Hieronymus Fabricius ab Acquapendente. - -Ingrassia (1510–1580), a Sicilian physician, cultivated osteology -assiduously, and is entitled to special credit for having first -described the stapes, the third one of the ossicles of hearing, and -for having made valuable contributions to our knowledge of epidemic -diseases. He was a professor in the University of Naples, and, after -the year 1563, held the position of Archiater in Palermo, Sicily. His -descriptions of the different bones of the skeleton were made with such -care and thoroughness that later anatomists found very little for them -to discover or to alter. - -Matthaeus Realdus Columbus (or simply Realdus Columbus), who died in -1559, was born in Cremona, Northern Italy. He served for some time as -Prosector to Vesalius at Padua, and then succeeded him in the Chair -of Anatomy, first at Padua and afterward at Pisa. The last teaching -position which he held was that of Professor of Anatomy in Rome, in -which city he counted Michael Angelo among his intimate friends. -The discoveries which he made in anatomy were quite numerous and of -considerable importance, and his descriptions were distinguished by -an unusual degree of accuracy and clearness. Unfortunately, he did -not hesitate, at the same time, to exalt the value of his own work by -disparaging that of his famous teacher. - -Arantius, who also was one of the pupils of Vesalius, occupied the -Chair of Anatomy in his native city of Bologna during the latter half -of the century. His death occurred in 1589. The particular department -in which he gained considerable fame was that of the foetus, the -placenta, the uterus, etc. His descriptions of these structures are -written with very great care. Blumenbach gives him credit for having -been the first anatomist to furnish a description of the pregnant -uterus in its different stages. His earliest published work bears the -title “_De humano foetu opusculum_” Rome, 1564. - -Constantinus Varolius, whose name is imperishably connected with that -part of the brain which is known as the “Pons Varolii,” was born in -Bologna in 1543. He was appointed Professor of Anatomy in the Academy -of his native city at an early age, and soon distinguished himself by -the careful studies which he made of the human brain and nervous system -in general. Before his untimely death at the age of thirty-two he was -chosen the attending physician of Pope Gregory the Thirteenth. His -earliest published work bears the title “_De nervis opticis, etc., -epistola_,” Padua, 1573. - -Volcher Koyter, who was born at Groningen, North Holland, in 1534, -studied under Fallopius and Guillaume Rondelet (1507–1566), to whom -the University of Montpellier was indebted for its anatomical theatre, -and to whom (rather than to Gaspard Bauhin of Basel) is due the honor -of discovering the ileo-caecal valve. Koyter was one of the earliest -workers in the field of comparative anatomy--a department of knowledge -to which Vesalius had already made some creditable additions; and -his two most important published treatises bear these titles: “_De -ossibus et cartilaginibus corporis humani tabulae_” (Bologna, 1566), -and “_Externarum et internarum principalium humani corporis partium -tabulae_” (Nuremberg, 1573). He died in 1600. - -Hieronymus Fabricius was born in 1537 at Acquapendente, a small city -of Etruria, about fifty miles northwest of Rome. He studied anatomy -at Padua under Fallopius, and, after the latter’s death, was assigned -to the duty of making the necessary dissections and anatomical -demonstrations before the class. In 1565 he was appointed Professor -of Surgery, with the understanding that he was to continue giving his -demonstrations in anatomy. The salary which he received for this double -work was 100 ducats, but it was increased from time to time until -finally he was paid 1100 ducats yearly. At the end of thirty-six years -he was retired upon a pension of 1000 ducats for the remainder of his -life, and was allowed the privilege of appointing his successor in the -Chair of Surgery. He gave the place to Julius Casserius in 1609. To -distinguish him from another Fabricius, who gained great distinction in -the field of surgery, it has always been customary for later historical -writers to speak of him as “Fabricius ab Acquapendente.” His namesake -is known as “Fabricius Hildanus.” - -As a teacher of anatomy, especially in its relations to physiology, -Fabricius was held in the highest esteem. Albert von Haller speaks of -him as being one of the glories of the Italian school of medicine. -Pupils came in flocks from all parts of Europe to attend his lectures, -and among them were some who, like William Harvey of England, afterward -attained great celebrity for the effective work which they did in -advancing the science of medicine. One of the attractive features of -Fabricius’ teaching was to be found in his practice--something quite -new at that period--of showing to the students, not only the particular -organ (human) upon which he happened then to be lecturing, but also -the corresponding organ in one or several of the animals; thus enabling -them to learn what were the features possessed in common by all the -species, and what were those in respect of which the species differed. -As time went on, the number of those who came to witness his anatomical -demonstrations increased so greatly that he felt impelled to build, -at his own expense, a new and larger amphitheatre. But even this, in -a short time, proved to be too small, and then the Senate at Venice, -which exercised a governing control over the University of Padua, -erected (in 1593) a much larger and more complete amphitheatre, upon -the walls of which there was placed an inscription stating that it had -been built in honor of Fabricius. Among the other distinctions which -were conferred upon him at this time he was raised to the rank of -Knight of the Order of Saint Mark and made an honorary citizen of Padua. - -Fabricius ab Acquapendente added to our stock of anatomical knowledge -by his researches on the structure of the oesophagus, stomach and -intestines, the eye, ear, larynx and foetus. One of his chief claims to -distinction, however, rests upon the fact that he wrote an elaborate -monograph on the valves of the veins. Although these structures had -been seen and described at an earlier date by Charles Estienne, -Berengarius, Vesalius, Cannani and others (Fra Paolo Sarpi, for -example), nobody had yet offered a satisfactory explanation of their -probable use or had traced them through the venous system at large. -In 1574 Fabricius demonstrated their presence in all the veins of the -extremities. - -But Fabricius ab Acquapendente was not merely a good anatomist and -physiologist; he was also a most distinguished surgeon and general -practitioner. From far and from near patients came to consult him -about their ailments, and he appears to have been immensely popular -among all classes of the community. His home, situated on the River -Brenta, just outside the city of Padua, was most attractive, and it was -there that he dispensed hospitality in a princely fashion. One of his -peculiarities was that in many cases he was unwilling to accept a fee -for his services. As a natural result, gifts of all sorts, many of them -of considerable value, were showered upon him. He devoted one of the -rooms of his residence to the purposes of a cabinet or museum, in which -all those gifts which were suited to such display might be properly -exposed to view, and over the doorway of the room he placed this -inscription, “_Lucri neglecti lucrum_,” which I venture to render -into English by the following, “Costly gifts representing unproductive -wealth.”[74] - -Fabricius remained a bachelor all his life, and at the time of his -death (May 21, 1619, at the age of eighty-two) his fortune, which he -bequeathed to his brother’s daughter, amounted to 200,000 ducats--a -very large sum in those days. - -The writings of Fabricius were published at Leipzig in a single volume -in 1687, but Johann Bohn, who edited the collection, omitted the -different prefaces which Fabricius had written. In the Leyden edition -of 1737 this defect has been remedied. - -To furnish here even a much abbreviated account of the important -discoveries made in anatomy and physiology during the sixteenth century -would call for a much larger amount of space than can possibly be given -to these two branches of medical science. Our modern text books on the -subject of anatomy alone are, in a certain sense, catalogues of these -very discoveries, and every physician knows what a vast amount of space -they occupy. I have already made mention of a few of these discoveries, -and, when I come to consider the splendid work done by William Harvey -in the early part of the seventeenth century, I shall have occasion -to recapitulate briefly the more important discoveries made by his -predecessors in this particular field. In this way I shall be able to -supply information regarding several of the discoveries which I am now -obliged to pass over in silence, but which, under other circumstances, -would more properly receive consideration in the present chapter. - - - - - CHAPTER XXVIII - - FURTHER DETAILS CONCERNING THE ADVANCE IN OUR KNOWLEDGE OF - ANATOMY--DISSECTING MADE A PART OF THE REGULAR TRAINING OF - A MEDICAL STUDENT--IATROCHEMISTS AND IATROPHYSICISTS--THE - EMPLOYMENT OF LATIN IN LECTURING AND WRITING ON MEDICAL TOPICS - - -_Further Details Concerning the Advance in Our Knowledge of Gross -Anatomy._--In the preceding chapter I have given some account of -the efforts made during the sixteenth century by certain physicians -to lay solidly the foundations of a gross anatomy of the human body. -The time was ripe for such a movement, and the right sort of men took -charge of it and pushed it forward to such a stage of successful -accomplishment that we physicians of to-day are able to continue in -the direction indicated, and under the impulse communicated, by these -master builders. These men, it should be remembered, did something more -than merely to lay solid and durable foundations in the form of an -accurate anatomy, they also taught the correct methods of procedure for -the erection of the superstructure of the science of medicine. - -Up to the end of the sixteenth century almost all the work done in -anatomy was effected with the aid of the scalpel alone, the object -being to isolate and expose clearly to view the larger tissues and -organs, such as muscles, arteries, veins, nerves, etc. In a very few -instances more elaborate methods were devised, even as early as during -the fifteenth century, by men of exceptional cleverness. Thus, for -example, in 1490, Alexander Benedetti, Professor of Anatomy at Padua, -invented a method of preserving muscles, nerves and blood-vessels as -permanent dry specimens, and it is said that he sold such preparations -for large sums of money. As already stated on a previous page, the -injection of blood-vessels with certain fluids was also employed to a -very limited extent at this early period as a means of distinguishing -them more easily from the surrounding structures; but this practice -gave place, during the seventeenth century, to the better method of -employing, as an injecting material, a semi-fluid preparation which -became quite solid soon after it had penetrated well into the interior -of the vessels, and to which any desired opaque color might be given. -This method was invented by the Hollander, John Swammerdam (1627–1680) -and perfected by Van Horne. It was largely by the employment of this -procedure that Friedrich Ruysch of Amsterdam (1638–1731), Professor -of Anatomy and Botany in the university of his native city, gained -such celebrity throughout Europe for the great beauty of his permanent -anatomical preparations. Hyrtl mentions the fact that Peter the Great -of Russia, who resided for a certain length of time at Zaandam, near -Amsterdam, in order that he might familiarize himself with the art of -ship-building, was in the habit of visiting Ruysch from time to time -in his museum and laboratory; and finally (in 1717) bought from him, -for the sum of 30,000 florins, his entire collection of specimens, -together with the formula of the mixture which he employed in making -his injections. The collection itself, it should be stated, contained -not only specimens illustrative of normal human anatomy (_e.g._, -the various solid and hollow organs, the organs of special sense, -and objects belonging to the vascular, muscular, nervous and osseous -systems), but also many specimens illustrating pathological and -comparative anatomy, and a great variety of monstrosities. - -Ruysch also attained remarkable success in restoring the rosy color -and soft flexibility of the skin and the natural facial expression -in certain dead bodies by the employment of a preservative fluid -widely known as “_Liquor balsamicus_.” Tradition says that in one -instance, that of a child whose corpse had been treated in this manner -by Ruysch, the face presented such a perfectly life-like appearance -that the Czar, as he passed near the object, thought he was looking -upon a sleeping child and gave it a kiss. - -The aged professor lived to be ninety-three, and continued giving his -lectures on anatomy almost up to the day of his death, which resulted -from accidental injuries. When it became clear that these were of so -serious a nature that he could not possibly recover, he asked to be -carried on a stretcher into the assembly room in order that he might -say a farewell to the students who had been attending his lectures. - -Although some critics have intimated that Ruysch should be ranked -merely as a very clever mechanic in the domain of anatomy, there are -certain well-established facts which show that this estimate of the man -is unfair. It is known, for example, that he was the first anatomist -to call attention to the features which distinguish the male from the -female skeleton (_e.g._, the differences in the form of the pelvis -and of the thorax). Ruysch also advanced our knowledge of the vascular -system by means of the improvements which he effected in the method of -injecting blood-vessels. His skill in this special work was so great -that people were wont to say of him that he possessed the fingers of -a fairy and the eyes of a lynx. It was Ruysch too who furnished the -first descriptions of the bronchial blood-vessels and of the vascular -plexuses of the heart. Finally, the term “_membrana Ruyschiana_,” -in connection with the choroid of the eye, bears testimony to the fact -that he was also an original worker in this very difficult corner of -the field of human anatomy. - -The crowning event in the life of Ruysch--an event which shows -how wasteful many of us men are of our productive powers when we -deliberately retire from all participation in active work, physical or -mental, at the comparatively early age of sixty-five--occurred in 1717, -when he had attained the age of seventy-nine. Peter the Great had -hardly left the premises with the great collection of specimens for -which he had paid such a fabulous price, when Ruysch began the making -of a new collection; and at this task he worked so diligently that in -less than ten years he was able to deliver to John Sobieski, King of -Poland, the greater part of the new collection (for which he received -the sum of 20,000 florins). Then followed a period of about three years -during which he continued active work as a teacher of anatomy, death -alone seeming to possess the power to arrest his extraordinary energy. - -Ruysch’s only published works are the following: Catalogue of the -Specimens contained in his Museum, Amsterdam, 1691; and a _Thesaurus -Anatomicus_, in 10 volumes, Amsterdam, 1701–1715. - -In reading over the account which I have given of the discoveries -made in gross anatomy and in physiology during the sixteenth and -seventeenth centuries, I find that I have omitted some that may just as -appropriately be mentioned in this section as in that which I intend to -devote to work done in the domain of minute anatomy. I shall therefore -refer to them briefly now, and then pass on to the consideration of the -latter branch of my subject. - -Eustachius, the famous Italian anatomist, deserves special credit -for the experimental methods which he devised and employed in his -efforts to gain a better knowledge of the anatomy and physiology of -the kidneys. Moritz Hofmann of Fürstenwald discovered in 1641, in the -turkey gobbler, the outlet duct of the pancreas, and a short time -afterward George Wirsung, a Bavarian, discovered the same structure in -the human being. Then, in 1651, Olaus Rudbeck, Professor of Anatomy -in the University of Upsala, Sweden, discovered the lymphatics of -the intestines, and established (at a later date) the fact that they -are a separate system from that of the chyle ducts. Francis Glisson -(1597–1677) of Cambridge University, England, one of Harvey’s pupils, -made two series of anatomical investigations of a most creditable -character--the first concerning the relationship which exists -between the intestinal lymphatics and the alimentary canal, and the -second regarding the internal construction of the liver (“capsule of -Glisson”). Thomas Wharton (1610–1673), a native of Yorkshire, England, -and a London practitioner of medicine, discovered the outlet channel -of the submaxillary salivary gland, now known as “Wharton’s duct,” -and he also published the first exhaustive treatise on the structure -of glands in general (thymus, pancreas, submaxillary, etc.). About -the middle of the seventeenth century Nathanael Highmore of Oxford, -England (1613–1685), discovered and adequately described the cavity -in the superior maxilla which bears his name (“antrum of Highmore”), -and which in comparatively recent years has assumed such importance -from the viewpoint of the practical surgeon. A Danish anatomist, -who is known to us English-speaking physicians as Nicholas Steno -(1638–1686), but to his own countrymen as Niels Stensen, discovered -the outlet duct of the parotid gland (“Steno’s duct”). Stephen -Blancaard (1650–1702), a practicing physician of Amsterdam, made the -first successful injections of capillary blood-vessels; and Domenico -de Marchettis (1626–1688), Professor in the University of Padua, -employing Blancaard’s technique, succeeded in proving that the finest -ramifications of both veins and arteries communicate the one with the -other. To Conrad Victor Schneider, a professor at the University of -Wittenberg, Germany (1614–1680), we are indebted for putting an end -forever to the erroneous doctrine that the nasal mucus is produced -in the brain. He did not, however, have the good fortune to discover -the glands from which this mucus actually comes; the credit for -this discovery being due to Niels Stensen. Among the host of other -successful discoverers in the domain of anatomy during the seventeenth -century the following men deserve at least to be mentioned by name: -Johann Conrad Peyer (1653–1712) of Schaffhausen, Switzerland; Johann -Conrad Brunner (1653–1727), also a native of Switzerland; Theodor -Kerckring (1640–1693) of Hamburg, Germany; Anton Nuck (1650–1692), -Professor of Anatomy at the University of Leyden, Holland; Reignier -de Graaf (1641–1673), a native of the Netherlands; and Thomas Willis -(1622–1675) and William Cowper (1666–1709), both of them Englishmen. - -And, finally, it may be stated that all the leading anatomists of the -sixteenth century devoted a great deal of time to the study of the -manner in which the nerves are distributed throughout the body and -to ascertaining the arrangement of the intracranial and intraspinal -nervous structures. To give even the most superficial account of what -these men accomplished would occupy far more space than can well be -spared for this purpose. Kurt Sprengel is my authority for saying -that, of all the workers in this particular field during the period in -question, Fallopius is entitled to receive the greatest credit for what -he accomplished. - -_The First Beginnings of Minute or Microscopic Anatomy._--The -anatomy of the tissues--microscopic anatomy--begins with Marcello -Malpighi (1628–1694), a native of Crevalcuore, near Bologna, Italy. -It is not positively known who was the inventor of the compound -microscope. First employed about the year 1620, the instruments of this -type came into fairly general use toward the middle of the seventeenth -century. But the early compound microscopes were not very satisfactory, -and consequently preference was given, for a long time, to those of -the simple type. Achromatic instruments were not purchasable until -1780, when the famous German physicist, Leonhard Euler, succeeded in -overcoming the obstacles which had up to that time stood in the way of -their successful manufacture. - -In 1661 Malpighi, who was in the habit of manufacturing his own -microscopes, was able, by aid of one of these instruments, to exhibit -the blood, loaded with its corpuscular bodies, passing rapidly from -one capillary vessel to another in the frog’s lung. Then in 1683 -Guillaume Molyneux, in 1690 Anton van Leeuwenhoek, and in 1697 William -Cowper, witnessed the same phenomenon in warm-blooded animals. Among -the other anatomists of this period who contributed in varying degrees -to our knowledge of the minute anatomy of the different tissues and -organs the following deserve to be mentioned: J. Riolan (1577–1657), -Boselli of Naples (1608–1679), Lower of Oxford, England (1631–1691), -Vesling of Minden, Germany (1598–1649), Regnier de Graaf of Delft, -Holland (1641–1673), who gained so great distinction by his accurate -description of the ovarian follicles (“Graafian follicles”); and -James Douglas (1676–1742), the English anatomist, who ascertained and -described the precise limits of the peritoneum. - -Of all the men whom I have mentioned above, Malpighi and Leeuwenhoek -are probably the best known to our readers for the large number -and important character of the contributions which they made to -microscopic anatomy. The list of Malpighi’s achievements, for example, -includes the following, in addition to the demonstration of the blood -in actual circulation, as already mentioned: contributions to our -knowledge of the finer structure of plants; the demonstration of -the minute anatomy of the skin (“_rete mucosum_” or “_rete -Malpighi_”); the amplification of our knowledge of the structure -of the teeth; the discovery that the lungs are composed to a large -extent of terminal vesicles, the walls of which are richly supplied -with blood-channels.; the demonstration that certain glands possess -an acinous structure (_i.e._, an outlet channel springing from -numerous small sacs, the whole group resembling a cluster of grapes); -more complete details regarding the structure of the spleen and -the kidneys (“Malpighian bodies or corpuscles”); additions to our -knowledge of the structure of the white and the gray substances of -the brain and the demonstration that fibres from the spinal cord pass -on into the brain; the declaration that the papillae of the tongue -are organs of taste and the papillae of the skin are organs of the -sense of touch; and not a few other contributions of greater or less -importance. During his long life Anton Leeuwenhoek (1632–1723) of -Delft, Holland, made a great many additions to microscopic anatomy, -some of the more important of which are the following: he was the -first to discover and to describe the many varieties of Infusoria -(the animalcules found in stagnant collections of water); to him is -also due the credit of first observing the faceted arrangement in -the eyes of insects; he made original investigations into the origin -and mode of development of several species of the lower organisms; he -was the first to observe the canaliculated mode of construction in -bone, and he also noted the existence of the so-called bone-corpuscles -(afterward rediscovered and more accurately described by Purkinje); he -discovered the striated condition of the bundles of muscular fibres, -and was also the first person to teach the doctrine that the growth -of muscles is effected by an enlargement of the primitive bundles of -fibres and not by a multiplication of these structures; he taught -further that muscle-substance consists of numberless small spheres; he -was the first to describe the crystalline lens as a structure composed -of fibres which are arranged in layers or sheets; in association with -Guillaume Molyneux he studied, under the microscope, the speed with -which the blood-current travels in the blood-vessels; he made valuable -observations on the nature of the spermatozoa; and, finally, the very -first studies in bacteriology appear to have been made by Leeuwenhoek. -As a result of his discovery of “round, rod-shaped, thread-like and -corkscrew-shaped bacteria” between the teeth of a human being, the -theory was set forth that probably many diseases owe their origin to -such “little animals.”[75] - -The same idea, as will be shown farther on, occurred to the -distinguished medical practitioner of Verona, Italy,--viz., -Fracastoro,--one hundred years earlier (1546). Leeuwenhoek, it should -here be stated, possessed a very great advantage over his rivals in -the field of minute anatomy, for he was in the habit of using, in -his investigations, microscopes which he himself had made, and which -magnified from 160 to 270 diameters, whereas those utilized by the -others were capable of magnifying, at the maximum, only 143 diameters. -While a large part of the work which he performed shows plainly that -he was a skilful and careful anatomist and endowed with good mental -powers, Leeuwenhoek nevertheless manifested certain mean traits of -character. Daremberg says that these “consisted in his disposition -to conceal his technical methods from his associates, and in his -jealousy of others--as manifested, for example, toward Leibnitz, who -had established a similar laboratory for research work in minute -anatomy. These traits of character showed that fundamentally he was -not a true lover of science, but rather an artisan. And yet, with all -these faults, he does not appear to have placed an inordinately high -value upon his discoveries or to have been unreasonably sure of the -correctness of his conclusions.” The first monograph published by -Leeuwenhoek bears the date 1673. It is a study of the minute anatomy -of the bee’s sting. He was the first to declare that the blood is the -nutritive fluid _par excellence_, and that it is to be found in -the entire series of organisms belonging to the animal kingdom. He -divided blood into two parts--the red, or the solid portion, and the -serum. The corpuscles which float in the serum and give to the whole -fluid its red color, are called by him “particles,” in the case of -blood from birds, reptiles and fishes, and “globules” in that from -quadrupeds. He employed this term “globules” because he believed that -these bodies were exactly spherical in shape. According to Daremberg, -Leeuwenhoek’s studies cover the entire field of human histology, and -his findings are for the most part correct. - -_The Founding of Organizations for the Advancement of Medical -Science._--During the seventeenth century there were formed a number -of associations which had for their object the promotion of scientific -knowledge, and these organizations contributed greatly to stimulate -original researches in anatomy and physiology and to secure accuracy in -the published results. Perhaps the most important institution of this -kind was the French _Académie des sciences_, which was founded in -1666, and which deserves the credit of having taken a very important -part in the perfecting of our knowledge of anatomy and physiology. -The Royal Society of London, founded in 1645, possesses a splendid -record of valuable work accomplished. The following organizations also -deserve to be honorably mentioned in this place: the _Accademia dei -Lincei_ at Rome, founded in 1603; the _Académie des Curieux de -la Nature_, 1652; and the _Accademia del Cimento_, founded at -Florence in 1657. New universities were also founded in Germany. - -During the second half of the seventeenth century there were three -French physicians who deserve credit for the excellence of the work -which they did in the departments of anatomy and physiology, viz., -Vieussens, du Verney and Dionis. - -Raymond Vieussens (1641–1716), a native of Rovergue, was Professor of -Anatomy at the University of Montpellier, in Southern France. Some idea -of the extraordinary industry displayed by this anatomist may be gained -from the fact that he is credited with having dissected more than five -hundred bodies. His more important published works relate to the heart, -the nervous system and the structures of the organ of hearing. Pagel -speaks of him as being entitled to the name of founder of the pathology -of diseases of the heart. - -Jean Guichard du Verney (1648–1730), who held the Chair of Anatomy -in the University of Paris, gained a large part of his fame as -an anatomist from the excellence of his investigations into the -complicated structures of the internal ear. - -Pierre Dionis, who died in 1718, was Demonstrator of Anatomy and -Surgery at the Jardin du Roi in Paris during the latter part of the -seventeenth century and early part of the eighteenth. In 1690 he -published a treatise on anatomy which remained the standard book on -this subject for a number of years. In course of time it was translated -into the Latin, English, German and Chinese languages. - -_Dissecting Made a Part of the Regular Training of a Medical -Student._--The opportunities for dissecting human bodies varied -greatly in different parts of Europe during the period of which I am -now treating. Vieussens, as we have just seen, dissected no fewer than -five hundred bodies during his long professorship at Montpellier; -and Joseph Lieutaud, Professor of Anatomy at Paris, dissected more -than twelve hundred bodies during the continuance of his connection -with that institution. So far as I have been able to learn from my -examination of the literature, the professors and their immediate -official assistants were the only persons who had, up to this time, -derived the principal benefits that flow from work of this nature; the -students merely listened to the instructor’s remarks upon the objects -which had previously been exposed to view by dissection. But toward -the end of the period--a little before or shortly after the beginning -of the eighteenth century--facilities were provided in some of the -medical schools, and before long in all of the leading ones, for the -students themselves to participate in this highly important part of a -physician’s education. The value of such training was emphasized by -the statement made by the English philosopher, John Locke (1632–1704), -toward the end of his life, viz., that all human understanding is based -upon experience. He wrote that at birth the human soul is like a clean -sheet of paper upon which all the objects perceived by the senses are -recorded as experiences, and there they remain until by the aid of -reflexion--_i.e._, by the aid of the understanding, which Locke -calls the inner sense--they are combined into conceptions or ideas. -Locke, it should be remembered, was educated as a physician, but he -never took his degree, nor did he ever practice medicine. - -The first stimulating effects of the Renaissance upon the devotees -of the science of medicine were felt in Italy toward the end of the -fifteenth century, and these effects rapidly gained in intensity -during the following century. First France and afterward Switzerland, -Belgium, Holland and England were almost simultaneously brought under -the same influence; and in all these countries the students manifested -a remarkable eagerness to acquire all the knowledge they possibly -could. In Germany, however, the influence of the Renaissance did not -make itself felt until a much later date, and the thirst for knowledge -was very much slower in developing than was the case in any of the -other countries mentioned. Thus Puschmann, in his “History of Medical -Education,” makes the following statement which shows clearly that in -Germany the university students of that period must have been a very -rough set of men: “In 1625 the Senate of the University of Leipzig was -obliged to warn its students that they must cease disturbing wedding -festivals and handling the guests roughly, that they must no longer -make obscene remarks to married women and maidens, etc. And in 1631 a -physician named Lotichius, in writing to a friend, made the statement -that ‘in our German high schools the students seem to prefer strife to -the reading of books, daggers to copy-books, swords to pens, bloody -encounters to learned discussions, incessant boozing and noisy reveling -to the quiet pursuit of their studies, and public-houses and brothels -to students’ work-rooms and libraries.’” In 1660 the students at Jena, -on one occasion, carried on a regular battle with the police, and as -a result of this encounter several persons were killed. In the light -of this evidence, therefore, it is not surprising that the science of -medicine made comparatively little advance in Germany until after the -eighteenth century was reached. - -_Iatrochemists and Iatrophysicists._--During the seventeenth -century there was a great deal of disputing among physiologists about -the nature of certain processes like assimilation and retrograde -metamorphosis, about the manner in which blood is formed, about -digestion, and about the rôle played by the lymph vessels. According to -Haeser a large proportion of the physicians of that day were confident -that chemistry was entirely competent to solve these riddles, and -yet, on the other hand, there were not a few who believed that the -science of physics, which was then much further advanced than that -of chemistry, was quite as competent to explain all the phenomena. -At first the split into these two factions was confined to men who -were interested in questions of a purely physiological nature, but in -a short time the practitioners of medicine were also drawn into the -controversy; and from that time onward it became customary to employ -the terms, “iatrochemists” and “iatrophysicists” in speaking of the -partisans of the two schools of medicine (the iatrochemical and -the iatrophysical or iatromechanical). The iatrochemists described -digestion as an act that is essentially chemical in character, a form -of fermentation; and by the latter term the more advanced members of -this school--François Deleboë Sylvius (1614–1672), who was born in -Hanau, Prussia, of Dutch parents, and who took his doctor’s degree in -Basel in 1637, and Thomas Willis of London (1622–1675)--understood -something quite different from our modern conception of fermentation. -Their interpretation was as follows: “An internal chemical movement -of matter which is set agoing and continued in action in the stomach -and intestinal canal through the agency of certain chemical reagents.” -(Haeser.) They attributed an important influence to the saliva, the -pancreatic juice and the bile in effecting the changes mentioned. The -iatrophysicists, on the other hand, and more particularly Archibald -Pitcairn of Edinburgh, Scotland (1652–1713), and Giorgio Baglivi of -Ragusa, Italy (1668–1707), described digestion as a purely mechanical -breaking up of the elements of the food partaken--a “trituration.” As -to the further fate of the resulting chyle (its mode of reaching the -blood, for example) the two schools were in perfect accord. - -Sprengel mentions it as an actual fact that, during the seventeenth -century, there were several physicians who combined the two careers -of teacher of medicine and hydraulic engineer (iatrophysicists or -iatromathematicians).[76] Several events conduced to the formation, -in Italy and in Great Britain, of a distinct iatromathematical -school. Among them may be mentioned, first and foremost, Harvey’s -discovery of the circulation of the blood; second, the spread of the -doctrines taught by Descartes favored in a marked degree the union -of medicine and mathematics (physiology, the iatromathematicians -claimed, was only a branch of applied mathematics); and, third, the -formation at Florence, in the middle of the seventeenth century, -of an association of the pupils of Galileo. The objects of this -association were to cultivate their master’s philosophy, to carry on -the work of experimental physics, and to apply its principles in every -department of natural science. Alphonso Borelli (1608–1679), Professor -of Mathematics first at Messina and afterward at Pisa, the author of -the famous treatise on “The Movements of Animals,” and the founder -of the iatromathematical school, was a member of the association. In -this connection it is important to mention another zealous worker -in the field of iatromathematics, viz., Sanctorius Sanctorinus, of -Capo d’Istria (1561–1636). His work was done quite independently of -any general movement among scientific investigators and at a much -earlier period than that during which the school flourished. He was -quite successful, for example, in his attempts to measure the actual -amount of imperceptible evaporation, and to determine the influence -which this process exerts upon health and disease. In the course of -these investigations in what he called “static medicine,” Sanctorinus -invented a number of unusual instruments. - -The phenomenon of the formation of schools or sects, the members of -which were keenly interested in the maintenance and promulgation -of certain physiological, pathological, or therapeutic doctrines, -manifested itself anew, as I have shown above, in the seventeenth -century. In the early years of the Christian era the partisans of -different medical doctrines formed schools of this nature which -flourished for a certain period of time and then died out completely. -Such, for example, were the sects of the Dogmatists, the Methodists, -the Pneumatists, etc. The mere fact of the existence of these different -schools or sects showed unmistakably that the science of medicine -was alive at that time and that its devotees were making vigorous -efforts to increase their stock of knowledge. Then followed the long -period of the Middle Ages, a series of many centuries, during which -medicine made only slight gains; but at last came the Renaissance,--the -fifteenth, sixteenth and seventeenth centuries,--and here again we have -a recurrence of the same phenomenon of sects in medicine; but note the -great difference between the earlier manifestations and those which -I have just outlined. The present group, it is proper to remark, is -merely the forerunner of several similar movements that are to occur -during the eighteenth and nineteenth centuries, movements that are all -based, in varying degrees, upon the truth. - -_The Employment of Latin in Lecturing and Writing on Medical -Topics._--In all the countries of Europe, but more particularly -in Germany, there existed during the sixteenth and seventeenth -centuries--and for a long time subsequently--the practice of delivering -all the lectures on medical topics in the Latin tongue--_i.e._, -in a language which at best could not be easily understood by more -than a small proportion of the students. Even the lecturers themselves -must have been hampered in the full expression of their thoughts by -this rule, which was practically compulsory. Paracelsus (1493–1534), -the famous Swiss physician, tried--a full century earlier, as will be -shown farther on--to break up this seemingly harmless but in reality -objectionable custom; his example, however, was not followed, and the -practice was continued without interruption for at least two centuries -longer. The use of Latin as the language in which all medical knowledge -was to be taught was undoubtedly based upon the idea that it was -necessary for the educated physician to be reasonably familiar with -that particular tongue, for the simple reason that it was the only -one in which, in those early days in Western Europe, the writings of -Galen were accessible, for nobody but a few expert scholars had yet -acquired any useful knowledge of Greek, the language in which all of -Galen’s works were originally written. But it is quite likely that -with this motive, which certainly was intended to produce good and -useful fruit, there was coupled the further idea that the great mass -of irregular practitioners--the quacks, the early barber-surgeons -(_Wundaerzte_), and the peripatetic physicians--would in this -way be debarred from entering the ranks of the regularly trained -physicians. It was only after the custom of using the Latin for -lecturing and writing purposes had become thoroughly rooted in the -minds of medical men as something right and proper, that it began to -dawn upon the minds of some of the brighter men that this practice was -harmful to the advance of medicine beyond the standards established -by Galen. Vesalius, who was a contemporary of Paracelsus, fully -appreciated how serious an obstacle to further progress in anatomical -knowledge the teachings of Galen were, and it was he who made the first -really successful attack on this great hindrance to further progress; -but there is no evidence to show that he had the slightest idea that -lecturing and writing about medical topics in Latin played any part in -the perpetuation of the evil which he was fighting. To Paracelsus alone -belongs the credit, so far as I know, of endeavoring, through the force -of example and by spoken arguments, to break up the practice which we -are here considering. I may be mistaken in the view which I have here -expressed, but it is difficult for me not to believe that the habitual -use of Latin as the proper vehicle for the transmission of facts and -ideas belonging to the domain of medicine must have materially hindered -the advancement of that science; for such use certainly tended to keep -men’s minds moving in fixed ruts, and those ruts all led straight -toward the faulty teachings of Galen. - - - - - CHAPTER XXIX - - THE CONTRIBUTIONS MADE BY DIFFERENT MEN DURING THE RENAISSANCE, - AND MORE PARTICULARLY BY WILLIAM HARVEY OF ENGLAND, TO OUR - KNOWLEDGE OF THE CIRCULATION OF THE BLOOD, LYMPH AND CHYLE - - -Among the earliest known doctrines relating to the nature of the blood -and its mode of distribution throughout the body are those attributed -to Erasistratus and Galen; for the still more ancient ones, of which -Diogenes of Apollonia, Aristotle and the Hippocratic writers are -reputed to be the authors, are too incomplete to call for serious -consideration in this place. - -_(a) The Doctrine Taught by Erasistratus._--Erasistratus, who -was born at Julis in the Island of Ceos (Aegean Sea) during the third -century before Christ, held the belief that the arteries contain -only air, which is drawn into the lungs by way of the trachea and -bronchi, whence it enters the pulmonary vein (called by him the “venous -artery”). In its further course this air passes from the pulmonary -vein into the left ventricle of the heart, and is then conveyed from -that organ through the arteries to the different tissues of the body. -Erasistratus further taught that the smallest subdivisions of both the -arteries and the veins lie side by side in the tissues, and that, in -certain abnormal bodily conditions, they communicate the one with the -other through anastomoses; but that, in a normal condition of the body, -no communication takes place between the two. In common with all other -physicians of that time, he believed that only the veins carry blood. -Here, then, we find the first glimmering of the truth with regard -to the nature of the circulating medium and also with regard to the -course which it pursues in one part of its circuit--that part, namely, -where the two kinds of vessels become capillary in character. His -substitution of air for blood in the arteries is plainly the principal -error in his scheme. - -_(b) The Teaching of Galen and of Caesalpinus with Regard to the -Nature of the Blood and Its Mode of Distribution._--Galen, in the -second century of the present era, disputed the correctness of the -doctrine taught by Erasistratus. His objections are thus stated: -“Inasmuch as blood flows from an artery when it is wounded, one of two -things must be the truth. Either blood was already contained in the -vessel before it was wounded, or it must have found its way in from the -outside. But, if the blood comes from the outside into a vessel which -contains only air, then air must necessarily escape from that vessel -(when wounded) before blood does--which is contrary to the fact, as -blood alone flows out. Therefore arteries contain only blood.” As a -further proof of the correctness of his statement Galen carried out the -following experiment: In a living animal he placed two ligatures around -an artery at points situated not far apart, and then made an opening -in the vessel between the two ligatures. The intervening section of -the artery, it was thus found, contained only blood. This experiment, -it might reasonably be supposed, would have definitely settled the -question; but such was not the case. The followers of Erasistratus -immediately raised this objection: If the arteries contain blood, how -may the air which is drawn into the lungs find its way to all parts -of the body? Galen replied that the inhaled air does not pass through -the lungs, but is rejected by them after it has cooled the blood. This -refrigerating process, he claimed, constitutes the sole purpose of the -respiratory act. - -Although Galen’s idea regarding the true function of respiration is -not in harmony with the doctrine taught by modern physiologists, it -nevertheless represents a marked advance over the belief previously -maintained. Even as recently as in the time of Albert von Haller -(approximately 1760–1780) physicians still continued to believe that -it was the function of respiration to cool the blood; and indeed it -was scarcely possible before 1800 to offer a more correct physiology -of the act of breathing, for it was not until after the lapse of many -centuries that the advance in our knowledge of chemistry reached a -point at which it became possible to find a satisfactory solution of so -complicated a problem. - -As to the nature of the blood itself Galen believed, as I have already -stated more fully in Part I. (“Ancient Medicine”), that there are two -kinds--spirituous blood (or spirit) and venous blood. He gave the name -of spirituous blood to that which is found circulating in the arteries, -and which is appreciably brighter in color than that which fills the -veins. According to Flourens, the distinguished French physiologist -of the nineteenth century, Galen was the first among the ancient -anatomists to make this distinction of two different kinds of blood. To -the spirituous variety Galen ascribed the function of nourishing the -more delicately constructed organs like the lungs, while he claimed -that the venous blood is suited to nourish only the coarser ones, like -the liver, spleen, etc. - -In his further development of a physiology of the circulation of the -blood Galen, who as a rule expresses his ideas with great clearness, -makes statements which I find it extremely difficult to comprehend. -I am therefore tempted to assume that the copyists, to whom we are -indebted for handing down his actual words from age to age, are the -persons upon whom should be cast the blame for the obscurity of which -I complain. However this may be, it is an unquestionable fact that -the ablest physiologists, were they to be confronted to-day with the -duty of solving this problem of the circulation under the conditions -of knowledge which existed during the third century of our era, would -surely not be able to provide a more correct solution than that which -is credited to Galen. The problem was attacked repeatedly by some -of the brightest and best-equipped minds of the Renaissance period, -but not one of these exceptionally clever men was able to offer an -entirely acceptable solution. Harvey alone, as will appear farther on -in this account, solved the riddle once and for all. - -The “spirit”--the purest part of the blood--is lodged, according to -Galen, in the left ventricle; and, inasmuch as even the venous blood, -if it is to fulfil in some degree the function of a nourishing fluid, -must possess a certain proportion of “spirit,” it is clear that the -two ventricles should communicate the one with the other; for how -otherwise--thought Galen--is it possible for a certain amount of -“spirit” to commingle with the venous blood? The locality at which -this communication was assumed to exist was the interventricular -septum; and, as nobody was able to find anything like a foramen in this -membrane, it was asserted that the communication is effected through -an infinite number of pores. For over one thousand years physicians -accepted this porous character of the interventricular septum as an -established fact. In his commentaries on Mondino’s “Anatomy” (1521), -Berengarius of Carpi timidly ventured the statement that the openings -of communication are not distinctly visible, and this apparently was -the first feeble expression of doubt concerning the correctness of the -prevailing doctrine. Vesalius, on the other hand, boldly denied their -existence altogether. - -According to Galen’s teaching the liver is the source of origin of all -the veins, just as the heart is the starting-point of all the arteries. -It is quite remarkable, says Flourens, that physicians who performed -almost daily the operation of venesection should, during a long series -of years, have failed to observe that this doctrine of blood flowing -through the veins from the liver to the different parts of the body, -could not possibly be true, inasmuch as at each such operation the -vein always became distended with blood _below_ (_i.e._, on -the distal side of) the ligature which they applied to the part (arm, -for example) before opening the vessel. This phenomenon, of course, -indicated clearly that the blood in the veins flowed _toward the -heart_, and not from any centrally located spot or organ _toward -the extremities_. And yet--he adds--even so bright and thoughtful -a man as Vesalius does not appear to have noticed this fact. Andreas -Caesalpinus (1519–1603), on the other hand, did observe and correctly -interpret the phenomenon; and he made the further observation that -physicians were habitually applying the ligature _above_ the -spot which they expected to bleed, regardless of the fact that in so -doing they were not acting in harmony with their belief concerning the -circulation of blood in the veins. Caesalpinus also states, in one part -of his writings, that “the blood, carried to the heart by the veins, -receives in that organ its last transformation toward perfection, -and is then--in this perfected state--transported by the arteries to -the remotest parts of the body.” So far as it relates to the general -movement of the blood this statement is correct, but it errs, as will -be shown presently, in mentioning the heart as the locality where the -perfecting process takes place. In his final remarks regarding the -anatomical relations which exist in the two chambers of the heart -Caesalpinus makes the following statement:-- - - Each ventricle possesses two vessels--one through which the - blood reaches that chamber, and a second one which serves to - carry it out of the ventricle. The vessel through which the - blood enters the right ventricle is called the _vena cava_, - and that by which it leaves this same chamber is called the - pulmonary artery. The vessel through which the blood arrives - in the left ventricle is called the pulmonary vein, and that - through which it leaves this left chamber of the heart is known - as the aorta. - -_The Circulation of the Blood as Elucidated by Michael -Servetus._--Michael Servetus, a native of Villanueva, Spain, -who in 1553 was burned alive at the stake near the city of Geneva, -Switzerland, because of his heretical teachings, is not infrequently -mentioned as the individual to whom credit is due for having furnished -the first description of the lesser or pulmonary circulation. There -is no question whatever regarding the justice of according to him -at least a part of this honor, but one should be careful to specify -that Servetus is entitled only to the credit of having been the first -to teach that the blood, in its journey from the right to the left -side of the heart, must pass entirely through the lungs. So far, his -doctrine is correct; but he also taught at the same time that the -fluid which enters the aorta from the left ventricle is not blood but -perfected “vital spirit” (Galen), and that it becomes genuine blood -only after it has tarried for a few brief instants in the ventricular -chamber and has there been subjected to some unknown influence -exerted by the heart itself. This second erroneous part of Servetus’ -description seems to me to diminish very materially the credit to which -he is otherwise entitled; and I cannot help feeling that Dezeimeris is -right when he claims that Realdus Columbus, whose more perfect account -of the lesser circulation was written only a little later than that of -Servetus, is perhaps better entitled to the honor in question. - -It is an interesting fact that Servetus introduces his disquisition -on the circulation of the blood in the very midst of a treatise which -bears the title “Restitution of Christianity,”--in other words, in a -treatise which would never, under ordinary circumstances, be consulted -by physicians in their search for information regarding an important -problem in physiology like that of the circulation of the blood. In -this physiologico-theological treatise Servetus, who--as I omitted to -state--was a theologian as well as a physiologist, used the following -expressions:-- - - The soul, says Holy Writ, is in the blood; as a matter of fact, - the soul is the blood. And since the soul is in the blood, one - should--if one wishes to learn how the soul is formed--endeavor - to learn how the blood is formed; and, in order to learn how - the blood is formed, it is necessary to ascertain how it moves. - (Flourens.) - -I am unable to state whether it was this particular chapter, or -the work taken as a whole, which appeared to the ecclesiastical -authorities--first those of France and afterward those of Geneva--to -warrant the author’s condemnation as a heretic. And, when we are -disposed to blame severely those bigots who, in the fifteenth and -sixteenth centuries, manifested such a keen desire to destroy -“heretics,” let us remember, with a proper sense of shame, that -we still have in our midst, in this twentieth century and in this -“land of freedom,” men of high social standing who are as virulent -heresy-hunters as ever were the enemies of Servetus. - -_Experiments of Realdus Columbus._--Matthaeus Realdus Columbus, -who was born at Cremona, Northern Italy, in the early part of the -sixteenth century, acted for some time as Vesalius’ prosector, and -must therefore have had ample opportunities for acquiring a thorough -knowledge of the experimental method of studying questions in -physiology. He wrote a description of the pulmonary circulation which -was more lucid and nearer to the truth than any which his predecessors -had furnished. This description, which will be found in his treatise -on anatomy (Venice, 1559), was based largely upon experiments that he -carried out upon living dogs. As rendered into English from the French -version supplied by Dezeimeris, it reads as follows:-- - - When the heart dilates the blood passes from the vena cava into - the right ventricle; from the latter chamber it is pushed into - the arterial vein (the pulmonary artery), along which channel - it is carried to the lung, there to be properly thinned and - mixed with air. Ultimately the blood passes on into the venous - artery (= the pulmonary vein), the function of which vessel is - to carry this fluid, now charged with air through the action of - the lung, into the left ventricle of the heart. Then follows - the contraction (systole) of this organ, as a result of which - action the tricuspid valves rise up into position and form a dam - that prevents the return of the blood into the vena cava and - the pulmonary veins. Simultaneously with this action the valves - placed at the opening which represents the commencement of the - aorta (left ventricle), and those placed at the opening which - corresponds to the beginning of the pulmonary artery (right - ventricle), yield and thus open the way for the distribution of - the blood throughout the rest of the body. - -The reader will, I believe, admit that this description, while perhaps -not faultless, is distinctly superior to that given by Servetus. - -Columbus’ experimental studies threw considerable light upon other -matters relating to the physiology of the heart. He demonstrated, -for example, that the fluid which enters the left ventricle from the -lungs is genuine blood, and he also learned by the same method of -investigation the true nature of the systole and diastole of the heart -and the relations of these acts to the pulse and to the changes in the -position of the heart. The discovery of all these facts constituted -a material advance in our knowledge of the physiology of that organ; -but, from this time onward, for a period of nearly three-quarters of a -century, no further advance was made until William Harvey of England -appeared on the scene. The explanation of the failure of such able -investigators as Realdus Columbus, Vesalius, Servetus and others to -push their researches still further is to be found largely in the fact -that they were all still in bondage to the doctrines taught by Galen -centuries earlier, and probably more particularly to that dogma which -maintains that blood--if it is to be accepted as genuine or fully -formed blood--must first have been elaborated in the depths of the -liver. The impossibility of harmonizing such a dogma with the facts -which by that time were well established, is too plainly evident to -warrant further discussion in these pages. - -_Discovery of Valves in the Larger Veins by Fabricius ab -Acquapendente._--The discovery of the presence of valves in the -interior of the larger veins is credited by some to Cannani (1546) -and by others to Fabricius ab Acquapendente (1574), but the best -authorities appear to favor the claim of Fabricius to this honor. -There are also a few authorities who maintain that Fra Sarpi, the -celebrated monk and scientist of Venice, is entitled to be considered -the discoverer of the valves in veins, but Tiraboschi, the historian of -Italian literature, makes it clear that this claim is unfounded. - -Although it was known to Fabricius that these valves are inclined -toward the heart, he does not appear to have appreciated the fact that -this arrangement is entirely incompatible with Galen’s doctrine that -the flow of venous blood is from the liver toward the extremities; nor -did any other anatomist, so far as I am able to learn, discover this -incompatibility before it was pointed out by Harvey nearly fifty years -later. - -_William Harvey, Who is Universally Acknowledged to be the Real -Discoverer of the Circulation of the Blood._--William Harvey was -born at Folkstone, England, in 1578, received his academic education at -Caius College, Cambridge, and became a doctor of medicine in 1602, at -the age of twenty-four. Four or five years before this event he went -to Padua, Italy, to study medicine under Fabricius ab Acquapendente, -who was considered at that period to be the ablest and most inspiring -teacher of anatomy and physiology in Europe. It was from him, it may -safely be assumed, that Harvey learned the importance of studying -Nature herself, rather than books, when one is desirous of learning her -secrets. Equipped with a thorough knowledge of the methods that may -best be employed in making studies of this character, Harvey returned -to England at the end of his long stay at Padua. He was soon afterward -made a member of the College of Physicians of London, and in 1615 was -elected to the Chair of Anatomy and Surgery in that institution. Later -still, he was appointed one of the physicians of St. Bartholomew’s -Hospital. He also held for several years the position of Court -Physician, first to James the First and then to Charles the First. It -was during this period of his professional career that he began working -in earnest upon the problem of the circulation of the blood, and he -kept steadily at this work throughout a period of several years. Among -the manuscripts preserved in the British Museum there is one bearing -the date of 1616 which shows that Harvey had already at this time -reached conclusions which, in all essential respects, agree with those -which appear in his final treatise published in 1628. The title of the -latter work is, “_Exercitatio anatomica de motu cordis et sanguinis -in animalibus_” (Frankfort, 1628). - -Although, as I have shown above, several of the links in the chain -of proofs bearing upon this question of the circulation had already -been discovered before Harvey began his researches, he was not -willing to accept them as proven facts until he had himself tested -them thoroughly by the experimental method. Furthermore, they were -often disconnected, and this lack of continuity obliged him to supply -missing links at several points; in other words, nobody had as yet -demonstrated the important fact that the blood travels regularly in an -unbroken circuit, and it was to this great task that Harvey devoted -himself at the period which we are now considering. He carried out -all these investigations with the most painstaking care and made -public announcement of his discoveries only after the lapse of an -extraordinary length of time; his chief object being that ample -opportunity might thereby be afforded for complete verification. The -following are among the more important questions which he investigated -and to which he furnished satisfactory solutions. He learned, for -example, that the auricle and ventricle of each side of the heart do -not contract simultaneously but in succession. When the right auricle -contracts the blood which it then contains passes into the right -ventricle; and when the right ventricle contracts the blood is driven -into the pulmonary artery. From this vessel it passes ultimately into -the pulmonary vein, and from the latter into the left auricle, which -then contracts and drives the blood into the left ventricle. The -latter chamber next contracts and forces the blood into the aorta, -whence it is carried into all the arteries of the body. From these, in -turn, it passes into the veins and thence back to the right auricle -of the heart--the point from which it started. He corroborated the -finding--by other anatomists who had preceded him--of membranous valves -at the spots where the blood passes from one chamber to the other; -and he compared these valves to little doors which open to permit the -passage of the blood in one direction, but which close when there is -any tendency for it to pass in the opposite direction. The valves -of the right auricle, for example, allow the blood to pass into the -right ventricle, but prevent it from returning into the auricle. Then, -further, the valves of the right ventricle permit the blood to pass -into the pulmonary artery, but prevent it from returning into the -ventricle. The valves of the left auricle permit the blood to pass -into the left ventricle, but do not permit it to return into the left -auricle. Finally, the valves of the left ventricle allow the blood to -pass into the aorta, but prevent it from regurgitating into the same -ventricle. The valves with which the veins are equipped permit the -blood to travel onward toward the heart, but do not permit it to back -up into the arteries. - - [Illustration: FIG. 15. WILLIAM HARVEY. - - (After the portrait by Cornelius Jonson.)] - -Galen taught that the arteries pulsated by reason of a “pulsific power” -which they derive in direct continuity from the tunics of the heart. -He tried to prove the correctness of his doctrine by experimental -methods, but in this he failed. Harvey was convinced that the arteries -do not pulsate by reason of their own inherent power, but by a force -of impulsion communicated to the blood at the heart. He refers to this -question in the following terms: “When an artery is opened the blood -escapes in jets of unequal force; the alternate jets being stronger -than the intermediate, and the stronger jets corresponding in time of -occurrence, not with the systoles but with the diastoles of the artery. -The artery, therefore, must be distended by impulsion, by the shock of -the blood. If the artery dilates by reason of its own inherent power, -the blood would not be expelled with the maximum force at the very -moment when this dilatation occurs.” As evidence of the non-existence -of Galen’s assumed “pulsific power,” Harvey mentions the fact that, in -the case of a patch-shaped calcification of the crural artery which -came under his observation, the pulsation took place as usual, but at a -point below (distal to) the edge of the patch. The intervening patch of -rigid calcareous matter was not able to prevent the traveling onward of -the propelling power. - -Harvey next takes up the consideration of the veins, and, after -showing that they permit a flow of the contained blood in only one -direction,--viz., that from the extremities toward the heart,--he -calls attention to certain experiences which he has had: (1) When a -cord is tied lightly around a limb the flow of blood is arrested _only -in the veins_, because these vessels are located near the surface of -the skin; but, if the cord is tied more tightly, the flow of blood -is also arrested in the arteries, which lie at a relatively great -depth. (2) When a vein is tied the resulting distension manifests -itself _only below_ (_i.e._, on the distal side of) the ligature; -whereas, when an artery is similarly tied, the distension takes place -_above_ (_i.e._, on the proximal side of) the ligature. It is therefore -plain that in the veins the blood flows from the individual parts -toward the heart, but that in the arteries the flow is in the reverse -direction--_i.e._, from the heart toward the individual parts. “If one -reflects upon the nature of the movement of the blood,” says Flourens, -“one will promptly realize how speedy it is. Scarcely has the blood -entered the heart before it is hurried into the arteries; and then -from these vessels it passes in an instant into the veins, from which, -with almost equal speed, it finally travels back to the heart again. -It is this never-ending movement from one channel into another, and -then eventually back to the starting-point, which constitutes the -circulation of the blood.... Modern physiology dates from the discovery -of the circulation of the blood. Up to the time of this discovery -physiologists followed the ancients; they did not dare to walk alone. -Harvey had discovered the most beautiful phenomenon in the animal -economy.... From this time forward, instead of swearing by Galen and by -Aristotle, one had to swear by Harvey!” - -Despite the great care which Harvey took to back up his scheme of the -circulation of the blood with unimpeachable proofs of its correctness, -he was obliged to pass through the same sort of experience as that to -which Vesalius and scores of other pioneers in the field of scientific -inquiry had been subjected. Two hostile forces stood constantly -ready, during that fruitful period of the Renaissance, to attack with -merciless bitterness all those who ventured to add new facts to our -stock of knowledge in the domain of medicine. On the one side were the -many men of small calibre, men filled with jealousy over the successes -gained by co-workers in the same field; and on the other was marshaled -the host of those who honestly believed that all medical wisdom ended -with Galen. Before his death, however (hardly thirty years later), -Harvey had the satisfaction of witnessing the almost unanimous -acceptance of his dogma concerning the circulation of the blood. Louis -the Fourteenth, King of France at this period, was so appreciative of -the importance of Harvey’s discoveries that he appointed Dionis, the -distinguished French anatomist, to demonstrate to the students of the -Medical School of the Jardin des Plantes at Paris the circulation of -the blood and other recent discoveries. Descartes (1596–1650), the -celebrated French philosopher, paid an even greater compliment to the -high character of the work accomplished by Harvey. His words, as quoted -by Flourens, are as follows:-- - - If I am asked why the supply of venous blood does not become - exhausted in flowing thus unceasingly into the heart, and why - the arteries--since all the blood that passes through the - heart must travel along these vessels--do not become filled to - overflowing, I can see no good reason why I should not give - to this question the very same answer that William Harvey, an - English physician, to whom praise is due for having taught ..., - has already given. [Then follows the text of Harvey’s reply.] - -Our readers have doubtless noted the fact that, while Harvey, as I have -endeavored to show in the preceding account, has clearly established -his right to be considered the discoverer of the circulation of the -blood in all its most essential features, his scheme fails to furnish -any information concerning the composition of the blood and the manner -in which it is built up into a life-giving fluid. In the minds of some -this may seem to be an omission. A moment’s reflection, however, will -satisfy any reasonable person that questions of this nature do not form -a legitimate part of the problem which Harvey was engaged in solving, -and that they therefore should receive separate consideration. Thus, -for example, Harvey’s scheme fails to furnish satisfactory information -concerning those portions of the circuit where the blood is obliged -to travel through a system of communicating capillary channels, as -happens in the lungs and in the tissues generally throughout the body. -But Harvey had no means at his command for investigating a question -of this nature. Capillary blood-vessels are invisible to the naked -eye, and may be studied only with the aid of a microscope; but this -instrument was not available until long after the time (1605–1616) -when Harvey was engaged in carrying out his investigations into the -circulation of the blood. - -_Other Discoveries Relating to the Vascular System._--To Vesalius -is due the credit of having discovered the fact that anastomoses exist -between the carotids and the vertebral arteries, thus explaining how a -man may continue to live even after both carotids have been severed or -ligated. His great rival, Fallopius, described these anastomoses in the -most detailed manner, and he noted the further fact that an anastomosis -with the basilar artery exists. - -By the end of the sixteenth century a certain amount of progress had -been made toward a correct knowledge of the lymphatics. Bartholomaeus -Eustachius, for example, discovered the existence (in horses) of the -thoracic duct, but he supposed it to be a vein. His description of this -vessel reads as follows:-- - - In these animals there is a large vessel which extends downward - from the inner aspect of the clavicular vein (= left subclavian - vein). At the point where it joins the vein it is closed by - means of a semicircular valve. This vessel is of a whitish - color and it contains a scanty watery fluid. Not far from its - starting-point it divides into two branches which very soon, - however, join together again, and then, as a single trunk from - which no further branches are given off, it passes down along - the left side of the spinal column, penetrates the diaphragm, - spreads itself out over the aorta, and ends in a manner unknown - to me. - -About one hundred years later (1647), Jean Pecquet of Dieppe, France, -professor in the Medical School of Montpellier, rediscovered (in a -dog) this same duct, with its tributary chyle ducts and also its point -of entrance into the left subclavian vein; and, as he had rightly -interpreted its nature, anatomists by common agreement accorded him the -rights of discoverer. - -At a still earlier date (1622) Caspar Aselli of Cremona, Northern -Italy, professor in the Medical School of Pavia, discovered the chyle -ducts. This discovery was made under the following circumstances, which -reveal the fact that good luck sometimes plays an important part in -the work of the searcher after truth in the departments of anatomy and -physiology:-- - - Aselli was studying the distribution of the recurrent nerves and - the movements of the diaphragm in a well-nourished living dog, - when his attention was drawn to the presence of a large number - of delicate white threads coursing as it were over the surface - of the mesentery. Following the accidental injuring of one of - these threads there escaped from the wounded structure quite - a large quantity of chyle. Aselli, who instantly appreciated - the full significance of what had happened, exclaimed, in the - presence of the bystanders, “Eureka!” At the time he supposed - that these chyle vessels terminated in the liver and contributed - in some manner to the elaboration of the blood (in harmony with - Galen’s universally accepted theory of sanguification); but - later, after he had carried out a carefully conducted series - of experiments, he was able to rectify this erroneous belief. - (Haeser.) - -Galen’s theory of sanguification may be stated as follows: The chyle is -received into the veins of the intestinal wall and carried thence to -the liver, in which organ they are all gathered together into a single -venous trunk which has received the name of “_vena portae_”--the -vein of the gateway. Everything that is destined to enter the liver -passes through this portal vein. In the organ itself the chyle -undergoes certain modifications, the result of which is, first, to -deprive it of its impurities and then, in addition, to effect other -changes that convert it into blood. Aselli’s glory, then, consists in -his having shown that chyle is taken up from the intestinal mucous -membrane by a set of its own vessels, and not by the veins, as taught -by Galen. - -In 1651 Olaus Rudbeck of Arosen, Sweden, discovered the lymphatics of -the intestinal canal and followed their distribution into the lymph -nodes; he also established their relations with the thoracic duct and -with the venous system. - -Thus, thanks to the series of brilliant discoveries made by William -Harvey, Realdus Columbus, Fabricius ab Acquapendente, Pecquet, Aselli -and a few others, the doctrine of the circulation of the blood and of -the part played by the accessory chyle and lymphatic vascular systems, -became firmly established before the end of the seventeenth century. - - - - - CHAPTER XXX - - ADVANCES MADE IN INTERNAL MEDICINE AND IN THE COLLATERAL - BRANCHES OF BOTANY, PHARMACOLOGY, CHEMISTRY AND PATHOLOGICAL - ANATOMY - - -_General Remarks._--In the fundamental branches of medical -knowledge--anatomy and physiology--advances of a very decided character -were accomplished during the sixteenth and seventeenth centuries; and -in the preceding chapters I have endeavored to give my readers some -idea of the nature of these advances, of the men who were instrumental -in effecting them, and of the extent to which the way was made easy, -during this period, for the accomplishment of still further advances. -In carrying on the work of correcting the many errors which were found -to exist in the two departments mentioned, it was soon discovered that -the obstacles to be overcome were of a serious character, and that -the most formidable one of the group was what is universally known as -Galenism. If I now refer to this subject once more, perhaps for the -second or third time in the course of this history, it is because I -fear that my remarks with regard to the harmful influence exerted by -Galenism may not be rightly interpreted. For Galen’s personal character -I entertain, as I have already stated in the section relating to -Ancient and Mediaeval Medicine, the deepest respect, and I am filled -with great admiration for what he accomplished in advancing the science -of medicine; but at the same time I cannot overlook the fact that he -was hemmed in by insurmountable limitations. No single human being, -living at the beginning of the present era and surrounded, as Galen -was, by a herd of jealous rivals, could have successfully bid defiance -to those who considered it sacrilegious to dissect the dead body of a -fellow man; and yet, without the knowledge which may only in this way -be gained, how was it practicable for any individual, no matter how -clever he might be, to lay the foundations for a further advance in -medical knowledge? It seems to me therefore plain that Galen did all -that lay in his power to advance the science of medicine; and whatever -words of condemnation I may have employed in the text, when speaking -of the Galenists, refer solely to those physicians of later centuries -who were of such a narrow-minded type, so rigidly crystallized in the -belief that Galen’s teachings had reached the limit of all possible -knowledge in the science of medicine, that they did not hesitate to -class the efforts of men like Vesalius as acts of unpardonable impiety. -Galenism, then, refers to the very widely prevalent tendency among -physicians of the fifteenth, sixteenth and seventeenth centuries to -uphold the teachings of Galen as the _only_ trustworthy code upon -which they should depend for their guidance. In short, Galenism, at the -period named, meant for medicine a complete arrest of development. - -I have now arrived at a point in the history of medicine where, owing -to the limited amount of space at my command, the difficulty of -deciding as to what subjects and what individual workers in the field -of medicine--a field now grown to very great proportions--shall receive -consideration in my sketch. Having decided from the very outset that my -best efforts shall be directed, consistently with a strict adherence -to historical truth, toward making my account readable, I now find it -absolutely necessary to jettison--if I may be permitted to use such a -nautical expression--much really valuable cargo, and to put ashore, -before continuing our voyage, many passengers of undoubted worth. -Nobody need bemoan the loss of all these valuable treasures, for the -great majority of them, I am confident, will be cared for properly by -those authors who are privileged to treat this whole subject with some -degree of thoroughness; and the reader, if he is familiar with German, -will even now find, in the excellent general treatises of Haeser, von -Gurlt, Pagel, Puschmann, Baas-Henderson and Neuburger, great stores -of the most satisfactory information concerning the thousand and one -details about which I am obliged to remain silent. - -_Internal Pathology._--During the fifteenth century the -practitioners of medicine in Italy and France were still strongly -under the influence of the teachings of the Arabian medical authors. -One of the first writers in Italy to place the doctrines of internal -medicine upon a firmer footing was Antonius Benevienus, a native of -Florence (1440–1502). His treatise on some of the unusual causes of -disease, which was printed in Florence in 1506, is said to be written -in very clear language and to be based entirely upon cases which came -under his own observation. According to Haeser the first improvements -in the doctrines relating to pathological anatomy may be credited to -Benevienus, who also taught that pathological phenomena should be -studied by direct observation rather than from books. - -Johannes Manardus of Ferrara (1462–1536) was a very sturdy opponent -of astrology, and, in general, did all in his power to weaken the -prevailing blind trust in the authority of the Arabian medical authors. -But the two physicians who, next to Fabricius ab Acquapendente, stand -out most conspicuously among their Italian contemporaries of the -sixteenth and seventeenth centuries, are Fracastoro and Lancisi--the -former a native of Northern and the latter of Southern Italy. - -Hieronymus Fracastoro of Verona (1483–1553) ranks very high among the -physicians of the first half of the sixteenth century for his valuable -contributions to our knowledge of internal pathology. In the treatise -which he published in 1546 on contagious maladies, he states in plain -language his belief that the causes of diseases of this nature are to -be found in living germs that are endowed with the power of propagating -themselves. He divides these diseases into the following three groups:-- - - 1, Those which infect only by contact; 2, Those which not - only infect by contact, but at the same time leave behind a - centre or focus of infection--in which category he places - tuberculosis, elephantiasis, and similar diseases; and 3, Those - which infect not only by direct contact, or through the agency - of a residuary centre or focus of infection, but also those - which are capable of spreading their infective elements over - wide areas--for instance, the pestilential fevers, certain - ophthalmias, variola, etc. (From Viktor Fossel’s version of - Fracastoro’s treatise published in Leipzig in 1910.) - -Speaking of tuberculosis (called by him “phthisis”), Fracastoro says -that it is astonishing for how great a length of time the virus of this -disease retains its infective power. “It has been noted, for example, -that in quite a number of instances the clothes worn by a tuberculous -patient have communicated the disease to a healthy individual as late -as two years subsequently to the date at which they were removed from -the original tuberculous individual.” The same power of communicating -infection, he continues, may reside in such other objects as the bed, -the walls and the floor of the room in which a tuberculosis patient has -died. Under these circumstances, he adds, we are obliged to assume that -germs of this infective disease have remained attached to the different -objects mentioned. - -Fracastoro was born in Verona, Italy, of parents who belonged to the -patrician class and were in easy circumstances. He studied mathematics -and philosophy at the University of Padua, and was quite prepared, -on reaching the age of twenty, to pass the examinations required of -candidates for the degree of Doctor of Medicine. Just at this time, -however, Padua was not a safe place of residence, owing to the war -that was threatened between the Emperor Maximilian the First and the -Republic of Venice. Accordingly Fracastoro took his degree at the -newly established Academy of Pordenone, in what is known to-day as the -Province of Udine (northeast of Venice); and shortly afterward, upon -the death of his father, he returned to Verona and began the practice -of medicine. As he quickly gained the confidence of the people, he -very soon found himself in a sufficiently prosperous condition to -warrant him in retaining possession of the family residence, which -was charmingly located at the foot of Monte Incaffi, midway between -the Adige River and the Lake of Garda. Here it was that Fracastoro -did a large part of his literary work, for he was a poet as well as -a physician. Pope Paul the Third appointed him to the position of -Physician-in-Ordinary to the Council of Trent, and it was by his advice -that, upon the appearance of the Plague in that city, the sittings -of the Council were thereafter held for a short season at Bologna. -Later, still other honors fell to his lot. He enjoyed the esteem of the -Emperor Charles the Fifth and of Francis the First, King of France; and -the latter’s highly cultivated sister, Margaret of Navarre, offered him -every inducement to settle at her Court, but the attractions of his own -home made it easy for him to decline all these offers. He died at his -villa on August 6, 1553, and six years later the city of Verona erected -in his honor a marble memorial tablet. - -Fossel, in his biographical sketch of Fracastoro, says that the most -popular of his poetical writings was that entitled, “_Syphilis sive -morbus Gallicus_.” It was published in several successive editions, -and was translated into nearly all the languages of European countries. -I shall have occasion to refer to it again in a later chapter. - -Giovanni Maria Lancisi was born at Rome on October 26, 1654. Like -Boerhaave he began his university studies under the service of the -Church, but, as time went on, his leaning toward the profession of -medicine became more and more pronounced, and he soon took up in -earnest the study of that science at the University of Sapienza, -devoting a large share of his time to dissecting and to clinical work -in the hospitals. In 1672, when he was only eighteen years old, he was -given the degree of Doctor of Medicine; and four years later, after a -competitive examination, he was appointed an assistant at the Hospital -of the Holy Ghost. In 1678 he was permitted, as a special honor, to -enrol himself as a student in the Collège de Saint-Sauveur. During -the following five years he enjoyed at this institution exceptional -facilities for studying medical literature, and was thus able to -accumulate an immense mass of useful extracts from the writings of the -best authors. In 1684 he was assigned to the duty of teaching anatomy -at the Sapienza, and for thirteen years he filled this post with great -credit to himself; Malpighi being one of those who took pleasure in -following his lectures. He had scarcely attained his thirtieth year -when he was honored by being appointed Physician-in-Chief and Privy -Councilor to Pope Innocent the Eleventh; and soon afterward he was made -a Canon of the Church of Saint Lawrence, the main purpose of which -appointment was to provide him with a suitable income. On the death -of the Pope in 1689 he resigned the latter office, in order that he -might have more leisure and freedom to pursue his professional duties. -Subsequently he became the regular medical attendant, first of Pope -Innocent the Twelfth and afterward of Pope Clement the Eleventh. He -died on January 21, 1720. - -Von Haller speaks of Lancisi as “a physician who was most highly -esteemed by Pope Clement the Eleventh, who was very learned and very -philanthropic, and who loved to give aid to the afflicted and to -prevent litigation by wise counsels.” It was Lancisi also, as I have -stated on a previous page, who discovered at Rome, in the possession of -the heirs of the artist Pini who made the original drawings, the copper -plates which Eustachius had ordered nearly two hundred years earlier, -and which were to have been used by this celebrated anatomist in the -production of a most beautiful set of anatomical illustrations.[77] - -The two most important original treatises published by Lancisi bear the -following titles: “_De motu cordis et aneurysmatibus_” (on the -movements of the heart and on aneurysms), Rome, 1728 (a later edition -in 1745); and “_De subitaneis mortibus Libri II_” (on sudden -deaths), Rome, 1707 (also later editions). - -_Botany and Botanical Gardens._--The Egyptians, the Persians, the -inhabitants of India and China, and the ancient Greeks accumulated a -great mass of information relating to plants which might be utilized -in the treatment of different diseases. Then, in the early part of the -present era, Galen contributed not a little to our further knowledge -on this subject; but from that time forward, until the sixteenth -century, pharmacology practically remained unchanged. The beginnings of -a systematic study of all plants--in other words, modern botany--may -be traced to the establishment of botanical gardens, first in Italy -and afterward in Holland and France. According to Berendes the very -earliest attempt in relatively modern times to cultivate such a garden -was made at Salerno by Matthaeus Silvaticus. Then Master Gualterus, in -1333, was permitted by the Governing Council of Venice to make use of -a certain plot of ground for the cultivation of the plants in which he -was specially interested. So far as one may judge, however, both of -these were private undertakings. In 1545, at the request of Francesco -Buonafrede, Professor of Therapeutics at the University of Padua, the -Senate of that city laid out a garden for his uses in teaching. This -appears to be the earliest instance of the establishment of a botanical -garden in connection with a regularly organized medical school. Then, -in fairly quick succession, similar gardens were established at Pisa -(1547), Bologna (1567), Leyden, Holland (by Boerhaave in 1577), and -Heidelberg (1593). In France the University of Montpellier received -its first botanical garden in the year last named. Thus it appears -that about the middle of the sixteenth century botany began to receive -attention as a branch of knowledge which, as was then believed, it was -important for physicians to study; and from that time forward, for -more than two centuries, it formed a regular part of the curriculum in -all the leading medical schools. The two chairs of botany and anatomy -were not infrequently combined. Fallopius, for example, held the Chair -of Anatomy, Surgery and Botany in the University of Padua, and so -also did Vesling in the same university at a somewhat later date. The -first systematic works on botany were also published in the sixteenth -century. They were all written by German or Swiss authors, the most -noteworthy one of the collection being that of Conrad Gesner of Zürich -(1516–1565), who is spoken of by Haeser as “a man of noble birth, of -extraordinary industry, of extensive knowledge in every department -of natural history, and the author of a large number of treatises, -which, by reason of their intrinsic value, cannot fail to perpetuate -the memory of this distinguished scientist throughout all time.” He -had much to contend with throughout his short but eventful life. In -the first place, he was very poor--so poor that both he and his young -wife were obliged to support themselves during the early years of their -married life by teaching school. Then he studied medicine at Basel, and -afterward accepted the professorship of Greek, first at Lausanne and -then in turn at Basel and at Zürich. From the beginning to the end of -his career he was hampered by poverty and by frequent illnesses. But, -despite these obstacles and also notwithstanding the fact that he was -an indefatigable worker in matters relating to natural history, he is -reported to have played one of the most influential parts in the drama -of the Reformation. Only a man of exceptionally strong character and -of unusual ability would have found it possible to attain the success -which Gesner attained in these different undertakings and under such -unfavorable circumstances. Andreas Caesalpinus, whom I have already -mentioned as one of the earliest investigators of the question of -the circulation of the blood, also interested himself in the science -of botany. Puschmann speaks of him as the greatest botanist of the -sixteenth century. For several years he was Professor of Philosophy and -Medicine in the University of Pisa, but at a later date Pope Clement -the Eighth chose him to be his private physician and also appointed him -Professor of Medicine in the University of Sapienza at Rome. His death -occurred in the latter city in 1603. - -Before dismissing all further consideration of the part played by -Italian and Spanish physicians during the sixteenth century in the -advancement of the science of medicine, I shall briefly mention a -few additional discoveries in botany and pharmacy that may serve to -render the present account more complete. In 1518 the monk Romano Pane -published the first account of the discovery of tobacco in America. -In 1560 Jean Nicot, a French diplomatist, brought back with him from -Portugal (to which country he had been sent as an ambassador) a small -supply of the seeds of the plant. To commemorate this service the -alkaloid found in the leaves of the tobacco plant was given the name of -_nicotine_. Capsicum was made known to the world by Dr. Chanca, a -companion of Christopher Columbus on the occasion of his second voyage -(1493) to America. Balsam of Copaiva was discovered by a Portuguese -monk in Brazil at some time between the years 1570 and 1600. It is -mentioned for the first time in the Amsterdam Pharmacopoeia of 1636. -Monardes described the Peruvian and Tolu balsams in 1565. Cacao was -first made known to Europeans by Fernando Cortez in 1519. About the -year 1550 coca was introduced as a drug that possesses the power of -allaying hunger and of enabling one to endure the fatigues attending -prolonged expeditions. Sarsaparilla came into use at about the same -date. Then followed jalap in 1556 and sassafras toward the end of the -century. - -In Germany and in the Netherlands there were, during the sixteenth -century, very few physicians who manifested any marked degree of -learning in the science of medicine. The teachings of Paracelsus met -with a favorable reception in these parts of Europe and they continued -to hold supreme sway over the minds of men during a long period of -time. There were some physicians, however, who had received their early -professional training in Italy and France, and who for this reason -were less ready to accept unreservedly the doctrines of Paracelsus; -and, among these more independent spirits, Rembert Dodoens (Dodonaeus, -1517–1586) of Malines, near Antwerp, distinguished himself by making a -number of valuable contributions to the science of medicine. He held -the Chair of Medicine at the University of Leyden and was also the -personal physician of the Emperors Maximilian the Second and Rudolphus -the Second. He was a very accurate observer, and his writings are -particularly rich in matters relating to pathological anatomy; for -which reason not a few authorities are inclined to credit him with the -honor of being the founder of this department of medical science. Felix -Platter of Basel, Switzerland, of whose experiences as a student at the -University of Montpellier I have given a brief account on a previous -page, and who was at this time Professor of Medicine in his native -city, was also greatly interested in pathological anatomy. Haeser gives -him credit for publishing a number of valuable contributions to this -department of medical knowledge, and also for making the first attempt -at a classification of diseases. - -Before I close this chapter it seems only fair that I should add a -few comments upon the careers of two physicians whose professional -attainments entitle them to some consideration. The men to whom I have -reference are Marcello Donato and Raymond Minderer. - -Marcello Donato was a distinguished medical practitioner of the city of -Mantua, Northeastern Italy, who died about the year 1600. He was one of -the few who, at that early period, taught that it was very important to -study disease from nature--_i.e._, from direct observation--and -not from books. His description of the epidemic of small-pox of 1567 -(published at Mantua in 1569) is worthy of commendation. His chief -work, however, is that which bears the title “_De medica historia -mirabili etc._” (Mantua, 1586.) It contains a remarkably large and -complete collection of rare and extraordinary cases belonging to every -department of medicine, and in his descriptions Donato pays particular -attention to the pathologico-anatomical aspects of each case. He -reports, for example, the instance of a Caesarian section performed on -a living woman in 1540 by Christopher Bain; the child being found dead. -Another interesting case reported by Donato is that of a child in whose -ear a cherry pit had been allowed to remain undisturbed until it began -to sprout; after which it was found easy to remove the impacted object. -In a somewhat similar case which Donato also reports, the sprouting -of the seed of Anagyris was hastened by the presence of a purulent -discharge from the ear. In both instances all attempts to extract the -foreign body had failed until the sprouting had caused the seed to -split. Finally, there is recorded the case of a young man into whose -nasal passage a leech had penetrated, while he was bathing, and had -then taken up its abode far back in the canal. Donato, by aid of direct -sunlight, “discovered the creature in that part where the nasal channel -merges into the oral cavity.” Presumably he succeeded in removing the -animal, but the text quoted by von Gurlt (Vol. II., p. 517) furnishes -no further particulars. - - - - - CHAPTER XXXI - - CHEMISTRY AND EXPERIMENTAL PHARMACOLOGY - - -The experiments which were carried out by Antonius Musa Brassavola, in -the early part of the sixteenth century, upon animals and criminals, -for the purpose of learning the effects produced by certain drugs when -administered internally, afford one of the earliest instances of a -genuine experimental pharmacology. The account of these experiments, -which was published at Rome, in 1536, under the title “_Examen omnium -simplicium, quorum usus est in publicis officinis_,” deserves -honorable mention. An even more remarkable evidence of the research -spirit which was abroad at that period is to be found in the work done -by Fortunatus Fedelis, a native of Palermo, Sicily, and an ardent -champion of the direct method of observation as applied to therapeutics. - -Van Helmont, of whose life and contributions to the science of medicine -I now propose to furnish a sketch, represents in a certain sense -Paracelsus’ successor; and, as a matter of fact, he was even more -closely associated with the development of chemistry as an independent -science than was his predecessor. - -Jean Baptiste Van Helmont was born at Brussels in 1577. His parents, -who belonged to the nobility, possessed ample financial means and -were therefore able to give their son every opportunity to secure a -liberal education. While still a lad he enrolled himself among the -students of the University of Louvain, and advanced so rapidly in his -studies that, already at the early age of seventeen, he had passed -all the examinations required of applicants for the degree of Master -of Philosophy. He was not willing, however, to receive this honor -at that time, feeling that he had not acquired sufficient knowledge -to justify such acceptance; and from that date forward he turned his -attention to the study of other branches of learning. Finally, in 1599, -he accepted from the same university the degree of Doctor of Medicine, -and soon afterward left Belgium with a large party of his friends to -make an extensive tour through the Alps of Switzerland and Savoy. After -his return home in 1602 he devoted his attention chiefly to chemical -researches; but in a very short time he started off again on a journey -to Spain and France, and eventually to England, where he spent nearly a -year in the city of London, returning to Belgium in 1605. He married, -about this time, a rich heiress of Wilworde, in the neighborhood of -Brussels, and resumed with great zest his labors in chemistry and -alchemy. He was thus enabled to manufacture many remarkable remedies -with which--as he himself declared--he succeeded in curing myriads -of patients who had failed to receive any benefit whatever from the -ordinary resources of medical science. He died on December 30, 1644. - -I do not feel equal to the task of expounding Van Helmont’s often very -obscure theories regarding the physical and psychological processes -that take place in the human being; regarding the distinctions which he -makes between the “_archaeus influus_”--the regulating principle -which governs all the psychical and physiological processes in the -body--and the “_archaeus insitus_”--the subsidiary power which -resides in each individual part of the body, but which at the same time -is under the control of the “_archaeus influus_”; and regarding -the doctrine that disease is the result of an “_idea morbosa_” of -the “_archaeus influus_.” August Hirsch says that in developing -these theories Van Helmont puts forward many bright ideas, which -unfortunately lead one into a wilderness of fantastic, theosophic -concepts. If sufficient time and space were at my command it might -be interesting to separate some of these bright thoughts from the -extravagances in which they are buried, and thus demonstrate the truth -of the statements made by both Hirsch and Dezeimeris to the effect -that Van Helmont, in matters relating to physiology and pathology, was -unquestionably a precise and critical observer, a sound thinker, and a -correct interpreter; but the plan of the present work will not permit -me to enter into all these details. I can only quote a few of the -teachings or sayings to which Hirsch refers:-- - - Digestion does not, as Galen maintains, depend upon heat, but - upon a certain ferment existing in the gastric juice. - - Heat is not, as has hitherto been taught, the cause of life, but - rather one of its products. - - The final cause of the sensory phenomena of life is the - _archaeus influus_, which, while it is inseparably - united with matter, nevertheless does not represent the soul - itself, but rather the organ of the soul, and is seated in the - “duumvirate” of the spleen and the stomach. - - Disease, in order to acquire sufficient power to antagonize - life effectively, must unite its forces with the _archaeus - influus_. - -It is claimed that Van Helmont, more than any other teacher -of medicine, was instrumental in giving the deathblow to the -practice--which prevailed in all the medical schools of that day--of -teaching the obsolescent Galenic doctrines, and that for this valuable -service alone he deserves full recognition at the hands of the medical -profession of to-day. But, as we learn from Ernest von Meyer’s history -of chemistry, Van Helmont has a much stronger claim for recognition in -the fact that he made many important contributions to iatrochemistry -and also to fundamental or pure chemistry. Taking one thing with -another, says von Meyer, we may safely assert that Van Helmont’s -useful contributions to the medical and chemical sciences by far -outweigh those which are of a fantastic or useless nature. It was he, -for example, who materially increased our knowledge of the nature of -carbonic acid. He demonstrated how it may be extracted from limestone -or from potash by the aid of acids, from burning coal, and from wine -and beer while they are undergoing fermentation. He also showed that -it is present in the stomach, in various mineral waters, and in -hollows in the earth. He gave it the name of “_gas sylvestre_.” -He would doubtless have carried his discoveries much farther along if -he had possessed the apparatus which is required for such researches. -However, despite the lack of these facilities, he was able to describe -hydrogen and marsh gas as special varieties which do not possess the -same composition as ordinary air. Finally, in his treatise entitled -“_Pharmacopolium ac dispensatorium modernum_” will be found -a goodly number of useful instructions as to the proper manner of -preparing drugs. - -A complete collection of his writings was published at Amsterdam by his -son, in 1648, under the title “_Ortus medicinae vel opera et opuscula -omnia_.” - -Theophrast von Hohenheim--who is known everywhere throughout the -world as “Paracelsus”--was the son of Wilhelm Bombast von Hohenheim, -a physician who belonged to one of the noble families of the Duchy -of Württemberg. He was born in 1493 at a spot called “_Das Hohe -Nest_” (the lofty nest) in the Canton of Schwyz, about one hour’s -distance from the celebrated monastery or cloister of Einsiedeln, of -which institution his father was the official physician. Switzerland, -therefore, has a right to claim Paracelsus as one of her sons. In 1502 -his father transferred his home to Villach, in Carinthia (to the east -of Tyrol), and continued to live there up to the time of his death in -1534. It is not known where the son obtained his degree of Doctor of -Medicine. It is a well-established fact, however, that he received the -first part of his training as a chemist from Johann Trietheim, the -Prior of Sponheim, and his subsequent education in the laboratory of -Sigmund Fugger, the cultivated owner of wines at Schwatz in the Tyrol. -He traveled all over Europe, going from one university to another and -making the acquaintance of people who were well informed in matters -relating to natural history, chemistry and metallurgy; and during all -this time he appears to have absorbed a great deal of information -relating to almost every department of human knowledge. Finally in -1526, soon after he had returned to Switzerland, he received, through -the aid of certain influential citizens, two important official -positions in Basel,--that of City Physician and that of Professor of -Medicine and Surgery in the University. To the surprise of all, and -contrary to long-established custom, he delivered his lectures in -German and not in Latin. This action on his part called forth bitter -criticism from the university authorities, but at first it met with the -approval of the students. During the following two years, however, he -gradually became unpopular with all classes of the community, and was -finally obliged to leave Basel. Haeser attributes this unpopularity -to Paracelsus’ rough manners, to his intolerance of the opinions of -his colleagues, and to his tirades against the apothecaries for their -excessive charges. It is very difficult to determine how far jealousy -was responsible for the state of affairs which I have just described. -Cabanès, the author of an admirable biography of Paracelsus (_Revue -Scientifique_, Paris, May 19, 1894), gives his own estimate of this -remarkable man’s character in the following terms: “Poor, miserable, -and persecuted during his lifetime, he was misunderstood even after -his death, and was calumniated by history.” Paracelsus evidently -believed it to be his bounden duty to destroy the then prevailing cult -of Aristotle, Galen and Avicenna as the great teachers in medicine; -and, filled with this idea, he prophesied the growth of a new science -of medicine on the ruins of their teachings. It is stated that the -students, after one of these excited lectures, made a bonfire and -burned a number of copies of the works of these famous authors, thus -showing that Paracelsus was sufficiently eloquent to infuse some of -his own reforming spirit into the minds of his auditors. He made -a great mistake, however, when he attacked in a similarly violent -manner the shortcomings of many of his contemporaries. “The medical -profession,” he said, “has become a mere money-making business.” As a -natural result of such tirades, Paracelsus was forced to leave Basel. -He fled first to Colmar in Alsace and at a later date took refuge in -St. Gall, Switzerland; and it was while he resided in that city that -he published three books of his “_Paramirum_.” Then in 1535 he -once more resumed his wandering life, in the course of which he visited -Poland, Lithuania, Illyria, etc. On reaching Salzburg, in Austria, he -fell ill and died on September 24, 1541, at the age of forty-eight. - -Paracelsus was a prolific writer. To all the treatises which he -published he gave extravagant titles. To his principal work, for -example, he gave that of “_Paramirum_”--The Surprising Marvel; -to another, that of “_Paragranum_”--Grain of Superior Quality; -and to a third, that of “_Archidoxia_,”--Transcendental Science. -He wrote treatises on syphilis, on the plague, on epidemics, on the -diseases of grave-diggers, on ore-smelters, etc. It is admitted by all -his critics that he devoted altogether too much time and thought to -alchemy, demonology, necromancy, etc. Cabanès quotes Cruveilhier as -saying that Paracelsus believed in the reality of beings of a fantastic -nature, but attached little or no importance to them. Then Cabanès -himself adds: “The thing which more than anything else absorbed his -thoughts was the irresistible desire to overthrow the Galenic idol -and substitute for it the science of experience, of observation pure -and simple.” Bordes-Pagès, another distinguished French physician, -says of this extraordinary man: “The great glory of Paracelsus is to -be found in the facts that he cast off the yoke of a former epoch, -more speculative than practical; that he summoned physicians to resume -their allegiance to experience; and that he opened a long career -for the alchemists, upon whom he urged the duty thenceforward of -making new remedies the principal object of their researches.... He -simplified and spiritualized therapeutics.” Some of Paracelsus’ own -sayings are worth preserving: “Without air all living creatures would -perish from suffocation.” “Man is the supreme animal, the one last -created.” “_Alterius non sit, qui suus esse potest_” [He who is -able to be his own master should not allow himself to be led blindly by -another]. When he was accused of being coarse-grained and of deceiving -the people, he replied: “By nature and also owing to the kind of -people with whom I associated in my youth I am not of a finely-spun -texture.... We were not nourished with figs and white bread, but with -cheese, milk and black bread-food that does not make delicate lads.... -They say of me that I lead the people astray, that I am possessed of a -devil, that I am a sorcerer, and that I am a magician. Whatever truth -there may be in these charges, one thing is certain: You are all of you -unworthy to unloose the latchets of my shoes.” (From _Paragranum_, -II., 120.) - -Oporinus, who acted for a long time as Paracelsus’ assistant, made the -following statements with regard to some of the methods of his former -master:-- - - He always kept several preparations stewing on his furnace--as, - for example, a sublimate of oil or of arsenic, a mixture - of saffron and iron, or his marvelous Opedeldoch. He never - prescribed a special diet nor any hygienic measures. As a purge - he gave a precipitate of theriaca or of mithridate, or simply - the juice of cherries or grapes, in the form of granules (about - the size of the droppings of mice), and he was careful always - to give them in uneven numbers (1, 3, or 5). He was bitterly - opposed to the polypharmacy which prevailed so widely in his day. - -Cabanès says that we probably owe to Paracelsus an increased knowledge -of the virtues possessed by the different preparations of antimony, -mercury and iron, and by salines. It was he who created the distinction -between officinal and magistral preparations. To our list of -pharmaceutical preparations, he added tincture of hellebore, compound -tincture of aloes, digestive ointment, the tincture of metals (“Lilium” -of Paracelsus), the “Saffron of Mars,” etc. He was the inventor of the -precious preparation known as “_la mumie_,” a preparation which -was popularly believed to possess marvelous healing powers. Ambroise -Paré, toward the end of his career, was greatly blamed because he did -not employ this remedy, and he was finally compelled in self-defense to -write a pamphlet on the subject. (The text is reprinted in Malgaigne’s -“_Ambroise Paré_,” under the title of “_Traité de la mumie et de -la licorne_.”) - -Adolphe Gubler of Paris credits Paracelsus with the distinction of -having been the first physician to give an impetus to the movement -which had for its object the application of chemistry to the perfection -of medicinal preparations. He also maintains that Paracelsus should be -looked upon as in a large degree the originator of specific remedies, -and that he is justly entitled to the distinction of having been the -first publicly to announce the “quintessences”--that is, the active -principles (vegetable alkaloids)--of drugs. According to this claim -it is understood that Paracelsus taught that each drug contained a -specially active elementary body which it was possible to extract -as a separate substance. Acting upon this belief Paracelsus did not -hesitate to give the preference to the pharmaceutical preparations -known as “tinctures”--that is, alcoholic extracts. Great credit is -also due to Paracelsus for his rejection of the doctrine that guaiac -is an efficient remedy against syphilis, and for his insistence that -mercury is the only useful agent in curing that disease. Tartar emetic -(potassium antimonyl tartrate) is one of the drugs the introduction of -which into our pharmacopoeia should be credited to Paracelsus. - -One of the earliest references to genuine diphtheria is to be found in -the writings of Paracelsus, who speaks of the disease in the following -terms:-- - - When this disease is located in an external wound it not - infrequently spreads to the muscles of the larynx; and, _vice - versa_, when a person has the disease in his throat, and at - the same time happens to have an external wound, the malady is - likely to spread to the wound. - -Paracelsus’ idea of the existence of an “_archaeus_,” a power -which presides over all physiological actions as well as over all -the operations of medicinal drugs, resembles very closely the “vital -force,” or “animism” so strongly championed by Stahl in the seventeenth -century. - -From all that I have said above regarding the excitable nature of -Paracelsus it seems almost a waste of time to tell our readers that his -contributions to the science of surgery were of very slight value. He -despised the study of anatomy, claiming that a knowledge of this branch -of medical science was not essential to a proper acquaintance with the -human body. “To dissect,” he once remarked, “was a peasant’s manner of -procedure.” (Cabanès.) His surgery, as one may imagine, showed clearly -the bad effects of such beliefs. - -During the latter part of the nineteenth century there developed -among the leading men of the medical profession a sentiment in favor -of honoring the memory of Paracelsus by the erection of a suitable -monument at Basel, Switzerland, the city in which he made his first -public appearance. The project met with a favorable reception and the -statue is now an accomplished fact. This is a remarkable instance of -tardy justice being rendered to the memory of a physician who, for -three hundred years, was almost universally looked upon as a vain, -half-crazy man. - -The next advances of any special importance in the department of -chemistry were made in Great Britain by Robert Boyle, who was born -at Lismore, County of Cork, Ireland, on January 25, 1626. He was the -fourteenth child of the Earl of Cork. His early training was obtained -at Eton, and then afterward he spent two years at Geneva, Switzerland, -in prosecuting his scientific studies. In 1654 he entered Oxford -University and became intimately acquainted with some of the most -learned men of that day. While he was a student at the university he -became a member of what was known as “The Invisible College,” a society -which was influential in bringing about the founding of “The Royal -Society,” of which organization he was president from the year 1680 to -the time of his death in 1691. - -Boyle was endowed with a noble character--modest, religious and -generous. He gained distinction as a chemist in several departments. -Applied chemistry is indebted to him for a number of important -contributions; he added to our knowledge of chemical combinations and -to the methods of analyzing them; he enriched the chemistry of gases -and also pharmacology; and he gave a clear and easily intelligible -definition of what a “chemical element” is. He laid stress upon the -doctrine that a chemical combination represents the union of two -component elements, and that this combination possesses characteristics -quite different from those possessed by either of the two component -elements. Before his day there was practically no such thing as -analytical chemistry, and it is to Boyle that we owe the establishment -of a clear conception of what the terms “chemical reaction” and -“chemical analysis” signify. The part played by atmospheric air in -combustion was made by him the subject of numerous experiments which -proved later to be of great assistance in the final solution of the -problem. - -In one of his writings Boyle says in substance that if men would devote -their energies to carrying out experiments and collecting observations, -rather than to the constructing of theories without having previously -tested with thoroughness the grounds upon which they believe them to -be based, the world would be greatly the gainer. The promulgation -and insistence upon the importance of this doctrine for the growth -of the science of chemistry constitute--so those competent to judge -claim--Boyle’s greatest merit in scientific work and his most important -contribution to chemistry. - -Among the chemical treatises which Boyle wrote and published the -following deserve to receive special mention: “Sceptical Chymist,” -1661; “_Tentamina quaedam physiologica_,” 1661; “_Experimenta -et considerationes de coloribus_,” 1663; and “Medical Experiments,” -1692–1698. Although Boyle was not an avowed follower of Bacon, he -carried out thoroughly the principles which the latter taught. - -Raymond Minderer, a practicing physician in Augsburg, Germany -(1570–1621), deserves the credit of having added to our stock of -remedies the acetate of ammonia (_liquor ammonii acetatis_). -Diluted with an equal quantity of water it is still employed to-day as -a remedy under the name of “Spirit of Mindererus.” He was the compiler, -in 1613, of the Augsburg Pharmacopoeia. - -_General Therapeutics.--Transfusion.--The Discovery of Cinchona -and Ipecacuanha._--In the department of general therapeutics, as -we learn from Berendes, several important new measures were brought -forward during the seventeenth century; and among these the following -deserve to receive brief mention in this place: the operation of -transfusing blood from a healthy individual to one who is ill; the -introduction of cinchona into the European pharmacopoeia as an -efficient remedy in the treatment of certain fevers; the similar -introduction of another South American drug--viz., ipecacuanha; and -the invention of many medico-chemical products and the improvement of -others that were already in common use. - -As regards the operation of transfusion, from which great things were -expected, Sir Christopher Wren (1632–1723), the famous architect and -astronomer of London, is reported to have been the first person to -urge a trial of this procedure. On the other hand, Robert Boyle, the -chemist, actually performed the operation on animals. He followed the -method suggested by Richard Lower (1631–1691) of England, viz., by -allowing the blood to flow from the carotid artery of one animal into -the jugular vein of a second animal; while Edmund King adopted the -plan of allowing the blood to pass from the jugular vein of one animal -into the corresponding vein of a second animal. Upon a human being the -operation was probably performed for the first time (in 1666) by Denys, -Professor of Philosophy and Mathematics in Paris. Repetitions of the -operation were made, two or three years later, in London and in Rome, -but they produced no good effects and in some instances they terminated -in the death of the individual for whose benefit the operation had -been performed. In 1668 the French Parliament and the Papal Government -forbade a repetition of the operation. - -In 1638--so the story runs--the wife of Count Cinchon, Viceroy of Peru, -was cured of a stubborn intermittent fever by the native physicians, -who employed, in their treatment of the malady, the bark of the tree -now universally known by the name of “Cinchona.” In 1640 Juan del -Vego, the regular medical attendant of Count Cinchon, introduced -the new remedy into Spain, but it was not until after the lapse of -about fourteen years that the drug found its way into England and -Central Europe. The price at which it could be purchased was at first -very high; it was almost literally “worth its weight in gold.” Even -as late as 1680 the bark sold in England for £8 sterling per pound. -Notwithstanding the generally recognized value of the drug in the -treatment of certain fevers there were not a few men who continued -for many years to oppose its use. Thus, Johann Kanold, a practitioner -of medicine in Breslau, Germany, is reported to have said, on his -death-bed in 1729, that he would rather die than be cured by a remedy -the action of which was so opposed to all the principles which he -considered right in therapeutics. - -Ipecacuanha, another very important drug, was added to our stock of -remedial agents toward the end of the seventeenth century. It was -brought into France from Brazil, in 1672, by a French physician named -Le Gras, but its value as a remedy for the cure of dysentery did not -begin to be appreciated until after Helvetius, a semi-quack, had sold -to Louis the Fourteenth, for one thousand louis-d’or (about $4000), -the formula for the preparation which he (Helvetius) had been using -with great success during the recent epidemic of that disease, and -which moreover had effected a remarkably rapid cure in the case of -the King’s own son--the Dauphin. After the purchase had been made by -Louis the Fourteenth, in the interest of the French people in general, -it was ascertained that the only active reagent among the ingredients -of the formula was ipecac, a drug with which the Paris physicians had -long been more or less familiar. Ipecac, it will also doubtless be -remembered, constitutes the important element in what is known as the -East Indian treatment of dysentery. - -Probably the earliest modern treatise on matters connected -with pharmacy is that which bears the title “_Onomasticon -Latino-Germanico-Polonicum rerum ad artem pharmaceuticam -pertinentium_.” It was published about the year 1600, and its author -was Paul Guldinus. - -One of the most important iatrochemical authorities of the seventeenth -century was Johann Rudolf Glauber (1604–1668), to whom we are indebted -for the invention or improvement of a large number of medico-chemical -products. The well-known “Glauber’s salt” may be named as one of these -products, and chloride of iron as another. - - - - - CHAPTER XXXII - - SOME OF THE LEADERS IN MEDICINE IN ITALY, FRANCE AND ENGLAND - DURING THE SIXTEENTH AND SEVENTEENTH CENTURIES - - -_Eminent French Physicians._--Among the physicians of France who -attained a widespread and well-grounded celebrity throughout Europe -during the sixteenth century, Pierre Brissot deserves to be given -the first place. He was born in 1478 at Fontenay-le-Comte, not far -from Rochelle, and was a professor of medicine at Paris. He attained -considerable distinction, during the sixteenth century, by his advocacy -of the superiority of the Hippocratic method of bloodletting over that -introduced--or, rather, perpetuated--by the practitioners of that day -in Central Europe. The rule which was laid down by Hippocrates was -to the effect that, in venesection, the blood should be drawn from -the vein lying nearest to the part inflamed. The Greek physicians -of a later period forgot all about this rule and adopted in its -place one that was based on the doctrine that venesection practiced -in the vicinity of a focus of inflammation favors a determination -of blood to that part and therefore does only harm; and they -accordingly--especially in cases of pleuritis--abstracted blood from -the arm on the side opposite to that on which the disease was located, -or from one of the veins of the foot. This new rule was subsequently -adopted by the Arabian physicians, and it remained in full force up to -the end of the sixteenth century. A wide experience in the treatment of -the epidemic pleuritis which raged in Paris in 1514 confirmed Brissot -in the belief that the Hippocratic method is the one to be preferred; -but, despite his pleadings, the Parisian physicians refused to adopt -the method which he advocated and used their influence in securing from -the French Parliament an order forbidding him to continue employing it -in Paris. Discouraged by the treatment which he experienced in that -city, Brissot removed to Lisbon in Portugal, and soon had occasion -(in the epidemic which raged at Evora in 1516) further to satisfy -himself that the Hippocratic rule is the correct one. But here too he -encountered bitter opposition on the part of the Portuguese physicians; -his most active opponent being Dionysius, the Physician-in-Ordinary -to the King. Brissot then wrote an elaborate defense of the method -which he advocated, and this treatise was submitted to the judgment of -the Medical Faculty of the University of Salamanca. When the decision -of this learned body was given in Brissot’s favor, his opponents, -dissatisfied with the result, made still another effort to gain -their point, viz., by appealing to the Emperor Charles the Fifth. -They assured his Majesty that the Brissot Heresy, as they termed it, -was fully as dangerous to the cause of humanity as that championed -by Luther. But here again they failed. This final victory, however, -brought no satisfaction to Brissot, who died of dysentery in 1522, -just before the decision was rendered. Haeser speaks of this unusually -bitter dispute as one of the last of the violent battles which occurred -between the adherents of the Arabian physicians and the supporters of -the teachings of Hippocrates, and which terminated in “a most brilliant -victory of experience over Arabian dogmatism.” - - [Illustration: FIG. 16. “THE LOVESICK MAIDEN.” - - (After the painting by Jan Steen, 1626–1679.) - - One of this famous Dutch artist’s objects, in painting the scene - here represented, was to satirize the practice, which was very - prevalent among certain physicians of that period, of pretending - to diagnose all sorts of maladies from the mere naked-eye - inspection of his patient’s urine. - - (Courtesy of Dr. Eugen Hollander, author of _Die Medizin in - der klassischen Malerei_, Stuttgart, 1903.)] - -During the first half of the sixteenth century there developed a -belief, among the more ignorant physicians, that, in many cases of -illness, important information may be derived from a simple naked-eye -inspection of the patent’s urine as exposed to view in a flask-shaped -glass vessel. In the Hippocratic writings no adequate grounds for -such a belief are discoverable, but in one of Galen’s treatises there -have been found statements which appear(?) to give some sanction to -this new idea. However this may be, it is an established fact that -uroscopy was taken up at the time named with great zeal by all the -quacks in the land and by large numbers of practitioners of medicine -who saw in this procedure an easy and safe method of bettering their -fortunes. The public at large were greatly impressed with this new and -wonderful manner of detecting disease, and for a long period--indeed, -for more than half a century--this piece of clap-trap charlatanry -continued to thrive, and to reflect only discredit upon the medical -profession. There came a time, however, when people generally began -to suspect that uroscopy was not all that the charlatans claimed it -to be, and these suspicions were voiced in the popular saying, “The -pulse is good, the urine is normal, and yet the patient dies.” The -writers who were the most active in showing up the hollowness of -the claims of the uroscopists were Scribonius of Marburg, Germany, -Peter Foreest (1522–1597) of Alkmaar, Holland, and Leonardo Botallo -of Asti, in Piedmont (born in 1530). The latter authority, it may be -recalled, owes his chief distinction to the fact that he rediscovered -what has been erroneously named in his honor the “_foramen -Botalli_”--_i.e._, the _ductus arteriosus_ in the foetus. -He also attained some distinction in another direction. He revived -the violent disputes about venesection by recommending a resort to -this therapeutic procedure in nearly all illnesses. He went so far -as to advocate four or five bloodlettings in the course of an acute -attack, in each one of which operations from three to four pounds -of blood should, as he believed, be abstracted. Indeed, he claimed -that in an extreme case it might be perfectly proper to abstract as -much as _seventeen pounds_(!). Inasmuch as Botallo’s practice -was largely confined to the strong soldiers of Northern Italy it is -easier to understand how such extravagant bloodletting did not more -often prove fatal than it did. When, soon afterward, the Paris Faculty -condemned the practice in the strongest possible terms, Botallo’s -followers characterized sarcastically the French physicians as “pigmy -bloodletters” (_petits saigneurs_). - -But the efforts of Scribonius, Botallo and others to put an end to the -uroscopy scandal were--I fully believe--not the only or perhaps even -the most potent factors in bringing about the suppression of the evil. -As many of our readers will remember, the art collections of European -capitals contain admirably painted specimens of Dutch and Flemish -genre pictures representing every phase of this uroscopic fraud, and -these striking masterpieces, revealing, as they undoubtedly did to the -community at large, the ridiculous character of the claims made by the -charlatans, could scarcely have failed to give a deadly blow to the -fraud. (See Fig. 17.) - -In the early part of the sixteenth century Jean Fernel of Amiens -(1497–1558) was one of the leading medical authorities of France. -After receiving his degree of Doctor of Medicine at Paris, in 1530, -he settled in that city and soon acquired considerable reputation, -not only as a practitioner but also as a lecturer. In 1545 he was -called upon to take charge, professionally, of Diane de Poitiers, the -mistress of Henry, the son of Francis the First, King of France. About -the same time he was asked to serve as First Physician to the Dauphin, -but he was not disposed to accept the latter position, as he disliked -the duties of the office and also because he feared that they would -interfere with his favorite studies. He pleaded poor health, and his -excuse was accepted as valid. That Fernel was held in very high esteem -by the royal family is evident from the events which succeeded this -refusal. In the first place, it was insisted that he should accept -the stipend (600 livres) attached to the office, as a mark of the -royal favor; and then, in 1547, when Henry was crowned king (Henry the -Second), Fernel was urged to become his First Physician; but again he -declined the honor, this time on the ground that Louis de Bourges, -who had held the position with great credit under Francis the First -(Henry’s father), was entitled to be retained in office. The King -yielded to Fernel’s generous intervention in behalf of de Bourges. -But in 1556, when the latter died, Fernel felt obliged to accept the -position which had then become vacant; and from that time forward, -until the time of his death on April 26, 1558, he accompanied the -King on all his military expeditions. As he did not possess a robust -constitution, his health suffered not a little from the frequent -exposures to hardships of all sorts to which he was subjected; and, in -addition, during this long period he saw very little of his wife to -whom he was devotedly attached. - -Fernel is universally admitted by French physicians to have been one -of the most cultivated teachers and practitioners of medicine of his -day. He was a very clear writer, and would doubtless have made a number -of valuable additions to the science if he had not been carried off by -illness at a comparatively early age. - -Of his published writings the following are reckoned the most -important: “_Universa medicina_,” Paris, 1567; “_De abditis -rerum causis_,” Paris, 1548, and “_Therapeutices universalis seu -medendi rationis libri VII._,” Paris, 1554. (Many editions of each -of these works were published.) - -In his discussion of various questions relating to physiology Fernel -maintains that the component elements of the body are vivified by means -of heat, and he elaborates this idea very much in the same manner as -Hippocrates does that of the “_callidum innatum_.” The spiritual -life, he says, is presided over by the soul (“_anima_”). When he -comes, however, to consider the individual powers of the soul, Fernel -treats the subject exactly as does Galen. He gives expression to one -rather bright idea: “The specific functions of each of the different -organs may be inferred in large measure from the character of the -structural elements of which they are composed.” - -In his scheme of pathology Fernel divides diseases into _simple_ -(“_similares_”)--diseases of the tissues; _compound_ -(“_organici_”)--diseases involving entire organs; and -_complicated_ (“_communes_”)--diseases in which the normal -relations between the different parts are broken up. - -In the chapter which Fernel devotes to the subject of therapeutics, -there is a section relating to venesection which, according to Haeser, -is well worth reading, as it reveals the power of the writer to grasp -the leading points and to reason correctly from them. - -_Two English Physicians Who Became Famous During the Sixteenth -Century._--In the early part of the sixteenth century the medical -profession of Great Britain was in a most unsatisfactory state. -Humbuggery, ignorance and superstition were at that period of time -the most prominent characteristics of the majority of physicians -upon whom the people at large had to depend for the relief or -cure of their bodily ailments, and there were very few and very -untrustworthy measures in force for the production of a better class of -practitioners. Just at this juncture there appeared on the scene a man -who was eminently well equipped to rescue England from this lamentable -state of affairs and to put her on the high road to the acquisition of -an honorable body of medical men and of a corps of apothecaries who -could be trusted to dispense pure drugs properly compounded. I refer -to Thomas Linacre, who was born at Canterbury in 1461 or 1462, was a -Fellow of All Souls College, Oxford, and a graduate of the University -of Padua, and whose biography is sketched by John Freind (1675–1728) in -such an admirably clear, concise and appreciative manner that I cannot -do better--in view of the great importance of this event in the history -of medicine in England--than to reproduce it here in considerable -fulness of detail. - - Thomas Linacre was a man of a bright genius and a clear - understanding, as well as unusual knowledge in different parts - of learning: ... and, being very desirous to make further - improvements by travelling, he thought he could no where succeed - in his designs so well as by going to Italy, which began then - to be famous for reviving the ancient Greek and Roman learning. - There he was treated with extraordinary kindness by Lorenzo - de Medicis, one of the politest men in his age and a great - patron of letters; who favoured him so far in his studies as - to give him the privilege of having the same preceptors with - his own sons. Linacre knew how to make all his advantages of - so lucky an opportunity; and accordingly, by the instructions - of Demetrius Chalcondylas, a native of Greece, he acquired a - perfect knowledge of the Greek tongue; and so far improved under - his Latin master Politian, as to arrive to a greater correctness - of style than even Politian himself.... - - Having laid in such an uncommon stock of learning, he applied - himself to the study of natural philosophy and physick; - particularly he made it his business, and was the first - Englishman who ever did so, to be well acquainted with the - original works of Aristotle and Galen. He translated and - published several tracts of the latter.... - - In his own Faculty he distinguished himself so much that, soon - after his return, he was pitched upon by that wise king, Henry - the Seventh, as the fittest person to be placed about Prince - Arthur, and to take care both of his health and his education. - He was afterward made successively Physician to that king, to - his successor Henry the Eighth, and to the Princess Mary.... - And indeed, as he was perfectly skilled himself in his own art, - so he always shewed a remarkable kindness for all those who - bent their studies that way; and wherever he found, in young - students, any ingenuity, learning, modesty, good manners, and a - desire to excel, he assisted them with his advice, his interest, - and his purse. And to give a still stronger proof, how much he - had the good of his own Profession and that of the Publick at - heart, he founded two _Lectures of Physick_ in Oxford, and - one at Cambridge.... - - But he had still further views for the advantage of our - Profession: he saw in how low a condition the practice of - Physick then was, that it was mostly engrossed by illiterate - monks and empiricks, who in an infamous manner imposed on the - Publick; the Bishop of London or the Dean of St. Paul’s for the - time being, having the chief power in approving and admitting - the practitioners in London, and the rest of the bishops in - their several dioceses. And he found that there was no way - left of redressing this grievance, but by giving encouragement - to men of reputation and learning, and placing this power of - licensing in more proper hands. Upon these motives he projected - the foundations of our College [of Physicians]; and using - his interest at Court, particularly with that great patriot - and munificent promoter of all learning, Cardinal Wolsey, he - procured Letters Patent from the King, which were confirmed - by Parliament, to establish a corporate Society of Physicians - in this city, by virtue of which authority the College, as a - corporation, now enjoys the sole privilege of admitting all - persons whatever to the practice of physick, as well as that - of supervising all prescriptions. And it is expressly declared - that no one shall be admitted to exercise physick in any of - the dioceses in England, out of London, till such time that he - be examined by the President and three of the Elects, and have - letters testimonial from them, unless he be a graduate in either - University, who, as such, by his very Degree, has a right to - practice all over England, except within seven miles of London, - without being obliged to take any license from the Bishop.... - - By other Acts another weighty affair is committed to the care of - the College, [viz.,] the visiting of shops and the inspection of - medicines; a thing surely of as much consequence at least to the - patient as to the prescriber.... - - Linacre was the first president of his new-erected college, and - held that office for the seven years he lived after.... And - perhaps no Founder ever had the good fortune to have his designs - succeed more to his wish; this society has constantly produced - one set of men after another, who have done both credit and - service to their country by their practice and their writings. - -If further evidence be needed to show what was the type of mind -possessed by this remarkable English physician, I may be permitted to -quote here a single brief statement made by his friend Erasmus, the -famous Dutch scholar and theologian, in a letter addressed to John -Fisher, Chancellor of Cambridge University: “Linacre is as deep and -acute a thinker as I have ever met with.” - -In England, during the seventeenth century, there appeared on the scene -only one practicing physician of such conspicuous ability and of so -marked personal traits of character as to place his name, after the -lapse of a few years from the time of his death, and by the almost -unanimous assent of his associates, high up on the roll of honor. I -refer to the famous physician Sydenham. - - [Illustration: FIG. 17. THOMAS SYDENHAM. - - (After the portrait in the hall of All Souls’ College, Oxford.)] - -Thomas Sydenham was born at Wynford Eagle, Dorsetshire, England, in -1624. At the age of eighteen he entered Magdalen College, Oxford, -and remained there until 1644, when he enlisted in the Parliamentary -Army. After a brief military service, he resumed his studies at the -university and received his Bachelor’s degree in 1648. It was only at -a much later date (1676), however, that he was given (after he had -pursued the prescribed course of studies) the degree of Doctor of -Medicine,--and then not by Oxford, but by Cambridge. After leaving -the university he first spent a few months at the Medical School of -Montpellier, France, and then settled (1666) in London as a practicing -physician, the necessary license having been granted him by the -College of Physicians. His first medical treatise, which bore the title -“_Methodus Curandi Febres_” [Method of Treating Fevers], was -published in 1666. The third edition of this work was issued ten years -later, but with the title changed to “_Observationes Medicae_ -etc.” Between 1666 and 1683 he published several other treatises, -the more important of which deal with epidemic diseases--syphilis, -small-pox, hysteria and gout. - -During the later period of Sydenham’s career he attained great -celebrity as a physician; but this celebrity would have been -short-lived if it had rested on nothing more substantial than mere -cleverness and professional success. As a matter of fact he had brought -about, by his teaching and also by his example, a most important -revolution in medicine, and it was the appreciation of this fact which -led the physicians of England to bestow upon him, after his death, the -appellation of “The English Hippocrates,” and which ultimately gave him -so highly honorable a position in the history of medicine in general. A -brief review of the state of medicine in England during the seventeenth -century will enable the reader to understand the full importance of the -change which Sydenham was instrumental in bringing about. - -The physicians of that period were split up into three sects: the -followers of Galen, with whom should be classed the Graeco-Arabists; -the iatrochemists; and the iatrophysicists. - -The Galenists were largely intent upon the strictest interpretation of -the teachings of Hippocrates, Galen and some of the Arabian authors. -Instead of studying disease itself they devoted their time and thoughts -largely to the interpretation of the words used by these fathers in -medicine--_i.e._, to philology. Real progress in the science -of medicine was not possible along this route. Accepting without -dispute the dogma of the four humoral qualities, together with the -different temperaments which result from the predominance of any one -of them, they combated these different temperaments or constitutions -by prescribing drugs in a very great variety of combinations -(polypharmacy). - -The iatrochemists, attaching small importance to simple dietetic -measures, prescribed without stint all the most active substances -belonging to the mineral kingdom and all the new remedies which the -chemists had evolved from their furnaces. - -Finally, the iatrophysicists directed their efforts to the removal or -diminution of all bodily conditions that appeared to act as mechanical -hindrances to health. - -Sydenham, who possessed a rare degree of common sense, cast aside -all these hypotheses, disregarded the prevailing routine methods of -treatment, and refused to accept the therapeutic novelties of the day. -“Nature is to be my guide,” he declared, and from that time forward he -studied disease at the bedside, and watched carefully, and with a mind -free from prejudice, the effects of the remedies which he employed. -Thus, pursuing the methods advocated by the great master Hippocrates, -he was able to place his medical brethren once more on the pathway -which leads to an increase in knowledge of the healing art. Practical -medicine, which had previously been falling into an almost moribund -condition, was by his efforts made again a living and growing science. -That Sydenham had a perfectly clear conception of what was needed at -that time to renew the vitality of the medical profession of England -is plainly shown by the following statement which he makes in the -dedication of one of his writings to Dr. Mapletoft:--[78] - - After studying medicine for a few years at the University of - Oxford, I returned to London and entered upon the practice of - my profession. As I devoted myself with all possible zeal to - the work in hand it was not long before I realized thoroughly - that the best way of increasing one’s knowledge of medicine is - to begin applying, in actual practice, such principles as one - may already have acquired; and thus I became convinced that - the physician who earnestly studies, with his own eyes,--and - not through the medium of books,--the natural phenomena of - the different diseases, must necessarily excel in the art of - discovering what, in any given case, are the true indications as - to the remedial measures that should be employed. This was the - method in which I placed my entire faith, being fully persuaded - that if I took Nature for my guide, I should never stray far - from the right road, even if from time to time I might find - myself traversing ground that was wholly new to me. - -In the brief account which I have thus far given of the part played by -Sydenham in advancing the science of medicine, I have called attention -only to the general character of the services which he rendered. It -may now be interesting to furnish here a few details that will aid -in completing the picture of this great English physician,--details -relating to his life and personal character, to his views regarding -certain diseases and the remedies which he was in the habit of -employing for their relief or cure, and to his later writings. - -Throughout the greater part of his professional career Sydenham was -a frequent sufferer from gout, some of the attacks being of a severe -type and occasionally of long duration. During the winter of 1676, for -example, he was seriously ill from renal calculus, haematuria being -brought on by the slightest movements of his body. All through the year -1677 he continued to experience frequent attacks of pain, and on one -occasion he was unable to leave the house for a period of three months. - -Speaking of the epidemic of the Plague in 1665, during the progress of -which he left London, Sydenham says: “When I saw that the danger was -in my immediate neighborhood I listened to the advice of my friends -and joined the crowd of those who were fleeing to the country. A -little later, when the epidemic had further increased in severity, -and before any of my neighbors had returned, I yielded to the calls -of those who had need of my services, and went back to London.” It is -worthy of remark, says Laboulbène, who fully appreciated the heroism -which prompted this last decision, that we should never have known -of Sydenham’s weakness in regard to facing his duty, if he himself -had not stated the facts. This famous epidemic, as is well known, was -accompanied by an appalling mortality. - -Andrew Browne, a Scotch physician of good standing, entertained serious -objections to some of the advice given by Sydenham in the treatise -entitled “_Schedula monitoria de novae febris ingressu_,”[79] -and, in order to learn more precisely what the author’s views on the -subject really were, he decided to run down to London for a day or two. -Sydenham gave him such a cordial reception and made his stay in the -metropolis so pleasant that he remained there several months--instead -of a day or two. “And when I returned to Scotland I felt contented and -joyful as if I were carrying back with me a valuable treasure.” - -As an instance of his thoughtful kindness, it is related that Sydenham -had occasion to treat a poor man who lived in his neighborhood for an -obstinate bilious colic, but his employment of narcotics did not effect -very much in the way of relief. “I felt moved by pity for this poor -man in his misery; and accordingly I loaned one of my horses to him in -order that he might take long excursions on horseback.” - -Sydenham had no eagerness for professional honors, although he -appreciated highly those which came to him spontaneously. As already -stated at the beginning of this sketch, the degree of Doctor of -Medicine was not conferred upon him by Cambridge as a mere honorary -affair, but was won by him after he had passed through the regular -course of training required of all candidates for this degree. His -case, however, was peculiar in one respect: he waited until after he -had been in active practice several years before he decided to pass -through the course of training required. He was not a member of the -College of Physicians of London, and he held no official position at -Court. - -The following summary may serve to convey some idea of Sydenham’s views -regarding pathology and treatment. He defines an acute disease as “a -helpful effort made by Nature to drive out of the body or system, in -every way possible, the morbific material.” As regards the latter he -makes the following remarks:-- - - Certain diseases are caused by particles which are disseminated - throughout the atmosphere, which possess qualities that are - antagonistic to the humors of the body, and which--when once - they gain an entrance into the system--become mingled with the - blood and thus are distributed throughout the entire organism. - Certain other diseases owe their origin to fermentations or - putrefactions of the humors, which fermentations vary in their - nature--in some cases the humors being excessive in quantity, - while in others they are bad in quality; and in either event the - body finds itself incapable of first assimilating them and then - excreting them--a state of affairs which cannot continue beyond - a certain length of time without producing further harmful - effects. - -According to Sydenham the fever, in the acute diseases, assists -Nature by separating from the general (total) mass of the blood those -particles which have undergone putrefaction or have been rendered -unassimilable. Then they are driven out of the body by the route of the -sweat-glands, by diarrhoea, by eruptions upon the skin, etc. On the -other hand, in chronic diseases the morbific material is not of such a -nature as to produce fever, which is a mechanism for securing complete -purification. It is therefore deposited in one part or another of the -body where no force exists which is capable of ejecting it; or its -final transformation is not completed until after the lapse of a long -period of time. - -In some of Sydenham’s writings one is occasionally surprised to find -teachings which seem to be strongly at variance with the advice which -he was so fond of giving--namely, that physicians should be careful -not to set up hypotheses which are not based upon observed facts. A -conspicuous instance of such a disregard of his own rule may be found -in his setting up of a pathological process to which he gives the name -of “inflammation of the blood.” This process, he maintains, is the -active cause of quite a large number of diseases, especially those -of an epidemic nature--such, for example, as pleurisy, pneumonia, -rheumatism, erysipelas, scarlet fever, etc. It is well-nigh impossible -for us moderns to comprehend how so practical and clear-headed a man as -Sydenham could have formulated such a purely hypothetical pathology, a -doctrine so completely lacking in anything like a solid foundation of -fact. - -Sydenham excelled in the description of the clinical manifestations of -certain diseases, as, for example, small-pox, hysterical affections, -the encystment of a renal calculus, and the gout--a disease from which, -as already stated, he was a very frequent sufferer throughout a large -portion of his life. All his published works are in the Latin language, -but translations have been made into English, French, German, Flemish -and Italian. At All Souls College, Oxford, where Sydenham spent eight -years of his life, it was a fixed rule that all its members should -habitually converse and write in Latin. - -Sydenham’s remarks upon liquid laudanum are worth recording:-- - - Of all the remedies which a kind Providence has bestowed upon - mankind for the purpose of lightening its miseries there is not - one which equals opium in its power to moderate the violence - of so many maladies and even to cure some of them.... Medicine - would be a one-arm man if it did not possess this remedy.... - Laudanum is the best of all the cordials; indeed, it is the only - genuine cordial that we possess to-day. [This was written in the - middle of the seventeenth century.] - -The laudanum employed by Sydenham was made according to the following -formula: Spanish wine, 400 grammes; Opium, 62 grammes; Saffron, 31 -grammes; Powder of Canella and Powder of Clove, of each 4 grammes. - -After much suffering and extreme weakness, Sydenham died on December -31, 1689. - -Andrew Browne, the Scotch physician of whom mention has already been -made on an earlier page, makes the following comments on the closing -days of Sydenham’s career: “It is a difficult matter to believe, -and yet it is the truth: This great physician, who throughout his -life gave the clearest proof of nobility of soul, generosity and -clear-sightedness, died with the accusation hanging over his head that -he was ‘an impostor and an assassin of humanity.’” Laboulbène adds: -“After years of self-sacrifice in behalf of his fellow men Sydenham -received as his final earthly reward calumny and ignominy, and the -jealousy of many professional brethren.” - - - - - CHAPTER XXXIII - - THE THREE LEADING PHYSICIANS OF GERMANY DURING THE LATTER HALF - OF THE SEVENTEENTH CENTURY: FRANZ DE LE BOË SYLVIUS, FRIEDRICH - HOFFMANN AND GEORG ERNST STAHL - - -The seventeenth century, says Berendes, was one of the saddest periods -in the history of Germany; but, during the greater part of this time, -the neighboring countries--Holland, France, England and Italy--still -continued to enjoy many of the blessings of the Renaissance,--such, -for example, as an uninterrupted activity of artistic efforts, of -scientific work, and of commerce;--but in Germany everything seemed to -be in a state of confusion. A bloody religious war was at this period -devastating the land, and the best powers of the people were being -wasted. Instead of increasing cultivation of manners and sentiments, -there was a steady growth of savagery. The Protestants, although they -probably were numerically superior, were split up into factions. The -Catholics, on the other hand, were united, and their power steadily -increased. In 1618 the disturbances, which previously had been -scattered in character, took on the form of what in time came to be -known as “The Thirty Years’ War,” a struggle which proved to be most -sanguinary, costing Germany a great deal in every respect. Finally, -the war was brought to an end by the signing of the Westphalian Treaty -of Peace at Lützen, in 1648. Some idea of the terribly destructive -nature of this long war may be gathered from the fact that the -population of Germany, which previously had been estimated at twenty -millions, was found to have been reduced to about six millions. Whole -towns and villages were laid in ashes, and as a consequence those -who had survived the disaster lost confidence in themselves and were -not able, at least for several years, to undertake anything in art, -literature or science; and this depressing atmosphere affected in some -degree the people of the Netherlands. Toward the end of the century, -however, there came a marked awakening among the younger generation of -physicians, and in the course of twenty or thirty years four men, only -three of whom, however, were of German birth, succeeded in attaining -a decided leadership in this department of science. The names of the -Germans are Franz de le Boë (commonly spoken of as Sylvius), Friedrich -Hoffmann and Georg Ernst Stahl. I shall now attempt to furnish, as -nearly as possible in proper chronological order, very brief sketches -of the lives of these distinguished physicians, together with an -account of the contributions which they made to the science of medicine. - -_Franz de le Boë (Sylvius)._--Franz de le Boë (Sylvius) was born -at Hanau, Prussia, in 1614, of parents who belonged to the nobility -and were wealthy, and who consequently were able to give their son -every opportunity for acquiring an excellent education. Thus Franz -first received a thorough training in philosophy and the classics and -afterward visited in turn all the leading universities of Holland, -France and Germany before he finally took his degree of Doctor of -Medicine at Basel, Switzerland, in 1637. From this time forward, for a -period of twenty-three years, he devoted himself to the practice of his -profession, first in his native city and then in Leyden and Amsterdam. -In 1660 he accepted an invitation to occupy the Chair of Medicine -in the University of Leyden, and this position he held during the -remainder of his life. He died in 1672. - -As a teacher Sylvius was very popular, Boerhaave alone, at a later -period, finding greater favor among the crowds of medical students and -physicians who frequented this university. Haeser and Haller both -attribute some portion of this popularity to the fact that Sylvius -combined genuine eloquence with a wonderful charm of manner and a -profound knowledge of chemistry, pharmacy and pathological anatomy. -In the practice of medicine he followed Van Helmont very closely, -but he was not willing to accept his teachings about an “_archaeus -insitus_” and an “_archaeus influus_.” The system which he -advocated was of a very simple character, and this fact undoubtedly -contributed much to his popularity among the students. His therapeutic -methods were also of a thoroughly practical nature. - -Of the works which Sylvius published the following deserve to receive -special mention: “_Disputationes medicae_,” a book in which are -set forth his views regarding the fundamental principles of the science -of medicine--physiology in particular; “_De methodo medendi_,” a -treatise on therapeutics; and “_Praxeos medicae idea nova_,” a new -idea concerning the practice of medicine. - -Sylvius was one of the earliest defenders of Harvey’s great discovery, -and he was also one of the first to call attention to the part played -by chemistry in elucidating some of the problems in physiology and -pathology. At the same time he was always ready to acknowledge the -importance of the part played by mechanics in respiration, in the -circulation of the blood, in the movements of the intestines, etc., in -which respects he was in entire agreement with the iatrophysicists or -iatromathematicians.[80] - -Finally, there is one more respect in which Sylvius is entitled to -great credit: he paid most careful attention to the work of giving -clinical instruction. Recognizing, as I do, the importance of this -branch of medicine, I shall not hesitate to devote here a page or two -to a brief review of the manner in which it came to hold the honorable -position which it occupies to-day in all the best schemes for medical -education. - -During the sixteenth century, as Puschmann assures us, an attempt was -made at Padua, Italy, to render clinical instruction an essential -part of the physician’s education, but the difficulties which were -encountered proved so much greater than was anticipated that it was -soon found necessary to abandon the plan; and then for many years no -further effort was made, either at Padua or at any of the other Italian -medical schools, to introduce clinical teaching. After the lapse of -nearly a century, Johannes Heurnius (1543–1601), Professor of Medicine -at the University of Leyden, made an effort to introduce the plan of -teaching medicine at the bedside; and a few years later (1630) two -other professors of the same university--viz., Otho Heurnius, son of -Johannes, and E. Schrevelius--formally introduced clinical instruction -at the city hospital. The plan which they adopted was the following: -The students in turn were permitted first to question the patient about -his ailment and then afterward to make whatever physical examination -appeared to be necessary; next, each one of them stated briefly what -he believed to be the nature of the malady, and also gave his views as -to the prognosis, symptoms and treatment; after which the professor -commented on these different reports, pointing out both the correct and -the incorrect features in each case. After a short trial of the plan -it became clear that it would have to be abandoned, for the students -did not like to have attention called in such a public manner to their -mistakes. Then, a few years later, Sylvius, who at that time was the -Professor of Medicine, introduced a system of clinical teaching which -is thus briefly described by his colleague, Lucas Schacht:-- - - When, followed by his pupils, he approached the bedside of a - patient, he assumed the air of one who is entirely ignorant - of the nature of that person’s malady, of the accompanying - symptoms, and of the treatment which was being carried out. - Then he began to ask first one and then another of the students - a great variety of questions respecting the case that was - under consideration,--questions which at first seemed to have - been propounded in a haphazard fashion, but which in reality - were so cleverly formulated as to elicit from the class all - the information needed for the making of a correct diagnosis, - while leaving on the minds of the students the impression that - they, and not the professor, had worked out the problem to a - successful result. - -This system, if such it may be termed, proved extremely successful, and -the knowledge of this success spread rapidly from one end of Europe -to the other, causing students and physicians to flock to Leyden from -Russia, Poland, Hungary, Germany, Denmark, Sweden, France, Italy and -England. So long as this particular university continued to possess, as -a member of its faculty, a professor of medicine who was clever enough -to carry on clinical instruction with the same profound knowledge -of human nature as had been displayed by Sylvius, just so long did -this institution remain without a rival in this part of the field of -medical education. Then Sylvius was followed, in the work of clinical -teaching, by Boerhaave, a man admirably fitted, both by nature and by -the training which he had received, to keep the University of Leyden -in the first rank of medical schools as regards this most useful -form of discipline. After 1738, the year in which Boerhaave died, -other universities besides that of Leyden began to provide fairly -satisfactory facilities for clinical study, and among the number of -such institutions those of Utrecht, Rome, Edinburgh, Paris and Halle -deserve to be mentioned. The lack of funds and doubtless also the lack -of the right sort of teachers were the principal reasons why these -schools were not able to vie with Leyden in furnishing the facilities -needed for clinical instruction. That the fault--at least in the case -of the University of Halle--was not to be attributed to a failure -on the part of the Medical Faculty to appreciate the value of such -instruction is clearly shown by the saying attributed to Friedrich -Hoffmann, who at that period was the Professor of Medicine:-- - - By a mere attendance upon medical lectures no man will ever - succeed in becoming a properly equipped practitioner of that - art; it is indispensable, in addition, that he should receive - clinical instruction. - -The fairly permanent establishment of this fundamental branch of -medical teaching was not effected until about the middle of the -eighteenth century, when Van Swieten, one of Boerhaave’s most -distinguished pupils, was given full authority by the Empress Maria -Theresa to furnish, at the University of Vienna, all the facilities -required for successfully carrying on such instruction. From that -time onward, to a quite recent date, Vienna has been the Mecca of all -the younger physicians who aspired to become fully equipped in the -practical branches of the science of medicine. - -_Georg Ernst Stahl._--Georg Ernst Stahl was born at Anspach, -Germany, in 1660. Little is known about his early life beyond the -fact that he pursued his studies at the University of Jena, received -the degree of Doctor of Medicine from that institution in 1684, and -shortly afterward began giving private courses in medicine which proved -to be very popular and soon brought him into public notice. In 1687 -he was given the position of Court Physician at Weimar. In 1694, upon -the recommendation of Friedrich Hoffmann, who was at that time the -incumbent of the regular Chair, he was appointed Associate Professor of -Medicine in the recently founded University of Halle, Prussian Saxony; -the understanding being that he was to devote his attention more -particularly to the physiological, pathological, chemical and botanical -aspects of the subject. He held this position up to the year 1716, when -he was appointed one of the attending physicians of Frederick William -the First, King of Prussia, and thereafter was obliged to reside in -Berlin, in which city he died in 1734. - -Stahl was a tireless worker, and wrote a large number of treatises -(two hundred and forty-four in all) on physiological and pathological -topics--all of them in Latin. Albert Lemoine, who has written an -elaborate monograph on one of these treatises (that relating to -animism), says that, despite the obscure style in which this and most -of his other treatises are written, one may, upon careful study, -satisfy himself that Stahl is a very close reasoner and possesses a -clear mind. His most conspicuous faults, Lemoine adds, are these: he -is opinionated and vain, and objects strongly to any criticisms that -his opponents make; and yet he is careful to take up these criticisms -one by one and subject them to a close analysis. His vanity led him to -maintain that he was the only person then living who was capable of -lifting medicine out of the rut in which it was at that time rigidly -held. He manifested a sovereign contempt, not only for the men whose -opinions differed from his, but also for those who complained of the -difficulty of comprehending the Latin in which his treatises are -written. Finally, Lemoine states that Stahl is addicted to mysticism, -as is shown by the invocations of all sorts with which he begins and -ends most of his writings. Haeser adds that Stahl possessed a gloomy, -reticent and overbearing spirit, in striking contrast with the charming -sweetness of temper of his colleague Hoffmann. - -Among Stahl’s numerous contributions to medical literature there -is only one in which our readers are likely to take any particular -interest; I refer to the treatise which bears the title “_Theoria -medica vera_”--the true theory upon which the science of medicine -is based. It is in this work more particularly that Stahl expounds -the doctrine of animism. As I have tried in vain to obtain a really -satisfactory conception of this doctrine, which occupied so great a -place in the thoughts of the physicians of the period between 1650 and -1750, I have decided to rest satisfied with merely reproducing here -the interpretation which William Cullen of Edinburgh, one of Stahl’s -contemporaries and also one of the greatest English physicians of -that period, gives in his celebrated “First Lines of the Practice of -Physic”:-- - - What is frequently spoken of as the power of nature--the “_vis - conservatrix et medicatrix naturae_”--resides entirely in - the rational soul. Stahl supposes that upon many occasions the - soul acts independently of the body, and that, without any - physical necessity arising from that state, the soul, purely - in consequence of its intelligence, perceiving the tendency of - noxious powers threatening, or of disorders any ways arising in - the system, immediately excites such motions in the body as are - suited to obviate the hurtful or pernicious consequences which - might otherwise take place. - -Barthélemy St. Hilaire of Paris (1805–1895) in one of his writings -says: “I am convinced that the central idea in Stahl’s physiology was -suggested to him by the reading of Aristotle’s ‘_De anima_,’ in -which this great philosopher states that the soul nourishes the body, -and also that nutrition is one of the four ways in which the soul -manifests itself.” - -Speaking of the effect of Stahl’s doctrines upon the actual practice -of medicine as a whole, Cullen says that it was of a controlling -character, leading physicians to propose the “art of curing by -expectation”; the natural result of which was that they advocated for -the most part the employment of only very inert and frivolous remedies. -On the other hand, they zealously opposed the use of some of the most -efficacious drugs, such as opium and the Peruvian bark, and resorted -to bleeding and to the administration of emetics only in exceptional -cases. Cullen adds that:-- - - The Stahlian system has often had a very baneful influence on - the practice of physic, as either leading physicians into, or - continuing them in, a weak and feeble practice, and at the same - time superseding or discouraging all the attempts of art.... - The opposition to chemical medicines in the sixteenth and - seventeenth centuries, and the noted condemnation of antimony by - the Medical Faculty of Paris, are to be attributed chiefly to - those prejudices which the physicians of France did not entirely - get the better of for near a hundred years after. We may take - notice of the reserve it produced in Boerhaave with respect to - the use of the Peruvian bark. - -Stahl, after taking up his residence in Berlin, devoted himself -energetically to the increase and spread of the knowledge of chemistry. -The thing which brought him the greatest celebrity, both in his own -lifetime and also during the years following his death, was his -propounding of the “phlogiston” theory. This theory was to the effect -that all combustible materials or substances contain (as he assumed) -an element to which he gave the name of _phlogiston_. He was not -able, however, to demonstrate the actual existence of this element; -he simply assumed that it existed. At the same time the fact should -here be stated that the terms “oxidation” and “reduction,” which came -into use during the following century, developed out of this theory of -phlogiston. - -_Friedrich Hoffmann._--Friedrich Hoffmann was born at Halle, -Prussian Saxony, February 19, 1660, and received his medical education -in his native city, largely under the direction of his father, who was -himself a physician. In 1678 he attended lectures at the University -of Jena, and in the following year visited Erfurt in order to -benefit from the instruction of Caspar Cramer, who was at that time -a distinguished authority in chemistry. At the end of two years he -returned to Jena, took his degree of Doctor of Medicine, and acquired -the right to deliver public lectures. Then, during the following three -years, he visited Holland and England, and, upon his return in 1685, -settled at Minden, Westphalia, as a general practitioner of medicine. -In 1686 he was appointed District Physician of the Principality of -Minden and also Court Physician of the Prince Elector; and two years -later he accepted the position of District Physician at Halberstadt. -After the inauguration of the new university at Halle, July 12, 1694, -Hoffmann appears as one of the earliest professors chosen to serve the -institution. In 1701, when Frederick the Third, Electoral Prince of -Prussia, assumed the crown under the title of Frederick the First, King -of Prussia, he extended to Hoffmann an invitation to come to Berlin and -accept the position of Private Physician to His Majesty. Hoffmann was -not at first willing to accept the invitation, but in 1708, when the -King, who had then become seriously ill, renewed his request, Hoffmann -accepted, on condition that he might retain his professorship. In 1712 -he returned to Halle and remained there until he died in 1742. - -Before Hoffmann’s time very little was known concerning the nature of -carbonous (or carbonic) oxide and concerning the fatal effects which -may be produced by inhalation of this gas. It was a common belief, -for example, that the gas was given off by freshly plastered walls; -and--as an even worse error--the theological authorities showed an -inclination, in many of the fatal instances which probably were due -to inhalation of carbonous oxide, but in which no recognizable cause -of death had been discovered, to explain the event as due to the -malign interference of the Devil. In our time it is well understood -in the community that the fumes of carbonous oxide constitute the -most dangerous gas that one is liable to encounter, but in Hoffmann’s -day the people appear to have been less well informed concerning this -danger than they were in ancient times. In the treatise on this subject -which Hoffmann published in 1716,[81] several of the earliest known -instances of such poisoning are narrated, the first one being that -mentioned very briefly by Aristotle (384–322 B. C.). Then follow two -very short references to this subject in the “_De rerum natura_” -of the Roman poet Titus Lucretius Carus (95–52 B. C.). They read as -follows: (1) “The fumes of burning charcoal easily affect the brain if -thou hast not first taken a drink of water.” (Book VI., verse 803.) (1) -“If the fumes of the night lamp,[82] after it has been extinguished, -are inhaled rather deeply the effect experienced will be the same as if -one had been struck down by a blow on the head.” (Book VI., verse 792.) -The idea that the previous drinking of water is competent to prevent -the effects of poisoning by charcoal fumes is declared by Neuburger, -the translator of Hoffmann’s treatise, to be erroneous. - -The earliest really satisfactory description of an instance of -non-fatal poisoning by the fumes of burning charcoal is credited by -Hoffmann to the Roman Emperor, Julian the Apostate, who reigned from -361 A. D. to 363 A. D. Before he was made Emperor, Julian was intrusted -by Constantius II., in 355 A. D., with the government of the Province -of Gaul, and in 357 he won a great battle against the Alamanni at -Strassburg; after which he took up his residence in the little city of -Lutetia, the present Paris. It was undoubtedly soon after this event -that he wrote the Greek satire which bears the title “Misopogon,” and -from which Hoffmann quotes the following account of Julian’s narrow -escape from death through the poisonous effects of carbonous oxide:-- - - The little city which the Celts call Lutetia is built upon a - small island in the midst of a river, and access to it from - both sides is gained by means of wooden bridges. Ordinarily the - winter climate in this region is mild, owing--as the people - of the place claim--to the proximity of the Ocean. Good wine - is produced there, and even fig-trees flourish provided care - be taken to wrap them well in wheat straw or some similar - protective material during the winter season. But my visit - happened to have been made during an exceptionally severe - winter, and as a result things which looked like slabs of - Phrygian marble, closely packed together, were constantly - floating down the river with the current, and, soon becoming - jammed, they formed a sort of natural bridge. Although most of - the houses--the one I occupied among the number--were provided - with fireplaces and chimney-flues, and might therefore readily - be heated, I was not willing that a fire should be kindled in my - bedroom. I was very little sensitive to cold, and, in addition, - I was desirous of becoming more and more hardened to its - influence.... As the severity of the weather, however, showed no - signs of letting up, I permitted the attendants to bring into - the room a few glowing coals, just enough to render the air of - the chamber less chilly. But, notwithstanding the very small - degree of heat which these few burning coals supplied, it proved - to be sufficient to draw out from the damp walls exhalations - that caused my head to feel as if it were tightly held in a - vice and also produced a sensation as if I were choking. I was - immediately removed from the room, and the physicians who were - promptly summoned administered an emetic which enabled me to - get rid of the food which I had eaten a short time before. Soon - afterward I had a refreshing sleep and was able on the following - day to resume my work as usual. [Translated from the German - version printed in Neuburger’s monograph.] - -As will be seen from the reports which I have just quoted, there -existed among the Germans, early in the eighteenth century, no fixed -belief as to the real cause of death in many of these unexplained fatal -cases; and it was therefore no small public service which Hoffmann -rendered when he, in whose judgment about such matters the people at -large placed the greatest confidence, published such a clear and simple -explanation of the real cause of these deaths as that which is given in -this interesting monograph. - -Hoffmann also added not a little to his fame by the invention of -a remedy which was first known as “Hoffmann’s drops,” but which -to-day appears in the United States Pharmacopoeia under the name -of “Hoffmann’s anodyne” or “_spiritus aetheris compositus_” -(sulphuric ether, 325; alcohol, 650; ethereal oil, 25). - - - - - CHAPTER XXXIV - - HERMANN BOERHAAVE OF LEYDEN, HOLLAND, ONE OF THE MOST - DISTINGUISHED PHYSICIANS OF THE SEVENTEENTH CENTURY - - -Hermann Boerhaave, who was born at Voorhont, near Leyden, Holland, on -December 31, 1668, was the son of a poor but highly educated clergyman; -and it was owing to this circumstance that he received in early youth -a most careful training in Latin and Greek and in belles-lettres. At -the age of fourteen he entered the public school of Leyden, and made -such rapid progress in his studies--history, mathematics, the different -branches of natural philosophy, Hebrew and Chaldean languages, and -metaphysics--that he was soon able to follow regularly the lectures -given at the university. He was only fifteen at the time when his -father died, leaving him absolutely penniless; but Van Alphen, the -Burgomaster of Leyden, befriended him and furnished all the funds -needed for a continuance of his studies at the university. But young -Boerhaave, who was not willing to be entirely dependent on the aid thus -provided, contributed to his own support not a little by giving private -instruction to young students of the wealthy class. In 1690 he received -the degree of Doctor of Philosophy, the subject of his dissertation -being a refutal of the doctrines of Epicurus, Hobbes and Spinosa. -His original intention had been to prepare himself for the ministry, -but, after continuing his studies in theology for a short time, he -determined that the better course for him would be to choose the career -of physician. Accordingly he began, at the age of twenty-two, to study -the anatomical treatises of Vesalius, Fallopius and Bartholinus, and at -the same time he followed a course of instruction in dissecting, under -the guidance of the anatomist Nuck, and also occasionally attended the -lectures given by Drelincourt, who at that time was Professor of the -Theory of Medicine. In his reading of medical literature he showed a -decided preference for the writings of Hippocrates and Sydenham; and -he devoted a large portion of his time to the study of botany and -chemistry, two branches of the science of medicine in which he took a -very strong interest all through life. In 1693 he received the degree -of Doctor of Medicine from the University of Harderwyk.[83] In 1701 -he was appointed Associate Professor of the Theory of Medicine in -the University of Leyden, and it was in this capacity that he began -building up that great reputation which in a very few years brought -crowds of students from all parts of the world to Leyden. As already -stated on a previous page, he owed a large part of his fame to the -admirable manner in which he conducted his clinical teaching. To show -how widely he was known throughout Europe the story is told that a -letter which had been sent to him from a mandarin living in China and -which bore the address, “To the illustrious Boerhaave, Physician in -Europe,” reached him in due course. - -Soon after his first appointment at Leyden, he received other most -flattering offers, such as that of William the Third, Hereditary Prince -of the Netherlands, to accept the position of Court Physician at The -Hague, and a call from the University of Groningen (1703) to occupy -the Chair of Medicine. He declined these offers as he preferred to -remain at Leyden; but, a few years later, in 1709, he accepted the -full professorship of the Practice of Medicine in the institution -with which he was already connected. From the vantage ground of this -more responsible position he was able most successfully to teach the -students the best methods of observing, identifying and treating the -different diseases; and as a further result of this promotion in rank -his private practice grew rapidly, monarchs and princes coming from -every country in Europe to consult him about their maladies. Boerhaave -was also most popular among his fellow townsmen. It is related of -him, for example, that on one occasion, after he had been confined to -the house for about six months by an illness of a gouty nature, the -citizens of Leyden manifested their joy at his recovery by inaugurating -a general illumination of the town during the evening of the day on -which he made his first appearance on the street. He had two relapses -of the gouty affection, one in 1727 and another in 1729, and he finally -died from disease of the heart on September 23, 1738. The monument -raised in his honor by the city of Leyden bears the inscription: -“_Salutifero Boerhaavii genio sacrum_” (Sacred to the memory of -the health-giving genius of Boerhaave). - -Some idea of the lucrative character of Boerhaave’s private practice -may be gained from the fact that he left to his only child, a daughter, -the sum of about four million francs. And yet he was noted for the -generous gifts which he made during his lifetime to all sorts of -scientific and benevolent objects. - -Boerhaave, says Dezeimeris, exercised during his career, and also for a -long time after his death, an immense influence upon medical thought. -He is justly ranked, he adds, among the iatromathematicians, and it -is correct to say that he was largely instrumental in overthrowing -the chemical system which de le Boë (Sylvius) had developed. His own -treatise on this branch of knowledge (“Elementa Chemiae”), which was -published toward the end of his life, soon became the standard work -on this subject, and it retained its popularity for many years. “It -is to be regretted that, possessing as Boerhaave unquestionably did, -remarkable powers of observation, he should have allowed himself, in -opposition to the very principles which he advocated so strongly, -to indulge in the making of systems and hypotheses. He commenced by -advocating with enthusiasm the method of Hippocrates, and ended by -following the brilliant but not very trustworthy example of Galen.” -(Dezeimeris.) - -The number of treatises which Boerhaave published is quite large, -the most important among them being the following: “_Oratio de -commendando studio Hippocratico_,” 1701; “_Institutiones medicae -in usus annuae exercitationis domesticos_,” 1708; “_Aphorismi -de cognoscendis et curandis morbis in usum doctrinae medicae_,” -1709 (English version printed in London in 1742); and “_Elementa -chemiae_,” 1732 (English translation by Peter Shaw, London, 1741). - -Of the “Aphorisms,” one of the most widely known of Boerhaave’s -published treatises, I shall take the liberty of saying a few words. -This work is in reality a very concise statement of the author’s views -regarding pathology, pathological anatomy and therapeutics, and I -believe that the following paragraphs, although few in number, will -suffice to give our readers a fair idea of the general character of the -book. At the same time I must confess that I have not found it an easy -matter to understand and satisfactorily digest many of the individual -aphorisms, the text of which has been compressed into such a small -space. It therefore does seem surprising to learn from one critic that, -if one wishes to ascertain what Boerhaave’s views are with regard to -the science of medicine, one should read by preference the Commentaries -of Van Swieten, who was Boerhaave’s favorite pupil and assistant. - -The following four or five aphorisms are typical specimens belonging to -the earlier sections of the book:--[84] - - (7.) A disease when present in a body, must needs be the bodily - effect of a particular cause directed to that body. - - (8.) Which effect being entirely removed, health is recovered. - - (9.) It may be removed by correcting the illness itself in - particular, _viz._, by the applications of medicines - to the particular diseased part, or by some remedies which - operate equally upon the whole: the first we’ll call a - _particular_, the latter a _general_ cure. - - (10.) The way to both is discovered either _by - observation_, or _by comparing_ one case with another, - or _by a true reasoning_ from them both. - - (13.) He who doth, with the greatest exactness imaginable, weigh - every individual thing that shall happen or hath happened to - his patient and may be known from the observations of his own - or of others, and who afterward compareth all these with one - another, and puts them in an opposite view to such things as - happen in an healthy state; and lastly, from all this, with the - nicest and severest bridle upon his reasoning faculty, riseth - to the knowledge of the very first cause of the disease, and of - the remedies fit to remove them; _he_, and _only he_, - deserveth the name of _a true physician_. - -Then Boerhaave proceeds to make a classification of diseases, and among -the very first groups which one finds in this classified list are the -following: “Distempers of a lax and weak fibre”; “Distempers of the -stiff and elastic fibre”; “Distempers of the less and larger vessels”; -“Distempers of weak and lax entrails”; “Distempers of the too strong -and stiff entrails”; etc.--from which it is apparent that the old -doctrine of the _strictum_ and the _laxum_, which was taught -by the Methodists in the early centuries of our era, has here been -adopted by Boerhaave in all its essential characters; and also that the -treatment which he recommends for some of these classes of maladies -does not materially differ from that advocated by this ancient school -of medicine. The following extracts, I believe, will suffice to give -the reader a fairly clear understanding of what Boerhaave means by the -expressions “distempers of the solid simple fibre,” “distempers of a -lax and weak fibre,” and “distempers of the stiff and elastic fibre,” -and will at the same time show what methods he employed for overcoming -these distempers. At the time when Boerhaave made use of the term -“fibre” (_fibra_) in the very uncertain sense in which he here -employs it, Leeuwenhoek and Malpighi were demonstrating, by aid of the -newly perfected microscope, that the so-called simple tissues were in -reality quite complex structures; and one’s first impulse, therefore, -is to express surprise that a physician of such high standing as our -author should have used the term. But we moderns must not forget that, -in those early days, it took decades for knowledge of this nature -to spread even a very short distance, as from Delft to Leyden, and -then to exert its legitimate influence upon medical thought--that -is, to be digested and afterward permanently appropriated. There can -be scarcely any doubt that, at the time (1709) when Boerhaave wrote -these aphorisms, he had already heard about the existence and the -capabilities of the recently perfected microscope, but it is not at all -likely that he had as yet digested the gains in anatomical knowledge -which had been acquired through the assistance of this instrument. The -extracts referred to above are the following:-- - - DISTEMPERS OF THE SOLID SIMPLE FIBRE - - (21) Those parts (which, being separated from the fluid - contained in the vessels, are applied and sticking to each other - by the strength of the living body, and make the least fibre) - are the least, the simplest, earthy, and hardly changeable from - or by virtue of any cause, which are found in our living bodies. - - DISTEMPERS OF A LAX AND WEAK FIBRE - - (24) The weakness of the fibre is that cohesion of the minutest - parts described (21), which is so loosely linked that it may be - pulled asunder even by that degree of motion which is requisite - in healthy bodies, or not much exceeding it. - - (26) The weakness produceth easily a stretching and a breaking - of the small vessels made up of those weak fibres (24), and - consequently abates of their power over the fluids therein - contained; from which distensions arise tumors, from the - stagnating or extravasated liquids putrefactions, and, farther, - all such innumerable ills as are the consequences of them both. - - (28) [In distempers of a lax and weak fibre] the cure must - be obtained, 1. By aliments that abound in such matter as - is described in section 21, and which [should] be almost so - prepared beforehand as they are in a strong and healthy body; - such are milk, eggs, flesh-broths, panadoes[85] rightly prepared - of well-fermented bread; and rough wines. All which must be - given in small quantities, but often. 2. By increasing and - invigorating the motion of the solids and fluids by means of - frictions with a flesh-brush, or with flannel; by riding on - horseback, and in a coach, or by being carried in a boat; and - lastly by walking, running and other bodily exercises. 3. By a - gentle pressure or a bandage upon the vessels, and a moderate - repelling of the liquids therein contained. 4. By medicines - both acid and austere, or such as are spirituous and well - fermented, but applied with great caution and gentleness. 5. By - any means that will remove and remedy the too great pulling of - them. - -[That Boerhaave belonged to the iatrophysical or iatromechanical school -appears very clearly throughout these quotations.] - - DISTEMPERS OF THE STIFF AND ELASTIC FIBRE - - (35) [In distempers of this group] the cure is effected, 1. - By such meat and drink as is thin and watery, without any - roughness, chiefly by the continued use of milk-whey, of - the softest herbs and salads, barley-water, thin gruel, and - unfermented liquors. 2. By avoiding of exercise, and dwelling in - a moist, coolish air, and taking long sleeps. 3. By the taking - or outwardly applying watery, lukewarm, tasteless medicines, and - such as contain the lightest and softest oils. - -In the second half of the volume I find abundant evidence of -Boerhaave’s ability to treat efficiently some of the acute and chronic -maladies; and, after a perusal of the text which deals with these -affections, I have no difficulty in understanding how he came to be -looked upon as one of the leading medical practitioners of the period -during which he lived. I should be glad to reproduce here such portions -of the aphorisms as would corroborate the statement that I have just -made, but unfortunately the small amount of space that I can command -does not permit me to do this. At every step, as I advance, I am warned -against the danger of exceeding the limits permitted, and I shall, -therefore, in the present instance, have to rest satisfied with quoting -the larger part of a single paragraph in which is given an account of -the treatment employed in a case of acute pleurisy. - - (890) ... If the same pleurisy be recent before the end of the - third day, yet violent from the many and strong symptoms, and - dry, in a strong, exercised, dry body, without the hopes of - the presence of (887 and 888) [a resolution or a concoction - and excretion of the cause], then let the patient immediately - be blooded largely, with a quick running stream out of a - great vessel, and a large orifice, keeping his body quiet and - leaning backwards, enforcing his breathing all the while with - coughing or panting, fomenting the side at the same time, and - gently rubbing it; which bleeding ought to be continued till the - pain seems to abate pretty considerably, unless a fainting fit - forces you to leave off sooner; at whose approach the vein must - immediately be stopped. Bleeding ought to be repeated according - as these symptoms do return upon whose account it was done the - first time; and when that skin doth not any longer appear upon - the surface of the blood, it is time to forbear more bleeding. - - From the beginning ought to be used fomentations, bathings, warm - streams, liniments, plaisters, and the like; which may be of use - as they loosen, resolve, mitigate, and avert.... - -As only extracts of considerable length would suffice to give our -readers a satisfactory idea of the attractive manner in which Boerhaave -deals with the subject of chemistry, I prefer to omit them altogether, -and to recommend to those who are specially interested in this -branch of science, that they consult Peter Shaw’s excellent English -translation of the “_Elementa Chemiae_.” - -Albert von Haller, the celebrated Swiss physiologist and historian of -medical literature, speaks of Boerhaave as “my beloved preceptor, a man -of refined taste and a speaker or lecturer so logical and charming that -one more gifted can hardly be imagined.” - - - - - CHAPTER XXXV - - GENERAL REMARKS ON THE DEVELOPMENT OF SURGERY IN EUROPE DURING - THE FIFTEENTH AND SIXTEENTH CENTURIES - - -In the early period of the Renaissance surgery was apparently the -first of the practical branches of medicine to spring forward into -active life. Anatomy,--that is, human anatomy,--the foundation that is -absolutely necessary to the solid growth of surgery, scarcely existed -before the beginning of the sixteenth century; and it is therefore -not surprising that the records of the past reveal to us so very few -instances of men who attained any eminence as surgeons. When this -fact is taken into consideration I cannot help feeling that, in the -sketches which I drew, on earlier pages, of Theodoric of Cervia, -William of Saliceto, Lanfranchi of Milan (and later of France), Henri -de Mondeville and Guy de Chauliac, I gave to these men only a small -fraction of the credit to which they were justly entitled. Indeed, -the excellence of the work done by them and recorded in the treatises -which they published, is so great as to arouse the suspicion that they -had clandestinely acquired more knowledge of human anatomy than they -dared to admit. The life of a dissector of human bodies, it should be -remembered, was by no means safe in those days. - -But the lack of a trustworthy knowledge of anatomy was not the only -hindrance to a healthy development of the art of surgery. There were -other obstacles which, up to a comparatively late period in the -sixteenth century, continued to block the advance of this art. Of -these, the principal one was perhaps the custom--not by any means -considered at that period professionally dishonorable--of keeping -secret the technique of certain operative procedures like that of -cutting for stone in the bladder or that of the radical cure of hernia. -Such knowledge was treated as private property, and was very carefully -handed down from father to son, or was sold for a large sum of money to -certain surgeons who engaged, under oath, not to reveal the details to -others. Thus we are assured by Haeser that two such eminent surgeons as -Ambroise Paré and Fabricius of Hilden were obliged to pay handsomely -for the information which they received from certain specialists -concerning their particular methods of procedure. It is from such -scraps of information which come to our knowledge casually that we -often learn the actual truth concerning the advance made at a given -period of time by a certain department of medical science. Although it -is not possible to fix the date when the custom to which I have just -referred was definitely abandoned, it may be stated as a fact that -after the seventeenth century very few instances of such ownership of -surgical secrets are discoverable in the records. - -Inasmuch as at the very beginning of the Renaissance surgery was looked -upon, in the southern and central parts of Europe, as an occupation of -a somewhat menial character, the regularly organized medical schools -made very inadequate provision for the proper education and training of -those young men who were disposed to adopt a surgical career. During -the fourteenth and fifteenth centuries surgery was still tolerated at -Montpellier, but after the papal seat had been removed from Avignon -to Rome--that is, after 1479,--the pupils of that university were -forbidden to do any surgical work. In 1490, however, a course in -surgery was provided for the exclusive use of barbers. At first the -instruction was given in Latin, but, as these men did not understand -this language, the professor was soon compelled to employ a barbaric -Latin (half French and half Latin) in making his comments upon the -text of the lecture. This state of affairs lasted for more than a -century. In fact, it was not until after Paré, Franco and Wuertz had -demonstrated by their remarkable careers how honorable was this branch -of the science of medicine, that provision was made at Montpellier (in -1597) for regular instruction in surgery. But even then, for a period -of several years, it was found to be a very difficult matter to keep -the peace between the two groups of students--the medical and the -surgical; the governing authorities being finally obliged, in order -to prevent the encounters which frequently took place between the -rival bodies, to appoint four a.m. as the hour when the instruction in -surgery was to be given. Those students who were pursuing the course in -medicine looked upon the surgical pupils as intruders, as men unworthy -to associate with them, and they availed themselves of every possible -opportunity for making their connection with the university unpleasant. - -In Paris, during the twelfth and thirteenth centuries the surgeons -formed themselves into corporations. Minor surgery was left entirely -in the hands of the barbers (a word which is derived from the Latin -“_barbarus_,” uncultivated) and barber-surgeons. They were -largely itinerant practitioners and army surgeons. As they traveled -from one city to another, the more enterprising ones announced their -approach by means of a sort of herald who proclaimed loudly the cures -which his chief was able to accomplish. In the course of time the -surgeons who lived in Paris formed themselves into the so-called -“College of Surgeons.” At a later date (1255) there was established -in that city by Jehan Pitard, the surgeon of Louis the Ninth (“Saint -Louis,” 1215–1270), a more perfect organization under the name of -the “College of Saint Cosmas,” which was placed under the protection -of Saints Cosmas and Damian. The members of this Brotherhood were -known as “Surgeons of the Long Robe,” to distinguish them from the -Barber-Surgeons or “Surgeons of the Short Robe”; and they were also -known as “_Maitres Chirurgiens Jurés_.” Through the influence of -Pitard this organization received from the King a set of governing -rules or constitution. - -It may prove interesting to learn who Cosmas and Damian were, how they -came to be canonized, and for what reasons the organizers of the new -brotherhood preferred them to all others, as guardian saints. Cosmas -and Damian were the youngest of five brothers who belonged to a family -of some distinction in Arabia. They chose the career of peripatetic -physicians, and gave their services free to those who might have need -of them. They spent some time in the Province of Cilicia, Asia Minor, -and while in that country they met the death of martyrs, somewhere -about 287 A. D., during the persecutions of the Christians which -occurred in the reign of Diocletian. In the church pictures they are -represented as physicians, each one of whom holds in his hand either -a vessel containing a remedial preparation, or a staff around which -the emblematic serpent is twined, or (less frequently) a surgical -instrument of some kind. During the time of the Crusades there existed -an Order of Knights of Saint Cosmas and Saint Damian, who devoted -themselves specially to the care of sick pilgrims and to the freeing of -those who were held as prisoners. - -In all the large cities of France there existed, during the fourteenth -and fifteenth centuries, corporations of surgeons, the great majority -of whom belonged to the class or grade of barbers. These men were not -permitted by their rules to use the knife, and, as a result, great -jealousy existed between them and the few who, having passed the -required examination, were authorized to perform cutting operations -and to assume the title of “Masters in Surgery.” In 1493, as the -result of an effort made by the barbers of Paris as a body, to gain -some knowledge of medical science, they obtained from the university -permission to purchase a corpse which had not yet been removed from the -gallows. They had, it appears, engaged a doctor of medicine to give -them instruction in anatomy, and it was upon a dissection of this body -that the teaching was to be based. In 1494 the Faculty made provision -for giving the barbers a regular course of lectures on surgery; and, -eleven years later (1505), additional privileges having in the meantime -been granted them by the university, they organized the “Corporation -of Barber Surgeons, or Surgeons of the Short Robe.” In the oath -which the members of this organization were obliged to take, it is -expressly stated, among other things, that “they will give due honor -and reverence to the Faculty, and will not administer any laxative or -alterative drug.” - -From 1601 to 1731, when the _Académie de Chirurgie_ was founded, -there was an almost continuous series of squabbles between the surgeons -and the barbers, on the one hand, and the Medical Faculty of the -University, on the other. At a still earlier period, dating back even -to the fourteenth century, the quarrels were between the surgeons -(École de St. Côme) and the barbers, but, during the seventeenth -century and the early part of the eighteenth, the surgeons and the -barbers seem to have harmonized their interests and to have made common -cause against the Faculty. An edict was issued by Louis the Twelfth -in 1613 to the effect that the two corporations (the surgeons and -the barbers) should be fused into a single organization; and, even -before this, it had become customary to employ the words “surgeon” and -“barber” as synonymous terms. Finally, in the years 1644, 1645 and -1656, further agreements were entered into by the two bodies. After the -founding of the Academy of Surgery in 1731 nothing further is heard of -barber-surgeons. - -In the account which I have thus far given of the agencies that were -available during the Renaissance for the perpetuation and increase of -medical knowledge, I make reference only to the established medical -schools and to the less pretentious but much more practical teaching -organizations furnished by the guilds or brotherhoods. In my remarks -I have said little or nothing about hospitals, which--potentially, at -least,--have a great deal to do with the advance of medical knowledge, -especially in the department of surgery. Unfortunately, my efforts to -procure information relating to this subject have not been rewarded -with much success and I shall therefore not be able to furnish more -than a few disconnected and very imperfect details. - -At the beginning of the sixteenth century the city of Lyons possessed -(and it still possesses) the oldest hospital in France--viz., the -Hôtel-Dieu,--which was founded by Childebert the First in 542 A. D. -The city itself was at that period second in importance only to -Paris, and in some respects it was the equal of the metropolis in -celebrity. The art of printing was introduced there in 1472, and the -presses of that city were soon reckoned the best in Europe. Many -medical books were published at Lyons. François Rabelais (1483–1553), -the celebrated author of the humorous and satirical works “Gargantua” -and “Pantagruel,” was a regularly educated physician, and during his -residence at Lyons he edited various works of Hippocrates and Galen. -Michael Servetus, who displayed such marked ability by his researches -in regard to the circulation of the blood, was also a resident of Lyons -from 1530 to 1543. Some idea of the way in which a large hospital was -managed in those early days may be gained from the following statement -of facts: In 1619 as many as five patients were permitted to occupy -one bed in Hôtel-Dieu at Lyons. Although the hospital possessed -accommodations for a total of five hundred and forty-nine patients -(including pilgrims and poor people), there was only one medical man -whose duty it was to look after the surgical cases, and he resided -outside the building. At a somewhat later date there was provided a -“_chirurgien principal_,” whose duty it was to give the needed -surgical care to this class of patients, and who was obliged to -reside in the hospital. When this chief surgeon required assistance -in the dressing of wounds, etc., he was authorized to make use of -the “apothecary’s boy.” The stock of surgical instruments possessed -by the hospital in 1543 comprised the following items: One uterine -speculum; one trephine, which was composed of thirteen separate -parts; one mouth-plug, for use in keeping the jaws separated; one -ear speculum; and one elevatorium. All these facts, taken together, -furnish strongly corroborative evidence of the statement made by von -Gurlt in his _Geschichte der Chirurgie_, viz., that in France, -during the sixteenth century, the occupation of surgeon was considered -by the community but little better than that of a hair-cutter. It -is therefore not surprising that the great hospital of Lyons should -have been managed at that time in accordance with such a low sanitary -standard and with an almost total disregard of the purposes for which -a hospital exists. So far as I am able to learn, the conditions just -described were not peculiar to the city of Lyons. “During the reign of -Francis the First (1515–1547) there were in the main room (thirty-six -feet wide) of the Infirmary of Hôtel-Dieu at Paris,” says Boisseau, -“six rows of beds (three feet wide), each one of which accommodated -ordinarily three (at times even four) sick persons, who necessarily -were very uncomfortable. This is not all; for there were also in this -same infirmary seven or eight beds which were designed to accommodate -from twenty-five to thirty infants or young children, the great -majority of whom died from the poor quality of air which they had to -breathe in that institution.” I do not need to furnish additional -proofs in corroboration of the truth of the statement that during the -Renaissance the French civil hospitals contributed practically nothing -to the advance of medical science. It is possible that in Italy these -institutions may have been better managed, for, in the account which he -gives of his trip to Rome, Luther speaks of having visited a hospital -which particularly attracted his notice by reason of its orderliness -and the conspicuous cleanliness of every part of the building. As an -offset, however, to this favorable testimony I should state that in -some documents discovered in comparatively recent times there are -memoranda relating to the duties of the medical staff in the civil -hospital of Padua (1569)--a city in which was located the most famous -medical school to be found anywhere in Europe during the sixteenth -century. These memoranda read as follows: “There shall be a doctor of -physic upon whom rests the duty of visiting all the poor patients in -the building, females as well as males; a doctor of surgery whose duty -it is to apply ointments to all the poor people in the hospital who -have wounds of any kind; and a barber who is competent to do, for the -women as well as for the men, all the other things that a good surgeon -usually does.” (The word “surgeon” is evidently employed here in the -sense of barber-surgeon, and not in the modern sense of the word.) This -testimony and that furnished on a preceding page with regard to the -management at the two leading civil hospitals in France amply justify -the statement that during the sixteenth century medicine received no -aid whatever from these institutions in its efforts to advance. - -For the sake of orderliness I shall, from this point onward, arrange -the information which I may find it desirable to furnish, under the -headings of the different countries of Europe; and in carrying out -this plan I shall begin with Germany, as it was there that the oldest -fifteenth-century treatises on practical surgery were first printed. - - - - - CHAPTER XXXVI - - SURGERY IN GERMANY AND SWITZERLAND DURING THE FIFTEENTH AND - SIXTEENTH CENTURIES - - -There were five men in Germany and German Switzerland who, during the -Renaissance, attained distinction as surgeons, and who at the same -time contributed, by their published writings as well as by the force -of example, to the advancement of medical science. The names of these -five surgeons are: Pfolspeundt, Brunschwig, von Gerssdorff, Fabricius -of Hilden and Felix Wuertz. The first three mentioned were born in the -early part of the fifteenth century, and all five of them derived their -practical knowledge of surgery in large measure from their experience -in warfare. Individual sketches of these men will be furnished farther -on, but I believe that these will be better understood if a brief -account of the state of medical education in general throughout -Germany, at the period which I am now considering, be first supplied. - -_State of Medical Education in General Throughout Germany -(1400–1600)._--The University of Heidelberg was founded in 1386, -but it was not until about 1550 that the first beginnings of medical -teaching made their appearance in that institution. Equally feeble -attempts were made, twenty years later, to organize the teaching of -medicine at the University of Wuertzburg; but very little appears to -have been accomplished during the immediately following years, as may -be judged from the official announcement, in 1587, of what things -the Professor of Surgery would teach in the three-years’ course. -“_First year_: Lectures on the subject of tumors, in accordance -with the teachings of Galen; _Second year_: Lectures on the -subjects of wounds and ulcers, in accordance with the teachings of -Galen and Hippocrates and the Arabian medical writers; _Third -year_: Lectures on fractures and dislocations, in accordance with -the teachings of Galen and Hippocrates. Then, if sufficient time -is available during this last year of the course, a certain amount -of anatomy is to be taught (during the winter season) from Galen’s -writings on this subject. In the summer time the subject of simple -remedies may be taken up advantageously, and botanical demonstrations -may also be given.” Von Gurlt quotes Koelliker as his authority for -the statement that throughout the seventeenth century the medical and -surgical teaching at the University of Wuertzburg was very defective, -“almost nothing worthy of mention being accomplished during that long -period in the departments of anatomy and physiology.” In the University -of Basel, Switzerland, which was founded in 1460, medical teaching -was as barren as it was in all the German universities at that early -period. It was only in 1542 that the first public dissection of a -human body took place there. Vesalius was visiting the city at that -time for the purpose of superintending the printing of his great work -on anatomy, and the university authorities availed themselves of the -opportunity to secure from him not only this single demonstration, but -also in addition a course of lectures on anatomy. Fifteen years later, -Felix Platter, a native of Basel and a man of exceptional ability -(see sketch on pp. 332 _et seq._), made the first postmortem -examination known to have been made in that city. Two years later -still (1559), following in the footsteps of Vesalius, he made a public -dissection of a criminal’s corpse in the Church of St. Elizabeth. -From 1581 onward, with occasional omissions, a public dissection of -the corpse of a criminal was made by the professor of anatomy once -every year. In 1590 the question was discussed by the Faculty whether -it “might not also be practicable to secure from the hospital, for -dissection, an occasional corpse.” The first body obtained from this -source was dissected in 1604, but it was not until 1669 that a second -one was available. There was no museum of anatomy and the medical -school owned only two human skeletons--one male, that had been set -up by Vesalius, and one female which had been prepared by Platter. -During the first two hundred years of the existence of this university, -only twenty-three copies of the different writings of Hippocrates, of -Galen, of Dioscorides and of Paulus Aegineta were available for the -instruction of the medical students. “These books should be diligently -read aloud to the young men if their contents are to furnish the -maximum of useful information.” As for clinical instruction, each -student was expected to secure for himself, by private arrangement -with some active practitioner, the position of assistant, or to obtain -from the Archiater or City Physician an occasional opportunity of -seeing patients at the hospital. According to the rules established by -the Faculty the students were permitted to take private courses with -different physicians. Another and very valuable source of information -that was within the reach of these young men, was supplied by the -public disputations which were held quite frequently. - -The preceding brief account, which I have compiled from von Gurlt’s -work, will serve, as I believe, to convey a fairly clear idea of the -primitive and very limited opportunities of acquiring a knowledge of -medicine and surgery which were afforded the student in Germany during -the fifteenth and sixteenth centuries. (It should be borne in mind that -Basel, although located in Switzerland, was in nearly all respects a -German city.) It was not until a much later period that the schools of -that country, in nearly every department of human knowledge, caught -up with and eventually surpassed--at least for a number of years--the -similar institutions in Italy and France. - - [Illustration: FIG. 18. CONSULTATION BY THREE PHYSICIANS UPON A CASE - OF WOUND IN THE CHEST. - - (From a woodcut in the _Surgery of Hieronymus Brunschwig_, - Strassburg, 1508.) - - This treatise, which was written by the author in 1497, passed - through nine successive editions, the last one in 1539. Probably - no woodcuts of a higher order of merit than those represented in - this and the two following illustrations (Figs. XIX and XX) are - to be found in medical literature.] - -_Hieronymus Brunschwig._--Hieronymus Brunschwig was born at -Strassburg during the early part of the fifteenth century, the exact -date not being known. It is believed that he attained a great age, some -even claiming that he was one hundred and ten years old at the time of -his death. His treatise on surgery, bearing the simple title “_Das -buchler Wund Artzeny_,” was first published in 1497, -when he was already an old man, and it passed through nine editions -during the following forty-two years. It was also twice translated -into English. Up to the time of the discovery of Pfolspeundt’s work -it was believed to be the oldest German treatise on surgery known. It -was very freely illustrated with original woodcuts, not a few of which -possess considerable artistic merit. (See accompanying reproduction.) -The following headings of some of the more important chapters will -convey at least a fair idea of the character of the book: “Definition -of the Word ‘Surgeon’”; “Anatomy”; “Fatality of Wounds in Different -Parts of the Body”; “Different Kinds of Wounds”; “Different Kinds of -Surgical Instruments”; “Different Modes of Ligating Blood-Vessels”; -“Wounds of Blood-Vessels and Nerves”; “Methods of Arresting Bleeding”; -“Foreign Bodies in Wounds”; “Treatment of Wounds Inflicted by Poisoned -Arrows”; “Bruised or Crushed Wounds”; “Stab Wounds”; “Bites and -Stings”; “Wounds of the Head”; “Operations for Hare-Lip”; and several -other chapters on wounds and pathological conditions of other parts of -the body. Syphilis is not once mentioned in the book; and from this -circumstance von Gurlt infers that a knowledge of the existence of -this disease had not yet, at that early date (1497), reached Germany. -In Brunschwig’s _Liber pestilentialis, etc._, however, which was -printed three years later, syphilis is incidentally mentioned as the -“_malefrancose_” or “_malum mortuum_.” That Brunschwig was -well informed in the earlier surgical literature is shown by the fact -that he quotes from the writings of Theodoric, Guillaume de Saliceto, -Guy de Chauliac, Henri de Mondeville, and many others. A hasty and -necessarily very superficial perusal of the text of a few of the more -important chapters of this remarkable book satisfies me that Brunschwig -deserves to be classed among the really great surgeons of the fifteenth -and sixteenth centuries. A copy of this rare book may be seen in the -Surgeon-General’s Library at Washington, D. C. - -_Heinrich von Pfolspeundt._--The earliest German treatise -relating to surgery is that which bears the title “_Buch der -Bündth-Ertznei_,” by Heinrich von Pfolspeundt, “_Bruder des -deutschen Ordens_.” It was written in 1460, and was first published -in printed form in 1868 by H. Haeser and A. Middeldorpf, Berlin. -The text of this very early German work on the practice of surgery -furnishes ample evidence to show that the author was worthy to be -ranked among the leading surgeons of the fifteenth century. At page -fifty-seven, says von Gurlt, may be read the remarkable statement that, -in the case of a wound of the intestinal canal, one may cut through -that organ at the point of injury and then introduce into the opposite -ends of the divided bowel a silver tube the margins of which have been -carefully bent so as not to offer at any point a cutting edge. The -tube may then be tied in place with thread of green silk. (Von Gurlt -speaks of this as the forerunner of Murphy’s button.) Speaking of -wounds caused by arrows, Pfolspeundt says that, to insure the patient’s -recovery, the planet under which he happens at that time to be, should -be in favorable conjunction. In one case which came under Pfolspeundt’s -care he was obliged to pay an astrologer the sum of fifty gulden in -order to ascertain whether the planet in question was or was not in a -favorable conjunction. - -There is only one place in the entire book, says von Gurlt, where a -gunshot wound is mentioned, and then only incidentally; but this is -positively the first reference (about the middle of the fifteenth -century) to such wounds discoverable in medical literature. - -Among the topics which are treated quite fully and in such a manner as -to show clearly that the author was well versed in at least this part -of operative surgery, those relating to rhinoplasty deserve to receive -special mention. From the viewpoint of history, this part of the book -is of very great importance. In no other treatise, says von Gurlt, do -we find an equally detailed and satisfactory account of the operative -method employed by the Two Brancas (father and son, from Catania, -Italy), who were contemporaries of Pfolspeundt. The latter learned this -method from an Italian surgeon, whose name he does not mention, and -he was particularly careful not to divulge the essential details to -anybody except two of his brethren in the Order to which he belonged. - -For anaesthetic purposes in operative cases, Pfolspeundt was in the -habit of employing sponges saturated with the juices of opium, Atropa -mandragora, Conium maculatum, Hedera helix or arborosa, Lactuca and -Daphne mezereum; his technique resembling very closely that employed by -Guy de Chauliac, Theodoric and others. (See the appropriate chapters in -the earlier part of this volume.) - -In his remarks upon the manner of bringing about the healing of an open -wound, Pfolspeundt says that “in all cases he tries to dispense with -stitches, but that, when he finds such support necessary, he first -spreads a thick layer of adhesive material over both margins of the -wound and afterward introduces the threaded needle through the mass -into the skin. Then, in order to bring the edges of the wound together, -he draws the thread taut and makes it fast by means of a very small -knot.... Whether the sharp fever which sometimes sets in afterward as -a complication, is due to simple inflammation or to erysipelas, is a -question which cannot always be decided; and it is still more difficult -to determine whether the thin watery secretion which sometimes develops -in a wound may not signify--as some writers maintain--the beginning of -suppuration in a joint.” - -Were it not for the difficulty which one experiences in translating -correctly the ancient provincial German of Pfolspeundt’s text, I might -readily furnish further examples of his surgical pathology and methods -of treatment. The few, however, which I have already given will have to -suffice. - - [Illustration: FIG. 19. BARBER-SURGEON (_WUNDARZT_) EXTRACTING - AN ARROW FROM A WOUNDED SOLDIER’S CHEST WHILE THE BATTLE IS STILL IN - PROGRESS. - - (From the _Feldbuch der Wundarznei_ of Hans von Gerssdorff, first - published in 1517; many later editions followed.)] - -_Hans von Gerssdorff._--Hans von Gerssdorff, who was also called -“Schielhans” (squint-eyed Hans), was born in Strassburg about the -middle of the fifteenth century. He was a bold and skilful surgeon, -and acquired a wide experience and great self-confidence from his long -service in connection with the army. He was present, for example, at -the famous battles of Grandson (1476, in Switzerland) and Nancy (1477, -in France), in both of which the slaughter was very great, and in both -also Charles the Bold, Duke of Burgundy, was badly beaten. In 1517 von -Gerssdorff published at Strassburg a treatise on military surgery, -under the title: “_Feldbuch der Wundartzney_.” This book, which -is illustrated with exceptionally good woodcuts, two specimens of -which are here reproduced (Figs. 19 and 20), contains the earliest -discussion of gunshot wounds; and, in his remarks on the proper manner -of treating such wounds, von Gerssdorff leads one to infer that he -shared, although somewhat hesitatingly, the at that time prevailing -belief that these wounds are poisoned. He was a pronounced advocate of -the use of the red-hot cautery in cases of serious hemorrhage from a -wound. When it was found that the ball had penetrated the flesh to some -depth, he recommended that it be cut out; and if, after the removal -of the missile, the patient complained of much pain in the wound, hot -oil was to be poured into it freely. Before the employment of firearms -in warfare, amputation of a limb was rarely performed--that is, only -in cases where gangrene had developed in the corresponding hand or -foot. But von Gerssdorff assures us that, up to the time of writing -his “_Feldbuch_,” he had personally performed “nearly two hundred -amputations.” This great increase in the frequency of performing this -operation is clearly to be attributed to the increased use of the new -agent--gunpowder--in warfare. In this operation, according to his own -declaration, von Gerssdorff was not in the habit of suturing the flaps. -Instead, he brought the opposing edges together and then covered the -stump thus formed with the bladder of some animal. There are a number -of other interesting details relating to von Gerssdorff’s manner of -conducting this important operation, but it is not practicable to give -up the space that would be required for a satisfactory description of -them. There is one point, however, to which I may be permitted to refer -very briefly in this place, viz., the manner in which the surgeons of -this and even much earlier periods secured a fairly satisfactory degree -of local anaesthesia when they had occasion to perform an amputation. -They produced insensibility of the part by tying a band tightly around -the limb a short distance above the spot at which the amputation was -to be performed. At a somewhat later period, as in the middle of the -seventeenth century, artificial anaesthesia was also effected through -the application of snow or ice to the part. - -The date of von Gerssdorff’s death is not known. - - [Illustration: FIG. 20. AMPUTATION OF THE LEG. - - (From Hans von Gerssdorff’s _Feldbuch der Wundarznei_.) - - Von Gurlt says that this is the earliest known pictorial - illustration of the amputation of a limb.] - -_Fabricius of Hilden._--Fabricius Hildanus--or Fabricius of -Hilden, near Düsseldorf--was born in 1560 and received his early -training in surgery from Cosmas Slotanus, a pupil of Vesalius and the -first barber-surgeon of Duke Wilhelm of Guelich-Cleve-Berg (eighteen -miles northeast of Aix-la-Chapelle). In 1585 he visited Geneva, -Switzerland, and continued his studies in that city under the guidance -of Jean Griffon, one of the most distinguished surgeons of that period. -After leaving Geneva he practiced medicine at Cologne, and during that -period (1591–1596) steadily increased his reputation as a skilful -surgeon, particularly well versed in anatomy. But he appears to have -acquired a strong liking for Switzerland and for the professional -friends whom he had gained in that country; and consequently it is not -surprising to learn that, during the later years of his life, he spent -long periods of time in Geneva, Lausanne and Berne, in the last of -which cities he filled the office of City Physician. He died in 1634, -at the age of seventy-four, full of honors and greatly beloved by all -who knew him. - -Fabricius of Hilden laid great stress upon the importance, to the -surgeon, of a thorough grounding in anatomy. He had been profoundly -impressed by the fact that his instructor at Geneva, Jean Griffon, -never undertook an important operation until after he had refreshed -his memory by a dissection of the region involved. He was also much -interested in pathological anatomy, and always availed himself of every -possible opportunity for making a postmortem examination. As evidence -of the slowness with which news of important scientific discoveries, -particularly in the domain of medicine, traveled in those days I may -mention here the fact that, up to the time of his death in 1634, -Fabricius had not heard of Harvey’s great discovery of the circulation -of the blood (1628). Although he gained distinction in more than one -field of medicine his greatest reputation was unquestionably gained in -that of surgery; and his success in this field was to be ascribed to -his profound knowledge of anatomy, to his inventive genius, and to his -great technical skill. He insisted very strongly upon the importance, -for the surgeon, of possessing good instruments and well-constructed -apparatus. - -If we compare Fabricius of Hilden with Ambroise Paré we are obliged -to admit that the latter, although decidedly inferior to his rival in -scientific training, was the greater surgeon of the two. It is perhaps -worth recording that Paracelsus and Wuertz were Fabricius’ bitter -opponents. - -Of his published contributions to surgical literature, the most -important are to be found in the work entitled: “_Observationum et -curationum chirurgicarum centuriae VII._,” published at Lyons in -1641. - -_Felix Wuertz._--Felix Wuertz was born at Zurich, Switzerland, -between the years 1500 and 1510 (the exact date is not known). As to -his early life and surroundings I am only able to say that his father -was a painter, that he himself took service under a barber, and that -at the end of two or three years, after he had learned the details of -this branch of work, he started out on his travels over Europe in the -character of a barber’s apprentice, as was, in those days, the regular -custom with apprentices of all trades or occupations. In this way he -visited such cities as Bamberg, Pforzheim, Nuernberg, Padua and Rome, -in each of which he spent a certain length of time as an aid to those -surgeons who were willing to employ him. It is not unlikely that it was -during this wandering period of his life that he gained some experience -in the treatment of gunshot wounds. In 1536, after an absence of -four or five years, he returned to his native city and was regularly -enrolled as a member of the barbers’ guild. During the following twenty -years he carried on the practice of medicine and surgery, but more -particularly the latter, with ever-increasing success. In 1559, for -reasons which are not mentioned by any of his biographers, he left -Zurich and established himself in Strassburg; and then, at the end of -another ten or twelve years, he again changed his residence, this time -giving the preference to Basel, a Swiss city located at the boundary -line between Germany and Switzerland. The exact date of Wuertz’s -death is not known, but--from various facts which he mentions in his -book--it may be inferred that it occurred in 1576, and that he was -residing at the time in the house of his son, who had the same name -as himself and was also a surgeon. The title of the treatise which he -wrote and which passed through a number of editions between the years -1563 and 1651,--not to mention translations into the French and Dutch -languages--was: “_Practica der Wundarznei_” (The Treatment of -Surgical Affections). - -Malgaigne--says von Gurlt, in his History of Surgery--does not hesitate -to speak of Wuertz as one of the three greatest surgeons of the -sixteenth century (Franco and Ambroise Paré being the other two); and -von Gurlt adds that Wuertz’s “_Practica_” is rich in facts which -he had gathered from his own experience in everyday practice, and upon -which he makes comments that really represent his own views and not -those of various other authors. The leading principles which guided -Wuertz in his treatment of wounds of all kinds are thus formulated by -him:-- - - Keep them as neat and clean as possible, and disturb them as - little as you can; so far as may be practicable, exclude the - air; favor healing under a scab; and do not give the patient a - lowering diet, but feed him as you would a woman recovering from - her confinement. - -According to von Gurlt, Wuertz attached relatively small importance -to healing by first intention, and only in rare cases did he make -special efforts to secure this result. On the other hand, he availed -himself of every opportunity to enter his protest against some of -the bad tendencies which had somewhat suddenly made their appearance -in the practice of surgery in his day, and more especially “against -the almost universal employment of caustics and the red-hot iron for -arresting bleeding; against the uncalled-for and positively harmful -habit of repeatedly probing a wound; against the unreasonable practice -of inserting tents into wounds; against the uncontrolled application -of mushy poultices to wounds; and against the excessive employment of -bloodletting in the treatment of wounds.” He exhibited his conservatism -in still other ways. Thus, for example, he was very slow in reaching a -decision to amputate a limb or to remove splinters or larger portions -of loose bone from a wound, for he put greater trust in the reparative -powers of Nature than did most of the surgeons of that day. Wuertz was -also slower than were most of them in resorting to the operation of -trephining the skull. His ideas with regard to the nature of gunshot -wounds were not very clear, for he still believed that the projectile -caused some burning and a certain degree of poisoning of the wound; -but he condemned all unnecessary efforts at extraction, especially by -means of complicated instruments. It was better, he said, to wait until -the bullet or other missile manifested its presence at some easily -accessible spot in the body. - -The statements made above bring out some of the good features -of Wuertz’s treatise. This work, however, says von Gurlt, also -contains not a few bad features, and among them he mentions the fact -that it abounds in repetitions and in evidences of the author’s -superstitiousness. - -Some of Wuertz’s comments on the symptoms which occasionally develop in -cases of injury to the head, and the suggestions which he makes as to -the treatment that should be adopted, throw considerable light upon his -mode of procedure in the presence of certain surgical phenomena. The -following clinical lesson is based upon three hypothetical developments -in a case of cranial injuries:-- - - (1) The patient’s wound in the head, let us suppose, has to - all appearances healed, when it unexpectedly becomes swollen - and painful and begins to discharge again. What measures are - indicated under these circumstances? The wound should at once - be freely reopened, for it may confidently be assumed that such - a lighting up of the local symptoms is due either to a loose - splinter of bone that is trying to escape or to the presence of - a small area of bone caries. If, under these circumstances, you - should not establish a free opening a large abscess will surely - collect in that region and will soon make for itself a new - outlet. - - (2) If the patient complains that he has constant pain in his - head on the same side as that on which the injury was originally - inflicted, that the pain is steadily increasing in severity, - and that in addition he feels a sensation of pulsation in his - head; and if, furthermore, you inspect closely the site of - the original wound, and pass your finger cautiously over the - spot, but fail to discover any appreciable external swelling, - you may feel almost certain that a splinter or a spicule of - bone projects from the inner table of the skull cap into the - substance of the brain. Then, when the surgeon believes that - the condition as just described truly represents the existing - intracranial lesions, he should not hesitate to make an opening - in the calvarium over the affected spot and remove the offending - splinter. - - (3) If the patient, after the external wound has healed, - complains of a throbbing and roaring in his head, not merely in - the region of the actual injury but involving the entire head, - and if the symptoms tend rather to increase than to diminish, - and eventually become so severe that the patient is almost - beside himself with the pain, then is the surgeon justified in - believing that a clot of blood is imprisoned somewhere beneath - the cranium and is gradually being converted into an abscess or - a condition of ulceration. And if at the same time some swelling - appears in the vicinity of the eyes, or if a bloody and purulent - discharge begins to flow from the nose or the ears, he may not - merely entertain a belief that his diagnosis is correct, but - may assert with positiveness that the lesions just named really - exist. And then the proper treatment for him to adopt is [in - essentials] the following: The head having first been shaved - over the site of the original wound, make a crucial incision - through the scalp and pericranium, turn the flaps back, apply - a strong, sharp-edged chisel to the surface of the bone, and - remove enough of the cranium to afford a satisfactory view - of the underlying parts. [Among the effects first observed] - probably pus will well up into the opening, and the patient will - then experience relief; and if a spicule of bone comes into - view, remove it forthwith. The plan of treatment here suggested - is the only one which can be trusted to effect a cure in a - case like that which is now being considered.... If a boring - instrument is employed for making an opening in the bone, be - careful not to allow any of the chips made by the borer to enter - or remain in the cranial cavity. Some surgeons teach that, if - pus be not found at the first opening, a second one should be - made at the distance of a finger’s breadth from the first, and - that the intervening bone should be broken down with a strong - and sharp knife so as to convert the two into a single opening. - [Wuertz adds that he had never found it necessary to act in - accordance with this advice.] After the pus or clot of blood - has been removed, one may as a rule readily discover the true - cause of the pain and other symptoms. As a final step, suitable - dressings should be applied to the wound. - -Another important department of practical surgery, in which Wuertz -appears to have gained special distinction, is that which relates to -wounds and certain diseases of the abdomen. Owing to lack of space it -will not be practicable to reproduce here any histories of the cases of -this nature which came under his observation, but I believe that the -following brief extracts from his remarks upon the best way of treating -them may in some measure answer the same purpose:-- - - Penetrating wounds of the abdomen are universally admitted to - be very dangerous, no matter what organs (stomach, intestines, - liver, gall-bladder, spleen or kidneys) be involved in the - injury. In the case of a wound of the liver or spleen it is not - advisable to employ sutures; instead, one may use some kind of - sticking plaster for bringing the edges of the wound together. - Proper regulation of the diet plays an important part in the - treatment of these conditions, and so also may venesection. When - an intestine is the organ wounded I adopt the plan of treatment - recommended by most authorities; that is, I stitch together the - opposite edges of the wound and I cleanse the surface of the - bowel carefully with milk that has been well saturated with the - juice of anise seeds. - -In his remarks about the treatment of suppurative processes involving -the thigh in the vicinity of the knee, Wuertz gives the following -advice:-- - - Do not allow the knee to remain quiet, but stretch the - surrounding parts and manipulate them as much as you can, in - order that the joint may not become permanently rigid; for if - you wait until the healing is completed before you resort to - these measures you will often find that it is already too late. - -Separate chapters are devoted to such topics as would to-day receive -the designations “pyaemia,” “hospital gangrene,” and “septicaemia”; -and in a separate short treatise which deals with the various ailments -of young children, Wuertz mentions the fact that he once suffered -greatly for ten days from an attack of migraine (hemicrania) and that -he experienced marked and permanent relief only after the operation -of arteriotomy had been performed upon his left temporal artery. In -another part of the volume he expresses himself in terms which justify -the belief that he must have performed amputation of the thigh on -one or more occasions. He does not, it is true, furnish any details -regarding the indications that point to the necessity of resorting -to this operation, nor does he state how it should be carried out; -he simply makes the remark, while speaking of the employment of the -red-hot cautery iron in arresting hemorrhage, that “it is useful in -amputation of a limb, particularly in the thicker part of the thigh, -and occasionally in other places, as in the removal of a tumor by the -use of the knife.” So far as I am aware, Celsus was the first among -ancient writers on surgery to say anything about amputations, and what -he does say on this subject consists simply of quotations from still -earlier writers--from Archigenes, Leonides and Heliodorus, surgeons -whose writings no longer exist except in the form of detached extracts -that appear in more modern treatises. The portions of text which Celsus -quotes show clearly that the surgeons whom I have just named were in -the habit of making flap operations in cases of amputation above the -elbow and above the knee; and Archigenes even taught the advisability -of first ligating the larger supply blood-vessels before one proceeds -to the amputation of a limb. - -From the remarks which Wuertz makes in one or two places it is easy -to see that he was often not a little annoyed by the criticisms which -his professional brethren made with regard to some of his methods of -procedure. Thus, for example, he boldly declares that one’s experience -is of much greater value than any rule that may have been laid down by -the ancients. - - There can be no doubt, he says, that the ancients occasionally - displayed great ignorance and great want of judgment, just as - happens in our own time.... How much do you suppose I care - whether Galen’s, or Avicenna’s, or Guy de Chauliac’s opinion - does or does not agree with mine? Every such opinion--it should - be remembered--was, at one time or another in their day, a new - [and therefore unproved] opinion.... In practical surgery much - more importance attaches to the manner in which one carries out - one’s manipulations, and to the amount of experience which one - may have acquired, than to the length of time which one devotes - to windy consultations. - -Fortune conferred very few favors upon Wuertz in the course of his -career; the aid granted by kings and princes played no part in the -moulding of his character; his greatness was entirely due to his -own unaided efforts. Paré, on the other hand, was certainly one of -Fortune’s favorites. He, too, like Franco and Wuertz, began his -professional life as a barber’s apprentice, but, as he was made of -a much finer clay, the ultimate product of his development was a -princely surgeon, perhaps no more efficient or skilful than his two -distinguished contemporaries, but unquestionably more many-sided, -more lovable than either of them. On the other hand, Wuertz rendered -a most valuable service to the science of surgery by his close and -patient study of certain symptoms which his confrères had overlooked -or incorrectly interpreted (such, for example, as pyaemia, hospital -gangrene and septicaemia); and he thus established the fact that these -were in reality independent diseases. - - - - - CHAPTER XXXVII - - THE DEVELOPMENT OF SURGERY IN ITALY DURING THE RENAISSANCE - - -During the latter part of the fifteenth, all of the sixteenth and the -early part of the seventeenth centuries quite a large number of Italian -surgeons attained honorable distinction by the contributions which they -made to the science of medicine; and even in the neighboring Latin -countries of Spain and Portugal,--countries in which the force of the -revival of all departments of learning had made itself felt to a much -feebler degree, and in which at the same time the opposition to such -revival was much more active,--several surgeons succeeded in winning -creditable places for themselves in the history of their art. The names -of the Italian surgeons are as follows: Giovanni da Vigo, Bartolommeo -Maggi, Marianus Sanctus, Fallopius, Carcano Leone, Fabricius ab -Acquapendente, Aranzi and Tagliacozzi. I will now add brief notices of -the careers of all these men, in order to convey at least some idea of -the grounds upon which their claim to honorable distinction rests. - -Giovanni da Vigo--perhaps more frequently referred to in literature -by the French form of his name, “Jean de Vigo”--was born at Rapallo, -near Genoa, Italy, about the year 1460. He was the son of Bernardo di -Rapallo, who was also a surgeon; and he himself was the founder of a -school which sent out quite a number of practical surgeons. In 1485 he -began the practice of his profession at Saluzzo, a small town about -forty miles south of Turin; and ten years later he settled at Savona, -which is located on the Mediterranean, a short distance to the west -of Genoa. In 1503 he was chosen the personal physician of Cardinal -Giuliano della Rovere, who resided at Savona, and he continued to hold -this position after the cardinal was elected to the papal office under -the name of Julius the Second. - -Da Vigo’s great treatise on surgery (“_Practica in arte chirurgica -copiosa continens novem libros_,” Rome, 1514) owed its celebrity, -during the early part of the sixteenth century, chiefly to the fact -that he was the first author to write somewhat thoroughly upon syphilis -and upon gunshot wounds--two surgical disorders of great importance -at that time. As to gunshot wounds, da Vigo was one of the first to -maintain that they were poisoned wounds; and for a long time afterward -this was the generally accepted opinion. Like all his contemporaries, -da Vigo was not willing to undertake such operations as those for the -cure of stone in the bladder, for the relief of cataract, and for the -cure of hernia. He left these, says Haeser, to the itinerant surgeons. -But he gained well-merited credit by his employment of ligatures for -the arrest of bleeding in a variety of conditions--not, however, -in amputations, as he appears to have avoided cutting operations. -According to the same authority, the circular pattern of trephine (the -kind which the surgeons of the present day prefer) was first introduced -by da Vigo. The following passage copied from his “_Practica_” -shows that he was familiar with the use of the ear speculum: “... -_si ad solem speculo instrumento aure ampliata_.” Da Vigo died -soon after 1517. - -Bartolommeo Maggi, who was born at Bologna either in 1477 (Haeser) -or in 1516 (von Gurlt), held the Chair of Anatomy and Surgery in the -medical school of his native city, and then at a later date accepted -the position of private physician to Pope Julius the Third (1550–1555). -He held this position, however, only for a short time, as he found that -the climate of Rome did not agree with him. His posthumous fame rests -largely on the treatise which he wrote on gunshot wounds and which -was published by his brother a short time after the former’s death. -His treatise, says von Gurlt, is one of the best of those which were -published on this subject during the sixteenth century. Henry the -Second, King of France, expressed his gratitude to Maggi for the care -which he took of the wounded French soldiers who fell into the hands of -the papal troops at the sieges of Parma and Mirandola. Maggi maintained -firmly the belief that gunshot wounds are either poisoned or burned. -His death occurred in 1552. The title of his treatise on gunshot wounds -is: “_De vulnerum bombardarum etc._,” Bologna, 1552. - -Marianus Sanctus of Barletta near Naples (born in 1489, died at some -unknown date after 1550) is credited with having been the first to -publish a description of the so-called “_apparatus magnus_”--the -name given in those early days to the method of extracting a calculus -from the urinary bladder through an incision in the perineum after a -grooved sound or director had first been passed into this organ by -way of the urethra. The title of the book in which this description -is given is the following: “_De lapide renum liber et de lapide ex -vesica per incisionem extrahendo_,” Venice, 1535. Marianus, however, -does not claim to have been the inventor of this method. Some writers -give the credit for this to Jean da Vigo’s father, Bernardo di Rapallo, -who communicated a knowledge of the method to Giovanni de Romanis, -who in turn instructed Marianus Sanctus. It is believed, furthermore, -by some writers that Giovanni de Romanis was the inventor of -lithontripsy[86]--the operation of crushing a stone in the bladder or -urethra. Laurent Colot, the famous French lithotomist of the eighteenth -century, obtained his knowledge from a certain Octavianus de Villa, a -friend of Marianus Sanctus, and then kept the matter secret for many -years. - -Fallopius, the famous anatomist of the early part of the sixteenth -century, does not appear to have attained equal distinction in the -field of surgery. So far as one may judge from the portions of the -text selected from his writings by von Gurlt, Fallopius was a very -conservative if not a very timid surgeon, in this respect being not -unlike Fabricius ab Acquapendente. In the text to which reference has -just been made, I find a brief mention of a case which passed under -Fallopius’ observation and which, perhaps, is of sufficient interest -to be recorded here. The patient’s--a German student’s--finger had -been nearly severed by some cutting instrument, and the greater part -of the member remained attached to the hand only by a narrow strip of -flesh. “I stitched together the separated edges, and at the end of -three or four days I was astonished to find that firm union between the -separated parts had already taken place. This result seemed to me like -something miraculous.” - -Carcano Leone was born at Milan in 1536, his parents being people of -good social standing. After receiving a thorough classical education, -he began his medical studies in his native city, under the guidance -of Pietro Martire, a pupil of Vesalius. He next continued his studies -at the University of Pavia, but eventually went to Padua, where he -enrolled himself among the pupils of Fallopius. After a residence of -two years in that city, he returned to Milan and opened a medical -school of his own. Upon the occasion of the death of the Cardinal and -Archbishop Carlo Borromeo, whose remains now rest in the cathedral of -Milan, it was Carcano Leone who was invited to make the postmortem -examination. He carried on the practice of his profession during a -period of about twenty-eight years, his death occurring--so far as may -now be learned--in 1606. - -Carcano Leone’s reputation as a surgeon rests mainly on the treatise -which he wrote on the wounds of the head, and which was published at -Milan in 1583. From among the numerous cases of this character which -came under his observation, and of which a certain number are reported -by von Gurlt, I have selected the very brief histories of three that -seem to me well adapted to serve as examples of Leone’s knowledge of -surgery and also of his ability to cope with problems of so serious -a character. They reveal the fact that he was a surgeon of excellent -judgment, most persevering, and very resourceful. Briefly told, the -accounts of the three cases to which I have referred read as follows:-- - - Case I.--A small boy was hit on the right temple by a stone - that had been thrown by one of his companions. Unconsciousness - resulted and lasted for six days. On the seventh day signs of - returning consciousness manifested themselves, but inability to - speak persisted. By the end of another week the boy had already - made some efforts to speak, but his speech was incomprehensible. - After the twentieth day it was possible to understand a little - of what the boy was trying to say; and from this time onward - steady improvement in this respect was recognizable from day - to day; but the boy’s speech did not become quite normal until - after the lapse of about a year. - - When Carcano Leone was called to see the patient he found that - the entire temporal muscle had been crushed and that almost the - entire right side of the head was occupied by a fluctuating - swelling. By making a free incision in the swelling Leone gave - exit to a large quantity of black coagulated blood. On the - following day, when he made an examination with the probe, he - found that the entire squamous portion of the temporal bone was - in a fractured state, one part of it overriding the rest. By the - aid of elevators he succeeded in lifting up the depressed part - of the bone, but the accomplishment of this result left a large - gap between the opposite edges of the fragments, and through - this opening one could see the movements of the dura mater. - Complete healing took place only after the lapse of twelve - months. - - When Leone reported the case to his former teacher, Fallopius, - the latter replied that he would not have had the courage to - adopt the course which his former pupil had pursued. - - Case II.--In another case the patient, a full-grown man, was - struck on the right temple by a highwayman with a heavy cane - which broke in two in the middle under the great force which - the assailant had employed. He was left lying on the roadside - in a state of unconsciousness until some passers-by discovered - him and carried him to his home. He remained unconscious for - several days. Before the physician was summoned all sorts of - measures had been resorted to for the purpose of dissipating the - swelling in the temporal region, but without success. Leone, on - arriving upon the scene, made a free incision which afforded - escape to a large quantity of decomposing blood that appeared to - be collected, not between the muscle and the skin, but between - the muscle and the bone. The latter was found to be fractured - transversely and depressed; and, in order to lift it back to - its proper level, it became necessary first to incise the - muscle transversely. At the end of three months the wound had - completely healed and the patient had regained his health. - -Speaking of the cases just narrated and of others of a similar nature, -Leone remarks that he has never had any experience that would justify -the fear expressed by Hippocrates that convulsions are likely to result -from dividing the temporal muscle. - -With reference to the value of trephining the skull in cases of injury -to the head, Leone narrates the following experience:-- - - Case III.--A man was struck by a heavy stone on the upper part - of the forehead close to where the hair grows, and was thrown - to the ground by the force of the blow. Here he lay as if dead. - When Leone was called, a short time afterward, to see the - patient he found the skin unbroken except at one small spot, - and from this point he made an incision of such length that he - was thereby enabled to explore the surface of the skull. In - this way he discovered that there was a fracture which appeared - to extend through the entire thickness of the skull. He then, - without further delay, trephined the cranium over the line - of the fracture. This was followed by such a copious flow of - blood that Leone was obliged to adopt measures for arresting - any further hemorrhage. During the following fourteen days (the - summer season then being at its height) large quantities of - decomposed and evil-smelling blood escaped from the wound; but - the dura mater gradually assumed a more natural appearance, many - splinters of bone were ejected, and finally--at the end of forty - days--the wound healed. (As no further details are given in the - text, it is fair to assume that there were no sequelae of an - unfavorable nature.) - -The whole subject of injuries to the skull is treated in a most -thorough manner by Leone, and the book is pronounced by Scarpa -(1752–1832), the famous anatomist, the best that, up to his time, had -been written on the subject. The three histories of cases which I have -here reproduced and which furnish such striking proof of what surgery -may accomplish when practiced by a man of good courage as well as of -good judgment, certainly justify the favorable opinion expressed by -Scarpa upon Leone’s work. - -Fabricius ab Acquapendente, of whom I have already given some account -on a previous page, was distinguished not only as an anatomist and as a -physiologist, but also--which was true of his instructor, Fallopius--as -a surgeon. From his published writings, however, it appears very -clearly that, like Fallopius, he had a decided aversion to the use -of the knife; his activities as a surgeon being restricted largely -to the improvement of certain of the more bloodless operations (for -example, tracheotomy and thoracentesis and operations for the relief -of stricture of the urethra). He also invented several new surgical -instruments and devised a number of machines for use in orthopaedic -practice. He attached great value to the teachings of Celsus and Paulus -Aegineta, his writings containing frequent and copious references -to these authorities and relatively few data based upon his own -experience. In the section which he devotes to the subject of wounds of -the abdomen, Fabricius confirms the opinion very generally held by the -ancients, viz., that a wound of the small intestine is invariably fatal. - -Gaspare Tagliacozzi was born at Bologna in 1546. He studied medicine -under Girolamo Cardano, Professor of Medicine, first at Pavia and -afterward at Bologna, and received his degree (“Doctor of Philosophy -and Medicine”) in 1570. Very soon afterward he began teaching surgery, -and a little later he also taught anatomy and the theoretical part of -medicine. In this work he was so successful that in 1576 he was made -a member of the Faculty. He died on November 7, 1599, at the age of -fifty-three. - -The Italian method of performing plastic operations, says von Gurlt, -had already flourished for about one hundred and fifty years before -Tagliacozzi took up the subject in serious earnest and attained results -of decided scientific value. There are some doubts, however, as to the -precise degree of credit that should be awarded Tagliacozzi for his -share in the development of the operation which bears his name. The -facts which throw some light upon this question may be stated in the -following paragraphs:-- - - (1.) Tagliacozzi’s Latin is not easy to understand, and he - certainly does not furnish satisfactory information as to the - manner in which he learned the details of the operation which we - are here considering. Vesalius, Paré and other surgical authors - of that period throw no light upon that question and furnish - erroneous descriptions of the steps of the operation. Apparently - they had never witnessed one of that character. (Von Gurlt.) - - (2.) The records seem to warrant the statement that, about - the middle of the fifteenth century a surgeon by the name of - Branca, who lived in the city of Catania on the southeast coast - of Sicily, devoted himself largely to the reconstruction of - damaged or defective noses. At first he transplanted a flap from - the forehead or cheek; but afterward his son sought to improve - the method by utilizing a flap of skin taken from the arm. By - this plan the disfiguring of the patient’s face was avoided. - The son employed the same method in repairing the lips and the - ears. Pupils of the latter carried a knowledge of the method to - the Bojano (Vianea or Vieneo) family in Tropea, Calabria, and - from them it was transmitted, about the middle of the sixteenth - century, to Tagliacozzi and eventually to the medical profession - in every part of the world. - - (3.) In 1581 there was published at Cracow, Galicia (formerly - Poland), a book which bore the title “Przymiot” and which gave - a most complete account of the disease syphilis in all its - manifestations and complications. This book, in its original - form, is to-day one of the greatest bibliographical rarities; - but a reprint of the work was published in 1881 by the Warsaw - Surgical Society. In this volume Wojciech Oczko, the personal - physician and secretary of the Polish kings Stephan Bathory and - Sigismund the Third, discusses other surgical topics beside - syphilis. He states, for example, that Aranzio (or Arantius), - who was Professor of Surgery at Bologna at the time (1569) when - he frequented that medical school, was successful in making a - new nose by transplanting a flap of skin from the patient’s - arm; and that he performed this operation without injuring the - muscles of the arm, and also with perfect success as regards - the creation of a straight and shapely nose. “This statement,” - says von Gurlt, “coming as it does from an eye-witness who was - at Bologna several years before Tagliacozzi’s time, furnishes - satisfactory proof that rhinoplasty was successfully performed - in that city several years before the date of publication - (1586) of Tagliacozzi’s earliest comments on the subject, - and that the credit for first bringing the operation to the - knowledge of European surgeons is due to Aranzio rather than - to Tagliacozzi.” The latter’s famous treatise on rhinoplasty - (“_De chirurgia curtorum per insitionem_”) was published at - Venice in 1597. - - [Illustration: FIG. 21. THE MANNER IN WHICH THE SO-CALLED - TAGLIACOTIAN OPERATION FOR REPAIRING A DEFECTIVE NOSE SHOULD BE - CARRIED OUT. - - (From the treatise published by Tagliacozzi, Venice, 1597.)] - - (4.) Fabricius of Hilden, the distinguished German surgeon - of the sixteenth century, assures us that his teacher, Jean - Griffon, at that time the leading surgeon of Lausanne (but, at - an earlier period, of Geneva), performed the same operation in - 1592. The patient was a young Genevese woman whose nose had been - cut off by some soldiers belonging to the army of the Duke of - Savoy who were enraged at the resistance which she offered to - their familiarities; and the operation proved most successful, - “the new nose eliciting the admiration of all who saw it.” - Fabricius adds that during the winter seasons, up to the year - 1613, the tip of this nose presented a somewhat purplish hue. - The woman married in 1603. - - (5.) During the short lifetime of Tagliacozzi several tablets, - on which laudatory inscriptions were engraved, were erected in - the high school (_archiginasio_) of Bologna, and after his - death a bust that represented him holding a nose in his hand was - erected in the same building. Corradi, the medical historian - (1833–1892), writes that in his time both bust and tablets had - disappeared. Tagliacozzi’s remains were temporarily lodged in - the cloisters of the church of San Giovanni Battista, and the - report was circulated that, a few weeks after his death, a - voice was heard saying that he was among the damned. Thereupon - the remains were removed to the walls of the city, and the - Tagliacotian method was soon forgotten, to be revived only after - the lapse of many years. - -All the data which I have reproduced in the preceding paragraphs -seem to point to the conclusion suggested by von Gurlt, viz., that -Tagliacozzi was willing to accept for himself a credit which belonged -in reality to another, and that there would be more justice in calling -the famous rhinoplastic method of procedure “the Arantian operation” -than the Tagliacotian; especially as our knowledge of the method -adopted by the younger Branca is entirely too vague to justify us in -bestowing this honor upon him. - -Giulio Cesare Aranzio (or Arantius) was born at Bologna about the year -1530. He studied medicine first in his native city, under the guidance -of his uncle, Bartolommeo Maggi, and then afterward went to Padua, -where he may possibly have been one of Vesalius’ pupils. In 1548 he -made, at Padua, his first anatomical discovery--that of the _musculus -levator palpebrae superioris_. Before he was twenty-seven years -old he was chosen Professor of Medicine, Surgery and Anatomy in the -University of Bologna, and he filled the position with distinction up -to the time of his death on April 7, 1589--_i.e._, during a period -of thirty-three years. - -The part taken by Aranzio in the advancement of surgery was apparently -of small importance. He succeeded, it is true (see remarks on page -479), in reviving the interest of contemporary surgeons in the -possibility of restoring damaged parts of the human face by means -of flaps taken from the patient’s arm. But I have not been able -to discover that he made any other material contributions to this -department of the science of medicine. It is possible, however, that -his plan of illuminating the interior of the nose and of operating upon -nasal polypi may possess some measure of originality; but I do not -feel competent to decide this question. As regards the procedure just -referred to, it may be stated briefly that Aranzio was in the habit, -when operating within the nasal cavity, of using by preference, for -illuminating purposes, the direct rays of the sun, which were allowed -to enter the room through a slit or hole in the wooden window blind; -and, when sunlight was not available, he used as a source of light -the rays emanating from a lighted wax candle. In the latter case he -increased the brilliancy of the illumination by interposing between the -flame of the candle and the illuminated field, a glass globe filled -with water,--an idea which probably originated with the goldsmiths or -the shoemakers. The employment of light reflected from a concave mirror -supplanted this method somewhere about the year 1866. - -In Italy, during the sixteenth century, there were several -surgeons--uneducated empirics--who contributed not a little to our -knowledge of the radical cure of hernia; and of this number the -members of the Norsa family (from Norsa, a small town in the district -of Naples) were undoubtedly the best known and most experienced -operators. Horazio Norsa, for example, is reputed to have performed the -radical operation (in combination with castration) no less than two -hundred times. It was this same Horazio Norsa who, in the latter part -of his career, complained to Fabricius ab Acquapendente that, since the -wearing of trusses had become so common a custom as it then was, the -number of operations for the cure of hernia had greatly diminished. - - - - - CHAPTER XXXVIII - -THE DEVELOPMENT OF SURGERY IN SPAIN AND PORTUGAL DURING THE RENAISSANCE - - -According to the authority of Morejon, who published (1842–1852) an -elaborate history of medicine in Spain and Portugal, these countries -almost rivaled Italy, during the sixteenth century, in the number and -excellence of their physicians. But, so far as I am able to judge -from the record, very few of these men appear to have taken a strong -interest in surgery, and of these few there are only three--Daza -Chacon, Francisco Arceo and Amatus Lusitanus--who left behind them -treatises which seem to call for a brief notice. - -Dionisio Daza Chacon, who was born in 1503 at Valladolid, about one -hundred miles north of Madrid, received his early training partly in -his native city and partly at the University of Salamanca. After being -engaged for some time in private practice he joined the imperial army -(Charles the Fifth) in the capacity of a field surgeon in charge of a -corps of three thousand men. In addition to these troops there were -six thousand English archers, in the pay of the Emperor. At the two -sieges in which these men participated--the siege of Landrecy in 1543 -and that of Saint Dizier in 1544--Daza Chacon acquired an extensive -experience in the treatment of both arrow and gunshot wounds, for the -number of those injured on those occasions was very great. In 1545, -after he had been chosen personal physician of Charles the Fifth, he -returned home by way of Madrid, and distinguished himself greatly in -1547 by his self-sacrificing attendance upon the victims of the Plague -in his native city. In 1557 he offered himself as a candidate for the -position of Surgeon-in-Chief of the hospital at Valladolid, and, after -passing with great credit the competitive examination, he was given the -appointment. During the following six years he served that institution -with conspicuous ability, and then accepted the position of private -physician to Prince Don Carlos, the son of Philip the Second, King of -Spain. Four years later he entered the service of Don Juan of Austria -(the natural brother of Philip the Second), and accompanied this prince -on his sea voyages to various parts of the Mediterranean; being with -him, for example, on the occasion of the bloody sea fight in the Gulf -of Lepanto in 1571. On reaching the age of seventy, Daza Chacon retired -from active practice and devoted himself to the writing of his great -work on surgery--“_Practica y teorica de cirujia, en Romance y en -Latin_,” Valladolid, 1600; and several later editions. The date -of Chacon’s death is not known, but it certainly occurred before the -publication of his book. - -Von Gurlt says that Chacon’s treatise is distinguished by the -systematic and clear manner in which the author treats the subjects -with which he deals, and it shows him to be well versed in the -teachings of other writers on surgery, that he is ready at all times -to give them full credit for any contributions which they may have -made to this branch of medicine, and that he is remarkably free from -the superstitiousness which was so prevalent in his day. Of all the -treatises on surgery which have been written by Spaniards, either -during the sixteenth century or at a more recent date, this work, says -von Gurlt, is unquestionably the best. - -The edition of the treatise published at Madrid in 1626 contains 922 -pages--a large work. Among the reports of cases published in Part II., -there are several which possess features of considerable interest, but -I shall be able to reproduce only one of them here:-- - - The young prince, Don Carlos, aged seventeen, while residing - temporarily at Alcalá de Henares, plunged head foremost, in - the dark, down a steep staircase and struck his head against a - closed door. When the lad was picked up it was found that, at - the back of his head, there was an open wound about the size of - a man’s thumbnail, that the surrounding scalp showed evidences - of being bruised, and that the pericranium in this region - had been laid bare. During the first three days following the - accident the patient manifested only a moderate degree of fever, - but on the fourth day the fever became more pronounced. The - wound, which by this time was discharging actively, presented at - first a healthy appearance, but it soon acquired an unhealthy - aspect, and the patient began to complain of numbness in the - right leg. Vesalius, the private physician of Charles the Fifth, - the boy’s grandfather, was one of the many physicians who were - called in to consult about the treatment of this case; he was - sent for on the eleventh day following the accident. On the - seventeenth day the wound was enlarged and the bone carefully - examined, but no evidence of a fracture or a fissure was - discovered. On the following day erysipelas manifested itself on - the head and neck and extended downward until it had involved - both arms. At the same time the fever increased very markedly, - and for five days the patient was delirious. As by this time - there was ample reason for suspecting that some intracranial - injury had occurred, it was decided to trephine the skull. The - operation was performed on the twenty-first day, but nothing of - importance was discovered. The patient’s life was now evidently - in great peril, and an unfavorable prognosis was pronounced. - Four days later, however, complete consciousness returned. - On the twenty-ninth day a quantity of pus was evacuated from - the very much swollen eyelids; and, three days later still, - the patient was found to be quite free from fever. On the - forty-sixth day he left his bed for the first time, and at the - end of ninety-three days the wound was found to have firmly - cicatrized. - - [Some interesting details concerning the subsequent life of Don - Carlos will be found in Motley’s “Rise of the Dutch Republic.” - They suggest the possibility that his attacks of violent temper - may have resulted from the lesions produced by the accident - narrated above.] - -Francisco Arceo was born, about the year 1493, at Fregenal in the -Province of Badajoz, Spain. It is not known at what university or other -educational institution he received his early training in the science -of medicine. It is a well-established fact, however, that at quite an -early stage of his professional career he acquired great celebrity for -his skill in treating both surgical and internal maladies, and that, -as a consequence, patients flocked in large numbers from all parts of -Spain to consult him. Rather late in life he wrote two treatises--one -on the treatment of wounds, as well as on ulcers and syphilis, and -another on the management of fevers. These two works were published at -Antwerp, in the year 1574, as a single volume, the author being at that -time, despite his advanced age (eighty), still in vigorous health and -able to practice with skill both branches of the science of medicine. -In 1658 a second edition of Arceo’s two treatises was published -at Amsterdam; and even at an earlier date there were published an -English translation (1588) and a German version (1614). A perusal of -the chapter which he devotes to the treatment of clubfoot gives the -impression that Arceo was an excellent surgeon--eminently practical -in his choice of means for securing certain results, and thoroughly -familiar with the extent to which he might depend upon the powers of -Nature to aid his efforts. The date of his death is not known. - -Amatus Lusitanus is the name by which the Portuguese medical writer, -Juan Rodriguez de Castel Bianco, is commonly known. He was born in the -Province of Beira, Portugal, in 1511, of Jewish parents, and studied -medicine at the University of Salamanca. After doing duty as a surgeon -in two of the hospitals of that city, he took up his residence, for -short periods of time, first in Antwerp and then in Ragusa, Dalmatia, -on the eastern coast of the Adriatic. At this period of our history -the Inquisition was extremely active throughout the domains that were -under the rule of Charles the Fifth, and as a result Amatus soon -found himself obliged to abandon all his books, instruments, etc., -and flee for his life to Northern Greece. As the Turks, who were in -possession of that country, were perfectly indifferent with regard to -the religious beliefs of the Jews, Amatus was allowed to settle down -quietly for the rest of his life at Thessalonica, in Macedonia. - -During the later years of his career he published several books on -topics relating to the science of medicine--two of them on materia -medica and two on the cases of special interest which had come under -his personal observation during the course of his practice. The -latter work, which is entitled “_Curationum medicinalium centuriae -VII._,”[87] was printed in its entirety in Venice, in 1556 (2 -vols.). Von Gurlt speaks of Amatus as a cultivated scholar and an -excellent observer. Of the seven hundred cases reported in this work -only a very few are of interest to the surgeon. Von Gurlt calls -attention to the fact that, during the earlier years of his practice, -Amatus devoted a fair share of his attention to surgery, but that -subsequently he performed no operations whatever; it being his rule to -intrust this work entirely to a regular surgeon or to a specialist. - -In my search among the dozen or more histories of cases selected by -von Gurlt from the seven “Centuries” (700) of the complete treatise -as suitably illustrating Amatus’ manner of reporting the cases which -he had seen in practice, the various methods of treatment which he -adopted in his efforts to relieve the diseases or injuries that came -under his observation, and the demeanor of the man in the presence of -the ever-changing problems presented to the physician, I have succeeded -in finding only four that seem to furnish in even a slight degree the -information which I have just outlined. Unsatisfactory as these four -reports are in certain respects,--especially in their failure to reveal -to us the more strictly surgical capabilities of Amatus,--they at least -show that he was an able and conscientious practitioner, and to this -extent they possess value. - - The first case reported in Century I. is that of a peasant girl, - aged thirteen, who, while walking barefooted in a field was - bitten by a viper. Amatus did not see the patient until three - hours later, but already at this early stage he observed many - blue and red patches, scattered over the leg and thigh of the - side on which the bite had been inflicted. Near the base of - the foot there were two quite black spots corresponding to the - bites of the reptile; and from the fact that there were only two - such spots Amatus inferred that the snake must have been a male - viper, which has only two poison fangs and is therefore less - dangerous than the female which has four. The symptoms which - the girl experienced were faintness, trembling and dizziness. - As regards the treatment adopted, the skin in the immediate - neighborhood of the bites was scarified and suction by the means - of cupping glasses was employed; afterward a plaster, which was - composed in part of theriaca, was applied to this region. The - patient made a complete recovery. - - In Century V., Amatus gives an account of a fatal case of ear - disease. The patient, a sickly-looking boy of eight who had - been affected for a long time with a discharge from one ear, - presented a non-sensitive lump on the side of the head. “As he - began to show signs of feverishness it was decided to incise the - lump; and when the incision had been made, it was found that a - large part of the skull in this region had been destroyed by - caries, as a result of which there was left a cavity in the side - of the head, and this cavity was filled with a foul-smelling - pus, débris, and granulation tissue that apparently rested on - the dura mater. Three days later the surgeon[88] succeeded in - removing from the cavity only a small quantity of the sanious - material. On the fourth day, after an attack of convulsions, the - patient died.” - - In Century VII. there is given an account of a man of the - wealthy class who had been exposed to an excessive degree of - cold for so long a time that he was literally almost half - frozen. “As he was being carried into the village he gave orders - that an ox should be slaughtered and that he himself should be - snugly stowed away inside the carcass of the animal as soon - as its interior furnishings had been removed. Thus he escaped - freezing to death.” - - In the same century Amatus speaks of having seen a rather - interesting case of _Filaria Medinensis_ (called by the - Arabs “_vena medena_”) in a negro boy, eighteen years old, - who had come to Thessalonica from Memphis, Egypt. “The worm - had caused the production of an ulcer close to the boy’s heel, - and in this the creature’s head, which looked very much like a - vein, was recognizable. After the Turks had correctly diagnosed - the nature of the trouble an Arabian physician, who had managed - to secure a purchase on the worm, began rolling it up on a - small stick. Gradually, after the lapse of several days, he - succeeded in uncoiling the animal in its entire length (three - cubits), as shown by the construction of the end of the tail, - and thus permanently freed the boy from his trouble. The ancient - authors express doubts as to the true nature of the object found - in these ulcers, but I, Amatus, having examined the slender - white creature and having witnessed its curved outlines as it - projected itself outside the opening, do vouch for the fact that - it possesses all the characteristics of a true worm.” - - - - - CHAPTER XXXIX - - THE DEVELOPMENT OF SURGERY IN FRANCE DURING THE RENAISSANCE.--PIERRE - FRANCO - - -Von Gurlt speaks of Pierre Franco as “one of the most skilful surgeons -and at the same time one of the most original medical writers of the -sixteenth century.” He and his contemporary, Ambroise Paré, were -of French birth, and to France therefore belongs the conspicuous -distinction of having contributed to medical science during the -Renaissance two of its most illuminating and efficient laborers. These -men, who were the leading operative surgeons in France during the -first half of the sixteenth century, did not owe their education as -physicians to the official training provided by the Medical Faculty, -but partly to the men who were classed as barbers and surgeons, or -barber-surgeons (_Collège de St. Côme_), and still more to -their own efforts. They gathered practical knowledge wherever they -might--largely from their official connection with armies during the -progress of different wars. Further details with regard to their -personal characters and the principal events of their professional -careers will be furnished in the following brief sketches. - -_Pierre Franco._--Pierre Franco was born in the village of -Turriers, in Provence (now the Department of Basses-Alpes), about -the year 1500. He received his instruction in surgery from itinerant -lithotomists, operators for cataract, hernia-healers and men of -that class; and it is quite likely that, in the early days of his -professional career in Provence, he was himself a practitioner of this -humble type. At a somewhat later date he left the southern part of -France and took up his residence in Switzerland, first at Berne and -then at Lausanne. He probably left Provence because, in the early -part of the sixteenth century, the Protestants of that region were -being subjected to every form of persecution; and it is almost certain -that Franco belonged then to the Reformed Church, for he accepted the -salaried office of City Surgeon at Berne, the authorities of which city -were bitterly opposed to everybody and everything connected with the -Roman Catholic Church. Franco held the office named during a period -of ten years, the first part of the time at Berne, and afterward at -Lausanne, which latter city was then under the control of the Bernese -Government. He was a very close observer, a most enthusiastic student -of his art, and a man of intensely religious nature. Malgaigne, the -distinguished editor of the modern edition of Paré’s writings, speaks -thus of Franco: “I have no intention of writing here the history of -this man who was endowed with such a fine surgical genius; I may say, -however, that his was a life devoted entirely to the advancement of -surgery as a science.” - -As an operative surgeon, says Edouard Nicaise, Franco ranked higher -than any of his contemporaries. Strange as it may appear, Ambroise Paré -frequently refused to take charge of cases in which an operation for -stone in the bladder, for hernia, or for cataract was required, whereas -Franco owed much of his reputation to the success which he had in -operating upon these three classes of cases. The latter, furthermore, -did most of his work on patients who belonged to the middle class, and -consequently his operations were characterized by very little of the -éclat which marked a large part of the work done by Paré, who from the -very beginning was befriended by Royalty and the Court circle. At the -same time, says Nicaise, Franco did more than any other man of that -period to enrich surgery with new discoveries. - -Franco has written only two treatises. The first one, which was -published in Lyons, France, in 1556, bears the title: “A Small -Treatise on the Operative Treatment of Hernia”--one of the most -important departments of surgery (a book of 144 pages, 8vo). The second -work, which was issued in 1561, also at Lyons but by a different -publisher, bears the title: “_Traité des hernies contenant une -ample déclaration de toutes leurs espèces, etc._” (a book of 554 -pages, 8vo). This work goes very thoroughly into the subject of hernia -in all its bearings, and also deals with several other important -surgical topics, such as genito-urinary diseases (in both the male -and the female), affections of the eyes, hare-lip, tumors, wounds in -general, dislocations, fractures, amputations, etc.; in short, it is -a fairly complete and decidedly original treatise on general surgery. -When Franco wrote the smaller work (that of 1556), he was settled at -Lausanne; but in 1561 he was living in Orange, which at that time was -the capital of a Principality that belonged to the House of Nassau.[89] -A few brief citations from the larger of the two treatises will suffice -to give our readers some idea of the manner in which Franco deals with -the subject-matter of the book. - -Franco, says von Gurlt, was one of the first surgeons--perhaps the -very first--to perform the operation required for the relief of -strangulated hernia and at the same time to furnish a description of -the manner in which it should be performed. After mentioning the fact -that the strangulation of a portion of the intestine is attended with -considerable danger to the patient’s life, Franco proceeds to consider -the subject in greater detail:-- - - Owing to the large amount of the fecal matter and gas contained - within the portion of the intestine that is imprisoned in - the scrotum, and also owing to the inflamed condition of - the parts, it is frequently not possible to push the bowel - back through the narrow aperture in the peritoneum; and this - condition of things is apt to be aggravated by the constipation - or by the efforts at vomiting that frequently accompany such - strangulation. The vomiting, it is true, may in certain cases - facilitate the desired reduction, but in others it does harm, - especially by forcing more fecal matter into the scrotum. If - the conditions described are permitted to continue unrelieved, - death may certainly be expected to result. In a few cases the - timely administration of medicine internally may overcome the - difficulty, but, if this measure fail to produce the desired - result, recourse must be had to surgery--not, however, if - already the scrotum and neighboring genital parts have changed - their color to a black, livid, bluish or some other unnatural - hue, or if the hernial tumor manifest a round rather than an - elongated shape, for all these signs are harbingers of death; - and, as further unfavorable signs, should be reckoned a livid - or black mucous membrane of the patient’s mouth, contracted - nostrils, and an appreciably sunken condition of the eyes. But - if, on the other hand, the scrotum possess a natural color and - if it have not a spherical form but rather an oval shape, then - it is proper, after a failure to secure the desired reduction by - the internal use of medicine, to resort to a surgical operation. - - For the proper performance of this operation the surgeon - should be provided with a nicely rounded metal staff, flat on - one side, and a little larger than a goose’s quill. [Paré’s - grooved sound or director, says von Gurlt, had not yet at that - time been invented, and this staff was intended to serve, in - a crude fashion, the same purpose.] The first step is to make - an incision in the upper part of the scrotum, the direction in - which it is to be carried being toward the symphysis pubis. When - the hernial sac is reached the staff is introduced into the slit - and pushed upward between the wall of the sac and the fleshy - part of the penis, the flat side of the instrument being kept - uppermost, as it is upon this surface that the cutting with the - scalpel or the razor is to be done. After the end of the staff - has been pushed well upward the flesh of the scrotum is to be - divided upon the flat surface of this instrument; all danger - of injuring the intestine being thus avoided. Then the attempt - should cautiously be made to reduce or replace the intestinal - folds. But if these efforts fail,--owing to the excessive - distension of the bowel or because the constricting band has - not yet been sufficiently relaxed,--then the following steps - should be taken:--Grasp the spermatic cord (“_didymis_”), - lift up its enveloping membranes one by one with hooks, and - divide each one of them completely upon one’s finger nail, up - to the point where the intestine is encountered. Then, having - established, between the intestinal wall and the membranous - coverings of the cord, an aperture large enough to admit the end - of the metal staff, push the instrument onward and upward while - at the same time it is held as it were balanced in the air, so - that early warning may be communicated to the holding fingers in - case the instrument, as it travels onward, should become caught - in the folds of the intestine--an accident, however, which the - slippery nature of the outer surface of the intestine renders - improbable, but which nevertheless may occur if at any point - there happen to be a break in the continuity of the tissues. As - the next step in the operation the cord should be completely - divided high up (the incision being made upon the staff) close - to the opening in the peritoneum through which the folds of the - intestine forced their way, in the first instance, into the - scrotum; but the surgeon must, without fear of doing harm, and - remembering that he is dealing with conditions of a desperate - nature, see to it that the opening made in the peritoneum is - amply large. Finally, with the aid of a soft piece of linen - he should return the folds of the intestine to the peritoneal - cavity, etc. [The remaining portions of the description are of - minor importance and may well be omitted here.] - -Franco, speaking of those cases in which a portion of the omentum is -found projecting into the hernial sac, lays great stress upon the -importance of “not doing what many a surgeon has done in the past -and what not a few are still doing in our time, viz., simply cutting -off the imprisoned distal portion of this membrane and returning -the remainder to the peritoneal cavity without first ligating the -divided blood-vessels and then cauterizing the cut surface; the -danger being that a failure to take these steps frequently leads to -a fatal hemorrhage into the peritoneal cavity--an occurrence which -actually happened to one of our most experienced surgeons in a case of -enterepiplocele.” - -There were certain operative procedures in which Franco took a greater -interest than in others. Thus, for example, he was particularly fond of -operating for the relief of cataract, and the results which he obtained -were exceptionally favorable (180 cures out of a total of 200 cases -subjected to operation). Von Gurlt quotes him as saying:-- - - If I had to choose between operations for the cure of cataract - and abandoning all the rest of my surgical practice, I should - prefer to adopt the latter course, so highly do I estimate the - amount of good which I can do in this line of work, so very - important does it appear to me, and so small is the amount of - labor and worry which it entails. - -Franco was also greatly interested in the cure of stone in the bladder, -and it was while treating cases of this character that he invented the -very important surgical procedure known in France as the “Franconian -operation for stone in the bladder” (hypogastric cystotomy, suprapubic -lithotomy). Here is the account which he gives of the circumstances -under which he was led to devise this method of removing a stone from -the bladder:-- - - I will mention here an experience which I had on one occasion - when I tried to remove a calculus from the bladder of a boy - about ten years of age. The stone was about as large as a - hen’s egg and resisted all my efforts to extract it by way of - the incision made in the perinaeum. Being in a quandary as to - how I should proceed next, and the parents and friends being - greatly demoralized by the suffering to which I was unavoidably - subjecting their child,--they maintained, I should add, that - they would rather have him die than be subjected to such awful - suffering;--and being influenced also by the thought that I - could not afford to have it charged against me that I was not - able to extract the calculus, I deliberately decided that I - would make an opening above the pubic bone, and would remove - the stone in this manner. Accordingly I incised the skin above - the pubes, a little to one side of the base of the penis, and - carried the knife through the soft tissues down to the calculus, - which I had simultaneously pushed upward by pressing the fingers - of my left hand against the perinaeum, while at the same time - my assistant made counter-pressure against the stone by firmly - compressing the abdominal wall above the object. This method of - extraction proved successful. - - In due time the wounds healed firmly and the patient was - relieved of his trouble, but only after a long and most serious - illness. - -Franco does not appear to have performed the suprapubic operation -for the extraction of a cystic calculus more than once (the case -just narrated), and he carefully refrains from recommending it to -other physicians. Most surgical authors, says Edouard Nicaise, blame -Franco very strongly for not having dared to recommend his suprapubic -operation. “But I do not agree with this judgment; Franco should rather -be praised for his prudence in not immediately announcing to the world -his invention of an important surgical operation.”[90] - -The subsequent history of suprapubic lithotomy shows that Franco was -laboring under an exaggerated idea of the dangers attending this -operation. The comments of Pascal Baseilhac--a nephew of “Brother -Cosmas” (the famous French lithotomist of the early part of the -eighteenth century) and himself a skilled lithotomist--are worthy -of being repeated here. He says (p. 318 of his “_Traité sur la -lithotomie_,” Paris, 1804): “Franco based his unwillingness to -recommend the operation of suprapubic lithotomy on the belief which -was then widely prevalent, and which still persists even in our time -(middle of the eighteenth century), that the making of an incision into -the main body of the urinary bladder is sure to prove fatal, a belief -which experience and observation have now shown to be unwarranted.” - -The Franconian operation, the great value of which was not sufficiently -appreciated by its inventor nor by contemporary surgeons, was revived -in 1719 by an Englishman, John Douglas, the distinguished surgeon of -Westminster Hospital, London, and the brother of James Douglas--the -anatomist who in 1730 described so minutely the relations of the -peritonaeum to the bladder (Douglas’ cul-de-sac). - -In the case the history of which has just been narrated, the -circumstances attending the invention of the operation known to-day as -suprapubic cystotomy[91] or “suprapubic lithotomy,” were certainly of -such an unfavorable character as to call for the display of an unusual -degree of courage, wisdom, patience and manual skill on the part of -the surgeon in charge; and it was through a careful consideration of -these facts that Edouard Nicaise was led to award such high praise to -Franco for the work which he had done. Scarcely less remarkable is -the talent which the latter displayed in the invention of a forceps -(Fig. 22) strong enough to crush all but the hardest calculi and -yet so cleverly planned that it is practicable, while the crushing -end of the instrument is lying inside the bladder, to separate the -blades sufficiently far apart to render possible the grasping of the -stone between the jaws of the instrument without at the same moment -injuriously crushing the soft parts in the narrow channel of the wound -or opening.[92] - - [Illustration: FIG. 22. PIERRE FRANCO’S FORCEPS FOR CRUSHING CALCULI - IN THE URINARY BLADDER. - - (From Edouard Nicaise’s _Pierre Franco_, Paris, 1895.) - - _a_, closed; _b_, open.] - -In Franco’s day the belief was widely prevalent that there were -remedies which possessed the power of dissolving a cystic calculus. -His own opinion in regard to this matter is expressed in the following -words: “I am astonished that there should be many men who do not -hesitate to undertake the disintegration and pulverization of a stone -in the bladder by the employment of remedies which are either to be -administered by the mouth or to be injected _per urethram_ into -that organ.” He adds that a remedy strong enough to dissolve even the -softer stones would become so changed and weakened in passing through -the various organs which it must traverse on its journey from the -mouth to the bladder that it could not possibly produce the desired -effect; nor could a chemical solution strong enough to dissolve such -a calculus be injected into the bladder by way of the urethra without -either causing inflammation and ulceration of the walls of that organ -or promptly exciting muscular contraction that would effectively expel -the solution. - -This seems to be an appropriate place in which to state that lithotrity -was practiced at an earlier date by Antonio Beniveni (1440–1502), a -Florentine physician whose writings reveal him to have been a man of -a very practical and unprejudiced type of mind, a very clear writer, -and a practitioner of wide experience. He also deserves credit for -having been the first surgeon to revive the operation of tracheotomy, a -procedure which was carried out by Antyllus fourteen centuries earlier, -but which appears to have been forgotten during this long interval. He -saved a patient’s life by means of the operation. - -The date of Franco’s death is not known. - - - - - CHAPTER XL - - THE DEVELOPMENT OF SURGERY IN FRANCE (Continued).--AMBROISE PARÉ - - -Ambroise Paré was born, about the year 1517, at Laval, a small town in -the Department of Mayenne, France. His father was probably the valet -and barber of the Count of Laval. He went to Paris in early manhood -and spent three years, at this period, in fitting himself for the -career of a surgeon. He attended lectures on anatomy and surgery, did a -certain amount of dissecting, served for over two years as a surgeon’s -assistant in the great hospital of Hôtel-Dieu, made notes of some of -the cases which he saw, and was occasionally permitted to prescribe -for patients and even to perform some minor operations. From 1536 -onward, nearly up to the time of his death, he was almost continuously -engaged, in the capacity of a surgeon, in accompanying different -French armies on their military expeditions. His professional title -at first was that of “barber,” but he doubtless very soon discovered -that, if he wished to advance, it would be absolutely necessary for -him to secure a higher title. Accordingly, in 1541, he and his friend -Thierry de Héry presented themselves for, and passed successfully, -the required examination and were accepted as “master-barbers.” It is -an interesting fact that, during his long professional career, Paré -was Chief Surgeon to four Kings of France in succession--first to -Henry the Second (1547–1559), next to Francis the Second (1559–1560), -then to Charles the Ninth (1560–1574), and finally to Henry the Third -(1574–1589). The last-named King bestowed upon him the additional -honor of “Councilor to his Majesty.” He also served, during a certain -period of his career, as an attending surgeon at Hôtel-Dieu. The three -large volumes of Paré’s writings (Malgaigne’s edition) are filled with -the rich experience which this great surgeon gained in the course -of a large private practice and in the field expeditions and sieges -conducted during the reigns of these Kings. Interspersed among the -reports of cases and descriptions of operations are to be found not a -few comments of a more general character and some biographic details -which add greatly to the charm of the work as a whole, and which at -the same time make it possible to form a general idea of Paré’s traits -of character. On almost every page one finds statements which reveal -the fact that he weighed almost all the duties of his daily life in a -profoundly religious manner. He showed himself warmly sympathetic for -all those whose ailments he was called upon to treat, and he was always -as ready to bestow his best services upon the Roman Catholics as upon -the Huguenots--to which latter denomination (if we may so call it) he -himself is commonly reported to have belonged. It seems to me more -probable, however, that he was a liberal-minded Roman Catholic rather -than a Protestant, for there is trustworthy evidence showing that all -his ten children were baptized in that faith and that he himself, -nineteen years before the night of Saint Bartholomew (August 24, 1572), -held the office of “_Pathe_” in the church of the parish in which -he lived. Another prominent trait of Paré’s character was the modest -estimate which he placed upon his own professional achievements. One of -his sayings, which occurs a number of times in his writings and which -has since become famous, is this:-- - - _Je le pansay, et Dieu le guarist._ - [I dressed his wound and God caused it to heal.] - -Some of the other sayings attributed to his pen and printed under -the heading “Surgical Canons and Rules,” at the end of Book XXVI., -are characterized by a homely type of wisdom which seems to have -secured for them a permanent place in French literature. I give here -in the form of English translations six or seven of the more striking -specimens:-- - - Mere knowledge without experience does not give the surgeon much - self-confidence. - - Small will be the influence exerted by him who chooses surgery - as a career simply for what he may make out of it. - - The frequent changing of physicians is not likely to bring - comfort to the patient. - - The facts already discovered are few in comparison with those - which are yet to be brought to light. We must not allow - ourselves to lie down or fall asleep under the impression - that the ancients knew all or have divulged all that is worth - knowing. What they have accomplished should be utilized by us as - a sort of scaffolding from which a more extensive view may be - obtained. - -In another place Paré expresses the same sentiment in a somewhat -different form, as follows:-- - - My professional brethren must not expect to find any new and - startling facts [Paré is speaking here of his treatise on - surgery], but simply here and there some little addition to - our previous stock of knowledge; for the good Guy de Chauliac - has taught us that we are like the child who sits astride the - giant’s neck; that is, we can see all that he sees and just a - little more--or, in other words, we are able, through the aid - afforded by the writings of our predecessors, to learn all that - they have learned, and may at the same time acquire a little - further knowledge through our own observations. - - A remedy that has been thoroughly tested is better than one - recently invented. - - An injury which opens a large blood-vessel is likely to lead the - victim of such a wound to the tomb. - - It is always wise to hold out hope to the patient, even if the - symptoms point strongly to a fatal issue. - -All through his professional career, but more especially during the -later years, Paré was repeatedly annoyed by the efforts which the -Medical Faculty made to bring him into disrepute. These men were -bitterly jealous of him on account of the great favor which he enjoyed -at Court, and so they adopted every possible means to injure his -reputation. When the complete collection of his writings was published -in 1575, they petitioned the authorities not to allow these “works of -a very impudent and ignorant man” to be sold until they should have -received the official sanction of the Faculty. One of Paré’s chief -offenses, as it appears, was that of not writing his treatises in -Latin, and among the twenty-nine specifications of his shortcomings was -that of plagiarism. (See remarks on this subject further on.) - -In his efforts to extend his knowledge of the science of medicine, and -in particular to learn what the ancients had written on the subject, -Paré soon discovered that many obstacles stood in his way. He did not -allow himself, however, to be discouraged by this fact, but set to -work, without delay and in his usual resolute fashion, to remove them. -He found, in the first place, that all the available treatises of the -ancient medical authors were written in Latin, a language of which he -possessed scarcely any knowledge. So he was obliged to hire men to -translate for his own use large portions of these books. Then, at a -later date, after he had begun to accumulate notes for the treatises -in which he proposed to publish his own experiences and his own views -about the surgical topics in which he was interested, he saw clearly -that suitable pictorial illustrations would add materially to the -value of the written text, and he therefore did not hesitate to spend -a considerable sum of money--Malgaigne says three thousand livres--in -having the needed drawings made. Paré was also in no small degree -a public benefactor, for he purchased the formulae of some of the -more valuable of the remedies employed by the leading charlatans, in -order that he might print them and so place them within the reach of -everybody. - -Paré gives the following picturesque account of his first experiences -as an army surgeon in actual warfare:-- - - In 1536, he says, I accompanied the large army sent to Turin by - Francis the First, King of France, to retake certain castles and - fortifications which were held at that time by the troops of - the Emperor Charles the Fifth. My official position was that of - surgeon to the foot soldiers; and when our men took possession - of Susa, after the enemy had been defeated, I was among the - first to enter the city. Our horses rode rough-shod over the - dead bodies lying on the roadway, and over the bodies of many - who were simply wounded. It excited my compassion strongly - to hear the cries of those who were thus subjected to great - additional suffering, and I could not help wishing that I had - never left Paris. Once actually in the city, I began to look - around for a stable in which the horses of myself and my orderly - might find shelter. The one I entered contained the corpses of - four soldiers who had presumably died there, and three badly - wounded men who were still alive, but whose faces were greatly - disfigured by the wounds which they had received, and who--as we - soon learned--were unable to see, hear or speak. An old soldier - who entered the stable at that moment, and whose pity was - excited by what he saw, asked me if it would be possible to save - the lives of the men who were so badly injured. I replied “No.” - He thereupon proceeded, without the least excitement and with - due gentleness, to cut the throats of all three. At the sight of - this act, of what seemed to me to be great cruelty, I exclaimed, - “You are a wicked man!” His reply was: “I pray God that, if it - should ever be my fate to be situated as these three men were - when I entered the stable, there may be somebody at hand who - will do to me what I have just done to these men, and will save - me from a lingering and painful death.” - - When the fighting was entirely over, we surgeons had much work - to do. I had not yet had any personal experience with the - treatment of gunshot wounds, but I had read in Giovanni da - Vigo’s work that such injuries should be considered poisoned - wounds, by reason of their contact with gunpowder, and that the - correct way of treating such wounds was to cauterize them with - oil of sambucus (elder flowers) that was actually boiling and - to which a little theriaca had been added. At first I hesitated - somewhat about carrying out this practice, but after watching - the other surgeons, in order to learn exactly how they applied - the boiling oil, I plucked up my courage and did exactly what - they did. My supply of oil, however, soon gave out, and I then - decided to use as a substitute a healing preparation composed of - yolk of egg, oil of roses, and turpentine. I slept badly that - night, as I greatly feared that, when I came to examine the - wounded on the following morning, I should find that those whose - wounds I had failed to treat with boiling oil had died from - poisoning. I arose at a very early hour, and was much surprised - to discover that the wounds to which I had applied the egg and - turpentine mixture were doing well; they were quite free from - swelling and from all evidence of inflammatory action; and the - patients themselves, who showed no signs of feverishness, said - that they had experienced little or no pain and had slept quite - well. - - On the other hand the men to whose wounds I had applied the - boiling oil said that they had experienced during the night, and - were still suffering from, much pain at the seat of the injury; - and I found that they were feverish and that their wounds were - inflamed and swollen. After thinking the matter over carefully, - I made up my mind that thenceforward I should abstain wholly - from the painful practice of treating gunshot wounds with - boiling oil. - -In 1545, when he was about twenty-eight years of age, Paré was sent as -a military surgeon to Boulogne-sur-Mer, which at that moment was being -besieged by the French. In 1544 the city had been captured by the army -of Henry the Eighth of England, and fighting of a desultory character -was in progress between the besiegers and the besieged at the time of -Paré’s arrival. He had not been there a long time when he was asked to -see professionally Francis of Lorraine, Duke of Guise, who had been -seriously wounded by a lance in a recent encounter with the enemy. The -metal head of the weapon, under the impulse of a glancing blow, had -penetrated the skin just above the right eye, had then traveled toward -the left side and in a slightly downward direction, along the surface -of the skull, and had finally come to rest at a point behind and below -the left ear, near the nape of the neck. When the lance had penetrated -thus far the wooden shaft broke in two, leaving the metal head in its -entirety and a part of the shaft so firmly lodged in the wound that -great force had to be employed before it was found possible, with the -aid of strong pincers, to extract it from its bed. An examination of -the injured parts then showed that there had been some fracturing of -the bony structures and extensive laceration of the arteries, veins, -nerves, etc., but that the left eye had apparently not been seriously -damaged. The onlookers were naturally impressed with the belief that -the Duke could not possibly recover from such a slashing of the face -and head; and Paré himself was careful at first not to commit himself -to a prognosis of too favorable a nature. However, he treated the -wound with the greatest care and in the course of a few weeks had the -satisfaction of seeing his patient restored to perfect health, but with -a deeply scarred face. - -As can readily be imagined, this experience proved a splendid triumph -for Paré, and speedily brought him into great favor at Court and among -the nobility throughout France. - -For several years subsequent to these events, Paré continued to serve -actively as a surgeon in the frequent wars which took place between -the royal troops of France and the armies of other European monarchs. -In 1552, when he was thirty-five years of age, his rank in the army -was raised to that of “Surgeon to the King,” the entire medical staff -of that period consisting of twelve surgeons of this rank. In 1554 he -was admitted to the _Collège de Saint Côme_ in Paris, the highest -professional honor to which a barber-surgeon might aspire; and in 1563, -after the siege of Rouen, he received the appointment of “First Surgeon -to Charles the Ninth.” After the latter’s death, Henry the Third also -appointed Paré to the same position in his Court. Thus, from almost the -very beginning of his professional career to the time of his death, -Paré was honored in every possible way by four successive Kings of -France. It was Charles the Ninth, however, who appears to have taken -a greater interest in Paré’s prosperity than did either of the other -three Kings. It was at Charles the Ninth’s request, for example, that -the brother-in-law of the Duke of Ascot, the Marquis of Auret, sent -for Paré to undertake the treatment of a wound which he had received -from a harquebus ball seven months previously. Paré gives the following -account of this interesting case which foreshadows--for example, in the -changing of the patient’s bed and linen and keeping him entertained -during convalescence--the best modern hospital nursing:-- - - On arriving at the Chateau of Auret, writes Paré, which is - located not far from Mons in Belgium, I learned that the - harquebus ball had entered the thigh near the knee, had done - considerable damage to the soft parts, and had fractured the - femur. When I was ushered into his bedchamber, I found the - Marquis very much emaciated, his eyes deeply sunken in their - sockets, his skin hot and of a yellowish hue, and his voice - feeble like that of man very near to death.... The leg was drawn - up against the wall of the abdomen, and two large bedsores - were visible posteriorly--one near the root of the spine and - the other somewhat higher up. Thus it was impossible for the - patient to assume any posture in which he would be free from - suffering.... All things considered, it did not seem to me that - the Marquis could possibly recover from such a combination of - bodily ills. Nevertheless, to give him some encouragement,--for - he was very low in spirits,--I told him that, with the aid of - God and the assistance of his regular medical attendants, I - would soon have him on his feet again.... - - After dinner, in the presence of the Duke of Ascot, a few - friends of the family, and the assembled physicians and - surgeons, I expressed considerable surprise that free openings - had not been made in the Marquis’s wounded thigh, in which bone - caries and decomposition of the resulting discharge were already - well established. The medical attendants replied that the - patient was unwilling to submit to any such measures, and that - he had even forbidden them to substitute clean linen bedclothes - for those which were soiled and which had not been changed - during the previous two months.... - - When the consultation had come to an end and the local medical - attendants had given their full approval of the different - measures which I recommended, ... I proceeded to carry them out - without further delay. - - Two or three hours after the completion of this operative work I - instructed the house servants who were in immediate attendance - upon the Marquis to place alongside his bed a second one - equipped with a soft mattress, over which a fresh linen sheet, - etc., had been spread. The transfer from one bed to the other - was easily effected by a strong attendant, and when the change - had been made the Marquis manifested great contentment. Two - feather pillows were so placed under his back and loins that no - pressure whatever would be made upon his bedsores. A refreshing - sleep of four hours’ duration followed the adoption of these - different measures, and there was much rejoicing in the entire - household. - -After a course of treatment lasting several weeks, Paré says:-- - - Under this treatment the fever steadily diminished, the pain - grew less and less, and the patient’s strength increased. When - the proper moment arrived, I advised the Marquis to engage the - services of some musicians (players on stringed instruments) - and one or two comedians, in order that his spirits might be - cheered by occasional entertainments of this character. Already - at the end of one month we found it practicable to carry him - in a chair into the garden and as far as the entrance gate, - where he could watch the passers-by. When it became known among - the peasants that he was in the habit of sitting close to the - highway, they came from far and near to sing and dance in groups - for his entertainment. He was greatly loved by both the common - people and the nobility. - - At the end of six weeks the Marquis was able to get about on - crutches, and two weeks later still I bade him good bye and - returned to Paris. Before I left he presented me with a gift of - great value, and the Duchess of Ascot insisted on my accepting - a beautiful diamond ring as a mark of her appreciation of the - services which I had rendered her brother. - -Among the varied experiences which fell to the lot of Paré during -his association with Charles the Ninth, there is one which throws a -little additional light upon the man’s manner of promptly dealing with -an event which, without such promptness of action, might have led to -serious consequences. - -He was passing through Montpellier one day in company with the King, -when he stopped for a few minutes at the shop of an apothecary for the -purpose of ascertaining how he preserved alive the vipers which he used -in compounding the remedy which is called “theriaca,” and which has -been used from time immemorial as an antidote to the poison of venomous -serpents. The apothecary placed before him a glass jar in which were -kept a number of these reptiles; and, when Paré took one of them up in -his fingers in order to obtain a better view of his fangs, the reptile -bit him near the tip of his index finger, between the nail and the -flesh. The pain which immediately followed was severe, partly, as Paré -explains, because the tip of the finger is a very sensitive part, and -probably also on account of the irritating effect of the venom. Then, -to quote Paré’s own words, “after making firm pressure upon the soft -parts above the wound, to prevent the poison from traveling upward, I -crowded the skin downward in the hope of forcing as much of the venom -as possible out of the finger. While doing these things I instructed -the apothecary’s assistant to mix some old theriaca with brandy, and -then to apply a pledget of cotton, saturated with the mixture, over -the wound. In the course of a few days, and with no other treatment, -all effects of the bite disappeared.” - -In 1536, two years after his first experience with actual warfare in -the vicinity of Susa, Italy, and while he was still very young to -assume so great a responsibility, Paré--as we learn from the text of -Chapter 28, Book X., of Malgaigne’s edition--performed the operation -of exarticulation of the elbow-joint (the first recorded instance of -this operation, says von Gurlt). The case was that of a common soldier -who had been shot through the forearm, a little above the wrist, who -had been treated unsuccessfully by other surgeons, and who, at the -time when he came under Paré’s care, was suffering from a variety of -complications--viz., gangrene extending as high up as the shoulders, -extensive inflammation of the integuments on the adjacent side of -the thorax, and other symptoms that pointed toward a fatal issue. To -complicate matters, it was winter and the only approximately warm -shelter available was a cow-stable. At this early date, in the history -of surgery, the practice of ligating the blood-vessels which had been -divided in the course of an amputation had not yet been adopted, and -consequently the red-hot cautery had to be employed for arresting -the bleeding which followed the operation. (See also page 512.) In -addition to the amputation it was found necessary to make a number of -long and deep incisions into the inflamed tissues and to apply the -actual cautery freely “for the purpose of drying up and destroying -the virulent matters that had penetrated these parts.” Then, fourteen -days later, the patient, who had been lying all this time, exposed to -draughts of air, upon a receptacle intended for the storage of grain, -and who was protected from the cold by only the scantiest coverings, -developed trismus (lockjaw). When this new complication appeared Paré, -already at his wits’ end to find means with which to overcome the -difficulties which surrounded the case, decided first to have the man -removed to an adjacent stall in which there were several cows, the -presence of which in such a confined space might be counted upon to -increase appreciably the warmth of the surrounding air. Next, he gave -orders to rub briskly the back of the patient’s neck, as well as the -shoulders, the uninjured arm and the legs, with heated cloths which -were immediately afterward to be wrapped around him; and then, for -an outside covering, he utilized the straw and cows’ dung which were -plentifully within reach. In addition, two braziers which had been -procured from a neighboring dwelling, were charged with coals and kept -burning close to him. During three successive days and nights these -measures were kept up faithfully, and from time to time a mixture of -milk and soft egg was introduced into the patient’s mouth through a -suitable tube, after the jaws had first been pried open by a bit of -willow wood. The effect of these measures was to make the patient -perspire copiously and to induce a gentle action of the bowels; and, -as a further effect, the trismus was also overcome. For some time -afterward, in addition to the ordinary dressing of the healing wounds, -it was thought best to apply the red-hot cautery regularly at certain -intervals to the end of the bone of the upper arm. (This practice was -abandoned by Paré at a later date.) Final and perfect healing took -place after several large splinters of bone had been exfoliated. - -At the end of his account of what one is tempted to call the wonderful -victory of a surgeon over the death that threatened to carry off this -gravely wounded soldier, Paré adds one of his characteristic appeals to -the oncoming younger generation of physicians:-- - - Both God and Nature constantly remind the surgeon that, no - matter how poor, in a given case, the prospect of a cure may - seem, he should not for one moment cease doing his full duty; - for Nature often accomplishes what the surgeon believes to be - impossible. Cornelius Celsus [about the time of Jesus Christ] - says: “_Contingunt in morbis monstra, sicut et in natura_.” - [Marvels are observed in diseases, very much in the same manner - as they are frequently encountered in nature.] - -In the two preceding histories of actual cases treated,--one of these -patients being a wealthy officer of high rank and birth, and the other -a common soldier of the peasant class,--we obtain the best of evidence -that Paré was not influenced by the wealth, rank or social position of -his patients. Upon both classes he bestowed freely the fruits of his -knowledge, experience and skill. - -The first mention, in medical literature, of a fracture through the -neck of the femur close to the joint, is to be found in Chapter 21, -Book XIII., of Paré’s treatise (page 753, Vol. II., of Malgaigne’s -edition). Furthermore, the first published account of a case of -diaphragmatic hernia is that given by Paré. (Von Gurlt.) - -In 1538, during a visit to Turin in the capacity of surgeon to the -Mareschal de Montjean, Paré was asked by the latter to take charge of -one of his pages who had been wounded by a stone which struck him on -the right side of the head, causing a fracture of the parietal bone, -with escape of a portion of the brain substance from the external -wound. The subsequent history of this case is given by Paré in the -following words:-- - - As soon as I fully realized the true nature of the injury and - had examined the mass of tissue (about the size of a small nut) - which had been expelled from the wound, I predicted that the - patient would probably not recover. A young surgeon who happened - to come into the room at this moment, examined the mass of - tissue which had escaped from the wound and at once pronounced - it to be fat. I assured him that, if he would wait until I had - finished dressing the patient’s wound, I would prove to him that - the mass was in reality cerebral tissue and not fat.... If this - substance, I said, is fat, it will float on the water; but, if - it is brain tissue, it will sink at once to the bottom of the - dish. And, again, if it is fat it will promptly melt on exposure - to heat, whereas brain substance will simply become desiccated. - These tests were applied and it was shown that the tissue - consisted, as I had declared, of brain substance. - - Notwithstanding the apparently serious damage which had been - inflicted upon his brain the page made a good recovery, but - remained permanently deaf in the right ear. - -Among Paré’s numerous reports of cases there is one which possesses, -as I believe, sufficient interest--as well from the viewpoint of the -pathologist as from that of the surgeon--to justify me in reproducing -it, in a somewhat condensed form, in the present chapter. - -Henry the Second, King of France, while tilting (June 30, 1559) -with Gabriel, Count of Montgomery, an officer of that sovereign’s -Scottish Lifeguard, received injuries which soon afterward proved -fatal. Montgomery’s lance--so Paré’s account states--struck the King’s -vizor and, breaking off at the spot where the metal tip or head is -attached to the wooden shaft, carried away this part of the helmet. -Then, impelled by the force which had originally been communicated -to the lance, the splintered end of its shaft struck the King’s now -unprotected head with great violence just above the right eyebrow, -tore up the skin and underlying muscular tissue of the forehead as -far as the outer angle of the left orbit, and finally destroyed the -adjacent eye. Five or six of the most experienced surgeons of France -were immediately summoned, and Philip the Second, King of Spain, sent -Vesalius from Brussels to aid them in their efforts to save the injured -King’s life. But all the measures adopted proved of no avail. Henry the -Second died on the eleventh day following the injury. Although in the -published account no statement is made to the effect that Paré was one -of the surgeons who attended the King during his illness, Malgaigne -expresses the opinion that he was probably present in the capacity of -a consultant; and the interesting comments which he (Paré) makes on -the nature and extent of the injury inflicted certainly justify this -opinion. No evidence of fracture of the skull was discovered either -before death or at the postmortem examination, and the most conspicuous -symptoms appear to have been fever and a comatose condition. At -the autopsy there was found, on the left side posteriorly, in the -occipital region, a clot of blood lying between the pia and the dura -mater. The brain substance in the immediate vicinity of the clot was -of a yellowish tinge and showed evidences of having already begun to -undergo decomposition. Paré’s diagnosis, in this case, was that of -violent concussion of the brain with rupture of meningeal vessels by -_contre-coup_ at a point opposite to that at which the blow -was originally inflicted by the lance. He did not believe that the -immediate damage done to the frontal portion of the cranium and to the -left eye had anything to do with the fatal issue. - - [Illustration: FIGS. 23 AND 24. - - FORCEPS DEVISED IN 1552 BY AMBROISE PARÉ FOR DRAWING OUT THE CUT - ENDS OF ARTERIES AFTER THE AMPUTATION OF A LIMB, AND HOLDING - THEM WHILE THE LIGATURE IS BEING APPLIED. - - (From von Gurlt’s _Geschichte der Chirurgie_, Berlin, 1898.) - - FIG. 23 represents the earlier; FIG. 24 the - later pattern (see text.)] - -One of the greatest discoveries made by Paré in the domain of surgery -is his method of promptly, effectively and safely arresting the -bleeding from the divided vessels of the stump after the amputation of -a limb. This discovery was made between the years 1552 and 1564, before -which period it had been customary to arrest the bleeding by applying -the red-hot cautery iron to the exposed ends of the divided vessels. -The new method consisted in tying a ligature (preferably doubled) -around the free or cut end of the blood-vessel, and allowing it to -remain undisturbed _in situ_ until, as the result of a localized -suppuration, it should be cast off. The accompanying cuts (Figs. 23 and -24) which have been copied from an earlier edition (1585) of Paré’s -work, represent the kind of forceps which he employed in separating -the free end of the artery or vein from the soft tissues in which it -was imbedded--a preliminary procedure which enabled him to tie the -ligature firmly around the vessel. The earlier pattern of forceps (Fig. -23) was not equipped with a spring, the purpose of which was to keep -the opposing blades separated, but the later pattern (Fig. 24) has -this useful addition. Another instrument which owes its origin to the -inventive genius of Paré is the grooved director--an instrument that -is of great value to the surgeon, particularly in operations for the -relief of strangulated hernia. - -Besides the two inventions to which a brief reference has just been -made, Paré describes and pictures in his great treatise scores of -instruments and apparatus of all sorts, many of them doubtless products -of his own inventive genius. But to assign to these contrivances their -true value calls for a degree of expert knowledge which I do not -possess. Rather than to attempt any such appraisal, I prefer to furnish -here a summary of the more important of Paré’s achievements in surgery; -for such an enumeration--although it may prove to be in some measure -a recapitulation of things that have already been mentioned in the -preceding account--may be found useful for purposes of reference:-- - - The discovery of improved methods of caring for the wounded - on the battle-field and of transporting them to a hospital or - other refuge; the introduction of better methods of treating - wounds inflicted in warfare--especially gunshot wounds; the - correction of the idea, universally accepted at the beginning - of the sixteenth century, that bullets are sufficiently hot, - upon penetration of the skin, to affect injuriously the wounds - which they inflict;[93] the substitution of ligation of bleeding - vessels (of an amputation stump) for the prevailing practice of - applying to them the red-hot cautery iron; the abandonment of - the practice of applying the heated cautery iron to the surface - of section of a sawed bone; the performance, for the first - time, of exarticulation of the elbow-joint; the demonstration - of the usefulness of more frequently employing orthopaedic - apparatus and prosthetic contrivances; and the introduction of - improvements in the operation of trephining the skull. - -It was a very common practice among the medical authors of the -sixteenth century--and, indeed, among authors generally--to utilize -the writings of their predecessors without giving them proper credit -for their work; and Paré, it appears, was not entirely free from this -fault. Von Gurlt mentions a few of the more glaring instances of such -sinning, and among them the following: Paré’s two chapters on tumors -are taken from the “_De institutione chirurgica_” of Jean Tagault -(Paris, 1543), who in turn is charged with having borrowed the data -from Guy de Chauliac’s treatise; in his chapter on wounds in general, -Paré has also borrowed largely from the same work; and the chapter -which he devotes to the subject of special wounds is taken from the -writings of Hippocrates; and, finally, he has transferred almost -bodily Philippe de Flesselle’s “_Introduction pour parvenir à la -vraie cognoissance de la chirurgie rationelle_.” Before we condemn -Paré for plagiarism, and although the facts as stated by von Gurlt are -undeniable, we should take several things into careful consideration. -It is fitting, for example, that we should make some sort of an -estimate of the value of the text thus appropriated, in order that we -may be able to measure the seriousness of Paré’s sinning; and, if we do -this, we cannot fail to be struck with its insignificance in comparison -with the admittedly valuable character of all the remaining text of -these three huge volumes--text which bears every mark of being the -product of Paré’s brain. Paré himself, in speaking of his borrowings -from other authors, says that his acts of this nature are “as harmless -as the lighting of one candle from the flame of another.” Then, again, -there are several of these borrowings which are evidently the handiwork -of a rather dull person, and this fact alone makes one bold to assert -that Paré, who was certainly not lacking in brains or in a desire -to follow the golden rule in his treatment of the property of such -writers, could scarcely have been guilty of such clumsily contrived -interpolations. Inasmuch, however, as many important facts bearing -upon the question at issue are not within my reach, I am obliged, in -my attempt to defend the memory of Paré, to fall back upon speculative -reasoning. The medical profession at large has long since heard this -charge of plagiarism and it refuses to attach any importance to it as -affecting the personal character of Paré. It prefers to believe that -he is guiltless and that somebody else--at a time, perhaps, when Paré, -being well advanced in years, was too ill to revise the manuscript of -the “Collection of his Writings” edited by Guillemeau--thoughtlessly -yielded to the impulse to remedy, by borrowing from other sources, -the trivial defects or omissions noted in the text. In any case, -whatever the actual truth may be, I am, I believe, justified in -maintaining that Paré is not rightly chargeable with the guilt of -plagiarism. - - [Illustration: FIG. 25. AMBROISE PARÉ, THE FAMOUS FRENCH SURGEON - OF THE SIXTEENTH CENTURY. - - (From von Gurlt’s reproduction of the portrait published by Le - Paulmier, Paris, 1885.)] - -Strange as it might appear, if history did not furnish many examples -of the same character, Paré’s merits as a man and as a surgeon were -not as fully appreciated as they deserved to be until after the -lapse of nearly two centuries. In 1812 the _Société de Médecine de -Bordeaux_ offered a prize for the best eulogy of Ambroise Paré, -and it was awarded to Vimont. Finally, in 1840, a fine bust of the -distinguished surgeon was completed by the sculptor David of Angers, -and set up in bronze in Laval, Paré’s birthplace. The portrait here -reproduced from the engraving in von Gurlt’s work represents the bust -in question (Fig. 25). - -A complete collection of the writings of Paré has been prepared by -J. F. Malgaigne, the distinguished French surgeon, and published in -three very large volumes (Paris, 1840–1841). This collection is based -on a careful comparison and collation of all the previously published -editions. The contents of these volumes cover very nearly the entire -range of surgery. - - - - - CHAPTER XLI - -SURGERY IN GREAT BRITAIN DURING THE SIXTEENTH AND SEVENTEENTH CENTURIES - - -In Great Britain the cultivation of the science of medicine began at -a much later date than it did on the continent of Europe, and, so far -as may be judged from the facts within our reach, there were, in the -early part of the sixteenth century, very few Englishmen who could -justly lay claim to the possession of more than the rudiments of -the art of surgery. Two centuries earlier, as I have already stated -in a previous chapter, there were three men in England who gained -considerable fame in this department of medicine. They were Gilbert -“the Englishman” (1210), John of Gaddesden (1320), the author of the -famous book entitled “Rosa Anglica,” and John of Ardern (_circa_ -1350); but afterward, for a period of nearly two hundred years, the -records fail to reveal to us a single surgeon of any note. Then during -the sixteenth century the only English surgeons whose names deserve to -be perpetuated are Gale, Clowes and Woodall, of whom I shall presently -give brief accounts. They were all at one time or another, as in the -case of the leading continental surgeons of that period, officially -connected with the army. Some idea of the unsatisfactory state of the -medical service in the English army of that period may be gathered from -the statements made by Gale regarding this matter. From his account it -appears that in 1544 the army was accompanied by a miscellaneous crowd -of men who were supposed to be in some measure physicians, but who in -reality were uneducated quacks, vendors of all sorts of dressings and -washes for wounds, of infallible cures for gunshot injuries, etc. The -mortality in the English camp was, as might readily be expected, very -heavy. The same state of things existed, at a somewhat later date, in -the fleet sent against the Spanish Armada. It is not to be wondered -at, therefore, that very few of the educated surgeons were willing to -accept service in the English army or the English fleet, especially as -the pay which they received was no greater than that of the drummers -and trumpeters. Toward the end of the century much greater attention -was paid to the care of the wounded and crippled, and, in corroboration -of this, it may be stated that Henry the Fourth, King of France,--who, -it may safely be assumed, was influenced to take this step by the -enlightened advice of Ambroise Paré,--ordered the establishment of -military hospitals for the use of the army which was at that time -besieging Amiens. And again, at a later date (1603), there was -established at Paris a retreat for old and infirm or mutilated officers -and soldiers. - -It is an interesting fact that during the year 1544, while Henry the -Eighth of England, in alliance with the German Emperor Charles the -Fifth, was carrying on the war against Francis the First, King of -France, there were present, on the soil of the latter country, all the -leading European surgeons of that period--viz., Ambroise Paré, with -the French army which was laying siege to Boulogne-sur-Mer (captured -a few months earlier by the English troops); Thomas Gale, the most -famous surgeon of that day in England, with the army of the besieged; -and Vesalius and Daza Chacon with the troops of Charles the Fifth -at Landrecy (near the Belgian boundary, south of Brussels) and at -St. Didier (in the northeastern part of France). I have already, in -preceding chapters, given brief accounts of the lives and professional -accomplishments of all these surgeons with the exception of Gale, and -it only remains now to supply such information as may be obtainable -concerning the latter and also concerning his contemporaries, the -English surgeons Clowes and Woodall. - -_Thomas Gale._--Thomas Gale was born in London in 1507, practiced -medicine for some years in that city, and then, in the capacity of -a surgeon, entered the service of the army under Henry the Eighth. -At a later date he joined the army of Philip the Second of Spain. In -1544 he was present at the battle of Montreuil in France, and he was -also present at the siege of St. Quentin, in 1557. Two years later he -returned to London and became a member of the Barber-Surgeons’ Company. -His death occurred in 1587. - -Gale was the author of several books on surgical subjects, the most -important of these works being that which deals with gunshot wounds. -His views regarding wounds of this nature agree in the main with the -teachings of Ambroise Paré; and yet, according to von Gurlt, he appears -to have formed his opinions independently, for he does not once mention -that surgeon’s name. He was not only a skilful surgeon, but also a man -of scientific and literary tastes, as shown by his translations of some -of Galen’s writings and of Giovanni da Vigo’s treatise on surgery, and -also by his own published works. His book on gunshot wounds, to which -reference has already been made, is the one which reflects the greatest -credit upon the author. One of its chief merits is to be found in the -fact that it enabled the physicians of England to keep in some measure -abreast of their brethren on the continent, at least in the matter of -treatment by surgical means. In one part of the work he makes reference -to the belief, which was held at that time by many surgeons, that the -bullet not only scorched the flesh of the wound which it inflicted but -also introduced into it a poisonous element. I quote here one or two -extracts from the comments to which I have just referred:-- - - The usuall Gonnepouder is not venemous, nother the shotte - of such hoteness as is able to warme the fleshe, much lesse - to make an ascar.... Hange a bagge ful of Gonnepouder on a - place convenient: and then stand so far of as your peece wil - shote leavell, and shote at the same, and you shall see the - Gonnepouder to bee no more set on fyer with the heat of the - stone [used as a bullet] than if you caste a cold stone at it. - -An English translation of Paré’s book, says von Haller, was not -published until 1577. It is therefore not strange that Gale, whose book -was printed fourteen years earlier (_i.e._, in 1563), should -have made no mention of that author’s method of applying ligatures -to the bleeding vessels of an amputation stump. The first reference -(in English) to this plan of preventing hemorrhage from the divided -blood-vessels in an amputation stump occurs--so far as I have been able -to discover--in the treatise published in London by William Clowes, in -1588, under the title “A prooved practise for all young chirurgians -etc.” Clowes, however, erroneously gives the credit for this important -procedure to Guillemeau, one of Paré’s pupils. - -In one of his writings Gale states, after witnessing the surgical -practice at the Royal hospitals of St. Bartholomew and St. Thomas in -1562, “that it was saide that Carpinters, women, weuvers, coblers and -tinkers did cure more people than the chirurgians.” (South.) - -_William Clowes._--William Clowes was born, about the year 1540, -at Kingsbury, in Warwickshire, and received his early training in -surgery under George Keble of London. In 1563 he accepted the position -of surgeon in the army which was under the command of Earl Ambrose -of Warwick and was stationed at that time in France. Six years later -he settled in London, and was made a member of the Barber-Surgeons’ -Company. In 1575 he received an appointment on the Surgical Staff of -St. Bartholomew’s Hospital and six years later still he was promoted to -the rank of full surgeon, a position which he already held in Christ’s -Hospital. In 1585 he resigned his appointment at St. Bartholomew’s and -accepted an invitation to serve in the Earl of Leicester’s army, which -was at that time in the Netherlands. During this war Clowes acquired -a rich and varied experience in the treatment of wounds. Soon after -his return to London in 1588 he joined the fleet which vanquished the -Spanish Armada. Later, he was given the appointment of Surgeon to the -Queen. His death took place at Plaistow, County of Essex, in August, -1604. Von Gurlt does not hesitate to qualify him as one of the most -distinguished English surgeons of his day. - -Of the four surgical treatises which were written by Clowes, and of -which several editions were published between the years 1575 and 1637, -there is only one to which I shall refer in this brief account, viz., -that which, in the edition of 1637, bears the title: “A profitable and -necessarie Book of Observations, for all those that are burned with the -flame of Gun-Powder.” This book is full of brief histories of cases -which came under the author’s personal observation, and it therefore -furnishes an excellent and truthful picture of the kind of wounds which -the highwaymen and soldiers of that day inflicted, and of the treatment -which was employed by the best English surgeons. The following may -serve as sufficient examples:-- - -(1) A clothier, who had been assailed by robbers, received a dangerous -wound in the left thigh. It was about four inches long and of such a -depth that “the rotula or round bone of the knee did hang downe very -much.” Clowes first removed a clot of blood from the wound and then, -“with a sharp and square-pointed needle, armed with a strong, even and -smooth silke thred, well waxed, introduced five stitches, one good -inch distant betweene every stitch, leaving a decent place for the -wound to purge at.” He then applied a suitable bandage. The patient’s -friends were not at all pleased that Clowes, having pronounced the -wound dangerous, should not have been willing to state how much time -would elapse before it would be healed. So they called in a charlatan, -who on the following day removed the dressings and cut through all -the stitches. Seven days later, Clowes was once more asked to see -the case. He found the wound gaping widely and in a bad state. After -adopting such measures as were most urgently required, he brought -the edges of the wound together by the application of three strips -of sticking-plaster. In due time healing took place, “but the motion -perished: for the patient had the imperfection of a stiff knee, which -constrained him to use a leather strap, fastened unto the toe of his -shooe, and again made fast unto his body; and so he remaineth unto this -day.” - -(2) The history of the second case may be given here in the following -brief outlines. The patient, a ship’s gunner, was wounded in the lower -part of the abdomen by what was probably a partially spent ball. The -wound made by the missile was of such a nature that it permitted a -large portion of the “zirbus” (omentum), together with some of the -intestinal canal, to protrude from the opening. After making a careful -examination of the parts, Clowes was satisfied that the intestine was -still uninjured. - - Then with a strong double thread I did tie fast the zirbus as - close unto the wound as possible wel I might, and within a - finger bredth or thereabouts I did cut off that part of the - zirb that hanged out of the wound, and so I cauterized it with - a hot iron almost to the knot; all this being done, I put again - into the body that part of the zirb which I had fast tied, and - I left the peece of thred hanging out of the wound: which, - within four or five days after, nature cast forth, the thred - as I say being fast tied; then presently I did take a needle - with a double strong silke thred waxed, wherewith I did thrust - thorow both mirach [skin, adipose layer and muscular tissue] - and ziphach [peritoneum] on the right side of the wound, but - on the left side of the wound I did put the needle but thorow - mirach only, and so tied these three fast together with a very - strong knot, and presently I did cut of the thred.... All which - is according to Weckers[94] and other learned men’s opinions - and practices, who also say that the stitches of the one side - must be higher than on the other side. [The usual dressings were - afterward applied and were renewed three days later. At the end - of twenty-one days the wound was found to be completely healed.] - -In chapter 27 of the same work there is given a list of the medicaments -and instruments with which a field-or ship’s-surgeon should be equipped -before he engages in active service. From this list I select the -following items as showing--at least in some measure--in what respect -the tools employed by surgeons four hundred years ago differ from -the modern ones of a similar character: “Small and long waxe candles -to search the hollownesse or depth of a wound.” “Small buttons or -cauterizing irons meete to stay the flux of an artery or veine.” “A -trepan.” “Needles two or three, some eight inches, some ten or twelve -inches in length, having a decent eye in it guttered like a Spanish -needle, and point or end blunt or round, that it offend not in the -going in of it, made fit to draw a Flammula, or a pece of fine lawne -or linnen cloth through the body or member that is wounded.” “As for -stitching quils and other instruments, that a Surgeon ought always to -carry about him, I leave unspoken of.” - -In praise of one of the plasters enumerated in the list, Clowes -narrates the following incident which occurred near Arnheim in the -Netherlands: “A horseman was wounded with a pike neere the middle of -his right thigh; the weapon so passing upwards that by good fortune it -rested upon the os pubis, otherwise he had been slaine.” As the first -step in the treatment, the copious bleeding was arrested; after which -warm _oleum hyperici_ [oil of St. John’s wort] was injected into -the wound, then a short tent was introduced, and the sticking plaster -was applied on the outside. “Thus he was cured in fourteene days, and -so was ready to serve in the field again.” - -_John Woodall._--John Woodall or Woodhall was born in England -about 1569, and was sent as a military surgeon to France by Queen -Elizabeth with the troops which Her Majesty placed at the disposal -of the French King, Henry the Fourth. After his return to England, -Woodall was made a surgeon of St. Bartholomew’s Hospital and also -Surgeon-General of the East India Company. He was already at that time -a member of the Company of Barber-Surgeons of London. Woodall must have -had a very extensive experience in the practice of surgery, for he -states that he had performed the operation of amputation of a limb more -than one hundred times. The date of his death is not known. - -Von Gurlt calls attention to the fact that the first notice printed -in English of Ambroise Paré’s method of ligating blood-vessels after -an amputation is to be found in the treatise written by John Woodall -and published in London in 1639, under the title: “The Surgeon’s Mate, -or Military and Domestic Surgery.” As the first edition of this book, -which was published in 1617, says nothing about Paré’s method, it seems -permissible to infer that the news of this improvement, one of the -most important made in surgery (1552), reached England from France only -after the lapse of eighty-seven years! There can be scarcely any doubt, -however, that individual English surgeons had already learned about -Paré’s improved method at a much earlier date. - -_State of Surgery in England During the Seventeenth -Century._--Before I pass on to the consideration of the state of -surgery in England during the seventeenth century it seems desirable -that I should say a few words with regard to the relative standing of -the two branches of the medical profession--the physicians and the -surgeons--in the esteem of their fellow Englishmen at this period -of history. In France, it will be remembered, a surgeon was looked -upon, even as recently as during the first half of the sixteenth -century, as a man of inferior social standing, perhaps a shade better -than an apothecary, but certainly far below his more highly educated -associate--the physician. The favors extended by French Royalty to -Ambroise Paré and the very high esteem in which he was held by French -society in general effected a great change in the relative status of -the two classes of practitioners in France; and, as a result of this -change in public opinion, medical practitioners, subsequent to 1560 or -1570, were led to realize that a surgeon, if sufficiently educated, -if earnestly devoted to his professional work, and if intent upon -helping his fellow men rather than upon accumulating a fortune, might -confidently aspire to a position of equality with the best physicians -of the community in which he lived. In England a similar change of -opinion in regard to the honorableness of the career of surgeon -took place about this time, probably in consequence of the great -reputation gained by Gale, Clowes and Woodall. In both countries the -change occurred slowly, and in France what was gained during Paré’s -lifetime seemed afterward to be lost for a period of several years. -But eventually the prevailing opinion again became favorable to the -surgeons, and from that time to the present they have enjoyed an -ever-increasing esteem in public opinion. But there was a brief period, -early in the seventeenth century, when it must have been very galling -to the pride of an honorable and experienced surgeon to be placed as -it were under the tutelage of the physicians who were his official -associates in certain hospitals--as, for example, in St. Bartholomew’s, -London. The following extracts[95] from the “Orders” or “Articles” of -that institution (1633) explain more precisely what is meant by the use -of the word “tutelage”:-- - - 9. That no surgeon or his man do trepan the head, pierce the - body, dismember or do any great operation on the body of any but - with the approbation and by the direction of the Doctor (when - conveniently it may be had) and the surgeons shall think it - needful to require. - - 13. That every surgeon shall follow the directions of the Doctor - in outward operations for inward causes, for recovery of every - patient under their several cures, and to this end shall once in - the week attend the Doctor, at the set hour he sitteth to give - directions for the poor. - - (From St. Bartholomew’s Hospital Reports, Vol. XXII., 1886.) - -Among the English surgeons of the seventeenth century there appears to -have been only one who attained some degree of eminence, viz., Richard -Wiseman, who is often spoken of as the Ambroise Paré of England. -Haeser mentions 1625 as the date of his birth, and at the same time -states that he was in the service of the Stuart Kings from Charles -the First to James the Second. It seems to me highly probable that -this statement regarding the date of Wiseman’s birth is erroneous; for -if it be accepted as correct, then he (Wiseman) must have been only -fifteen years of age when he first started out with the prince (in -1640) on the latter’s wanderings through France and the Low Countries. -On the other hand, if Wiseman was really born in 1625, then we shall be -justified in assuming that he traveled with the prince at first simply -as his companion and not in a professional capacity; and we shall be -further justified in assuming that he acquired his medical and surgical -training during his residence on the continent. - -In 1650 Wiseman returned with the prince to Scotland. At the battle -of Worcester he was taken prisoner by the Parliamentary army under -Cromwell and did not regain his liberty until 1652, at which time he -settled permanently in London. After the Restoration in 1660, his -practice increased very greatly and, so far as one may judge from the -large number of cases which he reports in his work on surgery that -was first published in 1676, it must have been very extensive and of -a most varied character. I have read many of these reports of cases -that occurred in Wiseman’s practice, and have been much impressed with -the thoroughly practical character of the treatment which he adopted -in the majority of instances, and also with the very clear and concise -manner in which he narrates the attendant circumstances--the nature of -the malady or of the injuries received, the treatment which he adopted, -and the final results attained. In the belief that they may furnish -corroborative evidence of the statements which I have just made, I now -take the liberty of reproducing here two of these reports of cases:-- - - (1) Whilst I was a prisoner at Chester (1651), after the battel - of Worcester, I was carried by Colonel Duckinfield’s order to a - man that out of much zeal to the Cause, pursuing our scattered - forces, was shot through the joint of the elbow; the bullet - entering in at the external part of the _os humeri_, and - passing out between the _ulna_ and _radius_. He had - been afflicted with great pain the space of six weeks. I found - the wound undigested,[96] and full of a loose, soft, white - flesh, the bones fractured, and not likely to unite, many - shivers lying included within the joints, and incapable of - being drawn out. The lower part of the arm was oedematous to - the fingers’ ends as full as the skin could well contain, and - the upper part was inflamed; also about the _os humeri_ - and _axilla_ a perfect phlegmon was formed. The patient - thus tired with pain, desired to be cured or have his arm cut - off. To which purpose he had procured the Governor’s leave for - my staying with him. But, while that phlegmon was upon the - upper parts, there was no hope of a prosperous amputation, nor - of cure while those shivers of bone lay pricking the nervous - parts within the joint. The phlegmon was too forward for - repercussion,[97] and yet not likely to suppurate in less than - a week’s time. Wherefore I endeavored by emollients and some - discutients to succour the grieved shoulder and parts thereabout - by hindering the increase of the phlegmon, and to give some - perspiration to the part. Then with good fomentations I - corroborated the weak and oedematous member below; in which end - I also raised his hand nearer to his breast. Also by detergents - and bandage I disposed the wounds and fractured part to a better - condition, made way for discharge of matter, and endeavored to - extract the shivers of bones; then applied medicaments to remove - the _caries_. After some days the abscess suppurated in - the upper part of the shoulder and in the armpit; and while the - matter discharged from thence, the tumour discussed, and that - upper orifice cured soon after. But the continual pain in the - fractured joint kept that opening in the axilla from healing. - The patient growing weaker, and without hopes of cure, I was - necessitated to proceed to amputation. To which purpose I sent - to Chester to Mr. Murry, a knowing chirurgeon (since Mayor of - that city), to come with instruments and other necessaries, - whereby I might the better do the work. He accordingly came, and - we prepared dressings ready; which were stupes or pledgits of - fine short tow well worked, some like _splenia_ [bandages], - others were round, and bigger or less. We wetted them all in - oxycrate [water and vinegar], and dried them; et cetera.... - - The apparatus thus made, and the patient some while before - refreshed with a good draught of caudle [a hot drink made of - spiced and sugared wine], his friends took him out of his bed, - and placed him in a chair toward the light. One of his servants - held his arm; another of his friends held his other hand. Then - Mr. Murry drew up the skin and museulous flesh of the arm - towards the shoulder, whilst I made a strong bandage, some three - or four fingers’ breadth, above the affected part. Then with a - good knife I cut off the flesh by a quick turn of my hand, Mr. - M. pulling up the flesh, whilst I bared the bones.[98] After - which, with as few motions of my saw [as possible], I separated - the bone[s], the patient not so much as whimpering the while. - After this Mr. Murry thrusting his hands downwards with the - museulous flesh and skin which he had drawn upwards, I passed - a strong needle and thread through the middle of the flesh and - skin on both sides, within half an inch of the edges, and - brought the lips close within a narrow compass; and having tied - that ligature fast, and cut off the string, I passed the needle - again through the two contrary sides, which I tied as close; - then loosened the ligature above, and applied the little round - stupes of tow spread with a quantity of Galen’s powder mixed - with egg albumen. The long pledgits were applied from the middle - of the stump each way upwards along the arm, over which I put on - a bladder and a cross cloth, then rowled up the stump, and made - the bandage [pass] under his other arm and over his neck.... He - being thus dressed up, we put him into his bed. The third day - we took off his dressings, and found the stump well digested, - and at least two spoonfuls of matter discharged.... During which - the bone exfoliated, and the stump soon after cicatrized. Then - having procured a pass to come to London, I hastened away. - - (2) A lady coming to town with a swelling in her left breast, - consulted some of our Profession, and at last me. She said she - had some years since kernels in her breast, which were judged - the “King’s Evil”; upon consideration of which she was presented - to His Majesty, and touched. In progress of time they swelled, - and her breast being extremely painful, she desired my judgment - of it. The swelling was large and round, and greatly inflamed, - under which it was soft and seemed to have matter in it. The - parts more distant were hard, and several tubercles lying - under the skin made it unequal; yet the breast was not fixed. - She urged me instantly to deliver my thoughts of it; which to - decline I turned from her, and told her friend it was a cancer, - and that I saw no hopes to save her life but by cutting it off. - He wished me to consider how I delivered such judgment of it, - two chirurgeons having lately assured her the contrary, they - taking it for a phlegmon. But I, not being used to guide my - judgment by what others delivered, confirmed to him what I had - before said by a sad prediction, which befel her in few weeks - after. And indeed there was no way then to deal with it but by - cutting off her breast. - -One is not a little startled, after reading a number of case-histories -like the two which I have just reproduced, to discover other portions -of text (Vol. I., pp. 384 and 385) which show clearly that Wiseman, -although a surgeon of the most practical character and a man equipped -with excellent reasoning powers when he was placed in the presence -of most of the problems which are constantly being submitted to -physicians for solution, was nevertheless the victim of a belief that -supernatural powers may reside in certain human beings. Speaking -of the cure of the “King’s Evil”--also called by him “struma” and -“scrofula”--Wiseman, in the chapter which he devotes to this subject, -makes the following statement:-- - - But when upon trial he (the chirurgeon) shall find the - contumaciousness of the disease, which frequently deluded his - best care and industry, he will find reason of acknowledging the - goodness of God; who hath dealt so bountifully with this Nation - in giving the Kings of it, at least from Edward the Confessor - downwards (if not for a longer time), an extraordinary power in - the miraculous cure thereof.... I myself have been a frequent - eye-witness of many hundreds of cures performed by his Majesty’s - touch alone, without any assistance of chirurgery; and those, - many of them, such as had tired out the endeavors of able - chirurgeons before they came thither. - -Some years before his death, which occurred in 1686, Wiseman was given -the title of Serjeant-Chirurgeon to King Charles the Second. - - - - - CHAPTER XLII - - REFORMS INSTITUTED BY THE ITALIAN SURGEON MAGATI IN THE - TREATMENT OF WOUNDS.--FINAL ENDING OF THE FEUD BETWEEN THE - SURGEONS AND THE PHYSICIANS OF PARIS.--REVIVAL OF INTEREST IN - THE SCIENCE OF OBSTETRICS - - -_Reforms Instituted by Magati._--Cesare Magati, who was born in -1579 at Scandiano, in the Duchy of Règgio, studied medicine at the -University of Bologna and received the degree of Doctor of Medicine -from that institution in 1597. Immediately afterward he went to Rome -and devoted himself particularly to the study of anatomy and surgery. -Then, upon his return to his native land, he quickly acquired so great -a reputation as a surgeon that the Duke of Bentivoglio, who was a man -of enlightened views and ambitious to promote in every possible way the -best interests of the University of Ferrara, offered Magati the Chair -of Surgery in that institution. The offer was accepted in 1612, and -Magati continued to hold the position for several years, his services -being highly appreciated both by the authorities of the university and -by the students. But, when his health began to break down,--he was -affected with stone in the bladder,--he decided that his best course -was to resign his professorship, retire from active practice, and -become a Capuchin monk. When he took this step he obtained permission -from the head of the Chapter to which he belonged, to resume in a -limited measure the surgical work which he was so well fitted to do. -But in the year 1647 his sufferings became so acute that he was obliged -to visit Bologna in the hope of obtaining relief through operative -interference. The operation, however, did not prove successful, and -death occurred shortly afterward. - -Magati effected, in a quiet and unostentatious manner, a number of -desirable reforms in surgical procedures. Thus, for example, he pointed -out how undesirable it is, in most cases, to change the dressings of -a wound so frequently as was, at that period, the common practice. -The process of cicatrization, he insisted, is not effected by the -efforts of the surgeon, but is fundamentally the work of Nature. Then, -in addition, he protested against the practice of introducing wicks -and pledgets of lint into wounds. These criticisms and this advice, -says von Gurlt, had been given many times before by different ancient -authors, but they undoubtedly had to be repeated from time to time. - -The treatise in which Magati has written these things bears the -following title: “_De rara medicatione vulnerum, seu de vulneribus -raro tractandis, libri duo_,” Venice, 1616 and 1676; also Nuremberg, -1733. - -_Final Extinguishment of the Long-standing Feud between the Surgeons -and the Physicians in Paris._--At several points in the course of -this sketch of the history of medicine, I have called attention to the -fact that, during the centuries preceding those which are reckoned by -certain authors as belonging to modern times, surgeons as a class were -generally looked upon, especially in the larger cities of France, as -decidedly inferior to physicians. The first attempt at something like -systematic instruction in surgery was made by the Brotherhood of Saint -Cosmas and Saint Damian at Paris. This organization, which was founded -by Jean Pitard about the middle of the thirteenth century, was composed -of a group of barbers who felt a strong desire to secure for themselves -a better training than was obtainable by the generality of barbers in -those days. The latter were known as “surgeons of the short gown,” -while the more ambitious men, who belonged to the group mentioned -above, were known as “surgeons of the long gown.” With the progress of -time this smaller group of barbers really succeeded in making better -surgeons of themselves, but in accomplishing this they intensified -at the same time the jealousy which the physicians as a class felt -toward them, a jealousy which repeatedly manifested itself in the form -of downright persecution. The data for a complete account of this -persecution, that persisted through centuries, are lacking, and even -if I possessed them I should not care to devote the time that would -be required for a proper presentation of the subject. It is pleasant, -however, to be able to record the fact that these plucky barbers -never entirely lost courage, but fought on, year after year, until -they eventually succeeded--with the help of a strongly sympathetic -public--in making the St. Côme Medical School the nursery of some -of the best surgeons in France during the sixteenth and seventeenth -centuries. It was here, for example, that Paré, Guillemeau, Thierry -de Héry and other men of distinction obtained their early training, -and it was doubtless through their influence that some of the wealthy -patients whom they had treated successfully, were induced to contribute -liberally to the support of the school. The final event in the history -of this institution was the complete overthrow of the opposing -physicians and the merging of the two surgical schools--that of the -regular Faculty and the St. Côme School--into one, under the direction -of de Lapeyronie, of whom I shall now furnish a brief sketch. - -_François de Lapeyronie._--François de Lapeyronie was born at -Montpellier on January 15, 1678, and he enjoyed the privilege of -receiving a most careful preliminary education. He was only seventeen -years of age when the academic degree which corresponds to our Master -of Arts was bestowed upon him. As the next step he visited Paris for -the purpose of perfecting his knowledge of surgery, the branch of -science in which he was specially interested; and upon his return -to Montpellier he began giving instruction in anatomy and surgery. -In a short time he was chosen Surgeon-in-Chief of the Montpellier -Hôtel-Dieu. In 1714 he was called to Paris to take charge of the Duc -de Chaulnes, whose malady had not yielded to the treatment adopted -by the surgeons of that city; and in this case the measures which he -employed proved so efficacious that de Lapeyronie decided to settle -permanently in the metropolis. He taught anatomy in the Collège de -Saint-Côme, and in a short time was chosen Head Surgeon of the Charité, -one of the largest hospitals of Paris. In 1731 he became one of the -founders of the Royal Academy of Surgery, and he took a most prominent -part in the struggle which was then actively going on between the -physicians and surgeons of Paris,--one of the last and most serious -of the attempts made by the former to render the surgeons subordinate -to the physicians. The surgeons won the battle (April 23, 1743), and -Dezeimeris says that the part taken by de Lapeyronie in this struggle -may be looked upon as one of the most honorable achievements recorded -in the history of medicine. De Lapeyronie died on April 25, 1747, after -a long and painful illness. In his will he made most liberal provision -for the promotion of medical science; establishing funds for the giving -of annual prizes, for the founding of a medical library, for the -building of an anatomical amphitheatre, etc. In his treatise on anatomy -Hyrtl, the distinguished professor at the University of Vienna, makes -the following brief statement with reference to a certain dissecting -room in Paris, but he does not state in what part of the city the -room in question is located, nor does he mention any other facts that -might enable his readers to fix its location. In the absence of more -precise information concerning this matter, I shall take the liberty of -suggesting that Hyrtl’s discovery was made in the Anatomical Institute -which de Lapeyronie founded. Hyrtl’s statement reads as follows:-- - - Over the entrance doorway of a dissecting room in Paris I read - this inscription: _Hic locus est ubi mors gaudet succurrere - vitae._ [Here is the spot where Death rejoices to render - assistance to Life.] No more beautiful or fitting words could - be employed for inspiring the student, upon his first entrance - into the room, with respect for the work in which he is about to - engage. - -And yet, a few pages beyond that on which the above statement is -printed, Hyrtl quotes Vicq d’Azyr as saying: “Among all the sciences -anatomy is perhaps the one the usefulness of which has been most -highly lauded, but at the same time the one for which the least has -been done to favor its advancement.” - -_The Revival of Interest in Obstetrics._--With Soranus, the -early Greek writer on obstetrics, this science seemed to come to -a standstill, and during all the intervening centuries, up to the -sixteenth, not a single work of any special value was published on -this subject; for it is safe to say that nobody would claim for the -one or two obstetrical treatises that were written by teachers in -the Medical School of Salerno during the ninth or tenth century, -that they contributed materially to advance our knowledge in regard -to this branch of medicine. It therefore seems fitting, as suggested -by Haeser, that during the century which gave birth to such immortal -works as those of Vesalius and Paré, there should appear somebody who -possessed the inclination to stir once more into life the dying embers -of the science of midwifery; and such a man was found in the person of -Eucharius Roesslin, the elder, more commonly known--says Dezeimeris--by -the Greek name of “Rhodion.” He lived during the first half of the -sixteenth century, his death occurring about the year 1526, and his -was the first modern treatise especially devoted to obstetrics. He -began the practice of medicine in the city of Worms, in the central -part of Germany, and then moved to Frankfort-on-the-Main, where he -filled the salaried office of City Physician. Midwifery, at that time, -was left entirely in the hands of ignorant old women; and it was only -in response to the wishes of Catherine, the Duchess of Brunswick and -Lüneberg, that Rhodion undertook to prepare a manual from which these -ignorant and careless women might learn to conduct their midwifery work -in a more efficient, safe and acceptable manner. This little treatise, -which was first published at Worms in 1513, passed through a number -of editions and was translated into Latin, French, Dutch and English. -Von Siebold says that Rhodion compiled its text from various ancient -sources, and added practically nothing from his own experience. The -woodcuts, which are supposed to represent the different positions of -the foetus in the uterus, are not at all in accordance with the truth, -and show the most marvelous products of the artist’s fancy. Von Siebold -states, however, that the prejudices which at that time existed in the -minds of the people against the slightest participation of males in the -operations of midwifery were so strong that Rhodion would not have been -permitted to do anything toward learning the truth by the employment of -direct observation and careful examination--the only possible way in -which the actual facts might have been learned. - -Rhodion’s book, notwithstanding the defects to which I have just -referred, accomplished much good. It also restored the operation of -podalic version to the position which it deserved, and it improved -the service of the midwives,--which was what the Duchess chiefly -desired,--and it undoubtedly emphasized the fact that the time had -arrived when obstetrics should receive the same degree of scientific -study that was being bestowed on all the other departments of medicine. - -The title of Rhodion’s (or Roesslin’s) little book reveals the fact -that he possessed no small degree of humor. It reads: “Garden of Roses -for Pregnant Women and for Midwives,” Worms, 1513. - -_The Operation Known as Caesarian Section._--The following -statements relating to the operation known as “Caesarian section” -have been compiled from Haeser’s _Geschichte der Medizin_:--This -operation, which owes its name to the erroneous idea that Caesar -was brought into the world by its aid, is commonly believed to have -been practiced on different occasions throughout antiquity, but -there has not yet been found in the records of history any account -which shows clearly that the operation was performed upon a living -woman, and also that the incision extended not merely through the -abdominal integuments, but also through the actual uterine wall. At -Siegershausen, in Switzerland,--according to the report of Caspar -Bauhin in the treatise (“_Gynaecia_”) which he published at Basel -in 1586,--a man named Jacob Nufer performed (about 1500) what was -believed to be a Caesarian section on his own wife, and delivered a -living child. Both mother and child did well; the child growing up -to the age of seventy-seven and the mother giving birth to living -children, _per vias naturales_, several times afterward. In this -instance it is generally believed that the case was one of abdominal -pregnancy and that the wall of the uterus had not been incised. - -The first separate treatise on Caesarian section was written by -François Rousset, and in it are reported several cases in which the -operation was said to have been performed successfully. But both von -Siebold and Kurt Sprengel do not seem willing to accept these reports -as genuine, and we are therefore compelled to assume that the first -trustworthy account of a Caesarian section successfully performed by -a Dr. Trautmann of Wittenberg (in 1610) is that given by Sennert in a -communication which was printed early in the seventeenth century. - -_Invention of the Obstetrical Forceps._--After the publication of -Roesslin’s “Garden of Roses,” the book of which I gave a brief sketch -on a previous page, nothing worthy of special note was done for a -period of several years to advance the existing knowledge of midwifery -or even to systematize that which had already accumulated. Then there -began to appear evidences of an awakening among those physicians who -recognized the importance of this department of medical science, and as -a result there were soon placed upon record accounts of two or three -advances of real and permanent value. One of the first of these gains, -for example, was the revival and general acceptance of the practice of -podalic version, or version by internal manipulations,--that is, the -operation of changing the faulty position of the foetus _in utero_ -in such a manner that the feet shall be the parts which protrude into -the vagina. Podalic version--as it appears from the account given by -von Siebold--was known to the ancients, both Celsus and Aëtius having -described it in their treatises, but it was afterward forgotten or -neglected until Ambroise Paré, in 1550, again recommended it in one of -his writings. At the same time Paré states, at the very beginning of -his monograph on this subject, that his colleagues, Thierry de Héry -and Nicole Lambert, had both of them already carried out the method in -certain cases. This fact, however, does not detract from the credit due -Paré for having been the first, after the lapse of several centuries, -to bring the operation to the knowledge of the medical profession; and -from that day to the present it has held a fixed place in the science -of obstetrics. As will be readily understood, this is not the proper -place in which to furnish details with regard to the operation itself. -When Paré was asked whether it would be permissible for the midwives -to undertake this operation of podalic version, he replied that it -would be, provided the individual who assumed this responsibility -felt convinced that she possessed the requisite degree of skill -and experience in work of this nature, and provided also that--as -soon as she began to suspect her inability to finish the operation -successfully--she would promptly call to her aid a skilful surgeon, one -who had acquired considerable experience in obstetrical operations. -Paré’s favorite pupil, Jacques Guillemeau (1550–1630), a native of -Orleans, France, made several important additions to our knowledge of -the operation of podalic version, and he was also in other respects an -important promoter of the science of operative obstetrics. His treatise -on this branch of practical medicine, which was originally written in -French and published at Paris in 1609, was soon translated into English -(“Childbirth, the Happy Deliverance of Women,” London, 1612). In the -opinion of von Siebold, podalic version may justly be considered the -most important contribution that was made to obstetrical science during -the sixteenth century. - -One of the French midwives of this period, Louise Bourgeois (or -Boursier), attained considerable celebrity by the excellence of the -treatise which she wrote on obstetrics. She was born at Paris about -the year 1564. In 1588 she began to fit herself for the career of -midwife, and in the course of a few years, after passing successfully -the required examinations, she was admitted by the authorities as a -“sworn midwife” of the city of Paris. She gained steadily in experience -and public favor, and the record states that already as early as 1601 -she had the good fortune to officiate at the delivery of Henry the -Fourth’s wife (Marie de Medicis) of a son--the Dauphin (later, Louis -the Thirteenth). Her royal patrons were much pleased with the services -which she rendered on this occasion, and, as a further evidence of -the confidence which she inspired, they asked her--as each of these -occasions approached--to preside at the births of five other children. - -One of the meritorious features of the treatise which Louise Bourgeois -wrote,[99] says von Siebold, is to be found in the fact that she -championed most earnestly podalic version. The book was translated into -both German (1644) and Dutch (1658). - -François Mauriceau (1637–1709), who was indisputably the most -distinguished writer on obstetrics of the seventeenth century, was -born in Paris. During the early part of his career he was simply a -general surgeon, but, after the lapse of a few years, he gave up all -his other work and confined himself strictly to midwifery. For quite a -long period he held the position of Chief Obstetrician at Hôtel-Dieu, -and at the same time he conducted an extensive private practice in -cases of confinement. Worn out by the excessive amount of work which he -performed during the most active period of his career, he was finally -obliged to retire from practice several years before his death. - -Mauriceau did not invent any remarkable obstetric instruments or -procedures, but he was the first to set forth in clear and precise -terms the principles of this science and art and to expound the rules -required for putting them into practice. The titles of his two most -celebrated treatises are the following: “_Traité des maladies des -femmes grosses_,” Paris, 1668; and “_Observations sur la grossesse -et l’accouchement_,” Paris, 1695. In 1706, three years before his -death, he also published “_Dernières observations sur les maladies -des femmes grosses_.” - -The first of the three books mentioned passed through five editions -during Mauriceau’s lifetime, and there were two reprintings after his -death. A noticeable feature of the work, says von Siebold, is the care -which the author takes to preface all his lectures with a detailed -exposition of the anatomical relations of the region concerning which -he is about to speak; and this custom, which he was the first to -introduce, has since then been followed by the great majority of those -who have written on the subject of midwifery. - -In the book which hears the title “_Observations sur la grossesse, -etc._,” Mauriceau gives an account of his first and only interview -with the English obstetrician, Hugh Chamberlen, to whom is commonly -accorded the credit of having invented the first pattern of the -obstetric forceps. From this account it appears that on August 19, -1670, Mauriceau was called to see a primiparous woman, thirty-eight -years old, who had already been in labor for several days, but -who had not yet been able, owing to the extreme narrowness of her -pelvis, to give birth to her child. (The case was one of head -presentation.) As Mauriceau was not at all willing to perform a -Caesarian section,--which alone, as he believed, promised a way out -of the difficulty,--Chamberlen, who happened to be in Paris at that -moment, was asked to see the patient. He came at once, made a hasty -examination, and declared that he needed only six or seven minutes for -effecting, by means of the method which he had invented, the delivery. -The patient was placed under his charge and he proceeded to apply his -method. Instead of a few minutes, he spent three hours in the attempt -to accomplish this purpose, but without success; and then admitted -that it was impossible, in this particular case, to effect delivery. -At the end of twenty-four hours the woman was dead. A postmortem -examination revealed the fact that the uterus was torn in several -places and perforated at one spot, all of which lesions had evidently -been produced by the instrument or instruments employed by Chamberlen. -“To complete this story,” adds Mauriceau, “it should be remembered -that, six months before the occurrence of the events just narrated, -this physician had come to Paris from England, and boasted that he -possessed a secret method by means of which he could, even in the most -desperate cases of labor, promptly effect the delivery of the child, -and had told the King’s Physician-in-Ordinary that he would sell the -knowledge of this secret for the sum of 10,000 Thalers (about $7500).” - -One naturally hesitates about giving any measure of credit to a -physician whose professional conduct, as revealed in his relations to -Mauriceau’s patient, is clearly that of a charlatan. At the same time -we are obliged to bear in mind that in 1670 it was still possible for -a physician or surgeon to own a secret method of treatment and yet not -forfeit all consideration on the part of his professional brethren. -But at no time in the history of medicine has such conduct as that -attributed to Hugh Chamberlen (apart from the question of ownership -of a secret process) been considered otherwise than reprehensible. -However, as there does not appear to have been an earlier claimant for -the honor of having invented the obstetric forceps,--crude as it must -have been in its first form,--it seems only fair that Chamberlen should -be granted undisputed possession of this honor. During the eighteenth -century--a period with which the present volume has no concern--the -obstetric forceps underwent many alterations, and finally was given, by -Levret and Baudelocque in France, by Smellie in England, and possibly -also by Palfyn in Holland, practically the form which it possesses -to-day. - -Before I finally dismiss the allied topics of obstetrics and -gynaecology, it seems desirable that I should add a few remarks -concerning two French surgeons who attained considerable eminence in -this special field, viz., Portal and Dionis. - -_Paul Portal._--Paul Portal, a native of Montpellier, France, was -a contemporary of Mauriceau and an excellent obstetrician. He received -his training under the best teachers at Paris, and more particularly -under the guidance of René Moreau, Dean of the Paris Faculty of -Medicine (1630 and 1631) and Royal Professor of Medicine and Surgery. -He died in 1703. In the treatise which he published at Paris in 1685 -(“_La pratique des accouchements, etc._”) he lays down very -strongly the maxim that the surgeon or the midwife who has charge of -a case of labor should make no attempt to accelerate the efforts of -Nature until it becomes plainly evident that artificial assistance is -absolutely necessary. Portal cultivated the art of digital exploration -to a very high degree of excellence. In Chapter VI., according to von -Siebold, he expounds with great clearness the dangers which result from -a prolapse of the umbilical cord. When this condition is discovered, no -time should be lost in delivering the child. “In narrating some of his -most remarkable cases Portal uses very simple and clear language, and -he puts on record many things which in later years have been published -as entirely new discoveries. But, unfortunately, his immediate -successors were not disposed to profit from Portal’s admirable -teachings.” (Von Siebold.) The only translations of his treatise into -foreign languages that have been published are one in Dutch (1690) and -another in Swedish by Van Hoorn (1723). - -_Pierre Dionis._--Pierre Dionis, who was born at Paris in the -early part of the seventeenth century, was in some degree related to -Mauriceau, the famous Parisian accoucheur. In 1673 he was appointed -Royal Demonstrator of Anatomy and Surgery at the institution known -as the “_Jardin-du-Roi_,” and from this date onward, up to -the year 1680, he gave instruction regularly in these branches of -medical knowledge to large classes of students. He was particularly -distinguished for the clear and methodical manner in which he handled -the subjects upon which he lectured. In the year last mentioned he was -called to Vienna to fill the position of Physician-in-Ordinary to Maria -Theresa, Empress of Austria, but von Siebold, who is my authority for -the present sketch, does not say for what length of time he continued -to hold this position. His death occurred in 1718. - -The earliest work published by Dionis bears the title: “_Histoire -anatomique d’une matrice extraordinaire_,” Paris, 1685. (Description -of a case of extra-uterine pregnancy.) Five years later he published -the treatise on human anatomy (“_L’anatomie de l’homme, etc._,” -Paris, 1690) upon which his celebrity largely rests. This book passed -through numerous editions and was translated into Latin, Dutch and -English (1723), and also Chinese; this last piece of work being -done by the Jesuit missionary, Father Parrenin, at the request of -Cam-Hi, Emperor of China, who died in 1723. Another treatise, which -perhaps contributed, even more than did his Anatomy, to render Dionis -celebrated, is that which bears the title: “_Cours d’opérations de -chirurgie démontrées au Jardin-du-Roi_,” Paris, 1707; and later -translations into German, Dutch and English. This book covers the -entire field of operative surgery, and its subject-matter is most -methodically arranged. It contains a large number of precepts which -are as sound to-day as they were two hundred years ago. From the -frequent mention which Dionis makes of the diseases to which the teeth -are liable, and from his descriptions of the operations that may be -performed for the cure or relief of these disorders, one is justified -in drawing the conclusion that, at that early period, this branch of -surgery was not, as many suppose, abandoned entirely to charlatans. - - - - - CHAPTER XLIII - - THE FIRST APPEARANCE OF SYPHILIS IN EUROPE AS AN EPIDEMIC - DISEASE.--MEDICAL JOURNALISM.--THE BEGINNINGS OF A MODERN - PHARMACOPOEIA.--ITINERANT LITHOTOMISTS - - -Toward the end of the fifteenth and during the early part of the -sixteenth centuries accounts concerning syphilis began to be published -in the medical literature of Spain, Italy and France. The word -“syphilis,” it is true, does not appear in any of these records, for -it had not yet been coined; but the accounts themselves leave no room -for doubt that this was the disease to which the authors of these -records referred. The prevailing views with regard to the origin and -nature of syphilis differed somewhat in the three countries named. In -Spain, for example, it was a common belief that the disease originated -in an unfavorable conjunction of the stars[100] and yet at the same -time it was generally admitted that it was a disease which belonged -in the category of luxuries and might be avoided if one were careful -not to have intercourse with dissolute women. For a brief period of -time there were physicians in all three of the Latin countries who -maintained that syphilis had been imported, in the first instance, -from America by the men who made the voyage with Columbus and by the -earliest Spanish explorers of South America; but it was soon shown -that this theory was not compatible with certain known facts--such, -for example, as the published reports made by the Spanish physicians -Pintor and Torrella,[101] who describe cases of syphilis which they had -treated prior to 1493 (the year in which the first discoverers returned -from America). In Italy, according to Giovanni da Vigo, the author -of an excellent treatise on surgery (“_Practica in arte chirurgica -copiosa_,” Rome, 1514), the disease was first observed in Europe in -December, 1494, soon after the arrival of Charles the Eighth’s (France) -army at Naples; and only a short time elapsed before there developed, -as a result of this great accession of French soldiers, a veritable -epidemic of what then began to be known quite generally as “_morbus -gallicus_” or “the French disease.” The King himself, it is stated, -was among the number of those who contracted the infection. - -So far as I am able to discover, the term “syphilis” was first -introduced into medical literature by Fracastoro, the distinguished -physician of Verona, who published in 1530 a Latin poem bearing the -title: “_Syphilis sive morbus gallicus_.” These verses were -received everywhere with great favor, were translated into several -modern languages, and speedily put an end forever to the employment of -the insulting term “_morbus gallicus_.” - -A few more words with reference to the origin and distribution of -syphilis throughout the world may not seem inappropriate in this -place. J. K. Proksch, the author of the most recent history of this -disease,[102] says it has been fully proved that syphilis existed among -the inhabitants of India as long ago as during the Middle Ages, and he -adds that the evidence thus far collected justifies the further belief -that it was not an uncommon malady among the ancient Greeks and Romans, -and even among the Babylonians and Assyrians. Doubtless a good deal -of what was called “leprosy” in early times was in reality syphilis. -Another syphilographer--Raphael Finckenstein--makes the following -sensible remarks about the efforts that have been made to ascertain -the precise date when this disease first appeared in Europe:--[103] - - It is just as foolish to suppose that the date of the first - appearance of syphilis may be discovered as it is to hope - that the disease will ever entirely disappear. As long as - wealth and idleness continue to exist, as long as there are - men who remain unmarried and women whose moral character is of - a yielding nature, and as long as it is not possible for the - police to creep into every nook and corner, just so long will - licentiousness and indulgence in fleshly lusts continue to - disturb the peace of the community. These are the conditions - necessary to the development and spread of syphilis. - -Some account of the treatment of this form of venereal disease comes -next in order. It is commonly believed, says the author just quoted, -that it was from the Spanish physicians of the sixteenth century -that we learned how to treat syphilis by the methodical employment -of mercurial preparations. (See footnote at the bottom of page 542.) -He adds that there was published by Juan Almenar at Venice, in 1502, -a book which bears the title: “A treatise on the Morbus Gallicus, -in which it is demonstrated how the patient may be treated in such -a successful manner that the disease will never return, nor will -any objectionable lesions develop in the mouth; and yet, during the -progress of the treatment, the patient is not required to remain -in bed.” The author of this book, who was a resident of Valencia, -Spain, was a man of noble birth. His treatise passed through eight -successive editions, the last of which was printed at Basel in 1536. -Almenar’s plan of treatment was to employ mercurial inunctions in such -moderate doses as not to induce salivation. If, at the end of a few -days, he saw evidences of an approach of this symptom, he substituted -baths and evacuant remedies (rhubarb and senna) for a short time, -and also prescribed a more nourishing diet and the taking of various -internal remedies. Then, later, the inunctions were resumed. The -exact duration of such a course of treatment is not stated. So far as -I am able to judge from the account given by Finckenstein, Almenar -found it necessary in some cases to repeat the series of mercurial -inunctions as many as four times. His aim, in other words, was to -accomplish a radical cure of the disease, whereas his contemporaries, -who were mainly ignorant and uneducated physicians, were satisfied to -carry out a purely symptomatic treatment. Morejon, the historian of -Spanish medicine, expresses the belief that Almenar was the first to -use steam baths in the treatment of syphilis. Both Hensler and Simon, -the best modern authorities with regard to the history of syphilis, -agree that Almenar’s inunction method of treating this disease forms, -notwithstanding its crudeness in certain respects, the basis of all -modern methods of the same general character. Unfortunately, the -physicians of a later period did not follow the relatively mild and -safe inunction method advocated by Almenar, but so modified it for the -worse that it became a common thing for men to say that the cure was -worse than the disease. - -_A Few Special Advances Worthy of Note._--The beginnings of -medical journalism belong to the second half of the seventeenth -century. In 1665, for example, there appeared for the first time, -a medical article in the “_Journal des Scavans_,” and during -the same year similar articles were printed in the “Philosophical -Transactions of the Royal Society of London.” According to August -Hirsch the earliest periodical that was devoted entirely to the -interests of the medical profession was the “_Journal des découvertes -en médecine_,” which was first published in 1679 and continued, -in 1680, under the title of “_Le Temple d’Esculape_.” Then -followed soon afterward: “_Le Journal des Nouvelles Découvertes en -Médecine_” (1681–1683); “_Le Mercure Savant_” (1684); “_Le -Zodiacus Medico-Gallicus_” (1680–1685), which was published in Latin -in Geneva, by Bonet; etc. - -In addition to the more important advances in anatomy and physiology -that have already been mentioned on previous pages, the following -deserve to receive at least a passing notice: In the department -of anatomy and physiology, William Briggs (1642–1704), one of the -physicians of St. Thomas’ Hospital, London, published at Cambridge in -1676, under the title of “_Ophthalmographia_,” a most important -contribution to the anatomy and physiology of the eye; and there were -four other English anatomists who, during the seventeenth century, -gained well-merited credit by the original work which they did in the -fields of anatomy and physiology--viz., Thomas Willis (1622–1675), -Francis Glisson (1597–1677), Thomas Wharton (1610–1673), and Nathaniel -Highmore (1613–1684). The part played by Germany in these gains in -anatomy and physiology, during the period now under consideration, was -chiefly that of a sympathetic recipient; for the political conditions -at that time were entirely unfavorable to any active participation on -the part of the physicians of that country. Early in the eighteenth -century, however, they began in earnest to do their share of work in -advancing the science of medicine. - -The relationship of the physical sciences to the theory and practice -of medicine is not of an intimate nature, and it will therefore not -be necessary for me to do more than briefly to enumerate the more -important of the discoveries of this character which occurred during -the sixteenth and seventeenth centuries. - -Galileo (1564–1642), a native of Pisa, Italy, was the creator of the -science of motion, and he gave the first satisfactory demonstration -of equilibrium on an inclined plane. He devised an imperfect -species of thermometer, a proportional compass, and the refracting -telescope, by means of which latter instrument he made a number of -other important discoveries in the domain of astronomy. His pupil, -Evangelista Torricelli (1608–1647), also a native of Italy, discovered -the barometer, and in addition arrived at many fundamental truths -in mechanics and hydrostatics. Otto von Guericke (1602–1686), a -native of Magdeburg, Germany, invented the air pump. Sir Isaac Newton -(1642–1727), born at Woolsthorpe, Lincolnshire, one of the world’s -greatest authorities in natural philosophy, was the first to formulate -clearly the law of gravitation. Edme Mariotte (1620–1684), a native -of Burgundy, France, was the discoverer of what is commonly known as -“Mariotte’s law”--_i.e._, a law of elastic fluids, according to -which the elastic force is exactly in the inverse proportion of the -space which the mass of fluid occupies. He also discovered that the -part of the retina at which it meets the optic nerve is not capable of -conveying the impression of sight. Finally, Denis Papin (1647–1710), -a Frenchman, invented the first steam engine, of an embryonic and not -very practical type; for in this apparatus the piston floated on the -water in a separate cylinder. - -The inventions which I have here briefly enumerated represent the more -important discoveries that were made in physical science during the -sixteenth and seventeenth centuries. - -_The Beginnings of a Modern Pharmacopoeia, and One of the Last -Attempts of the Disciples of Galen to Maintain Their Ascendancy in -Therapeutics._--In the domain of pharmacology the first attempt in -modern times to organize this department of practical medicine was -made by an apothecary in Barcelona in 1497, and was published by him -in printed form in 1521. (Von Gurlt.) This pharmacopoeia was doubtless -wholly unknown beyond the borders of Spain. Not far from one hundred -years later,--_i.e._, in the early part of the seventeenth -century,--Theodore Turquet de Mayerne, who was born in 1573, in a -small village near the city of Geneva, made the second attempt in -modern times to organize the pharmacological department of practical -medicine. After showing quite early in life a fondness for the study -of chemistry, he devoted himself particularly to the investigation -of the remedies that are produced in the chemist’s laboratory; the -preparations of antimony attracting his especial interest. A little -before this time the physicians of Paris were split up into two -strongly antagonistic parties as regards the propriety of administering -this metal in any form as a remedy; but those who opposed its -therapeutic employment finally managed to secure from Parliament, in -1566, a decree prohibiting its use. While this quarrel was in progress, -de Mayerne visited Paris (1602) and established himself in that city -as an independent lecturer on chemistry. As the regular faculty still -held the belief that the teachings of Galen were the only safe guide -for physicians to follow, de Mayerne’s action must have appeared to -them like an impudent challenge. In one of his writings he strongly -recommended the employment of antimonial preparations,--remedies -introduced originally by the much-hated Paracelsus,--and he even -went so far as to offer some for sale. This was too much for the -disciples of Galen to bear without a protest, and consequently in -1603 the Parliament issued a new decree, in accordance with which de -Mayerne was prohibited from practicing medicine in Paris. This measure -appears to have proved successful in putting a stop effectively to -his obnoxious teachings, for we learn that shortly afterward he was -known to be living in London, where, in 1611, he was appointed the -Physician-in-Ordinary to King James the First, and later to Charles the -First. He died in 1655. - -Jean Astruc, the distinguished French medical author of the eighteenth -century, speaks rather disparagingly of de Mayerne’s attempt to -organize a pharmacopoeia. An earlier, more successful, and much -more creditable attempt of this nature was made by Valerius Cordus, -whose “_Dispensatorium pharmacorum omnium_” was first published -at Nürnberg in 1535. This work, which subsequently bore the title -“_Pharmacopoeia Augustana_,” up to the year 1627 passed through -at least seven editions and was utilized to a greater or less extent -by the authors or editors of nearly all later pharmacopoeias. To -go still further back, the most ancient pharmacopoeia of which we -have any knowledge is that which bears the title of “_Antidotarium -Nicolai_,” the author of which work was Nicolaus, the President or -Dean of the Medical School at Salerno. The book was written originally -during the first half of the twelfth century, but it did not appear in -print, at Venice, until the year 1471, and then only in an incomplete -form. Quite recently a French translation of the book has been -made and published (1896) by Paul Dorveaux, of the Paris School of -Pharmacy. Most of the preparations there described have long since been -abandoned, but a few of them--such, for example, as citrine ointment, -honey of roses, oxymel, and oil of roses--are still to be found in the -pharmacopoeias of some nations. - -_Itinerant Lithotomists._--For an unknown number of years -preceding the sixteenth century it had been a well-established custom -for members of the medical profession in France, and also, doubtless, -in neighboring countries, to intrust--as the Hippocratic oath -enjoined--all cases of stone in the bladder to expert lithotomists. -Such special knowledge and skill were not easily acquired, and so it -came about that there were very few individuals who were acknowledged -to be experts and who were really capable of teaching the art, and -these few guarded most carefully the knowledge which they had gained. -During the period of time which we are now considering, certain -members of the Collot and Pineau families were the most distinguished -lithotomists in France, and the records show that in the year 1600 -Jehan Paradis and Nicolas Serre petitioned the Government for official -recognition of their special rights to enjoy a monopoly of operative -work of this character. “We ask that you give orders that all poor -patients who may apply to Hôtel-Dieu (the great city hospital of Paris) -or to the Bureau-of-the-Poor for relief from stone in the bladder, be -turned over to our care for proper treatment. The poor will receive -this treatment gratis, and those who can afford to pay will be charged -a very reasonable fee. And you will do well if you prohibit all other -persons from meddling with such cases in any manner.” In a document -bearing the date 1646 mention is made of four lithotomists--Philippe -and Charles Collot, Jacques Girault and Antoine Ruffin--who had erected -in the Faubourg Saint-Antoine, Paris, a building which was intended -to serve as a hospital “in which, at any time during the entire year, -those who are afflicted with stone in the bladder may be lodged, fed, -nursed and subjected to proper treatment,--the poor without charge of -any kind, and the well-to-do at a proper rate of remuneration.” - -In Franco’s time (middle of the sixteenth century) cutting for stone -in the bladder was by no means an uncommon operation, and was almost -always performed by itinerant lithotomists (“_inciseurs_”). The -Collots had, for many years, possessed almost a monopoly of this -business. Laurent Collot, who was the first one of the family to engage -in the work, was Royal Lithotomist in 1556, and handed down to his son -all the knowledge on this subject which he had acquired through long -experience. François Tolet was another of these popular lithotomists -who flourished in Paris during the sixteenth and seventeenth centuries. -He died in 1724 at the age of seventy-seven. His treatise on lithotomy, -which was published in Paris in 1681, and subsequently passed through -several editions, is said by Dezeimeris to contain the records of a -large number of his own cases and to show clearly that he was a surgeon -of sound judgment. No better treatise on this subject, he adds, was -published during that period of the history of medicine. - -In addition to those whom I have just mentioned there were two French -monks who gained wide celebrity as operators for stone in the bladder, -viz., Frère Jacques de Beaulieu and Frère Côme. The last-named belongs -to the early part of the eighteenth century, and should therefore--in -accordance with the plan which I have been following--not receive -consideration in the present account; but, in view of the fact that -these are the only two monks who, during the Renaissance and the period -immediately following, gained conspicuous credit for the honorable and -efficient service which they rendered, not merely to the science of -medicine but also to the cause of humanity, I believe that I cannot do -better than to place the two sketches together as if they both belonged -strictly to one and the same period of time. - - [Illustration: FIG. 26. FRÈRE JACQUES DE BEAULIEU. - - Born in 1651 in the village of Létendonne, Franche-Comté, France. - - (From the steel engraving in the treatise _De la Taille - Latérale par le Périnée_, etc., by Pascal Baseilhac, nephew - of Frère Côme, Paris, 1804.)] - -(_a_) Frère Jacques--or Brother James, who was born in 1561 at the -village of Létendonne, near Lons-le-Saulnier, Central France,--learned -the art of operating for stone in the bladder from an Italian surgeon -named Paulony, and acted as his assistant or associate up to the time -when he became a monk of the Order of Saint Francis--that is, of that -branch of the Order which had its chapter house at Feuillants in -Languedoc. He traveled about the country offering to treat gratuitously -all persons affected with stone in the bladder who were willing to -trust him, and he made it a rule, whenever such a thing was possible, -always to operate in the presence of one or more physicians or -surgeons. He was also ready at all times to give instruction to those -who wished to learn his method of procedure. He never asked to be -remunerated, but was always pleased to receive from his patients a -written testimonial of what he had done for them. Out of the moneys -which he received from the rich he retained only that which he required -for his own support and for the purchase of such instruments as he from -time to time required; the balance he distributed among the poor. He -was very faithful in performing his religious duties, and he succeeded -in gaining the good will and esteem of everybody with whom he had any -dealings. - -For a long time it was customary in France to credit Frère Jacques -(Fig. 26) with the invention of the lateral method of operating for -stone in the bladder. This, however, was an error, for Franco, on page -95 of E. Nicaise’s reproduction of the 1561 edition, describes this -operation clearly. It must therefore have been invented a long time -before Frère Jacques was born. The text (rendered into English) reads -as follows: “... the incision should be made between the anus and the -testicles, two or three finger-breadths to one side of the commissure -or perinaeum [median line of the perinaeum].” This is said to be the -earliest clear description of the first step of the lateral operation -of which we have any knowledge. - -In 1697, when Frère Jacques visited Paris, he had already attained -wide celebrity as a lithotomist; the number of his successful -operations--all of which had been performed according to the lateral -method of procedure--having reached a grand total of several thousand. -He therefore had a right to suppose that his visit would prove -acceptable to the physicians of that metropolis; but the published -account of this visit reveals plainly the fact that the surgeons of -that city were not at all pleased that an itinerant lithotomist from -one of the provinces should have the effrontery to request permission -of the authorities to exhibit his method before the Medical Faculty of -Paris. His request, however, was granted, and he was allowed to operate -on a man, forty years old, at Hôtel-Dieu. He performed the operation -before a large assembly of physicians, and, after the stone had been -successfully extracted, the patient made a prompt recovery. A short -time afterward he operated upon another patient at Fontainebleau in the -presence of several physicians, one of whom was Monsieur Félix, the -First Surgeon of the King, Louis the Fourteenth. In this case also, as -well as in several later cases, Frère Jacques was entirely successful, -and he now began to be treated by the public with marked consideration. -But, in a short time, owing to the jealousy exhibited by a large clique -of Paris surgeons, who were encouraged to pursue this course by Mery, -the Head Surgeon of Hôtel-Dieu, Frère Jacques was finally forced to -leave Paris. I cannot follow him on his further wanderings throughout -Europe, from the leading cities of Holland, Belgium and Switzerland to -Vienna and Rome. In 1716 he retired to Besançon and lived there quietly -up to the time of his death in 1719. But even then his enemies--men to -whom he had never done the slightest harm--did their best to destroy -the last traces of his existence. A visit made to Besançon by one of -his acquaintances not long after our Franciscan monk’s death, revealed -the fact that his name had been erased from the church registry of -deaths. The lateral method of operating for stone, which had been -revived and thoroughly developed by him, still finds favor among the -best surgeons of our own day; and the names of those mean-spirited men -who tried so hard to injure him have long since passed into complete -oblivion. - - [Illustration: FIG. 27. JEAN BASEILHAC, COMMONLY KNOWN IN FRANCE AS - FRÈRE CÔME. - - (From the steel engraving in Pascal Baseilhac’s treatise.)] - - [Illustration: FIG. 28. CONCEALED LITHOTOME INVENTED BY FRÈRE CÔME IN - 1748. - - (From the steel engraving in Pascal Baseilhac’s treatise.)] - -(_b_) Frère Jean de Saint-Côme,--or Brother John of Saint -Cosmas,--whose real name was Jean Baseilhac, was born in 1703 at -Poyestruc, Department of Hautes-Pyrenées, France. He received his -instruction in the principles of medicine from his father and his -grandfather, both of whom were regularly enrolled Masters in Surgery. -In 1722, when there could no longer be any doubt about young -Baseilhac’s settled purpose to fit himself for the practice of -medicine, his father sent him to Lyons, where his uncle, who was -himself a surgeon, would be able to superintend the boy’s further -training. Through the latter’s influence, young Baseilhac was allowed -to enter the Hôtel-Dieu of that city as one of its regular pupils. -At the end of two years--_i.e._, in 1724--he left Lyons and -went to Paris, where he hoped to add materially to his stock of -professional knowledge. His first step, after reaching the metropolis, -was to enter the service of a surgeon in active practice; and then, -aided by the latter’s influence, he succeeded (in 1726) in entering -the Paris Hôtel-Dieu as one of the regular pupils. Soon after he -had completed his term of service at the hospital, he was appointed -Physician-in-Ordinary to the Prince-Bishop of Bayeux, in Normandy. The -death of the latter in 1728, less than two years after Baseilhac had -entered his service, came as a great blow to the young surgeon, for he -had learned to esteem him very highly. In his will the Bishop left a -small legacy to Baseilhac--that is, a sum of money sufficient to pay -for the regular course of instruction at the Medical School of Saint -Cosmas in Paris, and also to procure a complete outfit of surgical -instruments. In 1740 he became a member of the Feuillants Branch of -the Franciscan monks, it being understood, however, that he was to be -allowed the special privilege of practicing surgery among the poorer -classes. Through accidental circumstances he was led gradually to drop -general surgery and to confine his work to operations for stone. His -official name at this time was “Frère Jean de Saint-Côme,” or simply -“Frère Côme.” (Fig. 27.) As he gained in experience as a lithotomist, -he became convinced that the method which his predecessor, Frère -Jacques, had practiced with such great success, was preferable to the -more complicated and more dangerous plan commonly pursued by surgeons -at that time, and thereafter he adopted it in all his cases. But he -modified the procedure to a certain extent; that is, he invented an -instrument by means of which the actual cutting of the perinaeum was -accomplished with a concealed knife (see Fig. 28). The chief advantage -to be gained by the employment of this instrument consisted--as was -claimed by Frère Jean and his nephew, Pascal Baseilhac,--in the fact -that in this way the danger of making the incision in the wrong place, -or of too great length, was materially diminished. - -The first patient upon whom the new instrument was tried (October 8, -1748), was a dealer in lime, sixty years of age and in rather delicate -health. In less than three weeks after the operation, he was entirely -cured. Subsequently the instrument was employed in a large number of -instances, and the method was found to be most satisfactory; successful -results being obtained--on the average--in twelve out of thirteen -cases, whereas the best results previously obtained by the method -commonly employed at that period was 50 per cent of cures. At a still -later date the statistics showed even better results--viz., 96 cures in -one group of 100 cases, and 316 cures in a second group of 330 cases. - -Owing to the rapidly increasing number of patients affected with stone -in the bladder who wished to be operated upon by Frère Jean himself, he -established in Paris in 1753, near the Saint Honoré gateway, a special -hospital for lithotomy cases, and kept it in active service up to the -time of his death. The laboring classes, and the poor in general, were -not expected to pay any fees, and indeed money was often bestowed -upon these people when they left the hospital, to enable them to -return comfortably to their villages; those in moderate circumstances -were asked to pay only the expenses that had been incurred in their -behalf; and the well-to-do made such voluntary contributions as they -thought proper toward the support of the hospital. The registers of the -institution showed that, first and last, over one thousand operations -had been performed there, either by Frère Jean or by his nephew, Pascal -Baseilhac. Our monk’s death occurred on July 8, 1781. - - - THE END - - - - - LIST OF THE MORE IMPORTANT AUTHORITIES CONSULTED - - - ARISTOTLE: HISTORY OF ANIMALS, translated by Richard Cresswell, - London, 1902. - - ASCHOFF, L.: KURZE UEBERSICHTSTABELLE ZUR GESCHICHTE DER - MEDIZIN; forms the second part of Schwalbe’s treatise (_q.v._). - - BAAS-HANDERSON: HISTORY OF MEDICINE, New York, 1910. - - BASEILHAC, PASCAL: DE LA TAILLE LATÉRALE PAR LA PÉRINÉE, ET - CELLE DE L’HYPOGASTRE, OU HAUT APPAREIL, Paris, 1804. (Includes - an account of the career of Frère Côme.) - - BERENDES, J.: DAS APOTHEKENWESEN, Stuttgart, 1907. - - BOERHAAVE: A NEW METHOD OF CHEMISTRY, translated by Peter Shaw, - M.D., London, 1741; APHORISMS, etc., English translation, - London, 1742. - - BOTTEY, F.: TRAITÉ THÉORIQUE ET PRATIQUE D’HYDROTHÉRAPIE - MÉDICALE, Paris, 1895. - - BROUSSAIS, F. J. V.: EXAMEN DES DOCTRINES MÉDICALES, - troisième edition (4 vols.), Paris, 1829–1834. - - CABANÈS: PARACELSE--L’HOMME ET L’ŒUVRE, article in _La Revue - Scientifique_, Paris, May 19, 1894. - - CASALIS: DE PROFANIS ROMANORUM RITIBUS; Chapter VII., DE - AESCULAPIO, Rome, 1644. - - CELSE, A. C.: TRAITÉ DE MÉDECINE; traduction par le Dr. A. - Védrènes, Paris, 1876. - - CHEREAU: LES ANCIENNES ÉCOLES DE MÉDECINE DE LA RUE DE LA - BUCHERIE, Paris, 1866. - - CULLEN, WILLIAM: FIRST LINES OF THE PRACTICE OF MEDICINE, - Edinburgh, 1802. (2 vols.) - - DAREMBERG, CHARLES: ŒUVRES ANATOMIQUES, PHYSIOLOGIQUES ET - MÉDICALES DE GALIEN, 2 vols., Paris, 1854–1856; ÉTAT DE LA - MÉDECINE ENTRE HOMÈRE ET HIPPOCRATE, Paris, 1869; HISTOIRE DES - SCIENCES MÉDICALES, 2 vols., Paris, 1870. - - DEZEIMERIS, OLLIVIER ET RAIGE-DELORME: DICTIONNAIRE HIST. DE LA - MÉD. ANC. ET MOD., 3 vols., Paris, 1828–1837. - - DIOSKURIDES, PEDANIOS: ARZNEIMITTELLEHRE, Uebersetzung von Dr. - J. Berendes, Stuttgart, 1902. - - DORVEAUX, PAUL: L’ANTIDOTAIRE NICOLAI (NICOLAUS PRAEPOSITUS), - Paris, 1896. - - FALK: GALEN’S LEHRE VOM GESUNDEN UND KRANKEN NERVENSYSTEME, - Leipzig, 1871. - - FINCKENSTEIN: ZUR GESCHICHTE DER SYPHILIS, Breslau, 1870. - - FOSSEL, VIKTOR: HIERONYMUS FRACASTORO; DREI BUECHER VON DEN - CONTAGIEN, DEN KONTAGIOESEN KRANKHEITEN UND DEREN BEHANDLUNG - (1546), Leipzig, 1910. - - FRANCO, PIERRE: CHIRURGIE, Nouvelle édition par E. Nicaise, - Paris, 1895. - - FREIND, J.: THE HISTORY OF PHYSICK, 2d edition, London, 1727. (2 - vols.) - - FRIEDLAENDER, L. H.: VORLESUNGEN UEBER DIE GESCHICHTE DER - HEILKUNDE, Leipzig, 1839. - - FROELICH, H.: GALEN UEBER KRANKHEITSVORTAEUSCHUNGEN, in - Friedrich’s Blaetter fuer Gerichtliche Medicin, I. Heft, - vierzigster Jahrgang, Nuernberg, 1889. - - GERMAIN, A.: L’ÉCOLE DE MÉDECINE DE MONTPELLIER, Montpellier, - 1880. - - GUERINI: A HISTORY OF DENTISTRY, etc., Philadelphia and New - York, 1909. - - VON GURLT: GESCHICHTE DER CHIRURGIE, Berlin, 1898. (3 vols.) - - GUY DE CHAULIAC: LA GRANDE CHIRURGIE, edited by Edouard Nicaise, - Paris, 1890. - - HAESER, H.: LEHRBUCH DER GESCHICHTE DER MEDICIN, zweite Ausgabe, - Jena, 1868. (3d edition, 1875.) - - VON HALLER, ALBERT: BIBLIOTHECA MEDICINAE PRACTICAE, Basel, - 1776. (4 vols.) - - HERODOTUS: HISTORY, translated by George Rawlinson, M.A. (2 - vols.) - - HIPPOCRATES: SAEMMTLICHE WERKE, translated into German by Dr. - Robert Fuchs (3 vols.), Munich, 1895–1900. - - HIRSCH, AUGUST: GESCHICHTE DER MED. WISSENSCHAFTEN IN - DEUTSCHLAND, Muenchen und Leipzig, 1893. - - HOLLAENDER, EUGEN: DIE MEDIZIN IN DER KLASSISCHEN MALEREI, - Stuttgart, 1903; PLASTIK UND MEDIZIN, Stuttgart, 1912. - - HOMER: THE ILIAD AND THE ODYSSEY, published by Dent & Sons, - London. (2 vols.) - - HYRTL, JOSEPH: LEHRBUCH DER ANATOMIE DES MENSCHEN, Vienna, 1846. - - JUSSERAND, J. J.: ENGLISH WAYFARING LIFE IN THE MIDDLE AGES - (14th century), G. P. Putnam’s Sons, New York and London, 1889. - - LABOULBÈNE, M. A.: SYNDENHAM ET SON OEUVRE, article in the - _Revue Scientifique_, Tome XLVIII, November 28, 1891. - - LE CLERC, DANIEL: HISTOIRE DE LA MÉDECINE, Amsterdam, 1723. - - LE CLERC, LUCIEN: HISTOIRE DE LA MÉDECINE ARABE (2 vols.), - Paris, 1876. - - LEMOINE, ALBERT: LE VITALISME ET L’ANIMISME DE STAHL, Paris, - 1864. - - MALGAIGNE: OEUVRES COMPLÈTES D’AMBROISE PARÉ, 1840–1841, (3 - vols.) - - MEYER-STEINEG: CORNELIUS CELSUS UEBER GRUNDFRAGEN DER MEDIZIN, - Leipzig, 1912; KRANKEN-ANSTALTEN IM GRIECHISCHROEMISCHEN - ALTERTUM, Jena, 1912. - - VON MEYER, E.: GESCHICHTE DER CHEMIE, 3d edition, Leipzig, 1905. - - MOMMSEN, THEODORE: THE HISTORY OF ROME, translated from the - German by W. P. Dickson and published by Dent & Sons, London. - - MUENZ, ISAAC: UEBER DIE JUEDISCHEN AERZTE IM MITTELALTER, - Berlin, 1887. - - NEUBURGER, ALBERT: FRIEDRICH HOFFMANN UEBER DAS KOHLENOXYDGAS, - Leipzig, 1912. - - NEUBURGER, MAX: GESCHICHTE DER MEDIZIN, Vol. I. and Vol. II., - zweiter Theil, 1906–1911. - - OPITZ, KARL: DIE MEDIZIN IM KORAN, Stuttgart, 1906. - - ORDRONAUX, JOHN: _Regimen sanitatis Salernitanum_, translated - into English verse, Philadelphia, 1871. - - PAGEL, JULIUS: EINFUEHRUNG IN DIE GESCHICHTE DER MEDICIN, - Berlin, 1898. - - PESSINA VON CECHOROD, W. M.: HEILIGE AERZTE UND PFLEGER DER - KRANKEN, Prag, 1859. - - PETERSEN, JULIUS: HAUPTMOMENTE IN DER GESCHICHTLICHEN - ENTWICKELUNG DER MEDICINISCHEN THERAPIE, Copenhagen, 1877. - - PLATO: THE REPUBLIC, TIMAEUS, AND CRITIAS, translated by Henry - Davis, London, 1911. - - PLATTER, FELIX ET THOMAS, à Montpellier (1552–1557; 1595–1599), - Montpellier, 1892. - - PRISCIANUS, THEODORUS: uebersetzt von Dr. Meyer-Steineg, Jena, - 1909. - - PUSCHMANN, THEODOR: THE ORIGINAL GREEK TEXT AND A GERMAN - TRANSLATION OF ALEXANDER OF TRALLES, Vienna, 1878; and - GESCHICHTE DES MEDICINISCHEN UNTERRICHTS, Leipzig, 1889. - - RUFUS D’EPHÉSE: OEUVRES, traduites par Daremberg et Ruelle, - Paris, 1879. - - RENAN, ERNEST: AVERROÈS ET L’AVERROISME, 2me édition, Paris, - 1861. - - SALICET, GUILLAUME DE: CHIRURGIE, traduction par Paul Pifteau, - Toulouse, 1898. - - SCHWALBE, ERNST: VORLESUNGEN UEBER GESCHICHTE DER MEDIZIN, 2te - Auflage, Jena, 1909. - - SIEBOLD, E. VON: VERSUCH EINER GESCHICHTE DER GEBURTSHUELFE (2 - vols.), Berlin, 1839. - - SOUTH, JOHN FLINT: MEMORIALS OF THE CRAFT OF SURGERY IN ENGLAND, - edited by D’Arcy Power, M.A. Oxon., F.R.C.S. Eng., 1886. - - SPIESS, G. A.: J. B. VAN HELMONT’S SYSTEM DER MEDICIN, Frankfort - am Main, 1840. - - SPRENGEL, KURT: VERSUCH EINER PRAGMATISCHEN GESCHICHTE DER - ARZNEIKUNDE (5 vols.), Halle, 1821–1828. - - TACITUS: THE ANNALS, edited by E. H. Blankeney, Dent & Sons, - London. - - TSINTSIROPOULOS, CONSTANTIN: LA MÉDECINE GRECQUE DEPUIS - ASCLÉPIADE JUSQU’ À GALIEN, Paris, 1892. - - WELLMANN, MAX: DIE PNEUMATISCHE SCHULE, Berlin, 1895. - - WISEMAN, RICHARD: EIGHT SURGICAL TREATISES, 5th edition, London, - 1719. - - - - - GENERAL INDEX - - - A - - ABDOMEN, penetrating wounds of, 469 - - ABELLA, teacher of medicine at Salerno, 245 - - ABOU BEKR, distinguished Arab physician in Spain, 232 - - ABOU SAHL EL MESSIHY, distinguished Persian physician, 223 - - ABSCESS, mediastinal, 229 - - ABULCASIS, famous Arab surgeon, 226 - - ABULPHARAGIUS, 184 - - ACADÉMIE DE CHIRURGIE, Paris (1731), 450 - - ACADÉMIE DES CURIEUX DA LA NATURE, 364 - - ACADÉMIE DES SCIENCES, 363 - - ACCADEMIA DEI LINCEI, Rome, 364 - - ACCADEMIA DEL CIMENTO, Florence, 364 - - ACRABADIN KEBIR, 209 - - ACUPRESSURE, 143 - - ADAMS, FREDERICK, 89 - - AEGIDIUS CORBOLIENSIS, 255 - - AENEAS, wounded in groin, 49 - - AESCULAPIUS, 47, 49 - symbol of, 315 - temple of, at Cos, 514 - - AËTIUS, 194, 318 - - AFFLACIUS, JOHN, 245, 248 - - AGATHINUS, 142 - - AGRATE, MARCO, 339 - - AIGLE, daughter of Aesculapius, 50 - - ALAE NASI, Galen’s comments on movements of, 173 - - ALBERT VON BOLLSTEDT (Albertus Magnus), 269 - - ALCMAEON, 73, 79 - - ALDEROTTI, THADDEUS, 272 - - ALEXANDER OF TRALLES, 195 - - ALEXANDER PHILALETHES, 115 - - ALEXANDER THE GREAT, 100 - - ALEXANDRIA, EGYPT, 100, 116 - - ALHAZEN, researches in optics, 233 - - ALKALOIDS (quintessences of Paracelsus), 405 - - ALMANSUR, Caliph of Bagdad, 184, 203 - - ALMENAR, JUAN, 544 - - ALPHANUS II., Abbot of Monte Cassino, 239 - - ALSAHARAVIUS, 227 - - ALU, 13 - - AMATUS LUSITANUS, 484, 487 - - AMBROSIA, antidote for poisons, 112 - - AMPUTATION OF LEG (Fig.), 463 - - AMROU, 116, 185 - - AMULETS and other magical remedies, 197 - - ANAESTHESIA, SURGICAL, from employment of soporific sponges, 253, - 462 - - ANATOMICAL DEMONSTRATIONS at Salerno, 253 - - ANATOMICAL SPECIMENS, preservation of, 356 - - ANATOMY AND PHYSIOLOGY, important discoveries during 16th century, - 353 - - ANATOMY, importance of study of, 312 - - ANATOMY, MICROSCOPIC, 360 - - ANAXIMANDER, 72 - - ANAXIMENES, 72 - - ANDREAS OF CARYSTUS, 114 - - ANIMISM, 405, 432 - - ANTIDOTARIUM, early name for pharmacopoeia, 319 - - ANTIDOTARIUM NICOLAI, 548 - - ANTIMONY, curative action of, 158, 548 - - ANTIOCHUS, cured by Erasistratus, 106 - - ANTONINUS PIUS, 57 - - ANTRUM OF HIGHMORE, 359 - - ANTYLLUS, 143, 201 - - APES, dissection of, 164 - - APOLLO, the god of medicine, 18, 50 - - APOLLONIUS MUS, 111 - - APOTHECARY, 316, 319 - - APPARATUS MAGNUS (operation for stone in the bladder), 474 - - APULEIUS, LUCIUS, 120, 126 - - AQUA VITAE, how prepared, 313 - - ARABIAN PHYSICIANS, dogmatism of, 412 - - ARAB RENAISSANCE, 203, 217, 233, 259 - - ARANTIAN OPERATION, a substitute for Tagliacotian operation, 481 - - ARANZIO or ARANTIUS, 349, 481 - - ARCEO, FRANCISCO, 484, 486 - - ARCHAEUS INFLUUS and ARCHAEUS INSITUS, 399 - - ARCHAGATHUS, 119 - - ARCHIGENES, 142, 174 - on ligation of larger blood-vessels before amputation of a limb, - 470 - - ARCHIMATHAEUS, 248 - - ARDERNE, JOHN, 307 - - ARETAEUS, 144 - - ARISTOPHANES, 58 - - ARISTOTLE, 73, 102, 433 - commentary by Averroes, 229 - - ARNOLD, of Villanova, 292–296 - - ARROW, EXTRACTION OF, from chest during battle (Fig.), 461 - - ARS PARVA, of Galen, 248 - - ARTERIES, ligaturing of divided, after an amputation, 289 - - ARTERIOTOMY, for relief of hemicrania, 470 - - ARTERY FORCEPS devised by Ambroise Paré, 512 - - ASAKKU, the demon who produces fever in the head, 13 - - ASCLEPIADES, founder of a new sect at Rome, 116, 119, 122 - - ASCLEPIEIA, 50, 52, 57 - - ASCLEPIEION at Cos (Figs.), 53 - at Epidaurus, 52 - - ASELLI, CASPAR, 385 - - ASSYRIAN MEDICINE, 11 - - ASTRINGENTS, 133 - - ASTROLOGER, a typical, 12 - - ASTROLOGERS in Babylonia, 14 - - ASTRUC, JEAN, 548 - - ATHENAEUS, founder of sect of Pneumatists, 141 - - ATHENS, a great medical centre, 96 - epidemic of the Plague at, 96 - - ATHLETIC EXERCISES as a therapeutic measure, 69 - - ATHOTIS, 17 - - AUGUSTUS, Roman Emperor, cured of gout by hydrotherapy, 129 - - AURICLES OF THE HEART, comments on, by H. de Mondeville, 290 - - AUSCULTATION of the chest, 20, 159 - - AUSTRICHILDIS, King Guntram’s wife, 240, 241 - - AUTHORS, numerous in Cordova in 12th century, 232 - - AVERROES, pupil of Avenzoar, 229 - - AVERROISM, 267 - - AVENZOAR, 228 - - AVICENNA, 221 - - - B - - BABYLONIA, genuine remedial agents employed in, 13 - - BABYLONIAN ASTROLOGERS, 14 - - BABYLONIANS, strange beliefs held by, in regard to human anatomy - and physiology, 13 - - BACON, FRANCIS, 338 - - BACON, ROGER, 271 - - BACTERIOLOGY, first studies in, 362 - - BAGDAD, a second great hospital founded at, in A. D. 914, 219 - - BAIN, CHRISTOPHER, 396 - - BAKHTICHOU BEN DJORDIS, 205, 207 - - BAKHTICHOU, GEORGE, 205 - - BARBARIC LATIN, 262 - - BARBERS, the earliest surgeons in France, 530 - - BARBERS AND BARBER-SURGEONS, 282, 369, 449, 464 - - BARBER-SURGEONS’ COMPANY, of London, 519 - - BARTHOLOMAEUS, 245 - - BASEILHAC, JEAN, 552 - - BASEILHAC, PASCAL, 496 - - BASEL, public dissection of human body at, 455 - visited by Vesalius in 1542, 455 - - BATHS extensively used by ancients, 157, 323 - - BAUDELOCQUE, 539 - - BEDE, THE VENERABLE, believed in cures by supernatural means, 241 - - BELLADONNA, when first used for dilating the pupils, 157 - - BENEDICTINE MONASTERY on Monte Cassino, 238 - - BENIVENI, ANTONIO, 389, 498 - - BENVENUTO CELLINI, 341 - - BERENDES, 159, 317, 322, 426 - - BERENGARIUS OF CARPI, 342, 374 - - BERNARDO DI RAPALLO, 472 - - BERTHARIUS, abbot of Monte Cassino, 239 - - BERTHELOT, on Geber, 320 - - BERTRUCIUS, 310 - - BILE, black and yellow, 86 - manner of production, 109 - - BLADDER, tuberculous ulceration of, 200 - - BLANCAARD, STEPHEN, 359 - - BLOOD, inflammation of (Sydenham), 423 - production of, according to Erasistratus, 109 - spirituous, 373 - transfusion of, 408 - - BLOODLETTING, comments on, by Celsus, 152 - from a vein, technique, 152 - how practice first originated, 6 - rule of Hippocrates regarding, 411 - under what circumstances advisable, 133 - - BLOOD-VESSELS, CAPILLARY, circulation in, 383 - when first injected artificially, 356, 359 - - BOERHAAVE, HERMANN, 144, 438, 441 - gives clinical instruction at Leyden, 430 - treatise on chemistry the standard for many years, 440 - - BOILING OF DRINKING WATER practiced by ancient Persians, 26 - - BOLOGNA MEDICAL SCHOOL, 272, 281, 332 - - BONIFACE VIII., POPE, successfully treated for stone in the - bladder, 293 - - BOOKS, great demand for, in 15th century, 329 - - BORELLI, ALPHONSO, 368 - - BOTALLO, LEONARDO, 413 - - BOTANICAL GARDENS, 17, 392, 393 - - BOUGIES, URETHRAL, 495 - - BOURGEOIS, LOUISE, 536 - - BOYLE, ROBERT, a distinguished chemist, 406 - - BRANCA, father and son, skilled in rhinoplasty, 459 - - BRASSAVOLA, experimental pharmacologist, 398 - - BREVIARIUM, ARNOLD’S, 294 - - BRIGGS, WILLIAM, 545 - - BRISSOT, PIERRE, 411 - - BRONZE SURGICAL KNIVES, 16 - - BROWNE, ANDREW, the friend of Sydenham, 422, 424 - - BRUNNER, JOHANN CONRAD, 359 - - BRUNSCHWIG, HIERONYMUS, 456 - - BRUNUS, 277 - - BULLETS not hot when they enter the flesh, 513 - - BURINNA, name of spring on the Island of Cos, 54 - - BYZANTIUM, the new capital of the Roman Empire, 180 - - - C - - CABANÈS, 402 - - CACAO, 395 - - CAELIUS AURELIANUS, 132, 159 - - CAESAR, JULIUS, liberality of, toward foreign physicians settled - in Rome, 119 - - CAESALPINUS, ANDREAS, 372, 375, 394 - - CAESARIAN SECTION, 396, 534 - - CAIRO PHYSICIANS distinguished ophthalmologists, 225 - - CALCAR, Vesalius’ draughtsman, 344 - - CALCULUS in the bladder may not be dissolved by internal remedies, - 498 - - CALLIDUM INNATUM of Hippocrates, 415 - - CALVIN, JOHN, visited by Felix Platter, 335 - - CANCER OF BREAST, sculptured in marble (Fig.), 68 - - CANCER, ULCERATED, not to be cauterized, 285 - - CANNANI, 378 - - CANON, THE, of Avicenna, 222 - - CAPSICUM, 395 - - CARAKA, East Indian medical author, 31 - - CARBONIC ACID, nature of, expounded by Van Helmont, 400 - - CARBONOUS OXIDE, 434 - - CARCANO LEONE, 475, 476 - - CASE HISTORIES recorded on tablets, 67 - - CASSIODORUS, 238 - - CASTOR OIL, perfected by Apollonius Mus, 111 - - CATARACT OPERATIONS of Pierre Franco, 494 - - CATO, MARCUS PORCIUS, 117, 235 - - CAUSTICS, too freely used as haemostatics, 466 - - CAUTERIZATION of ulcerated cancer not approved by Lanfranchi, 285 - - CAUTERIZING INSTRUMENTS, 279 - - CELSUS, AULUS CORNELIUS, 150, 151, 155 - - CEREBRAL NERVES, crossing of, in relation to paralysis of one side - of the body, 144 - - CERMISONE, ANTONIO, 313 - - CHAMBERLEN, HUGH, 538 - - CHALDEAN DOCTRINE OF NUMBERS, 74 - - CHARCOAL, fumes of burning, 435 - - CHAUCER’S ACCOUNT of a clever physician, 308 - - CHEMICAL ELEMENT defined, 407 - - CHEMISTRY in ancient Egypt, 17 - modern, developed gradually from alchemy, 320 - - CHICORY an effective remedy in abdominal diseases, 109 - - CHINESE CONCEPTIONS concerning human physiology, 41 - - CHINESE MEDICINE, 38, 39 - - CHIRON, 48 - - CHRISTIANITY, influence of, upon evolution of medicine, 179 - - CHRYSIPPUS, 141 - - CHYLE, distribution of, after it leaves the stomach, 109 - - CHYLE DUCTS, discovery of, 385 - - CICERO’S INTERPRETATION of the expression “gods” as employed by - the ancients, 18 - - CINCHONA, discovery of, 408 - - CIRCA INSTANS, the title commonly given to treatise of Matthew - Platearius, 253 - - CIRCULATION OF BLOOD, Galen’s physiology of, 373 - de Mondeville’s comments, 289 - - CITIZENSHIP, rights of, bestowed by Julius Caesar on all foreign - physicians practicing in Rome, 119, 130 - - CIVITAS HIPPOCRATICA, 243 - - CLAUDIUS, Roman Emperor, merciful action of, toward slaves, 235 - - CLEMENS, of Alexandria, Egypt, 17 - - CLEMENT IV., POPE, protects Roger Bacon, 272 - - CLEMENT V., POPE, removes papal seat from Rome to Avignon, 293 - - CLINICAL INSTRUCTION at Leyden Hospital, 429 - - CLOWES, William, 519 - - CNIDIAN SCHOOL OF MEDICINE, 81 - - CNIDUS, in Caria, Asia Minor, 51 - - COCA, 395 - - COLD, exposure to, unusual treatment of, 489 - - COLLEGE OF PHYSICIANS, London, 417 - - COLLEGE OF SAINT COSMAS, Paris, 283, 284, 448 - - COLLIGET, title of treatise written by Averroes, 229 - - COLOT, LAURENT, famous French lithotomist, 474 - - COLUMBUS, REALDUS, 349 - experiments relating to physiology of heart, 377 - - CÔME, FRÈRE, 550 - - COMMUNITIES, term employed by the Methodists for designating the - two conditions “laxum” and “strictum,” 130 - - COMPENDIUM AROMATARIORUM, the first modern treatise on materia - medica, 320 - - COMPENDIUM SALERNITANUM, 246 - - CONCILIATOR, title of one of Pietro d’Abano’s great works, 266, 267 - - CONSTANTINOPLE, taking of, by the Turks, an important aid to the - advance of medicine, 328 - - CONSTANTINUS THE AFRICAN, 239, 248, 260 - - CONTAGION, INNATE, 220 - - CONTAGIOUS DISEASES, Fracastoro’s classification of, 390 - - CONTINENS, title of Rhazes’ great work, 220, 262 - - CONTRARIA CONTRARIIS, principle of, in therapeutics, 132 - - COSMAS AND DAMIAN, 282, 449 - - COPAIVA, BALSAM OF, 395 - - COPHON, teacher of medicine at Salerno, 245 - - CORDOVA, SPAIN, centre of great intellectual activity, 218, 232 - - CORPSE, the touching of a, believed by the Persians to produce a - special contamination, 25 - - COS, ISLAND OF (Figs.), 53 - - COSTA BEN LUCA, 215, 216 - - COSTANZA CALENDA, 245 - - COWPER, WILLIAM, 360 - - CROKE, A., 250 - - CRONOS, 19 - - CROTONA, ITALY, 51 - - CULLEN, WILLIAM, 432 - - CURTIS, JOHN G., 72, 140 - - CYRENE, in Lybia, Africa, 51 - - CYSTOTOMY, HYPOGASTRIC, 495 - - - D - - DAMASCUS, an active medical centre in the 13th century, 225, 232 - - DAREMBERG, 50, 75, 240, 420 - - DARIUS I., King of the Persians, 26, 75 - - DAVID’S HARP-PLAYING, effect of, on King Saul’s melancholia, 27 - - DA VINCI, LEONARDO, 339 - - DAZA CHACON, 484 - - DE LE BOË, FRANZ, 427 - - DE MARCHETTIS, DOMENICO, 359 - - DEMETRIUS, OF APAMEA, 114 - - DEMOCEDES, 73, 75 - - DEMOCRITUS, 82 - - DEMOSTHENES, OF MARSEILLES, 115 - - DENYS, OF PARIS, 408 - - DESIDERIUS, Abbot of Monte Cassino, 239 - - DEZEIMERIS, 341, 400 - - DIETETICS OF PREGNANT WOMEN, 199 - - DIETING AND ATHLETIC EXERCISES, 69 - - DIETZ, REINHOLD, discoverer of an early Greek manuscript of - Soranus, 138 - - DIGESTION, physiology of, according to Erasistratus, 108 - according to Aretaeus, 144 - - DIOCLES, of Carystos, 103 - - DIONIS, PIERRE, distinguished French anatomist, 41, 364, 383, 540 - - DIOSCORIDES, PEDANIUS, 157, 317 - - DIPHTHERIA, GENUINE, recognized by Paracelsus, 405 - - DIPHTHERIA, PHARYNGEAL, known in 2d century as Syriac ulcer, 144 - - DISEASES mentioned in the papyrus Ebers, 20 - - DISLOCATION OF SHOULDER, successfully reduced by Gabriel - Bakhtichou, 207 - - DISSECTING OF HUMAN BODIES, early attempts, 309, 327, 331 - practice approved by University of Salamanca, 346 - practice made obligatory in the medical schools early in 18th - century, 364 - - DISTEMPERS of the stiff and elastic fibres (Boerhaave), 442 - - DIVINE WATER of the alchemists, 321 - - DJONDISABOUR, early establishment of a medical school at, 184, 204 - - DOCTOR, when first employed as a title, 280 - - DODOENS, REMBERT (Dodonaeus), 395 - - DOGMATISTS, sect of the, 101, 103, 149 - - DONATO, MARCELLO, 396 - - DON CARLOS, OF SPAIN, skull severely injured, 485 - - DORVEAUX, PAUL, 548 - - DOUGLAS, JAMES, 361 - - DRACHMA, value of, 207 - - DRACO, SON OF HIPPOCRATES, 82 - - DRACUNCULUS MEDINENSIS, 233 - - DRUGS, enumerated by Homer in the Odyssey, 18 - enumerated by Dioscorides, 18 - remedial effects of, 398 - - DRY TREATMENT OF WOUNDS, 275, 285 - - DUBOIS, JACQUES (Sylvius), the anatomist, 340, 345 - - DYSENTERY, East Indian treatment of, 409 - - - E - - EAR, cherry pit in, 396 - fatal disease of, 489 - - EAST INDIAN SURGEONS performed suprapubic cystotomy before the - Christian era, 497 - - EBEN EL KHAMMAR, a distinguished Persian physician, 222 - - EBERS PAPYRUS, the, 20 - - ECLECTICS, THE, 142, 149 - - EGYPT, ANCIENT, practice of medicine in, 16, 17 - process of embalming in, 17 - temples were used as hospitals and as medical schools, as well as - for purposes of worship, 19 - - EGYPTIANS, THE ANCIENT, surgical instruments used by, 21 - surgical methods employed by, 21 - therapeutics of, 20 - they were good sanitarians, 23 - they were the originators of many of the Mosaic laws, 27 - - ELEATIC SCHOOL OF PHILOSOPHY, 73 - - ELBOW-JOINT, EXARTICULATION OF, 508 - - ELECTRIC RAY, shocks communicated by, utilized in treatment of - severe headache, 155 - - ELISHA THE PROPHET cures Naaman’s so-called leprosy, 27 - - EMBALMING, Egyptian process of, 17 - - EMIR ADHAD EDDOULA founds a great hospital at Bagdad, 219 - - EMPEDOCLES (444 B. C.) places the seat of the hearing in the - labyrinth of the temporal bone, 80 - - EMPIRICS, sect of the, 101, 111, 149 - - ENCYCLOPAEDISTS, the, 156 - - EPICUREANS, the, 102 - - EPIDAURUS, in Argolis, Greece, 51 - - EPIONE, wife of Aesculapius, 50 - - ERASISTRATUS, 104, 106, 110 - teachings of, with regard to nature of the blood and the - circulation, 371 - - ERASMUS, on Linacre, 418 - - ÉTIENNE, ROBERT, 197 - - EUENOR, 99 - - EULER, LEONHARD, 360 - - EUPORISTA, title of Oribasius’ treatise, 192 - - EUPORISTON, title of treatise by Priscianus, 193 - - EUSTACHIUS, BARTHOLOMAEUS, 345, 348, 358, 384 - - EVIL SPIRITS, part played by, in producing disease, 8 - - EXERCISE, physical, not absolutely necessary to persons in normal - health, 125 - - EXPERIENCE, great value attached to, by Hippocrates, 148 - - - F - - FABIOLA, the widow, established the first hospital in Rome, 235 - - FABRICIUS AB ACQUAPENDENTE, 349, 351, 378, 478 - - FABRICIUS OF HILDEN, 464 - - FACIAL HEMIPARESIS, sculptured in marble (Fig.), 68 - - FALLOPIUS or FALLOPPIUS, GABRIELE, 341, 348, 360, 393, 474, 478 - - FARRAGUT, of Girgenti, Sicily, 262 - - FAUST, JOHANNES, 322 - - FEDELES, FORTUNATUS, 398 - - FEES, MEDICAL, in Babylonia, 15 - - FEVER, NATURE OF, as taught by Sydenham, 423 - - FELDBUCH DER WUNDARTZNEY, von Gerssdorff’s, 462 - - FEMUR, FRACTURE OF, 510 - - FERMENT IN BLOOD the cause of small-pox (Rhazes), 220 - - FERNEL, JEAN, 414 - - FILARIA MEDINENSIS, removal of, from boy’s leg, 489 - - FINCKENSTEIN, 543 - - FISTULA IN ANO, John Arderne’s treatise on, 307 - - FLAMMULA, 522 - - FLINT KNIVES, 9 - - FLOS MEDICINAE, title of medical treatise, 251 - - FLOURENS, 374 - - FORAMEN BOTALLI, 413 - - FORCEPS for crushing stone in the bladder (Fig.), 497 - - FORCEPS, obstetrical, invention of, 535 - - FOREEST, PETER, 413 - - FORMULARY of Sabour ben Sahl, 209 - - FOSSEL, 391 - - FRA SARPI, 378 - - FRACASTORO, HIERONYMUS, 221, 362, 389, 391 - - FRANCO, PIERRE, 490, 494, 495, 497 - - FRANCONIAN OPERATION, revived in 1719 by John Douglas of London, - 496 - - FREDERICK II., King of Sicily, promotes work of translating from - the Arabic, 261 - - FREIND, JOHN, 184, 195, 416 - - FRÈRE JACQUES DE BEAULIEU, 550 - - FRIEDLAENDER, 3 - - - G - - GABRIEL, the most distinguished member of the Bakhtichou family, - 207 - - GAIUS, OF NAPLES, a distinguished ophthalmologist, 115 - - GALE, THOMAS, 517 - - GALEAZZO DI SANTA SOFIA, Professor of Anatomy at Vienna, 311 - - GALEN, CLAUDIUS, 74, 160, 316, 344 - on the nature of the blood, 372 - on the true function of respiration, 372 - on the treatment of wounds, 275 - treatises written by, 167 - - GALENIC DOCTRINES, 400 - - GALENICAL PREPARATIONS, 317 - - GALENISM, meaning of the term, 388 - - GALENISTS, ENGLISH, in 17th century, 419 - - GALEN’S SYSTEM of therapeutics still used in Persia, 317 - - GALILEO, 546 - - GALLU, the demon who causes diseases of the hand, 13 - - GARIOPONTUS, a teacher at Salerno, 245, 247 - - GAS SYLVESTRE, 401 - - GEBER, credited with being the founder of chemistry, 233 - now believed to be a mythical personage, 320 - - GENTILE DA FOLIGNO, 266 - - GERARD OF CREMONA, 227, 261 - - GERM ORIGIN of certain febrile diseases suspected by Rhazes, 221 - - GERMANY, devastated during the 17th century, 426 - medical education in (from 1400 to 1600), 454 - - GERSSDORFF, HANS VON, 460 - - GESNER, CONRAD, 394 - - GILBERTUS ANGLICUS, 305, 516 - - GILLES DE CORBEIL, on urology, 255 - - GLADIATORS, SCHOOLS FOR, 68 - - GLAUBER’S SALT, 410 - - GLISSON, FRANCIS, 358, 546 - - GLOSSULAE QUATUOR MAGISTRORUM, 280 - - GORDONIUS, 296 - - GOURDON, BERNARD DE (Gordonius), 296 - - GOUT, remedy for, recommended by Aëtius, 195 - - GRAAF, REIGNIER DE, 359, 361 - - GRAPHEUS, BENEVENUTUS, celebrated eye surgeon of the 12th century, - 256 - - GRAVES, ROBBING OF, for dissecting material, 309, 332, 336 - - GREAT BRITAIN, condition of surgery in, during 16th and 17th - centuries, 516 - - GREEK PROVERBS relating to medicine, 77 - - GREGORY, BISHOP OF TOURS, 241 - - GRIFFON, JEAN, distinguished Genevese surgeon, 464 - - GUAIAC, inefficient anti-syphilitic remedy, 405 - - GUAINERIO, of Pavia, 496 - - GUARNA, REBECCA, 245 - - GUERICKE, OTTO VON, 546 - - GUIDO GUIDI (Vidus Vidius), the anatomist, 340 - - GUILLEMEAU, JACQUES, 536 - - GUISCARD, ROBERT, a resident at Salerno, 240 - - GULDINUS, PAUL, 409 - - GUNPOWDER, first employment of, in European warfare, 328 - - GUNSHOT WOUNDS, 467, 473 - - GURLT, VON, 455 - - GUY DE CHAULIAC, 227, 263, 298, 299, 310 - founder of didactic surgery, 300 - manner of treating injured nerves, 302 - manner of treating fractures of the thigh, 304 - - GYMNASTIC EXERCISES, institutions for cultivating, 68 - - GYNAECOLOGISTS, EARLY, 115 - - GYNAECOLOGY successfully practiced by Soranus, 140 - - - H - - HALLER, ALBERT VON, 142, 344 - - HALY, ABBAS, a Persian physician and the author of the famous - treatise called “Al-Maleky”--“The Royal Book,” 223 - - HAMMURABI’S LAW with reference to physicians’ fees in Babylonia, 15 - - HARDERWYK, UNIVERSITY OF, 439 - - HAROUN ALRASCHID, 206 - - HARVEY, WILLIAM, discoverer of the circulation of the blood, 379 - - HEAD, INJURIES OF (Wuertz), 467 - - HEART, anatomy of, according to de Mondeville, 289 - physiology of, 377 - - HEIDELBERG, UNIVERSITY OF, 454 - - HELIODORUS, 202 - - HELVETIUS, 409 - - HEMORRHAGE FROM A WOUND, different means of arresting, 154, 277 - - HENRY THE SECOND’s manner of death, 511 - - HENSCHEL, researches of, 246 - - HERAKLEIDES, OF TARENTUM, 111 - - HERCULES an ancestor of Hippocrates, 81 - - HERMETIC BOOKS relating to medicine, 18 - - HERNIA, RADICAL CURE OF, by members of the Norsa family, 482 - - HERNIA-HEALERS, 490 - - HERODICUS, of Selymbria, 69 - - HERODOTUS, a different person from the famous historian, 26, 142 - - HEROPHILUS, a distinguished physician of Chalcedon, 104 - - HERZOG, excavations made by, at Cos, 55 - - HESYCHIOS, 201 - - HEURNIUS, JOHANNES, clinical teacher at Leyden, 429 - - HIGH OPERATION for stone in the bladder (_le haut appareil_), 495, - 496 - - HIGHMORE, NATHANIEL, 359, 546 - - HINDU PHYSICIANS held very crude ideas about pathology, 31 - - HIPPOCRATES THE GREAT, 81, 82, 98, 411 - - HIPPOCRATIC OATH, 71 - - HIPPOCRATIC WRITINGS, French version of Littré, 83 - German version of Fuchs, 84 - short extracts, 89 - - HIRSCH, AUGUST, 399, 545 - - HOBEÏCH, 215 - - HOFMANN, MORITZ, 358 - - HOFFMANN, FRIEDRICH, 431, 434 - - HOFFMANN’S ANODYNE, 437 - - HOMERIC POEMS probably written about B. C. 800, 46 - - HOMER’S FAMILIARITY WITH ANATOMY, 48 - - HONEIN, 208, 212, 214, 317 - - HOSPITAL GANGRENE, Wuertz’s views regarding, 469 - - HOSPITALS in the Middle Ages, 219, 235 - - HÔTEL-DIEU AT LYONS founded in the 6th century, 236, 450 - - HÔTEL-DIEU AT PARIS over-crowded in early part of 16th century - (Fig.), 452 - - HRABANUS MAURUS, Abbot of Fulda Monastery, 241 - - HUGO BENZI (Hugo of Siena), 312 - - HUGO OF LUCCA, 275 - - HYDROTHERAPY at the Cos _Asclepieion_, 54 - in the treatment of gout, 129 - - HYGIEIA, daughter of Aesculapius, 50 - - HYOSCYAMUS, when first used for dilating the pupils, 157 - - HYRTL, JOSEPH, 311, 356, 532 - - - I - - IATREIA, or small private hospitals, 68 - - IATROCHEMISTS and IATROPHYSICISTS in 17th century, 366 - - IBRAHIM, pupil of George Bakhtichou, 206 - - IDEA MORBOSA (Van Helmont), 399 - - ILEO-CAECAL VALVE, discovery of, 350 - - ILIAD AND ODYSSEY, references in, to medicine, 47 - - INDIA, ANCIENT, rich in skilful surgeons, 35 - - INDIA, great mortality in, from bites of venomous serpents, 64 - the medicine of, 31 - - INGRASSIA, 349 - - INNOCENT XI., POPE, 392 - - INOCULATION against small-pox practiced by the Chinese in the 11th - century, 43 - - INTENTION, healing by first, 277 - - INTESTINE, wounds of, 255, 459 - - IONIAN SCHOOL OF PHILOSOPHY, 72 - - IPECACUANHA, discovery of, 408, 409 - - ISAAC, SON OF HONEIN, 215 - - ISIS, 19 - - ISOLA SAN BARTOLOMMEO, 51 - - ISRAELITES, medicine of the, 26, 27 - - ISSA BEN CHALATA, 205 - - ITINERANT LITHOTOMISTS, 549 - - - J - - JACOBUS PSYCHRESTOS, 201 - - JALAP, 395 - - JAMERIUS, author of “Chirurgia Jamati,” 255 - - JANISCUS, son of Aesculapius, 50 - - JAPANESE PHYSICIANS, modern, 45 - - JARDIN-DU-ROI, 540 - - JASO, daughter of Aesculapius, 50 - - JEAN DE VIGO, 472, 473 - - JEWISH MEDICAL STUDENTS, numerous at Montpellier, 265 - - JOHN of Arderne, 516 - of Capua, 261 - of Gaddesden, 305, 516 - of Salisbury, 264 - the Grammarian, of Alexandria, 185 - - JOURNALISM, MEDICAL, beginnings of, 545 - - JULIAN THE APOSTATE, Roman Emperor, 236, 435 - - JUSSERAND, 306 - - - K - - KERCKRING, THEODOR, 359 - - KING, EDMUND, 408 - - KITAB AL-KULLIDSCHAT (= “Colliget”), title of Averroes’ treatise, - 229 - - KOELLIKER, 455 - - - L - - LABOULBÈNE, comments on Sydenham, 425 - - LABYRINTH of temporal bone, 80 - - LANCISI, GIOVANNI MARIA, 349, 391 - discovers copper plates intended for Eustachius’ “Anatomy,” 392 - - LANFRANCHI, 282, 284 - - LANGUAGES, LEARNED, importance of acquiring a knowledge of them, - 271 - - LANOLIN, described by Dioscorides in A. D. 100, 318 - - LAPEYRONIE, FRANÇOIS DE, 531 - - LARYNGOSCOPY, DIRECT, mentioned by Savonarola, 313 - - LATIN, barbaric, 262, 300 - commonly employed by teachers of medicine in 16th and 17th - centuries, 369 - habitually spoken at Oxford and Cambridge in 17th century, 424 - - LAUDANUM, SYDENHAM’S LIQUID, formula for, 424 - - LAUREA ANGLICA, title of treatise written by Gilbertus Anglicus, - 305 - - LAXATIVES, a term originated by the Methodists, 133 - - LAXUM AND STRICTUM, 130 - - LE CLERC, DANIEL, 73, 171 - - LE CLERC, LUCIEN, 217 - - LEECH lodged in the naso-pharynx, 397 - - LEECHES, therapeutic employment of, first mentioned by Themison, - 133 - - LEEUWENHOEK, ANTON VAN, 360 - - LEG, AMPUTATION OF (Fig.), 463 - - LEIBNITZ, 363 - - LEONIDES, 201 - - LEONINE VERSIFICATION, 251 - - LEVRET, 539 - - LIBRARIES, PUBLIC, seventy possessed by Spain during the 12th - century, 232 - - LIEBREICH, originator of the term “lanolin,” 318 - - LIGATURES applied to blood-vessels by Archigenes in the early part - of 2d century, 143 - employment of, by Jean de Vigo, in 1460, 473 - used on amputation stumps, 519 - - LINACRE, THOMAS, 416 - founded two “lectures of physick” at Oxford, 417 - instrumental in securing the foundation of the College of - Physicians at London, 417 - - LIQUOR BALSAMICUS, 357 - - LITHONTRIPSY, Giovanni de Romanis supposed to be the inventor of, - 474 - - LITHOTOME OF FRÈRE CÔME (Fig.), 553 - - LITHOTOMISTS, ITINERANT, 490, 549 - - LITHOTOMY, SUPRAPUBIC, 495 - - LITHOTRITY practiced first by Beniveni in the 15th century, 498 - - LOUIS DE BOURGES, First Physician to Francis I., 414 - - LOUVAIN, UNIVERSITY OF, 345 - - LOWER, RICHARD, 408 - - LUCIUS VERUS, ROMAN EMPEROR, 165 - - LUCRUM NEGLECTUM, probable meaning of the expression, 353 - - LUKE, “THE BELOVED PHYSICIAN,” 30 - - LUTETIA, GAUL, the present city of Paris, 435 - - LUTHER, MARTIN, a believer in the “black art,” 322 - - LYMPHATICS, INTESTINAL, 385 - - LYONS, FRANCE, founding of the Hôtel-Dieu in that city - (6th century), 236 - - - M - - MACHAON AND PODALIRIUS, sons of Aesculapius, 47, 50 - - MAGATI, CESARE, 529 - - MAGGI, BARTOLOMMEO, 473 - discoverer of the fact that a bullet is not hot at moment of - inflicting a wound, 513 - - MAGICAL REMEDIES, 197 - - MAGNUS, disciple of Athenaeus, 142 - - MAGREB, 218 - - MAIMONIDES, esteemed the greatest Jew after Moses, 230 - - MALEVOLENT SPIRITS, capable of producing disease, 8 - - MALPIGHI, 360, 361 - - MANARDUS, JOHANNES, 389 - - MANFRED, KING OF SICILY, 262 - founds a university at Naples in 1258 A. D., 257 - - MANUSCRIPTS, MEDICAL, transcribing of, at Monastery of Saint Gall, - 244 - - MARC ANTONIO DELLA TORRE, 339 - - MARCUS AURELIUS, Roman Emperor, 165 - - MARIANUS SANCTUS, 474 - - MARIOTTE, EDME, 546 - - MARTYRDOM OF CHRISTIAN PHYSICIANS, 180 - - MASTER OF MEDICINE, grade of, 304 - - MATERIA MEDICA, early Greek, 158 - first modern treatise on (1447), 320 - - MAURICEAU, FRANÇOIS, 537 - - MAURUS, teacher of medicine at Salerno, 245 - - MAYERNE, TURQUET DE, 547 - - MEAUX SAINT-MARC, translator of “Schola Salernitana” into French, - 250 - - MEDIASTINITIS, case of, 228 - - MEDICAL TEACHING in Ancient Greece, 70, 85 - in the Asclepieia, 69 - - MEDICAL TREATISES, GREEK, destruction of, in Rome, during the 5th - century, 185 - - MEDICINE, beginnings of a rational system of, 67 - development of different sects, after the death of Hippocrates, - 101 - evolution of, as affected by the Arab Renaissance, 203, 233 - God of, 50 - influence of the Italian Renaissance upon, 260 - mediaeval, 191 - practice of, at Rome, in century preceding Christian era, 117 - pre-Homeric period of, in Greece, 46 - relation of monasteries to, 238 - slowness of development of, 3 - - MEDICINE MAN of the Indian tribes the earliest type of the - physician, 8 - - MEDINA WORM discovered by Abulcasis, 233 - - MEMBRANA RUYSCHIANA, 357 - - MENELAÜS wounded at siege of Troy, 48 - - MENOCRITUS, physician, honored by a marble column in Greece, 99 - - MERCURIADE, teacher of medicine at Salerno, 245 - - MESOPOTAMIA, medicine in, 11 - - MESUÉ, JOHN, THE ELDER, 209 - - METASYNCRISIS, a term originated by Thessalus, 136 - - METHODISTS, school of the, 129, 138, 149 - - MEYER, ERNEST VON, 400 - - MEYER-STEINEG, of Jena, Germany, 16, 52, 53, 68, 120, 129, 134, - 142 - - MICHAEL SCOTUS, 262 - - MICROSCOPIC ANATOMY, first beginnings of, 360, 362 - - MIGRAINE relieved by arteriotomy, 470 - - MIKROTECHNE of Galen, 248 - - MINDERER, RAYMOND, 407 - - MINERAL WATERS employed extensively by the ancients in the form of - baths, 157 - - MIRACH, 521 - - MIRFELD, JOHN, 306 - - MISOPOGON, title of satire written by Julian the Apostate, 436 - - MITHRIDATES, 127 - - MITHRIDATICUM, composition of, 112 - - MIXTUM, term employed by the Methodists, 131 - - MOMMSEN, 235 - - MONASTERIES in the Middle Ages, 181, 235 - relation of, to medicine, 238 - - MONDEVILLE, HENRI DE (Fig.), 287, 288, 289, 291 - - MONDINO, the anatomist, 274, 280, 312, 332 - - MONKS obliged to practice medicine during the Middle Ages, 141, 154 - - MONTE CASSINO, founding of Benedictine monastery on, 238, 239 - - MONTPELLIER, Medical School of, 264, 292, 332 - - MORBUS GALLICUS, 543 - - MOSAIC LAWS, the, related particularly to social hygiene, 26 - - MOSCHION, pupil of Soranus, 139 - - MOTASSEM, CALIPH, 210 - - MOXAE, MOXIBUSTION, 44 - - MURPHY’S BUTTON, Pfolspeundt’s (15th century) prototype of, 459 - - MUSA, ANTONIUS, physician of Emperor Augustus, 129 - - MUSANDINUS, 245, 254 - - MUSULMANS as zealous as the Christians in establishing hospitals, - 237 - - - N - - NAAMAN’S SO-CALLED LEPROSY cured by the prophet Elisha, 27 - - NAMTAR, the special demon of the Plague, 13 - - NAPLES, university established at, in 1258 A. D., 257 - - NASAL CAVITY, illuminating the, 482 - - NEO-LATIN, 262 - - NEOLITHIC AGE, state of medical knowledge during the, 9 - - NEPENTHES, 49 - - NERVES, WOUNDS OF, comments of Guy de Chauliac upon, 302 - - NEUBURGER, MAX, 24, 41, 51, 84, 132, 222, 228, 231, 249 - - NEWTON, SIR ISAAC, 546 - - NICAISE, EDOUARD, 228, 263, 282, 287, 300 - - NICHOLAS, THE MONK, sent by the Emperor Romanus to Cordova as an - interpreter of Dioscorides, 226 - - NICOLAUS MYREPSUS, 318 - - NICOLAUS PRAEPOSITUS, Antidotarium of, 253 - - NICOTINE, the alkaloid found in tobacco, 395 - - NORSA FAMILY, celebrated as operators for the radical cure of - hernia, 482 - - NUCK, ANTON, the anatomist, 359, 439 - - NUFER, JACOB, 534 - - - O - - OATH, HIPPOCRATIC, 71 - - OBSTETRIC METHODS, rational, of Soranus, 138, 139 - - OBSTETRICAL FORCEPS, 535 - - OBSTETRICS, practice of, in ancient Egypt, 17 - - ODYSSEY, reference to drugs in the, 18 - - OIL OF ST. JOHN’S WORT, 522 - - OISYPUM (LANOLIN), first described by Dioscorides (100 A. D.), 318 - - OLD TESTAMENT, medicine of the, 26 - - OLEUM HYPERICI, 522 - - ONASILOS, a physician, bronze tablet in honor of (5th century - B. C.), found in Island of Cyprus, 99 - - OPEDELDOCH, 404 - - OPHTHALMOLOGISTS, EARLY, 115 - - OPHTHALMOLOGY, important contributions to, 546 - - OPIUM, probably the drug referred to by term “nepenthes,” 49 - proper manner of obtaining, first described by Scribonius Largus, - 155 - Sydenham’s opinion with regard to the value of, 424 - - OPORINUS, Paracelsus’ assistant, 404 - - ORDRONAUX, JOHN, 250, 252 - - ORIBASIUS, 191 - - ORIENTAL MEDICINE, 11 - - OSIRIS, or Serapis, 19 - - OVER-EATING, according to the ancient Egyptians, is the cause of - the majority of diseases, 22 - - - P - - PADUA MEDICAL SCHOOL, 267, 352 - - PAGEL, 57 - - PALERMO, SICILY, a great centre of literary activity, 261 - - PANADOES, how prepared, 443 - - PANAKEIA, daughter of Aesculapius, 50 - - PANCREAS, outlet duct of, discovered in 1641, 358 - - PAPER, INVENTION OF, 328 - - PAPIN, DENIS, 547 - - PARACELSUS, 369, 401, 405, 465 - monument in honor of, at Basel, 406 - pharmaceutical preparations of, 404 - sayings of, 403 - treatises published by, 403 - - PARACENTESIS ABDOMINIS, 110, 124 - - PARAMIRUM, title of Paracelsus’ principal treatise, 403 - - PARCHMENT invented at Pergamum in 3d century B. C., 101 - - PARÉ, AMBROISE (Figs.), 404, 499, 500, 502, 515 - abandons use of boiling oil, 503 - arrests bleeding from divided blood-vessels by use of ligatures, - 512 - bitter jealousy shown by his contemporaries, 501 - charge of plagiarism against him not sustained, 514 - devises artery forceps and other surgical apparatus, 512 - exarticulation of elbow-joint performed by him, 508 - some of his sayings, 500, 501 - summary of his more important achievements in surgery, 513 - treatise on surgery not published in English until 1577, 518 - - PARIS MEDICAL SCHOOL, 282 - - PARMENIDES, 73 - - PARRENIN, FATHER, Jesuit missionary, 541 - - PASON (= APOLLO), who invented the art of medicine, 18 - - PASSAVANT, Dean of the Collège de St. Côme at Paris, 284 - - PASSIONARIUS, title of Gariopontus’ treatise, 247 - - PATHOLOGY, Fernel’s scheme of, 415 - views held by Hippocrates, 86 - - PATHOLOGY, INTERNAL, 389 - - PATROCLUS dresses the wound of Eurypylus, 49 - - PAUL, THE APOSTLE, bitten by a poisonous snake on the Island of - Melita, 29 - - PAULUS AEGINETA, 199, 227, 318 - - PECQUET, JEAN, rediscovers thoracic duct (in a dog), 384 - - PERICARDIUM, ABSCESS IN THE, Avenzoar refers to its actual - occurrence, 229 - - PERIODEUTS or ambulant physicians, 75 - - PERSIANS, THE ANCIENT, medicine of, 25 - took very little interest in surgery, 26 - - PETER THE GREAT purchases Ruysch’s anatomical collection, 356 - - PETRONCELLUS, a teacher of medicine at Salerno, 245 - - PEYER, JOHANN CONRAD, 359 - - PFOLSPEUNDT, HEINRICH VON, 458, 460 - - PHARMACIST, early use of the term, 316 - - PHARMACOLOGY, earliest treatise on, published by Dioscorides in - 77 A. D., 158 - - PHARMACOPOEIA, modern term for antidotarium, 319 - Augsburg, compiled by Minderer, 407 - modern, beginnings of, 547 - of India, very rich, 33 - - PHARMACY, in its infancy, 315 - first regularly established in the 8th century, 318 - - PHARMAKON, term employed by Galen for a remedial drug, 316 - - PHILINUS OF COS, 111 - - PHILOSOPHERS’ STONE, 321 - - PHILOSOPHY, SCHOOLS OF, in Greece and its colonies, 72 - - PHYSICIANS, consultation of (Fig.), 457 - honored publicly in ancient Greece, 98, 99, 100 - more highly esteemed than surgeons in 14th century, 304 - suffered martyrdom for their Christian faith, 180 - - PHYSIOLOGY, HUMAN, views held by Hippocrates, 86 - - PIETRO D’ABANO, 266 - - PINEAU FAMILY, lithotomists, 549 - - PINI, anatomical draughtsman, 348, 392 - - PITARD, JEHAN, Surgeon of Louis IX., 448, 530 - - PITCAIRN, ARCHIBALD, 367 - - PLAGUE AT ATHENS, history of, by Thucydides, 96 - - PLAGUE, THE, avoidance of, by Galen, 164 - - PLANTS, MEDICINAL VIRTUES OF, 157 - - PLATEARIUS, John and Matthew, teachers of medicine at Salerno, 245 - - PLATO, 73, 78 - views of, with regard to women physicians, 77 - - PLATTER, FELIX, 336, 396, 455 - early experiences at Montpellier, 332 - - PLEURISY, Boerhaave’s manner of treating it, 444 - - PLINY THE ELDER, 155 - - PNEUMA, or breath, plays the most important rôle in the mechanism - of life, 108 - or vital spirit, 141 - - PNEUMATISM not popular with the physicians of Rome, 142 - - PNEUMATISTS, the, 141 - - PODALIC VERSION, 535, 537 - - PODALIRIUS, 47 - - POISONOUS SNAKES, loss of life caused by the bites of, 64 - - POLYBUS, son-in-law of Hippocrates, 82 - - POMPEII, physicians’ houses disinterred at, 315 - - PONS VAROLII, 350 - - PORES, system of, for conveyance of tissue juices, 122 - - PORTAL, PAUL, 539 - - POULTICES, too free use of, condemned, 467 - - POWER, D’ARCY, 307 - - PRACTICA CHIRURGIAE of Roger, 254 - - PRACTICA OCULORUM of Benevenutus Grapheus, 256 - - PRACTICA of Bartholomaeus, 248 - - PRACTICA of Cophon the Younger, 249 - - PRACTITIONERS, improper behavior of, in the sick room, 193 - - PRAEPOSITUS, meaning of the term, 253 - - PRAXAGORAS OF COS, 103 - probably the first to distinguish the difference between arteries - and veins, 103 - - PRAYER FORMULAE employed by the Babylonians as protective remedies, - 13 - - PREGNANT WOMEN, dietetics of, 199 - - PREHISTORIC PERIOD of science of medicine, 4 - - PRE-HOMERIC PERIOD of medicine in Greece, 46 - - PRESCRIPTION WRITING first employed about A. D. 1400, 320 - - PRINTING, INVENTION OF, favored advance of science of medicine, 328 - - PRISCIANUS, THEODORUS, 192 - - PROKSCH, 543 - - PRZYMIOT, title of early Polish treatise on syphilis, 479 - - PTOLEMIES, learning greatly prospered under their reign, 100 - - PTOLEMY EUERGETES, OR PHYSCON, 116 - - PULSE, meaning of, according to Athenaeus, 142 - - PULSIFIC POWER OF ARTERIES (Galen), 381 - - PURKINJE’S BONE-CORPUSCLES, 362 - - PUSCHMANN, 70, 107, 196, 232, 257, 311, 365, 394 - - PYAEMIA, Wuertz’s views regarding, 469 - - PYTHAGORAS, 73, 74 - medical doctrines propounded by, 147 - - PYTHON, Aesculapius represented in the presence of a, 65 - - - Q - - QUINTESSENCES OF PARACELSUS, 405 - - QUINTUS, one of Galen’s teachers, 162 - - - R - - RABELAIS, FRANÇOIS, celebrated humorous writer, was a physician, - 451 - - RABISU, the demon who causes diseases of the skin, 13 - - RAPHAEL’S CELEBRATED PAINTING showing Plato and Aristotle, 102 - - RATIONAL SYSTEM OF MEDICINE, beginnings of, in Greece, 67 - - RECIPES, BOOKS OF, take the place of physicians in Rome, 117 - - RED-HOT CAUTERY IRON too freely used for arresting bleeding, 466 - - REFRACTION, researches of Alhazen in regard to, 233 - - REGIMEN SANITATIS SALERNITANUM, 246 - Arnold’s commentary on, 294 - - RELICS, SAINTLY, universal faith in their power to heal diseases, - 241 - - REMEDIAL AGENTS, GENUINE, employed in Babylonia, 13 - - REMEDIES, HOUSEHOLD, Cato’s collection of, 123 - - RENAISSANCE, influence of, upon progress of medicine in Western - Europe, 259 - - RENAN, ERNEST, 229, 231 - - RENZI, DE, on books written by physicians at Salerno, 246 - - REPERCUSSION, 526 - - RESPIRATION, physiology of, according to Erasistratus, 108 - according to Aretaeus, 144 - - RETE MALPIGHI, 361 - - RHAZES, illustrious Persian physician, 219, 318 - - RHINOPLASTY in Italy in the 15th century, 459 - - RHODION, 533 - - RIOLAN, J., 360 - - ROESSLIN, EUCHARIUS, 533 - - ROGER’S PRACTICA, the oldest treatise on surgery written in Italy - during the Middle Ages, 254 - - ROKITANSKY, the famous Viennese pathologist, advice of, to those - about to study medicine, 3 - - ROLAND OF PARMA, 254, 279 - - ROMAN PHYSICIANS, of foreign birth, awarded rights of citizenship - by Julius Caesar, 130 - - ROMANO PANE publishes first account of discovery of tobacco, 395 - - ROME, state of medicine at, after the death of Asclepiades, 129 - - ROSA ANGLICA, title of treatise written by John of Gaddesden, 306 - - ROUSSET, FRANÇOIS, 535 - - ROYAL SOCIETY OF LONDON, founding of, 363 - - RUDBECK, OLAUS, 358, 385 - - RUFUS OF EPHESUS, 145, 146 - - RUYSCH, FRIEDRICH, the anatomist, 356, 358 - - - S - - SABOUR BEN SAHL, 209 - - SAGE FEMME, possible origin of the term, 247 - - SAINT BARTHOLOMEW’S HOSPITAL, London, 524 - - SAINT BASIL, founder of a hospital at Caesarea, 236 - - SAINT CÔME, COLLÈGE DE, 490 - - SAINT COSMAS AND SAINT DAMIAN, Brotherhood of, 530 - - SALADIN OF ASCOLO, author of first modern treatise on materia - medica, 320 - - SALADIN, SULTAN OF EGYPT, 225 - - SALAMANCA, UNIVERSITY OF, 346 - - SALERNO MEDICAL SCHOOL, 243, 244, 265 - women teachers at, 245 - - SALICETO, WILLIAM OF, 277 - - SALMOUÏH BEN BAYAN, a distinguished pupil of the Djondisabour - school, 210 - - SALVINO DEGLI ARMATI of Florence, reputed inventor of spectacles, - 297 - - SANCTORIUS SANCTORINUS, 368 - - SANDWITH, DR. F. M., concerning the most ancient surgical - implements thus far discovered, 9 - - SANGUIFICATION, Galen’s theory of, 385 - - SANITARY SCIENCE in the 15th century, 314 - - SAPIENZA, UNIVERSITY OF, at Rome, 391 - - SARSAPARILLA, 395 - - SAVONAROLA, GIOVANNI MICHELE, 313 - - SCHIELHANS, nickname of Hans von Gerssdorff, 460 - - SCHNEIDER, CONRAD VICTOR, 359 - - SCHOOL OF SALERNO, title of poem, 250 - - SCHOOLS, significance of the term, 74 - - SCOTUS OR SCOTTUS, 262 - - SCRIBONIUS LARGUS, 155, 413 - - SECTS IN MEDICINE, 101, 147, 149 - - SEPTICAEMIA, Wuertz’s views regarding, 470, 471 - - SERAPION THE ELDER, 210 - - SERAPIS OR OSIRIS, 19 - - SERPENT, significance of the, in the statues and votive tablets - exposed to view in the Aesculapian temples, 62 - - SERVETUS, MICHAEL, 375 - on the circulation of the blood, 376 - - SHOULDER, DISLOCATION OF, cured by Gabriel Bakhtichou, 207 - - SIMON JANUENSIS, 261 - - SISMONDI, THE HISTORIAN, 116 - - SKULL, FRACTURES OF, 286, 476 - - SLAVES SOLD BY ROMANS when they became old and feeble, 235 - - SLEEP-WALKING, instance of, narrated by Alderotti, 273 - - SMALL-POX described by Herodotus, 142 - earliest treatise upon, 220 - Gaddesden’s successful treatment of, 306 - prophylactic inoculation against, 43 - - SMITH, SIR WILLIAM, 103 - - SNAKE, POISONOUS, treatment of bite by, 110 - - SNAKEROOT, an antidote for poisoning by the bite of a snake, 7 - - SOBIESKI, KING OF POLAND, purchases Ruysch’s second anatomical - collection, 358 - - SOCIAL HYGIENE, the Mosaic laws relate particularly to, 26 - - SOCRATES, 73 - - SOPORIFIC SPONGES, 253 - - SORANUS OF EPHESUS, 138, 139, 159 - rational obstetric methods of, 139 - - SOUL, SPIRIT OF THE, 291 - - SOUL, THE, is the blood, according to Servetus, 376 - - SPAIN, medicine flourished in, during the 10th century, 226 - - SPANISH SURGEONS of the 16th century, 484 - - SPECIALIZATION in medicine, 114 - - SPECTACLES, use of, first mentioned by Gordonius (A. D. 1285), 297 - - SPECULUM, aural, employed by Jean de Vigo, 473 - majus, of Vincent Beauvais, 270 - vaginal, of Paulus Aegineta, 201 - - SPINE, CURVATURE OF, 313 - - SPIRIT, THE, 291, 374 - disorders of, 141 - of Mindererus, 407 - - SPLENIA, 526 - - SPLINTS made with bundles of straw, 304 - - SPRENGEL, KURT, 342 - - SPRINGS, EUROPEAN, in 16th century, 323 - - STAHL, GEORG ERNST, 431 - doctrine of animism, 432 - his “phlogiston,” 433 - treatise on “theoria medica vera,” 432 - - STENO, NICHOLAS (Niels Stensen), 359 - - STIBIUM, 158 - - STOICS, THE, 102 - - STONE IN THE BLADDER, cutting for, 494 - Gaddesden’s peculiar method of treating, 306 - method of operating kept a secret by lithotomists, 447 - - STRANGULATED HERNIA, Franco’s operation for, 492 - - STRATON, a skilful gynaecologist, 115 - - STRAW SPLINTS, for use in fractures, 304 - - STRICTUM AND LAXUM, terms employed by the Methodists, 130 - Boerhaave adopts the doctrine, 442 - - STYRUS, one of Galen’s teachers, 162 - - SUGGESTION, power of, over the human mind, 241 - - SUPERSTITIOUS BELIEFS constitute one of the most extraordinary - characteristics of the human race, 10 - - SURGEON, characteristics which he should possess, 285 - - SURGEONS OF THE LONG ROBE, a name given to members of the Collège - de St. Côme, 448 - - SURGERY, considered a menial occupation during the Renaissance - (Fig.), 306, 447 - early, in Great Britain, 516, 523 - strong prejudice against among French physicians of the 15th - century, 300 - systematic instruction in, first given at Montpellier in 1597, - 448 - - SURGICAL OPERATIONS in the age of primitive medicine, 8 - - SUSRUTA, celebrated East Indian medical author, 31 - - SWAMMERDAM, JOHN, 356 - - SYDENHAM, THOMAS, 418 - a great sufferer from gout, 421 - describes an “inflammation of the blood,” 423 - experience with the great epidemic of the Plague, 421 - on the nature of fever, 423 - treatises published by, 419 - - SYLVIUS (Franz de le Boë), 367, 427 - clinical instruction cultivated by him at Leyden, 428, 429 - treatises published by him, 428 - - SYLVIUS, THE ANATOMIST, 340 - - SYPHILIS, 473, 542 - poem relating to, 391 - - SYRIAC ULCER (known to-day as pharyngeal diphtheria), 144 - - SYRINGE, earliest reference to use of, to be found in Abulcasis’ - treatise on surgery, 227 - - SYRINGOTOME, 313 - - SZANDALANI, Arabic name for pharmacists, 318 - - - T - - TAGLIACOTIAN OPERATION, the so-called, 478, 480 - - TAGLIACOZZI, GASPARE, 478 - - TALISMANS, amulets, etc., as means of protection against evil - spirits, 9, 13 - - TEISSIR, THE, Avenzoar’s great medical work, 228, 230 - - TELESPHORUS, son of, Aesculapius, 50 - - TEMPLE PRIESTS in ancient Egypt, 17 - - TEMPLE SLEEP at the Asclepieia, 57 - - TEMPLES, AESCULAPIAN, their chief purpose, 51 - - TENTS, PRACTICE OF EMPLOYING, in the treatment of wounds, - condemned, 466 - - TESRIF, THE, written by Abulcasis (= Alsaharavius), 227 - - TETANUS, TRAUMATIC, Lanfranchi’s treatment of, 285 - - THADDEUS ALDEROTTI, 272 - - THALES, of Miletus, 72 - - THEMISON, founder of the sect of the Methodists, 130 - the first to mention the employment of leaches, 133 - - THEODORIC OF LUCCA, 276 - - THEODORUS, a disciple of Athenaeus, 142 - - THESSALUS, SON OF HIPPOCRATES, 82, 133 - - THESSALUS, OF TRALLES, in Asia Minor, a prominent Methodist, 133 - - THIERRY DE HÉRY, 499 - - THIGH, amputation of, probably performed in early part of Christian - era, 470 - fractures of, 304 - - THIRTY YEARS’ WAR, THE, 426 - - THOMAS AQUINAS, a believer in the art of the magician, 321 - - THORACIC DUCT, 384 - - THOT OR THOÜT (Hermes), the god, author of the hermetic books, 18, - 19 - - THUCYDIDES, 96 - - TIRABOSCHI, 338, 378 - - TOBACCO, 395 - - TOLEDO, SPAIN, richly stocked with manuscript treasures of Arabic - literature, 261 - - TOLET, FRANÇOIS, 550 - - TOLU, BALSAM OF, 395 - - TORCULAR HEROPHILI, 105 - - TORRICELLA, 546 - - TOSORTHOS, 17 - - TOUCHING, for the “King’s evil,” 527, 528 - - TRACHEOTOMY performed by Asclepiades (90 B. C.), 124 - revived by Antonio Beniveni in the 15th century, 498 - - TRANSFUSION OF BLOOD, 408 - - TRANSMUTATION OF BASER METALS INTO GOLD, 321 - - TRAUTMANN, of Wittenberg, 535 - - TREPHINE, circular pattern of, 473 - - TREPHINING THE SKULL a very ancient surgical operation, 9 - Wuertz slow in resorting to the operation, 467 - - TRIKKA, THESSALY, 51 - - TROTULA, a teacher of medicine at Salerno, 245 - - TUBERCULOSIS, virus of, long-lived, according to Fracastoro, 390 - - TURQUET DE MAYERNE, 547 - - TYDIDES, who smote Aeneas, 49 - - - U - - ULCERS, treatment of, according to the method of Thessalus, 135 - - UROSCOPY eagerly adopted by charlatans in 16th century (Fig.), 412 - strongly denounced by Scribonius, Botallo and others, 413 - - UTUKKU, the demon who causes diseases of the throat, 13 - - - V - - VAGBHATA, a celebrated East Indian medical author, 31 - - VALERIUS CORDUS, 318 - - VALVES, DISCOVERY OF, IN THE LARGER VEINS, 378 - - VAN HELMONT, 398 - “archaeus influus” and “archaeus insitus,” 399 - characteristic sayings, 400 - remarkable remedies manufactured by him, 399 - - VAN SWIETEN introduces clinical instruction at the University of - Vienna, 431 - - VAROLIUS, 349 - - VEIN should be opened longitudinally in venesection, 286 - - VENA PORTAE, 385 - - VENESECTION, Celsus’ description of technical details, 152 - quantity of blood that may be withdrawn, 413 - spot from which blood should preferably be taken, 411 - - VENOUS ARTERY (pulmonary vein), 371 - - VENOUS BLOOD, FUNCTION OF, 373 - - VERSIFICATION employed in medical treatises, 251 - - VERSION, PODALIC, 535 - - VESALIUS, 340, 342, 345, 347, 370, 374, 456 - - VICQ D’AZYR, 532 - - VICTOR III., POPE, 239 - - VIDUS VIDIUS, 340 - - VIEUSSENS, RAYMOND, 364 - - VILLALOBOS, 542 - - VINCENT OF BEAUVAIS, 270 - encyclopaedia of, 263 - - VINDICIANUS, 192 - - VIPER, cases of persons bitten by, 488, 507 - - VIS CONSERVATRIX ET MEDICATRIX NATURAE (Stahl), 432 - - VITAL FORCE, Stahl’s, 405 - - VITAL SPIRIT, Galen’s, 376 - - VIVISECTION OF CRIMINALS utilized at Alexandria, Egypt, for - scientific purposes, 107 - - VIZIR ALI BEN ISSA founds a great hospital at Bagdad in A. D. 914, - 219 - - VOLCHER KOYTER, 349 - - - W - - WATER, CONTAMINATED, purification of, by distillation, 305 - of river Choaspes, ready boiled for use and stored in flagons of - silver, carried by King Cyrus on his campaigns, 26 - - WECKER, JOHANN JACOB, 521 - - WEIGHT-AND-PULLEY TREATMENT of thigh fractures, Guy de Chauliac’s, - 304 - - WHARTON, THOMAS, 359, 546 - - WILLIAM OF SALICETO, 277 - - WILLIAM THE CONQUEROR a patient at Salerno, 245 - - WILLIS, THOMAS, 360, 367, 546 - - WINE, Galen’s use of, in dressing wounds, 163 - proper employment of, according to Asclepiades, 125 - Thalassite, 126 - - WINTER, OF ANDERNACH, 340 - - WIRSUNG, GEORGE, discovers outlet duct of human pancreas, 358 - - WISEMAN, RICHARD, 524 - - WOMEN INSTRUCTORS IN MEDICINE highly esteemed at Salerno, 246 - - WOMEN PHYSICIANS among the Arabs in Spain, during the 12th century, - 232 - - WOODALL, JOHN, 522 - - WOUNDS, DRY METHOD OF TREATING, 275, 285 - too frequent probing of, condemned, 466 - - WREN, SIR CHRISTOPHER, 408 - - WUERTZ, FELIX, 465 - condemns universal employment of chemical caustics and the - red-hot iron for arresting bleeding, 466 - remarks on pyaemia, hospital gangrene and septicaemia, 469, 471 - remarks on treatment of penetrating wounds of abdomen, 469 - - WUNDAERZTE, 369 - - - X - - XENODOCHIA, institutions for the care of slaves, 235 - - XENOPHON, C. STERTINIUS, 54 - - - Y - - YPERMAN, JEHAN, a distinguished Flemish physician of 14th century, - 309 - - - Z - - ZEND-AVESTA, THE, 25 - - ZENO, founder of the Stoic philosophy, 103 - - ZERBI, GABRIEL, professional visit of, to Constantinople, cost him - his life, 337 - - ZEUXIS, organizer of a medical school at Laodicea, 111 - - ZIRHACH, 521 - - ZIRBUS, 521 - - ZOPYRUS classified drugs according to the effects which they - produce, 111 - - ZOSIMOS, of Panopolis, 321 - - - FOOTNOTES: - -[1] A third volume is in course of preparation, but the probable date -of its publication has not been announced. An English translation of -the first volume (by Ernest Playfair) was published by Hodder and -Stoughton, of London, in 1910. - -[2] Book I., section 197, of Rawlinson’s translation. - -[3] From the statements just quoted it appears that a certain kind -of bronze (an alloy of copper and tin, with the addition perhaps of -a little zinc) was used in Assyria, in the manufacture of surgical -knives, as early as during the twenty-third century B. C. Dr. -Meyer-Steineg, Professor of the History of Medicine in the University -of Jena, Germany, assures the writer that knives made of this material -are susceptible of being given as keen a cutting edge as are those made -of the best of steel. At least one such bronze knife may be seen in the -collection of ancient surgical instruments, votive offerings, etc., -which he is making for the benefit of the University. - -[4] A Christian ecclesiastical writer who lived about the year 200 A. D. - -[5] Lines 285–292 of Book IV. of the Earl of Derby’s translation, first -published in 1864. - -[6] Pason is the same as Apollo, who was believed by the Greeks to have -been the inventor or discoverer of the art of medicine. - -[7] See Le Clerc’s _Histoire de la Médecine_, Amsterdam, 1723. - -[8] At bottom of p. 15 of his _Histoire de la Médecine_. - -[9] Papyros Ebers, aus dem Aegyptischen zum ersten Male vollständig -ubersetzt von H. Joachim, Berlin, 1890. - -[10] Book I., p. 96, of George Rawlinson’s translation. - -[11] Neuburger speaks of the growth of medical knowledge in India as a -development that ran parallel with that of ancient Greece. - -[12] _From Neuburger._--Equally crude are their ideas respecting -the causes of disease, as shown by the following items selected from -quite a long list of etiological factors: errors in diet and in the -habits of life, climatic influences, psychic factors, heredity, poison, -supernatural influences like the anger of the gods, the evil powers of -demons, etc. For purposes of diagnosis the earlier Indian physicians -utilized not only inspection, palpation and auscultation, but also the -senses of taste and smell. They noted the losses and increases in the -weight of the body, changes in the appearance of the skin, the tongue -and the excretions, alterations in the configuration of the body, the -form and other characteristics of swellings, etc. They also noted -changes in the patient’s voice, in the character of the breathing, in -the noises accompanying movements of the joints and the twistings of -the intestines. The crepitus caused by the rubbing together of the -roughened ends of a fractured bone did not escape their notice. At -a later period, doubtless through the influence of the teachings of -foreign physicians, they attached great importance to the examination -of the pulse. - -[13] Nepenthes, believed to be opium, is the word employed in the -original. - -[14] Aesculapius was held to be the son of Apollo, the god of medicine, -and to have been instructed in the art of healing by Chiron, one of the -centaurs. Beside his famous sons, Machaon and Podalirius, he had four -daughters whose names--Hygieia, Jaso, Panakeia and Aigle--have come -down to us through the ages. His wife’s name was Epione, and those of -his two younger sons were Telesphorus and Janiscus, but all three of -these names are rarely mentioned by the Greek writers. - -[15] “Kranken-Anstalten im griechisch-römischen Altertum,” von Dr. med. -et jur. Theodor Meyer-Steineg, a. o. Professor an der Universität Jena; -Verlag von G. Fischer, 1912. - -[16] “Kranken-Anstalten im griechisch-romischen Altertum,” in _Jenaer -medizin.-historische Beiträge_, Jena, 1912. - -[17] All important traces of the earlier structures seem to have -disappeared. - -[18] The Emperor Antoninus Pius, in order to provide properly for these -patients, erected at Epidaurus a special building in which confinement -cases and those likely to end fatally might be lodged. - -[19] The slave of Chremulos. - -[20] To save space the head of the god alone has been reproduced in -Fig. 5. - -[21] _Histoire de la Médecine_, Amsterdam, 1723. - -[22] The word “school,” when employed in the strictly modern sense of -that term, means an establishment regularly organized for the purpose -of giving instruction. Here, however, it is intended to signify simply -that certain places, like Cos, Crotona, Cnidus, etc., had become -the rendezvous of men who desired to cultivate--some as teachers, -others as disciples or pupils--certain branches of knowledge, or -certain doctrines. At a later period (third century B. C.) there was -established at Alexandria, Egypt, a well-organized school of medicine -closely resembling those of modern times. - -[23] All of these are translations from the French. - -[24] The city of Cnidus was situated very close to the Island of Cos, -on a peninsula that projects from the coast of Caria, Asia Minor. - -[25] Black bile, it was believed, comes from the spleen, while the -yellow variety is a product of the liver. - -[26] Daremberg (_Hist. de la Méd._) makes the following comments -on this sentence: “How many are the occasions when we physicians would -have it in our power to avert death, or at least to postpone it for a -few hours, if we would only engrave upon our memories these words of -the old man of Cos! ‘What a cruel responsibility rests upon those whose -duty it is to summon the doctor at the proper moment! And how great -must be the remorse if he fails to arrive in time!’ On the other hand, -how wise is the remark of Celsus: ‘The best practitioner is he who -never loses sight of his patients.’” - -[27] After Alexandria first came under Roman rule (about 30 B. C.) -membership in the Museum was granted to athletes and other men of no -education, and it is said that even before that time Ptolemy Euergetes, -who had reopened the schools during the latter part of his reign, -bestowed some of the important positions upon men who were simply his -favorites. The library of the Museum was seriously damaged by fire at -the time when Julius Caesar was being besieged in Alexandria by the -inhabitants of that city, and was at last wholly destroyed by Amrou, -the Lieutenant of the Caliph Omar, in A. D. 651. The truth of this -extraordinary tale regarding the burning of books belonging to the -library at Alexandria in the seventh century is seriously doubted -by Sismondi (_Histoire de la Chute de l’Empire Romain_, Vol. -II., p. 57). “It was,” he says, “published for the first time, by -Abulpharagius, about six centuries after the event is supposed to have -occurred. And yet the contemporaneous national historians, Entychius -and Elmacin, make no mention of it whatever. An act of this nature, -furthermore, would be in direct conflict with the precepts of the -Koran and with the profound respect which the Mohammedans habitually -entertain for every scrap of paper on which the name of God happens to -be written.” - -Under the later rule of the Romans, Alexandria regained a good deal of -its literary importance and also became a chief seat of Christianity -and theological learning; but as a centre of medical influence its -glory had long since departed. - -[28] Asclepiades was not a descendant of Aesculapius, as one would -naturally infer from the name which he bore. - -[29] It would not be easy to fix, even approximately, the date -when remedies of this character ceased to find acceptance in the -popular mind of Europeans, but there can be no doubt that they were -employed rather frequently even as late as during the eighteenth -century;--indeed, measures that strongly smack of superstition are now -and then looked upon with favor by the well-educated members of our -modern society. For many centuries, however, they have been abandoned -by all physicians excepting those who are unworthy to bear that honored -title. - -[30] Neither Haller nor Dezeimeris furnishes any biographical -information with regard to Musa. - -[31] Antoninus Pius, however, established the rule that these -privileges were not to be granted to all physicians indiscriminately, -but only to a limited number; and, later still, it was decided that -only the parish physicians were entitled to receive them. - -[32] It seems almost unnecessary to call attention to the fact that the -subject of these remarks is not to be confounded with Thessalus, the -son of Hippocrates. - -[33] Ἰατρονίκης is the word employed in the original Greek. - -[34] The word “metasyncrisis,” as we are assured by Le Clerc, was -employed first by Cassius, one of the earlier disciples of Methodism, -and then, long after the time of Thessalus, by Galen, Oribasius, Aëtius -and Paulus Aegineta. - -[35] Le Clerc calls attention to the incorrectness--etymologically -speaking--of the use of the word “Eclectics” in connection with a -school or sect. The members of such a body are not, he says, “the -chosen ones” as the term signifies, but “the choosers.” - -[36] Boerhaave, the famous clinician of Leyden, Holland (eighteenth -century), was instrumental in having an excellent Latin translation -made of this work; and in 1858 a German translation by A. Mann was -published in Halle. - -[37] Translated from _Oeuvres de Rufus d’Éphèse_; édition Grecque -et Française, par Daremberg et Ruelle, Paris, 1879. - -[38] The term “dogmatists” is also employed by some authorities to -designate those physicians who laid great stress upon the importance of -following the teachings of Hippocrates and Galen. - -[39] The majority of the writings of Galen are reported to have been -kept, for safe preservation, in the Temple of Peace, near the Forum; -and the destruction of this building by fire, during the latter half of -the second century, entailed the loss of all these valuable works. - -[40] Book VI., Chapter XVII. (page 441 of Vol. I. of Daremberg’s -version). - -[41] In his Commentaries on the works of Hippocrates (Epidemic -Diseases, III., t. XVII. B. § 4) Galen states that he has often -observed this to-and-fro movement of the alae nasi in certain cases of -illness and that he has interpreted it as indicating the existence of -some serious disorder of the respiratory tract. (Daremberg.) - -[42] Hippocrates, Herophilus, Erasistratus, Asclepiades, Themison, -Celsus, Soranus and Athenaeus. Daremberg calls attention to the fact -that, although we possess to-day only a few fragments of the writings -of Archigenes, those few are of such a degree of excellence that we may -well ask ourselves whether Galen was not perfectly justified in placing -such a high estimate as he appears to have done upon the merits of this -writer,--and that, too, notwithstanding the unfavorable criticism which -he makes in the present paragraph about the author’s failure at times -to write with sufficient clearness on medical subjects. - -[43] John the Grammarian, whose nativity is not stated by Le Clerc, was -at first a simple boatman who ferried back and forth those who attended -a school which was located on one of the islands at Alexandria. As a -result of his frequent talks with these men, he became enamored with -philosophy and decided, notwithstanding his age (forty years), to -devote himself entirely to the study of the subject. Accordingly, he -sold his boat and attended the lectures regularly, becoming at last -an expert in philosophy. He wrote several important treatises and -commentaries, some of them dealing with medical topics, and he also -made a number of translations from the Greek into Arabic. - -[44] Third edition, London, 1726. - -[45] Anthemius is also credited with being the inventor of the -principle of dome construction in architecture. - -[46] Also written Paulus Aeginetes. - -[47] The account which is given in this and the following chapters -is based largely on Dr. Lucien Le Clerc’s _Histoire de la Médecine -Arabe_, Paris, 1876. - -[48] Le Clerc and Freind mention both Nishapur and Djondisabour as the -name of the capital of the Province of Khorassan in northeast Persia. - -[49] The drachma was a silver coin worth about 9¾ pence English money. -The fee paid to Gabriel for his surgical services amounted, therefore, -to a little less than £2000 or $10,000. - -[50] To distinguish him from Mesué the Younger, who lived at Cairo, -Egypt, about one hundred years later, and who attained considerable -celebrity on account of the treatises which he wrote on materia medica. - -[51] For further remarks concerning the origin of the Teïssir see page -229. - -[52] According to tradition the medical school at Salerno was founded -by four physicians--Adela, an Arab; Helinus, a Jew; Pontus, a Greek; -and Salernus, a Latin. - -[53] Perhaps the French title “sage-femme” originated from this. - -[54] There can be no question, says Neuburger (in agreement with -Daremberg), about the truth of the statement that Constantinus -allowed the authorship of several of the treatises issued at Salerno -under his name to be attributed to himself--as, for example, the -“_Liber Pantegni_” (_Pantechni_), which is in reality the -“_Liber Regalis_” of Haly Abbas; the “_Pieticum_,” which is -fundamentally the work of Ibn-al-Dschezzar; the “_De Oculis_,” -which is based upon Honein ben Ischak’s treatise on opthalmology; and -still other works which it is not necessary to specify. - -[55] Under the heading “_Epilogus_” on pages 268 and 269 of Meaux -Saint-Marc’s version. - -[56] Examples of leonine versification: “Contra vim _mortis_, -nulla est herba in _hortis_”; (p. 155 of Saint-Marc’s version) and -(from Shelley’s _Cloud_) “I am the _daughter_ of the earth -and _water_.” - -[57] The term “praepositus” means the president or the dean of the -school with which the person named is connected. - -[58] The Opus majus, ed. J. H. Bridges, Oxford, 1897 (2d edition, -1900); opera hactenus inedita, ed. B. Steele, Fasc. I., London. - -[59] Aurei. The aureus is said to have been worth about 16 shillings, -English money. - -[60] A church official to whom was intrusted the duty of granting -dispensations; “Almoner” is perhaps the equivalent term in English. - -[61] “Non enim est necesse saniem--sicut Rogerius et Rolandus -scripserunt et plerique eorum discipuli docent, et fere omnes cururgici -moderni servant--in vulneribus generare. Iste enim error est major quam -potest esse. Non est enim aliud, nisi impedire naturam, prolongare -morbum, prohibere conglutinationem et consolidationem vulneris.” (II., -cap. 27.) - -[62] The most recent edition of this work is a French translation made -by P. Pifteau and published at Toulouse, in 1898. - -[63] According to Daremberg (_Histoire des Sciences Médicales_, -Vol. I., p. 264) the title “Doctor” appears for the first time in the -Preface of Roger’s treatise (1180 A. D.). - -[64] “_La Grande Chirurgie de Guy de Chauliac_,” Paris, 1890. - -[65] The distinguishing sign of the barbers was the shaving dish, made -of _pewter_ and hung up at the door of the shop; that employed by -the surgeons was also a shaving dish, but made of polished brass. Those -surgeons who had received their training at the school of Saint Cosmas -and Saint Damian were permitted to display at the window a banner -bearing the coat of arms of this institution. - -[66] The surgeons Cosmas and Damian were chosen patron saints of the -new organization. They were born in Arabia in the third century, and -are said to have been educated there. After having practiced medicine -for a certain length of time in Sicily, they were tortured and killed, -because of their Christian faith, by order of the Emperor Diocletian, -303 A. D. Hence the title “Saints.” - -[67] Guy de Chauliac, who wrote a treatise on surgery in the latter -half of the fourteenth century, also speaks of the value of this -diagnostic sign. - -[68] See remarks on the subject of amulets, etc., on pages 197, 198. - -[69] A small town in the Department of Lot, France. The earliest Norman -ancestors of the Gurdon family in England are said to have derived -their name from that of this town. - -[70] Introduction to the “Oeuvres d’Ambroise Paré,” Paris, 1840. - -[71] “Gaddesden had for a long time been troubled how to cure stone: -‘At last,’ says he, in his _Rosa Anglica_, ‘I thought of -collecting a good quantity of those beetles which in summer are found -in the dung of oxen, also of the crickets which sing in the fields. I -cut off the heads and the wings of the crickets and put them with the -beetles and common oil into a pot; I covered it and left it afterwards -for a day and night in a bread oven. I drew out the pot and heated it -at a moderate fire, I pounded the whole and rubbed the sick parts; -in three days the pain had disappeared;’ under the influence of the -beetles and the crickets the stone was broken into bits. It was almost -always thus, by a sudden illumination, that this doctor discovered his -most efficacious remedies: Madame Trote [Trotula] of Salerno never -confided to her agents in various parts of the world the secret of more -marvelous and unexpected recipes.” (From Jusserand’s “English Wayfaring -Life in the Middle Ages.”) - -[72] Some weeks later our fellow voyager, Thomas Schoepfius, wrote -to me that, on the return journey, he learned at Berne that “Long -Peter,” the leader of the Mézières robbers, had been apprehended by the -authorities and executed for his crimes; and that, when stretched on -the rack, he had confessed, among other things, that he had tried to -murder and rob some students who passed through Mézières on their way -to Lausanne. - -[73] Also often spelled “Falloppius.” - -[74] The meaning of this Latin inscription can best be appreciated by -those physicians who have, through a long period of years, practiced -their profession largely among the well-to-do classes of a metropolitan -city. They alone, I believe, would understand the significance of -“_lucrum neglectum_” as applied to a large proportion of the gifts -which a practitioner of medicine receives from grateful patients; and -it is not at all likely that a layman who is not familiar with this -aspect of a physician’s life would, under the circumstances mentioned, -have the slightest suspicion that the device quoted above could -possibly bear the meaning that I have given to it. - -[75] See F. Loeffler: “Vorlesungen uber die geschichtliche Entwickelung -der Lehre von den Bakterien,” Leipzig, 1887, Th. 1; and also p. 310 of -Puschmann’s “Geschichte des Medicinischen Unterrichts,” Leipzig, 1889. - -[76] The iatrophysicists and the iatromathematicians constituted -apparently two kindred branches of the same school. - -[77] An edition of the completed set of these plates was published by -Lancisi at Rome in 1714. - -[78] Translated from the French version printed by Daremberg in his -_Histoire de la Médecine_, Vol. II, p. 706. The originals of -Sydenham’s writings are all in Latin. - -[79] Pronounced by Haeser to be a compilation, and not one of -Sydenham’s genuine writings. - -[80] Physicians who maintain that all physiological and pathological -phenomena may be explained by the laws of physics. - -[81] “Gründliches Bedenken und physicalische Anmerkungen von dem -tödtlichen Damff der Holzkohlen,” Halle, 1716. - -[82] Probably this refers simply to a brazier containing burning -charcoal, the light emitted by which would doubtless be sufficient to -answer the purpose of a night lamp. - -[83] A small seaport town located on the Zuider Zee, about thirty miles -northeast of Amsterdam. The university, which was founded there in -1648, was abandoned in 1818. - -[84] Quoted from the English translation mentioned above. - -[85] Bread boiled in water to the consistence of pulp. - -[86] The modern operation known as litholapaxy. - -[87] The word “_centuria_” is employed here in the sense of “a -group of one hundred.” - -[88] Not Amatus, but a specialist. See remark near the top of page 488. - -[89] Orange, which is only a short distance from Avignon and Turriers, -was ceded to France in 1713. - -[90] In the absence of a more fitting place in which to speak of the -employment of urethral bougies, it seems permissible to state here that -the first mention (in medical literature) of these instruments occurs -in Chapter XV. of the treatise of Guainerio, Professor of Medicine at -the University of Pavia. This work, which was first published in 1439, -bears the title: “_Practica Antonii Guainerii_,” and a later -edition was issued at Venice in 1508. Speaking of a case of stone in -the bladder, Guainerius says: “And if the urine does not flow from the -bladder ... introduce a slender flexible rod of tin or silver into the -urethra.” - -[91] Franco calls it the “high operation” or “hypogastric lithotomy.” - -[92] After I had written the preceding description of Franco’s new -method of extracting a calculus from the urinary bladder, I learned, -from Haeser’s account of the surgical writings of Susrutas in the -Ayur-Veda (Sanscrit), that already before the Christian era (the -exact date is not known) the surgeons of East India had performed -this very operation. This fact, however, could not possibly have been -known to Franco, who--so far as modern surgeons are concerned--should -continue to be looked upon as the real inventor of suprapubic -cystotomy.--AUTHOR. - -[93] The fact that bullets are not hot when they inflict a wound was -proven experimentally by Bartolommeo Maggi several years earlier, but -Paré makes no reference to this fact. - -[94] Johann Jacob Wecker (1528–1586), born at Basel, Switzerland, and -author of a treatise entitled “_Practica medicinae generalis_” -(Basel, 1585). - -[95] In this instance I have thought it best to modernize the spelling -of several of the words. - -[96] Not healing in a healthy manner. - -[97] Driving back. - -[98] Haeser speaks of Wiseman as having gained considerable distinction -by the careful manner in which he made provision for the flaps in his -amputations. - -[99] “_Observations diverses sur la stérilité, etc._,” Paris, 1609. - -[100] For a confirmation of this statement see the poem on syphilis -(“_Enfermedad de las Bubas_”) written by the Spanish physician -Francesco Lopez de Villalobos and published by him in 1498 at -Salamanca. The employment of mercurial inunctions is also mentioned in -this poem. - -[101] Physicians who had served at Rome as the regular medical -attendants of Pope Alexander the Sixth. - -[102] “Die Geschichte der venerischen Krankheiten,” Bonn, 1895. - -[103] “Zur Geschichte der Syphilis,” Breslau, 1870. - - -Transcriber’s Notes: - -1. Obvious printers’, punctuation and spelling errors have been -corrected silently. - -2. Some hyphenated and non-hyphenated versions of the same words have -been retained as in the original. - -3. 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-font-size: 90%; -} - -.poetry -{ -display: inline-block; -text-align: left; -margin-left: 2.5em; -line-height: 100%; -} - -.poetry .stanza -{ -margin: 1em 0em 1em 1em; -} - -.poetry .i1 {margin-left: 1em;} -.poetry .i2 {margin-left: 2em;} - -@media print { .poetry {display: block;} } -.x-ebookmaker .poetry {display: block;} - -/* Transcriber's notes */ -.transnote {background-color: #E6E6FA; - color: black; - font-size:smaller; - padding:0.5em; - margin-bottom:5em; - font-family:sans-serif, serif; } - - </style> - </head> -<body> -<p style='text-align:center; font-size:1.2em; font-weight:bold'>The Project Gutenberg eBook of The growth of medicine from the earliest times to about 1800, by Albert Henry Buck</p> -<div style='display:block; margin:1em 0'> -This eBook is for the use of anyone anywhere in the United States and -most other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms -of the Project Gutenberg License included with this eBook or online -at <a href="https://www.gutenberg.org">www.gutenberg.org</a>. If you -are not located in the United States, you will have to check the laws of the -country where you are located before using this eBook. -</div> - -<p style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>Title: The growth of medicine from the earliest times to about 1800</p> -<p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em'>Author: Albert Henry Buck</p> -<p style='display:block; text-indent:0; margin:1em 0'>Release Date: April 14, 2022 [eBook #67833]</p> -<p style='display:block; text-indent:0; margin:1em 0'>Language: English</p> - <p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em; text-align:left'>Produced by: Turgut Dincer, Karin Spence and the Online Distributed Proofreading Team at https://www.pgdp.net (This file was produced from images generously made available by The Internet Archive)</p> -<div style='margin-top:2em; margin-bottom:4em'>*** START OF THE PROJECT GUTENBERG EBOOK THE GROWTH OF MEDICINE FROM THE EARLIEST TIMES TO ABOUT 1800 ***</div> - -<p id="half-title" class="p6">THE GROWTH OF MEDICINE -<span class="smaller">FROM THE EARLIEST TIMES TO ABOUT 1800</span></p> - - -<div class="chapter"> -<p class="smcap center p6">Published on the Foundation</p> -</div> - -<p class="smcap center">Established in Memory of</p> - -<p class="center">WILLIAM CHAUNCEY WILLIAMS</p> - -<p class="smcap">of the Class of 1822, Yale Medical School</p> - -<p class="center xs">AND OF</p> - -<p class="center">WILLIAM COOK WILLIAMS</p> - -<p class="smcap">of the Class of 1850, Yale Medical School</p> - -<div class="chapter"> - -<h1>THE GROWTH OF MEDICINE</h1></div> - -<p class="center lg p2">FROM THE EARLIEST TIMES<br /> -TO ABOUT 1800</p> - - -<p class="smcap center xs p4">By</p> - -<p class="center sm">ALBERT H. BUCK, B.A., M.D.</p> - -<p class="center xs"><i>Formerly Clinical Professor of Diseases of the Ear, Columbia<br /> -University, New York—Consulting Aural Surgeon,<br /> -New York Eye and Ear Infirmary; etc.</i></p> - - <div class="figcenter" id="i_005" > - <img - class="p4" - src="images/i_005.jpg" - alt="" /> - </div> - -<p class="center sm p4">NEW HAVEN: YALE UNIVERSITY PRESS<br /> -LONDON: HUMPHREY MILFORD<br /> -OXFORD UNIVERSITY PRESS<br /> -MDCCCCXVII</p> - -<div class="chapter"> - -<p class="smcap center xs p6">Copyright, 1917<br /> -By Yale University Press</p></div> - -<p class="center xs">First published, February, 1917</p> - - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<h2 class="smaller1">THE WILLIAMS MEMORIAL PUBLICATION FUND</h2> -</div> - - -<p>The present volume is the first work published by the Yale University -Press on the Williams Memorial Publication Fund. This Foundation -was established June 15, 1916, by a gift made to Yale University by -Dr. George C. F. Williams, of Hartford, a member of the Class of -1878, Yale School of Medicine, where three generations of his family -studied—his father, William Cook Williams, in the Class of 1850, and -his grandfather, William Chauncey Williams, in the Class of 1822.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_ix">[ix]</span></p> - -<h2 class="smaller1">PREFACE</h2> -</div> - - -<p>Very few persons will challenge the truth of the statement that in the -United States and Canada there are not many physicians who possess -even a slight knowledge concerning the manner in which the science -of medicine has attained its present power as an agency for good, or -concerning the men who played the chief parts in bringing about this -great result. Up to the present time no blame may justly be attached to -any individuals or to any educational institutions for this prevailing -lack of knowledge, and for two very good reasons, <i>viz.</i>: first, -in a newly settled country, in which the population grows by leaps and -bounds through the influx of foreign immigrants, the training of young -men for the degree of M.D. must necessarily be almost entirely of a -practical character, and consequently the teaching of such a subject -as the history of medicine would be quite out of place; and, second, -the treatises on this subject which are purchasable by English-speaking -physicians are of rather too scientific a character to appeal either -to the undergraduate or to the busy practitioner. The first of the -reasons named, it may now safely be assumed, is rapidly losing its -validity, if indeed it has not already ceased entirely to afford a -legitimate excuse for neglecting the study of this branch of medical -science. On the other hand, the second reason mentioned is still in -force,—so far at least as the present writer knows,—and, if such be -the case, it certainly cannot fail to act as a deterrent influence of -great potency. Here, then, is my apology for attempting to prepare an -account of the history of medicine which shall present the essential -facts truthfully and with a sufficient degree of attractiveness to -win the continuing interest of the reader; which shall place before -him, and especially before those who are just at the threshold of -their professional career, word pictures of those physicians of past -ages whose lives<span class="pagenum" id="Page_x">[x]</span> may safely be taken as models worthy to be copied; -and which shall describe, so far as I am able to do this, the methods -which they employed to advance the science of medicine, to gain genuine -professional success, and to merit the enduring esteem of later -generations of physicians. If my efforts prove successful in producing -this kind of history it is fair to expect that, in a comparatively -short time, those physicians whose interest may have been aroused by -the perusal of this less complete and more popular work, will demand -something of a more exhaustive character—a book, for example, like the -admirable history which Max Neuburger, of Vienna, is now publishing, -and of which two volumes have already issued from the press (the -first in 1906 and the second in 1911).<a id="FNanchor_1" href="#Footnote_1" class="fnanchor">[1]</a> It is to this work and the -excellent history written by the late Dr. Haeser, of Breslau, that I -am chiefly indebted for the information supplied in these pages; and -I therefore desire to make special mention here of this indebtedness. -The other sources from which I have been an occasional borrower are -all mentioned in the “List of Authorities Consulted.” Footnotes and -cross-references in the text interfere greatly with one’s pleasure in -reading a book, and I have therefore not hesitated to introduce them -sparingly.</p> - -<p>It gives me a special pleasure to call attention here to the -far-sighted generosity displayed by the founder of The Williams -Memorial Fund in making it practicable henceforth for the Yale -University Press to accept for publication medical treatises which -deal with the historical and scientific questions of this branch of -knowledge, but which for sound business reasons cannot be published on -a merely commercial basis.</p> - -<p>And I have the further pleasure of expressing my real appreciation -of the skill with which the University Press has solved the problems -of a suitable size and style of type<span class="pagenum" id="Page_xi">[xi]</span> for this volume, and of the -sound advice which it has given with regard to the extent to which -the effectiveness of the book may be increased by the introduction of -pictorial illustrations.</p> - -<p>To my friend, Lawrence F. Abbott, of New York, I am deeply indebted for -the valuable assistance which he has rendered me throughout the entire -progress of this work. Indeed, without this assistance, I doubt whether -I should have had the courage to remain at my post to the very end.</p> - -<p class="smcap r2">Albert H. Buck.</p> - -<p class="p-min">Cornwall, N. Y., December 29, 1916.</p> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_xiii">[xiii]</span></p> - -<h2 class="smaller1">CONTENTS</h2> -</div> - -<table summary="contents" class="smaller" style="max-width: 50em;"> - <tr> - <td class="header1 lg" colspan="3">PART I. ANCIENT MEDICINE</td> - </tr> - - <tr> - <th></th> - <th></th> - <th class="pag">PAGE</th> - </tr> - - <tr> - <td class="chn" colspan="2">Preface</td> - <td class="pag"><a href="#Page_ix">ix</a></td> - </tr> - - <tr> - <td class="chn">Chapter I.</td> - <td class="cht">Development of the Science and Art of Medicine</td> - <td class="pag"><a href="#Page_3">3</a></td> - </tr> - - <tr> - <td class="chn">Chapter II.</td> - <td class="cht">Oriental Medicine</td> - <td class="pag"><a href="#Page_11">11</a></td> - </tr> - - <tr> - <td class="chn">Chapter III.</td> - <td class="cht">Oriental Medicine (continued)</td> - <td class="pag"><a href="#Page_25">25</a></td> - </tr> - - <tr> - <td class="chn">Chapter IV.</td> - <td class="cht">Greek Medicine at the Dawn of History</td> - <td class="pag"><a href="#Page_46">46</a></td> - </tr> - - <tr> - <td class="chn">Chapter V.</td> - <td class="cht">The Significance of the Serpent in the Statues and Votive Offerings Exposed to View in -the Aesculapian Temples</td> - <td class="pag"><a href="#Page_62">62</a></td> - </tr> - - <tr> - <td class="chn">Chapter VI.</td> - <td class="cht">The Beginnings of a Rational System of Medicine in Greece</td> - <td class="pag"><a href="#Page_67">67</a></td> - </tr> - - <tr> - <td class="chn">Chapter VII.</td> - <td class="cht">Hippocrates the Great</td> - <td class="pag"><a href="#Page_81">81</a></td> - </tr> - - <tr> - <td class="chn">Chapter VIII.</td> - <td class="cht">Brief Extracts from Some of the Hippocratic Writings</td> - <td class="pag"><a href="#Page_89">89</a></td> - </tr> - - <tr> - <td class="chn">Chapter IX.</td> - <td class="cht">The State of Greek Medicine after the Events of the Peloponnesian War; the Founding of -Alexandria in Egypt, at the Mouth of the Nile; and the Development of Different Sects in Medicine</td> - <td class="pag"><a href="#Page_96">96</a></td> - </tr> - - <tr> - <td class="chn">Chapter X.</td> - <td class="cht">Erasistratus and Herophilus, the Two Great -Leaders in Medicine at Alexandria; the Founding -of New Sects</td> - <td class="pag"><a href="#Page_104">104</a></td> - </tr> - - <tr> - <td class="chn">Chapter XI.</td> - <td class="cht">Asclepiades, the Introducer of Greek Medicine into Rome</td> - <td class="pag"><a href="#Page_116">116</a></td> - </tr> - - <tr> - <td class="chn">Chapter XII.</td> - <td class="cht">The State of Medicine at Rome after the -Death of Asclepiades; the Founding of the School -of the Methodists</td> - <td class="pag"><a href="#Page_129">129</a></td> - </tr> - - <tr> - <td class="chn">Chapter XIII.</td> - <td class="cht">The Further History of Methodism at -Rome, and the Development of Two New Sects, viz., -the Pneumatists and the Eclectics.—A General Survey -of the Subject of Sects in Medicine</td> - <td class="pag"><a href="#Page_138">138</a><span class="pagenum" id="Page_xiv">[xiv]</span></td> - </tr> - - <tr> - <td class="chn">Chapter XIV.</td> - <td class="cht">Well-known Medical Authors of the Early Centuries of the Christian Era</td> - <td class="pag"><a href="#Page_151">151</a></td> - </tr> - - <tr> - <td class="chn">Chapter XV.</td> - <td class="cht">Claudius Galen</td> - <td class="pag"><a href="#Page_160">160</a></td> - </tr> - - <tr> - <td class="chn">Chapter XVI.</td> - <td class="cht">The Influence of Christianity upon the -Evolution of Medicine</td> - <td class="pag"><a href="#Page_179">179</a></td> - </tr> - - <tr> - <td class="header lg" colspan="3">PART II. MEDIAEVAL MEDICINE</td> - </tr> - - <tr> - <td class="chn">Chapter XVII.</td> - <td class="cht">The Condition of Medicine at Byzantium -during the Early Part of the Middle Ages</td> - <td class="pag"><a href="#Page_191">191</a></td> - </tr> - - <tr> - <td class="chn">Chapter XVIII.</td> - <td class="cht">Beginning of the Arab Renaissance under -the Caliphs of Bagdad</td> - <td class="pag"><a href="#Page_203">203</a></td> - </tr> - - <tr> - <td class="chn">Chapter XIX.</td> - <td class="cht">Further Advance of the Arab Renaissance -during the Ninth and Succeeding Centuries of the -Christian Era</td> - <td class="pag"><a href="#Page_212">212</a></td> - </tr> - - <tr> - <td class="chn">Chapter XX.</td> - <td class="cht">Hospitals and Monasteries in the Middle Ages</td> - <td class="pag"><a href="#Page_235">235</a></td> - </tr> - - <tr> - <td class="chn">Chapter XXI.</td> - <td class="cht">Medical Instruction at Salerno, Italy, in the Middle Ages</td> - <td class="pag"><a href="#Page_243">243</a></td> - </tr> - - <tr> - <td class="chn">Chapter XXII.</td> - <td class="cht">Early Evidences of the Influence of the -Renaissance upon the Progress of Medicine in Western -Europe</td> - <td class="pag"><a href="#Page_259">259</a></td> - </tr> - - <tr> - <td class="chn">Chapter XXIII.</td> - <td class="cht">Further Progress of Medicine and Surgery -in Western Europe during the Thirteenth, -Fourteenth and a Part of the Fifteenth Centuries</td> - <td class="pag"><a href="#Page_269">269</a></td> - </tr> - - <tr> - <td class="chn">Chapter XXIV.</td> - <td class="cht">During the Latter Half of the Middle -Ages Surgery Assumes the Most Prominent Place -in the Advance of Medical Science</td> - <td class="pag"><a href="#Page_292">292</a></td> - </tr> - - <tr> - <td class="chn">Chapter XXV.</td> - <td class="cht">Brief History of the Allied Sciences—Pharmacy, -Chemistry and Balneotherapeutics</td> - <td class="pag"><a href="#Page_315">315</a></td> - </tr> - - <tr> - <td class="header lg" colspan="3">PART III. MEDICINE DURING THE RENAISSANCE</td> - </tr> - - <tr> - <td class="chn">Chapter XXVI.</td> - <td class="cht">Important Events that Preceded the -Renaissance—Early Attempts to Dissect the Human Body</td> - <td class="pag"><a href="#Page_327">327</a><span class="pagenum" id="Page_xv">[xv]</span></td> - </tr> - - <tr> - <td class="chn">Chapter XXVII.</td> - <td class="cht">The Founders of Human Anatomy and Physiology</td> - <td class="pag"><a href="#Page_340">340</a></td> - </tr> - - <tr> - <td class="chn">Chapter XXVIII.</td> - <td class="cht">Further Details Concerning the Advance -in Our Knowledge of Anatomy.—Dissecting -Made a Part of the Regular Training of a Medical -Student.—Iatrochemists and Iatrophysicists.—The -Employment of Latin in Lecturing and Writing on -Medical Topics</td> - <td class="pag"><a href="#Page_355">355</a></td> - </tr> - - <tr> - <td class="chn">Chapter XXIX.</td> - <td class="cht">The Contributions Made by Different -Men during the Renaissance, and More particularly -by William Harvey of England, to Our Knowledge -of the Circulation of the Blood, Lymph and Chyle</td> - <td class="pag"><a href="#Page_371">371</a></td> - </tr> - - <tr> - <td class="chn">Chapter XXX.</td> - <td class="cht">Advances Made in Internal Medicine and -in the Collateral Branches of Botany, Pharmacology, -Chemistry and Pathological Anatomy</td> - <td class="pag"><a href="#Page_387">387</a></td> - </tr> - - <tr> - <td class="chn">Chapter XXXI.</td> - <td class="cht">Chemistry and Experimental Pharmacology</td> - <td class="pag"><a href="#Page_398">398</a></td> - </tr> - - <tr> - <td class="chn">Chapter XXXII.</td> - <td class="cht">Some of the Leaders in Medicine in -Italy, France and England during the Sixteenth and -Seventeenth Centuries</td> - <td class="pag"><a href="#Page_411">411</a></td> - </tr> - - <tr> - <td class="chn">Chapter XXXIII.</td> - <td class="cht">The Three Leading Physicians of Germany -during the Latter Half of the Seventeenth Century: -Franz de le Boë Sylvius, Friedrich Hoffmann -and Georg Ernst Stahl</td> - <td class="pag"><a href="#Page_426">426</a></td> - </tr> - - <tr> - <td class="chn">Chapter XXXIV.</td> - <td class="cht">Hermann Boerhaave of Leyden, Holland, -one of the Most Distinguished Physicians of -the Seventeenth Century</td> - <td class="pag"><a href="#Page_438">438</a></td> - </tr> - - <tr> - <td class="chn">Chapter XXXV.</td> - <td class="cht">General Remarks on the Development of -Surgery in Europe during the Fifteenth and Sixteenth -Centuries</td> - <td class="pag"><a href="#Page_446">446</a></td> - </tr> - - <tr> - <td class="chn">Chapter XXXVI.</td> - <td class="cht">Surgery in Germany and Switzerland -during the Fifteenth and Sixteenth Centuries</td> - <td class="pag"><a href="#Page_454">454</a></td> - </tr> - - <tr> - <td class="chn">Chapter XXXVII.</td> - <td class="cht">The Development of Surgery in Italy -during the Renaissance</td> - <td class="pag"><a href="#Page_472">472</a></td> - </tr> - - <tr> - <td class="chn">Chapter XXXVIII.</td> - <td class="cht">The Development of Surgery in -Spain and Portugal during the Renaissance</td> - <td class="pag"><a href="#Page_484">484</a><span class="pagenum" id="Page_xvi">[xvi]</span></td> - </tr> - - <tr> - <td class="chn">Chapter XXXIX.</td> - <td class="cht">The Development of Surgery in France -during the Renaissance.—Pierre Franco</td> - <td class="pag"><a href="#Page_490">490</a></td> - </tr> - - <tr> - <td class="chn">Chapter XL.</td> - <td class="cht">The Development of Surgery in France (continued).—Ambroise Paré</td> - <td class="pag"><a href="#Page_499">499</a></td> - </tr> - - <tr> - <td class="chn">Chapter XLI.</td> - <td class="cht">Surgery in Great Britain during the Sixteenth -and Seventeenth Centuries</td> - <td class="pag"><a href="#Page_516">516</a></td> - </tr> - - <tr> - <td class="chn">Chapter XLII.</td> - <td class="cht">Reforms Instituted by the Italian Surgeon -Magati in the Treatment of Wounds.—Final Ending -of the Feud between the Surgeons and the Physicians -of Paris.—Revival of Interest in the Science of -Obstetrics</td> - <td class="pag"><a href="#Page_529">529</a></td> - </tr> - - <tr> - <td class="chn">Chapter XLIII.</td> - <td class="cht">The First Appearance of Syphilis in -Europe as an Epidemic Disease.—Medical Journalism.—The -Beginnings of a Modern Pharmacopoeia.—Itinerant -Lithotomists</td> - <td class="pag"><a href="#Page_542">542</a></td> - </tr> - - <tr> - <td class="chn" colspan="2">List of the More Important Authorities Consulted</td> - <td class="pag"><a href="#Page_557">557</a></td> - </tr> - - <tr> - <td class="chn" colspan="2">General Index</td> - <td class="pag"><a href="#Page_563">563</a></td> - </tr> -</table> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_xvii">[xvii]</span></p> - -<h2 class="smaller1">LIST OF ILLUSTRATIONS</h2> -</div> - -<table summary="illos" class="smaller" style="max-width: 50em"> - <tr> - <td class="cht">Fig. 1.</td> - <td class="cht1">View of the Temple of Aesculapius on the Island of Cos</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_fp052">52</a></td> - </tr> - - <tr> - <td class="cht">Fig. 2.</td> - <td class="cht1">Bird’s-eye View of the Temple of Aesculapius -and Associated Buildings on the Island of Cos</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_fp054">54</a></td> - </tr> - - <tr> - <td class="cht">Fig. 3.</td> - <td class="cht1">Ground Plan of the Asclepieion on the Island of Cos</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_p055">55</a></td> - </tr> - - <tr> - <td class="cht">Fig. 4.</td> - <td class="cht1">Ancient Statue of the God Aesculapius in the -Berlin Museum</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_fp062a">62</a></td> - </tr> - - <tr> - <td class="cht">Fig. 5.</td> - <td class="cht1">Head of the Marble Statue of the God Aesculapius -in the Naples Museum</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_fp062b">62</a></td> - </tr> - - <tr> - <td class="cht">Fig. 6.</td> - <td class="cht1">Bas-relief of Aesculapius, Accompanied by -Women and Children, in the Presence of an -Enormous Serpent</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_fp068a">68</a></td> - </tr> - - <tr> - <td class="cht">Fig. 7.</td> - <td class="cht1">Female Bust Showing Cancer of One Breast</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_fp068b">68</a></td> - </tr> - - <tr> - <td class="cht">Fig. 8.</td> - <td class="cht1">Paralysis of the Left Facial Nerve</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_fp070">70</a></td> - </tr> - - <tr> - <td class="cht">Fig. 9.</td> - <td class="cht1">The Oldest Known Pictorial Representation of a -Formal Dissection of the Human Body</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_fp280">280</a></td> - </tr> - - <tr> - <td class="cht">Fig. 10.</td> - <td class="cht1">The Manner of Giving Public Instruction in -Medicine during the Middle Ages</td> - <td class="cht1"></td> - <td class="pag1"><a href="#i_p283">281</a></td> - </tr> - - <tr> - <td class="cht">Fig. 11.</td> - <td class="cht1">Henri de Mondeville</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_fp288">288</a></td> - </tr> - - <tr> - <td class="cht">Fig. 12.</td> - <td class="cht1">One of the Wards in the Hôtel-Dieu of Paris</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_fp304">304</a></td> - </tr> - - <tr> - <td class="cht">Fig. 13.</td> - <td class="cht1">The Physician, the Surgeon and the Pharmacist</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_fp306">306</a></td> - </tr> - - <tr> - <td class="cht">Fig. 14.</td> - <td class="cht1">Andreas Vesalius</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_fp344">344</a></td> - </tr> - - <tr> - <td class="cht">Fig. 15.</td> - <td class="cht1">William Harvey</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_fp380">380</a></td> - </tr> - - <tr> - <td class="cht">Fig. 16.</td> - <td class="cht1">“The Lovesick Maiden”</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_fp412">412</a></td> - </tr> - - <tr> - <td class="cht">Fig. 17.</td> - <td class="cht1">Thomas Sydenham</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_fp418">418</a><span class="pagenum" id="Page_xviii">[xviii]</span></td> - </tr> - - <tr> - <td class="cht">Fig. 18.</td> - <td class="cht1">Consultation by Three Physicians upon a Case -of Wound in the Chest</td> - <td class="cht1"></td> - <td class="pag1"><a href="#i_p457">457</a></td> - </tr> - - <tr> - <td class="cht">Fig. 19.</td> - <td class="cht1">Barber Surgeon (<i>Wundarzt</i>) Extracting an -Arrow from a Wounded Soldier’s Chest while -the Battle is Still in Progress</td> - <td class="cht1"></td> - <td class="pag1"><a href="#i_p461">461</a></td> - </tr> - - <tr> - <td class="cht">Fig. 20.</td> - <td class="cht1">Amputation of the Leg</td> - <td class="cht1"></td> - <td class="pag1"><a href="#i_p463">463</a></td> - </tr> - - <tr> - <td class="cht">Fig. 21.</td> - <td class="cht1">The Manner in Which the So-called Tagliacotian -Operation for Repairing a Defective Nose -Should be Carried Out</td> - <td class="cht1"></td> - <td class="pag1"><a href="#i_p480">480</a></td> - </tr> - - <tr> - <td class="cht">Fig. 22.</td> - <td class="cht1">Pierre Franco’s Forceps for Crushing Calculi in -the Urinary Bladder</td> - <td class="cht1"></td> - <td class="pag1"><a href="#i_p497">497</a></td> - </tr> - - <tr> - <td class="cht">Figs. 23–24.</td> - <td class="cht1">Forceps Devised in 1552 by Ambroise Paré for -Drawing Out the Cut Ends of Arteries after -the Amputation of a Limb, and Holding Them -while the Ligature is Being Applied</td> - <td class="cht1"></td> - <td class="pag1"><a href="#i_p512">512</a></td> - </tr> - - <tr> - <td class="cht">Fig. 25.</td> - <td class="cht1">Ambroise Paré the Famous French Surgeon of -the Sixteenth Century</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_fp514">514</a></td> - </tr> - - <tr> - <td class="cht">Fig. 26.</td> - <td class="cht1">Frère Jacques de Beaulieu</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_fp550">550</a></td> - </tr> - - <tr> - <td class="cht">Fig. 27.</td> - <td class="cht1">Jean Baseilhac, commonly Known in France as Frère Côme</td> - <td class="cht1"><i>facing page</i></td> - <td class="pag1"><a href="#i_fp552">552</a></td> - </tr> - - <tr> - <td class="cht">Fig. 28.</td> - <td class="cht1">Concealed Lithotome Invented by Frère Côme in 1748</td> - <td class="cht1"></td> - <td class="pag1"><a href="#i_p553">553</a></td> - </tr> -</table> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_1">[1]</span></p> - -<h2>PART I<br /> -<span class="subhed">ANCIENT MEDICINE</span></h2></div> - - -<div class="chapter"> -<p><span class="pagenum" id="Page_3">[3]</span></p> - -<h3>CHAPTER I<br /> -<span class="subhed1">DEVELOPMENT OF THE SCIENCE AND ART OF MEDICINE</span></h3></div> - -<p>Friedlaender says that “in the temple of history, now hoary with age, -medicine also possesses its own chapel, not an accidental addition to -the edifice but a large and important part of the noble building.” In -this chapel is preserved the record of the efforts made by man, through -the ages, to maintain his body in good condition, to restore it to -health when it has become affected by disease or damaged by violence, -and to ward off the various maladies to which it is liable. It is a -record, therefore, in which every practitioner of medicine should -take a deep interest. Rokitansky, the famous pathologist of Vienna, -expressed the same idea very tersely when he said: “Those about to -study medicine and the younger physicians should light their torches at -the fires of the ancients.” Members of the medical profession, however, -are not the only persons in the community who take an interest in the -origin and growth of the science of medicine and the art of healing -the diseased or damaged body; the educated layman is but little less -interested than the physician, being ever ready to learn all he can -about the progress of a branch of knowledge which so profoundly affects -his welfare. But hitherto the only sources of information available for -those who are not familiar with French or German have been treatises -of so technical a character that even physicians have shown relatively -little disposition to read them.</p> - -<p>The science of medicine developed slowly from very humble beginnings, -and for this earliest period the historian has no records of any kind -which may be utilized for his<span class="pagenum" id="Page_4">[4]</span> guidance. It is reasonably certain, -furthermore, that this prehistoric period lasted for a very long time, -probably several thousand years; and when, finally, some light on the -subject appeared, it was found to emanate from several widely separated -regions—<i>e.g.</i>, from India, Mesopotamia, Egypt and Greece. Then, -after the lapse of additional hundreds or even thousands of years, -there was inaugurated the practice of making written records of all -important events, and, among others, of the different diseases which -affect mankind, of the means employed for curing them or for relieving -the effects which they produce, and of the men who distinguished -themselves in the practice of this art. While the “science of the -spade” and that of deciphering the writing of the papyri, monuments -and tablets thus brought to light, have already during the last half -century greatly altered our ideas with regard to ancient medicine, -there are good reasons for believing that much additional information -upon this subject may be looked for in the not distant future. It is -plain, therefore, that a history of the primitive period of medicine, -if written to-day, may have to be modified to-morrow in some important -respects. On the other hand, the facts relating to the later periods -are now so well established that a fair-minded writer should experience -no serious difficulty in judging correctly with regard to their value -and with regard to the claims of the different men to be honored for -the part which each has played in bringing the science and art of -medicine to their present high state of completeness and efficiency.</p> - -<p>The subdivision of the history of medicine into separate periods -is certainly desirable, provided it be found practicable to assign -reasonably well-defined limits to the periods chosen. But, when the -attempt is made to establish such subdivisions, one soon discovers that -the boundaries pass so gradually the one into the other at certain -points, or else overlap so conspicuously at other points, that one -hesitates to adopt any fixed plan of classification. Of the four -schemes which I have examined—viz., those of Daremberg, of Aschoff, -of Neuburger, and of Pagel—that of Neuburger seems to me to be the -best. That which has<span class="pagenum" id="Page_5">[5]</span> been adopted, however, in the preparation of the -present outline sketch combines some of the features of both the Pagel -and the Neuburger schemes.</p> - -<p><i>Periods in the History of Medicine.</i>—There are nine more or less -distinctly defined periods in the history of medicine, to wit:—</p> - -<p><span class="smcap">First Epoch</span>: <i>Primitive medicine</i>.—This period extends -through prehistoric ages to a date which differs for different parts of -the world. The duration of this period, in any case, is to be reckoned -by thousands of years.</p> - -<p><span class="smcap">Second Epoch</span>: <i>The medicine of the East</i>—that is, of -the cultivated oriental races of whose history we possess only a very -fragmentary knowledge.</p> - -<p><span class="smcap">Third Epoch</span>: <i>The medicine of the classical period of -antiquity</i>—the pre-Hippocratic period of Greek medicine.</p> - -<p><span class="smcap">Fourth Epoch</span>: <i>The medicine of the Hippocratic -writings</i>—the most flourishing period of Greek medicine.</p> - -<p><span class="smcap">Fifth Epoch</span>: <i>The medicine of the period during which the -centre of greatest intellectual activity was located at Alexandria, -Egypt</i>.</p> - -<p><span class="smcap">Sixth Epoch</span>: <i>The medicine of Galen</i>—an author whose -teachings exerted a preponderating influence upon the thought and -practice of physicians in every part of the civilized world up to -the seventeenth century of the Christian era. This period is also -characterized by the gradual diminution of the influence of Greek -medicine.</p> - -<p><span class="smcap">Seventh Epoch</span>: <i>The medicine of the Middle Ages</i>—a -period which includes a large part of the preceding epoch. Its most -characteristic feature is the important part played by the Arabs in -moulding the teachings and practice of the medical men of that time -(ninth to fifteenth century).</p> - -<p><span class="smcap">Eighth Epoch</span> (fifteenth and sixteenth centuries): <i>The -medicine of the Renaissance period</i>—characterized chiefly by the -adoption of the only effective method of studying the anatomy of -man—the actual dissection of human bodies.</p> - -<p><span class="smcap">Ninth Epoch</span> (from the beginning of the seventeenth century -to the present time): <i>Modern medicine</i>.—This epoch may with -advantage be divided into two periods—the first extending to about -the year 1775, soon after which<span class="pagenum" id="Page_6">[6]</span> time Jenner began his important work -on the subject of vaccination; and the second to the present time. No -attempt will be made in the following account to cover this second -period.</p> - -<p><i>The Beginnings of Medicine.</i>—In the early period of man’s -existence upon this earth he must have possessed an exceedingly small -stock of knowledge with regard to the maintenance of his body in -health and with regard to the means which he should adopt in order to -restore it to a normal condition after it had been injured by violence -or impaired in its working machinery by disease. With the progress of -time, utilizing his powers of observation and his reasoning faculty, he -slowly made additions to his stock of facts of this nature. Thus, for -example, he gradually learned that cold, under certain circumstances, -is competent to produce pain in the chest, shortness of breath, active -secretion of mucus, etc., and his instinct led him, when he became -affected in this manner, to crave the local application of heat as -a means of affording relief from these distressing symptoms. Again, -when he used certain plants as food he could scarcely fail to note the -facts that some of them produced a refreshing or cooling effect, that -others induced a sensation of warmth, and finally that others still, -by reason of their poisonous properties, did actual harm. Sooner or -later, such phenomena as nausea, vomiting and diarrhoea would also -be attributed by him to their true causes. In due course of time his -friends and neighbors, having made similar observations and having -tried various remedial procedures for the relief of their bodily ills, -would come together and compare with him their several experiences; and -so eventually the fact would be brought out that the particular method -adopted by one of their number for the relief of certain symptoms had -proved more effective than any of the others. Thus gradually this -isolated community or tribe of men must have learned how to treat, more -or less successfully, the simpler ills to which they were liable.</p> - -<p>Lucien Le Clerc quotes from the Arab historian Ebn Abi Ossaïbiah the -following account of the manner in which<span class="pagenum" id="Page_7">[7]</span> bloodletting probably first -came to be adopted as a remedial measure:—</p> - -<div class="blockquot"> - -<p>Let us suppose that in the earliest period of man’s history -somebody experienced the need of the medical art. He may, for -example, have felt a general sense of heaviness in his body -(plethora), associated perhaps with redness of the eyes, and -he probably did not know what he should do in order to obtain -relief from these sensations. Then, when his trouble was at its -worst, his nose began to bleed, and the bleeding continued until -he experienced decided relief from his discomfort. In this way -he learned an important fact, and cherished it in his memory.</p> - -<p>On a later occasion he experienced once more the same sense of -heaviness, and he lost no time in scratching the interior of his -nose in order to provoke a return of the bleeding. The nosebleed -thus excited again gave him entire relief from the unpleasant -sensations, and upon the first convenient occasion he told his -children and all his relatives about the successful results -obtained from this curative procedure. Little by little this -simple act, which was a first step in the healing art, developed -into the intelligently and skilfully performed operation of -venesection.</p> -</div> - -<p>Primitive man also increased his stock of knowledge in the healing art -by reading attentively the book of nature,—<i>i.e.</i>, by observing -how animals, when ill, eat the leaves or stems of certain plants and -thus obtain relief from their disorders. The virtues of a species of -origanum, as an antidote for poisoning from the bite of a snake, were -revealed, it is asserted, by the observation that turtles, when bitten -by one of these reptiles, immediately seek for the plant in question -and, after feeding upon it, experience no perceptible ill effects from -the poisonous bite. The natives of India ascribe the discovery of the -remarkable virtues of snakeroot (the bitter root of the ophiorrhiza -Mungos) as an antidote for poisoning by the bite of a snake, to the -ichneumon, a small animal of the rat species. The instinctive desire -to escape pain taught man, as it does the lower animals, to keep a -fractured limb at rest, thus giving the separated ends of the bone -an opportunity to reunite; after which the limb eventually becomes -as strong as it ever was. Simple as this mode of acquiring useful -medical<span class="pagenum" id="Page_8">[8]</span> knowledge may appear to us moderns, there are good reasons -for believing that hundreds of years must have elapsed before the -accumulated stock of such experiences became really considerable. -On the other hand, it is reasonable to suppose that this growth in -medical knowledge took place more rapidly in certain tribes or races -than in others, and that when, under the action of wars, the inferior -men became tributary to those of greater intellectual powers, they -acquired, through contact with their conquerors, additional knowledge -at a much more rapid rate. One great hindrance, however, stood in the -way of such progress. I refer to the deeply rooted belief, entertained -by man in this primitive period of his existence, in the agency of -malevolent spirits (demons) in the production of disease,—a belief -which continued to exist for many thousands of years. Out of such a -belief developed the necessity of discovering some practical method -of appeasing the evil spirits and of thus obtaining the desired cure -of the ills of the body. Usually some member of the tribe who had -displayed special skill in the treatment of disease, and who at the -same time was liberally endowed with the qualities which characterize -the charlatan, was chosen to be the priest or “medicine man.” It was -his duty to employ measures suitable for expelling the demon from the -patient’s body and for restoring the latter to health. Possessing -great influence, as these superstitious people believed he did, with -the unseen gods, such a physician-priest must have discouraged all -efforts to increase the stock of genuine medical knowledge; for such -an increase would necessarily mean a diminution of his own power and -influence.</p> - -<p>In what must still be termed the age of primitive medicine, but -undoubtedly at an advanced stage of that epoch, there were performed -surgical operations which imply a remarkable advance in the invention -of cutting instruments and in the knowledge of the location and nature -of certain comparatively rare diseases, and at the same time great -courage and wonderful enterprise on the part of those early physicians. -As evidence of the correctness of these<span class="pagenum" id="Page_9">[9]</span> statements the fact may be -mentioned that trepanned skulls belonging to the neolithic period have -been dug up in various parts of the world—in most of the countries -of Europe, in Algiers, in the Canary Islands, and in both North and -South America. From a careful study of these skulls it has been learned -that the individuals upon whom such severe surgical work had been -done—sometimes as often as three separate times—recovered from the -operation. The instruments used were made of sharpened flint (saws or -chisels). Pain in the head, spasms or convulsions, and mental disorders -are suggested by Neuburger as the indications which probably led to -the performance of the trepanning. This author also makes the further -statement that the ancient Egyptians employed knives made of flint for -opening the dead bodies which they were about to embalm and for the -operation of circumcision. Recent excavations have thrown additional -light upon the state of medical knowledge during this neolithic -age. Thus, there have been found specimens of anchylosed joints, of -fractured bones, of flint arrow heads lodged in different parts of -the skeleton, of rhachitis, of caries and necrosis of bone, etc. The -following quotation is taken from the printed report of a lecture -recently delivered in London by Dr. F. M. Sandwith, Consulting Surgeon -to the Khedive of Egypt. Speaking of certain excavations made in the -Nubian Desert and of the oldest surgical implements yet discovered, he -says:—</p> - -<div class="blockquot"> - -<p>In one place a graveyard was found, and here were remains of -bodies with fractured limbs that had been set with bark splints. -One was a right thigh bone that had been broken, and was still -held in position by a workmanlike splint and bandages. All the -knots were true reef-knots, and the wrappings showed how the -strips of palm-fibre cloth were set just as a good surgeon would -set them in these days so as to use the full strength of the -fabric.</p> -</div> - -<p>Among the most ancient remedies may be mentioned talismans, amulets -and medicine stones, which were furnished—presumably at a price—by -the physician-priests, and which were believed to afford the wearers -protection<span class="pagenum" id="Page_10">[10]</span> against evil spirits (the “evil eye,” for example). Various -objects were used for this purpose, and among them the following -deserve to be mentioned: disks of bone removed with the aid of a -trephine from the skull of a dead human body and worn with a string -around the neck; the teeth of different animals; bones of the weasel; -cats’ claws; the lower jaw of a squirrel; the trachea of some bird; one -of the vertebrae of an adder, etc. And where these measures failed, -the priests resorted to incantations, religious dances, and the -beating of drums or the rattling of dried gourds filled with pebbles. -Primitive races of men inhabiting the most widely separated parts of -the earth appear to have adopted means almost identical with those -just described for driving away evil spirits. The holding of these -superstitious beliefs is one of the most extraordinary characteristics -of the human race. It played an important part throughout the classical -period of Greek and Roman civilization, and also during the Middle -Ages. Christianity undoubtedly was a most potent agency in hastening -the eradication of the feeling, but even this great power has not yet -sufficed entirely to do away with superstition; for traces of this -weakness may still easily be detected in some of the men and women with -whom we daily come in contact.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_11">[11]</span></p> - -<h3>CHAPTER II<br /> -<span class="subhed1">ORIENTAL MEDICINE</span></h3></div> - -<p>The researches of the scholar working in combination with the engineer -have unearthed—more particularly in Mesopotamia, in Egypt and in -Greece—evidences of an ancient medical science far advanced beyond -that briefly described in the preceding chapter. These evidences relate -to nations that flourished as far back as four thousand years B. C. -While they are very fragmentary and cover historical events which -are often separated from one another by long periods of time, these -data nevertheless suffice to give one a fairly good idea of the then -prevailing state of medical knowledge. Both Pagel and Neuburger adopt -the plan of discussing these different nationalities separately, and I -shall follow their example.</p> - -<p><i>Medicine in Mesopotamia.</i>—As appears from the most recent -investigations the Sumerians were the first occupants of the region -lying between the Euphrates and the Tigris rivers. It was from them -that their Semitic conquerors, the Babylonians and the Assyrians, -received a civilization which, already about 4000 B. C., had -reached a wonderful degree of development. The canalization of the -low-lying lands of that region, the organization of a religious and -civil government of a most efficient type, the invention first of -picture-writing and then of the cuneiform characters, the cultivation -of the arts and natural sciences and especially of astronomy and -mathematics to a high degree of perfection,—these are among the things -which were accomplished by this very clever race of men. In addition, -however, to these useful activities the Babylonians developed and -cultivated diligently the science of astrology—that is, the science -of predicting human events<span class="pagenum" id="Page_12">[12]</span> (such as the death of the king, the -occurrence of the plague or of war, etc.) from various telluric and -cosmic phenomena—an eclipse of the sun, peculiarities of the weather, -the condition of vegetation, etc. The deeply rooted love of the human -race for the supernatural—a characteristic to which I have already -briefly referred—facilitated the development of this harmful practice, -and kept it alive through many succeeding centuries. Walter Scott, in -his romance entitled Quentin Durward, gives an admirable portrait of -a typical astrologer whom Louis XI. of France maintained at his court -during a part of the seventeenth century.</p> - -<p>While in other parts of the Orient the science of medicine, as -already stated at the beginning of this chapter, made a noteworthy -advance beyond the conditions observed among the primitive races, in -Mesopotamia this science, which was far more important to the welfare -of its inhabitants than all the other branches of knowledge combined, -received very little attention and consequently made only insignificant -advances. The British Museum has in its possession several thousand -tablets which were dug up from the ruins of Nineveh and which represent -a part of the library of the Assyrian King, Assurbanipal (668–626 B. -C.). Translations of the text of only a very few of these tablets have -thus far been published, and from these, which embody the greater -part of our knowledge of Assyrian medicine, it appears that, for the -present at least, the estimate recorded above must stand. A few new -facts, however, have been brought to light, and they appear to be of -sufficient importance to merit brief consideration here.</p> - -<p>In the first place, Herodotus, who visited Babylon about 300 B. C., has -this to say in relation to the state of medicine in that city:—</p> - -<div class="blockquot"> - -<p>The following custom seems to me the wisest of their -institutions next to the one lately praised. They have no -physicians, but, when a man is ill, they lay him in the public -square, and the passers-by come up to him, and if they have -ever had his disease themselves or have known any one who has -suffered from it, they give him advice, recommending him to do -whatever they found good in their<span class="pagenum" id="Page_13">[13]</span> own case, or in the case -known to them; and no one is allowed to pass the sick man in -silence without asking him what his ailment is.<a id="FNanchor_2" href="#Footnote_2" class="fnanchor">[2]</a></p> -</div> - -<p>The Babylonians held some rather strange beliefs regarding the -construction of the human body and the manner in which its functions -are performed. The living being, as they maintained, is composed of -soul and body. The intellect has its seat in the heart, the liver -serving as the central organ for the blood, which they considered to be -the true life principle. They divided this fluid into two kinds—blood -of the daytime (bright arterial) and that of the night (dark venous). -Although the blood was held by them to be the basis of life, they -evidently attached a certain value to respiration, for one of their -prayers begins with these words: “God, my creator, lead me by the -hand; guide the breath of my mouth.” Disease was always looked upon as -something (usually personified as a demon) that entered the body from -without and that consequently had to be expelled. There were special -demons for the different diseases. Thus, Asakku brought fever to the -head, Namtar threatened life with the plague, and Utukku attacked the -throat, Alu the breast, Gallu the hand, Rabisu the skin, and so on. The -most dreaded demons were the spirits of the dead. Special amulets were -employed as protective remedies. Prayer formulae were also used. Here -is one among several that I find mentioned in Neuburger’s treatise:—</p> - -<div class="blockquot"> - -<p>Wicked Consumption, villainous Consumption, Consumption which -never leaves a man, Consumption which cannot be driven away, -Consumption which cannot be induced to leave, Bad Consumption, -in the name of Heaven be placated, in the name of Earth I -conjure thee!</p> -</div> - -<p>The genuine remedial agents employed in Babylonia were of a most -varied nature: a mixture of honey and syrup of dates; medicinal herbs -of different kinds for internal administration; bloodletting; the use -of cups for drawing blood to the surface of the body; warm baths and<span class="pagenum" id="Page_14">[14]</span> -cold shower baths; rubbing oil over the body; medicated clysters; the -use of various salves; the use of secret remedies which were composed -of various ingredients and which bore such names as “the Sun God’s -remedy,” “the dog’s tongue,” “the skin of the yellow snake,” “the -medicine brought from the mountain of the human race,” etc.</p> - -<p>Some of the predictions made by the Babylonian astrologers are of -sufficient interest to be placed on record. Here are a few examples:—</p> - -<div class="blockquot"> - -<p>If the west wind is blowing when the new moon is first seen, -there is likely to be an unusual amount of illness during that -month.</p> - -<p>If Venus approaches the constellation of Cancer, there will be -respect for law and prosperity in the land; those who are ill -will recover, and pregnant women will have easy confinements.</p> - -<p>If Mercury makes its appearance on the fifteenth day of the -month, there will be corpses in the land. And again, if the -constellation of Cancer is obscured, a destructive demon will -take possession of the land, and there will be corpses.</p> - -<p>If Jupiter and the other planets stand opposite one another, -some calamity will overtake the land. If Mars and Jupiter come -into conjunction, there will be deaths among the cattle.</p> - -<p>If an eclipse of the Sun take place on the twenty-eighth day -of the month Ijar, the king will have a long reign; but, if it -take place on the twenty-ninth day of the month, there will be -corpses on the first day of the following month.</p> - -<p>If there should be thunder during the month of Tisri, a spirit -of enmity will prevail in the land; and if it should rain during -that month, both men and cattle will fall ill.</p> -</div> - -<p>Besides these predictions, which were based upon phenomena connected -with the movements of the stars and the conditions of the weather, -there were others which the people themselves were competent to make -without the aid of the professional astrologer or the official priest. -Such, for example, are the following “omens”:—</p> - -<div class="blockquot"> - -<p>If a woman gives birth to a child the right ear of which is -lacking, long will be the reign of the prince of that land.</p> - -<p>If a woman gives birth to a child both of whose ears are -lacking,<span class="pagenum" id="Page_15">[15]</span> sadness will come upon the land and it will lose some -of its importance.</p> - -<p>If a woman gives birth to a child whose face resembles the beak -of a bird, there will surely be peace in the land.</p> - -<p>If a woman gives birth to a child the right hand of which lacks -fingers, the sovereign of that country will be taken prisoner by -his enemies.</p> -</div> - -<p>The keen interest taken by the priests in the matter of predicting the -outcome of various diseases led in due time to their making records -of the nature, symptoms and progress of the latter. Although this -practice was inaugurated purely for the purpose of enabling them to -foretell with greater accuracy the probable issue of any given malady, -it nevertheless served also to establish on a firm basis the custom -of keeping records of the case-histories. Only one thing more was now -needed to render this practice the first step in a genuine advance of -medical knowledge; but this step could not be made in Babylonia, where -priestcraft and superstition had struck such deep roots in the public -life. It was only in free Greece, and at a time in its history when -the spirit of Hippocrates exerted an overpowering influence over the -minds of men, that the separation of the functions of the physician -from those of the priest became possible and was in due time effected. -(Neuburger.)</p> - -<p>Before closing this very incomplete account of the state of medical -knowledge in Babylonia, it will be well to mention some of the items of -the law laid down by Hammurabi (circa 2200 B. C.) for the guidance of -the physicians of that land with regard to the remuneration which they -should receive. At the same time I shall make no attempt to reconcile -the statement of Herodotus (given on page 12) with the wording of -this law, which distinctly recognizes the existence of physicians in -Mesopotamia. Possibly the conditions in Nineveh in the fourth century -B. C. were different from what they had been eighteen centuries earlier.</p> - -<div class="blockquot"> - -<p>If a physician makes a deep cut with an operating knife of -bronze and effects a cure, or if with such a knife he opens a -tumor<span class="pagenum" id="Page_16">[16]</span> and thus avoids damaging the patient’s eye, he shall -receive as his reward 10 shekels of silver. If the patient is -an emancipated slave, the fee shall be reduced to 5 shekels. In -the case of a slave the master to whom he belongs shall pay the -physician 2 shekels.</p> - -<p>If a physician makes a deep wound with an operating knife of -bronze and the patient dies, or if he opens a tumor with such a -knife and the patient’s eye is thereby destroyed, the operator -shall be punished by having his hands cut off.</p> - -<p>If a physician, in operating upon the slave of a freedman, makes -a deep wound with an operating knife of bronze and thus kills -the patient, he shall give the owner a slave in exchange for the -one killed. And if, in opening a tumor with such a knife, the -physician destroys the slave’s eye, he shall pay to the latter’s -owner one-half the slave’s value.</p> - -<p>If a physician effects the healing of a broken bone or cures a -disease of the intestines, he shall receive from the patient a -fee of 5 shekels of silver.<a id="FNanchor_3" href="#Footnote_3" class="fnanchor">[3]</a></p> -</div> - -<p>It would be difficult to imagine anything better adapted to arrest the -development of medical knowledge in a nation than the promulgation of a -law like that ascribed to Hammurabi; and one cannot be surprised at the -statement made by Herodotus, eighteen centuries later, “that there were -no physicians in Babylon.” Foolhardy, indeed, would be the man who, for -the sake of earning a possible reward of six shekels of silver, would -be willing to risk the danger of having both his hands cut off; and yet -every conscientious and faithful practitioner of medicine in Babylon at -the time mentioned must necessarily have been obliged to run this risk.</p> - -<p><i>Medicine in Ancient Egypt.</i>—Of the sources of information with -regard to the knowledge of medicine possessed by the ancient Egyptians -the most important are the following: Homer’s Odyssey; Herodotus; -Diodorus; Clemens of Alexandria; Pliny’s Natural History; Dioscorides;<span class="pagenum" id="Page_17">[17]</span> -the Papyrus Ebers; the Papyrus Brugsch; and the Papyrus Birch, in the -British Museum. Then, in addition to these sources, there are the -inscriptions found in recent times on the walls of the temples and -the pictures painted on the wrappings of mummies, from both of which -considerable information with regard to various therapeutic procedures -and to the details of the process of embalming has been derived. Some -of this information extends back to about 3000 B. C. The healing art -was at that time entirely in the hands of the temple priests, who -formed an organized body with a sort of physician-in-chief at its head. -Two of these—Athotis and Tosorthos—attained such a high standing and -possessed such influence that they were chosen Kings of Egypt. The -practice of obstetrics was entrusted to the care of women who had been -trained to this work and who acknowledged the authority of a skilled -head-nurse of their own sex. The patients who had received treatment -for their ailments at one or other of the temples presented to these -institutions gifts in the form of sculptured or painted representations -of the diseased or injured parts of the body. In these and in other -ways medicine and pharmacy received contributions which were of no mean -value. Botanical gardens were established at various places in Egypt -and were cultivated with care. Chemistry—a name which derives its -origin from a word in the Egyptian language—also made considerable -progress as a science. On the other hand, the knowledge of the -structure and functions of the different parts of the human body was -very imperfect and remained unchanged for many centuries. This would -probably not have been the case if the work of preparing the bodies -for the process of embalming had not been entrusted entirely to mere -menials, men who had no interest in anything but the mechanical part of -their occupation.</p> - -<p>According to the statement of Clemens of Alexandria<a id="FNanchor_4" href="#Footnote_4" class="fnanchor">[4]</a><span class="pagenum" id="Page_18">[18]</span> the Egyptian -science of medicine is set forth in the last six of the forty-two -hermetic books, which were composed, according to the prevailing -belief, by the god Thot or Thoüt (= Hermes of the Greeks). The first -one of these six books is devoted to the anatomy of the human body, -the second one to the diseases to which it is liable, the third to -surgery, the fourth to remedial agents, the fifth to the diseases of -the eye, and the sixth to diseases of women. As to the remedial agents, -Neuburger says that it has not been found practicable to identify more -than a very few of the Egyptian drugs enumerated by Dioscorides. Homer, -who wrote at least five hundred years B. C., has something to say on -this subject in the Odyssey.<a id="FNanchor_5" href="#Footnote_5" class="fnanchor">[5]</a> His words are as follows:—</p> - - <div class="poetry-container"> - <div class="poetry"> - <div class="stanza"> - <div>Such drugs Jove’s daughter owned, with skill prepar’d,</div> - <div>And of prime virtue, by the wife of Thone,</div> - <div>Aegyptian Polydamna, given her.</div> - <div>For Aegypt teems with drugs, yielding no few</div> - <div>Which, mingled with the drink, are good, and many</div> - <div>Of baneful juice, and enemies to life.</div> - <div>There every man in skill medicinal</div> - <div>Excels; for they are sons of Pason<a id="FNanchor_6" href="#Footnote_6" class="fnanchor">[6]</a> all.</div> - </div> - </div> - </div> - -<p>A physician of the present age, on reading the histories of the -ancient Egyptians, Greeks and other oriental nations, finds it almost -impossible to realize that many of the characters designated as gods -and goddesses, possibly all of them, were not mythological persons, as -they would have been termed only a few years ago, but real human beings -like ourselves. Such, for example, was the opinion of Cicero who, when -asked why these people were spoken of as gods, gave the following -reply:<a id="FNanchor_7" href="#Footnote_7" class="fnanchor">[7]</a> “It was a well-established custom among the ancients to deify -those who had rendered to their fellow men important services, as<span class="pagenum" id="Page_19">[19]</span> -Hercules, Castor and Pollux, Aesculapius, Bacchus and many others had -done.” And I find that those modern authors of the history of medicine -whose works I have consulted, are quite ready to accept even the gods -called by the Egyptians Osiris (or Serapis), Isis, and Thoüt (or -Hermes) as genuine historical personages. Such a belief receives some -degree of confirmation from the following inscriptions which, according -to the authority of Le Clerc,<a id="FNanchor_8" href="#Footnote_8" class="fnanchor">[8]</a> were found engraved upon two columns -discovered in the city of Nyoa, in Arabia:—</p> - -<div class="blockquot"> - -<p>(On the first column): My father is Cronos, the youngest of -all the gods. I am King Osiris, who have visited with my -armies every country on the face of the earth—the remotest -inhabitable parts of India, the regions lying beneath the Bear, -the neighborhood of the sources of the Danube, and the shores -of the Ocean. I am the oldest son of Cronos, the scion of a -fine and noble race. I am related to the day. There is no part -of the earth which I have not visited, and I have filled the -entire universe with my benefits. (On the second column): I -am Isis, Queen of all this country, and I have been taught by -Thoüt. There is nobody who has the power to loosen what I shall -bind. I am the oldest daughter of Cronos, the youngest of the -gods. I am the wife and at the same time the sister of King -Osiris. To me is due the credit of having been the first to -teach men agriculture. I am the mother of King Horus. I shine in -the dog-star. It is I who built the city of Bubastis. Farewell, -Egypt, my native land.</p> -</div> - -<p>The discovery of the art of medicine, says Le Clerc, was attributed to -Osiris and Isis, and they were also credited with having taught it to -Aesculapius.</p> - -<p>At the cities of On (Heliopolis), Sais, Memphis and Thebes were located -the most celebrated of the Egyptian temples, which were dedicated -not merely to the worship of their numerous gods, but also to the -dissemination of knowledge of various kinds and to the care of the -sick and maimed. In a word, they were—like the Aesculapian temples at -Trikka, Epidaurus and Cos, of which some account will be given farther -on—both hospitals for the<span class="pagenum" id="Page_20">[20]</span> treatment of disease and schools for the -training of physicians. The chief priest of the temple bore also the -title of the “physician-in-chief,” and exercised the prerogatives of -a chief magistrate. Under this system medical knowledge advanced to -a certain stage and then made no further progress. The preponderance -of the priestly (<i>i.e.</i>, the superstitious) influence was too -pronounced to permit anything like real progress.</p> - -<p>The papyrus Ebers makes mention of a number of diseases, and among them -the following may be noted: abdominal affections (probably dysentery), -intestinal worms, inflammations in the region of the anus, hemorrhoids, -painful disorders at the pit of the stomach, diseases of the heart, -pains in the head, urinary affections, dyspepsia, swellings in the -region of the neck, angina, a form of disease of the liver, about -thirty different affections of the eyes, diseases of the hair, diseases -of the skin, diseases of women, diseases of children, affections of the -nose, ears and teeth, tumors, abscesses and ulcers.</p> - -<p>In the matter of diagnosis the Egyptian physicians not only employed -inspection and palpation, but were in the habit of examining the urine. -A statement made in the papyrus Ebers is good ground for the belief -that they also employed auscultation to some extent.</p> - -<p>Therapeutics constituted beyond all question the strongest part of -Egyptian medicine. As might be expected from the strange mixture of the -priest and the medical man in every physician, the remedial measures -commonly employed consisted in part of prayers and incantations, and -in part of rational procedures and the use of drugs. Among the latter -class of remedies the following deserve to be mentioned: emetics, -cathartics and clysters. Bloodletting, sudorifics, diuretics and -substances which cause sneezing were also often employed in Egypt. To -produce vomiting the favorite agents were the copper salts and oxymel -of squills. Castor oil disguised in beer was given as an aperient. -Pomegranate was the drug preferred for the expulsion of worms. -Mandragora and opium were also employed as remedies. Foreign drugs -were largely imported by the Phoenicians,<span class="pagenum" id="Page_21">[21]</span> and in their successful -campaigns against Asiatic nations the Egyptians learned much about -the use of these rarer remedies. The different forms in which the -Egyptians administered their remedies included potions, electuaries, -gums to be chewed but not swallowed, gargles, snuffs, inhalations, -salves, plasters, poultices, injections, suppositories, clysters and -fumigations. The physicians, in their practice, were subjected to very -strict rules regarding the amount of the doses to be given and the -manner of administering the different remedies, and consequently they -received no encouragement to indulge in any individuality of action. -The prescriptions were written in very much the same manner as are -those of to-day; that is, they contained the fundamental or important -drugs, certain accessory materials, and something which was intended -merely to correct the unpleasant taste of the mixture. In comparison -with those commonly written at a somewhat later period these ancient -prescriptions were of a very simple character.</p> - -<p>Up to the present time the researches of the archaeologists have thrown -comparatively little light on the surgery of the ancient Egyptians. -The facts already ascertained, however, are sufficient to warrant the -statement that they had reached a degree of knowledge and skill in -this department of medicine well in advance of that reached by any of -their contemporaries. They performed the operations of circumcision -and castration, and they removed tumors, and their eye surgeons were -especially renowned for the work which they accomplished in their -special department. Their skill in manufacturing surgical instruments -is amply revealed in the specimens—instruments for cupping, knives, -hooks, forceps of different kinds, metal sounds and probes, etc.—which -have been dug up at the various sites of ancient ruins. They must also -have possessed considerable manual skill, for without it they could -not, in embalming a corpse, have removed the entire brain from the -skull with a long hook, by way of the nasal passages, and at the same -time have left the form of the face undisturbed.</p> - -<p><span class="pagenum" id="Page_22">[22]</span></p> - -<p>From Joachim’s German translation of the papyrus Ebers,<a id="FNanchor_9" href="#Footnote_9" class="fnanchor">[9]</a> as quoted by -Neuburger, I copy the following passages:—</p> - -<div class="blockquot"> - -<p>If thou findest, in some part of the surface of a patient’s -body, a tumor due to a collection of pus, and dost observe -that at one well-defined spot it rises up into a noticeable -prominence, of rounded form, thou should’st say to thyself: This -is a collection of pus, which is forming among the tissues; I -will treat the disease with the knife.... If thou findest, in -the throat of a patient, a small tumor containing pus, and dost -observe that it presents at one point a well-defined prominence -like a wart, thou may’st conclude that pus is collecting at -this point.... If thou findest, in a patient’s throat, a fatty -growth which resembles an abscess, but which yields a peculiar -sensation of softness under the pressure of the finger, say to -thyself: this man has a fatty tumor in his throat; I will treat -the disease with the knife, but at the same time I will be -careful to avoid the blood-vessels.</p> -</div> - -<p>These short extracts will suffice to show that the Egyptian physicians -of that early period—at least 1550 B. C.—reasoned about pathological -lesions in very much the same manner as a physician of to-day would -reason. In this same ancient papyrus, however, foolish as well as -sensible statements appear. Thus, for example, mention is made on the -one hand of the fact that, in order to give a certain remedy to an -infant, it is sufficient to administer it to the nurse who suckles the -child (a proceeding which is not uncommon in our own day); and then, -in another part of the text, it is stated that “if, on the day of its -birth, the infant does not cry, it will surely live; but, if it says -‘ba,’ it will die.”</p> - -<p>In matters relating to personal hygiene the ancient Egyptians often -displayed a remarkable degree of common sense. They maintained, for -example, that the majority of diseases are due to the taking of -food in excessive quantity; and, in harmony with this belief, they -introduced the custom of devoting three days out of every thirty to -the taking of emetics and clysters. Perhaps it was to this<span class="pagenum" id="Page_23">[23]</span> custom -that they owed their good health,—a fact to which both Herodotus and -Diodorus testify. In principle this practice agrees with that adopted -by modern physicians, who omit the emetics and substitute for the -clysters the drinking of certain mineral waters during a limited period -of the summer season and under the very agreeable surroundings of a -comfortable hotel at Carlsbad, Ems, Wiesbaden or Saratoga. While the -monthly plan of purging the system of harmful elements must certainly -have been the more effective of the two, it cannot for a moment be -doubted that exceedingly few moderns would be willing to subject -themselves to such a régime.</p> - -<p>In still other ways the ancient Egyptians displayed a most intelligent -respect for every measure that tended to promote the general health of -the community. They took care, for example, to prevent the entrance -of decomposing materials into the soil and the ground water; priests -skilled in work of this character made careful inspections of all meats -that were to be used for food; stress was laid upon the importance of -keeping the dwelling houses clean; the people were taught the value -of bathing the body frequently, of cultivating gymnastic exercises, -of clothing themselves suitably, and of employing the right sort of -diet. At a still later period of their history they adopted the custom -of drinking only water that had been either boiled or filtered. A -particular kind of beer, the gift of their first king, Osiris, was -the favorite beverage of the people. It was made from barley and -doubtless possessed intoxicating properties, as is suggested by one -of the papyrus texts in which the following charge is brought against -a student: “Thou hast abandoned thy books and art devoting thyself to -idle pleasures, going from one beer-house to another. Thou smellest so -strongly of beer that men avoid thee.”</p> - -<p>A large proportion of the sources of information regarding the medicine -of the ancient Egyptians have been brought to light during recent -years, but so many gaps in the series still remain unfilled that it is -not possible to furnish more than a disconnected and very imperfect -account. Archaeological investigations, however, are being<span class="pagenum" id="Page_24">[24]</span> conducted -with vigor and new discoveries are reported almost every month. There -are therefore good reasons for hoping that, in the course of the next -few years, much additional light will be shed on the mode of life and -accomplishments of these pioneers of civilization, who, before they -passed out of history, succeeded in attaining the highest degree of -cultivation in the science and art of medicine that had up to that -time been attained by any other nation. One thing is certain, says -Neuburger, they exerted a powerful influence upon the beginning of -medicine in Greece and upon the social hygiene of the Jewish people, -and therefore upon the human race at large.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_25">[25]</span></p> - -<h3>CHAPTER III<br /> -<span class="subhed1">ORIENTAL MEDICINE (Continued)</span></h3></div> - -<p><i>The Medicine of the Ancient Persians.</i>—After Cyrus the Great had -put an end to Babylon as a power among the nations the Persians became -the leaders in all the affairs not merely of Asia Minor but also of -the entire country from India to the shores of the Mediterranean; in -fact, they eventually also gained control of the land of the Pharaohs. -Notwithstanding the completeness of the political power which they -possessed over these conquered races, they permitted them to retain -their respective religions and even their individual languages; -as evidence of the correctness of which last statement the modern -discovery of inscriptions written in the three principal tongues may be -mentioned. The remarkable degree of general culture which existed at -Babylon at the time of the Persian conquest, and which the Sumerians -and Semites had originally introduced, was left undisturbed by the -political change.</p> - -<p>So far as we possess any knowledge regarding the medicine of the -ancient Persians, this information has been derived, according to -Neuburger, from the Zend-Avesta—one of the ancient religious writings -preserved by the Parsees. It furnishes comparatively few facts of -special interest to physicians. In the main, the practice of medicine -must have differed very little from that employed by the earliest -Babylonian physicians, and briefly described on pages 11–16. There are -one or two additional matters, however, which deserve to be mentioned -here. It was maintained, for example, that the touching of a corpse -produced a special contamination, a belief which interfered most -seriously with the study of anatomy, and therefore<span class="pagenum" id="Page_26">[26]</span> prevented any -real advance in medical knowledge. Then, again, the ancient Persians -appear to have taken comparatively little interest in surgery, for it -is said that King Darius I. was obliged, when he needed treatment for -a badly sprained ankle, to send for a Greek physician. Finally, there -may be found in Herodotus the following statement, which shows that the -Persians had learned something of value, in practical hygiene, from -their neighbors, the Egyptians:—</p> - -<div class="blockquot"> - -<p>The Great King (Cyrus), when he goes to the wars, is always -supplied with provisions carefully prepared at home, and with -cattle of his own. Water, too, from the river Choaspes, which -flows by Susa, is taken with him for his drink, as that is the -only water which the kings of Persia taste. Wherever he travels, -he is attended by a number of four-wheeled cars drawn by mules, -in which the Choaspes water, ready boiled for use, and stored in -flagons of silver, is moved with him from place to place.<a id="FNanchor_10" href="#Footnote_10" class="fnanchor">[10]</a></p> -</div> - -<p>Neuburger makes the remark that the ancient Persians are entitled to -the gratitude of later generations for the valuable service which they -rendered the science of medicine, inasmuch as, during the dynasty of -the Sassanide princes (fifth century A. D.) and at a time when European -culture was hastening to its destruction, they gave shelter both to -classical culture in general and to the medical knowledge of the -Greeks, and then afterward handed it over to the conquering Arabs, who -passed it on to our forefathers.</p> - -<p><i>The Medicine of the Old Testament.</i>—There are no medical -writings which give any information concerning the science and art of -medicine as possessed by the ancient Israelites, but the Bible contains -a number of passages that refer to matters which belong in the domain -of medicine, and more particularly in that of social hygiene. The -mosaic laws were framed with a view to the good of the Jewish people -as a whole, and were directed to such matters as the prevention and -suppression of epidemic diseases, the combating venereal affections -and prostitution, the care<span class="pagenum" id="Page_27">[27]</span> of the skin, the systematizing of work, -the regulation of sexual life, the intellectual cultivation of the -race, the provision of suitable clothing, dwellings and food, the use -of baths, etc. Many of these laws—like those, for example, which -prescribe rest on the Sabbath day, circumcision, abstinence from eating -the flesh of the pig, the isolation of persons affected with leprosy, -the observation of hygienic rules in camp life, etc.—testify to a -remarkably high degree of the power to reason correctly; and, when -considered in the light of modern science, they seem to justify the -prediction made in Deuteronomy iv., 6. A similar prediction (supposed -to be spoken by God from Mount Sinai) is made in Exodus xix., 6: “And -ye shall be unto me a kingdom of priests, and an holy nation.” That a -large part of the credit given to Moses for the wisdom displayed in -these sanitary laws really belongs to the Egyptians is shown by the -text of Acts vii., 22: “And Moses was learned in all the wisdom of the -Egyptians, and was mighty in words and in deeds.”</p> - -<p>As regards the manner in which the Israelites treated the diseases -which afflicted them the Bible furnishes ample proof of the fact -that they placed their chief reliance upon prayers, sacrifices, and -offerings at their temples, and made comparatively small use of -medicinal agents, dietetic measures, and external applications. The -favorable effect of David’s harp-playing upon the melancholia of King -Saul furnishes the only instance, to be found in the Bible, of the -curative value of music in certain mental disorders.</p> - -<p>The story of Naaman (2 Kings v.) deserves to be mentioned briefly here. -He was captain of the host of the King of Syria (about 894 B. C.) and -a man of valor, highly esteemed by his master, but he was—according -to the Bible statement—a leper. Learning casually that there was -in Samaria a prophet who might be able to cure his disease, he put -a large sum of money into his sack and departed for that country. -“So Naaman came with his horses and with his chariot, and stood at -the door of the house of Elisha. And Elisha sent a messenger unto -him, saying, Go and wash in Jordan seven times, and thy flesh shall -come again<span class="pagenum" id="Page_28">[28]</span> to thee, and thou shalt be clean.” Naaman, at first much -displeased with the advice given to him by Elisha, and especially by -the very informal manner in which it had been communicated to him, -finally decided to follow the prophet’s instructions. “Then went he -down, and dipped himself seven times in Jordan, ... and his flesh came -again like unto the flesh of a little child, and he was clean. And he -returned to the man of God, ... and came, and stood before him; and -he said, Behold, now I know that there is no God in all the earth, -but in Israel: now therefore, I pray thee, take a blessing of thy -servant.” Elisha, however, refused persistently to accept any reward -for the advice which he had given. He simply said to Naaman: “Go in -peace.” Before he departed, however, Naaman expressed to Elisha the -hope that he would be pardoned if he yielded to the necessity of bowing -down to the god Rimmon on certain occasions—as, for example, when he -accompanied his master, the king, on his visits to the temple of that -god for the purposes of worship. From the evidence furnished by this -account, as given in the Old Testament, it is fair to assume that both -Naaman and the writer of the book of Kings believed that the cure had -been effected by supernatural means. The modern physician, however, -is not ready to accept such an interpretation of the manner in which -Naaman’s cure was effected, but prefers to believe that the supposed -leprosy was in reality some curable form of skin disease which to -the unprofessional eye appeared like the other malady. It might, for -example, have been an aggravated general eczema, dependent upon such -excesses of eating and drinking as a wealthy captain of the king’s host -would be likely to indulge in. And if this supposition is correct, one -cannot but admire the great practical wisdom of Elisha in advising -Naaman to take seven baths—one a day presumably—in the river Jordan, -a spot so far removed from his home that it would scarcely be possible -for him to obtain any but the simplest kind of diet during this -comparatively long period of time.</p> - -<p>An interesting case of snake-bite is briefly related in Acts xxviii., -3–6. It is stated that “when Paul (after being<span class="pagenum" id="Page_29">[29]</span> shipwrecked on the -Island of Melita) had gathered a bundle of sticks, and laid them on the -fire, there came a viper out of the heat, and fastened on his hand. And -when the barbarians saw the venomous beast hang on his hand, they said -among themselves, No doubt this man is a murderer, whom, though he hath -escaped the sea, yet vengeance suffereth not to live. And he shook off -the beast into the fire, and felt no harm. Howbeit they looked when he -should have swollen, or fallen down dead suddenly: but after they had -looked a great while, and saw no harm come to him, they changed their -minds, and said that he was a god.” This narrative is interesting in -several respects, but there is one feature that deserves to receive -special mention, viz., the fact that Paul experienced no harm from the -bite of a poisonous serpent—a wound which frequently proves fatal. -Inasmuch as the account distinctly states that the reptile “fastened on -his hand” and that “the barbarians saw the venomous beast hang on his -hand,” the conclusion is warranted that one or both of the creature’s -fangs had entered the hand by a curving route, and probably in such -a manner that the free end of each fang, from which the poison is -ejected, passed completely through the skin from within outward. When -the bite of a poisonous snake is of a character such as I have just -described,—and not a few of them have this character,—only a very -small quantity of the venom is lodged in the subcutaneous tissues, -where the larger blood- and lymph-channels lie, and as a consequence the -person bitten escapes serious harm. On the other hand, when the fangs -enter the flesh in a less decidedly curving direction, thus permitting -a greater quantity of the venom to reach and remain in the deep-lying -tissues, serious or even fatal results may be anticipated. The point, -then, which I desire to make is simply this: Paul’s escape from death -in this instance may perfectly well be ascribed to natural causes.</p> - -<p>The Israelites, at a certain stage of their history, appear to have -completely divorced the practice of medicine from the priestly -function. In one place, for example, it is stated that King Asa sought -relief from his ailment, not from<span class="pagenum" id="Page_30">[30]</span> Jehovah, but from the physicians. -Jeremiah expresses astonishment that not a single physician is to -be found in Gilead. May this not be interpreted as signifying that -regularly established physicians were at that time (595 B. C.) to be -found in some parts of Palestine? And, at a much earlier period (1500 -B. C.), Job calls his friends “physicians of no value” (Job xiii., -iv.). From these and a number of other statements in the Bible it seems -permissible to believe that, at a very early period of history, the -Jewish physicians occupied an entirely independent position.</p> - -<p>It would doubtless appear strange to most readers of this brief sketch -of the history of medicine if some reference were not made in this -place to Luke, the author of the gospel which bears his name and of -the Acts of the Apostles, and who was also the companion of Paul on -his journey to Rome and during a portion of the latter’s stay in that -city. Luke was a native of Antioch, in Syria, and not a Jew. He was -a physician and tradition says that he was also a painter. It is not -known where he received his medical training, but it is not at all -unlikely that he studied at Alexandria, in Egypt, where the greatest -facilities for such training, obtainable at that period, were to -be found. His style of writing shows plainly that he was a man of -considerable cultivation and endowed with a clear and logical mind; and -if he had not possessed a genial personality he would hardly have been -known as “the beloved physician”; nor could any other motive but those -of loyal, self-sacrificing friendship for his friend, and a desire to -promote the cause of Christianity, have led him to share with Paul the -dangers and discomforts of the journey to Rome.</p> - -<p><i>The Medicine of India, China and Japan.</i>—It would be too much -of a departure from the plan which is being followed in the writing of -this history to attempt to describe, even in the briefest manner, the -mode of development of the science and art of medicine in India, China -and Japan. Unquestionably the earlier physicians of these countries -made many valuable contributions to<span class="pagenum" id="Page_31">[31]</span> medical knowledge, but they were -made at such a period of time, or under such conditions, that they -could not have exerted an appreciable influence upon the development -of medicine in ancient Greece,—certainly no such influence as was -exerted by Assyria and Persia, and especially by Egypt. It therefore -seems permissible to speak of the medicine of these more remote -countries only incidentally, and not as an integral part of the series -of centres of learning which made the medicine of ancient Greece the -direct ancestor—if I may use such a term—of European medicine.<a id="FNanchor_11" href="#Footnote_11" class="fnanchor">[11]</a> -In conformity with this idea it will be well to mention here briefly -a few of the more important facts relating to the achievements of the -physicians of the three countries named.</p> - -<p>The most celebrated medical authors in India were Caraka, Súsruta and -Vagbhata—“The ancient trinity,” as they were called. Caraka probably -lived during the early part of the Christian era, Súsruta during the -fifth century, and Vagbhata not later than during the seventh century -A. D. It is apparent, therefore, that none of the treatises written -by these authors could have exerted the slightest influence upon the -growth of medical knowledge in ancient Greece.</p> - -<p>The crudeness of many of the conceptions held by these Hindu physicians -concerning pathology is revealed in the following definition: -“Health is the expression of the normal composition of the three -elementary substances (air, mucus and bile) which play a vital -part in the machinery of the human body, and it is also dependent -upon the existence of normal quantitative relations between these -three substances; and when the latter are damaged, or when they are -abnormally increased or diminished, then disease of one kind or another -makes its appearance.”<a id="FNanchor_12" href="#Footnote_12" class="fnanchor">[12]</a></p> - -<p><span class="pagenum" id="Page_32">[32]</span></p> - -<p>Great stress was laid by the physicians as well as by the priests of -ancient India upon the observance of very elaborate rules respecting -the care of the person while in health and, very naturally, when a -patient became ill the physician in charge paid quite as much attention -to the employment of hygienic and dietetic measures in effecting the -desired cure as to the administering of drugs.</p> - -<p>The list of the commonly employed hygienic measures is too long for -reproduction in its entirety in this brief sketch, but an enumeration -of some of the more important items may prove interesting. In -estimating the value of these rules the reader should bear in mind -that they were intended for people living in a hot climate. Daily -bathing heads the list. Then follow: regulation of the bowels; rubbing -the teeth with fresh twigs of certain trees which possess astringent -properties, and also brushing them twice a day; rinsing the mouth with -appropriate washes; rubbing the eyes with salves; anointing the body -with perfumed oils; cutting the nails every five days, etc. Two meals -a day were prescribed—the first one between nine in the morning and -noon, and the second between seven and ten in the evening. “Only a -moderate amount of water should be drunk during the meal; drinking -water at the beginning of a meal delays digestion, while a copious -draught at the end produces obesity. After the meal the mouth should -be carefully cleansed and a short walk should be taken.” Among the -more important articles of food the following deserve to be mentioned: -rice, ripe fruit, the ordinary<span class="pagenum" id="Page_33">[33]</span> vegetables, ginger, garlic, salt, milk, -oil, melted butter, honey and sugar cane. If meat is eaten, preference -should be given to venison, wild fowl and the flesh of the buffalo. -The meat of the pig, and beef, as well as fish, are less conducive -to health. Gymnastic exercises in moderation are beneficial. Sleep -should be indulged in during the day only after some specially severe -exercise; at night it should not be extended beyond one hour before -sunrise. Bathing immediately after eating is harmful, and it is not to -be indulged in when one is affected with a cold, with a high fever, -with diarrhoea, or with some disease of the eyes or ears. A hot bath -or washing with warm water may be beneficial for the lower half of the -body, but for the upper half it is harmful. Sea bathing and cold baths -(preferably in the river Ganges) are beneficial. The clothing worn -should be clean; soiled garments are likely to produce skin diseases. -It is advisable to wear shoes, and an umbrella or a staff should be -carried. The wearing of garlands, finery, and jewels increases the -vital powers and keeps away evil spirits. The following are good -measures to adopt for the preservation of health: an emetic once a -week; a laxative once a month; and a bloodletting twice a year. All -the measures enumerated above were subject to modification according -to changes in the season, the locality, the weather, and various other -circumstances.</p> - -<p>In harmony with the extraordinary fruitfulness of the land the -pharmacopoeia of India is very rich. It is a remarkable fact that not -one of the numerous drugs mentioned in the official list is of European -origin. The great majority of them belong to the vegetable kingdom; -Caraka stating that he knew of 500 plants that possessed remedial -virtues, while Súsruta placed the number at 760. Then, too, the list -contains a goodly number of drugs which belong, some to the animal and -others to the mineral kingdom. It appears that the physicians of India -began using mineral substances, both externally and internally, at a -very early period of their history. Among such substances the following -may be mentioned: sulphate of copper, sulphate of iron, sulphate of -lead, oxide of lead, sulphur,<span class="pagenum" id="Page_34">[34]</span> arsenic, borax, alum, potash, chloride -of ammonium, gold, precious stones of different kinds, etc. The people -of India were skilled in chemical and pharmaceutical work. The drugs -were prepared by them in a great variety of ways—as, for instance, -extracts of the juices of plants, infusions, decoctions, electuaries, -mixtures, syrups, pills, pastes, powders, suppositories, collyria, -salves, etc. Practicing physicians carried with them a sort of portable -medicine chest, and they often collected, themselves, the medicinal -plants which they required. Súsruta gives instructions as to the spots -where certain plants are most likely to be found, and as to the seasons -when they should be gathered. Charlatanry and mysticism often played a -part in this business. Thus, it was maintained that drugs collected and -prepared by persons other than physicians did not produce the desired -effects. The fact that cosmetics (especially hair dyes), “elixirs of -life,” aphrodisiacs, poisons and antidotes for poisons, occupy the most -prominent place in the list of pharmaceutic preparations sold, casts -a glaring ray of light, as Neuburger states, on the degree of culture -among the people of ancient India.</p> - -<p>The list of separate maladies recognized by the physicians of the -latter country is inordinately long. There were 26 kinds of fevers, 13 -species of swellings of the lower abdomen, 20 different diseases due to -worms, 20 kinds of urinary diseases, 8 varieties of strangury, 5 kinds -of jaundice, 5 varieties of cough or asthma, 18 kinds of “leprosy,” 6 -kinds of abscesses, 76 different eye diseases, 28 affections of the -ear, 65 disorders of the mouth, 31 nasal affections, 18 diseases of -the throat, a large number of mental disorders, etc. It seems scarcely -necessary to remark that these so-called diseases were in reality -only groups of certain types of loosely related symptoms. The term -“leprosy,” for example, included, besides the disease which modern -physicians call by that name, a number of different affections of the -skin. It is worth noting here that diabetes mellitus, which is one -of the twenty different kinds of urinary diseases enumerated in the -classified list mentioned above, was first described by the physicians -of<span class="pagenum" id="Page_35">[35]</span> India, whose attention was directed to the disorder by observing -that flies and other insects were attracted to the urine of these -patients by reason of its sweetness. It is also an interesting fact -that occasionally these physicians, who, beyond a doubt, were keen -observers of symptoms, paid some attention to the anatomical features -of the individual cases. Thus, it is stated that the particular form of -swelling of the lower abdomen, to which they applied the name “splenic -belly,” is dependent upon “an enlarged spleen which distends the left -side, is as hard as a stone, and is arched like the back of a turtle”; -whereas they spoke of “an enlargement of the liver” when very much the -same conditions were observed on the right side of the abdomen. The -accuracy of their clinical observations is particularly noticeable in -their accounts of cases of consumption, apoplexy, epilepsy, hemicrania, -tetanus, rheumatism, venereal diseases, some affections of the skin, -and insanity. It was in their surgical technique, however, that -the physicians of ancient India were distinguished above all their -brethren of the neighboring oriental countries, and this superiority -they maintained for a very long time. Among the operations which they -performed the following may be mentioned: they removed tumors by -excising them, they opened abscesses by the use of the knife, they -employed scarifications (in inflammations of the throat) and made -punctures (in hydrocele and ascites), they passed probes into fistulae, -they extracted foreign bodies, and they employed needles armed with -hairs taken from the horsed tail or with thread composed of flax or -hemp. According to Súsruta their stock of instruments was composed of -101 blunt and 20 cutting instruments. Among those which were blunt -there were forceps of different sizes and forms, hooks, tubes, probes -or sounds, catheters, bougies, etc. They made use of the magnet -for drawing out foreign bodies of iron, and they applied cups for -therapeutic purposes. Their cutting instruments consisted of knives, -bistouris, lancets, scissors, trochars, needles, etc. Steel was the -metal of which they were made; for the people of India learned at a -very early period how<span class="pagenum" id="Page_36">[36]</span> to make steel. In suitable cases cauterization, -either with the actual cautery or with caustic potash, was a favorite -method of treatment with the surgeons of ancient India. “Burning with -the heated iron,” they taught, “is more effective than cauterization -with potash, inasmuch as it permanently cures diseases which may not be -cured by either drugs, surgical instruments, or chemical cauterizing -agents.” In cases of enlargement of the spleen they plunged red-hot -needles into the parenchyma of the organ, presumably through the -skin and other overlying tissues. There were fourteen different -kinds of surgical dressings; cotton, woolen, linen and silk being -the materials used for bandages, and strips of bamboo or some other -wood for splints. When the conditions permitted such a proceeding, -it was customary to sew up wounds of the head, face and windpipe. -Furthermore, it was the rule to perform all surgical operations at a -time when the constellations were favorable. Religious ceremonies were -performed both before the operation and after it was completed, and -it was also considered necessary that the operator should face the -west and the patient the east. Intoxication was employed as a means -of securing narcosis. Owing to their scrupulous cleanliness and the -minute attention which they paid to details, the surgeons of ancient -India obtained for a long time a much higher degree of success than -did the surgeons of other oriental nations. At the same time they were -not lacking in that degree of boldness which enables an operator—in -critical cases which probably without such prompt and radical action -would terminate fatally—to save life. For example, they did not -hesitate to open the abdominal cavity and to sew up a wound in the -intestines; they cut for stone in the bladder, employing for this -purpose the lateral method of operating; and they performed a great -variety of plastic operations.</p> - -<p>Some of their hygienic rules concerning pregnant and nursing women -are eminently practical; others would hardly be approved by modern -accoucheurs. Here are a few of these rules: During the period of a -woman’s pregnancy close attention should be paid to her diet, and<span class="pagenum" id="Page_37">[37]</span> -special care should be exercised by her to avoid excesses or errors -of any kind. When the ninth month is reached she should take up her -abode in the small cottage in which she is eventually to be confined—a -building erected with special religious ceremonies and thoroughly -fitted with everything that is likely to conduce to her comfort. At -the time of the actual confinement she should have with her four -female assistants, and all those measures, of either a religious or a -practical character, which have in view the hastening of the birth of -the infant, should be scrupulously carried out. If any delay in the -delivery of the after-birth occurs, the removal of the mass may be -promoted by the employment of well-directed pressure over the lower -part of the abdomen, by shaking the body, and also, if necessary, by -giving an emetic. The woman in childbed should not be allowed to get -up before the tenth day after her confinement, and for a period of -six weeks her diet should be most carefully watched. On the third day -the child should be put to the mother’s breast; up to that time it -should be given only honey and butter. If the mother, for any reason, -is not able to suckle the infant, a wet-nurse should be employed for -the purpose, but not until the physician shall have subjected her to -a most thorough examination and shall have instructed her minutely in -regard to her own diet. The subsequent care of the child was provided -for in the most particular manner: It was restricted to a carefully -planned diet; it was not allowed to sit or to lie except in certain -prescribed positions; its times for sleeping were strictly ordered; -it was permitted to amuse itself only in certain ways;—in brief, -everything was done according to strict rules, even special precautions -being taken to guard the child, during the first years of life, against -dangerous demons. Weaning began after the sixth month, and for a -certain length of time the child was fed largely on rice. In cases of -difficult labor and in their gynaecological practice the physicians of -ancient India did not manifest any special knowledge or skill.</p> - -<p>One of the instructions given to young physicians in India when they -were about to enter upon the practice of<span class="pagenum" id="Page_38">[38]</span> their profession, may be -of interest to the reader. It is worded as follows: “Let thy hair -and finger-nails be cut short, keep thy body clean, put on white -garments, wear shoes on thy feet, and carry a staff or umbrella in thy -hand. Thy demeanor should be humble, and thy heart pure and free from -deceitfulness.” The following proverb, although it originated in India, -is well worthy of acceptance in every part of the world: “When you are -ill the physician will be to you a father; when you have recovered from -your illness you will find him a friend; and when your health is fully -re-established he will act as your protector.”</p> - -<p>On a previous page the statement has been made that the science and -art of medicine developed in ancient Greece quite independently of -any influence that might have been exerted by the teachings of the -physicians of India. This statement should be somewhat modified, for it -is reasonable to suppose, although directly confirmatory evidence has -not yet been discovered, that, through the channels of trade between -the two countries, some knowledge of the doings of the physicians -of India must have reached the ears of their Greek brethren. On the -other hand, at a later period of history (after Alexander the Great -had invaded India), the relations between the two countries became -quite close and were kept up without a break for several hundred -years. During the earlier part of this later period, as appears from -the writings of Hippocrates, Dioscorides and Galen, various drugs and -methods of treatment employed by the physicians of India were adopted -by the practitioners of Greece.</p> - -<p><i>Medicine of the Chinese and Japanese.</i>—The isolation of China -with respect to those countries which were within comparatively easy -reach and in which there was a civilization that, already several -thousand years before the Christian era, had attained a remarkable -degree of development (India, Babylonia and Egypt, for example); her -blind belief in authority; her unwillingness to tolerate any influences -that seemed to emanate from foreigners; and her complete satisfaction -with her own methods of doing things, with her own beliefs, and with -her own<span class="pagenum" id="Page_39">[39]</span> natural and manufactured products,—these, it is generally -believed, were the most important factors in keeping this remarkable -nation in a state of immobility as regards at least some departments -of human knowledge and accomplishment. This is particularly true in -respect of the science and art of medicine. But China is at last -waking up from this lethargic state. A wonderful change has come over -her during the past twenty or thirty years, and she is now beginning -to realize that, with her millions of population and wonderful -natural resources, she has an important part to play in advancing the -civilization of the world.</p> - -<p>The preceding remarks must not be interpreted as signifying that, -during the long ages of the past, China has not been developing and -is not able at the present time to show a record of very creditable -work accomplished in many departments of human activity. In her early -history, many centuries ago, she accomplished great things, and all—so -far as we now know—without aid from neighboring nations; but there -came a time when all this creative activity ceased, and then, for long -periods of years, she appeared to rest satisfied with the advances -which she had already made, and to have no further ambition to add to -the stock of her possessions.</p> - -<p>Among the valuable things which should be credited to the Chinese -are the following: the discovery of the compass (about 1100 B. C.), -the making of porcelain, the invention of printing, the raising of -silkworms, the manufacture of glass and of paper, the successful dyeing -with purple, embroidering with gold, working in metals, the artistic -cutting of precious stones, enameling, the making of “India ink,” etc. -Furthermore, it is a fact most creditable to the Chinese that in no -other country in the world have scholars been held in such high esteem, -or assigned so high a rank, as they have been and still are in China.</p> - -<p>Chinese medicine possesses a very rich literature. The first medical -treatise, which deals with plants that possess medicinal virtues, is -ascribed to the Emperor Schin-Nung, who flourished about 2800 B. C. -This is the monarch who<span class="pagenum" id="Page_40">[40]</span> taught his people from which springs they -should drink, and who tested all the plants of his vast empire with -reference to their healing properties. According to the legend the -wall of his stomach was so thin that he could look through it and see -everything that was going on in the interior of that organ. In this way -he was able to carry on a large series of experiments upon himself in -regard to the action of different poisons and their antidotes. It is -also related that medical knowledge was still further advanced by the -yellow Emperor Hoang-Ti who lived about 2650 B. C., and who is credited -by the Chinese with having invented arithmetic and music. The treatise -called “Noi-King,” which deals with the subject of internal diseases -and gives a systematic account of human anatomy, is also credited -by the Chinese to this monarch; but Neuburger maintains that this -book, which is still in common use in China, is of much more recent -origin. There are several other medical treatises which deserve to be -mentioned. Such, for example, are the following: the celebrated book on -the pulse, written by Wang-Schu-Scho in the third century B. C.; two -very important books written by Cho-Chiyu-Kei—one bearing the title -“Schang-Han-Lun” (On Fevers) and the other that of “Kin-Kwéi” (Golden -Casket);—the different treatises written by Tschang-Ki (tenth century -A. D.) and published in the collection called “The Golden Mirror of -the Forefathers in Medicine” (I-Tsung-Kin-Kien); and, finally, the -very popular modern work (in forty volumes) entitled “The Trustworthy -Guide in the Science and Art of Medicine” (“Ching-Che-Chun-Ching”). Of -these forty volumes, seven are devoted to nosology, eight to pharmacy, -five to pathology, six to surgery, and the remainder to children’s and -women’s diseases.</p> - -<p>Anatomy, it appears, has never played other than a very insignificant -part in the Chinese system of medicine. This is not to be wondered -at when we remember that their religion makes the dissection of a -human body a sin worthy of punishment. No mutilated person, the -Chinese believed, would be permitted, upon reaching the domain of -the dead,<span class="pagenum" id="Page_41">[41]</span> to rejoin his ancestors. About the year 1700 A. D. the -Emperor Kang-Hi made the attempt to incorporate anatomy as a part -of the regular study of medicine in the Chinese Empire; his first -step being the authorization of P. Perennin, a Jesuit Father, to -translate Dionis’ work on anatomy into the Chinese. His efforts were, -however, unsuccessful, owing to the strong opposition offered by the -native physicians. And the attempts made during more recent times -to accomplish the desired reform by introducing copies of European -anatomical illustrations do not appear, as yet, to have produced any -appreciable impression. In very recent years, however, the medical -missionaries, sent out, if I am rightly informed, from the United -States, are giving excellent instruction in anatomy.</p> - -<p>Physiology, as taught by the Chinese, is something beyond the -comprehension of modern Europeans. Neuburger explains their views -in the following manner: “The cosmos is the product of the combined -action of two dissimilar forces—the male (Yâng) and the female (Yin). -When these forces work in harmony a state of equilibrium results.... -Matter consists of five elements, viz., wood, fire, earth, metal, and -water; and all things are composed of these elements. In sympathetic -relationship with these five elements stand the five planets (Jupiter, -Mars, Saturn, Venus, Mercury), the five different kinds of air (wind, -heat, moisture, dryness, cold), the five quarters of the globe (east, -south, west, north and the equator), the five periods of the year (in -addition to the four which we recognize, the Chinese make a fifth -period out of the last eighteen days of spring, summer, autumn and -winter), the five times of day, the five colors (green or blue, red, -yellow, white and black), the five musical tones, etc.... As in the -cosmos, so in man the two primeval forces—Yâng and Yin—underlie all -his vital processes. Thus, his body is made up of the five elements of -which all matter is composed, and health depends upon the maintenance -of a state of equilibrium between the male and the female forces, -etc.” After this brief exposition it seems unnecessary<span class="pagenum" id="Page_42">[42]</span> to devote any -further space to the consideration of the physiological doctrines of -the Chinese.</p> - -<p>With respect to the questions of diagnosis and prognosis it may be -stated that the Chinese attach great importance to the necessity of -making a most careful objective examination of the entire body; but, -when one investigates the precise manner in which this examination is -to be carried out, it soon appears that most of the details relate to -matters of a purely fanciful or mystical nature. The only steps of real -importance, according to them, are the examination of the patient’s -pulse and the inspection of his eyesight and his tongue. From the -examination of the pulse alone they believe it possible to diagnose -the nature and seat of the disease. To examine the pulse properly -is a complicated affair and can scarcely be carried out in actual -practice in less time than ten minutes; indeed, in certain cases the -physician may find it necessary to devote two or three hours to the -business. According to the Chinese scheme there are many different -kinds of pulse, and there are no less than thirty-seven different types -of condition presented by the tongue, each bearing its own special -pathological significance.</p> - -<p>Disease, so reads the Chinese doctrine, is a discord, a disturbance -of equilibrium, caused by the preponderance of one or the other of -the primeval forces (the male or the female). It manifests itself -in some disorder of the circulation of the vital air and the blood, -and eventually involves the organs of the body. Wind, cold, dryness, -moisture, the emotions and passions, poisons, and also evil spirits and -imaginary beasts are the causes of disease.</p> - -<p>No other nation, says Neuburger, has at its command such a large number -of remedial drugs; and it is also a fact, he adds, that the department -of therapeutics is that in which Chinese medicine has reached its -highest development. The steadfast belief that in nature there exists -a remedy for every human ill led the physicians of that country to -search diligently in all possible directions for vegetable and animal -and also, to some extent, mineral substances which might possess -remedial virtues. Although<span class="pagenum" id="Page_43">[43]</span> this search necessarily brought to notice -a lot of useless drugs, it cannot be denied that eventually it added a -considerable number of remedies which have proved useful to the medical -profession of the entire world. In this category belong the following: -rhubarb, pomegranate root as a cure for worms, camphor, aconite, -cannabis, iron (for the relief of anaemia), arsenic (for malarial and -skin diseases), sulphur and mercury (both of these for affections of -the skin), sodium sulphate, copper sulphate (as an emetic), alum, -sal ammoniac and musk (for nervous affections). Toward the middle -of the sixteenth century A. D. there was published, under the title -“Pen-Tsao-Kang-Mu,” a monumental work (fifty-two volumes) in which are -very fully described no fewer than 1800 remedies, mostly of a vegetable -nature. Prophylactic Inoculation with the pus from a small-pox pustule -was practised by the Chinese as long ago as during the eleventh century -A. D., “thus constituting a forerunner of our modern serum therapy.” -(Neuburger.) Vaccination was not introduced into China until during the -nineteenth century of the present era. It is a curious fact that, in -the choice of a remedy, the Chinese physicians attach a certain degree -of importance to the form and color of the drug, as symbols indicative -of the effect which they may be expected to produce. Thus, the red -blossoms of the hibiscus plant are believed to be more efficacious -than the white as an emmenagogue; saffron, being of a yellow color, -possesses the power to relieve jaundice; beans that have the shape of -a kidney should be prescribed in cases of renal disease; glow-worms -should form a part of all eye-washes, etc.</p> - -<p>The doses prescribed are very large, and the medicines are often put up -in an attractive form, with labels on which such descriptive titles as -these are written: “Powders of the Three very wise Men,” or “Powders -recommended by Five Distinguished Physicians”—titles which are -calculated to work upon the imagination of the patient.</p> - -<p>There are two methods of treatment which the Chinese physicians -are very fond of employing for the relief of a great variety of -diseases—viz., acupuncture and cauterization<span class="pagenum" id="Page_44">[44]</span> of the skin over the -seat of the malady by means of what are termed “moxae”—moxibustion. -Moxae are prepared by kneading together into a cone-shaped, tinder-like -mass the leaves of the artemisia vulgaris, then drying it thoroughly. -Such a mass is attached to the skin at the affected spot by simply -moistening the base of the cone, after which the apex is ignited. Some -physicians prefer to interpose a thin sheet of metal between the skin -and the base of the moxa. The manner in which these contrivances should -be used in the different diseases and the proper number to employ are -matters subject to fixed rules. In a strong individual, for example, -as many as fifty moxae may be used at a time. In affections of the -chest they were applied to the patient’s back, in diseases of the -stomach to the shoulders, and in venereal affections over the spinal -column. In acupuncture, which is a procedure invented by the Chinese, -slender needles of gold, silver or highly tempered steel, from 5 to 22 -centimetres (2 in.-8¼ in.) in length, were forced through the stretched -skin to different depths (1¼ in.-1½ in.) and then driven farther inward -in a rotary direction by means of a small hammer. The needles, after -being allowed to remain in situ for a few minutes, were withdrawn, and -pressure was made with the hand over the small wounds, or a moxa was -burned over the spot. There are in all 388 places where acupuncture may -be performed, and a chart of the body, showing where these places are -located, has been prepared for the guidance of the Chinese physicians. -Neuburger calls attention to the fact that the latter dislike the sight -of blood, and that this is one of the reasons why acupuncture and the -use of moxae have grown to be such popular remedies. Bloodletting -is rarely employed by them; but dry cupping, on the contrary, is a -favorite procedure in certain maladies. Massage is generally performed -by old or blind women, and much attention is devoted to the “movement -cure,” which is said to have been invented about 2500 B. C.</p> - -<p>As may readily be imagined, the Chinese—owing to their dislike for the -sight of blood and also by reason of<span class="pagenum" id="Page_45">[45]</span> their ignorance of anatomy—have -not advanced, in surgery, beyond the most primitive state of that art.</p> - -<p>The science of public health is quite unknown in China. In a Chinese -treatise entitled “Long Life,” the following advice is given: “Always -rise early in the morning, take some breakfast before you leave your -residence, drink a little tea before eating, at the mid-day meal -partake of well-cooked but not too highly salted food, eat slowly, take -a nap of two hours after the meal, eat lightly at night, and, before -going to bed, rinse your mouth with tea and have the soles of your feet -rubbed until they are warm.” (Neuburger.)</p> - -<p>Up to the latter part of the nineteenth century of the present era, -Japan, so far as medical matters are concerned, differed in no -material respect from China. During the last fifty or sixty years, -however,—that is, since the visit of Commodore Perry, of the United -States Navy, to that country,—wonderful changes have taken place; and -now Japan, as a result of her determination to adopt the methods of -education, of utilizing steam and electric power, etc., has already -taken a leading place in the council of nations. The physicians, many -of whom received their training in the best schools of Europe and -the United States, are contributing to-day their full share toward -advancing the science of medicine. That China is following in the -footsteps of Japan is already plainly evident, and no intelligent -observer entertains the slightest doubt of her ultimately—probably at -no distant day—possessing a corps of medical men as well educated, -as efficient in the treatment of disease, and as practical in public -hygiene as their European and American confrères. During thousands -of years China has suffered severely from the blighting tyranny of -superstition, priestcraft and selfish bureaucracy, and, now that the -sunlight of truth and genuine liberty is beginning to search every nook -and cranny of that great country, we who have had the advantage of this -beneficent influence for so many scores of years truly rejoice over the -change that is taking place in China.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_46">[46]</span></p> - -<h3>CHAPTER IV<br /> -<span class="subhed1">GREEK MEDICINE AT THE DAWN OF HISTORY</span></h3></div> - -<p>It is from Greece and from Greece alone, says Daremberg, that our -modern medicine derives its origin.</p> - -<div class="blockquot"> - -<p>It has come down to us, in a direct line, through the sheer -force of its inherent excellence, and with little or no aid from -outside sources. Harvey, Bichat and Broussais are as much the -legitimate heirs of Hippocrates, Herophilus, Galen, Berenger de -Carpi and Vesalius, as Hippocrates is the heir of Homer, and -as this divine singer of the anger of Achilles is himself the -product of a civilization that existed before his day and that -was in all probability the creation of Hindu influences.</p> -</div> - -<p>It is to the development of medical knowledge in Greece, therefore, -that our attention should next be directed, and more particularly to -that period which belongs to the dawn of history—the pre-Homeric -period.</p> - -<p><i>The pre-Homeric Period of Medicine in Greece.</i>—The poems of -Homer, the Iliad and the Odyssey, furnish us with the earliest and -almost the only written evidence of the state of medicine in Greece -during that period of time. They were probably written, according -to the authority of the Earl of Derby, somewhere about 800 B. C., -and modern investigations show that the siege of Troy, the theme -of the Iliad, occurred between the years 1194 and 1184 B. C. These -investigations also show that in this region, and especially in the -Island of Crete and in Mycenae on the neighboring mainland of Asia -Minor, at this time and probably several hundred years earlier, there -existed a high degree of civilization. Specimens of a written language, -for example, were found among the objects recovered from the ruins -of the palace of King Minos at<span class="pagenum" id="Page_47">[47]</span> Cnossus in Crete, but hitherto no -interpreter of this unknown language has been found. It is reasonable -to expect, however, that in due time these Minoan records will be -translated, that still other records belonging to this remote age -will be discovered, and that much valuable information regarding the -condition of medical knowledge in Greece during this long period -will then be revealed to us. Strange as it may appear, the classical -Greek writers seem to have possessed very little knowledge concerning -this highly developed civilization at Cnossus. And yet, if we stop -to consider the matter, their silence will appear less strange for -the following reasons. Some great calamity (war, an earthquake, or a -conflagration) must have destroyed many of the evidences of Minoan -civilization besides those which are now being brought to light; then, -also, several hundred years elapsed between the occurrence of this -disaster and the classical period of Greek culture; and, finally, there -is the fact that the knowledge of past historical events, when kept -alive simply by tradition, slowly vanishes, until finally it becomes -so vague as to possess very little value. The discoveries made in the -Island of Crete and at Mycenae were not known to Daremberg when he -wrote the lines quoted above, but he felt perfectly sure, from his -knowledge of the laws of development in general, that a product so -highly cultured as Homer could not have suddenly sprung into existence -out of the apparent darkness and ignorance of the centuries immediately -preceding his time.</p> - -<p><i>The State of Medical Knowledge at the Time of the Siege of -Troy.</i>—It is from Homer’s Iliad and Odyssey that our authoritative -knowledge of the most ancient Greek medicine is derived. In the former -work mention is made of Aesculapius and his two sons, Machaon and -Podalirius, both of whom accompanied Agamemnon and the Greek host in -their expedition against Troy. According to this author’s account they -served in the double capacity of surgeons to the army and valiant -leaders of troops. In order that the reader may judge for himself just -what is the nature of the evidence furnished by Homer with regard<span class="pagenum" id="Page_48">[48]</span> to -the medical knowledge of that period, it seems desirable to introduce -here a few of the more characteristic references which the poet makes -to spear, javelin and arrow wounds, to the injuries caused by fragments -of rocks hurled by the assailants, and to various remedial measures, -both surgical and medical, employed for the relief of the wounded or -sick warriors. There are at least one hundred such passages in the -Iliad alone, but the few which are here cited will serve as adequate -examples of Homer’s familiarity with anatomy and with some of the -methods of treating spear and arrow wounds,—a familiarity which -indicates that the poet must have had some medical training.</p> - - <div class="poetry-container"> - <div class="poetry"> - <div class="stanza"> - <div>Thus he; and not unmoved Machaon heard:</div> - <div class="hangingindent">They through the crowd, and through the widespread host,</div> - <div>Together took their way; but when they came</div> - <div>Where fair-hair’d Menelaüs, wounded, stood,</div> - <div>Around him in a ring the best of Greece,</div> - <div>And in the midst the godlike chief himself,</div> - <div>From the close-fitting belt the shaft he drew,</div> - <div>With sharp return of pain; the sparkling belt</div> - <div>He loosen’d, and the doublet underneath,</div> - <div>And coat of mail, the work of Arm’rer’s hand.</div> - <div>But when the wound appeared in sight, where struck</div> - <div>The stinging arrow, from the clotted blood</div> - <div>He cleans’d it, and applied with skilful hand</div> - <div>The healing ointments, which, in friendly guise,</div> - <div>The learned Chiron to his father gave.</div> - <div class="right">(Book IV. of the Iliad, Lines 221–259.)</div> - </div> - - <div class="stanza"> - <div class="spacing">*****</div> - </div> - - <div class="stanza"> - <div>He said: the spear, by Pallas guided, struck</div> - <div>Beside the nostril, underneath the eye;</div> - <div>Crashed through the teeth, and cutting through the tongue</div> - <div>Beneath the angle of the jaw came forth:</div> - <div>Down from the car he fell; and loudly rang</div> - <div>His glittering arms: aside the startled steeds</div> - <div>Sprang devious: from his limbs the spirit fled.</div> - <div>Down leaped Aeneas, spear and shield in hand,</div> - <div>Against the Greeks to guard the valiant dead;</div> - <div>And like a lion, fearless in his strength,<span class="pagenum" id="Page_49">[49]</span></div> - <div>Around the corpse he stalk’d, this way and that,</div> - <div>His spear and buckler round before him held,</div> - <div>To all who dar’d approach him threatening death,</div> - <div>With fearful shouts; a rocky fragment then</div> - <div>Tydides lifted up, a mighty mass,</div> - <div>Which scarce two men could raise, as men are now:</div> - <div>But he, unaided, lifted it with ease.</div> - <div>With this he smote Aeneas near the groin,</div> - <div>Where the thigh bone, inserted in the hip,</div> - <div>Turns in the socket joint; the rugged mass</div> - <div>The socket crushed, and both the tendons broke,</div> - <div>And tore away the flesh: down on his knees,</div> - <div>Yet resting on his hand, the hero fell;</div> - <div>And o’er his eyes the shades of darkness spread.</div> - <div class="right">(The Iliad, Book V., Lines 333–356.)</div> - </div> - - <div class="stanza"> - <div class="spacing">*****</div> - </div> - - <div class="stanza"> - <div>He said, and passing his supporting hand</div> - <div>Beneath his [Eurypylus’] breast, the wounded warrior led</div> - <div>Within the tent; th’ attendant saw, and spread</div> - <div>The ox-hide couch; then as he lay reclined,</div> - <div>Patroclus, with his dagger, from the thigh</div> - <div>Cut out the biting shaft; and from the wound</div> - <div>With tepid water cleans’d the clotted blood;</div> - <div>Then, pounded in his hands, a root applied</div> - <div>Astringent, anodyne, which all his pain</div> - <div>Allayed; the wound was dried, and stanch’d the blood.</div> - <div class="right">(The Iliad, Book XI., Lines 958–967.)</div> - </div> - - <div class="stanza"> - <div class="spacing">*****</div> - </div> - - <div class="stanza"> - <div>But Jove-born Helen otherwise, meantime,</div> - <div>Employed, into the wine of which they drank</div> - <div>A drug infused, antidote to the pains</div> - <div>Of grief and anger, a most potent charm</div> - <div>For ills of every name.<a id="FNanchor_13" href="#Footnote_13" class="fnanchor">[13]</a> Whoe’er his wine</div> - <div>So medicated drinks, he shall not pour</div> - <div>All day the tears down his wan cheeks, although</div> - <div>His father and his mother both were dead,</div> - <div>Nor even though his brother or his son</div> - <div>Had fallen in battle, and before his eyes.</div> - <div class="right">(Book IV. of the Odyssey, Lines 275–284.)</div> - </div> - </div> - </div> - -<p><span class="pagenum" id="Page_50">[50]</span></p> - -<p>In former years and down almost to the present time, it was the custom -among English medical writers to speak of Aesculapius only as the -“God of Medicine,” thus conveying to the minds of many readers that -he was a mythological character, not a real personage. To-day, and -especially since Schliemann has demonstrated, by his excavations at -the site of ancient Troy, that Homer’s Iliad is not merely a beautiful -creation of his poetic fancy, but a narration of events that actually -occurred about 1200 B. C., it is quite generally acknowledged that -Aesculapius<a id="FNanchor_14" href="#Footnote_14" class="fnanchor">[14]</a> is an historical character, an individual whose memory -should receive due honor from the physicians of modern times. Neither -Homer nor Pindar speaks of him as a god. In Athens he was publicly -deified in 420 B. C.</p> - -<p>When Daremberg, as quoted above, expressed the belief that Hippocrates -was the product of an earlier civilization, he undoubtedly gave due -weight to other circumstances beside those which are narrated in -Homer’s poems—circumstances, for example, which are referred to -casually by several of the classical Greek authors, and to which fresh -importance has been given by a number of recent discoveries. Thus, -there is an abundance of evidence showing that the Greeks, both before -and after Homer’s time, held the memory of Aesculapius in the very -highest honor. So great, as they believed, was his power over disease, -so wonderful were the cures which he accomplished, and so noble and -pure was his character, that they made him a god and erected temples -in his honor—not mere places where a barren worship might be carried -on, but veritable sanatoria—termed Asclepieia—where the extraordinary -healing powers of him whom they had made a god might be perpetuated -for the benefit of succeeding<span class="pagenum" id="Page_51">[51]</span> generations. While, on the one hand, -the ancient Greeks may have been full of superstitious beliefs, they -were at the same time as kindly disposed toward their fellow men, as -generous in their spending of money for this purpose, and as practical -in their selection of suitable methods as are the benefactors of to-day -all over the world. In course of time these so-called temples became -the prototypes of our hospitals, sanatoria and schools of medicine, -and it therefore seems only proper that they should here be described -somewhat in detail.</p> - -<p><i>The so-called Aesculapian Temples and their Chief Purpose.</i>—The -first of these temples, or Asclepieia, were established at Trikka, in -Thessaly; at Cnidus, on the coast of Caria in Asia Minor, opposite -Cos; at Epidaurus, in Argolis, Greece; at Cyrene on the northern -coast of Lybia, Africa, opposite the Island of Crete; at Crotona, -on the southeastern coast of Italy; and, finally, at Athens. It is -said that traces of as many as eighty of these Asclepieia have been -found in different parts of the ancient world. One of them, for -example, is known to have existed on the small island (Isola San -Bartolommeo) in the Tiber, at Rome. Their management was intrusted, in -the earlier years of their existence, to men who were descendants of -Aesculapius—i.e., the sons and grandsons of Machaon and Podalirius. -They were both priests and physicians, and are mentioned in history as -the Asclepiadae. With the progress of time it became necessary, as one -may readily understand, to intrust the temple service to individuals -who were not members of the family of Aesculapius. The original -Asclepiadae guarded as valuable secrets the methods of treatment and -the pharmaceutic formulae which had been handed down to them by the -head of the family. It was therefore natural, when these newly adopted -members were installed in office, that they should be made to promise, -under oath, not to “divulge these secrets to any but their own sons, -the sons of their teachers, or the pupils who were preparing themselves -to become regular physicians.” (Neuburger.)</p> - -<p>The divulging of these secrets, it may be assumed,<span class="pagenum" id="Page_52">[52]</span> would gradually -entail upon the organization of priest-physicians a serious money -loss. As will be seen further on, the oath known as “the Hippocratic -Oath” omits these mercenary features, and thus places the vocation of -physician upon a much higher level.</p> - -<p>It is an interesting fact, as noted by Hollaender, of Berlin, that -Homer does not make the slightest mention of temples dedicated to -Aesculapius; from which circumstance it may be inferred that a long -time—perhaps several hundred years—elapsed, after his death, before -his countrymen realized fully his greatness and the value of the -services which he had rendered in his rôle of physician. Of the temples -which were then built in his honor, all have long since fallen into -ruins, but in recent years excavations have been made at some of the -more important of these sites and under the guidance of competent -scholars, and as a result our knowledge of the state of medicine in -Greece between the time of Homer and the appearance of the Hippocratic -writings has been greatly enlarged. The facts revealed by these -excavations and the statements which are to be found in classical Greek -literature, but which previously did not receive all the consideration -that they deserved, have now been pieced together and we have thus -been furnished with a fairly satisfactory picture of the relations of -the different chambers and spaces in these temples, and with a more or -less complete account of the manner in which affairs were conducted by -those in charge. The following short description which is based on the -account recently published by Professor Meyer-Steineg of Jena, Germany, -will put the reader in possession of all the more important facts.<a id="FNanchor_15" href="#Footnote_15" class="fnanchor">[15]</a></p> - - <div class="figcenter" id="i_fp052" style="width: 750px"> - <img - class="p2" - src="images/i_fp052.jpg" - alt="" /> - <p class="center p0 sm">FIG. 1. VIEW OF THE TEMPLE OF AESCULAPIUS ON THE ISLAND OF COS.</p> - <p class="p0 sm">As it must have appeared to the traveler, in the third century -B. C., on his approach by sea to the port of that island.</p> - <p class="p-min sm">Reconstitution based upon recent photographs and upon surveys by -Herzog (<i>Koische Forschungen</i>, 1904).</p> - <p class="p-min sm">(Courtesy of Prof. Dr. Meyer-Steineg, of Jena, Germany.)</p> - </div> - -<p>There were two principal types of Asclepieia—one, like that of -Epidaurus, in Argolis, which occupied an inland situation, that had -clearly been chosen from religious motives alone, viz., because it was -believed, in accordance with an ancient tradition, that at this spot -Aesculapius had <span class="pagenum" id="Page_53">[53]</span>been born—and a second, like that of Cos, on the -island of the same name in the Aegean Sea, which situation without -doubt had been chosen chiefly because the locality was exceptionally -healthful. Of the first of these two types of temples, the sites of -both of which have been most carefully studied, very little need -be said in this brief sketch. The purely medical aspects of this -Asclepieion, to which at the height of its celebrity crowds flocked -from all parts of Greece, are of minor interest. The temple and its -accessory buildings, which appear to have been very extensive, were -located in a narrow valley, not far distant from the seaside village -which still to-day bears the name of Epidaurus. Then, also, the -locality is deficient in one important respect—it has an insufficient -supply of good drinking water; and, finally, it is only slightly -elevated above the sea-level. Dr. Meyer-Steineg remarks that the -patients who visited this temple must have owed whatever benefit they -derived from the visit to other influences than those of a purely -medical or hygienic character. Doubtless suggestion played an important -part in any relief which they may have obtained, and the so-called -temple-sleep was also doubtless a very effective factor in this -direction. The Asclepieion at Cos, on the other hand, occupied a most -healthful position on the northern slope of the ridge of mountains -which extends throughout the entire length of the island and attains a -maximum height of about 3000 feet. (See Fig. 1.)</p> - -<p>It now remains for me to describe, as best I may within the limited -space which is at my command, the results of the excavations and -surveys that have been made in recent years on the Island of Cos. -Professor Meyer-Steineg’s article on this subject<a id="FNanchor_16" href="#Footnote_16" class="fnanchor">[16]</a> is the source -from which I have derived the information contained in the following -account.</p> - -<p>The temple and its associated buildings stood at an elevation of -three hundred feet above the sea-level and at a distance of a little -more than two miles from the city of Cos. The heights behind the -temple were in former<span class="pagenum" id="Page_54">[54]</span> times covered with forests and afforded ample -protection against the debilitating and much-dreaded south wind. A -brook of considerable size and of very pure water passed through the -temple grounds; the spring (Burinna) from which it took its origin -being located about 300 feet higher up on the side of the mountain. -Not far off, in the same neighborhood, is a mineral spring, the water -from which contains both iron and sulphur. All the physical conditions -of this site were, therefore, very favorable to the restoration of -both mental and bodily health. Professor Meyer-Steineg declares that -it is scarcely possible to determine accurately the age of the Cos -Asclepieion,—<i>i.e.</i>, of the structures which the present ruins -represent,—but he believes that some of them date no farther back than -the third century B. C., at which time extensive structural alterations -were made.<a id="FNanchor_17" href="#Footnote_17" class="fnanchor">[17]</a> Then, at a still later date (first century A. D.), in -consequence of the damage done by an earthquake, C. Stertinius Xenophon -(at the instigation of the Roman Emperor Claudius, whose private -physician he was) carried out some very radical changes. Not only were -the separate buildings well supplied with running water, but even many -of the individual rooms (of which there were a large number) were -equipped with the same conveniences. Hydropathy evidently formed an -important part of the treatment in the reconstructed temple. (See Fig. -2.)</p> - -<p>As has been shown above, the climate, the freedom from disturbing -factors of all kinds, the existence at that spot of a plentiful supply -of pure water, the character of the structures composing the temple -group, and the widespread belief among the people that the Asclepiadae -were able, with the assistance of the god Aesculapius, to effect cures -which were obtainable nowhere else—all contributed to make the temple -at Cos one of the greatest sanatoria of ancient times.</p> - - <div class="figcenter" id="i_fp054" style="width: 615px"> - <img - class="p2" - src="images/i_fp054.jpg" - alt="" /> - <p class="center p0 sm">FIG. 2. BIRD’S-EYE VIEW OF THE TEMPLE OF AESCULAPIUS AND -ASSOCIATED BUILDINGS ON THE ISLAND OF COS.</p> - <p class="center p0 sm">As they appeared in the third century B. C.</p> - <p class="p0 sm">(Copied by permission from a model made by Prof. Dr. -Meyer-Steineg for the Medico-historical Museum of the University -of Jena, Germany.)</p> - </div> - - <div class="figcenter" id="i_p055" style="width: 750px"> - <img - class="p2" - src="images/i_p055.jpg" - alt="" /> - <p class="center p0 sm">FIG. 3. GROUND PLAN OF THE ASCLEPIEION ON THE ISLAND OF COS.</p> - <p class="center p0 sm">As Ascertained by the Researches of Dr. Herzog.</p> - <p class="p0 sm">The different structures are arranged as nearly as possible in -the same positions which they occupied in the third century, B.C.</p> - <p class="p-min sm"><i>A</i>, main entrance to Asclepieion; <i>B</i>, <i>B</i>, -<i>B</i>, gallery, 6 metres broad, with colonnade on one side; -<i>C</i>, open space or court, on the southern side of which is -a structure composed of recesses provided each with a bathing -basin (<i>D</i>); <i>H</i>, staircase leading to intermediate -terrace; <i>a</i>, massive series of steps leading to the upper -terrace; <i>b</i>, <i>b</i>, <i>b</i>, broad gallery similar to -that shown on the lower terrace; <i>d</i>, the temple proper.</p> - <p class="center p0 sm">(From Prof. Dr. Meyer-Steineg’s <i>Medizinisch-historische Beiträge</i>.)</p> - </div> - -<p>The buildings which constituted what is commonly termed the “Temple -of Aesculapius” at Cos were located on three artificially prepared -terraces. The principal <span class="pagenum" id="Page_55">[55]</span>entrance to the group, as the excavations -conducted quite recently by Herzog show, was on the lower terrace, -and faced north—that is, toward the sea. From this lower level a -broad staircase led to the second or intermediate terrace, which, in -turn, was connected with the upper one by means of a very broad and -massive series of steps. The southern limit of this upper terrace -ended abruptly at the slope of the mountain. The arrangement of the -buildings<span class="pagenum" id="Page_56">[56]</span> on the three different terraces may, in harmony with the -account given by Professor Meyer-Steineg, be briefly described as -follows: That which stood on the lower terrace occupied three sides -of a parallelogram (Fig. 3), the open part of which faced south. The -longer side of the building measured about 120 metres (390 feet) in -length, and the two shorter sides each 55 metres (180 feet). The -supply of running water in every part of this great building, which -appears to have been devoted mainly, if not entirely, to therapeutic -purposes, must have been most abundant. The source from which the -water came was the Burinna spring, situated higher up on the mountain -at a spot far beyond all possibility of contamination. It is not yet -clear, says Dr. Meyer-Steineg, whether or not there were any buildings -devoted to therapeutic purposes on the intermediate terrace. (Figs. -2 and 3.) On the other hand, the great halls, contained in the large -building which surrounded the temple on the upper terrace, appear to -correspond very closely to the rooms that constituted the main portion -of the building on the lower terrace, and it is therefore probable that -this upper building also served some useful purpose in the general -scheme of the Asclepieion. It is Herzog’s opinion—according to -Meyer-Steineg—that the central idea around which everything in this -assemblage of fine buildings revolved, was a clinic conducted by the -Asclepiadae. The means chiefly employed at first for the restoration -of health were such simple agents as sunlight, pure air, pure drinking -water, dietetic measures, massage, physical exercise, etc., and yet, -when the patient’s condition seemed to require their use, there was no -hesitation in resorting to the rational employment of drugs, and even -surgical operations were performed. The numerous instruments which Dr. -Meyer-Steineg collected at the site of the ruins when he visited Cos in -1910, furnish ample corroborative evidence of the correctness of this -last statement.</p> - -<p>Not the least important part which this famous Asclepieion played in -the history of medicine was the splendid opportunity which it afforded -to those who were preparing<span class="pagenum" id="Page_57">[57]</span> themselves to engage in the practice of -the healing art, for acquiring the necessary familiarity with the -different diseases and for learning how they should be treated.</p> - -<p>The manner of conducting the preliminary treatment was probably not -the same in every particular in all the different Asclepieia, and yet -in the main the plan of procedure followed in Epidaurus, in Cos and in -Athens undoubtedly resembled closely that which Pagel furnishes in his -<i>Geschichte der Medizin</i>. It may be briefly described as follows:—</p> - -<p>In the first place, moribund persons, the unclean, and women about to -be confined were not admitted into the temple enclosure. The management -of the latter class of patients was left entirely to women nurses, and, -when it became evident that a person was likely to die, the individual -was thereafter cared for outside the enclosure.<a id="FNanchor_18" href="#Footnote_18" class="fnanchor">[18]</a> In short, -everything possible was done to keep out of sight all such objects as -might produce an unpleasant impression upon applicants for treatment. -After preliminary bathing and dieting, the patient was conducted into -the temple enclosure and encouraged to make offerings and to pray to -the god Aesculapius, an imposing statue of whom in marble was one of -the first things that confronted him. As he was led about by the priest -or an attendant, his imagination was wrought upon by the sight of -numerous votive offerings exposed to view on the walls or columns of -the buildings, by the singing of hymns in adoration of the god, and by -the reading of the records of earlier cases inscribed on tablets or on -the columns. After his mind had thus been worked upon, he was asked to -furnish to the priest a detailed history of his own case and to submit -to some sort of physical examination. As a final and most important -step in this first stage of the treatment he was subjected to what was -termed “the temple-sleep,” during which the suggestion of the proper -remedies to be employed was supposed to be communicated to him by the -god himself.</p> - -<p><span class="pagenum" id="Page_58">[58]</span></p> - -<p>In our day it is difficult to understand how persons of a fair degree -of intelligence could for so long a period have continued to believe -in the efficacious interference of the deified Aesculapius in their -behalf. But that this belief really did exist is well known, and it was -only after the lapse of many centuries that the faith of the public -began to weaken, doubtless through the influence of several factors. -Perhaps the most important of these was the discovery of an increasing -number of instances of humbuggery or trickery, of which the officiating -priests, in some of the temples, had been guilty. The satirical writer, -Aristophanes, who flourished in Athens about 400 B. C., describes an -incident of this nature in his play entitled “Ploutos.” The following -extracts furnish an account of the doings observed by the slave Karion -on the occasion of his passing a night in the temple enclosure at -Athens:—</p> - -<div class="blockquot"> - -<p class="center">The Scene throughout is laid at Athens, in front of the -house of Chremulos.</p> - -<p class="spacing">*****</p> - -<p><i>Blepsidemos</i>: Ought n’t we then to bring in some doctor?</p> - -<p><i>Chremulos</i>: Prythee, what doctor is there now in the city? -For their pay is no longer anything worth, nor their art.</p> - -<p><i>Blep.</i>: Let us cast about.</p> - -<p><i>Chrem.</i>: Nay, there is not one.</p> - -<p><i>Blep.</i>: I believe there is not.</p> - -<p><i>Chrem.</i>: Nay, by Zeus, the best plan is to do what I have -been long preparing—(to conduct him [Ploutos]) to the temple of -Asklepios [and] make him lie down [there].</p> - -<p class="spacing">*****</p> - -<p><i>Chrem.</i>: Karion, my man, you must bring out the bedclothes -and lead Ploutos himself in the usual way, and carry everything -else that is ready within.</p> - -<p class="center">(<i>Exeunt omnes.</i>)</p> - -<p class="spacing">*****</p> - -<p><i>Chorus of Farmers.</i> What is the matter, Oh thou best -friend of—thyself? For you seem to have come as a messenger of -some good news.</p> - -<p><span class="pagenum" id="Page_59">[59]</span></p> - -<p><i>Karion.</i><a id="FNanchor_19" href="#Footnote_19" class="fnanchor">[19]</a> My master has fared most prosperously, or -rather Ploutos himself. For, instead of being a blind man, he -has been made to see again, and his pupils are clear-sighted, as -he has met with a kindly friend in Asklepios the Healer.</p> - -<p><i>Chorus.</i> You give me reason for joy, reason for shouts of -triumph.</p> - -<p><i>Karion.</i> Ye have reason to rejoice whether ye wish it or -not.</p> - -<p><i>Chorus.</i> I will shout aloud for Asklepios of the goodly -children, the great light to mortals.</p> - -<p class="spacing">*****</p> - -<p><i>Karion.</i> Well, as soon as ever we came to the god, -leading a man then, indeed, most miserable, but now blessed and -fortunate, if any other is so, first we led him to the sea, and -then we bathed him.</p> - -<p><i>Wife of Chremulos.</i> By Zeus, then the old man was -fortunate, bathing in the cold sea.</p> - -<p><i>Karion.</i> Then we went to the sacred enclosure of the god. -And when on the altar the cakes and offerings were dedicated -by the flame of murky Hephaistos, we laid down Ploutos, as was -proper; and each of us made up from little odds and ends a bed -for himself.</p> - -<p><i>Wife.</i> Then were there certain others beside yourselves -wanting the god?</p> - -<p><i>Karion.</i> Yes, Neokleides, for one, and he is blind; but -in stealing has far overshot those who can see; and there were -many others with all sorts of ailments. But when the minister of -the deity put out the lights and told us to go to sleep and said -that we were to keep silent, if any of us perceived a noise, we -all lay down in an orderly manner. And I was unable to sleep, -for my attention was arrested by a certain pitcher of porridge -a little way off from the head of a certain old woman, and I -strangely desired to creep over to that pitcher. Then I looked -up and saw the priest making a clean sweep of the cakes and -dried figs from the sacred table. After this he went round all -the altars in a circle to see if any cakes were left anywhere. -Then he consecrated them into a certain wallet; and I, believing -that there was great holiness in this proceeding, rise up to go -to the pitcher of porridge.</p> - -<p><i>Wife.</i> Oh you most miserable of men, were you not afraid -of the god?</p> - -<p><i>Karion.</i> Yes; by the gods I was afraid lest he with his -fillets should reach the pitcher before me; for the priest -had already<span class="pagenum" id="Page_60">[60]</span> given me a lesson. But, as soon as ever the old -woman perceived the noise I made, she lifted up her hand over -the pitcher (to protect it). Then I hissed and seized (her -hand) by the teeth as if I were a reddish-brown snake. But -she at once drew back her hand again and lay down peacefully, -rolling herself up. And then I at once gulped down a lot of the -porridge; and then, when I was full, I jumped up again.</p> - -<p><i>Wife.</i> And didn’t the god come up to you?</p> - -<p><i>Karion.</i> Not up to that time. After this I at once -covered myself up, being afraid; but he made a complete circuit -examining all the ailments in a most orderly fashion; and then a -slave set by him a little mortar and box of stone.</p> - -<p><i>Wife.</i> Of stone?</p> - -<p><i>Karion.</i> No, by Zeus, certainly not,—at least, not the -box.</p> - -<p><i>Wife.</i> To the deuce with you, how did you see since you -say you were covered up?</p> - -<p><i>Karion.</i> Through my old cloak; for, by Zeus, it had holes -not a few. First of all, he took in hand to pound a plaster -for Neokleides, and he threw in three cloves of Tenian garlic. -Then he bruised them in the mortar, mixing therewith the acid -juice of the fig-tree and squill; then, having diluted it with -Sphettian vinegar, he turned his eyelids inside out that he -might feel more pain, and then applied the mixture. But he, -squalling and bawling, jumped up and was running away, when the -god said with a laugh:—“Sit down there now, smeared with thy -plaster, that I may stop thee from going to the Assembly, having -for once a real excuse.”</p> - -<p><i>Wife.</i> What a patriot and sage the god is!</p> - -<p><i>Karion.</i> After that he sat down by the side of Ploutos, -and first he touched his head, and then, taking a clean towel, -he wiped his eyelids all round, and Panakeia covered his head -and all his face with a cloth of purple dye; and the god then -whistled. Thereupon two snakes of monstrous size darted forth -from the temple.</p> - -<p><i>Wife.</i> Dear Gods!</p> - -<p><i>Karion.</i> And these two (snakes) having quietly glided -under the crimson cloth, licked his eyelids all around, -methought. And before you could drink ten cups of wine, my -mistress, Ploutos stood up and was able to see: and I clapped -my hands with delight and awoke my master. And the god suddenly -took himself off from our view with the snakes into the temple.</p> -</div> - -<p>If one examines carefully the facts connected with the Aesculapian -temple treatment, so far as they are known<span class="pagenum" id="Page_61">[61]</span> to us, one cannot fail -to be impressed with their strong resemblance to what has been the -experience of similar semi-religious movements in more recent times, -not only in European countries but also in the United States. In all -of them there may be found a kernel of true religious belief, and no -candid observer can deny the fact that many persons have been benefited -thereby both in body and in mind. But, sooner or later, the method -has fallen into disrepute, either because it was employed in the vain -hope that it might accomplish a cure which surgical means alone could -effect, or else because unscrupulous persons, taking advantage of the -credulousness of those associated with the movement, utilized it for -their own selfish advantage.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_62">[62]</span></p> - -<h3>CHAPTER V<br /> -<span class="subhed1">THE SIGNIFICANCE OF THE SERPENT IN THE STATUES AND VOTIVE -OFFERINGS EXPOSED TO VIEW IN THE AESCULAPIAN TEMPLES</span></h3></div> - -<p>Almost every important gallery of sculpture in Europe possesses at -least one marble statue of Aesculapius, and in the majority of these -the god is represented as a middle-aged or elderly man of powerful -frame, having a full head of hair and full beard, and clothed only -with the pallium or mantle, which is so placed as to leave the right -shoulder and a large part of the chest uncovered. He holds in his -right hand a knotted staff around which, in many of the statues, is -coiled a serpent whose head approaches very closely to the hand. The -expression of the god’s countenance is strikingly peaceful and serene, -yet without any evidence of weakness. In not a few instances other -animals are represented alongside the statue, usually at the god’s -feet—as, for example, the cock, the owl, the eagle, the hawk or the -ram—and occasionally his daughter Hygieia is shown at his side feeding -the serpent. The cock is the symbol of watchfulness—a physician should -be vigilant; the owl symbolizes his need of clear-sightedness and of -readiness to care for his patients in the night as well as during the -day; the eagle has a penetrating eye and it is the emblem of long -life—a benefit which the healing art is capable of procuring; the hawk -was the bird consecrated to Isis, Queen of Egypt, who was believed by -the Egyptians to have been highly skilled in medicine; and the ram -is the symbol of dreams and divination. Pliny says that the patients -who were brought to the temple of Aesculapius were made to lie down -at night wrapped in the skin of a <span class="pagenum" id="Page_63">[63]</span>ram, in order that they might -have divine dreams. The presence of the serpent in nearly all of the -statues of Aesculapius is explained in a variety of ways. Some say -that this reptile, which sheds his skin once a year, is emblematic of -the sick person’s need to acquire a new body, or at least cast off -his old skin in the same manner as does the snake. Others consider -the serpent as merely the symbol of wisdom, as it is admittedly the -shrewdest and most cunning of all animals. In a few instances it is -represented as drinking from a receptacle held in the hand of Hygieia. -Perhaps the sculptor’s intention here was to show that the serpent, -although the wisest of all animals, believed that he might add to -his stock of wisdom by drinking from the fountain under the control -of Aesculapius, thus conveying the impression that the wisdom of the -latter was greater than his own. But all these interpretations are too -subtle for the uneducated mind to appreciate at a glance. They fail -also to satisfy our preconceived ideas of what such a statue should -be—viz., a memorial of the godlike character of Aesculapius and of -the priceless benefits which he conferred upon his fellow men, and, -at the same time, an object which, when first contemplated by one -who is ill, would at once evoke in that person feelings of perfect -confidence in the ability and the willingness of the god represented -by the statue to effect a cure. Some, perhaps even a majority, of the -statues thus far recovered from the ruins of the different Aesculapian -temples certainly fail to arouse any such sentiments in the minds of -ordinary observers; but there are others which do in some measure -accomplish this, and among the number the statue which may be seen in -the Berlin Museum and of which a photographic copy (Fig. 4) is here -reproduced, should certainly be included. The head of the god is less -imposing and the expression less kindly than are these features in -some of the other statues (see, for example, Fig. 5), but, to offset -this, the serpent represented in the latter is of the non-poisonous -variety.<a id="FNanchor_20" href="#Footnote_20" class="fnanchor">[20]</a> The addition of such a harmless creature to the figure -representing the god contributes<span class="pagenum" id="Page_64">[64]</span> nothing to the power of the statue -as a whole to impress the people—<i>i.e.</i>, the uneducated masses, -as, for example, the peasants, etc. On the other hand, the significance -of the poisonous snake in a statue of this character will be readily -appreciated if one considers the fact that in ancient times, as it is -even to-day in India, the loss of life caused by the bites of poisonous -snakes was enormous. In the presence of such a fact, therefore, it -would be difficult for a sculptor who was desirous of emphasizing -the extraordinary healing powers of his hero to accomplish this -more effectively than by embodying in his statue, along with other -impressive features, such characters as would show him to have gained -the mastery over that terribly fatal malady—the bite of the viper -and of the still more deadly serpents of India and parts of Africa. -Although we possess no facts which would warrant the statement that -Aesculapius had been particularly successful in the treatment of this -form of poisoning, these temple statues furnish indirect proof of a -strong character that his healing power in this direction had been -very great,—so great, indeed, as to have been largely instrumental -in winning for him the appellation of a god. Such a striking object, -especially when its more important features were commented upon by -the priest who accompanied the patient on his or her first tour of -inspection of temple wonders, could scarcely have failed to produce a -very deep impression upon the imagination.</p> - - <div class="figcenter" id="i_fp062a" style="width: 309px"> - <img - class="p2" - src="images/i_fp062a.jpg" - alt="" /> - <p class="center p0 sm">FIG. 4. ANCIENT STATUE OF THE GOD AESCULAPIUS IN THE -BERLIN MUSEUM.</p> - <p class="p0 sm">(From Holländer’s <i>Plastik und Medizin</i>, with the author’s -permission.)</p> - </div> - - <div class="figcenter" id="i_fp062b" style="width: 450px"> - <img - class="p2" - src="images/i_fp062b.jpg" - alt="" /> - <p class="center p0 sm">FIG. 5.</p> - <p class="center p0 sm">HEAD OF THE MARBLE STATUE OF THE GOD AESCULAPIUS IN THE NAPLES MUSEUM.</p> - </div> - -<p>In the illustration which has here been reproduced (Fig. 4), a viper, -as clearly shown by the shape of his head and neck and by the unusual -length of the jaw, has twined himself about the staff and is close -to the god’s hand, so close that in an instant’s time the fatal bite -might readily be inflicted. But Aesculapius shows by his countenance, -by the unconcerned manner in which he allows his right hand to remain -near the serpent’s head, and by the easy pose of his whole body, that -he is not at all concerned about the danger which appears to threaten -his life. In the estimation of the ancient Greeks this fearlessness was -undoubtedly attributed to the supernatural power which they<span class="pagenum" id="Page_65">[65]</span> believed -Aesculapius to possess over dangerous serpents as well as over diseases -of all kinds.</p> - -<p>So far as now appears, all the statues of the god that have been dug -up in Greece or its nearest colonies represent the serpent as of -the size commonly observed in that part of the world. Hollaender, -however, furnishes (on page 118 of his work) an illustration which -represents—as he believes—the god Aesculapius in the presence of -an enormous snake, evidently a python. (Fig. 6.) As this variety of -serpent is not to be found in Greece, or indeed at any point further -north than the Mediterranean coast of Africa, it is fair to assume -that the bas-relief which depicts this scene must have been made for -exhibition in an Asclepieion located at Cyrene or at the relatively -near city of Alexandria, where patients, who were more or less familiar -with this serpent and realized its power of crushing people to death, -would have occasion to witness this suggestive work of art. And, -furthermore, as if it were for the express purpose of emphasizing the -great protective power of the god, the sculptor has introduced, on one -side of the scene, the figures of three women, two young children and -a lamb. The women nearest to the monster have folded their arms and do -not manifest the least sign of fear. The children also appear to be -unaware of the presence of a deadly danger. In short, the proximity of -the god Aesculapius has instilled into the minds of these human beings -the most complete sense of fearlessness; he himself, as in the case -of the statue of Aesculapius shown in Fig. 4, exhibiting a complete -absence of fear in the presence of the dangerous monster. Neither death -by poisoning nor death by constriction has any terrors for him to whom -the patient is about to appeal for relief from disease.</p> - -<p>That pythons were a terror in former times to the people who inhabited -the coast regions near Cyrene is evident from a statement which -Aristotle makes in his History of Animals (Book VIII., Chapter -xxviii.). It reads as follows:—</p> - -<div class="blockquot"> - -<p>In Libya (Africa) the serpents, as has been already remarked, -are very large. For some persons say that, as they sailed along<span class="pagenum" id="Page_66">[66]</span> -the coast, they saw the bones of many oxen, and that it was -evident to them that they had been devoured by the serpents. -And, as the ships passed on, the serpents attacked the triremes, -and some of them threw themselves upon one of the triremes and -overturned it.</p> -</div> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_67">[67]</span></p> - -<h3>CHAPTER VI<br /> -<span class="subhed1">THE BEGINNINGS OF A RATIONAL SYSTEM OF MEDICINE IN GREECE</span></h3></div> - -<p>With the lapse of time the religious and mystical features of the -treatment carried on at the Asclepieia gave place, more and more, -to rational methods, and eventually—it is scarcely possible to -mention a date, but probably not many years before the Hippocratic -period—these institutions became centres for the spread of medical -knowledge of the most practical kind. This is particularly true of the -Asclepieion at Cos, where Hippocrates is believed to have received -his medical training. It is interesting to note that the mystical -features of the temple treatment—features which certainly did not -originate with Aesculapius himself or with his sons, Machaon and -Podalirius—eventually proved powerless to stay the slow but sure -advance of sound medical knowledge. Even during the period when these -false elements seemed to be most strongly rooted in the temple methods, -there were forces at work which in due time deprived them of much of -their pernicious power. This result was inevitable, for an organization -which, in order to prosper in its work of doing good to humanity, -depended upon the natural superstitiousness of the people, could not -possibly thrive for an indefinite length of time. That the evil results -did not develop sooner than they did simply shows how powerful and -stubborn is the force of superstition. In the absence of trustworthy -historical evidence, hypothetical statements only can be brought -forward, but there can scarcely be any doubt but that a genuine belief -in the power of Aesculapius (deified) to cure disease and restore -health persisted for centuries.</p> - -<p>The custom of recording the case histories on tablets or<span class="pagenum" id="Page_68">[68]</span> on the -columns of the temple,—for at this period writing was in general -use,—and also that of dedicating to the god images which represented -(sometimes with a remarkable degree of truthfulness) the pathological -condition for which the patient sought relief, contributed very greatly -to the substitution of sound learning for religious mysticism and -poorly concealed humbuggery.</p> - -<p>Among the interesting objects which may be seen at the Museum of the -History of Medicine in Jena, Germany, there are several of these -terra-cotta images (votive offerings) representing pathological -conditions; and among them the writer noticed more particularly one -which reproduced faithfully, though in diminutive size, the appearances -presented by cancer of the female breast. (Fig. 7.) There were also a -very carefully modeled statuette of the trunk of a woman affected with -ascites, and an admirable representation of a case of facial paralysis. -(Fig. 8.) These objects were obtained by Professor Meyer-Steineg on the -occasion of a recent visit to the ruins of the temple of Cos and other -similar ruins in Greece and Asia Minor. The British Museum possesses -many objects of the same character.</p> - - <div class="figcenter" id="i_fp068a" style="width: 550px"> - <img - class="p2" - src="images/i_fp068a.jpg" - alt="" /> - <p class="center p0 sm">FIG. 6. BAS-RELIEF OF AESCULAPIUS, ACCOMPANIED BY WOMEN -AND CHILDREN, IN THE PRESENCE OF AN ENORMOUS SERPENT.</p> - <p class="center 0 sm">The original is in the National Museum at Athens.</p> - </div> - - <div class="figcenter" id="i_fp068b" style="width: 350px"> - <img - class="p2" - src="images/i_fp068b.jpg" - alt="" /> - <p class="center p0 sm">FIG. 7. FEMALE BUST SHOWING CANCER OF ONE BREAST.</p> - <p class="center p0 sm">(Courtesy of Prof. Dr. Meyer-Steineg, of Jena, Germany.)</p> - </div> - -<p>It is not known at what precise date the <i>iatreia</i>, or small -private hospitals, first made their appearance, but it was about the -time when the religious character of the therapeutic work done in -the Asclepieia gave place to treatment of a more distinctly medical -character. Then, in addition to these <i>iatreia</i>, there were -schools for gladiators and institutions in which gymnastic exercises -were zealously cultivated; and in these places there was a frequent -demand for advice in regard to questions of diet, and for surgical -aid in the setting of broken bones, the reducing of dislocations, -and the curing of bruises and sprains. As may readily be understood, -the Asclepieia could not furnish the sort of professional aid which -these institutions needed, and thus a further stimulus was given to -the complete separation of the two kinds of medical practice—that -connected with the temple and that conducted by outside physicians.</p> - -<p><span class="pagenum" id="Page_69">[69]</span></p> - -<p>In Plato’s “Republic” (Book III., Chapter 15) mention is made of a -certain Herodicus (of Selymbria; about 450 B. C.) who effected many -cures by a method of treatment which combined athletic exercises -with dieting. He gained considerable celebrity in this way, and is -undoubtedly entitled to the credit of having been the first to call -serious attention to the value of this plan of treating certain -maladies. But, unfortunately, he made use of it in not a few instances -where it proved harmful rather than beneficial to the patient, and thus -brought discredit upon the method.</p> - -<p>Already previous to the time at which the changes mentioned above -took place, there had occurred still other changes in the character -and practice of medicine. The business of cutting for stone in the -bladder, for example, had been left entirely in the hands of men who -made a specialty of this branch of medicine—men who might truthfully -be called medical artisans. Then there was another class of men who -devoted their energies to collecting medicinal roots and plants. -They were a necessity to physicians, and constituted the first -representatives of the modern apothecary. Still another change in the -status of the Greek physicians had been slowly developing throughout -this pre-Hippocratic period, a change which tended more and more to -make them men of self-reliance and of considerable importance in their -respective communities, and which indicated very clearly that they were -steadily growing in skill and breadth of knowledge. As evidence of the -correctness of this statement it is sufficient to mention the fact that -Greek physicians had established so good a reputation that they were -frequently called to see important cases at a great distance—in Egypt, -in Persia, etc. But before further consideration is given to this -subject of the development of the Greek physician during the period -immediately preceding the appearance of the Hippocratic writings, -it seems advisable to say a few words concerning the facilities for -medical instruction which were available at that time.</p> - -<p><i>Medical Instruction in Connection with the Asclepieia.</i>—<span class="pagenum" id="Page_70">[70]</span> -It does not appear clearly in any of the published descriptions -of these ancient Greek sanatoria just what were the relations -between the priests and the men who utilized all this rich clinical -material—records of all sorts of diseases, and the means (other -than religious) employed in treating them, pictures or plastic -reproductions of the visible pathological lesions, etc.—for the -purpose of instructing the younger men who contemplated engaging in the -practice of medicine. The modern teachers of the art know very well how -difficult is the task of combining in a satisfactory manner these two -things—the safeguarding of the patient’s interests and the utilization -of their maladies as object lessons for men who are preparing to cure -or relieve the bodily ills of those who may at some future moment need -their professional services. To them, therefore, it would be a matter -of very great interest to learn how this difficult problem had been -solved nearly twenty-five hundred years ago. But, unfortunately, no -satisfactory data upon which a trustworthy account might be founded -are obtainable, and we are obliged to fall back upon such aid as our -imagination may furnish. From Puschmann’s work on medical teaching in -ancient times the following statement relating to the subject has been -taken:—</p> - -<div class="blockquot"> - -<p>The priests in the Aesculapian temples were not, as is generally -assumed, physicians in the ordinary sense. They may have -acquired some knowledge of the art, and they may even in some -instances have been regularly trained physicians, but the -important fact remains that they wished it to be understood that -the treatment carried out in the temple was in accordance with -revelations made to them by the god Aesculapius, and not the -mere fruit of human knowledge. Consequently the intervention -of regular physicians in the temple management of the sick -must have appeared to them quite superfluous. For this reason, -therefore, it is not likely that there existed, on the part of -either the temple priests or the physicians, any feeling of -animosity or opposition. It is more likely that the contrary -was the case, for the evidence shows that the physicians—the -Asclepiadae—paid most humble reverence to the sacred relics -of Aesculapius, and placed the most implicit confidence in the -opinions which he was supposed to give in desperate cases.</p> -</div> - - <div class="figcenter" id="i_fp070" style="width: 350px"> - <img - class="p2" - src="images/i_fp070.jpg" - alt="" /> - <p class="center p0 sm">FIG. 8. PARALYSIS OF THE LEFT FACIAL NERVE.</p> - <p class="p-min sm">(Courtesy of Prof. Dr. Meyer-Steineg, <i>Jenaer -medizinisch-historische Beiträge</i>, Heft 2, 1912.)</p> - </div> - -<p><span class="pagenum" id="Page_71">[71]</span></p> - -<p>While Puschmann does not say to what period in the history of these -temples his statement applies, it is safe to assume that he had in -mind only the earlier stages. When the systematic teachings of medical -pupils began, those physicians who gave the instruction—viz., the -Asclepiadae who were not at the same time priests—took up their abode -somewhere in the neighborhood of the temple. Thus, medical schools were -formed at different places, those of Rhodes, Crotone, Cyrene, Cos and -Cnidus attaining the greatest celebrity. The pupil paid a fee for his -instruction, and when his training was believed to be completed he was -admitted into the association or brotherhood of the Asclepiadae upon -taking the following oath, which for ages past has been known as “The -Hippocratic Oath,” but which is now believed to have been formulated -long before the time of Hippocrates:—</p> - - -<div class="blockquot"> - -<h4>THE HIPPOCRATIC OATH</h4> - -<p>I swear by Apollo the Physician and Aesculapius, and Hygieia and -Panacea and all the gods and all the goddesses—and I make them -my judges—that this mine oath and this my written engagement I -will fulfil as far as power and discernment shall be mine.</p> - -<p>Him who taught me this art I will esteem even as I do my -parents; he shall partake of my livelihood, and, if in want, -shall share my goods. I will regard his issue as my brothers and -will teach them this art without fee or written engagement if -they shall wish to learn it.</p> - -<p>I will give instruction by precept, by discourse, and in all -other ways, to my own sons, to those of him who taught me, to -disciples bound by written engagements and sworn according to -medical law, and to no other person.</p> - -<p>So far as power and discernment shall be mine, I will carry out -regimen for the benefit of the sick and will keep them from harm -and wrong. To none will I give a deadly drug even if solicited, -nor offer counsel to such an end; likewise to no woman will I -give a destructive suppository; but guiltless and hallowed will -I keep my life and mine art. I will cut no one whatever for the -stone, but will give way to those who work at this practice.</p> - -<p>Into whatsoever houses I shall enter I will go for the benefit -of the sick, holding aloof from all voluntary wrong and -corruption, including venereal acts upon the bodies of females -and males<span class="pagenum" id="Page_72">[72]</span> whether free or slaves. Whatsoever in my practice or -not in my practice I shall see or hear amid the lives of men -which ought not to be noised abroad—as to this I will keep -silence, holding such things unfitting to be spoken.</p> - -<p>And now if I shall fulfil this oath and break it not, may the -fruits of life and of art be mine, may I be honored of all men -for all time; the opposite if I shall transgress and be forsworn.</p> - -<p>(Translated from the Greek by the late John G. Curtis, M.D., of -New York.)</p> -</div> - -<p>While at first, according to Puschmann, many physicians did not belong -to the Aesculapian Brotherhood, there came a time when all were known -as Asclepiadae.</p> - -<p><i>Influence of the Schools of Philosophy on the Growth of Medical -Knowledge.</i>—About the beginning of the sixth century B. C. there -developed, in Greece and its colonies, schools of philosophy which -exerted a most excellent influence upon the growth of medicine. The -first of these was the one known as the Ionian School, whose founders -and chief representatives were Thales, of Miletus in Ionia (born in -640, died in 548 B. C.), and his pupils Anaximander and Anaximenes. -The guiding principle of these men was to study natural phenomena and -to learn, if possible, their causes and the laws of their action. -Physiology, therefore, became one of their special studies, and -thus they contributed to the laying of one of the most important -foundation-stones of medicine. Thanks to the good quality of the work -of instruction that had thus far been carried on at Cos, Cnidus, and -other Asclepieia, medicine had by this time reached a sufficient -degree of development for its devotees to derive a full measure of -benefit from the new teaching of the philosophers. Well grounded in the -observation of disease in its different forms and modes of behavior, -and also familiarized with the ordinary methods of treatment, these -physicians needed to be shown a new route along which they might -advance to greater heights of knowledge, and they also needed to be -stimulated to further endeavor. The introduction of the new school -accomplished both of these purposes. It taught the men of the older -organizations that they must make much<span class="pagenum" id="Page_73">[73]</span> greater use of their reasoning -powers than they had hitherto done, and at the same time, through -the creation of a group of rival physicians, it supplied them with -the required stimulus. Another important school of philosophy was -that known as the Eleatic School, which flourished at Elea, in Lower -Italy, its leaders being natives of that city. The most prominent men -connected with this school were Parmenides (born about 540 B. C.) and -Xenophanes of Colophon, in Asia Minor, whose contributions to mental -science formed the basis of Plato’s metaphysics.</p> - -<p>The period roughly embraced between the years 500 and 300 B. -C. represents the most brilliant age of Greek intellectual and -artistic activity. During this time there came into prominence such -philosophers, historians, poets, physicians, artists and generals of -armies as had never before been marshaled in historic array in so -rapid succession. Even at this late day the names of these great men -are almost household words—such names, for example, as Pythagoras, -Alcmaeon, Anaxagoras, Aristotle, Plato, Socrates, Sophocles, -Aeschylus, Euripides, Aristophanes, Pindar, Xenophon, Demosthenes, -Democedes, Hippocrates the Great, Phidias, Praxiteles, Zeuxis, -Apelles, Darius I., Alexander the Great, and many others of almost -equal celebrity. During the centuries immediately preceding this -golden age of Greek history, there seem to have been very few men of -great merit in any of the branches of learning or in the fields of -war or art, but this impression is certainly false. It is doubtless -to be explained by the fact that large quantities of documentary -evidence relating to these years have been entirely lost. Daniel Le -Clerc, for instance, states<a id="FNanchor_21" href="#Footnote_21" class="fnanchor">[21]</a> that, of the separate histories of -the descendants of Aesculapius which were written by Eratosthenes, -Pherecydes, Apollodorus, Arius of Tarsus and Polyanthus of Cyrene, -not one has come down to our time. If, then, in the single department -of medicine, the destruction of documentary evidence was as great as -is here represented, how enormous must have been the loss of precious -historical materials in all the departments<span class="pagenum" id="Page_74">[74]</span> of human activity taken -together. We may, therefore, safely assume that this golden age, which -lasted only about two hundred years, represents simply the culmination -of an even longer period of slow but steady development, a period of -creditable though perhaps less brilliant achievements.</p> - -<p>Of the names mentioned above there are several that belong to men who -were in various ways connected with the early history of medicine. -Pythagoras, for example, is said to have been one of the first among -the Greek philosophers to exert a strong and double impression upon -the medical teaching of that period. He was born in the Island of -Samos, near the coast of Asia Minor, about the year 575 B. C. After -spending several years in Egypt for purposes of study, and probably -visiting Babylon, at that time a great centre of learning and of -artistic cultivation, he established at Crotona, in the south of Italy, -a school<a id="FNanchor_22" href="#Footnote_22" class="fnanchor">[22]</a> where natural philosophy, mathematics, acoustics, etc., -were taught. He also devoted some attention to anatomy, to embryology, -to physiology and to therapeutics. According to his views of what -constituted hygienic living a man should accustom himself to a diet -of the simplest character, without meat. Pythagoras was a believer in -the Chaldean doctrine that the uneven numbers possess a more important -significance than the even, and that the number seven in particular -has a special relationship to the phenomena of certain diseases; the -crisis frequently falling on the seventh, fourteenth, or twenty-first -day. Galen, it is said, expressed surprise that a man as sensible and -learned as Pythagoras should have paid any attention to such trifles. -Not a few of the disciples of Pythagoras were physicians,<span class="pagenum" id="Page_75">[75]</span> and when -the brotherhood (if such it may be called) broke up, as it did in the -fifth century B. C., these men traveled about from one Grecian city to -another; from which fact they were given the name of “periodeuts” or -ambulant physicians. Crotona was also celebrated as the birthplace of -Milo, the athlete.</p> - -<p>Democedes, who was a contemporary of Pythagoras, but not one of his -disciples, was a native of Crotona. Dion Cassius, the author of a Roman -history, ranks him and Hippocrates as the two most eminent physicians -of antiquity. Daremberg, who derived his facts from the works of -Herodotus, gives the following account of the adventures of Democedes:—</p> - -<div class="blockquot"> - -<p>Being unable to bear any longer the frequent anger and harsh -treatment of his father, Calliphon, Democedes left Crotona, -and settled in practice at Aegina, on the Saronic Gulf, not -far from Athens. Almost from the very start he attained marked -success, and already in the second year of his residence in -Aegina he was made the recipient of a pension of one talent -(equal to about £240, or $1200,) out of the public treasury. -During the following year he was induced, by the offer of a -larger pension (100 minae, or about $3000,) to settle in Athens; -and, a year later, he accepted a still larger remuneration from -Polycrates, the tyrant of Samos. Having accompanied the latter -on a trip to Sardis, the capital of Lydia, in Asia Minor, he -fell a prisoner into the hands of the governor of that city, -and was made by him a slave. Not long afterward Darius gained -possession of this governor’s or satrap’s property, including -all his slaves; and thus, despite all his efforts to conceal -his profession through fear that a knowledge of it on the part -of the king might prolong his bondage indefinitely, Democedes -was unable to do so. The discovery came about in the following -manner. During a hunting trip Darius broke his ankle. He called -to his assistance the court physicians, who were esteemed the -most skilful that could be found in all Egypt, but they failed -to give him relief. By the violence of their manipulations -they rather made matters worse. For seven days and nights his -sufferings were so great that he was unable to obtain any sleep. -Finally, on the eighth day, one of the court attendants having -told Darius that there was a Greek physician among the slaves, -Democedes was sent for, and he appeared before the king clad in<span class="pagenum" id="Page_76">[76]</span> -rags and with chains on his ankles. When asked whether he knew -anything about medicine he denied such knowledge, being fearful -that the discovery of the truth about himself would stand in -the way of his ever getting back to Greece. Darius, perceiving -that he was dissimulating, ordered the attendants to fetch the -whips and pinchers. Whereupon Democedes made up his mind that -he had better confess the truth. He accordingly told the king -that, while not possessing a thorough knowledge of the healing -art, long association with a physician had familiarized him -more or less with the subject. The king then asked him to take -charge of the case. Democedes, following the treatment adopted -by the Greek physicians in similar conditions, applied soothing -remedies and soon succeeded in procuring sleep for the suffering -king. Eventually he obtained a complete cure, and Darius, who -had made up his mind that he would never again be able to use -his limb, was naturally delighted with the result. He loaded -Democedes with gifts, and, being charmed with his conversation, -made him sit at the royal table and did everything possible to -render court life attractive; but liberty was denied him, which -was the one thing that Democedes most ardently desired. The only -use which the latter made of the great influence which he had -obtained over Darius was to save the Egyptian physicians from -the death by crucifixion which the king had decided to inflict -upon them for their lack of skill.</p> - -<p>The means of escape finally presented themselves to Democedes -in a most unexpected manner. Atossa, who was the wife of Darius -and also the daughter of Cyrus, was afflicted with a swelling of -the breast which developed into an abscess and began to burrow -into the neighboring tissues. After, for a time, concealing -the trouble through a sense of false modesty, she made up her -mind to consult Democedes. He had the good fortune to cure her -of this malady in a relatively short time. As preparations -were then being made to send a number of spies to Greece with -instructions to examine the coast carefully for the purpose -of determining at what points the defenses were sufficiently -weak to render an attack by the Persians reasonably sure of -success, Democedes asked permission of Darius to accompany these -men as their guide. His request was granted; and, as soon as -the expedition reached Tarentum in Calabria, he delivered the -Persian spies into the hands of Aristophilides, the king of that -country, and then fled in all haste to Crotona, his native city. -Shortly afterward these Persians, having been set at liberty by -Aristophilides, made the<span class="pagenum" id="Page_77">[77]</span> attempt to capture Democedes and carry -him off by main force, but the citizens of Crotona thwarted -the attempt and compelled the men to return to Asia. Democedes -then married the daughter of Milo, the athlete, and history -furnishes no information regarding the subsequent career of this -extraordinary man.</p> -</div> - -<p>Daremberg calls attention to certain excellent proverbs which may be -found in the writings of the Greek poets and which are of some interest -to physicians. The following may serve as examples of those most widely -known:—<a id="FNanchor_23" href="#Footnote_23" class="fnanchor">[23]</a></p> - -<div class="blockquot"> - -<p>Joy is the best physician for fatigue.</p> - -<p class="r4 p-min">(Pindar, 522–442 B. C.)</p> -</div> - -<div class="blockquot"> - -<p>The good physician is he who knows how to employ the right -remedies at the proper time; the poor one, he who, in the -presence of a serious illness, loses his courage, becomes -flustered, and is unable to devise any helpful method of -treatment.</p> - -<p class="r2 p-min">(Aeschylus, 525–456 B. C.)</p> -</div> - -<div class="blockquot"> - -<p>Physician, heal thyself.</p> - -<p class="r4 p-min">(Euripides, 400–406 B. C.)</p> -</div> - -<p>Advice given to Phaedra by her nurse:—</p> - -<div class="blockquot"> - -<p>If thou hast some ailment which thou dost not care to reveal to -men, here are women who are competent to treat the condition -properly.</p> - -<p class="r2 p-min">(Euripides.)</p> -</div> - - <div class="poetry-container"> - <div class="poetry"> - <div class="stanza"> - <div class="i1">Sleep is the physician of pain,</div> - <div>and</div> - <div class="i1">Death is the supreme healer of maladies.</div> - <div class="right">(Sophocles, 495–406 B. C.)</div> - </div> - </div> - </div> - -<p>In Plato’s writings there are to be found a few passages in which this -philosopher gives his views in regard to certain matters that are not -without interest to modern physicians. The following extracts are of -this nature:—</p> - -<div class="blockquot"> - -<p>There is not then, my friend, any office among the whole -inhabitants of the city peculiar to the woman, considered as a -woman,<span class="pagenum" id="Page_78">[78]</span> nor to the man, considered as a man; but the geniuses -are indiscriminately diffused through both: the woman is -naturally fitted for sharing in all offices, and so is the man; -but in all the woman is weaker than the man.</p> - -<p>Perfectly so.</p> - -<p>Shall we then commit everything to the care of the men, and -nothing to the care of the women?</p> - -<p>How shall we do so?</p> - -<p>It is therefore, I imagine, as we say, that one woman, too, is -fitted by natural genius for being a physician, and another is -not; one is naturally a musician, and another is not.</p> - -<p class="r2 p-min">(From “The Republic” of Plato, translated by Spens.)</p> -</div> - - -<div class="blockquot"> - -<p>But tell me with reference to him who, accurately speaking, is -a physician, whom you now mentioned, whether he is a gainer of -money or one who taketh care of the sick? and speak of him who -is really a physician.</p> - -<p>One who taketh care, said he, of the sick.</p> - -<hr class="tb" /> - -<p>Why then, said I, no physician as far as he is a physician, -considers what is advantageous for the physician, nor enjoins -it, but what is advantageous for the sick; for it hath been -agreed that the accurate physician is one who taketh care of -sick bodies, and not an amasser of wealth. Hath it not been -agreed?</p> - -<p>He assented.</p> - -<p class="r2 p-min">(Plato, 428–547 B. C., translated by Spens.)</p> -</div> - - -<p>But Plato’s knowledge of human anatomy and physiology was very crude -and in some instances decidedly fanciful. In corroboration of this -statement the following extract from the “Timaeus” may be quoted:—</p> - -<div class="blockquot"> - -<p>And on this account, fearing to defile the Divine nature more -than was absolutely necessary, they [the junior gods] lodged -man’s mortal portion separately from the Divine, in a different -receptacle of the body; forming the head and breast and placing -the neck between, as an isthmus and limit to separate the two -extremes.</p> - -<p>In the breast, indeed, and what is called the thorax, they -seated the mortal part of the soul. And as one part of it was -naturally better, and another worse, they formed the cavity of -the thorax into two divisions (resembling the separate dwellings -of our men and women), placing the midriff as a partition -between them. That part of the soul, therefore, which partakes -of fortitude and<span class="pagenum" id="Page_79">[79]</span> spirit and loves contention they seated -nearer the head between the midriff and the neck; as it is the -business of the reason to unite with it in forcibly repressing -the desires, whenever they will not obey the mandate and word -issuing from the citadel above.</p> - -<p>The heart, which is the head and principle of the veins as well -as the fountain of the blood that impetuously circulates through -all the members, they placed in a kind of sentry-house, that, in -case of any outburst of anger, being informed by the reason of -any evil committed in its members, owing either to some foreign -cause, or else internal passions, it (the heart) might transmit -through all its channels the threatenings and exhortations of -reason, so as once more to reduce the body to perfect obedience, -and so permit what is the best within us to maintain supreme -command.</p> - -<p>But as the gods foreknew, with respect to the palpitation of -the heart under the dread of danger and the excitement of -passion, that all such swellings of the inflamed spirit would -be produced by fire, they formed the lungs to be a sort of -protection thereto; first of all, soft and bloodless, and next -internally provided with cavities perforated like a sponge, in -order to cool the breath which they receive, and give the heart -easy respiration and repose in its excessive heat. On this -account, then, they led the channels of the windpipe into the -lungs, which they placed like a soft cushion round the heart, in -order that when anger rises in it to an extreme height it might -fall on some yielding substance, and, so getting cool, yield -cheerfully and with less trouble to the authority of reason.</p> - -<p class="r2 p-min">(Plato’s “Timaeus,” translated by Henry Davis.)</p> -</div> - - -<p>Alcmaeon, Empedocles, Diogenes of Apollonia, Anaxagoras and Pausanias, -whose names are mentioned above in the list of eminent men who -flourished during the golden age of Greek history, are entitled to -further consideration. Alcmaeon of Crotona was a contemporary and -disciple of Pythagoras. He was specially devoted to the study of -anatomy and physiology, and is credited with the distinction of -having been the first person to dissect animals for the purpose of -learning the formation of the different parts of their bodies. With the -exception of a few fragments that are to be found scattered throughout -ancient medical literature, Alcmaeon’s writings have all been lost. -The discovery of the optic nerve is credited to him, and<span class="pagenum" id="Page_80">[80]</span> Neuburger -states that he deserves still greater credit for having been the first -to declare that the brain is the central organ of all intellectual -activity.</p> - -<p>Of all the disciples of Pythagoras, Empedocles attained the greatest -celebrity. He flourished about 444 B. C., his residence being at -Agrigentum, in Sicily. Much of his reputation appears to have been -due to the mystery which surrounded many of his actions. He was even -reputed to have brought again to life persons who were believed to be -dead. His works were all in verse, but only fragments have come down -to us. He placed the seat of hearing in the labyrinth of the temporal -bone. His death occurred in Peloponnesus at the age of sixty, as the -result of an accident.</p> - -<p>Anaxagoras was born at Clazomenae, in Ionia, 500 B. C. He was the -teacher of Euripides, the Athenian poet, and Pericles, the greatest of -Athenian statesmen. He and his contemporary, Diogenes of Apollonia, in -Crete, devoted a great deal of attention to the study of anatomy. They -dissected animals and made some genuine discoveries; Anaxagoras noting -the existence of the lateral ventricles of the brain, and Diogenes -furnishing a description—very erroneous, it is true—of the vascular -system of the body. Puschmann says that, according to Aristotle, -the philosophers of that period considered the study of man and his -diseases the most important one to which they could devote their time -and thoughts. Many of them indeed had been educated as physicians, and -not a few were actual practitioners of medicine.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_81">[81]</span></p> - -<h3>CHAPTER VII<br /> -<span class="subhed1">HIPPOCRATES THE GREAT</span></h3></div> - -<p>Hippocrates was born in 460 B. C. in the city of Cos, on the island of -the same name. Both his father and grandfather were eminent physicians, -descendants of Aesculapius. On his mother’s side he traced his descent -from Hercules. The famous painter, Apelles, also hailed from the city -of Cos. To distinguish Hippocrates from an earlier individual of the -same name he was called Hippocrates II., or the Great. He is said to -have received his first instruction in medicine at the school of the -Asclepiadae in his native city, but his frequently repeated and very -favorable comments on the teachings of the Cnidian school<a id="FNanchor_24" href="#Footnote_24" class="fnanchor">[24]</a> have -led some to believe that he may have received a part of his medical -training at the latter institution. At a later period of his life his -popularity as a teacher of medicine, in the school of the Asclepiadae -at Cos, attracted many pupils to that city. In accordance with a custom -which prevailed among the physicians of ancient Greece, Hippocrates, -at the beginning of his career, spent quite a long time in Athens, and -then traveled about, from one city to another, in the character of a -periodeutic or itinerant physician. In this way, as he himself reports -in some of his writings, he visited Thessaly, Thrace, the Island of -Thasos, Scythia, the countries bordering on the Black Sea, and even -Northern Egypt. Owing largely to domestic troubles he left his home in -Cos, during the latter part of his career, and removed to Thessaly. -He died about 370 B. C. at Larissa, at an<span class="pagenum" id="Page_82">[82]</span> advanced age. Soranus of -Ephesus, the celebrated obstetrician, reported that in his time (second -century A. D.) the tomb of Hippocrates was still standing, and that -it had been taken possession of by a swarm of bees whose honey was -far-famed for its efficacy in curing ulcers of the mouth in children.</p> - -<p>Among the pupils of Hippocrates were his two sons, Draco and Thessalus, -and his son-in-law, Polybus. Thessalus, in the capacity of a military -surgeon, accompanied Alcibiades on his expedition to Sicily, and -later in his career he served as private physician to Archelaus, King -of Macedonia. It is also believed that a number of the writings in -the Hippocratic collection are from his pen. On the other hand, it -is a well-established fact that Polybus is the author of a few of -these treatises. When Hippocrates gave up the work of teaching, his -son-in-law, who was at that time engaged in private practice in Cos, -was chosen his successor in the school.</p> - -<p>Among the many anecdotes which are related of Hippocrates, there is one -which may with propriety be repeated here:—</p> - -<div class="blockquot"> - -<p>On the occasion of a visit to Abdera, in the northern part of -Thrace, Hippocrates was requested to examine into the mental -condition of the philosopher Democritus, who was thought by -his narrow-minded countrymen to be insane. Hippocrates found -him deeply engrossed in the study of natural philosophy and -asked him what he was doing. Democritus replied that he was -investigating the foolishness of men. Whereupon Hippocrates -reported that he considered Democritus the wisest of men. -(Pagel.)</p> -</div> - -<p>No better evidence of the true greatness of a man can be furnished than -that which is afforded by the praise of his contemporaries in the same -rank or walk of life; and when the appreciation comes from such men as -Plato and Aristotle, it constitutes an absolute guarantee that it is -well and honestly earned. To Hippocrates belongs the singular honor -of having won unstinted praise from both of these great philosophers, -Aristotle giving him the title of “Hippocrates the Great,” and Plato -comparing him<span class="pagenum" id="Page_83">[83]</span> to those famous sculptors, Polyclytus and Phidias. His -writings and those of the members of his family who were associated -with him in the work of promoting a knowledge of medicine were most -carefully preserved by his successors. When the Ptolemies began to -establish libraries at Alexandria, Egypt (285 B. C.), and manifested -a decided readiness to purchase the works of the most celebrated -authors, copies of the Hippocratic writings were among those which -found their way to that city. This eagerness on the part of the Kings -of Egypt to purchase books or manuscripts stimulated unscrupulous -persons to attribute to celebrated authors not a few of these works -which they offered for sale. The librarians, whose duty it was to -guard against such frauds, were not sufficiently well informed to -prevent them; and thus there were accepted, as genuine productions, -a few books which could not possibly have been written by those to -whom they were attributed. The collection of Hippocratic writings -did not escape this fate, and the evil was also further aggravated -by the fact that copyists and incompetent editors made all sorts of -emendations and additions on their own responsibility. Thus, it is -not surprising that a collection which originally contained only the -writings of Hippocrates and his immediate family, should in course of -time have become expanded, not only by such alterations as have just -been described, but also by the addition of entire works that had -been written by others. At the beginning of the third century B. C., -the Ptolemies appointed a committee of learned men in Alexandria to -examine carefully the treatises reputed to be the work of Hippocrates -and to make a collection of those which appeared to them to be -genuine. They performed this task to the best of their ability, but -the result showed that they lacked the necessary critical powers; and -consequently during the past 2000 years repeated attempts have been -made to do what they failed to accomplish, but these efforts have only -succeeded in part. The French edition prepared by Émile Littré, the -distinguished member of the French Academy of Medicine, and published -in the years 1839–1861, was, until quite<span class="pagenum" id="Page_84">[84]</span> recently, universally -accepted as embodying the best results of modern research and criticism -with regard to this difficult question. But since 1861 other scholars -have been busily engaged in perfecting the text of the Hippocratic -writings, and their criticisms and suggestions have made it possible to -publish a German version of this great work which is of more practical -value to physicians than that of Littré, which forms a series of ten -large volumes and is no longer easy to obtain. On the other hand, the -German version by Robert Fuchs (Munich, 1895–1900), in three volumes -of moderate size, while in no respect inferior to the famous French -translation, is superior to it in several particulars: it is better -adapted to the needs of the ordinary practitioner of medicine, it -embodies the results of the excellent critical work done since 1861 -(e.g., by Ermerins of Utrecht, Daremberg of France, and Ilberg and -Kühlewein of Germany), and it costs very much less than its French -predecessor and rival.</p> - -<p>As regards the question of authenticity of the treatises contained in -the work known as “The Hippocratic Writings” the most important thing -to be determined is, not whether this or that book or chapter in the -collection was really written by Hippocrates, but whether the work in -its totality gives a correct and fairly complete picture of the best -medical thought and practice of the period during which Hippocrates -lived; and to this question a decided answer in the affirmative may be -given. As to the broad question of authenticity, Max Neuburger, the -distinguished Viennese author of the latest and most authoritative -history of medicine, thus expresses himself:—</p> - -<div class="blockquot"> - -<p>Notwithstanding the extremely small quantity of evidence which -the so-called “Hippocratic Writings” themselves furnish as to -who were the writers of the individual treatises and as to what -Hippocrates himself actually did or thought; and although it -is true that portions of the collection often contradict one -another both in regard to questions of theory and also in regard -to methods of treatment, one fact stands out conspicuously, -viz., that the peculiar character of these writings both as a -collection and taken separately, not only gives them a unique -position in medical<span class="pagenum" id="Page_85">[85]</span> literature, but reveals plainly that -they owe their origin directly or indirectly to the powerful -influence of a single commanding personality.</p> -</div> - -<p>As to the manner of teaching medicine, the Hippocratic writings show -that, at the time which is here under consideration, the mystical -features had almost completely disappeared. The science was now taught -by regular instructors, who agreed for a stipulated fee to take charge -of the pupil’s entire training from the beginning to the end of the -course. Candidates who were in delicate health were discouraged from -entering upon the career of a physician, and those who had completed -the regular course of instruction were sent out into the world equipped -with certain general principles for their future guidance in actual -practice. Some of these bear a close resemblance to the principles of -a similar nature which had been established at a much earlier period -in India. For example, the importance of cleanliness of the person is -strongly emphasized. Reticence, as well as courtesy, is classed as one -of the virtues of a good physician.</p> - -<div class="blockquot"> - -<p>He who acts hastily and does not take sufficient time for -consideration is sure to be criticised unfavorably. If he breaks -out too readily into laughter he will be thought uncultivated.</p> -</div> - -<p>In another of the Hippocratic writings the physician is urged not to -indulge in too much small talk, but to confine his conversation as much -as possible to matters relating to the treatment of the disorder.</p> - -<div class="blockquot"> - -<p>In his business dealings the physician, like a genuine -philosopher, should not display a greed for money, he should -assume a modest and dignified attitude, he should appear quiet -and calm, and his speech should be simple and straightforward -and free from all superstition.</p> -</div> - -<p>For their knowledge of human anatomy the physicians of that period -were obliged to depend on the dissection of animals. Specimens of -human bones were of course easily accessible, and consequently the -descriptions which are<span class="pagenum" id="Page_86">[86]</span> given of these structures are quite accurate, -even as regards many of the finer details.</p> - -<p>It would be a very difficult matter to furnish here, within a limited -space, a reasonably clear exposition of the views held by Hippocrates -with regard to human physiology and pathology. Empedocles, a Greek -physician and high priest of Agrigentum, in Sicily, who was born about -490 B. C., founded a system of philosophy on the theory that the -universe is made up of four elements—fire, air, earth and water; and -he maintained that fire is the essence of life, the other elements -forming the basis of matter. It was upon this system that Hippocrates -founded his own theories of life, death and disease, but he disagreed -with Empedocles in regard to the manner in which the four elements -are united, his own belief being that they form together a genuine -mixture, whereas Empedocles maintains that their union represents -merely a mechanical aggregation of separate atoms. He also held that -these original four elements, to which he gave the names of heat, -cold, dryness and moisture, were represented in the human body by the -following four cardinal fluids or “juices”: blood, mucus or phlegm, -black bile and yellow bile.<a id="FNanchor_25" href="#Footnote_25" class="fnanchor">[25]</a> He maintained, further, that when these -elements are mingled harmoniously so as to produce a state of perfect -equilibrium, health resulted; but that when some deficiency of one or -more of them, or some lack of harmony between them in other respects, -occurs, disease is produced. At a later date, a fifth element—wind or -air (pneuma)—was added to the other four; and when Hippocrates was -unable to account satisfactorily for certain phenomena of disease, he -was wont to refer the phenomenon observed to divine interference.</p> - -<p>This brief exposition of the physiological and pathological views -held by Hippocrates, incomplete and superficial as it is, will have -to suffice. Those who wish to acquire a more profound knowledge of -the subject should consult some of the larger treatises like those of -Daremberg,<span class="pagenum" id="Page_87">[87]</span> of Max Neuburger, and of Pagel, as well as the sections -devoted to these subjects in the French (Littré) and the German (Fuchs) -versions of the Hippocratic writings. At every step in such a study, -the modern physician will encounter ideas and individual terms which he -will have great difficulty in comprehending; and later on, as he reads -the sections which deal with the more practical matters of the medical -art, he will be astonished to find that Hippocrates was a most acute -and trustworthy observer of the phenomena of disease, a remarkably -clear writer, and a standard-bearer of very high aims.</p> - -<p>In the examination and treatment of the sick the physicians of -ancient Greece were highly trained. They paid very close attention -to the patient’s account of his symptoms, but it was to the physical -examination of the diseased body that they attached the greatest -importance. They noted with extreme care the color and other -peculiarities of the skin and mucous membranes, the condition of the -abdomen, and the shape and movements of the thorax; they tested the -patient’s temperature by placing the hand upon the body; and all -the excretions were subjected to the closest scrutiny. By means of -palpation they were able to determine not only the size of the liver -and spleen, but also the changes which occur in the form of these -organs in the course of certain diseases. They utilized succussion -both as an aid to diagnosis and as a means of favoring the breaking -through of pus into the bronchial tubes. They were familiar with the -pleuritic friction sound and with the finest râles, which they compared -to the creaking of leather or “the noise of boiling vinegar.” In -their descriptions of these sounds it is distinctly stated that the -examiner’s ear was kept tightly pressed against the patient’s chest.</p> - -<p>In speaking of the accounts of individual diseases which appear in the -Hippocratic writings, Puschmann says that they are evidently based -on cases actually observed in practice, and that they are admirably -written. It is in the laws which they have laid down with regard to -the treatment of disease, however, that the Hippocratic writers have<span class="pagenum" id="Page_88">[88]</span> -gained their chief distinction, a distinction which will belong to them -through all time.</p> - -<div class="blockquot"> - -<p>The physician should be the handy man of Nature, and he should -strive to aid and to imitate her efforts to effect a cure. -His first care should be to remove, so far as is possible, -the causes of the disease; and then, in the conduct of the -treatment, he should keep in view at all times the special -circumstances of the case, giving closer attention to the -patient than to the disease itself. In short, he should aim at -being useful, or at least he should be careful not to do any -harm.</p> -</div> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_89">[89]</span></p> - -<h3>CHAPTER VIII<br /> -<span class="subhed1">BRIEF EXTRACTS FROM SOME OF THE HIPPOCRATIC WRITINGS</span></h3></div> - -<p>The statements which have thus far been made in these pages with regard -to Hippocrates are only of a general character, and it may therefore -be interesting for the reader to have placed before him a few selected -extracts from the writings which have formed the basis of these -statements. The English text here used is a translation of the German -version of Robert Fuchs, to which reference has already been made. -It would have been a pleasure to use for this purpose the admirable -English translation of Frederick Adams, published in 1849 under the -auspices of the Sydenham Society of Great Britain; but, unfortunately, -this version contains only a part of the Hippocratic writings, and, -besides, this writer did not at that time have the advantage of -consulting the French and German versions which have been published -since 1849.</p> - -<p>It seems almost unnecessary to state here, by way of preface, that the -small amount of space which may properly be devoted to these extracts -renders it necessary to present many of them in a very fragmentary -and disconnected form, merely enough text being furnished to give the -reader some slight idea both of the manner in which Hippocrates and -those associated with him handled certain medical topics, and also of -the views which they entertained with regard to the same subjects.</p> - - -<h4>BRIEF EXTRACTS FROM SOME OF THE HIPPOCRATIC WRITINGS</h4> - -<div class="blockquot"> - -<p><i>Aphorisms.</i>—I.—1. Life is short, art is long, the right -moment lasts but an instant,<a id="FNanchor_26" href="#Footnote_26" class="fnanchor">[26]</a> experience is often deceptive, -a correct judgment is hard to reach.</p> - -<p><span class="pagenum" id="Page_90">[90]</span></p> - -<p>6. For the most serious ills extreme measures cautiously -employed are the best.</p> - -<p>8. When an illness has reached its acme the lightest diet must -be prescribed.</p> - -<p>11. During the exacerbations nourishment should be withheld, for -at these times the giving of food is harmful; and in illnesses -which are characterized by periodic paroxysms it is also best -not to give food during the paroxysms.</p> - -<p>13. Old people bear fasting very well, and the same is almost -true of persons of mature age; but young individuals do not bear -abstinence from food so well, and this is particularly the case -with children, especially with those of a lively disposition.</p> - -<p>24. In acute illnesses laxative remedies should rarely be -administered, and then only in the early stage of the malady and -with great caution.</p> - -<p>II.—2. When sleep puts an end to delirium it is a good sign.</p> - -<p>3. When either sleep or wakefulness oversteps the proper limit -it is harmful.</p> - -<p>5. Causeless depression is an indication of some disorder.</p> - -<p>19. In acute diseases the prognosis as regards either death or -recovery, is very uncertain.</p> - -<p>44. Corpulent persons are more likely than those who are slender -to die a quick death.</p> - -<p>V.—7. When epileptic attacks occur before the age of puberty, -a change for the better may be looked for; but if the disease -makes its first appearance when the individual has already -reached his twenty-fifth year, he may be expected to carry the -affliction with him to the time of his death.</p> - -<p>9. Consumption most commonly attacks persons who are between the -ages of eighteen and thirty-five.</p> - -<p>14. When a consumptive person has attacks of diarrhoea, a fatal -issue may be anticipated.</p> - -<p>VII.—1. If in the course of an acute illness the extremities -grow cold, it is an unfavorable sign.</p> - -<p><span class="pagenum" id="Page_91">[91]</span></p> - -<p>14. If, after a blow upon the head, stupefaction or delirium -manifests itself, the outlook is bad.</p> -</div> - -<p>[The total number of the aphorisms is 422.]</p> - -<div class="blockquot"> - -<p><i>The Book of Prognoses.</i>—1. I believe that it is best -for a physician to acquire a certain degree of practice in the -power to predict how the disease is likely to terminate; for if, -when he is in the presence of his patient, he is able to state, -not only what is going to take place in the future course of -the malady, but also certain other facts which relate to the -past behavior of the attack, but which were omitted from the -account given to him of the previous history of the case, he -will impress the patient with the belief that he is thoroughly -familiar with the disease from which the latter is suffering, -and that consequently he is a physician in whose knowledge and -skill he can place entire confidence. Then, besides, he will be -the gainer in another respect: his knowledge of what is likely -to be the subsequent course of any given disease will enable -him to treat it in the most effective manner. The ability to -restore all his patients to health would of course be a greater -power than that of correctly predicting the future behavior -of a malady in any particular case. This ability, however, is -clearly unattainable. One patient dies by reason of the severity -of the disease itself, even before the physician is called in; -a second one, shortly after the latter’s visit; and a third -lingers on for a day or two after the doctor’s arrival, dying -before the latter’s art has had time to produce a beneficial -effect in hindering the advance of the malady. The observation -of these different events should enable the physician to become -acquainted with the nature of the diseases observed, and—more -particularly—to learn to what extent, in individual instances, -they manifest a strength greater than the patient’s power of -resistance. At the same time, he must not forget that in many -cases divine interference plays a part in directing the course -of the disease. And thus, if he pays heed to all these things, -the physician will merit the confidence of his patients and will -gain the reputation of being a clever and skilful practitioner.</p> - -<p>IV.—It is better when the physician, upon the occasion of his -first visit, finds the patient lying upon one side, with his -hands, neck and thighs slightly flexed, and the entire body -placed in a perfectly natural position, like that which a man -assumes in bed when he is in a state of health. It is not so -well when the physician finds the patient lying upon his back, -with his hands, neck and<span class="pagenum" id="Page_92">[92]</span> thighs extended. But if the latter -is found curled up and sliding down toward the foot of the -bed, this is an unfavorable sign. Finally, if he is found with -rather cold feet projecting from under the bedclothes, and with -his arms outstretched and his neck and thighs exposed, his -condition may be considered dangerous, for this attitude of the -body betokens an agitated state of the mind. If the patient -sleeps with his mouth constantly open, lying upon his back and -with his thighs strongly flexed and widely separated, it may be -assumed that death is near at hand. If he lies upon his belly -when it is known that he was not in the habit of sleeping in -this manner before he was taken ill, the inference is warranted -either that he is delirious or that he is suffering from pain in -the lower part of his abdomen. Finally, if the patient shows an -inclination to maintain a sitting posture while the malady is -still in an active stage, this feature must be looked upon as a -grave symptom and especially so in inflammation of the lungs.</p> - -<p>XIV.—Pus that has a whitish color and a uniform consistency, -that is smooth and free from clumps, and the odor of which is -only slightly unpleasant, is the least harmful. On the other -hand, a pus which possesses the opposite characteristics is very -dangerous.</p> - -<p>XL.—Severe pain in the ear, if associated with a persistent -fever is dangerous, for the patient may become delirious and die.</p> -</div> - -<p>[There are 47 chapters in the Book of Prognoses; in addition, there -are 740 separate sections in the Coan Prognoses (<i>Praenotiones -Coacae</i>).]</p> - -<div class="blockquot"> - -<p><i>The Epidemic Diseases.</i>—VI.—4. The wife of Agasis -had already as a young girl been troubled with shortness of -breath. After she had reached womanhood, and soon after she had -given birth to a child, she lifted a heavy weight. Immediately -she heard, as she believed, a noise in her chest, and on the -following day she experienced some difficulty in breathing and a -certain amount of pain in her right hip. These two symptoms were -so related to each other that, whenever the pain in the hip made -its appearance, she immediately became conscious that she was -short of breath, and, vice versa, whenever the pain ceased, she -found that her breathing became easier. Her expectoration was -of a foamy character and of a rather bright color, but, after -it had been allowed to stand for a short time, it looked like -diluted biliary matter that had been vomited. The pain in the -hip troubled her chiefly when she performed manual work. She was -advised to<span class="pagenum" id="Page_93">[93]</span> abstain from eating garlic, pork, mutton, and beef, -and not to call loudly or to get excited while she was engaged -in work.</p> - -<p>VII.—7. The wife of Polycrates became feverish during the -summer season, and about the time of the dog star. In the -morning her breathing was somewhat embarrassed, but after -mid-day it became more difficult and at the same time more -rapid. From the very beginning of the illness she had a cough -and expectorated purulent masses. In the throat and along the -course of the trachea one could hear a hoarse whistling sound. -The patient’s face had a healthy color, and over the two halves -of the jaw there was some redness, not of a deep hue but rather -fresh and bright. A little later her voice also became hoarse, -she began to show some emaciation, raw spots developed over -the fleshy parts of her hips, and the surface of the body grew -more moist than it had been before. On the seventieth day the -outward evidences of fever became much less noticeable, but the -respiration grew more rapid; and from that day to the time of -her death, five or six days later, she was obliged to remain in -a sitting posture. Toward the end the tracheal râle grew louder, -and dangerous sweats occurred, but the patient never lost her -expression of intelligence.</p> - -<p><i>Fractures.</i>—II.—9. In the human body the foot, like the -hand, is composed of a number of small bones. As they are not -easily broken it may safely be assumed, when such a case of -fracture comes under observation, that some pointed or unusually -heavy object had caused the lesion, and that the surrounding -soft parts must necessarily have been injured at the same time. -(Injuries of this nature will be discussed in a later section.) -But if any part of this bony framework is pushed out of its -natural position—whether this take place in one of the toes, -or in one of the tarsal bones, it makes no difference—the -dislocated part should be forced back into position in the -manner recommended in section XXIV. In its essential features -the treatment consists in the employment of wax plaster, -compresses, and bandages, exactly the same as is done in the -treatment of fractures of the long bones, but without splints. -The same rules hold good with regard to the degree of pressure -to be applied, and every third day the dressings should be -renewed. On each occasion of such renewal the patient should be -questioned with regard to the sensations which he feels after -the bandages have been applied, and if necessary they should be -readjusted in accordance with the nature of the answers which -he gives. The great majority of these injuries heal completely -in twenty days. The exceptional cases are those in which the -fracture]<span class="pagenum" id="Page_94">[94]</span> involves a bone that stands in immediate relation -with the bones of the leg. It is advisable, however, that the -patient should remain in bed during the period mentioned; for, -in not a few instances, the persons thus affected, failing to -appreciate the gravity of the injury, walk about before the -parts have really healed; and then, for an indefinite period -of time, they are frequently reminded in a painful manner of -the injury which they received. There is nothing astonishing in -this when the fact is recalled to mind that the feet support the -entire weight of the body.</p> -</div> - -<p>[Forty-eight chapters or sections, some of them of considerable length, -are devoted to the subject of fractures. The authorities are almost -unanimous in stating that this portion of the so-called Hippocratic -writings was written by Hippocrates himself. Malgaigne and Petrequin, -two of the most competent French writers on questions relating to -surgery, declare that the treatises written by Hippocrates on fractures -and dislocations (the two forming in reality one continuous treatise) -are the best and most complete books ever written by a physician.]</p> - -<div class="blockquot"> - -<p><i>Wounds of the Head.</i>—10. The physician should, first of -all, before touching the patient’s head, inspect carefully the -wound and surrounding parts. After noting whether the injury -has been inflicted upon a strong or a weak portion of the head, -he should ascertain whether the hair has been cut by the fall -or the blow, and whether portions of it have penetrated into -the wound. In the latter event he should express his fear that -the skull at this point has been laid bare and has perhaps even -received some material injury. He should make this statement -before he has touched or probed the wound. Then afterward he -should proceed to a physical examination of the injured parts, -in order that he may learn positively whether the overlying soft -tissues have or have not been separated from the bone. If simple -inspection reveals the fact that the skull has been laid bare, -well and good; but, if the real condition is not thus revealed, -he should not hesitate to employ the probe. If he finds that the -soft parts have been separated from the bone and that the latter -has been more or less injured, he should continue this more -minute exploration until he shall have ascertained to just what -extent and in what manner the skull has been injured, and what -measures are required to remedy the damage; in brief, he should -make the diagnosis. At the<span class="pagenum" id="Page_95">[95]</span> same time, however, he should not -neglect to question the patient very closely about the manner -in which the wound was inflicted, for in this way he may be -able to infer the existence of a contusion, or even a fracture -of the skull, of which no material evidences are discoverable. -Important information may also be gathered by passing the hand -over the seat of injury in the bone,—information which the -employment of the probe is not competent to convey.</p> -</div> - -<p>[Twenty-one additional chapters are devoted to wounds of the head, -every possible phase of the subject being handled by Hippocrates in the -most careful and thorough manner.]</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_96">[96]</span></p> - -<h3>CHAPTER IX<br /> -<span class="subhed1">THE STATE OF GREEK MEDICINE AFTER THE EVENTS OF THE -PELOPONNESIAN WAR; THE FOUNDING OF ALEXANDRIA IN EGYPT, AT THE -MOUTH OF THE NILE; AND THE DEVELOPMENT OF DIFFERENT SECTS IN -MEDICINE</span></h3></div> - -<p>Up to the time when war broke out between Sparta and Athens (431 B. -C.), the latter city had for many years easily held the supremacy, not -merely in everything relating to the science and art of medicine, but -also in all other branches of learning and especially in the arts of -sculpture, painting and architecture. At the time named above came the -beginning of her downfall. For a period of about twenty-one years she -struggled against disasters of all sorts.</p> - -<p><i>The Plague at Athens, the first Recorded in History.</i>—Shortly -after the war began—a war engendered by the bitter jealousy of Sparta -over the ever increasing ascendancy of her rival—the latter city was -visited by a devastating plague, the first European pestilence that -has been recorded in history. Thucydides, who wrote the history of the -Peloponnesian War, gives a most lucid description of this plague of -Athens, from which I shall copy certain portions.</p> - -<div class="blockquot"> - -<p>It first began, it is said, in the parts of Ethiopia above -Egypt, and thence descended into Egypt and Libya and into most -of the King’s country. Suddenly falling upon Athens, it first -attacked the population in Piraeus,—which was the occasion -of their saying that the Peloponnesians had poisoned the -reservoirs, there being as yet no wells there,—and afterward -appeared in the upper city, when the deaths became much more -frequent. All speculation<span class="pagenum" id="Page_97">[97]</span> as to its origin and its causes, if -causes can be found adequate to produce so great a disturbance, -I leave to other writers, whether lay or professional; for -myself, I shall simply set down its nature, and explain the -symptoms by which perhaps it may be recognized by the student, -if it should ever break out again. This I can the better do, -as I had the disease myself, and watched its operation in -the case of others.... People in good health were all of a -sudden attacked by violent heats in the head and redness and -inflammation in the eyes, the inward parts, such as the throat -or tongue, becoming bloody and emitting an unnatural and fetid -breath. These symptoms were followed by sneezing and hoarseness, -after which the pain soon reached the chest, and produced a hard -cough. When it fixed in the stomach, it upset it; and discharges -of bile of every kind named by physicians ensued, accompanied -by very great distress. In most cases, also, an ineffectual -retching followed, producing violent spasms, which in some -cases ceased soon after, in others much later. Externally the -body was not very hot to the touch, nor pale in its appearance, -but reddish, livid, and breaking out into small pustules and -ulcers. But internally it burned so that the patient could not -bear to have on him clothing or linen even of the very lightest -description; or indeed to be otherwise than stark naked. What -they would have liked best would have been to throw themselves -into cold water; as indeed was done by some of the neglected -sick, who plunged into the rain-tanks in their agonies of -unquenchable thirst; though it made no difference whether they -drank little or much. Besides this, the miserable feeling of not -being able to rest or sleep never ceased to torment them. The -body meanwhile did not waste away so long as the distemper was -at its height, but held out to a marvel against its ravages; -so that when they succumbed, as in most cases, on the seventh -or eighth day to the internal inflammation, they had still -some strength in them. But if they passed this stage, and the -disease descended further into the bowels, inducing a violent -ulceration there accompanied by severe diarrhoea, this brought -on a weakness which was generally fatal. For the disorder first -settled in the head, ran its course from thence through the -whole of the body, and, even where it did not prove mortal, it -still left its mark on the extremities; ... some, too, escaped -with the loss of their eyes.... Some died in neglect, others in -the midst of every attention. No remedy was found that could be -used as a specific; for what did good in one case, did harm in -another.... Such was the nature of the<span class="pagenum" id="Page_98">[98]</span> calamity, and heavily -did it weigh on the Athenians; death raging within the city and -devastation without.</p> - -<p class="r2 p-min">(Translation of Richard Crawley; Dent & Sons, London.)</p> -</div> - - -<p><i>Athens Ceases to be the Centre of Medical Learning.</i>—It is safe -to assume that one by one the more prominent of the physicians who -had survived the events which have just been narrated, must have left -Athens and taken up their abode in the various cities of Asia Minor -and the neighboring islands, in Sicily, in Italy, etc. Hippocrates, -who was thirty years old at the time when the plague broke out in -Athens, appears not to have witnessed it. He practiced his profession -and taught medicine in his native city; then he spent a certain number -of years in traveling about as a peripatetic physician; and finally -settled for the remainder of his life in Thessaly. But the length of -each of these periods of his professional life is not mentioned by any -of the authorities. About forty years after the death of Hippocrates, -Alexander the Great had already nearly completed his series of -brilliant conquests, and was taking steps to found a city, or rather, a -university, in which medicine was to take an organized shape as one of -the great departments of human learning.</p> - -<p>It may be well at this point, however, to interrupt this narrative -of the regular course of events for the purpose of considering very -briefly how far the physicians of that period had advanced toward -gaining a permanent and honorable position in their respective -communities.</p> - -<p><i>The Degree of Esteem in which Physicians Were Held by Their Fellow -Citizens and by the Governing Authorities During the Centuries -Immediately Preceding the Christian Era.</i>—We have at our command -very little direct evidence bearing upon the question of the esteem in -which physicians were held three hundred years B. C. by the communities -in which they practiced their profession. We know positively that -the kings and princes of that period fully appreciated the value of -the services which were rendered to them by the physicians (commonly -Greeks) whom they employed. In the event of war they took with them -men who were skilled both in surgery and in the treatment of<span class="pagenum" id="Page_99">[99]</span> the -ordinary ills of the body. One of the sons of Hippocrates, for example, -served for some time in this capacity, and he is credited with the -statement that “the physician who wishes to obtain the best training -in surgery should enter the service of the army.” There were eight -surgeons officially connected with the “ten thousand” whom Xenophon -led back to Greece after the famous campaign in Asia Minor. The -army of Alexander the Great was accompanied by the most celebrated -surgeons of that period. Upon a bronze tablet found at Idalium, on -the Island of Cyprus, there is an inscription which dates back to the -fifth century B. C., and which commemorates the merits of a physician -named Onasilos, who, aided by his pupils, rendered valuable services, -without any remuneration, during one of the wars of the Greeks; and in -recognition of these services, the Government had bestowed upon him a -stipend and had exempted him from taxation. It is further known that -the Athenians lavishly heaped honors upon Hippocrates, initiating him -at public expense into the mysteries of the Eleusinia, giving him a -crown of gold, and distinguishing him in still other ways. These facts -show how highly the rulers of that day appreciated the services of a -competent physician; but, up to a comparatively recent date, it has -not been so easy to demonstrate what was his position in the esteem -of the community at large. The discovery, not many years ago, of two -inscriptions in Greek throw a certain amount of light upon this very -point. One of these, which bears the date of 388 B. C., states that -its purpose is to commemorate the fact that the physician Euenor, who -had been intrusted by the people with the work of supervising the -preparation of all the drugs intended for use in the public hospital, -had not only fulfilled his duty but had in addition spent large sums of -his own money in the accomplishment of this work. Another inscription, -which was unearthed in the Island of Carpathus, between Crete and -Rhodes, and which is believed to date back to the end of the fourth -or the beginning of the third century B. C., reads (in a somewhat -abbreviated form) as follows: “In view of the fact<span class="pagenum" id="Page_100">[100]</span> that, for more -than twenty years, Menocritus, the son of Metrodorus of Samos, has -devoted himself with much zeal and self-sacrifice to the duties of his -position as parish physician, living all this time in rather narrow -circumstances and not asking any pay for his services, we, the citizens -of Brycontium, have resolved to erect in his honor, in the temple of -Neptune, a marble column bearing an inscription that shall set forth -these facts, to crown him with a wreath of gold, and to announce -publicly, at the Aesculapian games, this our decision.” As apropos -of this subject I may be permitted to quote the following words from -Plato’s “The Republic” (Book 1, Chap. 18): “Will you call the medicinal -the mercenary art, if, in performing a cure, one earns a reward? No, -said he.”</p> - -<p><i>The Founding of Alexandria.</i>—Alexander the Great, after subduing -the Persians and the cities of Phoenicia, marched into Egypt and -founded (331 B. C.), at the mouth of the Nile, the city of Alexandria. -In October of the same year he crossed the Euphrates and the Tigris -and defeated, for the second time, the Persian hosts under Darius. -Alexander was now the conqueror of Asia. During the following eight -years he laid his plans most carefully for the consolidation of his -great empire, the capital of which was to have been Babylon; but, -while he was thus making provision for the welfare of his numerous -subjects, who were of widely different tastes and aspirations, he -succumbed (323 B. C.) to a severe attack of malarial fever, aggravated -by an excessive indulgence in wine on the occasion of some festivity. -In the meantime Alexandria was developing rapidly into a great centre -of learning in all the departments of human knowledge. The Ptolemies, -beginning with Ptolemy Soter, who reigned over Egypt from 323 to 285 -B. C., contributed greatly to this result. For a period of about 250 -years Alexandria remained the centre around which revolved all that was -best in the domains of medicine, philosophy, geometry, mathematics, -history, etc. Money was spent lavishly in collecting the writings of -all those authors who had distinguished themselves in these different -fields of learning, and no pains<span class="pagenum" id="Page_101">[101]</span> were spared to secure correct -versions of the different works; the septuagint version of the books of -the Old Testament of the Bible being a conspicuous example of what the -Ptolemies accomplished in this direction during the third century B. -C. Every possible facility was offered at the same time for the giving -and receiving of instruction; and thus, with the immense library as a -foundation of priceless value, the Museum at Alexandria became in every -material respect a great university, the first one of which history -gives us any fairly satisfactory information. Several years after -the Museum library was established a second one of somewhat smaller -proportions was organized in the Serapeum (Temple of Serapis). The -example set by the Ptolemies was followed by Attalus, King of Pergamum -in Mysia, Asia Minor (241 B. C.), and, before many years had elapsed, -the great library of that city almost rivaled those of the Museum and -Serapeum at Alexandria. It was the competition between these two royal -collectors of books that led to the issuing of a decree that no more -papyrus was to be exported from Egypt, and thus there was provided the -stimulus which led to the discovery or invention of a new and better -material on which books might be written—viz., Pergamentum (our -parchment), a word coined from the name of the city in which it was -invented.</p> - -<p><i>The Development of Different Sects or Schools of Medicine.</i>—Up -to the time of the death of Hippocrates medicine maintained the -character of a single organized and harmonious body; but, when this -great physician had disappeared from the scene and was no longer -there to guide the further development of medical science and to keep -his followers working shoulder to shoulder with a single spirit and -purpose, this hitherto homogeneous body split up into sects or schools, -each of which had some favorite doctrine the promulgation of which -seemed to each group of adherents to be of great importance. There -were at first two such principal groups, viz., the Dogmatics and the -Empirics. The former was composed of those who laid great stress upon -speculation or theorizing,—that is,<span class="pagenum" id="Page_102">[102]</span> upon the use of the reasoning -power,—and the latter of men who maintained that actual experience was -the only thing of any serious value. The respective leaders of these -two groups or sects were Plato and Aristotle.</p> - -<p>In Raphael’s celebrated painting, “The School of Athens,” these two -heroes of philosophy are represented standing side by side—Plato with -his right hand elevated and pointing toward heaven, while Aristotle is -looking distinctly at the earth. Pictorially, the tendencies of the two -schools of philosophy could not have been better represented. Plato’s -genius had taken its flight heavenward and was contemplating earthly -things from this point of vantage; his method being to ignore system -and to look at everything with the eyes of purest love. “Delightfully -poetic, but thoroughly unprofitable speculation as to what constitutes -scientific truth and perfected morality!” (Friedlaender.)</p> - -<p>Aristotle, whose father was a physician and a descendant of -Aesculapius, was the hero and guiding spirit of those who based their -philosophy on experience, on ascertained facts. Like his celebrated -pupil, Alexander the Great, who brought whole nations under his sway, -he too was a conqueror in every field of human knowledge. His ideas -ruled supreme over the minds of men for thousands of years and to-day, -although many of them are no longer accepted as valid, Aristotle -himself is universally held to have been the greatest thinker and -investigator who has ever lived upon this earth. (In chapter XIII. I -shall have occasion to say something further regarding the Dogmatics -and the Empirics.)</p> - -<p>Out of the teachings of Plato and Aristotle developed two schools of -philosophy that exerted, in course of time, a great influence upon -the minds of men and upon the growth of medical science. The schools -referred to are the Epicureans and the Stoics. Epicurus (242–270 B. -C.), who gave his name to the first of these, taught that the highest -good was happiness.</p> - -<div class="blockquot"> - -<p>The happiness he taught his followers to seek was not sensual -enjoyment, but peace of mind as the result of the cultivation -of<span class="pagenum" id="Page_103">[103]</span> all the virtues. According to the teaching of his school -virtue should be practiced <i>because</i> it leads to happiness; -whereas the Stoics taught that virtue should be cultivated for -her own sake, irrespective of the happiness it will ensure. Zeno -(circa 370–260 B. C.), the founder of the Stoic philosophy, -taught an ethical system according to which virtue consists in -absolute judgment, absolute mastery of desire, absolute control -of the soul over pain, and absolute justice. The keynote of the -system is <i>duty</i>, as that of Epicureanism is pleasure. (Sir -William Smith.)</p> -</div> - -<p>In addition to the sects named above, there was still another known -as the Older Dogmatic School, which was composed of men who had -been the direct followers of the great master, but who, forgetting -altogether the practical teachings of Hippocrates with regard to -the importance of experience, gave themselves up to all sorts of -hypotheses and theories. Among the names of the earliest followers of -this school one is astonished to find those of Thessalus and Draco, -the sons of Hippocrates, as well as the name of Polybus, the latter’s -son-in-law. Diocles of Carystos and Praxagoras of Cos, two of the most -distinguished men of that period, were also among the earliest members -of this dogmatic school. Diocles, who was one of the Asclepiadae, owed -his celebrity in part to his contributions to our knowledge of anatomy -and in part to the work which he had done in other departments of -medicine. Unfortunately, all of these writings have been lost with the -exception of a few fragments which came to light toward the middle of -the nineteenth century. Praxagoras was also one of the Asclepiadae. He -was distinguished, as has already been stated on an earlier page, by -the fact that he—and not Aristotle, as is sometimes stated—was first -to recognize the difference between arteries and veins, and also by -the further fact that he called attention to the practical value of -the pulse as an indication, in certain diseases, of the tone of the -patient’s bodily condition or vitality.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_104">[104]</span></p> - -<h3>CHAPTER X<br /> -<span class="subhed1">ERASISTRATUS AND HEROPHILUS, THE TWO GREAT LEADERS IN MEDICINE -AT ALEXANDRIA; THE FOUNDING OF NEW SECTS</span></h3></div> - - -<p>Two of the most celebrated physicians of that period (305–280 B. C.) -were Erasistratus and Herophilus, both of whom were distinguished -as the founders of schools or sects of medicine at Alexandria. They -had received their early training as physicians from Chrysippus, a -widely known Stoic philosopher, who, according to Albert von Haller, -had taught at the school of Cnidus and had also written on medical -topics; and, among the other teachers, it is stated that Anaxagoras -of Cos had instructed Herophilus, and that Metrodorus, the son-in-law -of Aristotle, had performed the same service for Erasistratus. So far -as fundamental principles are concerned, the schools founded by these -two physicians at Alexandria differed very little from each other, and -the men themselves also gained their distinction in very much the same -branches of medical knowledge, both of them having made a number of -original discoveries in anatomy and both of them having become eminent -practitioners.</p> - -<p>Herophilus was born at Chalcedon, a Greek city on the Propontus, -nearly opposite to Byzantium. We possess no knowledge whatever -regarding the earlier years of his career, notwithstanding the fact -that no fewer than four different men devoted their energies to the -writing of his biography. The books themselves have been either lost -or destroyed. Herophilus showed a decided leaning toward the study -of anatomy, and his contributions to this branch of medicine are -among the earliest which we possess.<span class="pagenum" id="Page_105">[105]</span> Herophilus strove to supply one -of the most conspicuous deficiencies in the Hippocratic system of -medicine, viz., inadequate knowledge of the nervous system; and to -this end he conducted a series of the most careful investigations, -as a result of which he was successful in establishing several facts -previously unknown. He described the membranes of the brain, the -choroid plexus, the venous sinuses, the structure which bears his -name,—the torcular Herophili,—the cerebral ventricles, and the -calamus scriptorius; he traced the course of the nerve trunks for some -distance from their origin in the brain and spinal cord; and it was he -who established the fact that two different sets of nerves exist—one -for conveying sensations to the brain and the other for producing -motion. In addition, he investigated the corpus vitreum, the retina, -the optic nerve, etc. He also called attention to the peculiar mode -of construction of the duodenum, and to the fact that the walls of -the arteries are thicker than those of the veins. Some idea of the -accurate manner in which he carried on his anatomical researches may be -gained from the fact that he noted the circumstance that the left vena -spermatica occasionally originates in the vena renalis.</p> - -<p>Herophilus also gained distinction in the practical branches of -medicine. According to Puschmann he laid the foundations for a -scientific sphygmography. Thus he distinguished several varieties -of pulse in accordance with the differences which he noted in its -strength, regularity, degree of fulness, and rate of speed. He also -must have had considerable experience in surgery, as is shown by his -remark that a dislocation of the thigh, owing to the tearing of the -ligamentum teres which necessarily accompanies such a dislocation, is -likely to occur again in the same individual. In his writings relating -to the practice of medicine, Herophilus upheld the principle that -experience alone should be our guide, as theoretical considerations are -not to be trusted. He is also credited with having said, in response to -the question, Whom do you consider the best physician? “Him who knows -how to distinguish what is attainable from what is unattainable.”</p> - -<p><span class="pagenum" id="Page_106">[106]</span></p> - -<p>Erasistratus, the contemporary of Herophilus and his associate in the -work of establishing at Alexandria a great anatomical and clinical -medical school, was a native of Julis, in the Island of Ceos, not far -from the coast of Attica. In the earlier part of his professional -career he spent some time at the Court of Seleucus, the founder of the -Syrian monarchy (312–280 B. C.). This monarch, who had been one of -Alexander the Great’s distinguished generals, consigned the government -of the eastern part of his vast kingdom to his son Antiochus. The -latter fell ill about this time, and the most distinguished physicians -of the Court were then called in to determine what was the nature of -his malady and to decide upon the proper treatment. The patient grew -more and more languid, showed complete indifference to all that took -place about him, and steadily lost flesh. Erasistratus, who was one of -the physicians summoned, observed his behavior very closely and soon -noted the fact that, whenever Stratonice, his young and attractive -stepmother, entered the sick room, Antiochus became agitated; his face -being flushed, his voice subdued, his pulse more rapid, and his eyes -brighter, all of which signs of excitement disappeared when Stratonice -left the room. From these phenomena this shrewd observer drew the -inference that the patient was deeply but hopelessly in love with his -father’s second wife. Accordingly he informed Seleucus that his son’s -illness was simply the result of having lost his heart to one who was -unable to return his affection. Seleucus, who was much astonished, -asked with deep interest who was the lady. “My wife,” replied -Erasistratus, without an instant’s hesitation. “But tell me then,” -asked Seleucus, “would you be willing to cause the death of my son, -who is so very dear to me, by refusing to give up your wife to him?” -“Would you, yourself, my lord, under similar circumstances,” replied -the physician, “be willing to give up Stratonice to the Prince, if it -had been she with whom he had fallen in love?” Seleucus having already -vowed that he would not hesitate for a moment to do so, Erasistratus -declared the whole truth to him, and of course there was nothing left -for the<span class="pagenum" id="Page_107">[107]</span> King but to keep his word. History fails to state whether or -not the lady made any objection to the transfer. As Antiochus lived -to reign for many years after the murder of his father, it is safe to -assume that he recovered his health.</p> - -<p>This brief tale, the truth of which is not disputed by any of the -authorities, reveals Erasistratus to have been a clever diagnostician, -to have possessed a profound knowledge of human nature, and to have -been a man of exceptional courage; in short, he was a physician -admirably fitted to act as the founder and leader of one of the two -great medical schools of Alexandria. The following account may suffice -to convey some idea of his career after he became established at the -latter city.</p> - -<p>At the beginning of his residence in Alexandria, Erasistratus, like -his great rival Herophilus, devoted his energies to anatomical and -physiological researches. These two men evidently realized to the full -how important it was to medicine, if it were to make a substantial -advance beyond the point to which Hippocrates and his followers had -already carried it, that a more complete understanding of the structure -and working of the human body should be obtained; and their efforts -in this direction were greatly aided by the enlightened views of the -kings of Egypt, the Ptolemies, who did everything in their power to -furnish these two investigators with all the human dissecting material -they could use to advantage. They even went so far as to allow them -the privilege of utilizing, for scientific purposes, the living bodies -of imprisoned criminals, “in order that they might in this way learn -the location, color, shape, size, construction, hardness, softness, -smoothness, nature of external surface, protuberances and recesses of -the individual organs during life.” The defense which they offered for -permitting such vivisections was this: “It is permissible to sacrifice -the lives of a few criminals if many worthy persons may thereby be -permanently benefited in health, or have their lives prolonged.” -(Puschmann.) Those who were opposed to such examinations upon human -beings expressed their disapproval in<span class="pagenum" id="Page_108">[108]</span> the following terms: “This -practice is not only cruel, but useless, and at the same time it -derogates from the dignity of the healing art, which is intended to -be a blessing and not a source of pain to man; for those in whom the -abdominal cavity is first opened and then the diaphragm divided, die -before it is possible to make the scientific examination ‘during life’ -which constitutes, as it is claimed, the justification for the entire -procedure.” (Puschmann.)</p> - -<p>As regards the work done by Erasistratus in the departments of anatomy -and physiology, the following statement may be made: He threw a great -deal of additional light upon the structure of the lacteals, the valves -of the heart, the brain, the nerves, and several other portions of the -body; and he assigned to the pneuma, or breath,—of which he assumed -that two kinds exist,—the most important rôle in the mechanism of -life. According to the description given by Galen and reported by Le -Clerc, the phenomena to which Erasistratus refers take place somewhat -as follows: “When the thorax or chest expands, the lungs also undergo -dilatation and fill themselves with air. This air, entering first by -way of the trachea, ultimately reaches the anastomosing terminals of -the bronchial tubes, from which locality the heart, by the act of -dilatation, draws it into itself, and then, immediately afterward -contracting, sends it, by way of the great artery (the Aorta), to every -part of the body.” When it is considered that at this remote period -of time nothing was known about oxygen and carbon dioxide, nor about -the power of these elements to pass freely through a thin membrane -(exosmosis and endosmosis), no surprise will be felt that Erasistratus -carried the physiology of respiration no farther than he did. On the -contrary, it is remarkable that he was able to describe so correctly -this complicated process. In fact, none of his successors, up to the -time when Harvey’s great discovery was announced, was able to furnish -a better description. The physiology of gastric digestion was another -of the problems concerning which Erasistratus held views that were -different from those commonly accepted by the physicians of that time. -The stomach, he<span class="pagenum" id="Page_109">[109]</span> maintained, first retracts when portions of food are -introduced and then contracts in such a manner as to break them up into -smaller and smaller fragments; this process taking the place of that -of “coction,” as taught by Hippocrates. The resulting chyle passes -from the stomach into the liver and is deposited in those spots where -the finer branches of the vena cava and the terminal twigs of the -channels which lead into the gall-bladder come together. Here the chyle -breaks up into two portions, one of which—viz., that which contains -biliary elements—gains an entrance into the channels that lead to the -gall-bladder, while the other, which is composed of elements suitable -for making pure blood, finds its way into the ramifications of the -vena cava. While holding these views about the mode of transformation -of gastric chyle into the bile and pure blood, Erasistratus did not -hesitate to confess that he was unable to say whether bile was produced -within the body or whether it already existed in the food that was -taken into the stomach.</p> - -<p>As regards the treatment of disease Erasistratus held certain views -which were decidedly at variance with those maintained by the majority -of his associates. Thus, for example, Straton, a distinguished disciple -of this master, praises him for having banished bloodletting from the -list of remedial measures, and adds that he can testify to the fact -that Erasistratus had, by other means, cured all the diseases in which -the ancients commonly employed bloodletting as the chief remedial -agent. His favorite substitutes for the latter procedure were fasting, -dieting, physical exercise, and—in cases of hemorrhage—placing -ligatures around the arms and legs. Caelius Aurelianus is authority for -the statement that, in certain very exceptional cases, Erasistratus did -resort to bloodletting. Another of the latter’s tenets was his strong -objection to the employment of purgatives and composite remedies. On -the other hand, he appears to have attached considerable importance -to the employment of chicory in the treatment of all disorders of the -abdominal organs. One of the evidences of his preference for this -drug is to be found in the care which<span class="pagenum" id="Page_110">[110]</span> he takes in describing how the -plant should be prepared for remedial purposes. “Boil a bunch of the -plant in water until the mass is thoroughly cooked; then cast it into -a fresh supply of boiling water (to drive out still more of its bitter -quality); and finally, upon removing it from the boiling water, place -it for conservation in a receptacle containing oil. When it is required -for use add a small quantity of weak vinegar.” Galen, in commenting -jocosely upon the stress which Erasistratus lays upon these details, -makes the remark: “As if our domestics did not know how to cook a bunch -of chicory!”</p> - -<p>Speaking of the effects produced by venom when one is bitten by a -poisonous snake, Erasistratus remarks that “from the effects which the -poison introduced in this manner produces, we may derive a general -indication as to how a cure may be obtained. The poison, it will be -noted, destroys very quickly the parts with which it comes in contact, -and then, by spreading throughout the body, causes death. The thing to -do, therefore, is to draw it as quickly as possible out of the body -and thus arrest its further spread. To this end the wound should first -be enlarged and its sides scarified; then, after it has been sucked, -a cupping glass should be applied over it; and, finally, it should be -cauterized.”</p> - -<p>Erasistratus cultivated surgery as well as the other branches of -medicine. He was a bold operator, as may be inferred from the fact -that, in cases of scirrhus or other variety of tumor of the liver, he -did not hesitate to incise the skin and overlying integuments, and -then, after the peritoneal cavity had been opened, to apply directly to -the seat of the disease such medicaments as seemed to him appropriate. -On the other hand, he did not approve of <i>paracentesis abdominis</i> -in cases of dropsical effusion, as a means of evacuating the fluid -accumulated in the peritoneal cavity.</p> - -<p>It appears that the disciples and successors of Herophilus and -Erasistratus soon abandoned the exact methods which these two great -masters had inaugurated and which, in a comparatively short time, had -produced such admirable<span class="pagenum" id="Page_111">[111]</span> results, and then they fell back into the -less arduous, the easy-going ways of speculation. Only a very few had -sufficient strength of character to walk in the older pathway, and -among the number were some who left Alexandria and established schools -in the other cities—as, for example, Zeuxis, who organized a new -centre of medical teaching at Laodicea, in the interior of Asia Minor, -and Hikesios, who founded another school at Smyrna, on the seacoast of -Lydia. It is not strange, therefore, that before many years had elapsed -the two original schools at Alexandria died a natural death. As Pliny -aptly writes, “It was so much more comfortable to sit on the benches -of the schools and have learning poured into your ears than to wander -daily through the desert outside in search of other nourishing plants.” -As a further result of this deadness of the schools at Alexandria (that -is, of the sect of the Dogmatics) the more serious-minded physicians -espoused with eagerness the side of the Empirics—a sect which -developed about this time, but which did not, it must be confessed, -hold out much hope of solving the physiological and pathological -problems of the day, but which nevertheless satisfied in some measure -their needs as practitioners.</p> - -<p>Philinus of Cos (286 B. C.) was looked upon as the founder of the -school of the Empirics, and among its most distinguished disciples -were: Serapion of Alexandria (279 B. C.), Glaucias, Apollonius -Biblas, and—perhaps the most celebrated of them all—Herakleides of -Tarentum (242 B. C.), who did such excellent work in the department -of pharmacology. It was he, for example, who defined more precisely -than had been done by any one of his predecessors the proper manner -of employing opium. In addition, he wrote a commentary on the -Hippocratic works and also separate treatises on medical, surgical -and pharmaceutical topics. In the latter category belongs his book -entitled “A Military Pharmacopoeia.” Last of all, Apollonius Mus, a -distinguished follower of Herophilus, deserves to be mentioned because -it was he who perfected the preparation of castor oil. At a still later -date (158 B. C.) Zopyrus proved himself to be a most worthy successor<span class="pagenum" id="Page_112">[112]</span> -to Herakleides. It was he who first classified drugs according to the -effects which they produce, and he also invented or discovered the -preparation named “ambrosia,” a general antidote for poisons of all -kinds. Kings and princes were, at that period, in constant fear of -being poisoned, and so it came about that those who were skilled in the -knowledge and preparation of drugs were greatly stimulated by their -royal patrons to find efficient antidotes. It is narrated that Attalus -Philometer, King of Pergamum, the native city of the famous physician -Galen, and Mithridates Eupator, King of Pontus, cultivated poisonous -plants in their gardens and tried the effects of the poisons distilled -from them on criminals. They also encouraged in every possible way -the preparation of antidotes; and thus was compounded a mixture which -even to-day is still known by the name of “<i>Mithridaticum</i>.” For -centuries it was a very popular remedy for poisoning by snake-bite. Le -Clerc states that one of the first things that the great Roman general -Pompey did, after conquering Mithridates and gaining possession of his -palace (about 64 B. C.), was to have a careful search made for the -recipe of this famous antidote. Upon finding it he was surprised to -learn what simple ingredients it was composed of—viz., “20 leaves of -rue, a pinch of salt, two nuts, and two dried figs.” The theriacum, -which one hundred years later was modeled after the Mithridaticum, -contained a great deal of honey and a large number of unimportant -drugs, introduced—as Pliny claims—“to magnify the importance of the -apothecary’s art, rather than to increase the curative effects of the -remedy.”</p> - -<p>The scepticism which already at that period had begun to take -possession of many of the best minds manifested itself in the form of -a disbelief in the possibility of discovering full scientific truth, -and men therefore taught the doctrine that the human understanding -is not capable of attaining anything higher than probability. The -acceptance of such a doctrine naturally acted as a powerful hindrance -to all further original research. And so the Empirics neglected the -study of anatomy and physiology<span class="pagenum" id="Page_113">[113]</span> as something quite superfluous and -unprofitable. They gave no further thought to the causes of disease, -and were quite satisfied simply to observe its manifestations, to -investigate the factors which appeared to bring it into a state of -activity, and to search for the means of effecting a cure. In carrying -on work of this character, they of course derived help, not only from -their own experience, but also from that of others—which latter became -in time a matter of history. When they encountered new experiences -and were unable to supply a satisfactory explanation they resorted -to a third method—that of reasoning by analogy. Upon this triple -support—one’s own individual experience, the experience of others -stored up in the form of history, and reasoning by analogy—rested the -entire structure of empiricism.</p> - -<p>Strange as it may at first appear, the science of medicine from this -time onward made no further conspicuous progress until the middle of -the seventeenth century of the present era. In certain branches of -practical medicine—as, for example, pharmacology, obstetrics and -general surgery, and also in certain special departments—the Empirics -made a number of material additions to our knowledge; but in all -essential particulars the medical science taught throughout this period -of about two thousand years varied but little from that taught at -Alexandria one hundred or two hundred years before the birth of Christ. -This extraordinary phenomenon of almost complete arrest of development -for so long a period of time should not excite surprise, for something -of a similar nature has certainly occurred in other departments of -human knowledge.</p> - -<p>The further history of the medical sects which flourished under the -Ptolemies and for a short time afterward, when Alexandria became -a colony of the Roman Empire, need not detain us long. Daremberg -furnishes a chronological chart of the physicians who played a more -or less prominent part in the work of these sects, and from this -it appears that they numbered thirty-four in all—ten followers of -Herophilus, fourteen of Erasistratus, and ten Empirics.<span class="pagenum" id="Page_114">[114]</span> Callamachur -and Bacchius, who belonged to the first of these groups, deserve to be -mentioned because they were its most distinguished members and because -they were the first physicians who wrote commentaries on the writings -of Hippocrates. In the sect of the Empirics the next in importance -after Philinus of Cos is Serapion of Alexandria. Mantias, another -disciple of Herophilus, gained considerable reputation from the fact -that he was the first to collect together into a single treatise the -different pharmaceutical formulae that were then in general use. He was -also an authoritative writer on surgical topics.</p> - -<p><i>Certain Branches of Medical Work Begin to Assume more Distinctly -the Character of Specialties.</i>—At the time of Hippocrates there -were no specialists, or at least none who received any sort of official -recognition from the general body of physicians; and yet, there were, -even then, a few practitioners who devoted themselves preferably to -the treatment of certain maladies, like the affections of the eye and -the teeth; and, beside these, there were undoubtedly, in the larger -communities, men who were ready and competent to undertake the more -serious surgical operations. But even these men, as appears from the -language of the so-called Hippocratic oath, could not honorably perform -an operation for stone in the bladder; this particular work having been -left from time immemorial entirely in the hands of the lithotomists, a -class of men who performed no other kind of surgery and who, in fact, -were considered outside the pale of the medical profession—merely -surgical artisans.</p> - -<p>During the Alexandrian period the attitude of the best physicians with -reference to specialization in medical practice evidently underwent -a change,—not a very marked one, it is true, but yet sufficient -in degree to attract some attention. We read, for example, that a -certain Demetrius of Apamea, a follower of Herophilus, was skilled -as an obstetrician and was also a clever diagnostician; that Andreas -of Carystus, another disciple of Herophilus and the physician upon -whose authority the incredible story of the burning of the Cnidian -archives by Hippocrates was<span class="pagenum" id="Page_115">[115]</span> spread abroad, was considered at this -time an expert in the science of obstetrics; that, toward the end of -the period (first century B. C.), Alexander Philalethes, a disciple -of Herophilus and well known as an author of treatises on the pulse -and on the doctrines taught by different physicians of that period, -acquired widespread celebrity as a gynaecologist; that Straton, a -disciple of Erasistratus, had gained considerable distinction as a -gynaecologist; and, finally, that two physicians—Gaius of Naples and -Demosthenes of Marseilles (Massilia)—were widely celebrated for their -skilfulness in the treatment of eye diseases. The latter was also a -successful author, for his treatise on ophthalmology retained its -popularity down to the Middle Ages. All these men, it should be noted, -were directly and indirectly connected with the work at Alexandria, and -were physicians of some degree of prominence. It is fair to assume, -therefore, that specialization in medical practice had by this time -become an accepted fact and was certainly not frowned upon by those in -authority. The result is entirely in accord with what might be expected -from a body of physicians as enlightened as were the men gathered -together at Alexandria during the centuries immediately preceding and -that immediately following the birth of Christ; but many additional -centuries were yet to elapse before anything like the well-defined -specialism of modern times was to become an established fact.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_116">[116]</span></p> - -<h3>CHAPTER XI<br /> -<span class="subhed1">ASCLEPIADES, THE INTRODUCER OF GREEK MEDICINE INTO ROME</span></h3></div> - -<p>The seventh Ptolemy, Ptolemy Euergetes or Physcon, whose reign lasted -from 146 to 117 B. C., drove all men of learning away from Alexandria -and closed the famous schools in that city. It was only a few years -after these events, and at a time when that city was fast losing its -supremacy as the great centre of medical learning,<a id="FNanchor_27" href="#Footnote_27" class="fnanchor">[27]</a> that there -appeared at Rome a Greek philosopher and physician who was destined to -become the founder of a new set of medical ideas and of a new kind of -medical practice. Being<span class="pagenum" id="Page_117">[117]</span> a man of general cultivation and attractive -personality, and not afraid to encounter the prejudices and ill will -which almost always greet a foreigner when he first establishes himself -in a strange country and among a people of a different race, he soon -overcame those obstacles and was eventually successful in making Rome -the starting-point and centre of the best medical thought and practice -of that period of the world’s history. To understand clearly, however, -the character of the work which Asclepiades accomplished in the city -which was soon to be the capital of the world as then known, it is -desirable that a brief account should be given of the condition of -medical affairs in Rome at the time of his arrival.</p> - -<p><i>The Practice of Medicine at Rome During the Century Immediately -Preceding the Christian Era.</i>—Foreigners were not encouraged to -settle in Rome until toward the latter part of the second century B. -C., and consequently the treatment of the sick in that city maintained -its distinctly Roman character for an unusually long time. In the -households of the better classes the head of the family commonly -prescribed for any illness which might befall its members. In not a few -instances one of the slaves—who was known as a <i>servus medicus</i>, -and who might perfectly well have been a regularly educated Greek -physician—took charge of the patient in place of the master of the -house. A book of domestic remedies was the usual source of information -from which the latter derived his knowledge of therapeutics. Marcus -Porcius Cato, the distinguished Roman censor (234–149 B. C.), was the -author of one of the most popular of these books of recipes. The text -of this work has come down to our time. There were, at this period, -no regularly established physicians and no such thing as a medical -practice. For several hundred years the Romans were almost constantly -at war with the neighboring tribes or nations, and this life of -outdoor exposure and active exercise kept them free from the numerous -and very varied bodily ills of the later generations. This state of -society alone was quite sufficient to prevent the thoroughly trained -physicians of Greece and<span class="pagenum" id="Page_118">[118]</span> Alexandria from settling in Rome. But there -were still other forces at work which greatly delayed their taking -such a step, viz., the unwillingness on the part of the authorities -to grant to foreigners the rights of citizenship, and the very strong -prejudice which the Roman aristocracy cherished with regard to the -Greek nation. Some idea of the strength of the latter feeling may -be gathered from the letter which Cato the Censor, perhaps the most -influential citizen of Rome at that time, wrote to his son Marcus. -Daremberg gives the following quotation from this epistle: “The Greeks -are a perverse and unteachable race. Believe that an oracle is speaking -to you when I say—Every time that the Greeks bring to us some branch -of knowledge they will not fail to corrupt our manners; and it will -be far worse for us if they should send us their physicians, for they -have bound themselves by an oath to kill all Barbarians by the aid of -medicine—and they have the insolence to reckon us also as Barbarians. -Remember that I have forbidden you to call in a physician.” Daremberg -adds: “The old man Cato must have been very simple-minded to believe -for a moment that physicians would be such egregious fools as willingly -to kill the patients from whom they derive their support.” But even -this strong prejudice on the part of the Roman aristocracy had to -give way in course of time to forces of a much stronger character. -During the second century B. C., the Romans, no longer fearing the -encroachments of their warlike neighbors and having overcome all danger -of an invasion on the part of their once powerful Carthaginian foe, -entered upon a career of conquest. The capture of an ever increasing -number of cities and towns in Greece, Asia Minor, Egypt and Africa -brought great wealth to Rome, and, with it, increasing luxury, an -increase in the prevalence and variety of diseases, and an increased -need of men who were competent to deal successfully with such diseases. -The physicians who first attempted to meet this need were men of an -inferior stamp, to whom the situation appeared simply to afford an -excellent opportunity for making money; and very naturally they failed -to gain the respect and confidence<span class="pagenum" id="Page_119">[119]</span> of the better citizens. At a later -date Julius Caesar, who was, at that time, Consul (about 90 B. C.), -extended the right of citizenship to all foreign physicians who were -practicing in Rome, and thus was removed one of the greatest obstacles -which prevented the better class of Greek medical men from settling in -that city.</p> - -<p>More than a hundred years before the time of which I am speaking -(<i>i.e.</i>, about 218 B. C.), a Greek physician named Archagathus had -the courage to take up his abode in Rome. He was the son of Lysanias, -a native of Peloponnesus. At first he appeared to gain the favor of -the community in which he practiced, for they bought and placed at his -disposal a shop, or office, in the cross-way of Acilius, and gave him -the name of <i>vulnerarius</i>—healer of wounds. Later, however, they -disliked his rather too free use of the knife and the actual cautery, -and thereafter he was spoken of as the <i>carnifex</i>, or executioner. -Medicine was thus brought into disrepute and we hear nothing further -about physicians in Rome for more than a century—that is, until about -90 B. C., when Asclepiades,<a id="FNanchor_28" href="#Footnote_28" class="fnanchor">[28]</a> a native of the city of Prusa, Bithynia -(northwest part of Asia Minor), made his appearance in that city. At -first he taught rhetoric, but, finding this occupation unprofitable, he -began the practice of medicine. Pliny says that he acquired a knowledge -of this art through the studies which he carried on after his arrival -in the city of Rome, but Neuburger makes the statement that he began -the study of rhetoric, philosophy and medicine in his youth and then -spent some time in perfecting his knowledge at Parion, a city of Mysia -on the Hellespont, at Athens, and probably also at Alexandria.</p> - -<p>As a practitioner Asclepiades appears to have met with unusual success. -He was well educated and possessed of agreeable manners, and was the -friend as well as the physician of Cicero, one of the most polished -men of whom history furnishes us any knowledge. He was also on terms -of intimacy with Atticus and other eminent citizens of<span class="pagenum" id="Page_120">[120]</span> Rome. The -possession of such friends was more than sufficient to render him one -of the favored and prosperous physicians of his day in that city. As -Meyer-Steineg aptly says, “he owed not a little of his success to the -happy manner in which the scientist, the clever physician, and—to -a slight degree—the charlatan were combined in his character.” The -following anecdote which is told of him by Lucius Apuleius shows, on -the one hand, that he possessed remarkably keen powers of observation, -and, on the other, that there were some grounds for the charge that his -behavior was at times somewhat theatrical in character:—</p> - -<div class="blockquot"> - -<p>One day, as Asclepiades was returning to the city, from his -place in the country, he observed the approach of a long funeral -procession. Desiring to learn whether the deceased was a person -of his acquaintance, and also in the hope of perhaps gaining -other information of a professional nature, he approached as -nearly as possible to the bier. The face of the corpse was -anointed with sweet-smelling ointments over which spices had -been sprinkled; but, notwithstanding this, he was able to detect -certain signs which led him to suspect that the man might not -yet be dead; and accordingly he examined the body very closely -and thus satisfied himself that such was indeed the fact. -Whereupon he called aloud that the man was still alive, and -told the bearers to extinguish the torches, to carry away the -materials for the pyre, and to remove the funeral feast from -the grave to a table. Some at once objected to the carrying -out of these measures and made sarcastic remarks about the -healing art—probably because they were already in possession -of the man’s estate, and were afraid that they might have to -give it up. The more influential ones, however, insisted that -the physician’s words should be heeded. Then Asclepiades, -notwithstanding the opposition which was made by the relatives, -succeeded in securing a brief delay, during which he had the -supposed corpse removed to his own house. Restorative measures -were employed, respiration was re-established, and the man was -brought back to life. At the succeeding festivities unlimited -praise was bestowed upon the wise physician.</p> -</div> - -<p>Whether this tale, which I have copied from Neuburger, is true or -not, it seems to fit in well with the bold and<span class="pagenum" id="Page_121">[121]</span> independent character -of Asclepiades as it is revealed to us by the different writers of -the history of medicine. In his comment upon this narrative the -distinguished Viennese historian makes the remark that Asclepiades -was very conceited, and—like most reformers—showed a disposition to -ignore the work accomplished by his predecessors. He also expresses the -belief that Asclepiades possessed a leaning toward the methods of the -charlatan; the episode just narrated revealing a love for theatrical -display in his professional activity. On the other hand, in the further -course of the chapter which he devotes to this famous Roman physician, -Neuburger gives fuller recognition to the value of the services which -he rendered to medicine, and thus, in the light of these services, one -is justified in overlooking any little weaknesses of character which he -may have displayed. Perhaps the most important of the services which -Asclepiades rendered was that of having introduced Greek medicine into -Rome—an important connecting link in the transmission of medical -knowledge from Greece to Modern Europe.</p> - -<p><i>The Views of Asclepiades with Regard to Physiology and -Pathology.</i>—The human body, according to the philosophy of -Asclepiades, is composed of atoms—that is, small bodies which are -invisible, have no definable quality, are in continual motion, through -mutual pressure undergo modifications in form, and break up into -innumerable smaller fragments or particles that differ both in size -and in shape. The arrangement of these small bodies is such that -intercommunicating spaces or pores are left between them, and through -these channels flows a sap or juice containing larger and smaller -particles; the larger ones composed of blood, and the smaller of vapor -or heat. Health, according to Asclepiades, is that state in which the -primitive atoms are properly distributed or placed and the flow of the -juices in the pores takes place normally. When, however, the flow is -arrested and the primitive atoms are disordered in their relations to -each other and to the pores, or when the elements composing the fluid -contents of the latter become mixed, disease results. Alterations in -the<span class="pagenum" id="Page_122">[122]</span> pores themselves, as contradistinguished from the fluid contained -within them, may also cause disease. Farther on, when the proper time -arrives for considering the sect of the Methodists, I shall have -occasion to discuss this subject again, and particularly that part -of it which relates to pathology. In the meantime, however, I cannot -resist the impulse to say a few words about the remarkable insight -possessed by Asclepiades into the manner of construction of the human -body, as manifested by this very brief but very significant anatomical -and physiological description. Upon a first reading one might easily -get the impression that Asclepiades has reference to only one kind or -system of “pores” or channels—viz., such as serve for the circulation -of tissue juices alone. But, upon a closer scrutiny of the text, one -finds some warrant for suspecting that he had in mind more than one -system of such channels; for he states distinctly that the fluid -circulating in these pores contains larger particles composed of blood -and smaller ones which consist of vapor (<i>spiritus</i>) or heat. The -question suggests itself: Could a man who had no knowledge of Harvey’s -discovery, who did not possess a microscope, and who at the same time -believed—as did all the ancients—that air circulated in the arteries -and blood in the veins, come any nearer to the actual truth than did -Asclepiades? His description needs very few alterations and additions -to make it fit correctly the system of terminal arterio-venous channels -known to-day as arterioles and capillaries.</p> - -<p><i>Methods of Treatment Adopted by Asclepiades.</i>—The prevailing -methods of treating diseases in Rome were not approved by Asclepiades, -and he lost no opportunity of giving expression to this disapproval. -In the first place, he protested vigorously against the practice -of prescribing on every possible occasion purgatives and remedies -capable of producing vomiting. He had a decided preference for gentler -measures, his idea being that a physician should cure his patients -<i>tuto, celeriter, et jucunde</i>—safely, quickly and agreeably. Le -Clerc adds that this is a fine sentiment, but that its realization -in actual practice is something<span class="pagenum" id="Page_123">[123]</span> which most physicians find it very -difficult to attain. Asclepiades condemned strongly the employment of -magical remedies, a practice which was still much in use at that time -in Rome, although it was already less common than it had previously -been. Cato’s collection of household remedies contains a short list -of some of these appeals to man’s superstition.<a id="FNanchor_29" href="#Footnote_29" class="fnanchor">[29]</a> In addition to -the remedial measures mentioned above, Asclepiades placed his chief -dependence on the following: abstinence from meat; the employment of -wine under certain well-defined circumstances; massage and frictions; -baths of different kinds (it is said that he devised a great variety); -walking; driving and being carried about in the open air in a litter -or in a boat on a quiet river or in the protected harbor. One of his -remedies in the case of sleeplessness consisted in having the patient -placed in a suspended couch which could easily be rocked from side to -side. As all these measures were agreeable and could at the same time -easily be employed by almost everybody, they met with general favor, -and in consequence Asclepiades was looked upon by the Romans as “a -person sent from heaven.” As a rule, he recommended the drinking of -simple water, but in certain cases (to be mentioned farther on) he did -not hesitate to advise the taking of wine in moderation. He advocated -tracheotomy, in cases of inflammation of the throat, in preference to -the then prevailing practice—both very painful and quite difficult to -carry out—of introducing a tube of some kind as a means of opening a -passage for the entrance of air into the lungs.</p> - -<p>Le Clerc quotes Galen as authority for the statement that Asclepiades, -who never hesitated for an instant to criticise the different -therapeutic procedures of his predecessors,<span class="pagenum" id="Page_124">[124]</span> did not go so far as to -condemn wholly the practice of bloodletting. Indeed, he was quite ready -to employ it in the treatment of painful affections because, as he -claimed, the pain was caused “by the retention of the larger particles -or atoms in the pores or channels of the tissues, and hence—as -these particles were composed of blood—bloodletting was the only -remedy capable of setting them free.” Thus, he resorted to bleeding -in pleurisy, because this affection is characterized by pain; but he -abstained from employing the remedy in “peripneumonia” or “inflammation -of the lung,” because in most cases it is not accompanied by pain; -and he also did not approve of its employment in inflammation of the -brain (<i>phrenitis</i>). On the other hand, he advocated bleeding -in epilepsy and all forms of disease in which convulsions occurred, -and he also advocated it in cases of hemorrhage of every description. -Quinsy sore throat was another malady in which he drew blood freely -from the veins of the arm, of the temple and even of the tongue; and -in addition, when the disease was severe, he scarified the skin at -suitable spots and applied cups to the part. In all these measures -his purpose was “to open the pores”; and when this treatment failed -he incised the tonsils or the uvula, and even, as a last resort, -performed laryngotomy or tracheotomy. In cases of dropsy he employed -<i>paracentesis abdominis</i>,—that is, he made a very small opening -in the abdominal wall to serve as an outlet for the fluid contained in -the peritoneal cavity. From these facts it is evident that Asclepiades -did not always abide by his rule not to use any but very gentle -remedies.</p> - -<p>Asclepiades showed, in his manner of treating still other pathological -conditions, how different was his practice from that of his -predecessors. In the first place, he was very partial, as has already -been stated, to such extremely mild forms of physical exercise in -the open air as one can obtain from driving or from being carried -in a litter or a boat. He prescribed these measures, not merely for -convalescents but also for those, for example, who were still in the -midst of an active fever. His idea was, that by means of such<span class="pagenum" id="Page_125">[125]</span> very -gentle forms of exercise the pores would become less clogged and -would permit the juices of the body to flow more freely. In cases of -dropsy, also, he was in the habit of employing friction for precisely -the same purpose. He even used this remedy in cases of inflammation -of the brain, in the expectation that he might thereby induce sleep -for these patients. Indeed, this subject of frictions was one on which -Asclepiades wrote at greater length than on any other remedial agent.</p> - -<p>It is a surprising fact that, in common with Erasistratus, he taught -the doctrine that physical exercise was not at all necessary to persons -in normal health. At the same time he approved of it, when carefully -graded, for those who were affected with bodily ills of a certain -nature.</p> - -<p>Wine was another remedy which Asclepiades was fond of prescribing -in all sorts of maladies, but his rules in regard to the manner in -which it should be employed were quite different from those adopted -by his contemporaries. A few illustrations will suffice to show the -different conditions for which he was wont to advocate the taking of -wine: He gave it, for example,—though probably much diluted with -water—to patients affected with fever, but only after the stage of -greatest activity had been passed. Strange as it may appear to-day, -he was rather in favor of giving to patients ill with inflammation of -the brain (<i>phrenitis</i>) wine in sufficient quantity to produce -intoxication; his belief being that he could in this way induce -drowsiness and eventually sleep—a thing so desirable for those -affected with that disease. Further, he instructed sufferers from -catarrh to drink twice or three times as much wine as they usually -drank, in consequence of which instructions the patients found it -necessary to dilute their wine with water to a less degree than -usual—that is, to such a degree that the proportion would be one-half -of each; thus showing, as Le Clerc remarks, how sober the ancients -must have been when they were in perfect health. They probably—he -adds—drank their wine ordinarily in the proportion of five-sixths -water to one-sixth wine, or, at most, three-quarters water to -one-quarter wine.</p> - -<p><span class="pagenum" id="Page_126">[126]</span></p> - -<p>In some cases Asclepiades prescribed the drinking of wine (particularly -the wine of Cos) to which sea-water had been added; his idea being -that the addition of salt would enable the wine to penetrate farther -into the tissues and thus open the pores more freely. This idea of -added salt was not original with him, for Pliny states that in certain -parts of Greece it was customary to place casks filled with new wine -in the sea and to leave them there for some time. The wine, it was -claimed, was rendered by this procedure mature and pleasanter to drink. -They called wine thus treated “Thalassite wine” (from the Greek word -“thalassa,” sea). In cases of jaundice he occasionally recommended the -drinking of plain sea-water, whereby the bowels were stimulated to act -more freely. Under ordinary circumstances he employed, for the relief -of constipation, clysters, but he was sparing in their use.</p> - -<p>The remedial measures enumerated above, together with dieting, are -those upon which Asclepiades chiefly relied in his practice. In acute -diseases he made very little use of drugs that were to be taken -internally, but in maladies of a chronic character he employed them -quite freely. Gargles, poultices and inunctions are mentioned among the -external remedies which he often prescribed.</p> - -<p><i>Further Particulars Regarding the Life and Career of -Asclepiades.</i>—Le Clerc furnishes a number of details which throw -additional light upon the career of Asclepiades. During the latter’s -lifetime his professional reputation was very great. Lucius Apuleius, -the famous Roman satirist and rhetorician, and a contemporary of -Asclepiades, calls him the Prince of Physicians, second only to -Hippocrates the Great; Scribonius Largus, a Roman physician and writer, -who flourished during the reigns of the Roman emperors Tiberius and -Claudius (37–54 A. D.), speaks of him as a great medical author; Sextus -Empiricus, a writer remarkable for his learning and acumen, who lived -in the first half of the third century A. D., calls him a physician of -unrivaled skill; and Celsus, who is termed the Cicero of physicians, -on account of the purity of his Latin, holds him in high esteem as a -medical authority. His fame as a<span class="pagenum" id="Page_127">[127]</span> physician had spread to Asia Minor, -for we are told that Mithridates, King of Pontus, who reigned from 120 -B. C. to 63 B. C., and who was a man of great ability and great energy, -invited him to take up his residence at his court; but Asclepiades -refused. Perhaps a still stronger evidence of his real worth as a man -is to be found in the fact that he was the physician and personal -friend of Cicero.</p> - -<p>Notwithstanding these strongly favorable estimates of the ability -of Asclepiades there were not a few men, and they too men of great -authority, who were indisposed to give him so conspicuous a place in -the temple of fame. Galen, for example, while admitting that he was a -very eloquent physician, maintained that he was a sophist, given to -quibbling, and disposed to contradict everybody. Caelius Aurelianus, a -contemporary of Galen and the author of the most important practical -treatise on Methodism that has come down to our time, appears to have -held the same opinion as Galen with regard to Asclepiades. The complete -disappearance of all the writings of the latter author makes it -impossible for us at the present time to form an independent judgment -as to the merits of these conflicting estimates of the man’s character. -Galen was a great admirer of Hippocrates and it is very likely that he -took offense at the failure of Asclepiades to accept all the teachings -and therapeutic methods of his hero. As to the reasons which led -Caelius Aurelianus to agree with the estimate made by Galen, we know -absolutely nothing.</p> - -<p>Toward the middle of the seventeenth century there was discovered at -Rome, not far from the Capena gate, a portrait bust in white marble -of Asclepiades. It was probably executed by a Greek sculptor residing -in Rome, for, if the work had been done in Greece, the face would -have been represented with a beard, as are the heads of Hippocrates, -Soranus and other celebrated physicians of antiquity. The absence of -the beard, furthermore, shows—according to the opinion of antiquarian -experts—that the bust must have been sculptured before the time of the -Emperor Claudius (41–54 A. D.), as he was the first of the Caesars to -wear a beard. This bust, which is a little larger<span class="pagenum" id="Page_128">[128]</span> than life-size, is -at present—if I am rightly informed—in the Capitoline Museum at Rome.</p> - -<p>Asclepiades lived to a great age. In descending, one day, a flight of -steps he fell and received injuries from which he died.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_129">[129]</span></p> - -<h3>CHAPTER XII<br /> -<span class="subhed1">THE STATE OF MEDICINE AT ROME AFTER THE DEATH OF ASCLEPIADES; -THE FOUNDING OF THE SCHOOL OF THE METHODISTS</span></h3></div> - -<p>In summing up the effects which were produced by the teaching and -practice of Asclepiades upon the science and art of medicine, Dr. -Meyer-Steineg makes the remark that the wide and ready acceptance of -both depended largely upon the personal character of the man, upon the -manner in which he carried out the measures which he advocated, and -upon the fact that the Romans happened at that period of their history -to be ready to respond favorably to such new doctrines and therapeutic -methods; but that, as soon as his strong personality had ceased to -exert its influence, as it did after he had passed the active period -of his life, and also because Rome did not at that moment possess any -physicians who were sufficiently endowed with his medical gifts and -sagacity to perpetuate his art, both it and his doctrines began to lose -ground. Nevertheless, as this writer states, Asclepiades had already -succeeded admirably in preparing the way for a further development of -the healing art, and for this valuable service full credit should be -given him.</p> - -<p>Not long after the death of Asclepiades, Antonius Musa,<a id="FNanchor_30" href="#Footnote_30" class="fnanchor">[30]</a> the -personal physician of the Emperor Augustus, succeeded, by means of -hydrotherapy, in curing his royal patient of a protracted gouty or -rheumatic affection from which he had been a sufferer; and, as a mark -of gratitude for the cure which he had effected, the Emperor raised -him<span class="pagenum" id="Page_130">[130]</span> to the rank of a noble (about the year 10 A. D.), erected a statue -in his honor in the temple of Aesculapius, and at the same time issued -a decree that from that time forward the physicians who practiced in -Rome should be exempted from taxation and from certain other civic -burdens. These privileges, which were afterward confirmed by Vespasian -(70–79 A. D.) and also by Antoninus Pius (138–161 A. D.),<a id="FNanchor_31" href="#Footnote_31" class="fnanchor">[31]</a> were of -great advantage to the medical profession as a whole. Julius Caesar -(100–44 B. C.), it will be remembered, had already (about half a -century earlier) bestowed Roman Citizenship upon the physicians who -practiced their profession in that city. Thus, at the time of which -we are now speaking, the medical men of Rome occupied the enviable -position of being on an equality with their fellow citizens of the -better class, a position which made it attractive for young men of -ability and of good social standing to enter the profession.</p> - -<p>Among the numerous followers of Asclepiades the most distinguished -was undoubtedly Themison of Laodicea, a city of Phrygia, Asia Minor, -who flourished about the middle of the first century B. C. When he -was well advanced in years he wrote a medical treatise in which he -developed a system of pathology and therapeutics that was accepted as -the professional creed of the sect known as “Methodists.” Starting -from the doctrine of pores and primitive atoms taught by Asclepiades, -he laid great stress upon the idea that in disease all the alterations -which take place in the tissues may be classed in one or the other of -these two categories—a relaxation (<i>laxum</i>) or a contraction -(<i>strictum</i>) of the parts. To these two categories, which the -Methodists termed “communities,” and which were the only ones at first -accepted as a part of their creed, a third was soon added, viz., that -condition in which both relaxed and contracted states appear side by -side, although not necessarily both of them developed to the same -degree;<span class="pagenum" id="Page_131">[131]</span> and to this third category or “community” they applied the -term “<i>mixtum</i>.” The ideas which are here stated in a somewhat -crude and imperfect manner owing to my lack of knowledge of all the -facts, constitute the basis of the pathology of the “Methodists”—a -pathology which held its own in the domain of medicine during a period -of four hundred years, and which—in contradistinction to the humoral -pathology of Hippocrates—is justly entitled to the name of “solidist -pathology.” This doctrine, as might be expected, underwent certain -modifications during this long period of time, but they were not -serious enough to alter materially the fundamental form of the teaching -as it has here been described.</p> - -<p>Themison and his followers, like their distinguished predecessor, -Asclepiades, possessed something more than a mere glimmering of the -truth in pathology as we know it to-day; and this idea suggests -the further thought that Morgagni, Rokitansky, Lebert, Virchow and -perhaps others whose names do not now occur to me, could scarcely have -developed a better pathology if they had lived during these first -centuries of the Christian era—a period of time when public sentiment -did not permit postmortem examinations, when Harvey’s discovery was not -even dreamed of, when the microscope was unknown, and when experimental -pathology was an impossibility. Many centuries had still to elapse -before medicine could gain that freedom of action, that rich equipment -of tools, and that stock of accumulated knowledge which enable her in -these days to make such giant strides forward as we have witnessed -during the past twenty or thirty years.</p> - -<p>The question will naturally arise, How did the Methodists decide, in -the presence of an actual case of illness, which one of these abnormal -states (the laxum, the strictum, or the mixtum) was the condition -that called for medical treatment? The answer which they gave to this -question was, that the condition of the different secretions and the -dejections furnished the principal indication as to what particular -part or organ of the body was ailing, and also as to what was the -nature of the morbid change or process<span class="pagenum" id="Page_132">[132]</span> that produced the malady. When, -for example, the secretion from an organ or part was excessive, they -inferred that the pores of such a part were relaxed and distended, -thus permitting an increased flow; and when the secretion was less -than it should be, they decided that the pores were contracted. The -<i>status mixtus</i> had reference to those cases in which a condition -of relaxation was observed in one part of the body, while that of -contraction was noted in another.</p> - -<p>Neuburger mentions the fact that the Methodists were somewhat arbitrary -in their classification of the different diseases, most of the acute -maladies being placed by them under the heading <i>Status strictus</i>, -while they assigned the majority of the chronic affections to the -category of <i>Status laxus</i>.</p> - -<p>The effect of the tendency of the Methodists to classify and simplify -all the departments of medicine was not wholly beneficial. It conveyed -to many the impression that medicine might readily be learned in the -course of a few months, and thus offered the temptation to inferior -men to choose the career of physician; and yet, on the other hand, -it infused into the art the essentially Roman characteristics of -orderliness, simplicity and efficiency. Anatomy, for example, was -studied only so far as a knowledge of this department of medicine was -necessary to render the physician familiar with the location, general -character and relations of the different organs. There was one field, -however, in which the adherents of this school displayed a high degree -of excellence, viz., in their descriptions of disease; and this is -especially true of those written by Caelius Aurelianus (fourth century -A. D.), whose manner of handling the subject of differential diagnosis -is far more thorough and satisfactory than that of any of the medical -authors who preceded him.</p> - -<p>In their treatment of disease, the Methodists were largely guided by -the principle of <i>contraria contrariis</i>,—<i>i.e.</i>, in those -cases in which, to the best of their belief, a <i>status laxus</i> -existed, they administered astringents, in the hope of thereby bringing -the parts back more nearly to a contracted condition; and, <i>vice -versa</i>, when the diagnosis<span class="pagenum" id="Page_133">[133]</span> of <i>status strictus</i> was made, they -gave a relaxing medicine. The terms “laxatives” and “astringents,” -which are still applied to many drugs, were originated by the -Methodists. Bloodletting, for example, was one of the remedies which -they used for producing relaxation, and an astringent was employed -when a contrary effect was desired. In the list of relaxing remedial -agents (aside from bloodletting) were placed the following: warm -baths, poultices, inunctions with warm oil, vapor baths, fasting and a -restricted diet, diuretics (very carefully watched and employed only in -exceptional cases), emetics, diaphoretics and laxatives. The following -agents, on the other hand, were classed as contracting, astringent and -tonic remedies: washing with cold water, cold baths, the application of -cloths dipped in cold water, living in cold air, strengthening diet, -wine, vinegar, alum, narcotics, etc. Themison, it should be added, is -the first one among the ancient writers to mention the use of leeches -as a means of extracting blood. It does not follow from this, however, -that he was the discoverer of this method of local bloodletting; for it -is highly probable that this procedure had been in common use for many -years previous to his time.</p> - -<p>Themison, as I have before stated, was an old man when he laid the -foundations for Methodism, and it is not probable that it attained -much importance as a sect until several years after his death. Then -Thessalus, a native of Tralles, a flourishing commercial city of Asia -Minor, and a man who had received his medical training in one of the -Greek schools, materially added to the body of doctrines held by this -sect, and at the same time rendered them more acceptable to physicians -generally. He was of humble birth, the son of a wool carder, and his -education had been rather neglected; but he nevertheless managed, by -his own efforts and in no small degree by the unlimited self-confidence -(Galen calls it impudence) which he possessed, to push his way to -the top of the ladder.<a id="FNanchor_32" href="#Footnote_32" class="fnanchor">[32]</a> He acquired a<span class="pagenum" id="Page_134">[134]</span> large fortune during the -reign of Nero (54–68 A. D.) and apparently succeeded in persuading -this monarch that he was a great physician. Here are some facts which -appear to justify Galen’s dislike for Thessalus: In a letter to Nero -the latter writes: “I have founded a new medical sect, the only -genuine one in existence. I was forced to do so because the physicians -who preceded me had failed to discover anything that is likely to -promote health or to drive away disease; even Hippocrates himself -having laid down doctrines which are positively harmful.” His vanity, -according to Le Clerc, reached such a pitch that he called himself the -“conqueror of physicians.”<a id="FNanchor_33" href="#Footnote_33" class="fnanchor">[33]</a> Pliny corroborates the latter statement -in the following words: “When he assumed the title of ‘conqueror of -physicians,’ a title which was engraved, according to his instructions, -on his tomb in the Appian Way.” Notwithstanding his unbounded conceit, -Thessalus appears to have made several important improvements in the -doctrines of the Methodists. He is also, as it appears, entitled to the -credit of having been the first to inaugurate the practice of giving -systematic instruction at the bedside; thus establishing for all time a -most valuable precedent for the guidance of his successors.</p> - -<div class="blockquot"> - -<p>“He was an excellent practitioner and an original thinker.... -He was also a prolific writer, as is shown by the number and -variety of treatises which—as we are assured by Caelius -Aurelianus—were composed by him.” The same authority speaks of -him as “a leader among our chiefs,” thus affording good evidence -of the degree of esteem in which he was held by the members -of his own school. The fact that pupils came in throngs to be -taught by him shows clearly how thoroughly he understood the -needs of the physicians of Rome. (Meyer-Steineg.)</p> -</div> - -<p>Thessalus, notwithstanding his declaration that medicine might readily -be taught in six months, wrote a larger number of treatises on -professional topics than any student of medicine could possibly read -and digest in the course of<span class="pagenum" id="Page_135">[135]</span> two or three years. They filled several -large volumes, but not one of them is known to exist to-day. He wrote -at great length, as we are assured, on the subject of surgery, a -subject in which he took an active interest. He taught that ulcers, no -matter in what part of the body they may be located, require the same -kind of treatment.</p> - -<div class="blockquot"> - -<p>If an ulcer is excavated, it is necessary to bring about a -filling-up of the excavation; if its surface is on a level with -the surrounding skin, the aim should be to make it cicatrize; -if the growth of new tissue is excessive, the redundant portion -should be destroyed by burning with caustic; and, finally, if -the ulcer is of recent development and bleeds readily, the -attempt should be made, by approximating the edges, to effect an -immediate healing.</p> -</div> - -<p>In the treatment of chronic ulcers which show little or no disposition -to heal, and which, when they do finally heal, are very prone to break -open afresh, Thessalus urges the great importance of ascertaining, if -possible, the cause or causes of this behavior. If it be found that -the trouble is due to some weakness or abnormal predisposition of -the part in which the ulcer is located, or that the condition of the -entire body is probably the real cause of the trouble, he recommends -the employment of “metasyncritic remedies”—that is, remedial measures -which effect a marked change in the individual’s vital processes -throughout the body, and also such as exert an alterative effect upon -the ulcer itself. Among the measures of the first class he enumerates -the following: Various forms of physical exercise; alternately -increasing and diminishing the amount of nourishment taken; and perhaps -the taking of an emetic at the very commencement of the treatment. -As to the second class of measures—those needed to bring about a -change in the ulcer itself—he makes the following recommendations: -Remove from the diseased tissues as much as will restore the parts, -as nearly as possible, to the condition of a healthy wound, and then -adopt the treatment suited for the latter condition. In cases in which -the ulcer heals and then subsequently breaks open again, it will<span class="pagenum" id="Page_136">[136]</span> -sometimes be found beneficial to apply in the neighborhood a plaster -containing an irritating substance like mustard, the effect of which -is often to change the disposition of the parts. In actual practice he -recommends that the local measures should be employed first, and then, -if they fail to accomplish the desired purpose, the physician should -have recourse to those enumerated in the first class—the strictly -metasyncritic remedies.</p> - -<p>It is rather difficult to believe that a man so full of conceit and so -unjust in his criticisms of his predecessors as Thessalus clearly was, -could be capable of formulating such a concise statement of the nature -of chronic ulcers and such a practical rule for their proper treatment. -His development of the idea of “metasyncrisis”—or renovation of the -body (<i>recorporatio</i>), as Caelius Aurelianus translates the -word—seems to have been original with Thessalus.<a id="FNanchor_34" href="#Footnote_34" class="fnanchor">[34]</a> The Methodists, -it should be added, deserve special credit for having been the first -to introduce and carry into effect the systematic treatment of chronic -diseases; and, as a general proposition, it may be said that their -treatment of all forms of disease was thoroughly practical, free from -all tendency to resort to magical methods, and based largely on the -employment of such hygienic measures as the use of baths of different -kinds (hydrotherapy), massage, moderate outdoor exercise, passive -movements, sea voyages, fasting, regulation of the diet, etc. One -of the favorite practices—of which Thessalus was said to have been -the originator—was to begin the treatment of almost all maladies by -prescribing an abstinence from all food for a period of three full -days. When I come to speak of Soranus and Caelius Aurelianus I shall -probably have occasion to give further details regarding the methods of -treatment employed by the Methodists.</p> - -<p>As a system, says Neuburger, Methodism was not capable of inaugurating -any fundamental advances in medicine; the most that it was able -to accomplish was to broaden and<span class="pagenum" id="Page_137">[137]</span> otherwise improve the domain of -therapeutics, and some of its wiser members were diligent in collecting -and sifting critically a large number of valuable experiences, which -were then courteously registered by them to the credit of the sect.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_138">[138]</span></p> - -<h3>CHAPTER XIII<br /> -<span class="subhed1">THE FURTHER HISTORY OF METHODISM AT ROME, AND THE DEVELOPMENT -OF TWO NEW SECTS, VIZ., THE PNEUMATISTS AND THE ECLECTICS.—A -GENERAL SURVEY OF THE SUBJECT OF SECTS IN MEDICINE</span></h3></div> - -<p>Among the Methodists there were many physicians who attained more -or less distinction during their professional career, but only two -of them, beside those whose contributions to medical knowledge have -already been mentioned in these pages, gained sufficient celebrity to -justify me in devoting some additional space to the description of the -work which they accomplished. Soranus, of Ephesus on the coast of Asia -Minor, and Caelius Aurelianus, of Sicca in the north of Africa, are the -physicians to whom I have reference.</p> - -<p>It was Soranus, says Le Clerc, who gave the finishing touches to -the system of the Methodists, and the work which he did was of such -excellence that he may with justice be called the ablest and most -skilful of all the members of that school. Caelius calls him “a chief -among the leaders of our sect.” He received his medical training at -Alexandria and came to Rome about the year 100 A. D. His professional -career covered the period corresponding to the reigns of Trajan and -Hadrian (98–138 A. D.). He is known to posterity chiefly through -his two treatises—one on obstetrics and gynaecology and the other -on acute and chronic diseases. The first of these treatises, in the -original Greek, was rediscovered in 1838 by Reinhold Dietz, Professor -of Medicine in the University of Königsberg,<span class="pagenum" id="Page_139">[139]</span> Prussia, and a German -translation of the work (by Lüneberg and Huber) was published in Munich -in 1894. Moschion, who was probably a pupil of Soranus, wrote a popular -treatise on the same subject for the use of midwives, and in this book -he has reproduced much of the material which is to be found in the work -of his master. The treatise written by Caelius Aurelianus on acute and -chronic diseases is admitted by him to be founded on that which Soranus -wrote on the same subject. In fact, as Daremberg states, the work of -the former represents almost a translation (into Latin) of Soranus’ -treatise. The sources just named are the principal ones from which our -knowledge of this author is derived.</p> - -<p>Soranus was a prolific writer; the treatises which he wrote and which -deal with a great variety of subjects, number thirty in all. The -majority of these works, however, have been lost. He had many followers -and his influence upon medical science was very great, not simply -during his lifetime, but also for several centuries after his death. -He commanded the respect and confidence of the opponents of Methodism -as well as of the members of his own sect. One of his most pronounced -traits of character was his readiness to condemn, on every possible -occasion, superstitious practices, such as the employment of amulets, -magnets, etc. He was also a very persistent and earnest advocate of -the gentler and more rational obstetric methods. For example, he -disapproved of the reckless employment of remedies for hastening the -expulsion of the foetus, of the practice of succussion (which was -carried out by the aid of a ladder), of making the pregnant woman run -up and down stairs, of a resort to rough mechanical procedures for -extracting the placenta, etc. The following quotation from one of -Soranus’ treatises (Gynaeciorum, Lib. I., cap. 19) reveals clearly what -sort of a man and physician he was:—</p> - -<div class="blockquot"> - -<p>There is a disagreement; for some reject destructive practices, -calling to witness Hippocrates, who says, “I will give nothing -whatever destructive” and deeming it the special province of -medicine to guard and preserve what nature generates. Another<span class="pagenum" id="Page_140">[140]</span> -party maintains the same view, but makes this distinction, -viz.: that the fruit of conception is not to be destroyed at -will because of adultery or of care for beauty, but is to be -destroyed to avert danger impending at parturition, if the -uterus be small and cannot subserve the perfecting of the fruit, -or have hard swellings and cracks at its mouth, or if some -similar condition prevail. This party says the same thing about -preventing conception, and with it I agree.</p> - -<p class="p-min r2">(Translated from the Greek by the late John G. Curtis, M.D., of -New York.)</p> -</div> - -<p>Soranus was not only a great obstetrician,—admitted by all the -authorities to have been the greatest in ancient times,—he was also -in high repute for the work which he did in other departments of -medicine—in gynaecology, for example, in the instruction of midwives, -in the management of children’s diseases, in the diagnosis and -treatment of both acute and chronic diseases, in surgery, etc. While in -general he adhered to the fundamental teachings of the Methodists, he -did not hesitate to depart from the beaten pathway of that sect in his -explanations of certain pathological conditions; for he was more of a -clinical observer than a sectarian, and it was probably his independent -manner of thinking that gave the sect new vigor and thus enabled it to -live on through such a long period of time. Galen, who was not at all -disposed to speak favorably of the Methodists, says that he tried a -number of the remedies recommended by Soranus and found them good.</p> - -<p>Caelius Aurelianus probably flourished during the third century A. D. -The different authorities, however, do not agree as to the limits of -the period during which he lived; some saying that his career antedated -that of Galen, while others claim that he came upon the scene after -the death of the latter, which occurred early in the third century A. -D. His chief merit appears to have been that, through his translation -of the writings of Soranus into Latin, he placed within reach of the -physicians of Rome the teachings of that admirable diagnostician and -therapeutist; for it must be remembered that the great majority of the -Roman<span class="pagenum" id="Page_141">[141]</span> medical men were not able to read Greek. On the other hand, -Caelius Aurelianus, who was himself a thoroughly practical physician, -deserves considerable credit for having enriched the text of his book -with many very appropriate examples (chiefly with regard to questions -of diagnosis) drawn from his own personal experience, which must -have been extensive. During the Middle Ages, as we are informed by -Friedlaender, this work furnished the chief source from which the monks -derived their knowledge about diseases and their proper treatment. -The Latin in which the book is written is described by nearly all the -authorities as barbaric.</p> - -<p><i>The Pneumatists.</i>—Methodism had been established only a very -few years when Athenaeus of Attalia, a city on the coast of Pamphylia, -Asia Minor, founded (about 50 A. D.) a new sect—that of “Pneumatism.” -He was not the discoverer of the “pneuma” or “vital spirit,” for that -had already been admitted by the earlier schools of philosophy as a -fifth primary creative element, supplementary to the four well-known -substances—fire, air, earth and water. He believed that heat, cold, -moisture and dryness (the primary qualities of these four bodies) -were not the veritable elements of living beings. Heat and cold, he -maintained, were “efficient causes” and moisture and dryness “material -causes.” To these he added “spirit” as a fifth element; and he taught -that this spirit enters into the formation of all bodies and preserves -them in what may be termed their natural state. It was from the -Stoics, more particularly, that Athenaeus borrowed this belief, and -it was the latter fact, as Le Clerc says, which led Galen to speak of -Chrysippus—one of the most famous of the Stoics—as “the Father of the -Sect of the Pneumatists.”</p> - -<p>In his application of the doctrine of Pneumatism to the science of -medicine, Athenaeus maintained that the majority of diseases owed their -origin to some disturbance or disorder of the spirit; but it is almost -impossible to understand, from the scanty data which have come down -to us, what Athenaeus really meant by the term “spirit,” and by the -expression “disorder of the spirit.”</p> - -<p><span class="pagenum" id="Page_142">[142]</span></p> - -<div class="blockquot"> - -<p>From the definition which he gives of the word “pulse” one -is justified in drawing the conclusion that he considered -the spirit to be an actual substance, capable of undergoing, -to a greater or less degree, such changes as expansion and -contraction. The same obscurity of meaning is encountered when -one endeavors to discover how the new doctrine affected the -practice of medicine. (Le Clerc.)</p> -</div> - -<p>In view of all these circumstances it is not at all surprising that -Pneumatism was not very popular with the physicians of Rome, and -that, after a brief period had elapsed, many of the adherents of -this doctrine abandoned it and gave their preference to the more -practical teachings of the Methodists. Meyer-Steineg goes so far as to -remark that, to all intents and purposes, such a thing as a sect of -Pneumatists did not exist.</p> - -<p>The most prominent of the disciples of Athenaeus were Theodorus, -Agathinus, Herodotus, Magnus and Archigenes.</p> - -<p>Haller speaks of Theodorus as the inventor of a remedy which, as he -claimed, cures all cases of poisoning.</p> - -<p><i>The Eclectics.</i>—Agathinus, a native of Sparta, was the teacher -of Herodotus and Archigenes. His chief distinction is to be found -in the fact that he gave to the offshoot from the school of the -Pneumatists the name of “Eclectics,”<a id="FNanchor_35" href="#Footnote_35" class="fnanchor">[35]</a> his object being, as we are -assured by Neuburger, to bring the three sects (Pneumatists, Empirics -and Methodists) into closer union.</p> - -<p>Herodotus—who, it is perhaps desirable to state, is a different person -from the famous historical writer of the same name—lived during the -latter part of the first century A. D., and was more closely allied to -the Methodists than to the Pneumatists. It appears from the text of a -fragment of one of his treatises that he wrote a description of the -disease now called small-pox and directed attention to its contagious -character.</p> - -<p>Magnus, a native of Ephesus in Asia Minor, is reported<span class="pagenum" id="Page_143">[143]</span> to have been -the writer of a collection of letters on medical topics and also of a -history of the discoveries made in medicine subsequently to the time of -Themison.</p> - -<p>Archigenes, the fifth member of this group of Pneumatists, was born -in Apamea, Syria, and lived in Rome under the reigns of Trajan -(98–117 A. D.) and Hadrian (117–138 A. D.). Le Clerc speaks of him as -belonging to the Eclectics rather than to the Pneumatists. This is -a matter, however, of small importance, as the sects were, at that -period, very much mixed. The poet Juvenal, who was a contemporary -of Archigenes, refers to him briefly as a physician who had a large -practice; and the historian Suidas says that he wrote a great deal -about physics as well as about medicine. That he was esteemed highly -as an authority in practical surgery is shown by the fact that Galen, -when he discusses surgical topics, makes frequent quotations from -the writings of Archigenes. Only fragments of the latter, however, -have come down to our time. His popularity as a practitioner was very -great; notwithstanding which he managed to write several treatises -on a variety of topics—on the pulse, on feverish diseases, on the -different types of fevers, on local affections, on the diagnosis and -treatment of acute and chronic maladies, on the right moment when -surgical operations should be performed, on drugs, and on therapeutic -procedures in general. He applied ligatures to blood-vessels and also -arrested further bleeding from them by passing needles through the -adjacent parts in such a manner as to exert pressure upon the vessel (a -procedure which is termed “acupressure”); he operated for the removal -of both mammary and uterine cancers; he employed the red-hot cautery -iron for the arrest of hemorrhage and also for the relief of coxalgia, -and he was familiar with the use of the vaginal speculum.</p> - -<p>Antyllus, another prominent surgeon of that period, joined the -Methodists at a considerably later date. He was also the author -of an excellent treatise on surgery, the greater part of which, -unfortunately, has been lost or destroyed.</p> - -<p><span class="pagenum" id="Page_144">[144]</span></p> - -<p>Aretaeus of Cappadocia, a district of Asia Minor, lived during the -second century A. D. He was a man of very broad culture. From the -fact that he assigned an important rôle to the pneuma, he is usually -classed among the Pneumatists. He does not appear, however, to have -taken a very active interest in the doctrines of that school, and both -Le Clerc and Daremberg seem disposed to call him an Eclectic, and we -may therefore rank him as one of the independent physicians of that -period. It is doubtful whether he ever practiced in Rome. His two -treatises—one on the causes and means of identifying acute and chronic -diseases, and the other on the treatment of these diseases—are written -in Greek, and are characterized by the clearness and simplicity of his -descriptions, which very closely resemble those of Hippocrates, and by -the soundness of the advice which he gives in regard to the methods -of treatment.<a id="FNanchor_36" href="#Footnote_36" class="fnanchor">[36]</a> In his conceptions of what a physician should aim -to be, Aretaeus maintained a very high standard. Some of his views -regarding human physiology and pathology are given here very briefly: -Respiration serves the purpose of cooling the warmth of the heart, and -the lungs are therefore prompted by the latter organ to draw cool air -into their cavities; digestion takes place not only in the stomach -but also in the intestinal canal, and owes its origin to warmth; the -cerebral nerves, close to the spot from which they originate, cross -from one side to the other, and by the aid of this fact paralysis on -one side of the body may be explained. Aretaeus has gained considerable -fame, says Puschmann, from his description of the “Syriac ulcer,” the -picture of which he draws agreeing perfectly with what is known to-day -as pharyngeal diphtheria. In various places throughout his writings -he displays a thorough knowledge of normal anatomy—as, for example, -when he describes the ramifications of the vena portae and gall-ducts -of the liver. He was also well informed in matters belonging to the -domain of pathology, for he gives<span class="pagenum" id="Page_145">[145]</span> admirable descriptions of many of -the diseases—for example, pleurisy with empyema, pneumonia, pulmonary -consumption, cerebral apoplexy, paraplegia, tetanus, epilepsy, diabetes -mellitus, gout, etc. From the character of these descriptions one is -strongly tempted to believe that he must have made a certain number of -postmortem examinations.</p> - -<p>According to Neuburger, Aretaeus enters very fully into details -when he discusses the subject of diagnosis; his statements in one -place warranting the belief that he even auscultated the heart. His -methods of treatment were based largely upon his own experience and -were generally of a simple character. He attached great importance, -for example, to a very careful regulation of the diet, muscular -exercise, massage, etc., and his employment of remedies was confined -to a very small number of such drugs as exert a mild action. When the -case, however, was of such a character as to call for more vigorous -interference, he did not hesitate to resort to the use of opium, -emetics, cathartics, venesection, blistering, the red-hot cautery iron, -etc.</p> - -<p>Rufus, a native of Ephesus, a city of Asia Minor, about thirty-five -miles from Smyrna, is reckoned by most authorities among the Eclectics; -in other words, he was an independent, or one who adopted from the -teachings of the different sects such doctrines as met with his -approval, but who, at the same time, did not care to pose as the -disciple of any one of them. He received his medical training at -Alexandria, but it is not known where he practiced his profession. -Almost no details concerning his life or his professional career have -come down to our time. It is simply known that he flourished during -the reign of the Emperor Trajan (98–117 A. D.). Ebn Ali, an Arabian -physician and author, says that he was the leading medical authority -of his time and that his works were highly esteemed by Galen. His -treatise on anatomy (entitled “The Names of the Different Parts of the -Human Body”), which is one of the few that have escaped destruction, -is described as a treatise which was written for students, and<span class="pagenum" id="Page_146">[146]</span> which -possesses great value for the history of anatomical nomenclature. The -same authority says that Rufus was the first to describe the chiasma, -that he came very near establishing the existence of two different -kinds of nerves—motor and sensory—and that he attributed the control -of all bodily functions to the nervous system. He also states that he -was one of the first to furnish a description of the oriental bubonic -plague. Some idea of Rufus’ style of writing may be gathered from the -following quotations which have been taken from his short treatise -entitled “The Questioning of Patients”:—<a id="FNanchor_37" href="#Footnote_37" class="fnanchor">[37]</a></p> - -<div class="blockquot"> - -<p>It is necessary to question the patient, for by so doing one -may gather more exact information concerning the nature of the -malady, and will then be able to treat it more intelligently. -In this way also one may learn whether the patient’s mind is -in a normal or an excited state, and whether any change has -taken place in his physical strength. Some idea regarding the -nature and seat of the disease is usually obtained from such -questioning. If, for example, the patient answers clearly and to -the point, and does not hesitate; if his memory does not play -him false; if his speech is not thick or indistinct; if, being a -well-bred man, he gives his responses in a polite and cultivated -manner; or if, in the case of a person who is naturally timid, -the answers reflect this timidity, then you may feel confident -that your patient’s mind is not affected. But if, on the other -hand, you ask him about one thing and he gives you a reply about -something entirely different; if, as he talks, he appears to -forget what he was talking about; if he has a trembling tongue -the movements of which are also uncertain; and, finally, if from -a certain state of mind he passes rapidly to one of a totally -different character,—all these changes are evidences that the -brain is beginning to be affected.... If the patient speaks -distinctly and with a fairly strong voice, and is able to tell -his story without stopping from time to time in order to rest, -the inference is warranted that his physical strength is not -materially affected....</p> -</div> - -<p>The following quotation is from his treatise on gout:—</p> - -<div class="blockquot"> - -<p>If the patient complains that one of his joints is painful, he -should be asked whether or not the part has received a blow. If<span class="pagenum" id="Page_147">[147]</span> -he replies that it has not, then (you may infer that the pain -is due to gout and) you should forthwith put him on a suitable -diet, order a clyster and bleed him at a spot not far (from the -seat of the pain).... The withdrawal of nourishment is ordered -for the purpose of arresting any further formation of new blood -and thus preventing the joints from growing more sluggish in -their movements. The clyster is ordered because we believe that -it is beneficial (in this condition) to evacuate the bowels. -The bleeding will be found useful, but to a less degree in -the lower than in the upper limbs.... One must be careful not -to assume that the patient is cured when he has been entirely -relieved of his pain, because with the lapse of time fresh -attacks are liable to occur; this disease, like certain other -affections, possesses a periodic character.... Therefore it is -well, immediately after the bloodletting, to employ friction, to -get rid of the excess of moisture in the body by some laborious -form of exercise, to take such articles of food as are easily -digested,—in brief, to aim chiefly at reducing as much as -possible the moisture of the body.</p> -</div> - -<p>One cannot but feel a keen regret that so few of the writings of this -thoroughly practical and highly educated physician should have come -down to our time. So far as I am able to learn, Rufus wrote no fewer -than 102 treatises, all of which, with the exception of the seven -about to be mentioned (together with a number of fragments preserved -by different writers of antiquity) have either disappeared or been -destroyed. The titles of the treatises which have been preserved are as -follows: (1) Diseases of the Kidneys and Bladder; (2) On Satyriasis and -Gonorrhoea; (3) Purgatives; (4) The Names of the Different Parts of the -Human Body; (5) On the Questioning of Patients; (6) On the Pulse; (7) -On Gout.</p> - -<p><i>A General Survey of the Subject of Sects in Medicine.</i>—During -the sixth century B. C.,—that is, about two hundred years before -the formation of the more distinctly medical sects of which mention -was made in Chapter IX.,—Pythagoras of Samos and his disciples put -forward certain beliefs or doctrines with regard to the mode of -action of some of the functions or vital processes of the human body, -and all those who accepted these teachings as affording a true and -satisfactory explanation of the<span class="pagenum" id="Page_148">[148]</span> phenomena in question constituted what -is generally termed a school or sect. Some of these individuals were -physicians—that is, men who undertook to cure or at least to relieve -those who were ill; but probably the majority were simply philosophers, -mere “lovers of wisdom,” who by studying problems of this nature sought -to satisfy their longing for a more perfect knowledge of the truth -respecting the various phenomena of life.</p> - -<p>A few years later, Heraclitus of Ephesus, who, like Pythagoras, was -both a philosopher and a practicing physician, taught the doctrine that -all things owe their origin to fire. One is not at all surprised to -learn that he had relatively few followers, for history tells us that -he was both a misanthrope and a slanderer of the medical profession, -as shown by the following saying which is attributed to him: “Next to -physicians the grammarians are the biggest fools in the world.”</p> - -<p>Hippocrates attached much importance to the value of experience and -to the necessity of studying disease at the bedside; at the same time -he upheld what is commonly known by the name of humoral pathology—a -doctrine which refers all maladies to some abnormal change in the -humors or fluid portions of the body. His writings also show that he -made full use of the reasoning power. The followers of this great -physician did not form a sect in the ordinary sense of the term; they -were his adherents simply because he was an able diagnostician, a -successful teacher, an excellent therapeutist, a skilful surgeon, a man -of very high moral character,—in short, a great physician. Every sect -which developed in the centuries following his death contained a goodly -proportion of Hippocratists.</p> - -<p>Nearly two centuries after the active period of the professional life -of Hippocrates, Erasistratus and Herophilus gathered about themselves -in Alexandria (about 280 B. C.) large groups of followers, who held for -their respective teachers a degree of esteem which amounted, according -to Galen, almost to veneration. As there was little or no antagonism -or lack of harmony between the doctrines taught by these physicians, -the two groups cannot<span class="pagenum" id="Page_149">[149]</span> properly be classified among the sects. In -fact, it would be more correct to say that Erasistratus and Herophilus -contributed facts of permanent value to our stock of knowledge rather -than doctrines which might prove highly popular for a few scores of -years, but which would probably in due course of time be set aside as -no longer of value.</p> - -<p>The four most characteristic types of sects in medicine were the -following: the Dogmatists—or Rationalists, as Daremberg calls them -in one place; their great rivals, the Empirics; the Methodists; and -the Eclectics. The oldest sect, the Dogmatists, did not come into -prominence until after the medical schools at Alexandria had already -been in operation for a long time. The development of the rival sect of -the Empirics at this late period brought with it endless discussions -regarding the merits of their respective teachings, and thus both of -them gained a degree of prominence which seems to us moderns to have -been out of all proportion to the importance of the subject-matters -discussed. The Dogmatists, says one writer, insisted that it is just as -necessary to be acquainted with the “hidden causes” of disease as with -those which are plainly recognizable, and that it is only by aid of the -reasoning power that we gain some knowledge of this class of causes. -They claimed that, while a knowledge of anatomy is of very great -service to the surgeon, it usually renders this service through the aid -of the reasoning power; as when, in the performance of a lithotomy, the -operator selects the fleshy (<i>i.e.</i>, vascular) neck of the bladder -as the spot in which to make the opening with the knife, in preference -to the base of the organ, which is chiefly membranous in structure and -therefore less likely to heal solidly.</p> - -<p>The plausible but rather shallow response made by the Empirics to -the arguments advanced by their rivals consisted in quoting certain -maxims, as, for example: “The farmer and the helmsman do not acquire -knowledge of their respective occupations from discussions, but from -actual practice”; “It is not of vital importance to know what are the -causes of the different diseases, but what<span class="pagenum" id="Page_150">[150]</span> remedies are competent to -cure them”; and “Diseases are not cured by eloquence, but by remedial -agents.”</p> - -<p>Among the comments made by Celsus with regard to the differences which -distinguished the Dogmatists from the Empirics we find the following -statement: “The two sects employed the same remedies and pursued very -much the same course of treatment, but their reasonings about such -matters were different.”</p> - -<p>Modern physicians will, at first thought, be disposed to wonder how men -as clever as many of these physicians were could have split up into -separate and more or less antagonistic sects because of such apparently -trivial differences of opinion. It must be remembered, however, that -these men were groping in comparative darkness whenever they tried to -advance their knowledge of pathology, and that in this imperfect light -many things seemed of much greater importance than they appeared to be -in the brighter light of later centuries. It is only fair, therefore, -to withhold criticism and to ask ourselves whether this strong desire -on the part of those men to advance their knowledge of pathology—a -desire which manifested itself in the formation of sects—was not in -reality an evidence of the great vitality of Greek medicine on Roman -soil in those early centuries.</p> - -<p>The remarks made above with regard to the Dogmatists and the Empirics -apply in a general manner to the sects known as the Methodists and the -Eclectics, a sufficiently full account of which has been given in the -preceding chapter.<a id="FNanchor_38" href="#Footnote_38" class="fnanchor">[38]</a></p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_151">[151]</span></p> - -<h3>CHAPTER XIV<br /> -<span class="subhed1">WELL-KNOWN MEDICAL AUTHORS OF THE EARLY CENTURIES OF THE CHRISTIAN ERA</span></h3></div> - -<p>There were four men who were not especially identified with any of the -sects described in the preceding chapters, and yet who occupied, as -authors of medical treatises, very prominent places in the history of -medicine of the period or epoch which we have just been considering. -They are Celsus, Scribonius Largus, Pliny the Elder and Dioscorides. -These men lived during the first and second centuries A. D. and they -therefore all belong strictly to the period which is designated in our -scheme as the fourth epoch. I shall give here brief sketches of all of -these writers and of their works. While Caelius Aurelianus, another -important medical author, belonged to a much later period, I shall, for -reasons of convenience, describe in the same chapter with the others -the part which he played in the evolution of medicine.</p> - -<p>Aulus Cornelius Celsus, called by some the Latin Hippocrates and by -others the Cicero of physicians because of the correctness and elegance -of his Latin and the clear manner in which he puts his thoughts into -words, flourished during the reign of the Emperor Augustus (27 B. -C.-14 A. D.). The date and place of his birth are not known, but it is -generally believed that he was born and received his education at Rome. -The great work which he wrote and upon which he must have been engaged -the larger part of his lifetime was a sort of cyclopaedia, which -bore the title “<i>Artium libri</i>,” and in which each department -of knowledge was represented by a separate treatise. It is said that -five books were devoted to agriculture, seven to rhetoric, eight to -medicine, etc.; but all of these treatises,<span class="pagenum" id="Page_152">[152]</span> excepting those relating -to the latter science, have been lost or destroyed. It is not certainly -known to which of the professions Celsus belonged, but the very skilful -and judicious manner in which he has culled all that is best from the -medical treatises published before his time, the remarkable knowledge -of technical details which he displays in every part of his own work, -and the fine tone of medical thought which pervades these eight -books, almost compel the conclusion that the author was a very clever -clinician, although probably not a physician who practiced for a money -reward. In no other published treatise is a more perfect picture of the -medical practice of antiquity to be found than that which Celsus gives -us in his work “<i>De arte medica libri octo</i>.”</p> - -<p>It is not an easy matter to select, from a treatise of several hundred -pages in length, one or two passages of such a character that they may -be accepted as fairly representing the author’s manner of dealing with -medical and surgical questions of practical interest. The two given -below are translations from Védrènes’ version (Paris, 1876), and they -deal, the one with venesection and the other with the proper manner of -arresting hemorrhage from a wound. Both the passages quoted represent -only fragments, as sufficient space for more extensive extracts is not -available.</p> - -<div class="blockquot"> - -<p><i>Book II., Chapter X.</i>—<i>Bloodletting from a -Vein.</i>—Incising a vein for the purpose of drawing blood from -it, is not a new procedure; but it is certainly a new thing to -resort to bloodletting in almost all diseases. Again, it is an -ancient custom to employ bloodletting in young subjects and in -women who are not pregnant, but it is a new thing to perform -this operation on infants and aged individuals, and on women -approaching the period of confinement. It was the idea of the -ancients that persons at the two extremes of life were not able -to support this sort of treatment, and they were convinced that -a pregnant woman, if subjected to the operation of bloodletting, -would almost surely be confined before the completion of her -time. Since then, however, experience has shown that there is -no fixed rule about this matter, and that a physician should -preferably regulate his course in accordance with observations -of a different nature. The determining factor,<span class="pagenum" id="Page_153">[153]</span> for instance, -is neither the age nor the pregnant state of the patient, but -rather the degree of physical strength. In the case of a youth -who is feeble, or of a delicate woman (aside from the question -of pregnancy), it would be wrong to draw blood, for it would be -robbing them of what little strength they possessed. But, in the -case of a vigorous child, a robust old man, or a pregnant woman -who is in good health, one need not hesitate to resort to this -procedure. Nevertheless, there may arise, in connection with the -operation of venesection, a number of questions which are quite -likely to puzzle an inexperienced physician and perhaps lead him -into error. For example, infants and old people possess as a -rule diminished vigor, and the woman who is about to be confined -needs all her strength for the period following delivery, both -for herself and for the nourishing of the child. But the mere -fact that one must give some thought to questions of this nature -and must exercise prudence does not justify the immediate -rejection of a method of treatment like that of venesection. For -is it not the very essence of our art, not merely to consider -the factors of age and the pregnant state, but also to form an -estimate of that other and more important factor, viz., the -patient’s strength,—be that patient an infant, an aged person, -or a woman advanced in pregnancy,—and then to decide whether -it is, or is not, great enough to bear the loss of blood? -In deciding a question of this kind it will be necessary to -distinguish between real vigor and obesity, between thinness and -feebleness, etc.</p> - -<hr class="tb" /> - -<p>Venesection is an easy operation for a physician who has already -familiarized himself with the manner of performing it, but -for one who is ignorant of these details it may prove very -difficult. It is necessary, for example, to bear in mind that -the artery and vein are united and that they are accompanied -by nerves; and, further, that the injuring of the latter -will induce spasms and violent pains. On the other hand, it -must also not be forgotten that an artery once opened has no -disposition to close, nor does it heal, and that sometimes the -blood escapes in an impetuous manner. If, perchance, the vein -is cut transversely, the edges of the opening contract and no -more blood escapes. Again, if the scalpel is plunged into the -parts timidly, the skin alone will be divided and the vein will -not be opened. In some cases this vessel is so hidden from -sight that the physician may experience difficulty in bringing -it into view. Thus it will be seen that there are several -circumstances which may render this operation difficult for an -ignorant or inexperienced<span class="pagenum" id="Page_154">[154]</span> physician. The vein should be incised -in a longitudinal direction, midway between its two sides. The -moment the blood gushes from the opening its color and general -appearance should be carefully noted, etc.</p> - -<p><i>Book V., Chapter XXVI.</i>—<i>The Proper Manner of Arresting -Hemorrhage from a Wound.</i>—If there is fear that there -may be bleeding, one should fill the wound with dry lint, -place over it a sponge wrung out of cold water, and press -upon it with the hand. If the bleeding still continues, it is -advisable to change the stuffing of lint somewhat frequently; -and, if this step proves ineffective, then lint moistened with -vinegar may be tried, for this liquid acts energetically in -arresting hemorrhage. Some physicians, indeed, actually pour -it into the wound. There is a strong objection, however, to -the use of an agent which, like vinegar, arrests the bleeding -too completely—viz., that it is apt to set up afterwards an -intense inflammation of the parts. The same reasoning applies -with even greater force to the employment of corrosives and -caustics, which produce an eschar. Despite the effectiveness -of most of these in arresting hemorrhage, their use should be -discouraged.... Finally, if the bleeding continues it will be -necessary to grasp the vessel from which the blood is escaping, -to ligature it in two places close to the wound, and then to -divide the vessel between the two ligatures, in order that -it may retract (both of the new orifices having already been -closed by the ligatures). If the circumstances are such that the -plan just recommended cannot be carried out, it will then be -advisable to apply the red-hot cautery to the bleeding vessel. -When a rather free hemorrhage occurs at a part of the body where -there are no nerve trunks and no muscles,—as on the forehead or -at the top of the head,—the simplest plan is to apply a cup at -some little distance from the source of the bleeding and thus -divert the current of the blood from the spot affected.</p> -</div> - -<p>And to these two longer extracts may be added a third:—</p> - -<div class="blockquot"> - -<p>From these considerations the inference is warranted that a -physician cannot possibly give proper attention to a large -number of patients. (Book III., Chapter IV.)</p> -</div> - -<p>Celsus’ treatise was ignored by physicians for many centuries, but -it was considered by the monks, in the Middle Ages, a valuable -guide in the treatment of disease; and it was probably owing to -this circumstance, says Védrènes,<span class="pagenum" id="Page_155">[155]</span> that the book did not altogether -disappear. It was not until the year 1443 that Thomas de Sazanne, -afterward Pope Nicholas V., discovered a copy of the work in the church -of Saint Ambrosius, at Milan, but it was only in 1478 that the book was -printed for the first time (at Florence). Then, as if to make up for -the long neglect to which it had been subjected, no fewer than sixty -Latin editions were issued during the two succeeding centuries; and, -in addition, it was eventually translated into every modern European -language.</p> - -<p>Scribonius Largus, a Roman physician who lived during the reigns -of Tiberius and Claudius (14–54 A. D.), owes his celebrity to the -fact that he wrote and published (in 47 A. D.) a book containing a -collection of the best medical formulae and popular recipes known at -that time. He appears to have had a large private practice and to have -spent a considerable portion of his professional life in the service -of the army. He accompanied the Emperor Claudius, for example, in his -campaign against Britain (43 A. D.), and the book which he wrote, and -which has just been mentioned, was dedicated by him to that emperor. -According to Neuburger, Scribonius is to be credited with having been -the first to describe correctly the proper manner of obtaining the drug -known as opium, and also the first to recommend, in the treatment of -severe headaches, the employment of electric shocks as communicated by -the fish called the “electric ray.”</p> - -<p>Medical practice at that period, says Le Clerc, was divided among three -kinds of practitioners—those who treated their cases exclusively by -dietetic measures, those who effected cures by surgical means, and -those who took charge only of such patients as required chiefly the -employment of external remedies. But Scribonius Largus insists that -such a division was more theoretical than real, as no one of these -classes could get along without the cooperation of the others.</p> - -<p>C. Plinius Secundus, commonly called Pliny the Elder, was born near the -beginning of the first century of the Christian era, either at Verona -or at Como in the north<span class="pagenum" id="Page_156">[156]</span> of Italy, and settled in Rome at an early -period of his life. At the beginning of his career he served for some -time in the army in Germany, and upon his return to Rome practiced as -a pleader. Subsequently he held various official positions which gave -him the opportunity of visiting other countries of Europe. He perished -at Stabiae (near the modern Castellamare, on the Gulf of Naples) in 79 -A. D., at the age of fifty-six years, while watching the eruption of -Vesuvius, which overwhelmed Herculaneum and Pompeii. He was in command -of the Roman fleet at the time.</p> - -<p>Pliny was indefatigable as a writer and as a gatherer of knowledge of -all sorts, and he and Celsus are well named the Encyclopaedists. He -is said to have written twenty books on the war with the Germans, an -unknown number on rhetoric and grammar, and thirty-seven on natural -history. The latter books alone have come down to our time. Pliny’s -nephew, who is known as Pliny the Younger, and who edited the great -work of his uncle on natural history, furnishes us, in a letter -addressed to the historian Tacitus, with some interesting details -regarding the elder Pliny’s manner of life. It appears from this -account, that the latter read almost incessantly. During his meals and -while he was taking his bath, an attendant read aloud to him. He also -took his books with him on his travels and was always accompanied by -a person who could write rapidly under dictation. He continued this -practice upon his return to Rome and dictated to his amanuensis even -while he was being carried about in a sedan chair. Books 20–27 of his -great work on natural history are devoted to the subject of remedial -agents belonging to the vegetable kingdom, books 28–32 deal with those -which belong to the animal kingdom, and books 33–37 treat of mineralogy -with special reference to medicine, painting and sculpture. Pliny was a -compiler and not an original investigator. Some idea of the popularity -of his treatise on natural history may be gathered from the fact that -it was the second book to be printed after the invention of printing, -the Bible being the first. Another interesting fact connected with -Pliny’s treatise is mentioned by Neuburger, viz., that the<span class="pagenum" id="Page_157">[157]</span> use of -hyoscyamus and belladonna as agents capable of dilating the pupils, -owed its origin to the discovery (by C. Himly, in 1800) of a place in -the text (Book XXV., 92) where it is stated that the juice of the plant -Anagallis was rubbed into the eyes before the operation for cataract -was undertaken.</p> - -<p>According to Pliny (Book XXXI., Chapter VI.), the ancients employed -mineral waters extensively in the form of baths, and they also -occasionally used them as internal remedies. Galen, too, mentions the -fact that these waters were in demand in the spring or autumn for -purgative purposes.</p> - -<p>In Book XXXIX., 8, 3, Pliny—as quoted by Védrènes—makes the following -remarks:—</p> - -<div class="blockquot"> - -<p>Very few Romans have shown an active interest in medical -affairs, and those few speedily found it necessary to pass -themselves off as Greeks. For it is a well-known fact that those -physicians who, without being able to speak Greek, attempted to -build up a practice in Rome, failed to gain the confidence of -their patients, even of those who were not at all familiar with -that language.... When one’s health is the question at issue the -readiness to place confidence in a medical adviser is apt to -diminish in proportion as one’s knowledge of the man increases. -Indeed, medicine is the only art in which one is quite ready -at first to put faith in almost anybody who calls himself a -physician, and that too, despite the acknowledged fact that in -no other circumstances of life is an imposture more fraught with -danger.</p> -</div> - -<p>English versions of Pliny’s Natural History and of Pliny the Younger’s -Letters have been published in what is known as Bohn’s Libraries.</p> - -<p>Pedanius Dioscorides, a native of Anazarba, a small Greek town near -Tarsus in Cilicia, lived about the middle of the first century A. D. -(during the reigns of Nero and Vespasian). From his earliest youth he -took a great interest in botany, and, after reaching manhood, traveled -extensively in the wake of different Roman armies, for the sole purpose -of studying by direct observation the plants of different countries -and of verifying the medicinal virtues which each one was reputed to -possess. In this<span class="pagenum" id="Page_158">[158]</span> way he visited, in turn, Greece, Italy, Asia Minor -and perhaps also the southern portion of France (the Narbonaise). He -collected great quantities of specimens of every kind of drug—animal -and mineral substances as well as objects belonging to the vegetable -kingdom; and, wherever it was possible to do so, he wrote memoranda of -the traditions of the natives with regard to the uses and medicinal -effects of these different drugs. After he had completed all these -researches and had gathered together all this vast mass of materials, -he wrote his famous treatise on materia medica—“the most complete, -the best considered, and the most useful work of its kind to be found -anywhere to-day.” (Galen.) It is from this treatise, therefore, says -Dezeimeris, that one can derive the most satisfactory idea of the -early Greek materia medica; but at the same time, he adds, it is not -a book in which will be found a detailed account of the manner in -which the practitioners of that period employed the remedies which he -describes. The same authority calls attention to the great difficulty -which modern physicians often experience in their attempts to identify -the drugs which Dioscorides describes. Le Clerc calls attention to -the fact that the physicians who were contemporaries of Dioscorides -were not in the habit of employing either iron or antimony (called by -them <i>stibium</i>) internally. Apparently they had not yet learned -that these substances possess properties which exert a curative action -in certain diseases. On the other hand, he mentions the manner of -extracting quicksilver, by chemical means, from cinnabar [red sulphide -of mercury], the steps required for preparing acetate of lead, and the -proper way of making lime water.</p> - -<p>The work to which reference has been made above was published by -Dioscorides about the year 77 A. D. It is the earliest pharmacological -treatise that has come down to our time, and for many succeeding -centuries it served as the authoritative guide in all questions -relating to drugs. The first printed edition of the Greek original -appeared in Venice in 1499, but a still earlier Latin version was -issued in 1478. According to Pagel the best edition (in Latin and<span class="pagenum" id="Page_159">[159]</span> -fully illustrated) is that of Pietro Andrea Mattioli, which was printed -in Venice in 1554. Neuburger commends highly the German version by J. -Berendes. (Stuttgart, 1902.)</p> - -<p>Of Caelius Aurelianus we possess no biographical details beyond the -facts that he was a native of Sicca in Numidia, Africa, and that he -lived toward the end of the fourth or during the first part of the -fifth century of the present era. He was the author of several works, -all but one of which, however, have been lost. The single treatise -which has come down to our time treats of acute and chronic diseases, -and is spoken of by Daremberg as being virtually a translation of -one of the lost writings of Soranus. This book, says Haeser in his -History of Medicine, is the most important source from which our -knowledge of Methodism is derived; and Neuburger not only agrees with -this statement, but adds that the treatise of Caelius Aurelianus -played a most important part, toward the end of the Middle Ages, in -the evolution of medicine. Up to the present time no translation of -this work into any modern language has been published, but Neuburger -furnishes a very full analysis of its important parts. In two places, -as appears from this analysis, Caelius Aurelianus mentions—among -the signs and symptoms of certain affections of the respiratory -apparatus—phenomena which show beyond a doubt that he (or Soranus) was -familiar with auscultation of the chest. The words which he uses are -these:—</p> - -<p>“<i>Stridor vel sonitus interius resonans aut sibilans in ea parte quae -patitur,” and “sibilatus vehemens atque asper in ultimo etiam pectoris -resonans stridor.</i>”</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_160">[160]</span></p> - -<h3>CHAPTER XV<br /> -<span class="subhed1">CLAUDIUS GALEN</span></h3></div> - -<p>During the centuries immediately preceding the Christian era, Greek -medicine was represented by a collection of treatises which had been -written by Hippocrates and his followers on anatomical, physiological, -pathological, therapeutical and ethical subjects, and which constituted -a fairly complete but not always easily intelligible system. As -time went on, however, and especially as new and useful facts were -constantly being added to the existing stock of medical knowledge, -the more thoughtful physicians began to feel that the system, which -up to that day had proved acceptable, needed to be perfected in a -number of respects; and accordingly, as a result of this feeling of -dissatisfaction, and also as an expression of the prevailing desire -for a more perfect knowledge of the truth, there developed, as has -been stated in the preceding chapters, a number of different medical -sects. When Galen first appeared in the field as a physician of unusual -promise, these various sects were all still in a thriving condition. -The Methodists, in particular, were very popular. Galen did not favor -any special sect, but in his writings he made it manifest that he -attached more importance to the teachings of Hippocrates than to those -of any other author. “It was Hippocrates,” he said, “who laid the real -foundations of the science of medicine.” It is therefore not surprising -that Galen should have devoted so much time to the writing of elaborate -commentaries on the works of Hippocrates. The service which he thus -rendered to medicine, says Daremberg, was of very great value. But -Galen, notwithstanding his great admiration for Hippocrates, did not -hesitate to<span class="pagenum" id="Page_161">[161]</span> criticise a number of his teachings, and especially those -which, as he believed, were not stated with sufficient clearness. -Valuable as was the service rendered to medicine by the writing of -these commentaries, there still remained an urgent need for a service -of a different and much more difficult kind, viz., that of welding -together into a single clearly written and easily intelligible system -of medicine, all that was good in the Hippocratic writings and in the -disconnected and at times antagonistic teachings of the sects. To -accomplish this successfully required the services of a man endowed -with mental gifts of a most exceptional character—complete knowledge -of medicine in all its departments, a mind thoroughly trained in -philosophy, the power to express his thoughts in simple language, -and an independence and fairness of judgment which would render him -indifferent to the petty interests of the sects. Claudius Galen, as -subsequent events showed, possessed these very gifts in a high degree, -and he devoted the better part of his reasonably long lifetime to the -accomplishment of this much-needed work. How greatly it was needed at -that particular period of time, nobody then knew or could even suspect. -It soon appeared, however, that all the vaunted civilization of the -Graeco-Roman world—much of it of the purest gold and a great deal -of the basest alloy—was to be swept so completely off the face of -the earth that, for thirteen hundred or more years, almost no thought -whatever could possibly be given to the science and art of medicine. -Fortunate, most fortunate it was, therefore, that, before this wave -of destruction reached Rome, all the best part of Greek medical -literature—for such it was in truth—had been gathered together and -carefully systematized by Galen and stowed away in the recesses and -chambers of remotely situated monasteries and churches by clear-sighted -monks for the benefit of later generations of physicians.</p> - -<p><i>Brief Biographical Sketch.</i>—Claudius Galen was born in Pergamum, -an important Greek city of Asia Minor, about the year 131 A. D., under -the reign of the Emperor Hadrian. His father, whose name was Nicon, -was a man<span class="pagenum" id="Page_162">[162]</span> of ample means, well informed in philosophy, astronomy and -geometry, and most liberal in providing for the thorough education of -his son in every branch of useful knowledge. In two or three places -in his writings Galen speaks of his father in terms of affection. On -the other hand, he does not hesitate to state in the plainest language -possible that his mother was a veritable Xanthippe. In her moments of -bad temper she would not only shout and scream in a violent manner, but -would sometimes go so far as to bite her serving-maids. Pergamum, at -the time of which I am writing, offered unusually good opportunities -for studying disease. Its Asclepieion, which was built during Galen’s -boyhood, had already become one of the famous temples of Asia Minor, -and the sick and maimed flocked to it in large numbers. Then, in -addition, the city was well equipped with able physicians, who appear, -according to Neuburger, to have been on very friendly terms with the -priests of the temple. It was under the guidance of such men that -Galen—at the early age of seventeen, and after a careful training in -philosophy, mathematics, etc.—began the study of medicine. He speaks -with special interest and respect of one of his instructors, a certain -Quintus, who had the reputation of being an excellent anatomist and at -the same time one of the most distinguished practitioners of that day. -Another anatomist, Styrus, was also one of Galen’s teachers.</p> - -<p>On the death of his father Galen left his home and devoted the -succeeding nine years to visiting all the different cities in which -he believed he might gain some additional knowledge in medicine and -surgery. A large part of this long period was spent in Alexandria, -which still retained much of its importance as a home of all the -sciences. On attaining his twenty-eighth year he left that city and -returned to Pergamum, evidently with the purpose of establishing -himself there in the regular practice of his profession. Through -the influence of the temple officials, and especially of the High -Priest, Galen received the appointment of physician to the gladiators, -a position which he held with credit for a period of four years, -and<span class="pagenum" id="Page_163">[163]</span> which afforded him excellent opportunities for cultivating his -knowledge of surgery. It was while he was serving in this capacity -that he devised and put into practice a method of saturating the -dressings (in cases of severe wounds) with red wine, for the purpose -of preventing the development of inflammation in the parts affected; -and the success which he thus obtained was so great that not one of the -gladiators intrusted to his care died from his wounds. History does -not state the precise manner in which Galen carried out his method of -utilizing wine in the dressing of wounds, and we are therefore unable -to determine just how much credit he was entitled to receive for this -crude but apparently effective means of securing local antisepsis. -It is clear, however, that Galen’s treatment could only have been a -modification of a much older method, for Jesus, in his answer to a -question put to him by a lawyer, said: “But a certain Samaritan, as he -journeyed, came where he (the injured man) was: and when he saw him, -he had compassion on him, and went to him, and bound up his wounds, -pouring in oil and wine, and set him on his own beast, ...” (St. Luke -x., 33, 34).</p> - -<p>At the end of four years there broke out in Pergamum a riot which -rendered residence there, at least for a certain length of time, -undesirable. Accordingly Galen, who was now thirty-two years old, -and who was probably glad of an excuse for leaving a place where a -physician of his education and talents had so few opportunities for -gaining distinction, decided to visit Rome, and—if circumstances -appeared to favor the plan—to settle there. His first impressions -after arriving in that metropolis were favorable to the plan of -establishing himself there permanently, but at the end of a few years -he became conscious of the growing hostility of those practitioners -who had been for a longer time than he well established in that city. -This hostility increased as he rose in favor and esteem with people -of position and influence. He had treated skilfully and with success -Eudemus, a peripatetic philosopher of great celebrity, for a quartan -fever. He had also cured the wife of Boëthus (a patrician who belonged -to the consular class)<span class="pagenum" id="Page_164">[164]</span> of a serious illness and had received as an -expression of appreciation a gift of four hundred pieces of gold. He -had won the friendship and esteem of such men as Sergius Paulus, the -Praetor; of Barbaras, the uncle of the Emperor Lucius; and of Severus, -who was at that time Consul, but who later became Emperor. These very -influential men took an active interest in Galen’s scientific work, -having been invited by him on more than one occasion to witness his -dissections of apes,—dissections which he made for the particular -purpose of demonstrating the organs of respiration and of the voice. -All these facts soon became known to Galen’s rivals and probably helped -to fan the spark of their envy into a flame; but it is very doubtful -whether he was justified in saying that the ill feeling thus engendered -threatened to end in some act of personal violence, for which reason -he decided to leave Rome and return to Pergamum. His secret manner -of departure, without taking leave of anybody, and the fact that the -Plague was just at that time rapidly approaching Rome, justify the -belief, says Neuburger, that it was not fear of personal violence at -the hands of his jealous rivals that drove Galen away so mysteriously -from the city in which, in the short space of four or five years, -he had won so great professional success, but an unwillingness to -face his duty, which was, to remain and aid in the approaching fight -against the great destroyer—the Plague. If Galen had been a simple -physician, one of the great body of medical practitioners in Rome, no -one would be disposed to question the justice of the criticism which -the distinguished Viennese historian makes of his decision to abandon -that city at the moment of her distress and peril. But, as a matter -of fact, Galen was not a practitioner of medicine in the full sense -of that term. He treated cases of illness because in no other way -would it be possible for him to acquire the necessary familiarity with -disease; but, almost from the very beginning, he seems to have fully -realized that he was destined to devote his time and his energies to -a very different kind of professional work,—work which was urgently -needed, which promised to be of very great<span class="pagenum" id="Page_165">[165]</span> value to medical science, -and which probably no other physician then living was competent to do -effectively. Furthermore, he was himself profoundly conscious that the -work in question constituted the main object of his life. His own words -(see his statement with reference to Archigenes, on page 174) show -this plainly, and the huge mass of medical treatises which he wrote -reveal in the most unmistakable manner with what untiring persistency -he pursued the path which he believed it was his duty to follow. It -being assumed, then, that such were the motives which actuated Galen, -was it a mistake on his part to conclude that duty did not require him -to remain in Rome? The question is a difficult one to answer, and I do -not feel called upon to decide it. We do not, however, brand a general -in the army a coward because he endeavors to protect himself as much -as possible from danger during a battle, that he may be able, to the -very end, to direct the soldiers under his command. Similarly, was not -Galen justified in avoiding every risk which was likely to imperil the -performance of duties which were of far greater value to medicine and -to humanity at large than that of acting as a mere soldier in the ranks -of medical men?</p> - -<p>It seems a great pity that one of the most inspiring figures in the -history of medicine should be represented to posterity with such a -blemish upon his character, and I have therefore ventured to suggest a -possible defense of Galen’s action.</p> - -<p>Not very long after he had returned to Pergamum, Galen was summoned -by the Emperors Marcus Aurelius and Lucius Verus, who were then with -the army at Aquileia, a few miles north of the present Trieste, to -join them at that city; and he was, of course, obliged to obey. A -fresh outbreak of the Plague had occurred and there had already been -many fatal cases among the troops. It was therefore decided by the -emperors, almost immediately after Galen’s arrival, to return to Rome -with a part of the army. A start was accordingly made, and the company -had already advanced some distance on their way, when Lucius Verus -died. This unexpected event greatly increased<span class="pagenum" id="Page_166">[166]</span> the difficulties of -the return journey, as it was deemed necessary to carry the remains -of the deceased Emperor back to the imperial city. Thus Galen found -himself once more settled in Rome, this time in the capacity of private -physician to the Emperor Marcus Aurelius and his sons Commodus and -Sextus. The position was extremely well adapted to the needs of Galen, -who, from that time forward, for a period of several years, had at his -disposal ample time for writing and for conducting his experimental -work in anatomy and physiology, a privilege of which he appears to have -made excellent use. He lived to be seventy years of age, his death -occurring during the latter part of the reign of Severus, or at the -beginning of that of Caracalla (about 201 A. D.).</p> - -<p>All Galen’s critics agree that he possessed his full share of -peculiarities,—not to call them by the harsher name of faults. He was -constantly ready, for example, to praise his own doings and sayings, -and he rarely lost an opportunity of holding up the physicians of Rome -to ridicule and contempt. He was specially bitter in his criticisms of -Methodism and its adherents—“the donkeys of Thessalus,” as he called -them. At the same time, no other physician of ancient or modern times -has manifested to an equal degree such extraordinary industry as a -writer and original investigator in a great variety of departments of -knowledge. Although many of his works have been lost,<a id="FNanchor_39" href="#Footnote_39" class="fnanchor">[39]</a> those which -have come down to our time are still very numerous—“a sufficient -number,” says Neuburger, “to constitute a library by themselves.” I -give here a few of the titles of these works, in order that the reader -may get at least some idea of the great variety of medical topics which -Galen has discussed in his writings. The more complete list furnished -by Daniel Le Clerc contains nearly two hundred titles, and yet even -this is believed to fall short of the actual number.</p> - -<p><span class="pagenum" id="Page_167">[167]</span></p> - - -<h4>SELECTED LIST OF THE WORKS OF GALEN RELATING TO MEDICINE. (FROM LE -CLERC.)</h4> - -<ul class="smaller"> - <li class="hangingindent">Explanation of some of the Ancient Terms Employed by Hippocrates.</li> - <li>On the Establishment of the Art of Medicine.</li> - <li>Definitions of Medical Terms.</li> - <li>On the Different Sects in Medicine.</li> - <li>Discourse against the Empirics.</li> - <li class="hangingindent">On the Importance, for a Physician, of a Thorough training in -Philosophy.</li> - <li>The Physician; or Introduction to Medicine.</li> - <li>The Elements, as taught by Hippocrates. (2 books.)</li> - <li>The Different Temperaments. (3 books.)</li> - <li class="hangingindent">On the Nature of Man; Commentaries on two Books of Hippocrates. (2 books.)</li> - <li>The Humors.</li> - <li>Do the Arteries Normally contain Blood?</li> - <li>On Black Bile.</li> - <li>On the Bones. (For Students in anatomy.)</li> - <li>Dissection of the Vocal Organs.</li> - <li>The Anatomy of the Eyes.</li> - <li>Dissection of the Veins and Arteries.</li> - <li>Dissection of the Nerves.</li> - <li class="hangingindent">On the Utility of the Different parts of the Body. (17 books.)</li> - <li>On the Natural Faculties. (3 books.)</li> - <li>The Sentiments of Hippocrates and of Plato. (9 books.)</li> - <li>The Organ of Smell.</li> - <li>The Movements of the Muscles. (2 books.)</li> - <li>The Physiology of Respiration.</li> - <li>On Obesity.</li> - <li>On the Maintenance of Health. (6 books.)</li> - <li>The Characteristics of Different Foods. (3 books.)</li> - <li class="hangingindent">Precepts regarding the Diet best suited to the Four Different -Seasons and to Each of the Twelve Months of the Year.</li> - <li class="hangingindent">On the Manner of Living best suited to those who Wish to -Preserve their Health. (3 books.)</li> - <li>On Habit.</li> - <li>On the Differences between Diseases.</li> - <li>On the Causes of Diseases.</li> - <li>On Marasmus or Consumption.</li> - <li>On the Different Kinds of Fevers. (2 books.)</li> - <li>On Thirst.<span class="pagenum" id="Page_168">[168]</span></li> - <li>On the Parts of the Body Affected. (6 books.)</li> - <li>The Diseases of Women.</li> - <li>The Different Kinds of Pulse. (16 books.)</li> - <li>The Different Kinds of Urine.</li> - <li>On Critical Days. (3 books.)</li> - <li>Commentaries on the Treatises of Hippocrates. (39 books.)</li> - <li>On the Manner of Treating Different Maladies. (17 books.)</li> - <li>On Venesection. (3 books.)</li> - <li>On the Use of Cups, Leeches and Scarifications.</li> - <li>On Purgatives. (3 books.)</li> - <li>On Colic.</li> - <li>On Jaundice.</li> - <li>On Gout.</li> - <li>On Stone in the Bladder.</li> - <li class="i2">Etc.</li> -</ul> - -<p>The numerous works of Galen, says Pagel, constitute a complete and -very satisfactory encyclopaedia of medicine. The most available -edition of his works in Greek is that of Karl Gottlob Kühn of Leipzig -(1821–1828; 22 Vols. of about 1000 pages each). There is scarcely a -department which this great physician has not treated quite fully. But, -unfortunately, the translations into modern languages are relatively -few, and they cover only small portions of the entire work. That -of Daremberg, entitled “<i>Oeuvres anatomiques, physiologiques et -médicales de Galien, etc.</i>” (Paris, 1854–1857; 2 Vols.), is in every -way most satisfactory, and it is from this source that I have made a -few extracts—just sufficient to give the reader some idea of Galen’s -style of writing and of his competency to deal with such subjects as -human anatomy and physiology. To attempt anything like a complete -exposition of his views regarding pathology, therapeutics, hygiene, -etc., would necessitate my devoting more space to this part of the -history of medicine than I can afford to give. To those who desire to -obtain more ample information about Galen’s views regarding pathology -and therapeutics I would recommend a study of Daremberg’s admirable -work and a perusal of the careful analysis made by Neuburger of certain -portions of Galen’s text.</p> - -<p><i>Galen’s Contributions to Anatomy and Physiology.</i>—At<span class="pagenum" id="Page_169">[169]</span> the -period of time about which I am now writing, and for many centuries -afterward, there existed among all classes of the community a very -strong prejudice against dissecting human corpses. And even Galen -himself appears to have shared this prejudice, for, in spite of his -intense eagerness to gain a more perfect knowledge of human anatomy, he -apparently did not dare to undertake any such investigation, even when -a favorable opportunity for so doing presented itself, as it did on the -occasion to which he refers in the following brief extract taken from -one of his treatises:—</p> - -<div class="blockquot"> - -<p>A carelessly constructed sepulchre on the banks of a river had -been undermined during a season of flood, and the corpse thus -set free had floated down stream a short distance, until it -finally lodged on the shore of a small cove. Passing near by I -had the opportunity of inspecting this corpse. The fleshy parts -had already disappeared to a great extent through the process -of decomposition, but the bones were still held together by -their fibrous connections. The picture presented to the eye was -that of a human skeleton specially prepared for the instruction -of young physicians. On another occasion, a few steps from the -main road, I came across the dead body of a robber who had been -killed by the traveler whose money he had attempted to steal. -The peasants of that neighborhood were not willing to bury the -corpse of such a bad man, and they accordingly allowed it to -remain at the spot where it was first discovered. In the course -of the following two days, as might be expected, the vultures -removed every particle of flesh from the bones, so that, when -I saw what remained of the body, the only thing visible was a -nicely cleaned skeleton.</p> - -<p class="r2 p-min">(Le Clerc: <i>Histoire de la Médecine</i>, p. 711.)</p> -</div> - - -<p>Here were two excellent opportunities for gaining the additional -knowledge of human anatomy which Galen so much desired, but he -evidently was not at all disposed to avail himself of them—doubtless -because his mind was deeply imbued with the feeling that any such -interference on his part would be a sacrilegious act. Under the -circumstances, therefore, there was nothing left for him to do but -to utilize animals for purposes of dissection, and more particularly -apes, whose anatomy very closely resembles<span class="pagenum" id="Page_170">[170]</span> that of the human being. -Several of Galen’s books on anatomy have come down to our time, but -quite a number of others have been lost. From those which we possess, -and especially from the one entitled “Anatomical Administrations,” -it is permissible to conclude that he was a most skilful dissector -and an extremely close and careful observer, and that he was very -particular to set down the results of his observations in admirably -clear language. Indeed, Le Clerc assures us that Vesalius, the great -Flemish anatomist of the sixteenth century, bestowed high praise upon -Galen’s anatomical descriptions; and that, too, notwithstanding the -fact that the latter sometimes erred in his statements regarding the -similarity between certain parts observed in dissections of an animal -and the corresponding parts in man. In one of his treatises<a id="FNanchor_40" href="#Footnote_40" class="fnanchor">[40]</a> Galen -states distinctly that the arteries contain blood. In another he gives -a remarkably full and accurate description of the nervous system, -including the brain, spinal cord, and many of the nerves.</p> - -<div class="blockquot"> - -<p>He describes the optic nerve, the oculo-motorius and -trochlearis, the different ramifications of the trigeminus, the -acusticus and facialis, the vagus and glossopharyngeus, the -nerves of the pharynx and larynx, the sympatheticus (with the -accompanying ganglia), and the radial, ulnar, median, crural and -ischiatic nerves. (Puschmann.)</p> -</div> - -<p>Although it is true that certain important anatomical and physiological -facts are found recorded for the first time in the works of Galen, -this must not be accepted as evidence that Galen himself is the real -discoverer of these facts. The most that can be claimed for him is that -he is the first writer to bring the facts in question to the knowledge -of us moderns. When the ancient books that have been lost are once -more brought to light, as they very well may be at any time, we shall -be able, perhaps, to give credit where credit is due. But there is one -department in which Galen did experimental work of an entirely original -character and for which he deserves unstinted praise. I refer to the -experiments which he made concerning the physiology of<span class="pagenum" id="Page_171">[171]</span> the brain and -spinal cord. They are related in the following extract, which has been -translated from the account given by Neuburger (<i>op. cit.</i>, Vol. -I., p. 380):—</p> - -<div class="blockquot"> - -<p>The brain itself is not sensitive; it expands and contracts -synchronously with the respiratory movements, the purpose of -which action is to drive the pneuma from the cavities of that -organ into the nerves. The function of the meninges is to hold -the parts firmly together and to unite the blood-vessels. -Pressure upon the brain causes stupor. An injury of the tissues -surrounding the fourth ventricle or of those which constitute -the beginning of the spinal cord produces death. The seat of -the soul is in the substance of the brain, and not in its -membranes. The spinal cord serves as a conductor of sensation -and of motor impulses, and it also plays the part of a brain -for those structures of the body which lie below the head. -It gives off nerves like streamlets. Division of the spinal -cord longitudinally in its median axis does not give rise to -paralysis. Transverse division, on the other hand, causes -symmetrical paralyses. If the cord is divided between the third -and fourth cervical vertebrae, respiration is arrested, and -if the division is made between the cervical and the thoracic -portions of the spinal column, the animal breathes with the aid -only of its diaphragm and of the upper muscles of the trunk of -the body. Division of the recurrent nerves produces aphonia; if -the fifth cervical nerve is divided, the scapular muscles on -the corresponding side will be paralyzed. Galen considers the -ganglia to be organs for reinforcing the energy of the nerves. -The fact that both cerebral and spinal-cord nerve-filaments -enter into the composition of the sympathetic nerve explains the -extraordinary sensitiveness of the abdominal organs.</p> -</div> - -<p>When we consider that these experiments are the first of their kind -of which history makes mention, that they were carried out nearly -seventeen hundred years ago, and that—so far as we know—they sprang -entirely from the brain of the experimenter, we may well express -unlimited admiration for Claudius Galen.</p> - -<p>Daniel Le Clerc says that Galen’s principal treatise on human -physiology, entitled “Utility of the Different Parts of the Human -Body,” constitutes a <i>chef-d’oeuvre</i> which has challenged the -admiration of physicians and philosophers in all ages. Christians, -however, he adds, are<span class="pagenum" id="Page_172">[172]</span> particularly gratified to learn from this work -that “Galen, although classed as a Pagan, unhesitatingly recognizes -that it was an all-wise, an all-powerful, an all-good God who created -man and all the other animals.” Further on, Le Clerc refers to another -statement which was made by Galen and which will be found on page 261 -of Daremberg’s version. It reads as follows:—</p> - -<div class="blockquot"> - -<p>If I were to spend any more time in talking about such -brutes—by which term he designates men who cannot appreciate -the wisdom of God in distributing the different parts of the -body in the manner in which He has done this—I should justly -incur the blame of sensible persons. They would accuse me of -desecrating the account which I am writing, an account which is -intended as a hymn of sincere praise of the Creator of man. I -believe that true piety consists, not in sacrificing numberless -hecatombs nor in burning unlimited quantities of incense and a -thousand perfumes, but in first searching out and then making -known to my fellow men how great are the wisdom, the power, and -the goodness of the Creator.</p> -</div> - -<p>Galen’s work on “The Utility of the Different Parts of the Human Body” -is composed of seventeen books, all of which exist to-day in a complete -state. Taken together they form, as may be seen by the following list -of contents, a remarkably complete treatise on physiology. Books I. and -II. are devoted to the hand, forearm and arm (105 pages); Book III. to -the thigh, leg and foot (62 pages); Books IV. and V. to the alimentary -organs and their accessories (101 pages); Book VI. to the respiratory -organs (78 pages); Book VII. to the organs of the voice (67 pages); -Book VIII. to the head, the encephalon and the organs of special sense -(45 pages); Book IX. to the cranium, the encephalon and the cranial -nerves (38 pages); Book X. to the eyes and their accessories (45 -pages); Book XI. to the face and more particularly the jaws (55 pages); -Book XII. to the neck and the rest of the spinal column (46 pages); -Book XIII. to the shoulder and the structure of the spinal column in -detail (40 pages); Books XIV. and XV. to the genital organs and the -parts in which the foetus develops (70 pages); Book XVI. to the nerves, -arteries and veins (43 pages); and Book XVII. Epilogue (11 pages).</p> - -<p><span class="pagenum" id="Page_173">[173]</span></p> - -<p>There are very few modern text books in which the author treats the -subject in as exhaustive a manner as Galen has done in these seventeen -books. As may readily be imagined from the great number and length -of his writings, he often wanders off into side issues and thus lays -himself open to the charge of being a diffuse writer. At the same -time he cannot be accused of dullness, for in reading Daremberg’s -version one is seldom tempted to omit any of the text, and his style -is interesting. The following brief extracts, to which should be added -that given on a previous page, may be taken as fair samples of his -manner of treating questions in the department of physiology:—</p> - -<div class="blockquot"> - -<p><i>Reasons why the Alae Nasi are Cartilaginous and why they may -be Moved by Voluntary Muscular Action.</i>—We have already -explained in some measure the reasons why the alae nasi should -be composed of cartilage and why it should be possible for the -animal to move them at will.<a id="FNanchor_41" href="#Footnote_41" class="fnanchor">[41]</a> It is an established fact that -the movements of these parts are competent to aid in no small -degree the somewhat forcible inspirations and expirations. This -is the reason why the alae are constructed in such a manner as -to be easily movable. They are made of cartilage because this -substance is hard to fracture or to tear apart. The placing -of these alar movements under the control of the will, and -not under that of some other bodily force (like the arterial -impulse, for example), is certainly an excellent arrangement; -and, if one does not appreciate this without any further -explanation, it must be because my previous reasonings about -such matters have fallen upon inattentive ears.</p> - -<p class="p-min r2">(Translated from Book XI., Chapter XVII., of Daremberg’s French -version of Galen’s works.)</p> -</div> - -<p>Another brief extract may be given here. It forms a part of the chapter -relating to the action of the sigmoid valves of the pulmonary artery, -etc., and merits special attention because it furnishes additional -evidence of the<span class="pagenum" id="Page_174">[174]</span> correctness of Daremberg’s statement that Galen was -the leader of the most advanced school of experimentation:—</p> - -<div class="blockquot"> - -<p>The more strongly the thorax, in its exertion of a compressing -force, tends to drive the blood (out of the heart), the more -tightly do these membranes (the sigmoid valves) close the -opening. Invested in a circular manner from within outward, -extending throughout the entire circumference of the interior -of the vessel, these membranous valves are, each one of them, -so accurately patterned and so perfectly fitted that when they -are put upon the stretch by the column of blood, they constitute -a single large membrane which closes (watertight) the orifice. -Pushed back by the return flow of the blood, they fall back -against the inner surface of the vein, and permit an easy -passage of the blood through the amply dilated orifice (which -they, an instant before, closed so perfectly).</p> - -<p class="p-min r2">(Translated from Book VI., Chapter XI., of Daremberg’s French -version of the works of Galen.)</p> -</div> - -<p>In his comments upon the account of the sigmoid valves which I have -just quoted, Daremberg says that the description of these structures -given by Erasistratus at least four hundred years earlier is admitted -by Galen to be so correct that it would scarcely be possible to furnish -a better one.</p> - -<p><i>Galen’s Remarks upon the Subject of Diagnosis.</i>—In the treatise -entitled “On the parts of the Body Affected” (Book II., Chapter X.) -Galen gives the following advice with regard to the method which it is -desirable to adopt when one wishes to ascertain which part or organ is -affected, what is the nature of the disease there located, and whether -it is primary in its nature or secondary to some affection of earlier -development:—</p> - -<div class="blockquot"> - -<p>It should have been the special duty of Archigenes, who -appeared on the scene next in order after a series of the most -illustrious physicians,<a id="FNanchor_42" href="#Footnote_42" class="fnanchor">[42]</a> to infuse more light into medical -teaching. Unfortunately,<span class="pagenum" id="Page_175">[175]</span> he did the very opposite; for we who -have grown old in the exercise of the art (and should therefore -find it easy to comprehend what is written about medicine), are -at times unable to understand what he says. Such being the true -state of affairs, I now propose to undertake what Archigenes -failed to accomplish. I shall commence by indicating in a -general way what is the proper method to adopt when one wishes -to ascertain in what part or organ the disease is located and -how one should proceed when it is proposed to teach the method -to others. This method may be stated in the following terms:—</p> - -<p>In the first place, the part should be carefully examined in -order that we may ascertain whether it presents any signs of -special value as indicating the nature of the disease. In the -next place, it is important in such an examination to know -beforehand what are the particular signs which belong to each -of the diseases that may affect the part or organ in question, -and also whether these signs vary according to the particular -section of the organ involved. In inflammation of the lung, -for example, there are: difficulty in breathing (dyspnoea) and -great general distress (malaise), the patient being obliged to -remain in a sitting posture (orthopnoea)—all of which are signs -indicating the possibility of suffocation. Furthermore, the -air expired from the infected lung is sensibly hot, especially -if the inflammation is of the erysipelatous variety, and, as -a consequence, the patient shows a disposition to draw long -breaths, knowing that the cold air which he thus draws into -his lungs will afford him some measure of relief. The sputa -expectorated when he coughs are differently colored; some -being red, yellowish, or of a rusty appearance, while others -are almost black, livid, or frothy. The patient also often -experiences the sensation of a heavy weight in his chest, -together with more or less pain, which seems to be located -deep down in that region and which shoots backward into his -spinal column or forward toward the sternum. Add to these -manifestations a high fever and a pulse such as we have already -described on another page, and you will have....</p> - -<p class="r2 p-min">(Translated from Daremberg’s French version of Galen’s works.)</p> -</div> - -<p>It has been said that Galen possessed more than the ordinary share of -vanity with regard to his cleverness as<span class="pagenum" id="Page_176">[176]</span> a diagnostician; and certainly -some of the accounts which he gives, in his clinical and scientific -treatises, of his own experiences, seem to bear out this accusation. -One hesitates to expose the weak spots in the character of one of the -really great men of antiquity lest such exposure may convey a wrong -impression; at the same time it would be an error to represent him as -a man entirely free from the foibles common to humanity,—even to the -best and wisest of men. I therefore repeat here Galen’s own account of -a professional visit which he made to a brother physician whose malady -presented to himself and to his friends many obscure features.</p> - -<div class="blockquot"> - -<p>Upon the occasion of my first visit to Rome I completely won the -admiration of the philosopher Glaucon by the diagnosis which I -made in the case of one of his friends. Meeting me one day in -the street he shook hands with me and said: “I have just come -from the house of a sick man, and I wish that you would visit -him with me. He is a Sicilian physician, the same person with -whom I was walking when you met me the other day.” “What is the -matter with him?” I asked. Then coming nearer to me he said, -in the frankest manner possible: “Gorgias and Apelas told me -yesterday that you had made some diagnoses and prognoses which -looked to them more like acts of divination than products of the -medical art pure and simple. I would therefore like very much to -see some proof, not of your knowledge but of this extraordinary -art which you are said to possess.” At this very moment we -reached the entrance of the patient’s house, and so, to my -regret, I was prevented from having any further conversation -with him on the subject and from explaining to him how the -element of good luck often renders it possible for a physician -to give, as it were off-hand, diagnoses and prognoses of this -exceptional character. Just as we were approaching the first -door, after entering the house, we met a servant who had in his -hand a basin which he had brought from the sick room and which -he was on his way to empty upon the dung heap. As we passed -him I appeared not to pay any attention to the contents of the -basin, but at a mere glance I perceived that they consisted of a -thin sanio-sanguinolent fluid, in which floated excrementitious -masses that resembled shreds of flesh—an unmistakable evidence -of disease of the liver. Glaucon and I, not a word having been -spoken by either of us, passed on into the patient’s room. When -I put out my hand to feel of the<span class="pagenum" id="Page_177">[177]</span> latter’s pulse, he called my -attention to the fact that he had just had a stool, and that, -owing to the circumstance of his having gotten out of bed, his -pulse might be accelerated. It was in fact somewhat more rapid -than it should be, but I attributed this to the existence of -an inflammation. Then, observing upon the window sill a vessel -containing a mixture of hyssop and honey and water, I made up -my mind that the patient, who was himself a physician, believed -that the malady from which he was suffering was a pleurisy; the -pain which he experienced on the right side in the region of -the false ribs (and which is also associated with inflammation -of the liver) confirming him in this belief, and thus inducing -him to order for the relief of the slight accompanying cough -the mixture to which I have just called attention. It was then -that the idea came into my mind that, as fortune had thrown the -opportunity in my way, I would avail myself of it to enhance -my reputation in Glaucon’s estimation. Accordingly, placing my -hand on the patient’s right side over the false rib, I remarked: -“This is the spot where the disease is located.” He, supposing -that I must have gained this knowledge by simply feeling his -pulse, replied with a look which plainly expressed admiration -mingled with astonishment, that I was entirely right. “And”—I -added simply to increase his astonishment—“you will doubtless -admit that at long intervals you feel impelled to indulge in -a shallow, dry cough, unaccompanied by any expectoration.” As -luck would have it, he coughed in just this manner almost before -I had got the words out of my mouth. At this Glaucon, who had -hitherto not spoken a word, broke out into a volley of praises. -“Do not imagine,” I replied, “that what you have observed -represents the utmost of which medical art is capable in the -matter of fathoming the mysteries of disease in a living person. -There still remain one or two other symptoms to which I will -direct your attention.” Turning then to the patient I remarked: -“When you draw a longer breath you feel a more marked pain, do -you not, in the region which I indicated; and with this pain -there is associated a sense of weight in the hypochondrium?” -At these words the patient expressed his astonishment and -admiration in the strongest possible terms. I wanted to go a -step farther and announce to my audience still another symptom -which is sometimes observed in the more serious maladies of the -liver (scirrhus, for example), but I was afraid that I might -compromise the laudation which had been bestowed upon me. It -then occurred to me that I might safely make the announcement -if I put it somewhat in the form<span class="pagenum" id="Page_178">[178]</span> of a prognosis. So I remarked -to the patient: “You will probably soon experience, if you have -not already done so, a sensation of something pulling upon the -right clavicle.” He admitted that he had already noticed this -symptom. “Then I will give just one more evidence of this power -of divination which you believe that I possess. You, yourself, -before I arrived on the scene, had made up your mind that your -ailment was an attack of pleurisy, etc.”</p> - -<p>Glaucon’s confidence in me and in the medical art, after this -episode, was unbounded.</p> -</div> - -<p>Thirty or forty years elapsed after Galen’s death before the Profession -began to realize how great an authority he had become in all matters -relating to medicine; not perhaps among the majority of physicians, but -among the better educated and those more given to reasoning about the -various problems in physiology and pathology. Then came the invasion -of Rome by the Barbarians, and with it the scattering of nearly all -those who were at the time practicing medicine in that great city. -This was the beginning of the long period known as the Middle Ages, -a period during which, so far as Italy and Gaul were concerned, the -science of medicine made no advance whatever. The physicians living -in a precarious manner in the towns, and the monks who practiced -medicine in the country districts, took very little interest, as may -readily be imagined, in the achievements of Galen. Through all those -years they clung to the doctrines of the Methodists, as revealed to -them in the work of Caelius Aurelianus, the favorite medical treatise -of that period. It was only during the latter part of the Middle Ages -that Galen’s teachings began once more to be appreciated at their true -value; and, as time went on, they gained a stronger and stronger hold -on the minds of medical men, until finally they held undisputed sway. -Friedlaender, speaking of medicine in those dark times, uses these -words: “Galen’s colossal personality loomed up throughout that long -night as a brilliant guiding star to light the intricate pathways of -medicine.”</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_179">[179]</span></p> - -<h3>CHAPTER XVI<br /> -<span class="subhed1">THE INFLUENCE OF CHRISTIANITY UPON THE EVOLUTION OF MEDICINE</span></h3></div> - -<p>The religion established by Jesus Christ in Judea during the early part -of the first century remained confined within the limits of that region -for a number of years, but already during the latter half of that -period groups of Christians were to be found in every part of the Roman -Empire, and in certain localities the membership of the new church had -increased so greatly in numbers as to excite the alarm and hostility -of the temple priests and of the governing officials. Persecutions, -especially in the city of Rome and at the instigation of Nero, became -more and more frequent and more and more pitiless, but they failed -utterly to destroy the new religion, so firmly was it rooted in the -followers of Jesus Christ. As a matter of fact its spread was checked -for only a few years, and then its adherents increased in numbers more -rapidly than ever. Neuburger, in his “History of Medicine,” makes the -following quotation from the account which Dionysius of Alexandria -gives of the great plague that occurred during the third century A. D.:</p> - -<div class="blockquot"> - -<p>The majority of our brethren in their love for their neighbors -did not spare themselves, but acted as a unit in their efforts -to assist. They visited the sick without the slightest fear and -gave them the very best of care, for the sake of Christ.... -Among the non-Christians, however, the very opposite was true. -As soon as any of their number fell ill they pushed them to one -side, even those who were dearest to them, and, before they were -more than half-dead, they threw them out into the street and -took no care to bury the dead bodies.</p> -</div> - -<p><span class="pagenum" id="Page_180">[180]</span></p> - -<p>Such an example of self-sacrifice and humanity—and there must have -been very many similar examples—could not possibly have failed to make -a profound impression upon the community at large. Daniel Le Clerc says -that three physicians suffered martyrdom for their Christian faith -during the reigns of the Emperors Marcus Aurelius, Lucius Verus and -Commodus. They were Papila (of Pergamum), Alexander (of Lyons) and -Sanctus (a contemporary of Galen), whose death was of a particularly -cruel character. Credit should also be given to Christianity, says -the same writer, for having established the rule that every community -should assume the expense and responsibility of caring for its own -poor and sick. This was a step of the greatest importance; and, at -a still later period, when Christianity became largely an affair of -the state, a complete hospital organization was effected, with the -bishop as the chief officer and, under him, deacons and deaconesses. -Such well-organized institutions proved to be of the greatest possible -benefit to the advance of medical science. They were the worthy -successors of those more ancient hospitals, the Aesculapian temples, -which were first established by the Greeks in the pre-Hippocratic age, -and they have continued in an unbroken chain from the institutions of -those primitive times to the thoroughly well-equipped hospitals of the -present day.</p> - -<p>In 330 A. D. the new capital of the Roman Empire was established -in Byzantium, afterward called Constantinople, and Rome, which for -hundreds of years had been the metropolis of the world and the source -from which a large part of Roman history had emanated, was given a -subordinate position. Then followed, in 410 A. D., the conquest of the -latter city by the Visigoths, a horde of uneducated Barbarians who had -felt the might of Rome in previous years, and who now doubtless took -immense satisfaction in humiliating her and in destroying her valuable -possessions. There are good reasons for believing that, when the -Emperor Constantine established his residence in Byzantium, the leading -physicians of Rome followed him; and it is not likely that many of -those who,<span class="pagenum" id="Page_181">[181]</span> for one reason or another, preferred to remain in the old -capital, continued to do so after it became known that the Barbarians -were approaching the city. But the migration of these physicians to the -new capital did not mean a renewal there of the scientific activity -which had characterized the growth of Greek medicine in Rome during -the first two centuries of the Christian Era. It is probable that -the fugitives, being obliged to travel with the smallest amount of -baggage possible, left the major part of their books and papyrus rolls -behind, hoping, no doubt, that they might be able at some later date -to recover them. But the favorable occasion never arrived, and thus a -great deal of valuable medical literature entirely disappeared. The -loss, however, might have been even more serious than it was if the -Christian church had not already (during the third century) begun to -establish monasteries in secluded and inaccessible spots. It was to -these institutions that not only books of a religious character, but -also those relating to the science of medicine, were transported for -safe keeping during the early Middle Ages. Farther on, I shall have -occasion to refer to this subject again and to discuss more fully -certain other benefits which accrued to medical science from these -monastic institutions.</p> - -<p>But while, on the one hand, the Christian church through the -instrumentality of the monasteries was lending its aid to the -preservation of the sources of medical knowledge, it was, on the other, -doing its best to arrest all further evolution of that branch of -science; not consciously, it must be admitted, but through a mistaken -sense of its duty to God. Thus it came about that the Emperor Justinian -I. (527–567 A. D.), acting under the narrow-minded advice of his -ecclesiastical counsellors, closed the medical schools at Athens and -Alexandria and at the same time withdrew the regular allowance of money -which up to that time had been paid to the state physicians and to -special scholars. A few years later, however (<i>i.e.</i>, in the early -part of the seventh century A. D.), some of the more highly educated -physicians of Alexandria got together and made the attempt to organize -a school of medicine in that city. A<span class="pagenum" id="Page_182">[182]</span> course of lectures was planned -and sixteen of Galen’s works, carefully chosen for the purpose, were -made the basis of the new course of instruction. The books selected -were first carefully edited and simplified, and then commentaries -were added in order that in their final shape these treatises might -be better suited to the uses of students. The invasion of Alexandria -by the Arabs, however, soon put an effectual stop to this promising -attempt to revive Greek medicine.</p> - -<p>In this brief sketch I have thus far mentioned only the more direct -effects produced by the new religion upon the evolution of medicine. -The indirect effects, however, were also in some cases of very great -importance. At the beginning of her history there developed in the -Christian church, among her chief men, a strong disposition to quarrel -over dogmas. To apply the term quarrelsomeness to this tendency may -easily convey a wrong impression. It was, more strictly speaking, a -highly developed conscientiousness on the part of men whose minds were -deeply imbued with the idea that they were rendering God a service by -keeping what they believed to be the true and only religion free from -errors of all kinds. It took many centuries to impress the leaders -of the church with the fact that the religion of Jesus Christ, like -the science of medicine or the natural sciences, was capable of -development to an almost indefinite extent; and it is owing to our -appreciation of this important fact that we moderns look with so much -more lenient eyes upon the distressing, not to say cruel, events -of mediaeval ecclesiastical history. At the time of which I am now -writing, however, it was considered highly unchristian—especially -for one holding authority in the church—to believe otherwise than -as her doctrines taught; and accordingly, in the early part of the -fifth century A. D., Nestorius, the Patriarch of Constantinople, was -deposed from his high office by a Council of the church and imprisoned -because he was unwilling to teach the doctrine of the miraculous birth -of Jesus Christ. Those who accepted the view held by Nestorius—and -they eventually became a very numerous and a very influential<span class="pagenum" id="Page_183">[183]</span> body of -Christians—were driven out of Constantinople and compelled to seek -homes in distant places. This affords, perhaps, an explanation of the -fact that, during the eighth century A. D., many Nestorian Christians -were found living in the eastern part of Syria and in Persia; and it -seems fair to assume that these Christian communities represented -to some extent the direct successors of those Nestorians who had -taken refuge in this remote corner of Asia Minor three hundred years -earlier. Furthermore, it is highly probable that there were Christian -communities in this region several centuries before the Nestorians -arrived, for it is believed that the Apostles James and Thomas visited -Persia and the northeastern part of Syria in the course of their work -as evangelists. It is not known, though, how many of the descendants of -these earlier Christians adopted the peculiar beliefs of the Nestorian -refugees.</p> - -<p>And here it should be stated that the facts which have thus far -been mentioned are not the only ones that throw some light upon the -relationship subsisting between Christianity and the spread of medical -knowledge to Western Europe. Those which remain to be considered -are of two kinds, viz., facts relating to the origin of the Arabic -Renaissance, and facts which show that the Christian church, from the -fourth century onward, was contributing not a little, through the -establishment of the great monastic orders, such as the Benedictines, -the Dominicans, and the Franciscans, to the preservation if not to the -further evolution of Graeco-Roman medical knowledge. I shall reserve -for consideration in a later chapter this particular part of the -history of medicine; and in the meantime I shall endeavor to describe -the events which preceded and rendered possible the active study of -Greek medicine on the part of the followers of Mohammed.</p> - -<p>So far as history furnishes us with any information on the subject, the -Nestorians who lived in Persia, Syria and Mesopotamia were Christians -of a remarkably liberal type. They appear to have been an unusually -peaceable people, for not only were they kindly disposed toward one -another,<span class="pagenum" id="Page_184">[184]</span> but they seem to have been on the best of terms with their -Jewish neighbors, who, like themselves, were eager after knowledge. -Already at a very early period there existed at Djondisabour—a -town which had been founded in the Province of Khorassan, in the -northeastern part of Persia, about the year 260 A. D., by Sapor II., -King of that country—a school in which the medicine of Hippocrates -was taught. Freind, in his “History of Physick” (London, 1727), -says that about the year 272 A. D. the Emperor Aurelian (Lucius -Domitius Aurelianus), as a compliment to his daughter, who was the -wife of the King of Persia, sent to Djondisabour, the city in which -she resided, several Greek physicians; and Abulpharagius, the Arab -historian (thirteenth century), intimates that these were the men -who conducted the teaching in the newly established medical school. -Another possibility suggests itself. After the death of Alexander the -Great in Babylon (323 B. C.), from malarial fever, it is not unlikely -that some of the numerous Greek physicians who accompanied the army in -an official character, and who, we are warranted in believing, were -exceptionally well educated, decided not to remain in that unhealthy -district, but to settle in some of the neighboring towns (<i>e.g.</i>, -Nisibis in the hill country to the north of Babylon, or Sura to the -east of the river Tigris); and that these men also contributed their -share toward the planting and perpetuation of Greek medicine in this -district of the Orient. However, the salient fact in this period of -the history of medicine is this: When Almansur, the Caliph of Bagdad -(712 to 775 A. D.), made up his mind to introduce Greek medicine into -his kingdom and looked around for the ways and means of accomplishing -this, he found at the city of Djondisabour men who were not only well -versed in Greek medicine, but who at the same time were so thoroughly -grounded in all departments of scholarship that they could at once -begin the work of translating the writings of Hippocrates and other -classical medical authors into Arabic, the language of the Mohammedans. -But at this stage of affairs the existence of a serious obstacle was -discovered. The writings which it was proposed to translate<span class="pagenum" id="Page_185">[185]</span> were not -immediately obtainable, and it therefore became necessary to institute -without delay a vigorous search for the books required. In order that -the reader may appreciate fully the difficulties which Almansur had to -overcome, in this matter of a scarcity of Greek originals, it seems -best to pause at this point, and to review briefly some of the facts -which bear upon the question at issue.</p> - -<p><i>The Wholesale Destruction of Medical Literature during the Early -Centuries of the Christian Era.</i>—The invasion of Rome in 410 A. D. -was one of the first events which entailed a serious loss of the Greek -medical books that had been accumulating for several centuries in that -city. Fortunately, not a few of these works were rescued in time by -the church authorities and deposited for safe keeping in the various -monasteries scattered all over the Roman Empire. A still more serious -destruction of books occurred about the year 638 A. D., when Amrou, a -famous Arabian warrior, captured Alexandria and—under the instructions -of his master, Omar ben Khattab—destroyed the greater part of the -contents of the famous libraries located in that city. The narrative of -this event, as told by Lucien Le Clerc, is as follows:—</p> - -<div class="blockquot"> - -<p>John the Grammarian,<a id="FNanchor_43" href="#Footnote_43" class="fnanchor">[43]</a> who was living at that time in -Alexandria, held the following conversation with Amrou on a -certain occasion: “You have inspected all the edifices of -Alexandria, and have sequestrated all their contents. I have no -objections to your appropriating everything that may be of use -to you; there are certain things, however, which you may not -wish to possess, but which are highly prized by us.”</p> - -<p>“What are those objects?” inquired Amrou.</p> - -<p><span class="pagenum" id="Page_186">[186]</span></p> - -<p>“The works on philosophy, which are contained in the public -libraries,” John replied.</p> - -<p>“I can do nothing about them without a special order from the -Prince of Believers, Omar ben Khattab,” was the answer given by -Amrou.</p> - -<p>John’s wish having in the meantime been conveyed by the General -to Omar, the latter sent this reply:—</p> - -<p>“As to the books of which you speak, I have this to say. If -their contents agree with what is written in the word of God, -the books are of no use to us, the Holy Writ being sufficient -for our guidance. But if they are at variance with God’s word, -then surely they should be destroyed.”</p> - -<p>Amrou therefore ordered all the books to be sent to the bathing -establishments of Alexandria, to be used as fuel in heating -the baths. So great was the number of books contained in the -libraries that it took six months to consume them all. (Sismondi -questions the correctness of this account.)</p> -</div> - -<p>While the invasion of Rome by the Barbarians in the fifth century -and the capture of Alexandria by the Arabs in the early part of the -seventh gave rise to an enormous loss of valuable books relating to -medicine and philosophy in general, these were by no means the only -occasions when books were probably destroyed in great quantities. Wars -were frequent in those days and towns were constantly being sacked. -Everywhere throughout the East the modern traveler encounters the ruins -of large cities, and in those cities—the centres, as they were, of -wealth and culture—there must have been large collections of books. It -is not at all strange, therefore, that when the Caliph Almansur made -a serious beginning of the work which was to convert the Arabs into -rivals of the ancient Greeks, he should have found a great scarcity of -medical works which, after being translated, were to serve as manuals -of instruction. However, his ambition was very great, his wealth almost -inexhaustible, and his associates eager to aid him in realizing the -<i>renaissance</i> which he had planned for his people; and, as will -appear later on, he and those who aided him eventually succeeded in -overcoming this apparently insurmountable obstacle.</p> - -<p><span class="pagenum" id="Page_187">[187]</span></p> - -<p>Among the medical books which, upon the approach of the Goths, -were carried from Rome and other cities to different monasteries -for safe keeping there must have been very few that were written -in Latin, and yet these were the only ones from which the monks -individually could derive any benefit. Several centuries later, when -all the monasteries of Italy and the East were visited by those who -were searching eagerly for original manuscript copies of the Greek -medical writers,—Hippocrates, Soranus, Rufus of Ephesus, Aretaeus, -Dioscorides, Galen,—it was found that such copies existed in a number -of these institutions, thus showing that the monks had been actuated by -unselfish and far-seeing loyalty to the best interests of mankind when -they rescued these particular treasures from the hands of the enemy. -They themselves could make no use of them, being unable to read Greek, -but they knew their priceless value to medical science.</p> - -<p>The Latin treatises which they had also rescued, and of which they made -excellent use during the succeeding centuries, were those of Celsus, -Scribonius Largus, Pliny the Elder (to a slight degree only) and -Caelius Aurelianus.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_189">[189]</span></p> - -<h2>PART II<br /> -<span class="subhed">MEDIAEVAL MEDICINE</span></h2></div> - -<div class="chapter"> -<p><span class="pagenum" id="Page_191">[191]</span></p> - -<h3>CHAPTER XVII<br /> -<span class="subhed1">THE CONDITION OF MEDICINE AT BYZANTIUM DURING THE EARLY PART OF -THE MIDDLE AGES</span></h3></div> - -<p>The Byzantine period of the history of medicine begins about the middle -of the fourth century A. D. and retains some degree of importance up to -or perhaps a little beyond the beginning of the eighth century. During -this period of nearly four centuries there appeared on the scene five -physicians whose writings form a very creditable part of the late Greek -medical literature. The names of these authors are: Oribasius, Aëtius, -Alexander of Tralles, Theodore Priscianus and Paulus Aegineta.</p> - -<p><i>Oribasius.</i>—The first physician named in this list, Oribasius, -was born about the year 325 A. D. in Pergamum, an important city -of Asia Minor and the birthplace of Galen. He received his medical -training at Alexandria, settled in Constantinople (the new name given -to Byzantium), and soon afterward became the personal physician of -the Emperor Julian the Apostate, the nephew of Constantine the Great. -Subsequently he was appointed Quaestor of Constantinople, but, upon -the death of Julian (363 A. D.) and the accession of Valens and -Valentinianus to power, his property was confiscated and he himself was -obliged to take refuge among the Ostrogoths, who dwelt on the shores of -the Black Sea. These people received him with open arms, and he soon -acquired great influence among them. After a time, however, he was -recalled to Constantinople and all his former privileges were once more -granted to him. He died about the year 403 A. D.</p> - -<p><span class="pagenum" id="Page_192">[192]</span></p> - -<p>Despite his duties as a practicing physician of the very highest -rank—duties which he could not wholly set aside when he accepted the -office of Quaestor of Constantinople—and despite the necessity of -devoting considerable time to the work which this non-medical official -position entailed, Oribasius, like Pliny, appears to have been a most -energetic contributor to medical literature. We possess to-day, for -example, a large part of the medical cyclopaedia (72 books) which he -prepared at the command of the Emperor Julian, and which—even in its -incomplete state—contains very full information regarding anatomy, -physiology, surgery, pathology and pharmacology. Although the work -is simply a compilation, its present value is great, for it contains -numerous extracts from earlier and contemporary treatises, many of -which have entirely disappeared,—treatises of which we should have had -no knowledge whatever if Oribasius had not introduced numerous extracts -from them into his cyclopaedia.</p> - -<p>About the year 390 A. D., when Oribasius was already an old man, he -published (in nine books) a “Synopsis” of the larger work, chiefly -for the benefit of his son Eustathios, who was at that time studying -medicine. Surgery is omitted from this work, as that branch of medicine -was assumed to belong entirely to specialists. At a still later date -(about 395 A. D.), Oribasius published a third work (in four books) -entitled “Euporista,” which was intended chiefly for the use of -laymen. The subject-matter of this treatise consists of diet, hygiene -and general therapeutics. Neuburger speaks well of all three of the -published works of Oribasius, and furnishes a fairly full analysis of -the contents of each one.</p> - -<p>Bussemaker and Daremberg have published, in six volumes (Paris, -1856–1876), an excellent French version of the works of Oribasius.</p> - -<p><i>Priscianus.</i>—Theodorus Priscianus lived during the latter part -of the fourth and the first part of the fifth century of the present -era. Very little is known about his professional career beyond the -facts that he was a pupil of Vindicianus, a distinguished physician -who lived during<span class="pagenum" id="Page_193">[193]</span> the reign of the Emperor Valentinianus I. at -Constantinople (364–375 A. D.), and that subsequently he was chosen -the private physician of the Emperor Gratianus (375–383 A. D.). The -treatise which he composed, and which bore the title of “Euporiston,” -was originally written in Greek, but was afterward translated by -its author into Latin. An excellent German version of the work by -Meyer-Steineg was published in Jena in 1909. As the book was intended -by Priscianus to serve chiefly as a guide to practitioners of the -art, it contains practically nothing about anatomy and physiology. -In his pathology he follows closely the teachings of the Methodists; -his first question, in the presence of a case of illness, being: “Do -the symptoms point to a condition of <i>strictum</i> rather than to -one of <i>laxum</i>, or <i>vice versa</i>?” “In his treatment,” says -Meyer-Steineg, “Priscianus follows very closely the rule that every -patient, no matter what may be the disease with which he is affected, -should first undergo a certain amount of general treatment.” In his -choice of remedies Priscianus invariably gives the preference to those -agents which are of a simple character and easy to obtain. On the other -hand, he does not hesitate to admit that he sometimes employs certain -magical remedies, as is shown by the following quotation taken from -Book IV., Chapter I., section 4:—</p> - -<div class="blockquot"> - -<p>If a person wears, during the waning of the moon, a wreath -of polygonum on his head, he will obtain relief from his -headache.... If one drinks of the water from which an ox has -just drank, he will be relieved of the pain in his head.... If -a loadstone be held upon the head it will draw out the hidden -pain, and the same effect may be obtained by rubbing over the -forehead a swallow’s nest thoroughly mixed with vinegar.</p> -</div> - -<p>In Book I, paragraph 2, Priscianus draws a picture of the rude -and uncivilized behavior of the practitioners of his day in the -sick-room. The following are his words as translated from the German of -Meyer-Steineg:—</p> - -<div class="blockquot"> - -<p>As the patient lies on his bed prostrated by the severity of -the disease, there quickly comes into the room a crowd of us -physicians. No feeling of sympathy for the sick man have we, -nor do<span class="pagenum" id="Page_194">[194]</span> we realize how impotent we all are in the presence of -these forces of nature. Instead, we struggle to the utmost of -our ability to obtain charge of the case; one depending for -success on his powers of persuasion, a second on the strength -of the arguments which he is able to bring forward, a third on -his readiness to agree with everything that is said, and the -fourth on his skill in contradicting the opinion of everybody -else. And, as this quarrel goes on, the patient continues to lie -there in a state of exhaustion. “For shame!” Nature seems to -say, “you men are an ungrateful lot! You do not even permit the -patient to die quietly; you simply kill him. And then, moreover, -you accuse me of not furnishing sufficient means of effecting a -cure. Illness is certainly a painful affair, but I have provided -plenty of remedies. Poisons, I admit, are hidden in some of the -plants, but the healing agents which may be extracted from them -are much more numerous. Away, then, with your angry disputes and -your self-glorifying chatter; for in these are not to be found -the remedial agents which I have bestowed upon man, but rather -in the powerful forces which reside in the seeds, fruits, plants -and other objects which I have created in his interests.”</p> -</div> - -<p><i>Aëtius.</i>—Aëtius was a native of Amida, in Mesopotamia, and -he lived during the early part of the sixth century A. D., under -the Emperor Justinian I. He studied medicine at Alexandria and then -settled in Constantinople, where he was appointed to the double office -of private physician to the emperor and commanding officer of his -body-guard (<i>Comes obsequii</i>),—an arrangement which made it -practicable for the emperor to have his physician near his person on -all possible occasions. Almost nothing is known about the subsequent -private life and professional career of Aëtius beyond the facts that -he was a Christian and that he wrote a treatise on medicine in sixteen -books, which together form a large volume. The work, says Le Clerc, is -almost entirely a compilation from the treatises of earlier writers -on medicine and surgery; the best parts of the book being those which -relate to the pathology and treatment of internal diseases, to materia -medica, and to ophthalmology. The Christianity of Aëtius, like that of -Alexander of Tralles, and other physicians of a later period, appears -to have permitted a belief in magical<span class="pagenum" id="Page_195">[195]</span> remedies. For example, Aëtius -gives formulae containing the names of the Saviour and the Holy Martyrs -for exorcising certain maladies, and he recommends the employment of -amulets. The subject of baths is treated by him quite thoroughly, and -he lays stress upon the importance of physical exercise as a means of -maintaining one’s health. Freind, the author of an English history of -medicine which was very popular in its day,<a id="FNanchor_44" href="#Footnote_44" class="fnanchor">[44]</a> quotes the following -remedy for gout from the treatise of Aëtius:—</p> - -<ul class="smaller"> - <li>In September to drink milk;</li> - <li>in October to eat garlick;</li> - <li>in November to abstain from bathing;</li> - <li>in December not to eat cabbage;</li> - <li>in January to take a glass of pure wine in the morning;</li> - <li>in February to eat no beet;</li> - <li class="hangingindent">in March to mix sweet things both in eatables and drinkables;</li> - <li>in April not to eat horseradish;</li> - <li>nor in May the fish called Polypus;</li> - <li class="hangingindent">in June to drink cold water;—and so on through the remainder of the year.</li> -</ul> - -<p>At the end of the French version of “<i>Les Oeuvres de Rufus -d’Éphèse</i>” (translated from the Greek by Daremberg and Ruelle) -will be found fragments of some of the books of Aëtius; in 1899 J. -Hirschberg translated into German Book VII. (eye diseases) of the -same author; and, two years later (1901) Max Wegscheider published a -German version of Book XVI. (obstetrics and gynaecology). No other -translations of the writings of Aëtius into either French, German or -English are—so far as I am able to learn—available.</p> - -<p><i>Alexander of Tralles.</i>—Alexander of Tralles, a city of Lydia, -in Asia Minor, was born about 525 A. D. His father Stephanus was -highly esteemed as a practicing physician, and his four brothers, -all of them older than himself, were men of distinction in their -several callings; Anthemius, the oldest, being one of the greatest -mathematicians and mechanicians of his day and the man to<span class="pagenum" id="Page_196">[196]</span> whom the -Emperor Justinian intrusted the rebuilding of the church of St. -Sophia in Constantinople;<a id="FNanchor_45" href="#Footnote_45" class="fnanchor">[45]</a> Metrodorus, a celebrated grammarian and -the honored teacher of the youth belonging to the highest circles -of that metropolis; Olympius, a leading authority in jurisprudence; -and Dioscorus, a prominent physician in his native city. Alexander -received his first instruction in medicine from his father, but he -obtained his real training from a physician who was the father of his -most intimate friend Cosmas, and who, throughout Alexander’s entire -subsequent career, proved most helpful in advancing his interests. At -first he traveled extensively, visiting in succession—probably in -the capacity of a military surgeon—Italy, Northern Africa, Gaul and -Spain. Afterward, he settled permanently at Rome and practiced medicine -there during the remainder of a long life. Puschmann, the translator -of his writings, seems disposed to believe that he was both a teacher -and a practitioner of medicine during his residence in that city. When -he became too old to bear the heavy burdens of medical practice, he -wrote an account of his life,—a life which was rich in professional -experience,—and thus built for himself “a monument more striking and -more durable than the splendid temple erected by his eldest brother.” -(Meyer, quoted by Puschmann.)</p> - -<p>Various circumstances justify the conclusion that Alexander of Tralles -was a Christian. His style of writing is simple and direct, and he -states his views with a degree of modesty which wins for him at once -the sympathy and confidence of his readers. He gives full and generous -recognition to the great physicians who lived and wrote before his -time, and more especially to Hippocrates. On the other hand, he does -not hesitate, when he believes that he is right, to put forward views -which are in direct antagonism with those of even so great an authority -as Galen. In the domain of therapeutics, says Puschmann, Alexander was -decidedly superior to Galen. His teachings<span class="pagenum" id="Page_197">[197]</span> are based on experience -gained in actual practice, whereas Galen was very often disposed to -trust to considerations of a theoretical nature; for he was chiefly -interested in establishing the pathology of the different diseases and -in opening up new territories in medicine in which the human mind might -display its activity.</p> - -<p>The twelve books of which the treatise of Alexander of Tralles -consists, were printed in the original Greek for the first time in -1548, by Robert Étienne, the celebrated printer of Francis I., King of -France. The last and most perfect edition of the Greek text is that -of the late Dr. Theodore Puschmann, which was published in Vienna -in 1878 (two Vols.). It contains, in addition to the Greek version, -a careful analysis of the twelve individual books, and an admirable -German translation of the entire work. It is from the latter that the -following brief extracts (translated into English) are taken:—</p> - -<div class="blockquot"> - -<p><i>Introduction to the writings of Alexander of -Tralles.</i>—Upon a certain occasion, my dearest Cosmas, thou -didst urge me to publish my rich experiences in the domain of -practical medicine, and I am now gladly complying with thy wish, -for I feel under deep obligations to both thyself and thy father -for the kindness which you have shown to me on every possible -occasion in the past. Thy father was always a most helpful -patron to me, not only in my practice, but also in all other -relations of life. And thou also, even when thou wert living -abroad, stood staunchly by me through all the trials which I -experienced and the severe blows dealt me by Fate. For these -reasons I will now in my old age, when it is no longer possible -for me to endure the labor and worries of practice, do as thou -desirest, and will write a book in which shall be set forth the -experience which I have gained during my long service in the -treatment of disease. I hope that many of those who read what -is here written, with minds free from jealousy, will experience -real pleasure in noting the well-founded and scientific -character of the rules which I have laid down and the brevity -and preciseness of my descriptions. For I have done my very best -always to employ simple words, in order that everybody may find -it easy to understand my book.</p> - -<p><i>Some Magical Remedies or Amulets Recommended by Alexander -of Tralles, as Effective in the Treatment of Colic.</i>—The<span class="pagenum" id="Page_198">[198]</span> -Thracians remove the heart from a lark while the bird is still -alive, and wear it, prepared as an amulet, on the left thigh.</p> - -<p>Procure a little of the dung of a wolf, preferably some which -contains small bits of bone, and pack it in a tube which the -patient may easily wear as an amulet on his right arm, thigh, or -hip during the attack. He must be very careful, however, not to -allow the parts around the seat of the pain to come in contact -with the earth or with the water of a bath. This amulet is, in -my experience, an unfailing remedy, and almost all physicians of -any celebrity have commended its virtues.</p> - -<p>Remove the nipple-like projection from the caecum of a young -pig, mix myrrh with it, wrap it in the skin of a wolf or dog, -and instruct the patient to wear it as an amulet during the -waning of the moon. Striking effects may be looked for from this -remedy.</p> - -<p>Let the design of Hercules throttling a lion be engraved upon a -Median stone, and then instruct the patient to wear it on his -finger after it has been properly set in a ring of gold.</p> - -<p>Take an iron ring and have the hoop made eight-sided. Then -engrave upon the eighth side these words: “Flee, flee, oh Gaul! -the lark has sought thee out.” On the under surface of the -head or seal of the ring engrave the letters J. C., thus: -<img src="images/symbol.jpg" alt="symbol" -style="height:2em; padding:0 0em 0 0em;" /> - I have often made use of this amulet; -and, while I should consider it wrong to keep silence about a -remedial agent of such extraordinary efficacy in cases of colic, -I feel bound to say that it should not be recommended to the -first comer, but only to believers and to those individuals -who know how to guard it carefully. The Great Hippocrates, -with remarkable insight, gave the advice that things which are -holy should be intrusted only to those who are of a religious -character, and should be withheld from the profane. As regards -the ring, however, the patient must be careful, before wearing -it, to have a sketch made of it on either the seventeenth or the -twenty-first day of the moon.</p> -</div> - -<p>Alexander has been severely criticised for his advocacy of the -employment of amulets in the treatment of diseases; but he defends -himself against such criticism by saying that physicians owe it as a -duty to their patients to study carefully what he calls the hidden -forces of nature, and to pay unprejudiced attention to the effects -produced by amulets and other magical remedies. He reminds his critics -that Galen and other eminent medical authorities have insisted that -a place be given to this class of agents in the list of<span class="pagenum" id="Page_199">[199]</span> authorized -remedies; and he adds that Galen further emphasizes the duty of the -physician to employ them when other measures fail, or when the patients -themselves frankly confess that they have faith in their efficacy and -therefore wish them to be tried. Alexander also makes the statement -that Galen, after treating for a long time all reports about the -beneficial results obtained from the employment of magical measures -as old women’s tales, had finally decided that these benefits were at -times marvelous and should be accepted as genuine by physicians even if -they are unable to explain them.</p> - -<p>How much Alexander of Tralles really believed in these supernatural -agents, or to what extent he relied upon their effect in influencing -the imagination, we may not know; but his was an age of superstition, -and the conditions governing society at that time were very different -from those which control the world at the present day.</p> - -<p><i>Paulus Aegineta.</i>—Paulus Aegineta<a id="FNanchor_46" href="#Footnote_46" class="fnanchor">[46]</a> was born in the Island of -Aegina, not far from Athens, in the early part of the seventh century -A. D., and practiced medicine in Alexandria, Egypt. He is known to us -as the author of a compend of medicine which was very popular during -a long period of time, especially among the Arabs, who, as early as -two hundred years after his death, translated his work from the Greek -into their own language. At a still later period it was also translated -into Latin, the two best versions in this language which we now possess -being those of Guintherus Andernacus (Paris, 1532) and of J. Cornarius -(Basel, 1556). There is also an English translation by F. Adams (“The -Seven Books of Paulus Aegineta,” London, 1845–1847), which is favorably -spoken of by Neuburger, and which is apparently at the present time -the only existing version of the work of Paulus of Aegina in a modern -European language; for the French translation by René Briau (“<i>La -Chirurgie de Paul d’Égine</i>,” Paris, 1855) comprises only Book VI.</p> - -<p>The contents of the entire work are as follows: <i>Book -I.</i>—Dietetics of Pregnant Women and of Children;<span class="pagenum" id="Page_200">[200]</span> Children’s -Diseases; Massage, Gymnastics, Sexual Hygiene, Bathing, etc.; <i>Book -II.</i>—General Pathology, the Doctrine of Fevers, Semeiology; <i>Book -III.</i>—Diseases of the Hair, Diseases of the Brain and Nerves, -Diseases of the Eyes, Ears, Nose, Mouth, Teeth and Face; <i>Book -IV.</i>—Leprosy, Skin Diseases, Inflammations, Swellings, Tumors, -Wounds, Ulcers, Fistulae, Hemorrhage, Worms, Affections of the Joints, -etc.; <i>Book V.</i>—Toxicology; <i>Book VI.</i>—Surgery; <i>Book -VII.</i>—Materia Medica.</p> - -<p>To furnish even a very superficial analysis of the contents of this -treatise would call for more space than can well be given up here -to such a purpose. I shall therefore simply mention a few points of -special interest to which Neuburger calls attention in the course -of his very full analysis of the work. He states, for example, that -Paulus mentions several instances in which patients affected with lung -disease, coughed up calculi or small stone-like masses. He also states -that the same author was familiar with the fact that in the course of -“phthisis,” the pus may find its way into the bladder and there cause -ulceration [in other words, that pus containing tubercle baccilli -may flow down by way of the ureters and cause tuberculous ulceration -of the bladder]. Paulus’ theory regarding the origin of gout, adds -Neuburger, is quite remarkable for that early period. He maintains, for -example, that in persons who lead a rather inactive life and who are -often affected with digestive disorders, there is produced, through the -inadequate power of the tissues of the body to assimilate the excess -of nutriment brought to them, a <i>materies morbi</i> which is drawn -first to the parts that are weakest or least capable of resistance (the -joints, for example) and then also to other structures, as the liver, -spleen, throat, ears and teeth. These ideas—let it be remembered—were -set down in writing in 650 A. D.</p> - -<p>At the beginning of his analysis of Book VI., Neuburger makes this -remark: “Although the description given by Paulus of the surgery of -the ancients is based upon the writings of Hippocrates and Galen, as -well as upon those of Leonides, Soranus and Antyllus, one finds at -every step<span class="pagenum" id="Page_201">[201]</span> ample evidence that the writer possessed both independence -of judgment and the manual skill which belongs to a physician who is -familiar with surgical work.” He calls particular attention to the -section (No. 88) which deals with the manner of removing the heads of -arrows from wounds, and he gives special praise to Paulus for his most -instructive account of the diagnostic signs to be looked for in a case -of suspected wounding of a vital organ. He is extremely thorough, says -Neuburger, in his teachings about fractures and dislocations, and he -not infrequently differs from the views expressed by his predecessors.</p> - -<p>In the section devoted to gynaecological operations Paulus makes it -perfectly clear that he was in the habit of using a speculum of a very -practical form. Here are his words:—</p> - -<div class="blockquot"> - -<p>... and, while the operator is holding the instrument in -position, an assistant turns the screw until the blades of the -instrument have been separated to the distance desired.</p> -</div> - -<p>In other chapters of Book VI., Paulus furnishes most interesting and -minute descriptions of a great variety of operations in general surgery -and also in obstetrics, ophthalmology, otology and rhinology. Those who -desire to learn further details about these surgical matters should -consult the English version mentioned on a previous page.</p> - -<p>It is not at all unlikely that at some future day it will be found -desirable—by reason of the discovery of the treatises which they -are known to have written, but which have been lost—to add to this -short list of ancient medical authors the names of the following men -who are frequently quoted by them in their works: Antyllus, who made -some really valuable additions to our knowledge of the proper manner -of treating aneurysms, and who must have been a surgeon of great -resourcefulness; Leonides, the Alexandrian, who lived about the time of -Galen, and who appears to have been highly considered for his practical -common sense in the choice of surgical measures; Hesychios of Byzantium -and his distinguished son, Jacobus Psychrestus, who was highly spoken -of by his contemporaries<span class="pagenum" id="Page_202">[202]</span> (fifth century A. D.), in whose honor a -public statue was erected (Haller), and to whom is attributed the -saying: “A good physician should either decline at the start to take -charge of a patient, or else he should not leave him until he shall -have brought about some measure of improvement”; finally, Heliodorus, -and perhaps a few others who are less well known.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_203">[203]</span></p> - -<h3>CHAPTER XVIII<br /> -<span class="subhed1">BEGINNING OF THE ARAB RENAISSANCE UNDER THE CALIPHS OF BAGDAD</span></h3></div> - -<p>Toward the end of the sixth century A. D. the prospects for the -perpetuation and further evolution of Greek medicine looked decidedly -dark. In Rome and in the larger Italian towns of the Roman Empire, -physicians were doubtless still to be found, but they must have led -very precarious lives and they certainly could not have had any leisure -or opportunity for scientific work. In these earlier years of the -Middle Ages the monks conducted the larger part of whatever medical -practice was required in the districts in which the monasteries were -located. In Byzantium, also, the outlook at this period of Roman -history was very unfavorable; and nowhere else, as a matter of fact, -would it have been possible for the casual observer to discover any -signs that indicated the approach of a revival in the study of the -sciences. And yet, even at that seemingly darkest moment in the history -of medicine, there were forces at work which would soon revive these -precious seeds of Greek knowledge, and, after transplanting them to -a richer soil, cause them to produce even better fruit and in larger -quantities than ever before.</p> - -<p>The rulers under whose auspices the first steps in the great Arab -Renaissance were taken, belonged to what is known as the Abbaside -Dynasty, the founder of which was Abbas (566–652 A. D.), the uncle of -Mohammed. His descendants ruled as Caliphs of Bagdad, on the eastern -bank of the Tigris, for many centuries (from 750 A. D. onward).<a id="FNanchor_47" href="#Footnote_47" class="fnanchor">[47]</a> -Almansur, the second Caliph of this dynasty,<span class="pagenum" id="Page_204">[204]</span> felt a very strong desire -that his people, the Arabs, should acquire knowledge of all the useful -branches of learning, and more especially of medicine and philosophy; -and accordingly, as the Greeks were then universally admitted to be -the only nation which possessed that knowledge, and as scarcely any -scientific books written in the Arabic language existed at that early -date, he directed all his efforts to the finding of Greek originals and -of the men qualified to translate them into Arabic. Already as early -as the sixth century A. D., Sergius, a Christian of Ras el Ain, had -translated a considerable number of Greek treatises into the Syrian -tongue, but his work was found to be of an inferior character, and for -this reason could not be utilized to any great extent in the present -undertaking. Honein (ninth century), one of the most eminent scholars -of the Arabic Renaissance, revised a few of these translations and -thus rendered them of some service; but by far the larger part of this -gigantic task of creating Arabic versions of the classical works of -Greek literature, was performed during the ninth century, a period -during which the reign of the Arabs extended from the Ganges on the -east to the Atlantic on the west. By the end of the eighth century -the work of translating had advanced only to the point of producing a -single treatise on medicine and a few relating to alchemy; but before -the ninth was completed, the Arabs had in their possession, in the form -of translations, nearly all the scientific literature of Greece, and, -more than this, they could boast that not a few men belonging to their -own nation had already become celebrated as scientists of the very -first rank.</p> - -<p>The medical school at Djondisabour<a id="FNanchor_48" href="#Footnote_48" class="fnanchor">[48]</a> at the time (765 A. D.) when -the Caliph Almansur decided to carry out the ambitious scheme which -he had been meditating, was practically under the control of a family -of Nestorian Christians. A large hospital formed the nucleus of the -institution and furnished all the material needed for familiarizing the -student with the different diseases and<span class="pagenum" id="Page_205">[205]</span> injuries commonly encountered -in that part of the world and with the methods of treatment which, as -long experience had shown, offered the best chances of affording relief -or effecting a cure. It was a clinical school of a most practical type, -and at the head of it was George Bakhtichou, who had been recommended -to Almansur as the physician best fitted to take responsible charge of -the new work which was then about to begin. George Bakhtichou was not -the organizer of the school at Djondisabour, but simply its head at -the time of which I am now speaking. Medicine had been taught there, -it appears, since the early part of the seventh century A. D. The -languages commonly spoken in that town were the Syrian, the Arabian -and the Persian, and probably only a few persons understood Greek. The -Caliph believed that, as the first and most important step in the new -work, medical text books, translations of the works of the best Greek -physicians, should be provided with as little loss of time as possible, -and George Bakhtichou agreed with this opinion entirely. The latter, -therefore, upon the urgent invitation of the Caliph, left the hospital -at Djondisabour in the charge of his son, Bakhtichou ben Djordis, and -went to Bagdad in company with two of his pupils, Ibrahim and Issa ben -Chalata. He was well received at Court, partly because he displayed a -readiness to further the Caliph’s educational plans, and partly also -because he was promptly successful in relieving him of a distressing -dyspepsia. Not long after he had arrived in Bagdad, however, he was -himself taken ill and was obliged to return to Djondisabour. Before -his departure the Caliph presented him with a gift of 10,000 pieces of -gold. Issa ben Chalata, one of the two pupils whom George Bakhtichou -had brought with him to Bagdad, was left behind to look after the -Caliph’s health. He proved faithless to his trust, however; and, as -soon as it was discovered that he was selling his supposed influence -with the Caliph, he was not only dismissed in disgrace but all his -property was confiscated. After this disagreeable experience the Caliph -did his best to induce George to return to Court, but the latter was -then unable to travel,<span class="pagenum" id="Page_206">[206]</span> owing to the injuries which he had received -from an accidental fall. His pupil Ibrahim went to Bagdad in his place.</p> - -<p>It is known that George Bakhtichou personally took an active part in -the work of translating Greek medical treatises into Arabic, but it has -not yet been ascertained which books in particular were assigned to his -care in the distribution of the different tasks. Ossaibiah, the Arabian -historian, makes the statement that the work of translating Greek -medical treatises was entirely under the control and guidance of George -Bakhtichou; and in the “Continens” of Rhazes frequent mention is made -of the latter’s name. All of which confirms the belief that, at the -beginning of the Arabic Renaissance, George Bakhtichou was in reality -the head and front of the movement, so far at least as medicine was -concerned. When he became too old and infirm to continue his attendance -at the Djondisabour hospital, he intrusted the management of that -institution to Issa ben Thaherbakht, who was one of his best pupils. He -died in 771 A. D.</p> - -<p>In 786 A. D., Haroun Alraschid succeeded to the caliphate; and not long -afterward, on the occasion of some temporary illness, he requested -Bakhtichou ben Djordis, the son of George and his successor in the work -of translating from the Greek, to consult with the regularly appointed -physicians of the Court in regard to the nature and proper treatment of -his malady. The consultation took place at the appointed time, and one -of the Caliph’s physicians, thinking that he might catch Bakhtichou in -a trap, submitted to him a specimen of urine which purported to come -from the Caliph, but which in reality had been obtained from a beast of -burden. Alraschid, who knew of the deception, asked:—</p> - -<p>“What remedy would you administer to the person from whom this urine -came?”</p> - -<p>Bakhtichou, who had been clever enough to recognize the true character -of the specimen, replied promptly: “Some oats, your Majesty.”</p> - -<p>The Caliph laughed heartily over the episode, loaded<span class="pagenum" id="Page_207">[207]</span> George’s son -with presents, and appointed him the chief of all his physicians,—the -first instance among the Arabians, it is said, of the appointment of an -Archiater.</p> - -<p>Bakhtichou ben Djordis was the author of a collection of short medical -treatises, and he also wrote, for the special use of his son Gabriel, a -medical “remembrancer.” He was as highly esteemed by the Arabs as his -father had been before him. The date of his death is not known.</p> - -<p>Gabriel, the son of Bakhtichou and a grandson of the famous George -Bakhtichou, was the most distinguished member of this remarkable -family of physicians. In the year 792 A. D., five years after the -consultation mentioned above had taken place, Gabriel was sent by his -father to give medical advice to Jafar, the son of the Grand Vizier. -The treatment which he recommended proved to be entirely successful, -and, pleased with the result, Jafar soon afterward had an opportunity -to speak to Haroun Alraschid of Gabriel as the physician best fitted to -effect a cure in the case of his own favorite wife, who, in a fit of -yawning, had dislocated her shoulder. The Arabian physician had tried -friction, different sorts of ointments, and manipulations of every -imaginable kind, but all in vain. The dislocation still persisted. -When Gabriel arrived on the scene he told the Caliph that he could -bring the shoulder back into place provided no offense would be taken -at the means which he was about to employ. Alraschid gave the desired -promise and Gabriel made a movement as if he were about to lift up the -bedclothes. Instantly the patient, through a natural sense of modesty, -stretched out her dislocated arm to keep the bed-covering in place. -“There! she is cured!” exclaimed Gabriel, and such indeed was the -truth. The sudden movement of the limb had reduced the dislocation.—It -only remains for me to add that the sum of 500,000 drachmae<a id="FNanchor_49" href="#Footnote_49" class="fnanchor">[49]</a> was -paid to Gabriel by Haroun Alraschid for his successful treatment.</p> - -<p>Some surprise having been expressed by the Caliph’s<span class="pagenum" id="Page_208">[208]</span> relatives that -he should display such extravagant generosity toward a Christian, he -replied: “The fate of the empire is bound up in my fate, and my life is -in the hands of Gabriel.”</p> - -<p>Gabriel Bakhtichou died in the early part of the ninth century, not -long after the Caliph El Mâmoun had started on his expedition against -the Greeks (828 A. D.). He was the author of several medical treatises, -and, like his famous grandfather, George Bakhtichou, he did everything -in his power to promote the work of translating from the Greek -into the Arabic. Gabriel’s brother, also named George, and his son -Bakhtichou ben Djabriel were both of them physicians of considerable -distinction. The latter accompanied El Mâmoun on his expedition against -the Greeks. It is a fact worth noting here, that throughout this war -the Caliph never for a moment lost sight of the great national scheme -of education which his predecessor Almansur had inaugurated and which -was still engaging the time and best efforts of many scholars and -copyists in Bagdad. Whenever he captured a city he insisted upon the -delivery to him of whatever copies of scientific treatises its citizens -might possess. But even these extraordinary methods of securing the -books which they needed did not satisfy the Arabs, their eagerness -to accumulate as many text books as possible being insatiable. -Accordingly, from time to time, one of the translators—some member -of the Bakhtichou family, for example—would be sent to the different -cities of Syria and Persia to search out and get possession of as -many Greek manuscripts as possible. Thus, Honein is reported to have -said: “I have not been able to procure a complete copy of Galen’s -‘Demonstration.’ Gabriel endeavored to find a copy, but did not -succeed; and I myself hunted through Irak, Syria, Palestine and Egypt, -but was at last only partially successful. I found one-half of the text -in Damascus.”</p> - -<p>The work of translation was kept up with unremitting zeal until the -middle of the ninth century (reigns of El Ouatocq and of Moutaouakkel).</p> - -<p>Among the physicians who received their training at the<span class="pagenum" id="Page_209">[209]</span> Djondisabour -medical school the Bakhtichous were not the only ones who attained -considerable distinction. John Mesué the Elder,<a id="FNanchor_50" href="#Footnote_50" class="fnanchor">[50]</a> for example, -who was a Nestorian Christian and the son of an apothecary, became -more famous than any member of that family. He not only did his full -share of the translating, but he was also a prolific author and a -very faithful and efficient teacher, Galen’s writings furnishing the -basis of his lectures. He lived to be about eighty years of age, his -death occurring in 857 A. D. Most of his writings have been lost. Of -the twenty or more which have come down to our time those bearing the -following titles deserve to receive special mention:—</p> - -<ul class="smaller"> - <li>Book of Fevers.</li> - <li>On the Different kinds of Food and Drink.</li> - <li>On Venesection and Scarifications.</li> - <li>On Tubercular Leprosy.</li> - <li>On Abnormal Prominence of the Abdomen.</li> - <li>On Purgative Remedies.</li> - <li>On Baths.</li> - <li>On the Regulation of Diet.</li> - <li>On Poisons and Poisoning.</li> - <li>On Vertigo.</li> - <li>On the Treatment of Sterility.</li> - <li>On Dentifrices and Gargles.</li> -</ul> - -<p>Sabour ben Sahl, whose death occurred in 869 A. D., was also connected -with the hospital at Djondisabour. He was distinguished on account -of his special knowledge of the properties of simple drugs and their -combinations. He was also the author of the exhaustive formulary -known as <i>Acrabadin Kebir</i>—probably the first one of its kind, -says Le Clerc, of which history makes any mention. This formulary or -dispensatory—of which a large and a small edition existed—was in -general use in all the hospitals, physicians’ offices, etc., of that -time.</p> - -<p>Still another most distinguished physician and author of medical -treatises received his training at the Djondisabour<span class="pagenum" id="Page_210">[210]</span> school—viz., -John, son of Serapion (or Serapion the Elder, as he is commonly -called). He lived about the middle of the ninth century of the -Christian era and wrote entirely in the Syrian language, but at a later -date his works were all translated into Arabic. The smaller of his two -most important treatises, and at the same time the one which appears -to have attracted the most attention, was called the Kounnach. About -the middle of the twelfth century A. D. it was translated into Latin by -Gerard of Cremona, and named by him <i>Breviarium</i>; a still later -translation received the name of <i>Practica</i>. The first part of -this smaller treatise (the Breviarium or the Practica) is divided into -six books, the titles of which are as follows:—</p> - -<ul class="smaller"> - <li>1. On Nodosities, Ophiasis, and Alopecia.</li> - <li>2. On the Falling Out of the Eyelashes.</li> - <li class="hangingindent">3. On the Mild Form of Tinea, the form which resembles Favus.</li> - <li class="hangingindent">4. Scaly Affections of the Head and of Other Parts of the Skin.</li> - <li>5. Lice of the Head and of the Body.</li> - <li class="hangingindent">6. Headache caused by Exposure to the Sun; and other forms of Cephalalgia.</li> -</ul> - -<p>Salmouïh ben Bayan, a Christian, was the last one of the pupils of the -Djondisabour school who attained considerable celebrity as a physician. -When the Caliph Motassem came to the throne in 833 A. D., he appointed -Salmouïh his personal physician and soon became very much attached -to him; leaning upon him more and more for advice in all sorts of -troubles. Salmouïh was the author of several medical treatises, but -they have all been lost, not even their titles are now known to us. -When dying (early in 840 A. D.), he sent word to the Caliph not to -put his entire trust in the medical judgment of Mesué if he should -find it necessary to call upon the latter for advice in the event of a -serious attack of illness. This celebrated physician was universally -admitted to be most learned in everything relating to medicine, but -there were many of his professional brethren—and Salmouïh was among -the number—who did not esteem him so highly as a practitioner. “The -most important thing in medicine,” said the latter,<span class="pagenum" id="Page_211">[211]</span> “is to appreciate -correctly the intensity of the disease, and that is something which -Mesué, with all his learning, is not able to do.” However, despite the -death-bed warning given by Salmouïh to Motassem, this ruler died less -than two years later from the effects of the treatment which Mesué -the Elder, who had been called in to prescribe for his Highness, had -ordered.</p> - -<p>In addition to the pupils already mentioned there are a few others who, -according to the testimony of Le Clerc, reflected some credit upon the -institution in which they acquired their medical training. But enough -has already been said, I believe, to establish the fact that, in this -remote Persian province of Khorassan (to the west of the country known -to-day as Afghanistan), there existed during the eighth and ninth -centuries of the present era a most efficient medical school, which was -entirely managed by Nestorian Christians, and which sent out into the -world trained physicians of the very highest type.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_212">[212]</span></p> - -<h3>CHAPTER XIX<br /> -<span class="subhed1">FURTHER ADVANCE OF THE ARAB RENAISSANCE DURING THE NINTH AND -SUCCEEDING CENTURIES OF THE CHRISTIAN ERA</span></h3></div> - -<p>During the latter part of the eighth century the Arab Renaissance, so -far at least as the science of medicine was concerned, was controlled -and kept in vigorous life almost entirely by physicians who were -connected with the school at Djondisabour—one might almost say, by -physicians who were members of the Bakhtichou family. To this family, -therefore, belongs the chief credit for the admirable results attained -during this, the first stage of the Renaissance. But during the ninth -century A. D. men who had not received their professional training -at this famous school came to the fore and gave a fresh and a more -vigorous impulse to the work than their predecessors had given. Under -the Bakhtichous the translating had been well started, and in addition -a few original medical treatises had been written in the Arabic -language. During the period which followed, however, the translating -and copying became more active than before, and, in addition, several -really valuable treatises were produced by men who wrote in Arabic, -and who were—if not racially Arabs—at least the adopted sons of that -nation. Of these men none stands out more prominently than Honein, who, -according to Le Clerc, “accomplished a marvellous amount of work of -the most varied character and of a very high degree of excellence, and -that too despite many obstacles. While he was not the originator of the -Renaissance in the East, he took the most active part in keeping it up.”</p> - -<p>Honein, who may rightly be considered as having at least inaugurated -the second stage of the Arab Renaissance,<span class="pagenum" id="Page_213">[213]</span> was born in 809 A. D. at -Hira, where his father Isaac, a Christian Arab, conducted a pharmacy. -The inhabitants of this town were known to be somewhat lacking in -cultivation, and it was therefore not surprising that, when Honein -went to Bagdad and presented himself to John, the son of Mesué, as one -who wished to become his pupil, his request was promptly declined on -the general ground that the people of Hira had not received sufficient -education to warrant any one of their number in undertaking the study -of medicine. This decision was of course a great disappointment to -Honein, but it disturbed him only for a short time. Soon afterward he -went to Greece where he worked hard to perfect himself in the knowledge -of the Greek language. Then, after a residence of two years in that -country, he returned to Bagdad, taking with him a considerable supply -of Greek books. His next step was directed toward gaining a better -knowledge of Arabic, and with this object in view he spent some time -in Bassora, a town which was situated not far to the south of Bagdad, -and which possessed good educational facilities. While residing there -he devoted a certain portion of his time to the translation of Galen’s -treatise on anatomy; and he was accordingly prepared, upon his return -to Bagdad, to submit to John, the son of Mesué, and to Gabriel, the son -of Bakhtichou (who by that time was well advanced in years), a specimen -of the work upon which he had been engaged. Both of these men were -greatly pleased with the excellence of the translation, and encouraged -Honein to go on with the work. El Mâmoun (the second son of Haroun -Alraschid), who was the then reigning Caliph, engaged his services both -as a translator of Greek writings (into Syriac as well as Arabic) and -as a reviser of the translations which had been made by others, and he -paid him most generously for these services. According to Le Clerc, -the amount of literary work done by Honein was simply prodigious. -He translated large portions of the treatises of Galen, Oribasius -and Paulus Aegineta, as well as several of the works of Aristotle -and of Plato, of the mathematicians and astronomers, and also of the -philosophers; and<span class="pagenum" id="Page_214">[214]</span> in addition he wrote a large number of original -treatises—such, for example, as a complete set of commentaries on the -writings of Hippocrates, a practical work on the diseases of the eyes, -etc.</p> - -<p>The following account of Honein’s experience at the Court of the Caliph -Moutaouakkel (middle of the ninth century A. D.) furnishes some insight -into his character:—</p> - -<div class="blockquot"> - -<p>The Caliph, who had heard of the great learning, ability, and -industry of Honein, but who had at the same time feared that he -might be in secret communication with the Greeks, decided to -subject him to a test that would reveal how far he was venal. -Accordingly he sent for him, clothed him in robes of honor, gave -him 50,000 drachmae, and then said:</p> - -<p>“I wish that thou wouldst prepare for me a secret combination of -drugs which will enable me to get rid of one of my enemies.”</p> - -<p>Honein replied: “I have no knowledge of any but salutary -remedies, and it never occurred to me that the Prince of -Believers might ask me to furnish those of a different kind. -However, if it be the wish of your Majesty, I will see what I -can do; but I shall require plenty of time.”</p> - -<p>After waiting in vain for the desired preparation and finding -that even threats failed to accomplish anything the Caliph put -Honein in prison. Then, at the end of a year, which interval -the latter had employed diligently in the work of translating, -Moutaouakkel gave orders for the prisoner to be brought into -his presence. Before this was done, however, a heap of objects -of value was placed on one side of the room and instruments of -torture on the other. When Honein was brought in, the Caliph -said to him: “Time is passing, and my wishes have not yet been -gratified. If thou art now ready to obey my behest, these -treasures and many others in addition shall be thine. But, if -thou continuest to refuse, I will subject thee to tortures and -will finally put thee to death.”</p> - -<p>“I have already told the Prince of Believers,” replied Honein, -“that my knowledge is limited to the preparation of salutary -remedies.”</p> - -<p>Whereupon the Caliph said: “Have no fear! I simply wished to -test thee! But tell me, what are the reasons upon which thy -refusal is based?”</p> - -<p>“There are two reasons,” replied Honein: “my religion and my -profession. The first teaches us to do good to our enemies; -and<span class="pagenum" id="Page_215">[215]</span> the second, not to do any harm to the human race. Every -physician has registered an oath that he will never administer a -poison.”</p> - -<p>“Those are two excellent laws,” remarked the Caliph; and he -proceeded to load Honein with presents.</p> -</div> - -<p>Among those who were associated with Honein in his work of translating -Greek medical books into Arabic there are three whose names also -deserve to be remembered. They are: his son Isaac; his nephew Hobeïch; -and a Christian Greek named Costa ben Luca, whose residence was at -Baalbek. To men of the present time all these names of oriental -physicians are, as a rule, mere meaningless words, conveying no idea -of an important relationship to the evolution of medicine. During the -ninth and tenth centuries of the present era, however, and indeed -for many years subsequent to that time, they were accorded by the -physicians of that period almost as much honor for the part which they -took in furthering the revival of medicine among the Arabs as was given -to Honein himself. It seems therefore appropriate that at least a brief -account of the lives of these men and of the work which they did should -be given here.</p> - -<p>Isaac received his education from his father Honein, and soon after -reaching manhood he was set to work translating from the Greek into -both Syrian and Arabic—two sister languages. He was a man of great -intelligence, and was thought by many to be the equal of his father -in the knowledge of Greek, Syriac and Arabic. He also had, like his -father, the good fortune to find favor with the rulers of that period. -He died in 912 A. D. as the result of a stroke of cerebral apoplexy. -In addition to his translations he wrote original treatises on the -following topics:—</p> - -<ul class="smaller"> - <li>Simple Medicaments.</li> - <li>Origins of Medicine.</li> - <li>Correctives of Purgative Remedies.</li> - <li>Treatment by Cutting Instruments.</li> - <li>The means of Preserving the Health and the Memory.</li> -</ul> - -<p>Hobeïch was the son of Honein’s sister. The date of his birth is not -known. He received his training in the languages<span class="pagenum" id="Page_216">[216]</span> from his uncle, and -in the course of time became associated with the latter in the work -of translating. Eventually he reached his uncle’s high standard of -scholarship, and the text of his translations was from that time forth -accepted without any revision. The Caliph Moutaouakkel appointed him -Court Physician, and the immediate successors of this Caliph retained -him in the same position. His death occurred during the second half of -the ninth century of the Christian era.</p> - -<p>Hobeïch translated the “Oath of Hippocrates” and a large number of the -more important of Galen’s treatises. In addition, he left to posterity -several original writings. Quotations from these are to be found in the -works of Rhazes, of Ebn el Beithar, and of Serapion the Younger, and -they reveal two important facts: first, that Hobeïch was an excellent -practicing physician; and, second, that the Arabs had already at this -comparatively early date begun to gather their medical information -from other sources than the Greek treatises. The following drugs, for -example, are described by Hobeïch in the quotations just mentioned, and -yet they do not appear to have been known to the Greek medical writers: -Turbith, Convolvulus of the Nile, Nux Vomica, Colocynth, Croton -Tiglium, Aloes and Myrobolans.</p> - -<p>Costa, the son of Luca, was a Christian Greek from Baalbek, in Syria. -The dates of his birth and death are not known, but it is believed that -he lived during the first half of the tenth century of the present era. -He was an excellent Greek and Arabic scholar and was also familiar with -the Syriac language. His translations were esteemed equal to those -of Honein. After spending some time in Greece he settled in Irak, a -province of Persia, and devoted himself to the translation of the books -which he had brought with him from Greece. At a later period of his -life he removed to Armenia, a country which lies to the north of Irak, -between it and the Black Sea, and it was during his residence there -that he wrote a number of treatises. It was in Armenia, also, so far as -may be judged from the accounts which we possess, that his death took<span class="pagenum" id="Page_217">[217]</span> -place. As an evidence of the fact that he was highly esteemed by his -contemporaries, his biographer states that a cupola was built over his -tomb.</p> - -<p>Among the medical works which he translated from the Greek the -following are the only ones of special importance: The Aphorisms of -Hippocrates, and Galen’s commentaries upon them.</p> - -<p>The ninth century, the period during which the major portion of the -work described in the preceding part of this chapter was accomplished, -is considered by Lucien Le Clerc the most remarkable in the worlds -history. He speaks of it in the following terms:—</p> - -<div class="blockquot"> - -<p>Its greatness is emphasized by the fact that, except in this one -corner of the globe, everything was in a state of decadence.... -Great as is the credit due the Abbaside Dynasty and its -ministers, still greater is our admiration for the Arab nation -on account of the eagerness with which it met the wishes of its -rulers and also because it pursued resolutely, and despite all -the obstacles (political and religious) which were placed in -its way, the course laid down for it to follow.... The Arabs -also knew how to choose men who were really eminent and to -rescue them from lives which otherwise would probably have been -sterile; they claimed the inheritance of Greek science; and they -revealed to the world that they were worthy of this inheritance.</p> -</div> - -<p>Some idea of the completeness of the list of Greek medical works which -the Arabs translated may be gained from the fact that Galen’s writings -are more complete in the Arabic than they are in the Greek, the -language in which they were originally composed.</p> - -<p>With Costa the second stage in the Arab Renaissance came to an end. -All the work accomplished at Bagdad up to this period in our history -received its inspiration from the different Caliphs belonging to -the Abbaside Dynasty. But now the political conditions in the East -underwent a change, and other Arabian dynasties, each in its turn, -gained control of the power previously wielded by Almansur, Haroun -Alraschid and their successors. Fortunately, all of these new rulers -seem to have been favorably inclined toward the revival of literature, -and<span class="pagenum" id="Page_218">[218]</span> consequently the Arabs continued to take an active part in the -advance of medical knowledge during the tenth and eleventh centuries. -Bagdad, however, ceased to be the centre of all this intellectual -activity, and eventually Cordova in Spain almost rivaled the capital -of ancient Greece in the eagerness with which she sought to increase -her stores of books, and in her readiness to honor scholars. By this -time the Arabs controlled, not only Persia and Arabia, but also Egypt, -Palestine, Syria, Marseilles, the coast of Asia Minor, Greece, Sicily, -the northern part of Africa and Spain. Owing to the limited space at my -command I shall be obliged to confine my account to the more salient -features of the progress made during this later or third stage of the -Arab Renaissance.</p> - -<p>Already as early as toward the end of the ninth century the number of -physicians in the East had increased so greatly, and the territory -where well-educated medical men were to be found had broadened to -such an extent, that I shall now be obliged, in order to maintain -some approach to chronological order in my account of the evolution -of medical science, to treat the subject according to countries. If -the men who stand out foremost in this third stage of the scientific -renaissance are not in every instance Arabs or Persians or Syrians, I -may at least claim that they are the product, directly or indirectly, -of the great Arab movement. The countries in which their best work was -done are the following: Persia (apart from Bagdad and its immediate -neighborhood), Egypt, Magreb (the modern Algiers and Tunis), Fez -and Spain. But, before I consider the progress of medicine in these -different parts of the Orient, I should say at least a few words about -the events which characterized the cessation of literary work at -Bagdad. As might be expected, that city, after the Greek medical and -scientific treatises had all been translated into Arabic, gradually -lost its pre-eminence as a centre of learning, and new centres -developed in other cities throughout the vast Musulman Empire. It must -not be inferred, however, that this change was wholly or even largely -due to the cessation of literary work. Other factors contributed<span class="pagenum" id="Page_219">[219]</span> to -this result, viz.: the decadence of the caliphate and the fact that -the caliphs themselves appeared to lose their interest in promoting -the sciences actively. It was not until during the tenth century that -any further interest in the advancement of medical science was taken -by those in authority at Bagdad. Then the Emir Adhad Eddoula built a -splendid hospital, and organized it on the basis of several separate -services—one for fever cases, another for accidental injuries, a third -for ophthalmic cases, and so on. Twenty-four physicians, who had been -selected because of their special aptitude for some particular class of -medical work, were appointed to take charge of the different services; -and it is interesting to note that nearly all of these men bear Arab -names. Nevertheless, for a still further period of many years, says Le -Clerc, there continued to be as many Christian as Mohammedan physicians -in Bagdad.</p> - -<p>In the tenth century other hospitals were established in Bagdad. Thus, -in 914 A. D., the Vizir Ali ben Issa founded one which he endowed -in the most liberal manner. This Vizir must have been a most humane -person, for, when the physician-in-charge wrote to him for further -instructions regarding the course which he should pursue with respect -to people of different religions, the Vizir replied: “Use the fund for -the benefit of all classes alike, and be sure to remember the animals.”</p> - -<p><i>Persia.</i>—Rhazes, whose full name is Abou Beer Mohammed ben -Zakarya, is generally admitted to have been the most illustrious of -Persia’s physicians, and probably the most distinguished representative -of Arab medical learning. He was born at Raj, in the Province of -Khorassan, about 850 A. D. After he had received his professional -training at Bagdad, he settled at Raj and was soon afterward appointed -director of the local hospital. At a later date he was placed in -charge of the hospital at Bagdad, but before many months had elapsed -he returned to Raj, his native town, and here he spent most of the -remaining years of his long life. The date of his death is stated by -Haeser as either 923 or 932 A. D., but Le Clerc mentions only the -latter date.</p> - -<p><span class="pagenum" id="Page_220">[220]</span></p> - -<p>Rhazes was a very hard worker and was highly esteemed by his fellow -countrymen, who called him the Arabian Galen. The total number of -writings which he left behind him at the time of his death was -237, most of them dealing with medical subjects. A few of them, -however, were devoted to the discussion of chemical, anatomical and -philosophical questions. To-day we possess only 36 of the treatises -written by Rhazes, and of this number only six have been printed in -Latin. His greatest work, as all critics admit, is that which is -commonly known as the “Continens” (or “El Haouy”). In this work, which -is divided into twenty-two books, Rhazes gives in a condensed form the -views entertained by all his predecessors regarding the more important -questions in medical science, and then adds thereto the conclusions -which his own experience has led him to form.</p> - -<p>He also wrote a second treatise (in ten books) which was esteemed -by the physicians of that and later periods almost as highly as -the Continens. It was called the “Mansoury,” and its contents are -distributed as follows: I., Anatomy; II., the Different Temperaments; -III., Alimentary Substances and Drugs; IV., Hygiene; V., Cosmetics; -VI., the Regimen to be adopted in Traveling; VII., Surgery; VIII., -Poisons; IX., Maladies in General; X., Fevers.</p> - -<p>A third treatise of considerable importance is that which is devoted -by Rhazes to the description and treatment of small-pox and measles. -So far as is known at the present time this is the first treatise that -has been written on these diseases, and its celebrity rests, not only -upon this circumstance, but also upon the facts that its author is -evidently familiar with the different types of small-pox and with the -characteristic features which distinguish this disease from measles. -Freind, in commenting upon this treatise, says that Rhazes assigned -for small-pox a cause “entirely new in physick, a sort of an <i>innate -contagion</i>. This is a <i>ferment</i> in the blood, like that in -must, which purifies itself sooner or later by throwing off the peccant -matter at the glands of the skin; an hypothesis since applied, though -upon very slight grounds, to feavers in general<span class="pagenum" id="Page_221">[221]</span> by many moderns.” From -this account it is fair to conclude that Rhazes, in the tenth century -of the Christian era, as clearly suspected the germ origin of certain -febrile diseases as Liebermeister did toward the end of the nineteenth, -or as Fracastoro did in the sixteenth. And one cannot help exclaiming: -How many centuries had to elapse, and what an immense amount of other -facts had still to be discovered—facts in anatomy, in physiology, in -chemistry, in optics, etc.—before it became possible to convert this -suspicion, this simple product of the reasoning faculty, into an actual -demonstration of the truth in pathology!</p> - -<p>Among the Arabian physicians of the eleventh century Avicenna is -certainly one who should be placed in the first rank. He was born in -980 A. D. at Afschena, a village in the Province of Khorassan, Persia, -and spent his youth in Bokhara, where his father held some high office -under the Government. His great intellectual capacity was revealed at -an early age. It is said, for example, that already before he was ten -years old he had committed the entire Koran to memory; and it is added, -further, that when he was only seventeen years old he had already -acquired such knowledge of medicine that he was invited to take part -in a consultation regarding some malady with which the Emir Nuch ben -Mansur was affected. The advice which he gave on this occasion was -followed, and in the sequel it proved so good that he was granted, as -a reward, unrestricted access to the royal library,—a privilege which -he utilized to the very best advantage. When his father died Avicenna -came into possession of a large fortune, which enabled him to indulge -in a great deal of traveling. In this way he visited one Persian Court -after another throughout a period of several years. Finally, during a -residence at Hamadan, the Prince Schems ed-Daula, whom Avicenna had -successfully treated for some malady, made him his Vizir. While he -held this office he managed, without neglecting his official duties, -to continue his scientific studies; but he was not able entirely to -keep out of political intrigues, and as a consequence his life was for -a short time in some danger. He was confined for several months<span class="pagenum" id="Page_222">[222]</span> in a -fortress, from which, however, he managed eventually to make his escape -to the Court of Ibn Kakujah, in Ispahan. He resided in that city during -the following fourteen years, and it was there that he wrote his two -principal works—the famous medical treatise known as the “Canon,” and -the equally celebrated cyclopaedic work on philosophy. Worn out by -his incessant and most exhausting literary labors and by his excesses -in other directions, Avicenna died in June, 1037 A. D., while he was -accompanying the Emir on his expedition to Hamadan. His tomb may still -be seen in the latter city.</p> - -<p>Neuburger, from whose excellent History of Medicine the preceding -details have been gleaned, makes the statement that the treatise in -which Avicenna’s clinical experience was recorded has not come down to -our time, and that, consequently, we lack the means of estimating just -how great a physician—just how close a clinical observer and how wise -a practitioner—he really was. So far, however, as may be judged from -the evidence furnished by the Canon, Avicenna was not the equal, in all -practical matters relating to medicine, of Haly Abbas and of Rhazes. -He was perhaps too much inclined to “look at bedside phenomena through -the spectacles of preconceived theories.” In brief, he was, first and -foremost, a philosopher, and only in a subordinate degree a physician, -although a most excellent one. In Book III., where he discusses certain -surgical procedures, statements are made which justify the belief that -Avicenna was acquainted with intubation of the larynx.</p> - -<p>Le Clerc mentions six other Persians who, during the tenth century of -the present era, gained more or less distinction as physicians. In the -following paragraphs brief notices are given of each of these men.</p> - -<p>Eben el Khammar, born in 942 A. D., was a Christian and an excellent -practitioner. He was well versed in the science of medicine and a -writer of some importance. Date of death unknown.</p> - -<p>Abou Sahl el Messihy, who was also a Christian, was a contemporary and -intimate friend of Avicenna. He died in 1000 A. D. He was the author -of a complete and very<span class="pagenum" id="Page_223">[223]</span> useful summary of medicine, entitled “Kitab el -Meya”; and the Arab historian Ossaibiah speaks in terms of admiration -of another treatise which he wrote and which bears the title, -“Exposition of God’s wisdom as Manifested in the Creation of Man.”</p> - -<p>Abou Soleiman Essedjestany, commonly called “El Mantaky.” The dates -of his birth and death are not known. He wrote a number of treatises, -and—among others—one on “The Organization of the Human Faculties.”</p> - -<p>Aboul Hassan Ahmed Etthabary, a native of Thabaristan, in the Province -of Khorassan. He was employed as a physician by the Emir Rokn eddoula -ben Bouïh, and is known as the author of a compendium of medicine -entitled: “Hippocratic Methods of Treatment.” He died in 970 A. D.</p> - -<p>El Comry was one of the most eminent medical practitioners of his time, -and was in high favor with the royal household. He wrote a compendium -of medicine which bears the title “R’any ou Many,” and he was also -the author of a treatise on the causes of disease. His death occurred -toward the end of the tenth century of the Christian era.</p> - -<p>Alfaraby, who is highly commended by Avicenna, should be classed among -the philosophers rather than among the physicians. He died in 950 A. D.</p> - -<p>The sixth Persian physician of some distinction mentioned by Le Clerc -is Ali ben el Abbas—usually spoken of as Haly Abbas. The dates of his -birth and death are not stated by any of the authorities, but it is -known that he was a native of Ahouaz, a small town on the Karun river, -to the southeast of Bagdad, and that he was still living in 994 A. D. -Haly Abbas, it is claimed, was the first medical writer who ventured to -prepare a complete and systematically arranged Practice of Medicine. -He gave it the title of Al-Maleky—“The Royal Book,”—and dedicated -it to the Emir Adhad-ad-Daula, whose private physician he was. It is -a much smaller treatise than the “Continens” of Rhazes, and somewhat -more complete than the same<span class="pagenum" id="Page_224">[224]</span> author’s shorter work—the “Mansoury.” It -covers the entire field of medicine and is distinguished by its very -practical character. It was first translated into Latin in 1127 A. D.</p> - -<p>Haly Abbas, in one of his treatises, speaks of Hippocrates in the -following terms: “Hippocrates, who is the prince of the medical art and -the first physician who ever wrote a book on this art, is the author of -many treatises on all sorts of medical topics.... But he writes in such -a very concise manner that much of what he says is obscure, and as a -consequence the reader, if he wishes to understand him, is obliged to -seek the aid of a commentary.”</p> - -<p><i>Egypt.</i>—The dynasty of the Fatimides—the descendants of Fatima -(the daughter of Mohammed) and of Ismael, a great-grandson of Ali, the -fourth of Mohammed’s successors—reigned over Egypt for nearly two -centuries (10th to 12th of the present era), and they showed toward -the scientists the same spirit of generosity that had been manifested -toward them by the Abbasides in the earlier part of their reign. In 970 -A. D. Moëz Eddoula drove out the reigning family, assumed the title of -Caliph, and founded the city of Cairo. In 972 he built the celebrated -mosque Al Azhar and constructed, as a sort of annex to it, a school, a -veritable university, where ultimately all the sciences were taught. -It throve vigorously, and students flocked to it in great numbers from -all quarters of the Moslem empire. During the eleventh and twelfth -centuries Egypt was once more, as it had been in the palmy days of -Alexandria, the home of many excellent and vigorous institutions of -learning. Among the physicians, however, who received their education -in medicine at Cairo during this long period, there was not one who -attained great eminence.</p> - -<p>At the end of the eleventh century the Crusaders, under the leadership -of Godfrey de Bouillon and others, made their first serious attack -on Palestine and Syria, and from that time onward, for about two -centuries, they and the different armies sent out successively -from Europe carried on almost constant warfare, which Michaud the -distinguished<span class="pagenum" id="Page_225">[225]</span> French historian (about 1800 A. D.) calls the product -of a pious delirium. Wars of religion are the most savage and pitiless -of all wars, says Le Clerc, and this was emphatically true of those -waged by the Crusaders. On the other hand, says the same writer, “the -tolerance exhibited at that period by the Arabs in religious matters -is a well-attested fact, and it owes its origin to the circumstance -that their scientific education was conducted by Christians. Of -Saladin’s fifteen physicians two-thirds were either Jews or Christians. -Cultivation and good training were the characteristics of the Arabs -at that period of their history, whereas fanaticism and brute force -were the distinguishing features of the European soldiers. Several -hundred thousand adventurers first ravaged Europe and then pounced -upon Asia. At Antioch Godfrey de Bouillon committed all sorts of -excesses, and then, when he had taken Jerusalem, he massacred 70,000 -of its inhabitants—Jews and Musulmans. Eighty years later, Saladin -retook Jerusalem; and, with the exception of a comparatively small -number, he allowed all of his captives to go free. His brother, Malek -el Adel, paid the ransom of 2000 of the prisoners. Contrast these -fruits of civilization with the barbarism of the European conquerors -under Godfrey de Bouillon. Another result of the Crusades was this: -The Franks lost a good deal of their savagery through contact with the -Arabs. At a still later period Western Europe drew a large part of her -supplies of knowledge from Spain—<i>i.e.</i>, from the Musulmans.”</p> - -<p><i>Syria.</i>—In the thirteenth century Damascus, the capital of -Syria, assumed considerable importance as a centre of medical activity. -Bagdad and Cairo had by this time lost the greater part of their -attractiveness for those who wished to perfect their knowledge of -the healing art, and the vandalism of the so-called Soldiers of the -Cross had put an end for many years to come to all hopes of making -Constantinople once more the home of scientific or artistic effort. -There was one branch of medical practice, however, in which the Cairo -physicians excelled all others—that, namely, of ophthalmology. This is -explained by the well-known<span class="pagenum" id="Page_226">[226]</span> fact that at all periods of her history -Egypt has been afflicted with ophthalmias to a much greater degree than -any of the other countries of the Mediterranean basin. The great wealth -accumulated in Damascus, the large number of hospitals which were -located in the city, and the attractiveness of the town as a place of -residence undoubtedly had much to do with the fact that it attained at -this period so great popularity as a centre of medical activity.</p> - -<p><i>Spain.</i>—During the tenth century of the present era the Moslem -reign in Spain flourished greatly under the two enlightened rulers -of the Ommiade Dynasty—Abdurrahman Ennasser and Hakem, and medicine -shared fully in this prosperity. During Abdurrahman’s reign the Emperor -Romanus at Constantinople sent an embassy to Cordova in Spain, and -among the gifts which they took with them for the Prince, was a copy -of the treatise of Dioscorides in the original Greek, illustrated by -marvelously beautiful paintings of the different medicinal plants. -But there was nobody in Cordova at that time who could read Greek. -Accordingly, Abdurrahman begged the Emperor to send him a man who was -familiar with both the Greek and the Latin tongues, and it was in -answer to this request that the monk Nicholas was sent to Cordova (951 -A. D.). Working in conjunction with several of the most distinguished -physicians of that city he succeeded in identifying nearly all of the -plants mentioned by Dioscorides.</p> - -<p>Among the physicians of Arab, Persian or Jewish extraction who, during -the eleventh and twelfth centuries, practiced their profession in Spain -and attained considerable celebrity, the following deserve to receive -special mention here: Abulcasis, Avenzoar, Averroes and Maimonides.</p> - -<p><i>Abulcasis.</i>—Abulcasis is universally credited with being the -greatest surgeon of whom the Arabs may rightfully boast. He was born -at Zahra near Cordova in 936 A. D., and his death occurred 1013 A. -D. Quite early in his professional career (before he had reached his -twenty-fifth year) he was appointed one of Abdurrahman’s private<span class="pagenum" id="Page_227">[227]</span> -physicians. Although he owes his reputation chiefly to the treatises -which he wrote on surgery Abulcasis was also the author of several -medical works. He published a collection of all his writings under the -title of “The Tesrif,” which is divided into thirty parts or books, -and which—according to Lucien Le Clerc—constitutes a veritable -encyclopaedia. During the course of the twelfth century Gerard of -Cremona translated into Latin the part relating to surgery; it is not -known at what time or by whom the remainder of the collection was -translated. The author’s name in the Latin edition is given, not as -Abulcasis, but as Alsaharavius.</p> - -<p>During the lifetime of Abulcasis his writings, and especially his work -on surgery, were not very highly appreciated in Spain. This was largely -due to the fact that the Mohammedan inhabitants of that country did not -look upon surgery with any degree of favor. The Arabs of the East held -Abulcasis in much greater honor. Guy de Chauliac, the famous French -surgeon of the fourteenth century, in his treatise on surgery, quotes -Abulcasis no less than two hundred times. Le Clerc, in the course -of his remarks upon the value of the surgical treatise written by -Abulcasis, says: “This book will always be considered, in the history -of medicine, to represent the first formal and distinct scientific -treatise on surgery.” At the same time, the prevailing testimony makes -it appear that the book contains only a small portion of original -matter, a large part of its substance having been borrowed from the -work of the Greek author, Paulus Aegineta. Its chief merit consists in -the orderly and very clear manner in which the facts are presented, and -doubtless the popularity of the book was materially increased by the -fact that many of the instruments required for the different operations -were illustrated pictorially.</p> - -<p>Lucien Le Clerc has published (Paris, 1861) a French translation of -Abulcasis’ Treatise on Surgery, and on page 71 of this version the -following statement will be found:—</p> - -<div class="blockquot"> - -<p>... you may also introduce into the cannula a specially adapted -piston in copper, or a stylet the end of which is armed<span class="pagenum" id="Page_228">[228]</span> with -cotton. Then fill the cannula with oil or some other suitable -fluid, introduce into one end the stylet armed with cotton, and -push it onward until the liquid enters the ear.</p> -</div> - -<p>Edouard Nicaise, commenting on these words in his version of Guy de -Chauliac’s <i>La Grande Chirurgie</i> (page 690), says that they -constitute the first reference, thus far discovered in medical -literature, to the use of the instrument known as a syringe.</p> - -<p><i>Avenzoar.</i>—Avenzoar was born in Seville, in the southern part -of Spain, during the latter part of the eleventh century. The exact -date is not known. His father was a physician of some distinction, and -his son also attained considerable eminence in the same profession. -According to Neuburger, Avenzoar died, at an advanced age, in 1162 A. -D., and was buried in Seville.</p> - -<p>It is said that in actual practice Avenzoar, who was a man of some -wealth, confined himself to consultation work. He considered it beneath -the dignity of a physician to prepare drugs, to apply leeches, or -to perform certain surgical operations—as, for example, lithotomy; -but Le Clerc seems disposed to believe that Avenzoar did not adopt -this view until after he had become somewhat celebrated and had -accumulated a fortune. Neuburger ranks him next to Rhazes as a clinical -observer and a practitioner of sound common sense, and he speaks of -his great medical work, the Teïssir, as a treatise that abounds in -most interesting histories of cases of disease. Among these will be -found the account of an attack of mediastinitis which occurred in -his own person, and which ended in suppuration that found a vent for -its products by way of one of the bronchi.<a id="FNanchor_51" href="#Footnote_51" class="fnanchor">[51]</a> As this disease is of -rare occurrence, and as Freind’s account of the attack is presumably -a translation of the original report in Arabic made by Avenzoar, its -reproduction here may be interesting. I shall take the liberty of -modernizing the text very slightly and of abbreviating it in one or two -places.</p> - -<p><span class="pagenum" id="Page_229">[229]</span></p> - -<div class="blockquot"> - -<p>I felt some pain in the region of the mediastinum (the membrane -which divides the thorax in the middle) while I was on a -journey. As it increased a cough developed, and I observed -that my pulse was very hard and that I had an acute fever. On -the fourth night I took away a pint of blood, but this gave me -very little relief. Being obliged to travel all day I was much -fatigued when I retired at night, and I fell asleep. During my -sleep the bandage on the arm came off, and when I awoke I found -the bed deluged with blood and my strength greatly exhausted. -The next day I began to cough up a sanious matter, and my mind -wandered at times. Gradually all the symptoms subsided and I -recovered my health. Although I partook of large quantities of -barley water, I believe that my recovery was not due to this, -but rather to the great loss of blood which I had experienced.</p> -</div> - -<p>Freind adds that “Avenzoar not only takes notice of an abscess in the -mediastinum, but in the pericardium likewise; which I don’t find had -been described or even observed by any of the Greeks or Arabians: and -there is no doubt but this membrane and the mediastinum to which it -is contiguous, are subject, as well as the pleura and lungs, to an -inflammation.”</p> - -<p>It is one of the distinguishing features of Avenzoar’s character that, -in his writings, he does not hesitate to differ from his predecessors -whenever he believes that their views are erroneous.</p> - -<p><i>Averroes.</i>—Averroes was one of Avenzoar’s most distinguished -pupils. Indeed, the latter’s famous work, the Teïssir, is dedicated to -Averroes. Thanks to the distinguished French historian and philosopher, -Ernest Renan, our knowledge of Averroes has been greatly expanded since -1852. Averroes was born at Cordova in 1126 A. D. His father and his -grandfather had both held the office of Cadhi (Alcalde, in Spanish), -and were therefore people of importance in that city. His studies were -confined at first largely to philosophy, and when he reached mature -age he gained a great reputation as the commentator and interpreter of -the writings of Aristotle. Still later in life much of his attention -was devoted to medicine, and he wrote a book which bears the title -“Kitab al-kullidschat”<span class="pagenum" id="Page_230">[230]</span> (General principles of Medicine). Among the -physicians of the later Middle Ages this work was commonly spoken of as -the “Colliget” (from kullidschat), and was almost as highly esteemed as -the Canon of Avicenna. The idea of writing a treatise on the individual -diseases was first entertained, among Arabian physicians, by Averroes; -but on reflection he abandoned the idea, and, instead, urged Avenzoar, -his friend and former instructor, to undertake the work in his place. -It was in this way that the Teïssir—the finest work on the practice of -medicine produced by an Arab writer—came to be written.</p> - -<p>The topics treated in the “Colliget” are distributed throughout the -seven books in the following manner:—</p> - -<table summary="books" class="smaller"> - <tr> - <td class="cht">Book I.</td> - <td class="cht">Anatomy.</td> - </tr> - - - <tr> - <td class="cht">Book II.</td> - <td class="cht">Health (Physiology).</td> - </tr> - - <tr> - <td class="cht">Book III.</td> - <td class="cht">Diseases.</td> - </tr> - - <tr> - <td class="cht">Book IV.</td> - <td class="cht">Signs or Symptoms.</td> - </tr> - - <tr> - <td class="cht">Book V.</td> - <td class="cht">Remedial agents and Foods.</td> - </tr> - - <tr> - <td class="cht">Book VI.</td> - <td class="cht">The Preservation of Health.</td> - </tr> - - <tr> - <td class="cht">Book VII.</td> - <td class="cht">The Treatment of Diseases.</td> - </tr> -</table> - -<p>Neuburger speaks of the “Colliget” as a fine piece of philosophical -writing, but adds that it is not at all suited to the needs of the -practical physician. Indeed, he doubts whether any person who has not -received a thorough training in natural philosophy—the philosophy of -Aristotle—would be able to follow the author intelligently.</p> - -<p><i>Maimonides.</i>—Maimonides, who is ranked by Le Clerc as the -greatest Jew, after Moses, of whom the history of that nation makes -mention, was born at Cordova, Spain, in 1135 A. D. In early youth -his teachers were his father and a disciple of Ebn Badja. At the age -of thirteen, and from that time until he had reached his thirtieth -year, he was obliged under the pressure of circumstances, to profess, -at least outwardly, the faith of Islam. Death or banishment was -the only alternative. During the intervening period of seventeen -years he devoted himself exclusively to his studies. In 1160 A. D. -he accompanied his family to Fez, Morocco, and five years later he -settled<span class="pagenum" id="Page_231">[231]</span> at Fostath, near Cairo, Egypt. As a means of gaining his -livelihood he engaged in the business of trafficking in precious -stones, continuing his studies at the same time and carrying on a -certain amount of medical practice. Not long afterward he gained the -favor of the Vizir El Fadhl Beissâny, the friend of Saladin, Sultan of -Egypt and Syria, and was by him appointed one of the Court physicians. -This enabled him to give up entirely his commercial business. He -prospered in the practice of medicine and was very highly esteemed in -the community in which he lived. His death occurred in 1204 A. D.</p> - -<p>Among the books which he wrote (generally in Arabic) on medical -subjects, the following deserve to receive special mention:—</p> - -<table summary="books" class="smaller"> - <tr> - <td class="right">I.</td> - <td class="cht">Commentary on the Aphorisms of Hippocrates.</td> - </tr> - - <tr> - <td class="right">II.</td> - <td class="cht">A work known as “Aphorisms of Maimonides” (borrowed partly -from Hippocrates and partly from Galen).</td> - </tr> - - <tr> - <td class="right">III.</td> - <td class="cht">Résumé of the writings of Galen.</td> - </tr> - - <tr> - <td class="right">IV.</td> - <td class="cht">A letter relating to the subject of personal hygiene.</td> - </tr> - - <tr> - <td class="right">V.-IX.</td> - <td class="cht">Treatises on asthma; on hemorrhoids; on venoms and -poisons in general; on drugs; and on forbidden articles of diet.</td> - </tr> - - <tr> - <td class="right">X.</td> - <td class="cht">A translation of one of Avicenna’s works.</td> - </tr> -</table> - -<p>Neuburger speaks in very favorable terms of the medical writings of -Maimonides, and adds that he also wrote a treatise which bears the -title: “Guide to Those in Perplexity”—a work which aims to reconcile -reason and faith. The book has been translated into French by Munk; and -the treatise on poisons has also been translated into the same language -by J. M. Rabbinowicz (Paris, 1867).</p> - -<p>Speaking of the remarkable manner in which philosophy and medicine had -flourished in Spain during the tenth and eleventh centuries, under the -reigns of Haken II. and his successors, Ernest Renan says:</p> - -<div class="blockquot"> - -<p>The love of science and of things beautiful had established, -in that privileged corner of the world, a degree of tolerance -that can scarcely be matched in modern times. Christians, Jews, -Musulmans all spoke the same language, sang the same poems, and -took<span class="pagenum" id="Page_232">[232]</span> part in the same literary and scientific studies. All the -barriers which commonly separate men were thrown down, and all -worked with equal zeal in behalf of our common civilization.</p> -</div> - -<p>With the death of Averroes (1198 A. D.), however, Arab philosophy lost -its last representative, and the Koran resumed its full authority over -freedom of thought. In the succeeding period of decadence (thirteenth -century of the Christian era) there were no physicians of first -importance, at least in Spain and Persia; and even in Egypt and Syria, -over which reigned at this time the enlightened family of Saladin, -the leading physicians were not of the same calibre as the men whose -names I have just mentioned. Bagdad and Cordova had by this time become -cities of less importance than Damascus, and botany and ophthalmology -were esteemed of greater value in the scheme of medical education -than at any previous time. It will not appear strange, however, -that medicine should have stood still during this later part of the -Middle Ages if we bear in mind the fact that warfare was then such a -frequently occurring event that nobody had either time or inclination -for scientific studies. The invasions of the Mongolians and the -Crusaders were most disturbing factors.</p> - -<p>During the twelfth century of the present era there were—so we are -assured by Le Clerc—women physicians among the Arabs in Spain. It is -said, for example, that Abou Bekr, a distinguished medical practitioner -of that period, had a sister who was well trained in medicine, and that -it was she who acted as midwife at all the confinements of the wives of -the Caliph Almansur. After her death her niece officiated in the same -capacity in her place. There can scarcely be any reasonable doubt that, -almost from time immemorial, women as well as men have taken active -part in the practice of medicine.</p> - -<p>According to Puschmann, Spain possessed, during the twelfth century of -the Christian era, seventy public libraries and seventeen institutions -for instruction in the higher branches of learning. Among the residents -of the city of Cordova there were, during the same period, no fewer -than one hundred and fifty authors; and the smaller cities of<span class="pagenum" id="Page_233">[233]</span> Almeria, -Murcia and Malaga could each claim proportionally an equally large -number, viz., fifty-two, sixty-one and fifty-three.</p> - -<p><i>The Effects of the Arab Renaissance as a Whole upon the Evolution of -Medicine.</i>—Although the series of events which I have endeavored -to sketch here in brief outlines reveals an extraordinary degree of -zeal and persistence on the part of the Arab rulers and their subjects -to endow the nation with the knowledge and skill of their models, -the Greeks, the final results gained, at least so far as they relate -to the evolution of medicine as a whole, were not very great. The -movement lasted for five or six centuries, but nevertheless only a few -relatively unimportant facts were added by the Arabs to the stock of -knowledge which was possessed at the time of Galen’s death. Alhazen’s -brilliant researches in the eleventh century of our era in optics (more -particularly with reference to refraction) paved the way for a more -perfect knowledge, in modern times, of the physiology of vision; Geber, -who lived during the eighth century of the Christian era, and who is -spoken of by Le Clerc as “occupying the same place in the history of -chemistry that Hippocrates does in the history of medicine,” laid the -foundations of that important branch of science; Abulcasis discovered -the Medina worm (<i>dracunculus Medinensis</i>) and wrote an excellent -description of the pathological effects which it produces when it -lodges under the skin of a man’s leg; and, finally, our pharmacopoeia -was enriched, during these centuries, by the addition to it of a number -of new drugs and pharmaceutical preparations. These are among the more -important contributions which the Arabs made to the general stock of -medical knowledge. On the other hand, they contributed, in an indirect -manner, to the advance of the science of medicine. From the thirteenth -century onward, for a long period, the Latin language was destined to -serve as the vehicle by means of which all scientific knowledge was -to be spread abroad in the countries which are now known as Italy, -Spain, France, Switzerland, Germany, Belgium and Holland, and therefore -an immense amount of translating<span class="pagenum" id="Page_234">[234]</span> had to be done before the works of -Hippocrates, Galen and other Greek medical authors could be brought -within reach of the physicians of these different countries. At that -late date it was by no means always feasible to get possession of an -original copy of one of these classical treatises, and consequently in -such cases it became necessary to employ an Arabic version in the place -of the Greek original. It was in this indirect manner, therefore, that -the Mohammedan Renaissance contributed most effectively in advancing -the development of medical science in general.</p> - -<p>One cannot dismiss the subject of Arabic medicine without calling -attention once more to the spectacle which this remarkable Renaissance -offers—that of an entire nation deliberately working to educate itself -up to the level of such intellectual and artistic giants as the ancient -Greeks; a work which continued with unabated zeal throughout several -centuries in spite of obstacles and discouragements, and which never -ceased for a moment. It is a spectacle without parallel in the world’s -history.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_235">[235]</span></p> - -<h3>CHAPTER XX<br /> -<span class="subhed1">HOSPITALS AND MONASTERIES IN THE MIDDLE AGES</span></h3></div> - -<p>Long before the Christian era it was the practice among the Greeks -to make suitable provision for those who, by reason of poverty or -illness, were unable to provide for their own wants or to secure the -services of a physician. Their slaves, for example, were sent, when -overtaken with illness, or when they had become too feeble to work, to -what was termed <i>Xenodochia</i>—institutions where they received -kindly care and such medical treatment as was necessary. (Mommsen.) In -strong contrast with this humane practice stands the action of those -wealthy Roman property owners who, adopting the course recommended by -Cato, the famous censor (96–46 B. C.), “sold their slaves when they -became old and feeble or ill, as they would old iron, or oxen that -can no longer be utilized for work.” This cruel practice not only -continued throughout a period of nearly three centuries, but apparently -became more and more common, for we are told that the Emperor Claudius -(268–270 A. D.) was obliged, in order to mitigate the evil, to issue a -decree that, when a slave was driven out of the house by his owner, he -should be declared free.</p> - -<p><i>Hospitals and Other Kindred Institutions.</i>—Toward the end of the -fourth century of the present era the first hospital was established in -Rome by the widow Fabiola, a member of the distinguished Fabian family, -and her example induced other wealthy Roman ladies to found similar -institutions. But already several years before this time the influence -of Christianity had made itself felt so strongly in the eastern branch -of the Roman Empire that<span class="pagenum" id="Page_236">[236]</span> the Emperor Julian, who had previously been -among its most bitter opponents, was forced to say, in one of his -letters:—</p> - -<div class="blockquot"> - -<p>Now we can see what it is that makes these Christians such -powerful enemies of our gods; it is the brotherly love which -they manifest toward strangers and toward the sick and the poor, -the thoughtful manner in which they care for the dead, and the -purity of their own lives.</p> -</div> - -<p>Moved by these considerations, he decided forthwith to erect hospitals -in all the cities of the empire. We do not know whether he acted upon -this resolution or not, but it is a matter of record that St. Basil, -Bishop of Caesarea (370–379 A. D.), founded in that city, which is -about thirty miles distant from Jerusalem, a settlement composed of -numerous dwellings that were devoted to the use of the poor and the -sick. This institution was managed in an admirable manner, a special -corps of physicians and nurses being assigned to the duty of caring for -its inmates. At Edessa, the capital of Northern Mesopotamia, another -hospital was founded in 375 A. D. The date of the establishment of the -celebrated hospital at Djondisabour in Persia, of which mention is made -elsewhere (see page 204 <i>et seq.</i>), is not known. About the middle -of the sixth century of the present era, Childebert I., King of the -Franks and son of Clovis, founded at Lyons, France, the Hôtel-Dieu, a -hospital which has afforded shelter and comfort to thousands of human -beings during the past fourteen hundred years, and which is in active -operation at the present time; a hospital, too, which has served as a -training school for a long line of distinguished physicians, surgeons -and gynaecologists. It is an interesting fact that Childebert intrusted -the management of this great institution to laymen (instead of the -ecclesiastical powers). Finally, toward the end of the sixth century, -Bishop Masona founded in Merida, Spain, a hospital in which Jews, -slaves and freemen were received and treated on the same footing; and -he laid down the rule that one-half of the moneys and other gifts -received by the church was to be devoted to<span class="pagenum" id="Page_237">[237]</span> the maintenance of this -institution. The list of hospitals and other charitable organizations -which were established in these early centuries is very long, and it -reveals the fact that in every known land there existed, throughout -these years, a strong wish to give aid and comfort to the poor, the -sick and the helpless. The Musulmans appear to have been as zealous -as the Christians in promoting works of this kind; for the records -show that in Bagdad, Cairo, Damascus, Cordova and many of the other -cities which were under their control, they provided ample hospital -accommodations. Indeed, one of the largest and most perfectly equipped -institutions of this character of which the history of the Middle -Ages furnishes any record, was that planned and constructed at Cairo, -Egypt, in 1283 A. D., by the Sultan El Mansur Gilavun. While it was -building, the workmen employed were not permitted to engage in any -undertaking for private citizens, and the Sultan himself never failed -to visit the spot every day during the progress of the work. The site -chosen was that of one of the royal palaces, and in tearing down this -structure, in order to make room for the new building, the workmen -brought to light a large chest filled with gold and precious stones, -the value of which was sufficient to pay the entire expense of erecting -the hospital. Upon the completion of the building and the equipment -of its spacious wards in the most perfect manner possible, the Sultan -expressed himself in the following terms:—</p> - -<div class="blockquot"> - -<p>I have founded this institution for people of my own class -and for those who occupy an humbler station in life—for the -king and for the servant, for the common soldier and for the -Emir, for the rich man and for the poor, for the freeman and -for the slave, for men and also for women. I have made ample -provision for all the remedial agents that may be required, for -physicians, and for everything else that may prove useful in any -form of illness....</p> -</div> - -<p>One of the characteristic features in the management of this hospital, -says Le Clerc, was the custom of giving to each of the poorer inmates, -when he left the institution, five pieces of gold, in order that he -might be spared the<span class="pagenum" id="Page_238">[238]</span> necessity of undertaking immediately work of an -exhausting character.</p> - -<p><i>Monasteries in Their Relation to Medicine.</i>—While at first -these institutions were designed chiefly as places of refuge from -the turmoil of the world and from the violence of frequent warfare, -it became evident in the course of time that the evils incident to -such a secluded and self-centered life hindered rather than promoted -the development of those particular virtues which Jesus Christ urged -his followers to cultivate. This experience led to the adoption of -a different kind of cloister life; and so it came about, as stated -by Neuburger, that in 529 A. D. Benedictus of Nursia founded, at an -isolated spot high up on the slope of Monte Cassino, in Campania, -Italy, the now famous parent monastery of the Benedictine Order. -According to the original regulations of this order, the monks were -obliged to perform every day a certain amount of manual labor as well -as devotional exercises. Nine years later Cassiodorus, who had for -a long period been a sort of Secretary of State under Theodoric the -Great and his successors, became a monk, and, from that time to the -day of his death, “devoted all his energies to the service of God -and the advancement of science.” He secured a house not far from the -Benedictine monastery on Monte Cassino, gathered together there a -considerable library, and made it a rule of the place that the copying -of original codices (the majority of them theological) constituted -the most useful and honorable form of manual labor. A few years -later, this smaller establishment was made a part of the monastery at -Monte Cassino, and the rule just mentioned was thereafter adopted by -the enlarged institution. But the care of the sick, the feeble, and -children was the particular work which Benedictus, the founder of this -institution, had most at heart. Cassiodorus went even farther and urged -upon the brethren the desirability of studying the healing art and of -utilizing, for this purpose, the works of ancient medical authors.</p> - -<div class="blockquot"> - -<p>Learn all you can, he said, about the characteristics of -different plants and about the methods of preparing medicinal -mixtures,<span class="pagenum" id="Page_239">[239]</span> but set all your hopes upon the Lord who is the -preserver of our lives. In your search for knowledge about -drugs consult the herbarium of Dioscorides, who has described -and pictured the different herbs with great accuracy. Afterward -read Latin translations of the works written by Hippocrates and -by Galen, particularly the latter’s treatise on therapeutics, -the one which he addresses to the philosopher Glaucon; and, in -addition, study the work of Caelius Aurelianus on the practice -of medicine, that of Hippocrates on medicinal plants and methods -of treatment, and some of the other writings on medicine which -you will find in my library and which I have left behind me for -the benefit of my brethren in this institution.</p> -</div> - -<p>The advice given by Cassiodorus was heeded, not only by those to whom -it was addressed, but also by many succeeding generations of monks. -Even at the present time, says Neuburger, the books which Cassiodorus -recommended are still to be found, either in the form of original -manuscript copies or in that of translations, in the library of the -parent institution. Furthermore, when it is remembered how large a -number of affiliated Benedictine monasteries were established in -different parts of Europe, it will readily be appreciated that the good -accomplished by the advice which Cassiodorus gave must have been very -great.</p> - -<p>Among the later abbots of Monte Cassino there were three who attained -considerable distinction as physicians. They were Bertharius, who wrote -two treatises on medical topics; Alphanus II., Archbishop of Salerno, -who was celebrated both as a physician and as a poet; and Desiderius -(1027–1087 A. D.), who was skilled, not only in medicine, but also in -jurisprudence, and who was elected Pope under the title of Victor III. -The monastery attained the height of its celebrity at the time when -Constantinus the African became one of its regular members. Although -Constantinus was a native Arab (born at Carthage about 1018 A. D.), -he became converted to Christianity quite early in life. It is said -that he was a great traveler as well as a great scholar, and that he -devoted several years to visiting foreign lands—Babylonia, India, -Egypt and Ethiopia. It was in this way that he became so well versed in -the languages<span class="pagenum" id="Page_240">[240]</span> of the East. Upon visiting Spain as a fugitive from his -native city, he took with him several of the works of Hippocrates and -Galen, and in course of time translated them into Latin. Finally, he -accepted the position of secretary to Robert Guiscard, the first Norman -Duke of Calabria and Apulia, who appears to have selected Salerno as -his place of residence. At the same time he became one of the teachers -at the medical school of that city, and served in this capacity for a -certain length of time; but, at the end of a few years, he was formally -accepted by the Abbot Desiderius as a member of the Monte Cassino -community, and it was here that he did the larger part of his literary -work. His death occurred in 1087 A. D., the same year in which the -Abbot Desiderius—or, rather, Pope Victor III.—died.</p> - -<p>Constantinus was a prodigious worker, but it is doubtful whether he did -anything of an original character. Not a few of the treatises which -were, at that time, credited to him as original productions, are now -known—thanks largely to the researches of the great French historian -and linguist, Daremberg—to be simply translations from the Arabic.</p> - -<p>It is believed by some authorities that at Monte Cassino medicine was -taught to laymen as well as to those who were preparing to become -members of the Benedictine Order of monks. It is not likely, however, -that this was done to any great extent, as much better facilities for -acquiring knowledge of medicine were available at Salerno in the near -neighborhood.</p> - -<p>In some parts of Gaul, in the early Middle Ages, physicians received -very little consideration; indeed, to us moderns it seems strange -that any one should have possessed sufficient courage to accept -the responsibility of prescribing for a member of one of the royal -families. It is related by Neuburger, on the authority of Gregory of -Tours’ History of the Franks, that when Austrichildis, the wife of King -Guntram (sixth century A. D.), was ill with the plague and perceived -that her death was near at hand, she sent for her husband and extracted -from him a<span class="pagenum" id="Page_241">[241]</span> promise that he would behead the two physicians, Nicolaus -and Donatus, who had treated her and whose prescriptions had failed to -effect a cure. Her wish was carried out, in order—as the statement -reads—“that her Majesty might not enter the Realm of the Dead entirely -alone.” Many centuries later, however, when civilization had certainly -advanced far beyond the stage which it had reached in Gaul in the sixth -century of the present era, there were instances in which able and -conscientious physicians were subjected to equally cruel treatment for -their failure to effect a cure.</p> - -<p>It was at about this same period, as is amply verified by the -statements made by Bishop Gregory of Tours, that faith in the power of -saintly relics to heal diseases became almost universal. So great was -the effect produced upon the minds of the people by the public display -of these objects—bones of saints, portions of their grave-stones, -etc.—that a large number of marvelous cures were reported as the -result of such displays; and doubtless—so great is the power of -suggestion over the human mind—many of these reports were true. A -century later (673–735 A. D.), the Venerable Bede, author of the famous -work entitled “Ecclesiastical History of the English Nation,” gave, in -the course of his narrative, an account of a case of aphasia in which -“a remarkable cure was effected”; and, although he mentions a course -of “systematic exercises in speaking” as the means used to effect that -cure, he attributes it to supernatural causes and not to the practical -treatment adopted. He also describes some of the epidemics of his time, -and gives most interesting though brief accounts of the methods of -treatment employed by the priests and the monks.</p> - -<p>During the ninth and tenth centuries, as we learn from the very full -descriptions given by Neuburger in his History of Medicine, much zeal -was manifested by the monks at St. Gall in Switzerland, at Reichenau in -Saxony, and at Fulda, in Hesse Nassau, in the study of the different -branches of knowledge, medicine included. The following are the names -of those monks who attained the greatest distinction in this work: -Hrabanus Maurus, Abbot of the<span class="pagenum" id="Page_242">[242]</span> Fulda Monastery, afterward Archbishop -of Mayence, and the author of an encyclopaedia in which the science of -medicine receives quite full consideration; and Walahfrid Strabo, a -pupil of Maurus, Abbot of Reichenau, and the author of a treatise in -verse on medicinal plants.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_243">[243]</span></p> - -<h3>CHAPTER XXI<br /> -<span class="subhed1">MEDICAL INSTRUCTION AT SALERNO, ITALY, IN THE MIDDLE AGES</span></h3></div> - -<p>The date of origin of the Medical School at Salerno is not known, -but such evidence as we possess shows without a doubt that already -in the earliest part of the Middle Ages some sort of facilities for -studying medicine were provided in that little town—the <i>Civitas -Hippocratica</i>, as it was called at a later period. It seems to -be the general impression, says Daremberg, that during those early -centuries only ignorance and superstition prevailed in Italy and Gaul; -in other words, that all desire for scientific research had vanished, -and that there no longer existed such a thing as the regular practice -of medicine. This impression, he adds, is erroneous. History shows -that schools modeled after those established by the Merovingian and -Carlovingian kings (448–639 A. D.), existed up to as recent a date as -the middle of the seventh century, and that subsequently the bishops -organized the teaching in such a manner that it should be entirely -under their control. As time went on, however, the schools assumed a -more public character, although the actual teaching was still carried -on in the cloisters and church edifices. It is well known, furthermore, -that the chief of the Ostrogoths, Visigoths and Lombards—the so-called -Barbarians, who at that time occupied these parts of Europe as -conquerors—showed themselves on many an occasion to be the enlightened -protectors of public instruction and the enthusiastic admirers of -classical literature and science.</p> - -<div class="blockquot"> - -<p>At Milan there is preserved a manuscript which furnishes -satisfactory proof that the writings of Hippocrates and Galen -were<span class="pagenum" id="Page_244">[244]</span> made the subject of public teaching at Ravenna toward -the end of the eighth century of the present era.... And the -transcribing of medical manuscripts was known to be carried -on at the Monastery of St. Gall, in Switzerland, during the -eighth century.... It is plain, therefore, that throughout -those extensive regions which previously had formed a part of -the Roman Empire, but which during the Middle Ages were under -the dominion of Barbarian kings, there was never an entire lack -of physicians, or of medical knowledge, or of facilities for -teaching medicine. (Daremberg.)</p> -</div> - -<p>In the light of these statements it is easy to believe that the -original development of the Medical School at Salerno was a perfectly -natural event like that of the founding of any of the medical -schools of a more recent date. The remarkably healthy and singularly -attractive character of the spot where the town of Salerno is located; -the proximity of mineral springs; the comparatively short distance -which separated it from such important centres of population as -Naples and the cities of the Island of Sicily, and from the famous -Benedictine Monasteries at La Cava, Beneventum and Monte Cassino; and -the circumstance that a Ducal Court was established there—all these -are facts which amply explain both why a medical school was founded -here rather than at some other spot, and why physicians of exceptional -ability were easily induced to make the place their home. At no time -in the history of the school, it is important to state, do the church -authorities appear to have been in control of its affairs. At most, -one or two of the monks seem to have taken part in the teaching for -limited periods of time; but in its main characteristics the school -may truthfully be described as an institution created and managed -by physicians for the advancement of medical science and the best -interests of the profession as a whole.<a id="FNanchor_52" href="#Footnote_52" class="fnanchor">[52]</a></p> - -<p>The organization of hospitals and their utilization for purposes of -clinical instruction must have been the most important events which -followed next in order. It is only<span class="pagenum" id="Page_245">[245]</span> upon this assumption that we can -satisfactorily explain why, for many years in succession, physicians -traveled all the way from France, Germany and England to Salerno. They -were eager to gain additional knowledge of medicine, and clinical -instruction afforded the only sure way of obtaining it; but instruction -of this kind was nowhere else to be obtained at that remote period, and -consequently men of this earnest and ambitious stamp were compelled to -make the long journey and to incur the expense and the risk incident to -such a trip. As a further evidence of the value which the physicians of -the later Middle Ages set upon the writings of the teachers at Salerno, -the fact deserves to be mentioned that, toward the end of the twelfth -century and all through the thirteenth and fourteenth centuries, these -works were frequently quoted.</p> - -<p>But the ability and learning of the Salerno physicians were highly -appreciated by the public at large as well as by their confrères in -other lands; for many people of wealth and of high social standing -visited Salerno for the purpose of consulting them. Among the number -were Adalberon, Bishop of Verdun, France, who journeyed thither in 984 -A. D., but failed to obtain the relief which he required; Desiderius, -the Abbot of Monte Cassino; Bohemund, the son of Duke Robert Guiscard; -and William the Conqueror, afterward King of England. The two last -named remained for some time in Salerno, in order to secure needed -treatment for the wounds which they had received in battle.</p> - -<p>Toward the end of the tenth, or at the beginning of the eleventh, -century the teaching of medicine at Salerno began to assume the -character of regularly organized work. The names of the men and women -who conducted it—for there were women as well as men in the corps of -teachers—are mentioned in various contemporaneous documents which have -come down to our time. They are as follows: Petroncellus, Gariopuntus, -Alphanus, Bartholomaeus, Cophon, Trotula, John and Matthew Platearius, -Abella, Mercuriade, Costanza Calenda, Rebecca Guarna, Afflacius, -Maurus, Musandinus and many others. According to Puschmann, the list -of physicians who, during the existence<span class="pagenum" id="Page_246">[246]</span> of the Medical School at -Salerno,—a period of nearly one thousand years,—acted as teachers -in the institution, comprised no less than 340 names. The presence -of several women among the instructors of this school, and the great -esteem in which they were held by the men of that time, both for their -ability as practitioners and for the excellence of the treatises which -they wrote, furnish strong confirmation of the statement which Plato -makes in his work entitled “The Republic,” and which I have already -quoted in one of the earlier chapters, viz.: “For women have as -pronounced an aptitude as men for the profession of medicine.” And, if -further evidence of the correctness of Plato’s opinion were needed, the -success attained by women physicians during the past thirty or forty -years in the United States of America might be cited.</p> - -<p>To the general statement made above I may with advantage add a few -details regarding both the individual physicians at Salerno and the -books which they wrote. During recent years, thanks to the researches -of Henschel, de Renzi and Piero Giacosa, our knowledge of these matters -has been greatly enlarged. In 1837 Henschel found, in the library -at Breslau, Germany, a manuscript collection of Salerno medical -treatises (“Compendium Salernitanum”) dating back as far as the latter -part of the twelfth century of the present era. De Renzi, working -in association with Daremberg and Baudry de Balzac, succeeded in -collecting from the different libraries of Italy quite a large number -of additional Salerno treatises, all of which have since been published -under the title “<i>Collectio Salernitana, ossia documenti inediti e -trattati di medicina appartenenti alla scuola medica Salernitana</i>” -(5 vols., Naples, 1852–1859). Finally, Piero Giacosa has added to this -stock of Salerno writings by the publication (Turin, 1901) of a work -which bears the title “<i>Magistri Salernitani nondum editi etc.</i>” -Beside the treatises to be found in these three collections there is -one other which, according to Neuburger, contributed more than all the -others combined to the fame of the Medical School of Salerno. The title -of this extraordinary work is: “<i>Regimen sanitatis Salernitanum</i>.”</p> - -<p><span class="pagenum" id="Page_247">[247]</span></p> - -<p>The Salernian writings, it appears, may readily be divided into two -groups—those of the earlier and those of the later epoch of this -famous school. The treatises which belong to the older epoch are -written in the degraded Latin of the Middle Ages, and seem to have -been composed entirely for didactic purposes. In the main they are -compilations of still earlier Graeco-Latin works, but here and there, -especially in the parts which relate to therapeutics, evidences of a -certain measure of originality are discoverable. The pathology adopted -shows a hodge-podge of the humoral doctrine and that of the Methodists.</p> - -<p>The chief representative of this early epoch is Gariopontus (first -half of the eleventh century), whose treatise on special pathology -and therapeutics—entitled “<i>Passionarius</i>”—was very popular -for a long period of years. Next in order comes Petroncellus, whose -“<i>Practica</i>” calls for no special comment. Of the works of -Alphanus, John Platearius (the elder) and Cophon (the elder), we -possess only fragments. Trotula, who lived about 1059 A. D. and was -believed to be the wife of John Platearius I., attained greater -celebrity than any of those just mentioned. She was related to Roger -I., Count of Sicily, and was therefore probably of Norman extraction, -and she was considered by her contemporaries to be very learned -(“<i>sapiens matrona</i>”).<a id="FNanchor_53" href="#Footnote_53" class="fnanchor">[53]</a> Her writings, which are quite numerous, -are frequently quoted by later authors, this being especially true of -her work on diseases of women. The four other women who took an active -and creditable part in the work of the Salerno Medical School also -wrote treatises on various subjects: Abella, on “Black Bile”, (written -in verse); Mercuriade, on “Pestilential Fever,” and also on “The -Treatment of Wounds”; and Rebecca Guarna, on “Fevers.” In the case of -Costanza Calenda, the daughter of the Dean of the medical school and -a woman remarkable for her wisdom as well as for her great beauty, no -record of the treatises which she wrote appears to have been preserved.</p> - -<p>The later epoch of the literature created by the Medical School of -Salerno begins about the year 1100 of the present<span class="pagenum" id="Page_248">[248]</span> era, after the Latin -translations and compilations made by Constantinus the African had -taught the physicians who were then at the head of affairs something -about the medicine of the Arabs, and had, at the same time, through -the latter medium, brought to their attention afresh the teachings -and practice of the ancient Greeks.<a id="FNanchor_54" href="#Footnote_54" class="fnanchor">[54]</a> Among the works of the latter -character—works which in their Latin dress proved most valuable to the -Salerno physicians—are the following: “The Aphorisms of Hippocrates”; -“Galen’s <i>Ars Parva</i>” (<i>Mikrotechne</i>); and the same author’s -“Commentaries on the Hippocratic Writings.”</p> - -<p>John Afflacius, a monk who lived during the latter half of the eleventh -century of the present era, was one of the pupils of Constantinus. His -treatise “On Fevers,” according to Neuburger, contains ample evidence -of the author’s ability as a clinical observer.</p> - -<p>Something still remains to be said concerning Bartholomaeus, Cophon -the Younger, John Platearius the Younger and Archimathaeus. They -have already been mentioned in the list of authors whose writings -contributed materially to the celebrity of the Medical School of -Salerno, and it is now only necessary to furnish a few particulars -with regard to their lives and the nature of the work which they -accomplished.</p> - -<p>Bartholomaeus wrote a treatise (entitled “<i>Practica</i>”) on the -practice of medicine as taught by Hippocrates, Galen, Constantinus and -the Greek physicians. Its enduring popularity is evidenced by the facts -that it was translated at an early period into several languages and -that portions of its text are often quoted by later authors. The book -contains ample evidence that its author was a very<span class="pagenum" id="Page_249">[249]</span> close observer and -a physician who strove to make accurate diagnoses.</p> - -<p>Cophon the Younger (about 1100 A. D.) was the author of two works: a -treatise on anatomy which bore the title “<i>Anatomia Porci</i>,” and -one on the practice of medicine (“<i>Practica</i>”). The ancients, it -is stated, selected a pig for purposes of anatomical study “because its -internal organs present a very close resemblance to those of the human -being.” Both books are written in a clear and simple style.</p> - -<p>John Platearius the Younger was the author of a work on internal -medicine (“<i>Practica Brevis</i>”) and also of one on the subject of -urine (“<i>Regulae Urinarum</i>”).</p> - -<p>Archimathaeus wrote and published three treatises: one on “Urines,” -another on practical medicine (“<i>Practica</i>”), and the third -on “The Demeanor which a Physician should Observe when he Visits a -Sick Person” (“<i>De Aventu Medici</i>”). The latter treatise, says -Neuburger, is “a mixture of piety, artlessness, and slyness; but it -furnishes a capital picture of the carefully regulated behavior of the -mediaeval physician at the patient’s bedside, of the manner in which he -conducted his examination of the case, and of his intercourse with the -household as well as with the sick person.”</p> - -<p>In addition to the treatises referred to above,—treatises which are -known to have been written by the authors to whom I have credited -them,—the <i>Collectio Salernitana</i> contains several of which the -authorship is not known. One of these, which bears the title “<i>De -Aegritudinum Curatione</i>,” is reputed to furnish a better account -of the special pathology and therapeutics taught at the Medical -School of Salerno during the height of its celebrity than is to be -found in any of the other treatises. In one part of the book—that, -namely, in which local affections are discussed—the anonymous author -gives in succession the opinions held by the seven leading teachers -of the school (Platearius II., Cophon II., Petronius, Afflacius, -Bartholomaeus, Ferrarius and Trotula) with regard to each one of<span class="pagenum" id="Page_250">[250]</span> a -certain number of local diseases; thus enabling the reader to obtain a -very fair idea of what was the condition of medical science at Salerno -during the twelfth century of the present era.</p> - -<p>The famous didactic poem known as the “School of Salerno” (<i>Schola -Salernitana</i>) and also as the “Code of Health of the School of -Salerno” (<i>Regimen Sanitatis Salernitanum</i>), was composed -originally about 1100 A. D. It was clearly intended in the first -instance for the guidance of laymen in matters relating to diet, the -conservation of health and the prevention of disease; but from time to -time, as the years rolled on, there were added to it several sections -which changed materially the character of the poem. From a mere code of -health it became eventually a fairly complete cyclopaedia of medicine -in versified form; the number of the verses having increased fully -tenfold during this long period. The poem, in its latest state, is -arranged in ten principal sections, as follows: Hygiene (8 chapters); -materia medica (4 chapters); anatomy (4 chapters); physiology (9 -chapters); etiology (3 chapters); significance of different signs (24 -chapters); pathology (8 chapters); therapeutics (22 chapters); nosology -(20 chapters); and the practice of medicine as actually experienced (5 -chapters).</p> - -<p>The work has been translated into nearly every modern language, and, -according to an estimate which was made in 1857, there are in existence -no fewer than 240 different editions. The most recent of these is the -French translation made by Meaux Saint-Marc and published by him (2d -edition) in Paris in 1880. There are two English versions—that by -A. Croke (Oxford, 1830), and the more recent one by John Ordronaux -(Philadelphia, 1871).</p> - -<p>Some authorities make the statement that the poem was written -originally for the guidance of Robert, the son of William the -Conqueror; but Neuburger says that the dedication of the work to this -prince is lacking in many of the original manuscript copies and that -in some instances the word “Francorum” is to be found in the place -of<span class="pagenum" id="Page_251">[251]</span> “Anglorum”; for which reason he believes that the introduction -of a dedication was made long after the poem had been written. It -will probably appear strange to most readers that the author of the -“<i>Regimen Sanitatis</i>” (or “<i>Flos Medicinae</i>,” as it was -sometimes called) should have written his text in the form of verse -rather than in that of prose. He himself states briefly, at the end -of the poem,<a id="FNanchor_55" href="#Footnote_55" class="fnanchor">[55]</a> some of the reasons why he preferred to adopt this -course. Rhythm, he maintains, makes it easy to say a great deal in a -few words; besides which, it facilitates by its novelty the memorizing -of new facts, and also enables one quickly to recall to mind those -which have been learned at some previous time. His judgment seems -to have been entirely correct, for the book proved to be immensely -popular, and retained its popularity throughout an extraordinarily long -period of time. Furthermore, as already stated, it accomplished a great -deal toward enhancing the reputation of the Salerno School of Medicine. -When we consider how difficult it must have been in those days for -students of medicine to memorize facts which were stored in books that -were very costly and oftentimes not obtainable at any price, we cease -to wonder at the great popularity of this miniature cyclopaedia in -leonine verse.<a id="FNanchor_56" href="#Footnote_56" class="fnanchor">[56]</a> Here were to be found, at one-fourth or one-tenth -the price of any similar book written in prose, all the essentials -(anatomy, physiology, pathology, etc.) required by the candidate for -medical honors; and if, perchance, he possessed a good memory, he -might, without a very great mental effort, transfer the entire poem to -his own private storehouse of facts.</p> - -<p>A few extracts from this remarkable piece of medical literature are -given below, in the belief that many of our readers will find them of -interest.</p> - -<p><span class="pagenum" id="Page_252">[252]</span></p> - -<table summary="books" class="smaller" style="max-width: 50em"> - <tr> - <td class="ctr sm">ORIGINAL TEXT</td> - <td class="ctr sm">DR. JOHN ORDRONAUX’S TRANSLATION</td> - </tr> - - - <tr> - <td class="cht">Si vis incolumen, si vis te vivere sanum,</td> - <td class="cht">If thou to health and vigor wouldst attain,</td> - </tr> - - <tr> - <td class="cht">Curas tolle graves, irasci crede profanum,</td> - <td class="cht">Shun weighty cares—all anger deem profane,</td> - </tr> - - <tr> - <td class="cht">Parce mero, coenato parum; non tibi vanum</td> - <td class="cht">From heavy suppers and much sit wine abstain.</td> - </tr> - - <tr> - <td class="cht">Surgere post epulas; somnum fuge meridianum;</td> - <td class="cht">Nor trivial count it, after pompous fare,</td> - </tr> - - <tr> - <td class="cht">Ne mictum retine, ne comprime fortiter anum.</td> - <td class="cht">To rise from table and to take the air.</td> - </tr> - - <tr> - <td class="cht">Haec bene si serves, tu longo tempore vives.</td> - <td class="cht">Shun idle, noonday slumber, nor delay</td> - </tr> - - <tr> - <td class="cht"></td> - <td class="cht">The urgent calls of Nature to obey.</td> - </tr> - - <tr> - <td class="ctr"><i>Conditiones Necessariae Medico.</i></td> - <td class="ctr"><i>Demeanor Necessary For the Physician.</i></td> - </tr> - - <tr> - <td class="cht">Clemens accedat medicus cum vesta polita;</td> - <td class="cht">Let doctors call in clothing fine arrayed,</td> - </tr> - - <tr> - <td class="cht">Luceat in digitis splendida gemma suis.</td> - <td class="cht">With sparkling jewels on their hands displayed;</td> - </tr> - - <tr> - <td class="cht">Si fieri valeat, quadrupes sibi sit pretiosus;</td> - <td class="cht">And, if their means allow, let there be had,</td> - </tr> - - <tr> - <td class="cht">Ejus et ornatus splendidus atque decens.</td> - <td class="cht">To ride, a showy, rich-attired pad.</td> - </tr> - - <tr> - <td class="cht">Ornatu nitido conabere carior esse,</td> - <td class="cht">For when well dressed and looking over-nice,</td> - </tr> - - <tr> - <td class="cht">Splendidus ornatus plurima dona dabit</td> - <td class="cht">You may presume to charge a higher price,</td> - </tr> - - <tr> - <td class="cht">Viliter inductus munus sibi vile parabit,</td> - <td class="cht">Since patients always pay those doctors best,</td> - </tr> - - <tr> - <td class="cht">Nam pauper medicus vilia dona capit.</td> - <td class="cht">Who make their calls in finest clothing dressed,</td> - </tr> - - <tr> - <td class="cht"></td> - <td class="cht">While such as go about in simple frieze,</td> - </tr> - - <tr> - <td class="cht"></td> - <td class="cht">Must put up with the meanest grade of fees;</td> - </tr> - - <tr> - <td class="cht"></td> - <td class="cht">For thus it is, poor doctors everywhere</td> - </tr> - - <tr> - <td class="cht"></td> - <td class="cht">Get but the smallest pittance for their share.</td> - </tr> -</table> - -<p><span class="pagenum" id="Page_253">[253]</span></p> - -<p>At Salerno the anatomical demonstration made, apparently only once a -year, for the benefit of the students, consisted in exposing to view -the abdominal viscera of the pig and commenting upon the features -which distinguish them from the same organs in the human body. In the -“<i>Regimen Sanitatis</i>” only eight lines of text are devoted to -anatomy.</p> - -<p>In section IV., which relates to physiology, the text is more -instructive and entertaining, but still—as compared with the splendid -work accomplished by Galen—extremely incomplete and superficial.</p> - -<p>In the early part of the twelfth century, Nicolaus Praepositus<a id="FNanchor_57" href="#Footnote_57" class="fnanchor">[57]</a> -composed, at the request of his colleagues in the school of Salerno, -an “Antidotarium”—that is, a collection of formulae for combining -together, in a single pharmaceutical preparation, various drugs, both -those commonly employed in that part of Europe and others which were -then known only to the Arabian physicians. This book of formulae, -containing as it did descriptions of the effects which might be -expected from the different preparations, and furnishing instructions -with regard to the proper mode of employing them, served its purpose -admirably, not only in Salerno but throughout Europe, at least -during the Middle Ages. All the pharmacopoeias of a later date were -based upon his “Antidotarium,” and indirectly upon the still earlier -celebrated treatises written by Matthew Platearius and bearing the -titles “<i>Glossae</i>” and “<i>Circa instans</i>” (also that of “<i>De -simplici medicina</i>”). The most remarkable item, however, which -is to be found in the Antidotarium is that in which mention is made -of the use of soporific sponges (“<i>spongia soporifera</i>”), for -anaesthetizing purposes by means of inhalations, in certain surgical -procedures. (Neuburger.) They were made by impregnating the sponges -thoroughly with the juices of narcotic plants (opium, hyoscyamus, -mandragora, lactuca, cicuta, etc.), drying them, and putting them aside -until they were actually needed. Then the sponge was saturated for<span class="pagenum" id="Page_254">[254]</span> -about an hour with hot water or steamed, after which it was applied -over the patient’s nostrils and held there until the inhalation of the -fumes had induced sleep.</p> - -<p>Another Salernian treatise worth mentioning is that written by Peter -Musandinus, under the title “On Foods and Beverages suitable for -Persons affected with a Fever.” This writer, who was one of the -teachers at the school of Salerno about the middle of the twelfth -century, says that great attention was paid in his time to the -preparation of foods in such a manner as to tempt the appetite of -people who were ill. He speaks of a meat extract which is prepared -from the flesh of the chicken, and also recommends that a soup -made by boiling a fowl in rose water be given to patients who are -affected with diarrhoea. He even goes so far as to lay stress upon -the importance of serving food to a sick person in dishes which are -pleasing to the eye. Apropos of the subject of foods that are easily -digestible and therefore suitable for invalids I may mention how Meaux -Saint-Marc translates or interprets the line in the “Regimen Sanitatis -Salernitanum” which reads <i>O fluvialis anas, quanta dulcedine -manas!</i> His version may be rendered into English thus:</p> - -<p>“Oh wood-duck, how gently doth thy soft flesh glide over the internal -surface of the stomach!”</p> - -<p>Toward the end of the twelfth century (1180 A. D.) there was published -at Salerno a work on surgery—the oldest treatise on this subject -that is known to have been written in Italy during the Middle Ages. -It is now called “Roger’s Practice of Surgery,” but originally it was -spoken of (in accordance with a custom quite common in those days) as -“<i>Post mundi fabricam</i>,” which are the first three words of the -text. This book is of a very practical character and is written in a -simple, straightforward style. While it contains the usual amount of -traditional knowledge about surgical matters, it gives at the same time -the results of the personal experience of Roger, of his teachers, and -of his associates. As published in the “<i>Collectio Salernitana</i>” -the work represents, not the treatise as it was originally written, -but a revision made by Rolando of Parma. It is<span class="pagenum" id="Page_255">[255]</span> divided into four -parts or books, the topics treated in which comprise most of those -usually discussed in works on surgery. Under the heading “Wounds of -the Intestine,” in Book III., there occurs this most remarkable piece -of advice, viz., “to insert into the intestinal canal a small tubular -piece of elder and then to stitch the raw edges of the bowel together -over it.”</p> - -<p>Another treatise on surgery, entitled “<i>Chirurgia Jamati</i>,” -was published at Salerno before the end of the twelfth century. Its -authorship is attributed to Jamerius, and in many respects it resembles -closely the treatise of Roger.</p> - -<p>The “<i>Regimen Sanitatis</i>” was not, it appears, the only treatise -on medicine which was published at that period in the form of a poem. -Gilles de Corbeil (Petrus Aegidius Corboliensis), who had received -his professional training at the school of Salerno and was afterward -appointed the personal physician of King Philip Augustus in Paris -(1180–1223 A. D.), wrote versified treatises on these two groups of -topics—“The pulse, the urine, and the beneficial characteristics of -composite remedies,” and “The signs and symptoms of the different -maladies.” Both of these treatises were received everywhere throughout -Europe with great favor and they maintained their popularity for a -period of over four centuries. A French translation (by C. Vieillard) -of the treatise on urology was published in Paris in 1903. An edition -of the “<i>De signis et symptomatibus aegritudinum</i>” was printed in -Leipzig in 1907. The following five lines are quoted by Neuburger; and -they certainly display the remarkable gift possessed by Aegidius for -condensing a large amount of information into a very small space:—</p> - - -<h4 class="sm">DE CONDITIONIBUS URINAE</h4> - -<ul class="smaller"> - <li class="hangingindent"><i>Quale, quid, aut quid in hoc, quantum, quotiens, ubi, quando,</i></li> - <li><i>Aetas, natura, sexus, labor, ira, diaeta,</i></li> - <li><i>Cura, fames, motus, lavacrum, cibus, unctio, potus,</i></li> - <li><i>Debent artifici certa ratione notari,</i></li> - <li><i>Si cupit urinae judex consultus haberi.</i></li> -</ul> - -<p><span class="pagenum" id="Page_256">[256]</span></p> - -<p>To translate this into easily comprehensible English prose would -certainly require the employment of at least five times as many words.</p> - -<p>Another physician who received a part of his training at Salerno and -who is mentioned by Neuburger as “The greatest eye surgeon of the -Middle Ages,” is Benevenutus Grapheus (twelfth century), a native of -Jerusalem, and probably of Jewish parentage. He wrote a practical -treatise (“<i>Practica oculorum</i>”) which had a wide circulation, and -which has been translated into Provençal, French and English.</p> - -<p>Toward the end of the thirteenth century the famous Medical School -of Salerno began to show signs of decadence. Various circumstances -were responsible for this change. In the first place, its career of -great usefulness had already covered a period of about seven hundred -years, and—according to the law affecting all things human—its -time of decrepitude was already more than due. Then, in the next -place, vigorous rivals were beginning to appear in different parts -of Europe,—at Bologna, at Montpellier and at Paris,—and these new -schools must have attracted large numbers of students who otherwise -would have frequented the University of Salerno for the educational -facilities which they required. Commercialism—if such a term may be -employed to characterize the action of those who were not willing -to undergo the entire course of training required for obtaining the -full privileges belonging to a physician—may perhaps also be named -as one of the influences which contributed to the slow breaking up of -the school. That this force had already begun to exert some effect -upon the management of the institution may be inferred from the fact -that in 1140 A. D., Roger, King of Sicily and Naples, promulgated -the law that nobody would be permitted to practice medicine in his -kingdom until he should have satisfied the royal authorities that he -was properly qualified to undertake such practice. The establishment -of such a law surely indicated that the number of those who were -incompetent to assume the responsibilities of a practitioner of -medicine was alarmingly<span class="pagenum" id="Page_257">[257]</span> on the increase; and, after it had gone into -effect, many must have been deterred from choosing a medical career, -and perhaps others have been diverted to schools which were located -in countries where the laws were more lax. In 1240 A. D. the Roman -Emperor Frederic II., who was also King of Sicily, made it a law that -the course of medical studies at Salerno should cover a period of -five years. All these factors taken together would seem to have been -sufficient slowly to diminish the popularity of this celebrated school. -But to these there were added, in the latter half of the thirteenth -century,—if we may believe Puschmann,—two new factors, which exerted -a powerful influence in destroying all hope of further regeneration, -viz., the establishment of a university at Naples, in 1258 A. D., by -Manfred, King of Sicily, and the narrow and illiberal spirit in which -the Church, by this time in almost full control of the education at -Salerno, managed the medical school.</p> - -<p>During the following four centuries the University of Salerno—for -during the thirteenth century it became a university in fact, if not -in name—retrograded steadily, until finally the French Government, on -November 29, 1811, officially put an end to its existence. The traveler -who to-day visits Salerno, in the hope of seeing some remains of the -oldest medical school in Europe, will find there only a collection of -squalid buildings which serve as dwellings for the poorer classes, a -dirty and uncomfortable inn, and shops of nearly the same dimensions -as those which once lined the narrow streets of Pompeii. As he gazes, -however, at the superb view presented by the Gulf of Salerno he may -readily, by an effort of the imagination, reconstruct the picture of -the famous “Hippocratic City” as it was when William the Conqueror and -other distinguished persons visited it nearly a thousand years ago.</p> - -<p>Neuburger, in his review of the career of the Salerno Medical School, -sums up its contributions to the science of medicine in about these -terms: Those who taught at Salerno were the first physicians in the -Christian part of Western Europe who procured for medicine a home in<span class="pagenum" id="Page_258">[258]</span> -which scientific considerations alone prevailed, where the Church -exercised no control whatever, and where all the different branches of -the science were favored to an equal degree. They devoted their best -energies, by oral teaching and by their writings, to the single object -of communicating practical knowledge of the healing art to all who -desired to obtain it; and, by the admirable example of their own lives, -they furnished a high standard for the guidance of those who wished to -reflect honor upon the name of physician.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_259">[259]</span></p> - -<h3>CHAPTER XXII<br /> -<span class="subhed1">EARLY EVIDENCES OF THE INFLUENCE OF THE RENAISSANCE UPON THE -PROGRESS OF MEDICINE IN WESTERN EUROPE</span></h3></div> - -<p>In previous chapters we have seen how the Arabs, inspired with an -extraordinary zeal for acquiring knowledge of the different sciences, -devoted time and money freely, throughout a period of several -centuries, to the accomplishment of this purpose. They were fired -with ambition to become a great nation, and their studies of the -world’s history taught them that the ancient Greeks had accumulated -in their literature vast stores of the very knowledge which they were -so anxious to acquire. Accordingly all their energies were directed -toward converting these stores from the Greek into their own language, -the Arabic. This widespread eagerness of the nation, at a given period -of its history, to improve itself intellectually is spoken of as the -Arabic Renaissance, and, at the time which I am now about to consider, -the movement had practically come to a standstill. A short time, -however, before this occurred, the physicians of Italy and of the more -northerly countries of Western Europe began to show a similar desire -to add to their medical literature; and their first step, like that -of the Arabs four or five centuries earlier, was directed to the work -of translating Arabic medical treatises into debased Latin, which was -the language commonly employed by the learned during the Middle Ages. -The knowledge which they desired to acquire could not at that time be -obtained in any other way, for nobody was acquainted with the Greek -language, and, besides, Greek originals had not yet been brought into -Western<span class="pagenum" id="Page_260">[260]</span> Europe. These first evidences of the Renaissance in that part -of the world were not confined to physicians; they were to be found -in every walk of life. The development of the movement reminds one of -what takes place near the sea coast, where a period of heat and calm is -suddenly broken by the appearance of a few gentle puffs of wind, which -are quickly succeeded by the full force of a steady and refreshing -sea-breeze. In like manner feeble indications of the coming movement -appeared in Italy, France, Germany and even England, and these were -soon followed by unmistakable evidences that a genuine Renaissance of -widespread proportions had begun. It was as if a great awakening had -taken place among the nations which had for centuries lain dormant; -an awakening which was followed by a desire to lay aside the trivial -pursuits in which they had so far been engaged, and to attain those -results which were, later on, to excite the wonder and admiration -of the world. Such were, for example, the development of the art of -printing with movable types; the discovery of America; the production -of such clever painters, sculptors, engravers, workers in metal, -etc., as Michael Angelo, Raphael, Albrecht Dürer, Benvenuto Cellini, -Rembrandt, and literally scores of others of nearly equal merit; the -development of a Shakespeare, a Milton and a Dante in the field of -literature; the production of a Luther, a man who had the courage to -protest against evil practices which had crept into the Christian -church. And medicine, as I have already stated, felt the influence -of the approaching Renaissance, and responded to it by efforts which -had for their object the acquisition of such knowledge as might be -furnished by translations from Arabic treatises. Constantinus, the -African, of whom mention has been made on a previous page, seems to -have been the first person (toward the end of the eleventh century) who -did any work of this kind; but his associates in Salerno do not appear -to have valued these translations very highly, or else, perhaps, they -were not yet prepared to give serious consideration to works which were -new to them. In the twelfth century, as will now be seen, the<span class="pagenum" id="Page_261">[261]</span> attitude -of the physicians of Western Europe underwent a change.</p> - -<p>The city of Toledo, in Spain, was richly stocked with the manuscript -treasures of Arabic literature at the time (1085 A. D.) when it fell -into the hands of the Christians. One of the earliest scholars to -engage in the work of translating these treasures into Latin was -Gerard of Cremona, in Lombardy, who lived during the twelfth century -(1114–1187 A. D.). He spent most of his lifetime in Toledo, “learning -and teaching, reading and translating.” (Neuburger.) Among the medical -works which he translated from the Arabic the most important are the -following: Several of the writings of Hippocrates and Galen; the -Breviarium of Serapion; several of the writings of Rhazes and of Isaac -Judaeus; the treatise on surgery by Abulcasis; the Canon of Avicenna, -etc. This stimulated many others to follow in the footsteps of Gerard -of Cremona; and thus, during the thirteenth century, a number of works -of importance were translated in addition to those already mentioned. -Such, for example, were the “Colliget” of Averroes by Bonacosa, a Jew -(1255) of Padua; the “<i>Teïssir</i>” of Avenzoar, and the “Dietetics” -of Maimonides by John of Capua, a Jewish convert to Christianity -(1262–1278); the “<i>De veribus cordis</i>” of Avicenna by Arnaldus -of Villanova (about 1282); the treatise “<i>De simplicibus</i>” of -Serapion the Younger, and the “<i>Liber servitoris</i>” of Abulcasis, -by Simon Januensis; and many others. This wave of keen interest in -the writings of Arabic physicians and in the Arabic versions of Greek -medical authors soon reached Languedoc in France, and then passed over -from there into Italy. For a long time the Salerno physicians resisted -its influence, but they finally yielded to it, as the leaders in the -schools of Bologna, Naples, Montpellier and Paris had already done. -It was at Palermo, in Sicily, however, that the movement received its -greatest impetus. Frederick II., at that time King of Sicily, and a -ruler who was most tolerant in religious matters, had at his Court an -entire staff of Arabic physicians, philosophers, astrologers and poets; -and, in addition, he kept a number of<span class="pagenum" id="Page_262">[262]</span> learned Christians and Jews -constantly busy translating Arabic works into Latin. The most widely -known member of the latter group was Michael Scotus (or Scottus), -who at one time had been a teacher in the Medical School of Salerno. -Among the books which he translated while he was at Palermo there were -several of Aristotle’s treatises, more particularly those which dealt -with psychological topics and with natural history. Frederick not -only did everything in his power to promote the work of translating, -he also took pains to distribute copies of the Latin versions, when -completed, among the universities of Western Europe. His son, Manfred, -who succeeded him on the throne, seems to have been almost as much -interested in the work as his father had been. It was from him, for -example, that the University of Paris received a set of the Aristotle -volumes in Latin. When Charles I., King of Naples (1265–1285 A. D.), -conquered Sicily he manifested considerable interest in continuing the -work of his predecessors, particularly as regards treatises relating -to medicine. Among the translators whom he employed for this work -was Farragut (in Arabic, Faradsch ben Salem), from Girgenti, a small -town on the south coast of Sicily, about sixty miles from Palermo. In -addition to several treatises of minor importance he translated into -Latin the colossal work of Rhazes—the “Continens.” Charles I. kept at -his Court not only expert translators, but also skilled illuminators; -and it was by them that the celebrated manuscript copy of this work -which is to-day in the <i>Bibliothèque Nationale</i> at Paris, was -illustrated with miniatures, three of which are portraits of Farragut. -This particular copy of the “Continens” was completed in 1282 A. D. -Not a few of the translations made during this period, it should be -stated, are now very difficult to understand. In the first, place, the -Latin in which they are written is of the barbaric type (neo-Latin), -something quite different from that employed by Cicero, Tacitus and -other Roman authors of the classical period; and, in the next, it is -not infrequently evident that the translator himself did not clearly -apprehend the meaning of the original Arabic text. Despite all<span class="pagenum" id="Page_263">[263]</span> these -drawbacks, however, the placing of Latin versions of Arabic writings -within the reach of European physicians accomplished much good. Even -the imperfections to which reference has just been made probably -served to increase the eagerness of these men to gain access to the -real sources of Arabic learning—viz., the writings in the original -Greek. To anticipate a little, I may say here that this object was -not attained until after the lapse of about two more centuries—that -is, not until the scholars of Western Europe had learned to read the -Greek, and had also brought out from their hiding places in churches -and monasteries of the East the needed originals. At that period of the -world’s history centuries corresponded to decades as modern events are -recorded.</p> - -<p>One may gain some idea of the extent to which these Latin translations -of Arabic original treatises and of Arabic versions of Greek medical -works influenced the physicians of Western Europe, by consulting one -of the important medical treatises of the fourteenth century—that, -for example, of Guy de Chauliac (written 1363 A. D.). Edouard Nicaise, -the accomplished editor of this and several other mediaeval medical -treatises, has printed in his preface Joubert’s table showing just how -often Guy quotes each one of about four score earlier authors, and from -this analysis it appears that Abulcasis was quoted 175 times, Aristotle -62 times, Avicenna 661 times, Galen 890 times, Haly Abbas 149 times, -Mesué 61 times, Hippocrates 120 times, and Rhazes 161 times; or, to -state the facts somewhat differently, the quotations from treatises -introduced into Western Europe by the Arabs represent, in the present -instance, 70 per cent of all the quotations (2279 of a total of 3243) -made by this author. Another equally strong piece of evidence is that -afforded by Vincent de Beauvais’ encyclopaedia,—a work published -in Paris toward the middle of the thirteenth century,—in which the -parts relating to medicine appear to have been taken very largely from -treatises written by Arabic authors. (See statement on page 270.) There -can therefore be no reasonable doubt that the Arabs played a most -important part<span class="pagenum" id="Page_264">[264]</span> in the renaissance of medical learning which began a -century or two earlier, which already in the thirteenth century had -made great progress, and which very soon—as time is reckoned in the -calendar of all important world movements—was to culminate in that -still greater renaissance called “modern medicine.”</p> - -<p>During the later portion of the Middle Ages (thirteenth and fourteenth -centuries) there were four universities which possessed medical schools -of considerable importance—viz., those of Bologna and Padua in Italy, -and those of Montpellier and Paris in France. All of these seats of -learning, like the famous school at Salerno, developed so gradually -and from such modest beginnings that it is scarcely possible to assign -to any of them a date of origin. Medicine was taught at several other -places—as, for instance, at Oxford, England; at Naples, Vicenza, -Siena, Rome, Florence, Ferrara, Pisa and Pavia, in Italy; at Salamanca -and Lerida, in Spain; at Prague, in Bohemia; at Cologne, in Germany; -at Vienna, in Austria, etc. But the part which these smaller schools -played in the work of advancing our knowledge of medicine was certainly -of far less importance than that which fell to the lot of the four -institutions just mentioned.</p> - -<p>The University of Montpellier, if not the oldest of the four schools -mentioned, was apparently the first to attain some degree of -celebrity. It is known, for example, that the Archbishop of Lyons, -who was suffering at the time from some malady which the physicians -of that city were not able to cure, visited Montpellier 1153 A. D. -in the belief that he might there obtain the desired relief. John of -Salisbury, who lived during the latter half of the twelfth century and -who was considered one of the greatest scholars of his time, declared -that those who wished to acquire a satisfactory knowledge of medicine, -found that Salerno and Montpellier were the only places where the -desired instruction might be obtained. Gilles de Corbeil (mentioned -in the last chapter), Von der Aue, and other eminent men of the same -period spoke in equally favorable terms of the merits of Montpellier. -The celebrated monk,<span class="pagenum" id="Page_265">[265]</span> Caesarius of Heisterbach, calls the university of -that city “the headquarters of medical wisdom”; but at the same time -he expresses regret that the physicians of that school not only do not -believe in miraculous cures, but speak of them ironically. It was one -of the characteristics of the institution that the teachers, both the -medical and the philosophical, were, at a very early period, allowed -great freedom of thought and speech; but, as time went on, this liberty -became very much curtailed. During the thirteenth and fourteenth -centuries there were, it appears, many Jews among the students at -Montpellier, not merely in the department of medicine, but also in the -other departments of the university.</p> - -<p>The medical schools of Salerno and Montpellier seemed, at this early -period (thirteenth century), to possess more individuality than did the -similar organizations at Bologna, Padua and Paris; for limited periods -of time each of them in turn enjoyed a certain amount of fame by -reason of the fact that some teacher or writer of special distinction -happened then to be officially connected with the school. In other -words, it was the fame of the man and not of the school, that induced -students to visit Bologna or Padua, or Paris, during the thirteenth -and fourteenth centuries. At a somewhat later period (fifteenth -and sixteenth centuries) all three of these institutions stood out -prominently before the world as celebrated medical schools, with -distinctive characteristics. To be invited to occupy a chair in one of -these institutions conferred honorable distinction upon the incumbent -selected, and when I reach that period, farther on in this history, -I shall describe each one of the more important schools separately. -In dealing with the earlier epoch, however, it seems best to devote -our attention more particularly to individual physicians than to the -schools with which they may happen to be connected.</p> - -<p>Among the physicians belonging to the latter half of the thirteenth and -the first quarter of the fourteenth century there is one whose proper -place in the history of medicine is by no means easy to determine, and -who yet played a part of no small importance. This man was Pietro<span class="pagenum" id="Page_266">[266]</span> -d’Abano, or Petrus Aponensis, who was born at Abano, a small village -near Padua, 1250 A. D. Very little is known about his early youth, -but from this little we are warranted in drawing the conclusion that -his father, a notary, must have taken great pains to afford him every -possible educational advantage. He gave his son, for example, the -opportunity of studying Greek in Constantinople,—a thing of rare -occurrence in those early days,—and allowed him to remain there until -he had so far mastered the language that he was able to translate the -“<i>Problemata</i>” of Aristotle from the original text. Then, upon his -return home from Constantinople, he was sent to Paris for the purpose -of perfecting his knowledge of philosophy, mathematics and medicine. -After this thorough training for his life work, Pietro d’Abano began -teaching philosophy in Padua, and almost immediately he gained such -success that people spoke of him as “the great Lombard.” However, like -most of the men of that time who became conspicuous through their -intellectual attainments, Pietro d’Abano was soon accused by the -Dominicans of being a heretic and of cultivating the magician’s art. He -was able to parry this blow by making a journey to Rome and obtaining -from Pope Boniface VIII. a decree of absolution. About the same -time he began writing his two great works—the “<i>Conciliator</i>” -and the “Commentaries on Aristotle’s <i>Problemata</i>.” He did not -begin to teach medicine at the University of Padua until 1306, when -he was already fifty-six years of age. But his lectures, reflecting -as they did the depth and extent of his learning and the keenness of -his powers of analysis, were a source of great astonishment to his -contemporaries. It is reported by Neuburger, for example, that Gentile -da Foligno, one of the most distinguished professors in the Medical -School of Padua, happening to pass near the auditorium while Pietro -d’Abano was delivering his lecture, listened for a short time and then -exclaimed: “<i>Salve o santo tempio</i>”—“Hail to this time which has -brought forth such wonders!” With the increase of Pietro’s fame came -also a decided increase in the bitterness of the persecution carried -on against him<span class="pagenum" id="Page_267">[267]</span> by his ecclesiastical foes, largely due perhaps to his -open and courageous defense of the Averroism which they so much hated. -There is very little doubt that he would have been burned at the stake -about this time if the friendly disposition of the Popes and the mighty -influence possessed by the city of Padua had not shielded him from this -danger. In 1314 the newly founded school of Treviso invited Pietro -d’Abano to occupy the Chair of Medicine and Physics, and he accepted; -but he was taken ill and died during the following year. Shortly before -the occurrence of this event he was placed on trial for heresy by the -Inquisition, and the proceedings were continued even after his death. -Indeed, according to one account of this famous trial, not only was -the charge sustained, but the prescribed penalty was inflicted either -upon the disinterred corpse or upon an effigy of the condemned man. One -century later, the city of Padua erected a permanent memorial in Pietro -d’Abano’s honor.</p> - -<p>The principal work of this remarkable physician—viz., the -“<i>Conciliator differentiarium philosophorum et praecipue -medicorum</i>”—was first printed at Venice in 1471. (It is said to -be one of the earliest printed books known.) It was a most popular -treatise, as is shown by the fact that between the year last mentioned -and 1621 it passed through a number of editions. Of the other treatises -which he wrote—some seven or eight in all—it will be sufficient -to mention here that one alone to which reference has already been -made in the preceding account, viz., the work entitled “<i>Expositio -problematum Aristotelis</i>” (Mantua, 1475, and Paris, 1520).</p> - -<p>At this early period in the history of the Padua Medical School there -were one or two other men who attained a considerable degree of -celebrity for the excellence of the work which they did, either as -authors or as class-room teachers. A brief account of one of these, -Aegidius Corboliensis, has already been given on a preceding page, and -it seems only fair that I should furnish here similar brief accounts of -some of the others—Gentile da Foligno, Massilio and Galeazzo de St. -Sophia, Giacomo and Giovanni<span class="pagenum" id="Page_268">[268]</span> de’ Dondi, and Giacomo della Torre, from -Forli, all of whom contributed greatly to the steadily increasing fame -of the Padua School of Medicine; but, under the conditions which govern -the preparation of this brief history, I must reluctantly pass over -these names in silence.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_269">[269]</span></p> - -<h3>CHAPTER XXIII<br /> -<span class="subhed1">FURTHER PROGRESS OF MEDICINE AND SURGERY IN WESTERN EUROPE -DURING THE THIRTEENTH, FOURTEENTH AND A PART OF THE FIFTEENTH -CENTURIES</span></h3></div> - -<p>Among the men who, during the thirteenth century, exerted more or -less influence upon the growth of medical knowledge there are three -who deserve to receive some consideration at our hands. They were not -physicians, but yet some of their writings deal with topics which -are closely related to the science of medicine. They are: Albert von -Bollstädt, a German who is generally known as Albertus Magnus, one of -the greatest scholastic philosophers of the Middle Ages; Vincent of -Beauvais (Vincentius Bellovacensis), a French Dominican monk, who was -reader to Louis IX., and who compiled a general encyclopaedia which -brought him great fame at that period; and Roger Bacon, an Englishman -who, by reason of the extraordinary extent of his knowledge and his -remarkable powers of observation, was given the name of “Doctor -mirabilis.”</p> - -<p><i>Albertus Magnus.</i>—Albertus Magnus was born at Lauingen, Swabia, -in 1193 A. D., obtained his education in Italy (at the University of -Padua, during the latter part of his stay), joined the Order of the -Dominicans on arriving at the age of thirty, and afterwards, throughout -his long life, devoted himself largely to teaching, particularly at -Paris and Cologne. He was a prolific writer and his works, particularly -those which treat of topics belonging to the domain of natural history, -were greatly appreciated. The effect, however, which they produced -upon a certain class of readers was to persuade them that he was a -great<span class="pagenum" id="Page_270">[270]</span> magician. The chief distinction of his writings lies in the -fact that they contain a large number of original observations which -he made during the course of his journeys afoot through Germany in -the character of Provincial of the Dominican Order. This habit of -exercising entire independence in the use of his reasoning powers -was something quite rare in those days. His observations were -directed chiefly to matters belonging to the domains of zoölogy, -botany, climatology, mineralogy, chemistry and physics. The following -significant advice, says Neuburger, is attributed to him: “As regards -the doctrines which relate to questions of belief and of morality, it -is the part of wisdom to attach greater authority to Saint Augustine -than to the philosophers; in matters belonging to the domain of -medicine put your chief trust in Galen and in Hippocrates; in natural -history, however, your best guide is Aristotle.” Neuburger adds that, -throughout the writings of Albertus Magnus, there appear interesting -statements relating to anatomy, physiology, psychology, and the plants -and minerals which may be used for remedial purposes.</p> - -<p>An edition of the writings of Albertus Magnus (21 folio volumes) was -published in Lyons by Petrus Jamy in 1651. The work was republished in -Paris in 1892 and following years.</p> - -<p><i>Vincent of Beauvais.</i>—Vincent of Beauvais, France, a Dominican -monk who lived during the first half of the thirteenth century and -was the tutor of Louis the Ninth’s children, devoted the major part -of his time to literary work. He wrote many theological treatises -and also edited a large encyclopaedia in which information is -furnished regarding everything that was known at that time. Several -hundred authors aided him in compiling this work, which is entitled -“<i>Speculum Majus</i>.” It is arranged in three parts, one of which -(“<i>Speculum Naturale</i>”) consists of 33 books that are divided -into 3740 chapters; and quite a number of the divisions are devoted -to topics relating to medicine. The authors, from whose writings this -medical information has been abstracted, are Hippocrates, Aristotle, -Dioscorides,<span class="pagenum" id="Page_271">[271]</span> Haly Abbas, Rhazes, Avicenna and several others—not to -mention the Church Fathers and other encyclopaedic writers connected -with the Church. The first printed edition of this great work appeared -toward the end of the fifteenth century (1473–1475 A. D.); the last, -or one of the last, in 1624. Lack of space will not permit me to give -any details concerning the works of a somewhat similar character -which were prepared, about the same time, by the English Franciscan -monk Bartholomaeus of Glanvilla (1260); by the Dominican, Thomas of -Cantimpré (1204–1280 A. D.), a pupil of Albertus Magnus; and by others.</p> - -<p><i>Roger Bacon.</i>—Roger Bacon was born about 1210 A. D. in -Ilchester, Somersetshire, England, and received his early training at -Oxford. When he was thirty years of age he went to Paris and, after -devoting himself assiduously for seven years to the study of various -branches of learning, he received the Doctor’s degree (1247). The -wish to acquire a thorough knowledge of whatever subject he undertook -to study constituted a prominent feature of his character. He was -fond of languages, but he had an even greater love for mathematics, -particularly in connection with astronomy, and for experimental work -in the department of chemistry. It is said that he expended a large -sum of money (£2000) upon these chemical investigations. He left -Paris in 1250, returned to England, and not long afterward joined the -Order of the Franciscans. Robert Grossetête, Bishop of Lincoln, and -the Franciscan monk Adam of Marisco—two men whom Neuburger describes -as theologians of a very liberal type—exercised a strong influence -upon Bacon at this period of his life. They confirmed him in the -belief that familiarity with the learned languages was an acquisition -greatly to be prized, and at the same time they gave him every -encouragement to pursue his researches in mathematics and in natural -history. For a certain length of time he was an instructor at Oxford, -but his views with regard to ecclesiastic and moral questions and -the discoveries which he made in physics (especially in optics) were -beyond the comprehension of his contemporaries, who did not hesitate to -pronounce them works of the Devil and to subject Bacon<span class="pagenum" id="Page_272">[272]</span> to all sorts of -punishments and deprivations. Fortunately for him and for the cause of -science the newly elected Pope, Clement IV. (1266), came to his rescue -in those dark days and granted him—under the promise of absolute -secrecy—permission to continue his researches without hindrance and to -perfect the plans which he had in mind for reforms of different kinds. -I cannot follow this pioneer of scientific research work, this man who -was several centuries ahead of the time in which he lived, through all -the vicissitudes of his interesting and extraordinarily fruitful life; -I may simply add that his death occurred about the year 1294; that -he left behind him many important treatises, only a small portion of -which have thus far been published,<a id="FNanchor_58" href="#Footnote_58" class="fnanchor">[58]</a> and that from these alone one -is justified in classing Roger Bacon as one of the greatest thinkers -whom history has recorded. So far as is now known, he wrote very little -concerning medicine, and—strange to say—he seems to have attached -considerable importance to astrology; indeed, he went so far as to -blame the physicians of his day for their ignorance regarding this -science, “as a result of which they neglect the best part of medicine.” -In strange contrast with these views, which to-day we characterize as -foolishness, is Bacon’s famous dictum: “Experiment is a firmer and more -trustworthy basis of knowledge than argument”—a maxim which is the -guiding principle of modern medicine.</p> - -<p>The Medical School of Bologna.—The Medical School of Bologna first -began to assume a certain degree of prominence in the early part of -the thirteenth century, under the teaching of Thaddeus Alderotti—also -frequently called Thaddeus of Florence.</p> - -<p><i>Thaddeus Alderotti.</i>—Thaddeus Alderotti, who was born at -Florence, Italy, 1223 A. D., of humble parentage, began the study -of philosophy and medicine at Bologna only after he had reached -manhood; but he was such an earnest student and made such good use of -his opportunities that in 1260 he was chosen to serve as one of the -teachers in the school. Throughout a period of many years he filled -the office so<span class="pagenum" id="Page_273">[273]</span> acceptably that his colleagues bestowed upon him the -name of “Master of Physicians.” Before this time arrived, however, -his lack of funds was sorely felt, for he was obliged, in order to -support himself, to offer consecrated wax candles for sale at the -entrance of the church. He is reported to have been not merely a most -learned physician, but also a very successful practitioner. He was -called into consultation from all parts of the country, so highly -was his opinion valued by other physicians; and thus in due time he -accumulated a large fortune. His charges were by no means small. It is -related, for example, that Pope Honorius IV. sent for him to come to -Rome, and, after the treatment was completed, paid him a fee of 10,000 -gold pieces<a id="FNanchor_59" href="#Footnote_59" class="fnanchor">[59]</a>—but not until after he had expressed surprise that -Thaddeus should have charged as much as 100 gold pieces per day for his -services. To this demurrer on the part of the Pope, Thaddeus replied -that the petty princes and even the simple nobles made no objection to -paying him 50 or more gold pieces per day. It is scarcely necessary to -add that the Holy Father did not wish to be outdone by his inferiors.</p> - -<p>Alderotti died 1303 A. D.</p> - -<p>Among the writings of Thaddeus Alderotti which have come down to our -time there are to be found a number of autobiographical references -which are not without interest. In one place, for example, he mentions -the fact that he occasionally walks in his sleep, and then proceeds -(in Latin) to discuss the phenomenon of sleep-walking as observed in -his own case. I give here a free translation of the text printed in -Neuburger’s History:—</p> - -<div class="blockquot"> - -<p>The fourth question which suggests itself is this: Can the -senses during sleep come into active operation? Touching this -fourth question I reason thus: It appears as if, when one -is asleep, the senses must act, for a person may move about -without incurring any harm when he is in that state, as is -often observed in the case of those who, like myself, walk in -their sleep.... Furthermore, it has been remarked that these -people are able to harness a horse and then to ride the animal -safely,—acts which it is not<span class="pagenum" id="Page_274">[274]</span> possible to perform without the -aid of the senses. On the other hand, Aristotle maintains that -a man, when asleep, is not capable of using his senses. To this -I reply by conceding that during sleep a man certainly does not -perceive what is going on about him. Wherefore, if you answer me -by saying that the mere fact of a man’s ability to walk while -he is asleep furnishes conclusive evidence that he possesses -his senses, I reply that movements like that of walking are not -the result of an impression made upon the mind (“<i>impressio -imaginativa</i>”), but the product of a different mechanism, of -a nature which permits it to operate during sleep.... As to the -second point to which you call attention—that, namely, with -regard to the power of bridling and riding a horse while one is -asleep—I make this reply: These acts are performed as a result -of an impression made upon the mind through the working of the -imagination, and not as a direct consequence of any images -created upon the eye; for, if the sleep-walker happens to be in -a strange house when the impulse to walk seizes him, he will not -go to the stable. The route which he is sure to take will be one -with which he is familiar, as happened in the case of the blind -teacher who, unaccompanied by any person, walked habitually -through the streets of Bologna. And then, besides, I am able to -speak from personal experience, for in one of my sleep walks I -jumped down from an elevation about four feet above the ground -without awaking from my sleep.... When, in the course of one -of these walks, I am exposed to cold, or when I hear somebody -speaking near me, I refer these phenomena entirely to something -within myself, and I return to my bed.</p> -</div> - -<p>Of the four medical schools to which a brief reference was made on a -preceding page, that of Bologna was probably the first to attain a -certain degree of celebrity; and it owed this distinction very largely -to the work done by men who were primarily surgeons, viz.: Hugo of -Lucca; Theodoric, Hugo’s son; William of Saliceto; and possibly, to -a very slight extent, Roland of Parma, who spent only a part of his -professional life in Bologna. But there was one other who, while he was -not a surgeon, yet contributed very greatly to the fame of the Bologna -school and at the same time to the real advance in surgical knowledge -which characterized the work of the men whose names have just been -mentioned—viz., Mondino. These men, especially<span class="pagenum" id="Page_275">[275]</span> Mondino, cultivated -the study of anatomy much more earnestly than their rivals at Salerno -had ever done, and the surgical methods which they adopted were of -a more scientific character than those practiced by Roger. In the -treatment of wounds, for example, instead of striving to bring about -healing by the application of remedies which stimulate suppuration, -they favored the dry method; in which practice they were justified -not only by their own experience but also by Galen’s teaching: “A dry -state of the wound approaches more nearly to what may be considered -the normal condition, whereas a moist state is surely unhealthy.” -(<i>Methodi medend.</i>, IV., 5.) As an offset to the latter authority -the Salerno surgeons quoted that particular aphorism of Hippocrates -(V., 67) which reads: “<i>Laxa bona, cruda vero mala.</i>”—almost the -very opposite of Galen’s doctrine. Then again, the Bologna surgeons -effected improvements in other directions: They materially restricted -the use of the red-hot cautery iron, and they cast aside as useless -many of the complicated apparatuses which had previously been employed -in the treatment of fractures and dislocations. It is evident from -these facts that the Bologna surgeons were not, as were most of the -physicians of the twelfth and thirteenth centuries (Thaddeus of -Florence perhaps excepted), slavish followers of the ancients or even -of the more modern Arabs, but men who thought independently and who -were not afraid to use their own powers of observation.</p> - -<p><i>Hugo of Lucca.</i>—Hugo Borgognoni, more commonly called Hugo of -Lucca—was born in that city about the middle of the twelfth century, -served as municipal physician to the city of Bologna, accompanied -the Bolognese Crusaders on their expedition to Syria and Egypt, was -present at the siege of Damietta in 1219 A. D., and died a short time -before 1258, at the age of nearly one hundred. He acquired a great -reputation as a surgeon and brought up several sons who followed in -the same walk of life, among the number being Theodoric, who gained -even greater celebrity than his father in the domain of surgery. As -Hugo himself left no writings of any kind, we are<span class="pagenum" id="Page_276">[276]</span> largely dependent, -for a knowledge of his achievements, on the treatises which his son -Theodoric wrote. From this source we learn that Hugo recommended, for -use in surgical operations, the employment of narcotizing sponges like -those described on page 253, and was also an advocate of the plan of -treating wounds by the dry method (compresses soaked in wine over -which simple dressings were applied). In the treatment of empyema, of -abscesses, of penetrating wounds of the chest, and of both complicated -and simple wounds of the skull, he emphasized the wisdom of adopting -simple measures, of interfering with the parts as little as possible, -of abstaining from the use of the probe, and of observing strict -cleanliness. In cases of fracture of a rib it was his practice to -place the patient in a bath, and then, with fingers which had been -thoroughly oiled, to attempt the replacement of the separated ends of -the fractured bone. Neuburger regards Hugo of Lucca as the founder of -the Bologna School of Surgery.</p> - -<p><i>Theodoric of Lucca</i>, known also as Bishop Theodoric, was born -1206 A. D. While still quite a young man he joined the recently -established order of preachers, and not long afterward was appointed -Almoner (<i>Poenitentiarius</i>)<a id="FNanchor_60" href="#Footnote_60" class="fnanchor">[60]</a> to Pope Innocent IV. Eventually -he became Bishop of Cervia, near Ravenna. By special permission of -the Pope, he was able to complete the surgical training which he had -received from his father, Hugo of Lucca; and thus, while he still held -the office of Bishop, he practiced surgery to some extent in Bologna. -In course of time his practice became very extensive and also very -lucrative; as a result of which he was able to leave a large fortune to -various charitable institutions. The first printed edition of his work -on surgery appeared in Venice in 1498, and was followed by numerous -later issues.</p> - -<p>Theodoric, says Neuburger, was a most uncompromising advocate of the -dry method of treating wounds. His (Theodoric’s) words are these: “For -it is not necessary—as Roger and Roland have said, as most of their -disciples<span class="pagenum" id="Page_277">[277]</span> teach, and as almost all modern surgeons practice—to favor -the generation of pus in wounds. This doctrine is a very great error. -To follow such teaching is simply to put an obstacle in the way of -nature’s efforts, to prolong the diseased action, and to prohibit the -agglutination and final consolidation of the wound.”<a id="FNanchor_61" href="#Footnote_61" class="fnanchor">[61]</a></p> - -<p>In his enumeration of the different means that may be employed for -arresting hemorrhage, Theodoric mentions cauterization, tamponading, -the application of a ligature, and the complete division of the injured -blood-vessel. He attached great importance to the proper feeding of the -patient. In Book III., chapter 49, of his treatise on surgery, he gives -minute instructions with regard to the proper manner of employing a -salve made with quicksilver, and at the same time he mentions the fact -that he observed a flow of saliva as one of the results of its use.</p> - -<p>The expressions “healing by first intention” and “healing by second -intention” are encountered for the first time in the writings of -Brunus, a surgeon who practiced in the cities of Verona and Padua about -the middle of the thirteenth century, and who was a vigorous advocate -of the dry method of treating wounds. His two treatises (“<i>Chirurgia -magna</i>” and “<i>Chirurgia minor</i>”) were printed in Venice in -1546. Neuburger says that although a large part of the text in these -volumes consists of extracts from Galen, Avicenna, Hippocrates, -Abulcasis and other authorities, there are to be found at the same time -not a few observations of an original character.</p> - -<p><i>William of Saliceto.</i>—William of Saliceto (<i>Guglielmo da -Saliceto</i>) is accorded by Neuburger the honor of being Bologna’s -greatest surgeon—if not, indeed, the greatest surgeon of that period. -He was born in the early part of the thirteenth century and spent a -large portion of his professional life in Bologna, where he not only -practiced<span class="pagenum" id="Page_278">[278]</span> medicine but also acted in the capacity of a teacher of this -science. During the latter part of his career he lived in Verona, where -he held the position of Municipal Physician and Attending Physician of -the City Hospital. He died about the year 1280.</p> - -<p>Saliceto’s work on surgery is of a thoroughly practical character and -reveals the author to have been a born surgeon.<a id="FNanchor_62" href="#Footnote_62" class="fnanchor">[62]</a> In addition to the -“<i>Cyrurgia</i>,” which was first printed in Piacenza 1476 A. D., he -wrote a treatise which bears the title “<i>Summa conservationis et -curationis</i>” (printed first in Piacenza in 1475). The “Surgery” -is divided into five books, preceded by a short chapter on general -methods, etc. Book I. is devoted to affections of the cranium, -eruptions on the head, eye diseases, ear diseases (snaring of ear -polypi), nasal polypi, abscesses in the axilla, affections of the -mammary gland, tumors in different parts of the body, venereal lesions -in the groin, and a long list of other surgical maladies. Book II. -describes wounds of all sorts, including those produced by arrows -(with reports of cases), penetrating wounds of the chest and abdomen -(with instructions about sewing both longitudinal and transverse -wounds of the intestine), etc. Under the head of penetrating wounds -of nerves (declared by the author to be very dangerous), Saliceto -recommends enlargement of the wound, the application of oil, and -the employment of opium or hyoscyamus to quiet the pain. Book III. -treats the subject of fractures and dislocations in a most thorough -manner. Mention is made of the crepitation noise heard in fractures -(<i>sonitus ossis fracti</i>) and a warning is given not to apply -the bandages too tightly and to be careful to change the dressings -every three or four days. The instructions given with regard to the -reduction of dislocations are said by Neuburger to be most sensible. -Book IV. contains such anatomical descriptions as may be helpful to -the practical surgeon. From these, however, it is evident that the -writer had never dissected the human cadaver. Book V. is devoted to -the subject of<span class="pagenum" id="Page_279">[279]</span> cauterizing and to the consideration of those remedial -agents which are commonly employed in surgery. The instruments used -for cauterizing purposes were made of different metals, gold or silver -being preferred for the more delicate ones, and brass and iron for the -others. Immediately after the cauterization it was customary to apply -butter, or the fat of some animal, or oil scented with roses, to the -burned part.</p> - -<p>Saliceto’s other treatise—the <i>Summa conservationis etc.</i>—is -also divided into five books, which contain chapters devoted to all -the more important branches of internal medicine and to questions -of diet, of the physician’s behavior in the presence of a patient, -etc. Especially interesting are his remarks about the importance of -considering the psychological effect produced upon the patient by -such matters as the physician’s manner of feeling the pulse, his -carefulness to inquire about the patient’s various symptoms (how the -night was passed, what food and drink had been taken, etc.)—an effect -which oftentimes is “greater than that produced by instruments and -medicines.” In discussing the subject of prognosis, Saliceto makes the -remark that it is always proper for the physician to hold out to the -patient hope of recovery, although he urges at the same time the wisdom -of telling the whole truth to the friends of the patient. He also lays -great stress upon the importance of “not holding any conversation with -the lady of the house upon confidential matters.” Neuburger gives a -number of other extracts from this most interesting work; but I must -abstain from devoting any more space to this one mediaeval author, -whose manner of writing makes it difficult to realize that the treatise -which he has written belongs to the thirteenth century and not to a -very recent period.</p> - -<p><i>Roland of Parma.</i>—Roland, who was born in the city of Parma -and who spent a part of his life in Bologna, not only edited the work -of his teacher, Roger of Salerno, but also wrote a concise treatise -on surgery that is entitled “<i>Rolandina</i>.” Neuburger speaks -of this book as differing<span class="pagenum" id="Page_280">[280]</span> but little from Roger’s “<i>Practica -chirurgiae</i>.”<a id="FNanchor_63" href="#Footnote_63" class="fnanchor">[63]</a> “It contains, however, the report of a case of -penetrating wound of the chest in which Roland showed not a little -courage by daring to cut off, flush with the skin, a portion of lung -tissue which happened to protrude from the wound, and then applying a -simple dressing.”</p> - -<p>The treatise known by the title “<i>Glossulae quatuor magistrorum super -chirurgiam Rogerii et Rolandi</i>” was written by an unknown author or -perhaps by several authors. It represents a collection of commentaries -on the works of the two who are mentioned in the title of the book, and -should probably be classed as a part of the literature of the Salerno -School of Medicine.</p> - -<p><i>Mondino the Anatomist.</i>—Mondino, who was the first physician, -after an interval of about fifteen hundred years, to revive the -practice of dissecting human bodies, was born at Bologna at about 1275 -A. D. He received his professional training at the medical school of -his native city and was given the degree of Doctor in 1290, at the age -of fifteen(!). Not long afterward he began to teach anatomy in the same -institution and continued to serve in this capacity up to the time -of his death in 1326. The physicians who aided him in his anatomical -researches were Ottone Agenio Lustrulano, his prosector, and a woman -named Alessandra Gilliani, from Perriceto.</p> - -<p>Mondino’s method of teaching anatomy was to deliver his lectures with -the dissected cadaver directly before him; that is, he demonstrated -the correctness of his statements as fast as he made them. (See Fig. -9.) Such a method was entirely new at the time and proved immensely -popular, attracting students to Bologna in large numbers. Partly in -this way and partly by means of the treatise on anatomy which he wrote -(“<i>Anatomia Mundini</i>”), he became the instructor of numerous -generations of physicians. His treatise remained the authoritative -guide in anatomy up to the middle of the sixteenth century.</p> - - <div class="figcenter" id="i_fp280" style="width: 750px"> - <img - class="p2" - src="images/i_fp280.jpg" - alt="" /> - <p class="center p0 sm">FIG. 9. THE OLDEST KNOWN PICTORIAL REPRESENTATION OF A -FORMAL DISSECTION OF THE HUMAN BODY.</p> -<div class="bbox"> -<p class="smaller">The original, which is in the library of the University of -Montpellier, France, appears in a manuscript copy of Guy de -Chauliac’s <i>Chirurgia magna</i> (fourteenth century). Eugen -Holländer of Berlin, the author of <i>Die Medizin in der -klassischen Malerei</i>, has courteously given permission to -copy the reproduction. The many defects which appear in this -picture are due to the fact that the reproduction was taken -directly from the original miniature, now six hundred years old. -Holländer gives the following description of this interesting -scene:</p> - -<p class="sm">“In one of the rooms of the hospital a woman’s dead body is -lying upon a table. Alongside the bed in which she died a nun -is praying for her soul. Two physicians are busily engaged in -the work of dissecting the body. An instructor is reading out -of a book, for the benefit of the students who are crowding -into the room, such portions of the text as apply to the case -in hand, and at the same time he is directing their attention -to the uterus which one of the dissectors is lifting out of the -abdominal cavity. Owing to the defective state of the original -miniature it is not possible to state positively what part the -three women who stand near the head of the corpse are taking in -the scene, but it is not unlikely that they too are physicians, -especially as their presence on such an occasion would be quite -in harmony with the customs of that period of time.”</p> -</div> -</div> - -<p><span class="pagenum" id="Page_281">[281]</span></p> - -<p>In one place in his “Anatomy” Mondino states explicitly that he -dissected two human cadavers in the month of January, 1315. This -statement renders it possible to fix the exact date when the -practice of making such dissections—which had been carried on for a -considerable period of time about 250 B. C.—was first resumed. If -one reflects upon the nature of the obstacles which in 1315 stood in -the way of a revival of this practice,—for example, the deep-seated -prejudice against it entertained by all classes of the community, and -the very strong opposition of the ecclesiastic authorities to what -they honestly believed to be a desecration of the human body,—one -will readily appreciate how great was the courage displayed by Mondino -when he almost openly undertook his first dissection. The subsequent -career of this famous teacher of anatomy justifies the belief that -his determination to take the course which he did was based upon -the profound conviction that the first step toward increasing the -scanty stock of knowledge possessed at that time with regard to the -structure of the human body in all its parts, must necessarily be one -in continuation of that which Erasistratus and his associates had taken -centuries earlier, but which had not been succeeded by a sufficient -number of other steps in the same direction. The series of discoveries -in anatomy, physiology and pathology which resulted from Mondino’s -courageous and intelligent act, form a part of the history of modern -medicine, and do not therefore call for consideration in this place. We -may simply add that much information of a very interesting character is -furnished by Neuburger (<i>op. cit.</i>) with regard to the manner in -which Mondino and his immediate successors carried on their instruction -in anatomy from that time forward.</p> - -<p>The Medical School at Bologna, as may well be imagined, gained great -fame from the possession of such distinguished teachers as those -whose careers I have briefly sketched—Hugo and Theodoric of Lucca, -William of Saliceto, and Mondino; and it retained a large part of this -celebrity throughout the fourteenth and fifteenth centuries, despite -the appearance on the scene, toward the end of this time,<span class="pagenum" id="Page_282">[282]</span> of several -formidable claimants for high honors in the domain of medical research -and education—viz., the schools at Montpellier and Paris, in France, -and that of Padua, in Italy.</p> - -<p><i>Lanfranchi and the Medical School of Paris.</i>—According to -Edouard Nicaise<a id="FNanchor_64" href="#Footnote_64" class="fnanchor">[64]</a> medicine was not taught publicly at Paris -previously to 1160 A. D. The teaching was carried on at that time -by associations of physicians, and it was only during the following -century (about 1250 A. D.) that something like a university was -established in that city. Up to the end of the sixteenth century (1595 -A. D.), during the reign of Henry IV., this institution remained under -the control of the Church. Its functions—so far at least as medicine -was concerned—were limited to the bestowing of degrees, for it -possessed at that time no organization of instructors and no permanent -quarters in which the teaching might be carried on systematically; a -church (see Fig. 10) or the Dean’s residence serving as the locality in -which the lectures were commonly delivered.</p> - -<p>During the middle part of the thirteenth century and for a long -time afterward, the practice of surgery, which was then of a rather -primitive type, was entirely in the hands of two classes of men—the -barbers and the so-called surgeons.<a id="FNanchor_65" href="#Footnote_65" class="fnanchor">[65]</a> As time went on, the surgeons -began to feel the necessity of securing better protection for their -material interests, which were being more and more encroached upon by -the barbers—a class of men who were not privileged by the authorities -to include in their field of activities anything beyond hair-cutting, -shaving, cupping, the extraction of teeth, the application of -leeches, the incision of boils and perhaps one or two other simple -operations. For this reason, therefore, and also probably because -they too felt<span class="pagenum" id="Page_283">[283]</span> in some measure the effects of the Renaissance spirit -which was then abroad in the land, they organized themselves (1254 -A. D.) into an association which bore the name of “College of Saint -Cosmas” (<i>Collège de St. Côme</i>).<a id="FNanchor_66" href="#Footnote_66" class="fnanchor">[66]</a> One of the early acts of -this association was to establish the rule that all applicants for -membership should pass successfully an examination as to their fitness -before they could be admitted. Very little is known about the doings of -the organization during the early years of its existence. Later, as we -shall see, it played a very important part in the history of medicine -in France.</p> - - <div class="figcenter" id="i_p283" style="width: 747px"> - <img - class="p2" - src="images/i_p283.jpg" - alt="" /> - <p class="center p0 sm">FIG. 10. THE MANNER OF GIVING PUBLIC INSTRUCTION IN -MEDICINE DURING THE MIDDLE AGES.</p> - <p class="center p-min sm">(From Meaux Saint-Marc’s <i>L’École de Salerne</i>.)</p> - <p class="center p0 sm">The present cut is evidently a modern copy of a much earlier original.</p> - </div> - -<p><span class="pagenum" id="Page_284">[284]</span></p> - -<p>From the account given by Nicaise it appears that no -regular instruction in anatomy was given in the University of Paris -until after the fourteenth century, and then only from three to five -times a year, when the body of a person who had been hung was publicly -dissected. “Such a dissection lasted seven days and was a veritable -scientific festival.” No official cliniques were held and the only -way in which the student of medicine could obtain some practical -acquaintance with disease and with the methods of treatment was by -attaching himself to a physician or a surgeon, or to a barber.</p> - -<p>From the preceding brief and very incomplete account the reader will, I -trust, be able to form some idea of the condition of affairs, medical -and surgical, in Paris at the time when Lanfranchi arrived in that city.</p> - -<p>Lanfranchi, says Neuburger, was born in Milan, Italy, and was -undoubtedly the most distinguished among the pupils of Saliceto at -Bologna. After leaving the medical school he practiced both medicine -and surgery for a certain length of time in his native city; but -finally, becoming involved in the quarrels between the Guelphs and -the Ghibellines, he—like many other Italian physicians—was obliged -to take refuge in France. In Lyons, which was his first place of -residence, he engaged for a short time in the practice of medicine and -also wrote his first treatise on surgery—“<i>Chirurgia Parva</i>.” -Then, after traveling from one place to another in the provinces, he -finally (1295 A. D.) settled permanently in Paris. In that city he very -soon acquired a large practice, and, at the same time, built up for -himself a great reputation as a teacher of medicine. The <i>Collège de -St. Côme</i> elected him a member of that organization and profited -greatly from the fame which his teaching brought to the institution. -It is said that Jean Passavant, who was at that time the Dean of the -Medical Faculty of Paris, aided Lanfranchi in his work by every means -in his power. As a result Paris, during a considerable period of time, -was one of the few places in which genuine clinical instruction was -given to all those who desired to acquire a practical acquaintance -with disease.<span class="pagenum" id="Page_285">[285]</span> His larger treatise, the “<i>Chirurgia Magna</i>,” was -completed in 1296. It was dedicated to the King of France, Philip -IV., commonly called “<i>Phillippe le Bel</i>,” and its intrinsic -merits assured him a permanent reputation as a surgeon. This work, -which was translated years ago into English and has recently (1894) -been published by the “Early English Text Society,” under the title -“Lanfrank’s Science of Cirurgie,” consists of five separate fasciculi -or parts. A few extracts from the text of this celebrated work may -prove of interest to the reader. Not having access to the English -version just mentioned, I shall have to translate from the version -(partly Latin and partly German) supplied by Neuburger.</p> - -<p>Part I. of the <i>Chirurgia Parva</i> mentions some of the -characteristics which a surgeon should possess. He should, for example, -have well-formed hands, with fingers that are long and slender; his -body should be strong and firm in its movements; his hands and fingers -should respond quickly to the workings of the mind; his mind should -be of a subtle type; in character he should not be over-bold, but -self-reliant and yet modest; he should have a good supply of common -sense; he should be well-informed not only in medicine, but also in all -the branches of philosophy; he should be a good logician; he should be -familiar with the writings of medical authors; he should be virtuous -and ethical; he should be trustworthy; he should not be avaricious nor -envious; ... and, finally, he should be thoroughly familiar with all -the diseases to which the human body is liable. In one place Lanfranchi -refers to the fact that exposure to the air favors the production of -pus in a wound. Among the methods which may be employed for arresting -hemorrhage he mentions digital compression and ligaturing of the -bleeding vessels. He recommends that a wounded individual should -abstain from wine and from an over-nutritious diet. No attempt, he -says, should be made to extirpate, with the knife or by means of the -actual cautery, an ulcerated cancer, unless it appears probable that -by such means complete destruction of the tumor may be effected. In -traumatic tetanus dependent<span class="pagenum" id="Page_286">[286]</span> upon an injury of a tendon or nerve trunk -he recommends complete division of the wounded structure.</p> - -<p>Part II. is devoted to the consideration of wounds of the different -parts of the body, taken in regular order from the head to the feet. -The descriptions, in each instance, are preceded by an adequate account -of the region affected. In his discussion of fractures of the skull he -speaks of the diagnostic value of the rough and jarring sound perceived -by the patient when the physician taps with a rod upon the injured -skull; and he also states that an aid to diagnosis may be derived from -the fact that a person whose skull is fractured experiences pain at the -seat of the injury when somebody passes the ends of his finger-nails -along a string which the patient holds suspended between his teeth.<a id="FNanchor_67" href="#Footnote_67" class="fnanchor">[67]</a> -According to Neuburger the description which Lanfranchi gives of -the various symptoms observed in cases of fracture of the skull is -admirable. In the section relating to the treatment of such fractures -he warns against the tendency to resort too readily to the use of the -trephine, and expresses the belief that this instrument should be -employed only when the fractured bone is depressed or when there is -evidence of irritation of the dura mater.</p> - -<p>Part III. deals with skin diseases and various forms of tumors, -including those of the thyroid gland; and with diseases of the eye, -the ear and the nasal cavities; with the various kinds of hernia; with -renal and cystic calculi; with hemorrhoids, varicose veins, etc.; with -abdominal dropsy; and with still other affections. In bloodletting he -recommends the practice of opening the vein longitudinally. He is very -emphatic in his manner of insisting that medicine and surgery should -not be divorced, and that the operation of drawing blood should not be -intrusted to barbers.</p> - -<p>After the death or retirement of Lanfranchi during the first decade -of the fourteenth century, Paris appears to have played, at least for -a few years, a comparatively small part in the history of medical -teaching. Her rivals at<span class="pagenum" id="Page_287">[287]</span> Montpellier, in the south of France, and at -Bologna and Padua, in Italy, far outstripped her during this period. -There was one physician at Paris, however,—Henri de Mondeville,—who -would probably have proved a worthy successor of Lanfranchi if -circumstances had not seriously interfered with his acting the part of -a teacher.</p> - -<p><i>Henri de Mondeville.</i>—Henri de Mondeville, says Edouard -Nicaise, was born about 1260 A. D. in Normandy. In his native -village—Mondeville or Mandeville, or Amondaville, all of which names -are found in the manuscripts—he was known simply as Henri, but in the -outside world and in medical literature he is mentioned, in accordance -with the prevailing custom of that period, as Henri de Mondeville. -After studying medicine for a certain length of time in Paris and -Montpellier, he went to Italy and became the pupil of Theodoric of -Bologna. He is said to have been passionately fond of surgery, which -at that period was, in France, a much despised branch of medicine. In -Italy, on the contrary, such men as William of Saliceto, Hugo of Lucca, -Theodoric and Lanfranchi had raised surgery to a position of great -honor, and Henri de Mondeville cherished the hope that he also might be -able to accomplish the same result in France. Upon his return to Paris -he was chosen one of the physicians (there were four in all) of the -royal household, and from that time onward he was frequently obliged to -set aside, for longer or shorter periods, all his personal interests -(private practice, lecturing to medical students, hospital service at -Hôtel-Dieu, etc.) in order to attend the King or the Comte de Valois -on some military expedition. This sort of service, however, was by no -means time lost, for it afforded him the opportunity to acquire great -experience in the treatment of wounds, an experience which reveals -itself on almost every page of his treatise on surgery. And yet there -came a time (1312) when de Mondeville complained bitterly of these -interruptions, for which he received no pay and which interfered -seriously with his literary work. Despite these hindrances, he appears -to have made a fair degree of progress in the writing of his book, -for at the date last<span class="pagenum" id="Page_288">[288]</span> named he gave a public reading of the first two -sections “before a large and noble assemblage of medical students and -other distinguished personages.” The portrait of de Mondeville which -is here reproduced is a copy of the miniature which appears in one of -the manuscripts of his treatise that was prepared 1314 A. D., and is -now preserved in the <i>Bibliothèque Nationale</i> at Paris. Nicaise -furnishes the following details regarding the original miniature.</p> - -<div class="blockquot"> - -<p>Inasmuch as the MS. bears the date 1314 the portrait must have -been painted while De Mondeville was still living. The master is -represented wearing a violet-colored gown, red stockings, and a -black skull-cap. He is thin, his beard is scanty and of a grey -color like the hair of his head, his features are finely cut, -and he appears to be a fairly tall man. So far as one may judge -from this portrait De Mondeville’s age was then about fifty.</p> -</div> - -<p>The date of his death is not known exactly, but it must have been -somewhere about 1320 A. D.</p> - -<p>Nicaise sums up de Mondeville’s personal history and his contributions -to the science of medicine somewhat as follows: He was a man of -warm impulses, who loved the truth and despised all shams. He never -hesitated to speak his opinion about others, the King himself not being -excluded from his criticisms. He was also quite frank in his exposures -of the ignorance of both nobles and members of the clergy. He was not -in the least degree superstitious. He remained unmarried throughout -life and seems to have entertained a slight disposition to find fault -with women, for he attacks somewhat violently their mode of life and -their extravagance, especially in the case of the women of Montpellier. -Although he possessed a great reputation and a very large clientele of -patients, he did not acquire a fortune. He is quoted as saying: “I was -obliged from the very first to work hard for a living.” Suppuration, -according to the view of de Mondeville, was not a necessary phenomenon -in the healing of wounds.</p> - - <div class="figcenter" id="i_fp288" style="width: 484px"> - <img - class="p2" - src="images/i_fp288.jpg" - alt="" /> - <p class="center p0 sm">FIG. 11. HENRI DE MONDEVILLE.</p> - <p class="center p0 sm">(From Nicaise’s Version, Paris, 1893.)</p> - <p class="p0 sm">From a miniature at the head of a manuscript which bears the -date A. D. 1313, now preserved in the Bibliothèque Nationale at -Paris.</p> - </div> - -<p>About the year 1316 the condition of de Mondeville’s health—he -probably had pulmonary tuberculosis—began to give him serious cause -for anxiety lest he might not live <span class="pagenum" id="Page_289">[289]</span>long enough to complete his book; -and, as a matter of fact, the treatise which we now possess shows -that his fears proved to be well grounded. The important subjects -of fractures, dislocations and hernia, for example, are mentioned -only casually. Those subjects, however, which he did discuss are -treated in a very clear and practical manner. Thus, for example, his -instructions with regard to the proper manner of treating wounds is -most satisfactory. Theodoric and he were the great champions of the -so-called dry treatment, which had been introduced at some remote -period of antiquity, but which apparently had not met with general -acceptance. Then, again, in his remarks on the subject of amputations, -he taught that the ligaturing of the severed arteries after the removal -of the amputated part, was universally recognized as the proper course -to adopt and should never be neglected.</p> - -<p>In Chapter VII. of the first section of his treatise, de Mondeville -gives a description of the anatomy of the heart and related -blood-vessels, and at the same time furnishes an unusually clear -account of the physiology of the circulation which was universally -accepted by the physicians of that period, as it had already been -by those of earlier centuries. It seems desirable to reproduce this -account here in order that it may serve for purposes of comparison with -that which Harvey was to give three centuries later. It is only by -making such a comparison that the physicians of our time can appreciate -the vast importance which attaches to Harvey’s wonderful discovery. De -Mondeville’s account, abbreviated wherever it seemed practicable to do -this, reads as follows:—</p> - -<div class="blockquot"> - -<p>The heart is the most important of all the organs. It transmits -to the other members of the body vitalizing blood, heat and -spirit. Its muscular tissue, unlike ordinary muscle, is composed -of three kinds of fibres, and it is not under the control of -the will. It has the shape of a pineapple and is located in -the centre of the chest, like a prince in the middle of his -kingdom. Its lower extremity is directed somewhat to the left -of the chest, as we are assured by the Philosopher (Aristotle) -in his history of animals. There are two reasons why it points -toward the left: 1., in order that it may<span class="pagenum" id="Page_290">[290]</span> not press upon the -liver or be pressed upon by it; and 2., in order that it may not -communicate its heat to the left side (the cool side) of that -organ.</p> - -<p>It is important to note the fact that the heart is the only -structure which contains blood in its substance; in all the -other members of the body the blood is contained in the veins. -The base of the heart is situated at its highest point and -represents the broadest portion of the organ; it is attached to -the posterior wall of the chest by a few ligaments, than which -no stronger are to be found in any part of the body. These bands -do not touch the heart at any point except at the top, where -they take their origin; and their great strength is explained by -the fact that it is their duty to hold the heart firmly in its -proper position.</p> - -<p>The heart possesses two ventricles or cavities, of which the -left one—by reason of the natural position of the organ as a -whole—is a little higher than the right. Between these two -cavities there is placed a partition which in its turn contains -a small cavity—termed by some <i>the third ventricle</i>. -Above each of the larger ventricles there is a sort of -appendix—cartilaginous in structure, but flexible and at -the same time strong,—which contains a cavity and has some -resemblance to a cat’s ear. These structures, to which the -common people have given the name <i>auricles</i>, alternately -contract and dilate. The purpose for which they exist is to -serve as reservoirs for the blood and air that are needed for -the nourishment and cooling of the heart.</p> - -<p>To the right ventricle there comes a many-branched vein which -conducts to the heart a coarse, thick and warm blood destined -to nourish that organ. The portion of this abundant fluid which -is not needed for this purpose is then rendered less coarse and -thick by some subtle power possessed by the heart itself, after -which it is driven into the cavity that is located within the -partition wall which separates the ventricles the one from the -other. From this smaller cavity, this so-called third ventricle, -in which it receives additional heat and at the same time -undergoes further thinning as well as some kind of digestion and -purification, the blood passes on into the left ventricle and -there undergoes a further change—one which is characterized by -the development of that element which we call <i>spirit</i>, -something clearer, more subtle, more pure, more glorious than -any known substance in the human body, and therefore more nearly -allied in its nature to celestial things. This new element -forms a friendly and very appropriate link between the body and -the soul; it is the direct agent or instrument<span class="pagenum" id="Page_291">[291]</span> of the latter, -conveying to man the different faculties with which he may be -endowed.</p> - -<p>From the left ventricle of the heart, alongside its auricle, two -arteries are given off. One of them, which is only furnished -with one tunic (as in the case of a vein) and which is called -the <i>arteria venalis</i> (pulmonary vein), carries to the -lungs the blood which they require for their nourishment, and -breaks up into many branches after entering these structures; -the other artery is provided with two tunics and is called -<i>the grand artery</i> (the aorta). From the latter vessel -are given off the numberless arteries which are distributed -throughout the entire body—vessels which transport to every -organ and structure both the blood which they need for their -nourishment and the spirit required for their revivification. -When this spirit passes into the ventricles of the brain it is -subjected to a new species of digestion, which converts it into -the <i>spirit of the soul</i>. Similarly, when it enters the -liver it becomes <i>a nutritive spirit</i>; when it enters the -testicles, <i>a generative spirit</i>, and so on through all the -different organs.</p> -</div> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_292">[292]</span></p> - -<h3>CHAPTER XXIV<br /> -<span class="subhed1">DURING THE LATTER HALF OF THE MIDDLE AGES SURGERY ASSUMES THE -MOST PROMINENT PLACE IN THE ADVANCE OF MEDICAL SCIENCE</span></h3></div> - -<p>During the first half of the fourteenth century, as has been shown -in the preceding chapter, Henri de Mondeville was largely successful -in rendering Paris the most prominent centre of medical activity in -France, if not in Western Europe generally. His life, however, was -short, and his position as one of the leading surgeons of the French -Army subjected him to many and prolonged interruptions, for which -reasons he was not able to complete his excellent treatise on surgery. -No physician of the same intellectual capacity and of equally strong -character appears to have been living in Paris at the time of De -Mondeville’s death, and consequently the importance of that city as a -centre of medical education diminished rapidly after that event. On -the other hand, the Medical School at Montpellier in the southern part -of France began at about this period, under the influence of Arnold of -Villanova (probably a small town in Catalonia, Spain, in the diocese of -Valencia), to acquire importance.</p> - -<p><i>Arnold of Villanova and the Medical School of -Montpellier.</i>—Arnold of Villanova was born about 1240 A. D., of -humble parentage. He obtained his early education in a Dominican -cloister, and afterward devoted all his energies to the study of -languages (especially Hebrew), theology, philosophy, the natural -sciences (physics, alchemy), and medicine. Paris and Montpellier were -the principal cities in which he prosecuted those studies. Already as -early<span class="pagenum" id="Page_293">[293]</span> as the year 1270, Arnold had attained considerable celebrity -as a physician. Between the years 1289 and 1299 he appears to have -made his home in Montpellier, and to have been very actively engaged -both as a practicing physician and as a teacher of medicine. It was -in that city also that he wrote the more important of his numerous -medical treatises. At a later period of his life he appears largely -to have lost his interest in medicine, for in 1299 we find him acting -as an ambassador from the King of Aragon, whose private physician -he was, to the Court of Philippe le Bel, King of France, and deeply -entangled, during his stay in Paris, in disputes with the theologians -of that city respecting certain religious doctrines. He was also at -the same time busily engaged in championing various ecclesiastic -reforms which he was anxious to see inaugurated. His opponents haled -him before the tribunal of the Inquisition and succeeded in having him -cast into prison, where he remained until he expressed a willingness -to retract the obnoxious opinions which he had advanced. The same -tribunal pronounced his treatise “<i>De Adventu Antichristi</i>” to -be heretical. After these persecutions Arnold endeavored to procure -aid and comfort from Popes Boniface VIII. and Benedict XI. The former -was inclined in his favor, but Benedict manifested no disposition to -aid him. Boniface’s sentiments were doubtless influenced by the fact -that Arnold had treated him successfully for stone in the bladder; and -Neuburger incidentally states that, in the effecting of this cure, -not only medical and dietetic treatment had been employed, but also -two other measures—viz., the application of a bandage or truss which -encircled the loins snugly, and the wearing (by the patient) of a -magic seal ring upon which was engraved the effigy of a lion.<a id="FNanchor_68" href="#Footnote_68" class="fnanchor">[68]</a> When -Pope Clement V. (1305–1315 A. D.) removed the papal seat from Rome -to Avignon, in France, Arnold was relieved from the charge of heresy -and reinstated in the respect of his contemporaries. He became the -trusted adviser of royalty, won the sympathy of Jayme II. and of his -brother, Frederic III., King of Sicily,<span class="pagenum" id="Page_294">[294]</span> for his broad-minded views -regarding religious matters, and was both hated and feared by his -enemies. According to trustworthy chronicles, Arnold of Villanova died -at sea in 1311, within sight of the coast of Genoa, while he was on a -voyage (probably from Sicily) to visit the Court of Clement V. In 1316 -the Inquisition pronounced most of his philosophical and theological -writings heretical, and ordered them to be destroyed.</p> - -<p>A complete collection of the medical writings of Arnold of Villanova, -so far at least as they were then known to exist, was printed at -Lyons, France, in 1586. It is said that many of the treatises which -this author wrote have been lost. Of those which have come down to our -time there are only three which call for any special comment—Arnold’s -“<i>Breviarium</i>,” a compendium of the practice of medicine; his -“<i>Commentary on the Regimen Salernitanum</i>,” the sales of which, -according to Neuburger, reached an enormous figure; and a work which -bears the title “<i>Parabolae medicationis secundum instinctum -veritatis aeternae, quae dicuntur a medicis regulae generales -curationis morborum</i>.” (Basel, 1560.) The latter treatise, which -might with propriety be given the simple title of “General Rules -regarding the Treatment of Diseases,” is dedicated (1300 A. D.) to -Philippe le Bel, King of France. It contains a number of chapters on -the principles of general pathology, and others on special pathology -and therapeutics, with relation both to internal diseases and to -those which particularly interest the surgeon. It also furnishes 345 -aphorisms, many of which embody truths of the highest importance and -reveal the author to have been a man of independent judgment, of wide -experience, and of a philosophical type of mind.</p> - -<p>In the “<i>Parabolae</i>” and the “<i>Breviarium</i>,” says Neuburger, -are to be found the most marked evidences of the knowledge and ability -which this great physician possessed. He then adds:—</p> - -<div class="blockquot"> - -<p>Arnold attached much importance to hygiene and the proper -regulation of the diet as effective measures in preventing -diseases, and he formulated an admirable set of rules for -the ordering of<span class="pagenum" id="Page_295">[295]</span> one’s manner of living. In these he gives -prominence to the value of baths, to the importance of taking -a certain amount of physical exercise, and to the selection -of the right kinds of food. He also describes in detail how -wine may be utilized advantageously in cases of illness. As -regards the choice of remedies to be employed he says that the -physician should be guided by a very careful consideration -of the patient’s age, temperament, habits of living, etc.; -and, so long as there remains any doubt about the correctness -of the diagnosis, he should employ only mild and indifferent -remedies. The greatest care, he adds, should be exercised in the -preparation of the drugs that are to be administered, and one -should be very cautious about prescribing substances which have -not been sufficiently tried.</p> -</div> - -<p>Arnold’s writings are full of precepts which, like those quoted above, -show him to have been an excellent practitioner of medicine as well as -a man of sound common sense. And yet at the same time he appears to -have been more or less tainted with the prevailing belief in astrology, -in the efficacy of amulets (as in the case of Pope Boniface referred -to on a previous page), etc. His enemies gave him the reputation -of being a sorcerer upon whom the Devil had bestowed the power of -transmuting metals,—a reputation which undoubtedly was based upon the -fact that Arnold interested himself greatly in alchemistic processes, -often referring to them as closely resembling such organic phenomena -as generation, birth, growth, etc. But, in our judgment of the man, -we should be careful to remember that during the thirteenth century a -belief in alchemy, astrology, the efficacy of amulets, the influence -of supernatural agencies, etc., was almost universal. Even theologians -maintained that it was a sin for a practitioner of medicine to neglect -the influence of certain constellations. Indeed, there are even to-day, -not a few very sensible people in whose minds exists a lingering belief -in the interference of supernatural agencies in human affairs.</p> - -<p>The importance of the influence which Arnold of Villanova exerted upon -the progress of medical science, and more especially upon the fame of -the Medical School of Montpellier, should not be estimated exclusively -from the<span class="pagenum" id="Page_296">[296]</span> value of his writings nor from the character of the work -which he performed as an instructor in that school. In the thirteenth -and fourteenth centuries physicians as a class did not hold so high -a position socially in Western Europe as they were probably entitled -to hold, and consequently Arnold’s later career, in which he showed -himself to be a wise, broad-minded, and very able statesman and as -an enthusiastic champion of greater liberty of thought in the domain -of religion, must be looked upon as having aided very materially in -raising the profession of medicine to a higher rank and in adding éclat -to the School of Montpellier.</p> - -<p><i>Contemporaries and Successors of Arnold of Villanova at -Montpellier.</i>—During Arnold’s lifetime there does not appear to -have been another physician at Montpellier who could be compared with -him in professional ability or in general culture. There was one, -however, who attained considerable fame as a medical author, and who -certainly deserves at least a brief notice in this place—Bernard de -Gourdon, also known as Gordonius.</p> - -<p>Bernard de Gourdon<a id="FNanchor_69" href="#Footnote_69" class="fnanchor">[69]</a> began teaching medicine in Montpellier in 1285 -A. D. He was the author of a treatise which bore the title “<i>Lilium -Medicinae</i>,” and which enjoyed an unusual degree of popularity for -a long period of time. The earliest printed edition appeared in Lyons -in 1474 and was followed by several others in 1491, 1550, 1559 and -1574. One of the latest editions is that of Frankfort, 1617. The book -was also translated into both French and Spanish. In his description -of the seven parts into which the book is divided, the author says, by -way of praising his own work: “In the lily there are many different -kinds of blossoms and in each one of these there are seven grains of a -golden character.” The book treats of fevers, poisonings, abscesses, -tumors, wounds and ulcers, of diseases of the liver, spleen, kidneys -and bladder, of affections of the eyes, and of numerous other topics. -The work as a whole,<span class="pagenum" id="Page_297">[297]</span> says Neuburger, lacks depth and thoroughness, -and reveals the author to be overfond of employing drugs, especially -in combination, and by no means free from a belief in the efficacy of -amulets and other supernatural remedies. It contains, however, one -or two references to matters of historical interest. For example, in -Chapter V., Part III., mention is made of spectacles. So far as now -appears, this is the first time that these useful contrivances are -referred to in medical literature; and the casual manner in which the -author speaks of them suggests the idea that they had already been -known for some time. Possibly Roger Bacon, who interested himself in -researches in the department of optics and who was a contemporary -of Gordonius, may have had something to do with the invention of -spectacles.</p> - -<p>At the ceremony of the marriage of the Duchess Juta of Austria to -Count Louis of Oettingen, at Vienna in 1319, Pietro Buonaparte, the -Podesta of Padua, created considerable excitement by wearing a pair of -spectacles which he had received a short time previously from Salvino -degli Armati of Florence, the reputed inventor of these contrivances. -It is not generally known that the printing of books in very large -and bold type during the latter part of the fifteenth and the early -part of the sixteenth centuries was done expressly for the benefit of -far-sighted readers—this defect in vision characterizing a very large -percentage of the learned men of that period. The great number of books -which, during those early days of the art of printing, were published -in this style, emphasizes the fact that the usefulness of spectacles -was not generally appreciated until after the lapse of many scores of -years. Being very expensive they were within the reach of only persons -of wealth, and, in addition, they were extremely difficult to obtain. -As late as during the year 1572, Augustus, Elector of Saxony, moved by -a strong wish to possess a pair of spectacles, despatched a special -messenger first to Leipzig and then to Augsburg with instructions to -purchase them for him at the great annual fair. This agent, however, -was unsuccessful in the attempt, and, accordingly, in the summer of -1574, he was instructed to ride on as far as<span class="pagenum" id="Page_298">[298]</span> Venice. But, on arriving -there, he was informed that no glasses would be ground before the -month of October. He was consequently obliged to remain in that city -until the autumn, at which time he sent word to his master that the -optician’s charge for the instrument would be 50 thalers (equivalent to -$250 at the present value of money). The Elector, it appears, was only -too glad to pay this sum for the coveted article. The first spectacles -made were equipped with only convex glasses, for the use of far-sighted -persons. It was not until about two hundred years later that the art of -grinding concave glasses for the relief of short-sighted individuals -was discovered.</p> - - -<p><i>Guy de Chauliac.</i>—After the lapse of a few years there appeared -a man who was destined to add greatly to the fame of the Medical -School of Montpellier—not in the way in which Arnold of Villanova -had accomplished this result, but by the publication of the first -systematic treatise on surgery which was written in Western Europe -during the Middle Ages. This man was Guy de Chauliac, about whose early -life very little is known. He was born in the village of Chauliac, in -Auvergne, France, toward the end of the thirteenth century, his parents -being simple peasants; and during early boyhood he probably attended -the school connected with the village church. His medical studies were -begun at Toulouse and completed at Montpellier. But, at some time later -than 1326, he went to Bologna and perfected his knowledge of anatomy -under the guidance of Bertrucius, Mondino’s successor. After leaving -Bologna Guy visited Paris, arriving there subsequently to the deaths -of Lanfranchi, Pitard and Henri de Mondeville. Although he remained in -that great city only a short time, he appears to have formed a warm -friendship with several of the instructors in the medical school.</p> - -<p>About the year 1330 he took up his residence in Lyons. His appointment -to the position of Canon of Saint-Just, a church which is located in -that city, doubtless made it necessary for him to adopt this course. -And yet it is most improbable that he spent much of his time in Lyons, -for his other duties—his attendance at the Papal Court in<span class="pagenum" id="Page_299">[299]</span> Avignon, -as private physician to three Popes in succession, and the numerous -calls made upon him for professional advice and especially for surgical -assistance by people living at a long distance from Lyons—compelled -him repeatedly to absent himself from his home, sometimes for several -days at a time. In 1348 the plague visited Avignon and carried off -large numbers of people, the poet Petrarch’s Laura being one of -the victims. During that terrible epidemic Guy was most faithful -in his devotion to Clement VI. and to many others who needed his -professional services. In 1357 he was promoted by Innocent VI. to the -office of Provost of Saint-Just. In 1363 when—according to, his own -declaration—he was an old man, he wrote the treatise on surgery which -has rendered his name famous in the history of medicine. His death -occurred about July 23, 1368.</p> - -<p>Guy was not, as some writers have asserted, a professor of surgery in -the University of Montpellier; he was simply a physician who had won at -that institution the title of “Master in Medicine”—the highest grade -conferred by the university authorities, and one which necessarily -implied that the recipient had given a certain number of public -readings on medical topics. And yet in actual practice Guy manifested -a strong preference for the management of diseases which demanded -surgical treatment. His writings, furthermore, make it clear that he -had a strong affection for the institution in which he had been both a -student and in some measure an instructor.</p> - -<p>The book which Guy de Chauliac wrote, and which bears the title -“<i>La Grande Chirurgie</i>,” is described by Malgaigne,<a id="FNanchor_70" href="#Footnote_70" class="fnanchor">[70]</a> one of -the most distinguished French surgeons of the nineteenth century, in -the following terms: “I do not hesitate to say that, with the single -exception of the book written by Hippocrates, there is not a work on -surgery, no matter in what language written, which ranks higher than, -or is even equal to, the magnificent treatise of Guy de Chauliac.” -Although most surgeons of the present day will scarcely assent to -praise of such an extravagant<span class="pagenum" id="Page_300">[300]</span> nature, they will undoubtedly agree -in according to this admirable author of the fourteenth century a -high place of honor in the Temple of Fame. Nicaise, the editor of the -most recent version of Guy de Chauliac’s treatise, speaks of him as -the “founder of didactic surgery.” From 1363 A. D., the date of its -first publication in manuscript, to 1478, a period of more than one -hundred years, Guy’s book was universally regarded as the authoritative -treatise on surgery. But this branch of medicine, it must not be -forgotten, was, at that period of the Middle Ages, held in very small -esteem by physicians generally, and therefore it is almost certain that -Guy received no encouragement whatever from any outside source. All -the greater credit, therefore, is due him for the admirable manner in -which he carried on the task which he had set before himself during the -last years of his life. Extraordinary as it appears to us to-day, the -Montpellier School of Medicine, toward the end of the fifteenth century -(that is, only a comparatively short time after Guy’s death), issued a -decree that thereafter their pupils were not to study nor to practice -surgery. From this and other well-authenticated facts it appears that -the prejudice which existed at that period among physicians against -surgery, was strong enough to render them blind to the reality that -it was through the instrumentality of this very branch of medical -activity that the school at Montpellier had gained such an increase -in celebrity. They were unable to dispossess their minds of the idea -that operative and all other surgical procedures were derogatory to the -dignity of the educated physician.</p> - -<p>Guy de Chauliac wrote his treatise originally in Latin—not the -Latin of the classical authors, but a Latin greatly deformed by the -introduction of French, Arabic and Provençal terms—barbaric Latin, -as it is often called. This language was commonly employed at the -University of Montpellier and at all other universities at that period; -but, as Nicaise states, the style of his writing is so concise, and at -the same time so intelligible, that it would scarcely be possible to -translate it into modern French without the<span class="pagenum" id="Page_301">[301]</span> loss of much of that which -constitutes the charm of the book. It was for the latter reason that -he decided to write his version of Guy’s treatise in old French—the -French of the thirteenth and fourteenth centuries. In order that our -readers, most of whom are doubtless more or less familiar with the -finished language of modern French literature, may see for themselves -to what extent the latter differs from its fourteenth century ancestor, -I shall introduce here a single paragraph of Nicaise’s text. I have -chosen it, more or less at random, from the admirable chapter which Guy -has written on wounds in general.</p> - -<div class="blockquot"> - -<p>Consequemment playes mortelles non necessairement, ains pour la -pluspart, sont petites playes, et superficielles és susdites -parties, et qui penetrent iusques à icelles et aux chefs -des muscles. La raison est, parce que si elles ne sont bien -traitées, il advient qu’on en meurt: et si sont bien traitées, -on en guerit: ainsi que i’ay veu de la partie posterieure du -cerveau, de laquelle sortit un peu de la substance du cerveau, -ce qui fut reconnu par l’offense de la mémoire, laquelle il -recouvra apres la curation. Ie ne dis pas toutesfois qu’on -vesquit, s’il en sortoit toute une cellule, comme Theodore -raconte d’un cellier. Aussi Galen ne dit pas, de deux blessez -qu’il vit guerir en Smyrne du vivant de son maistre Pelope, -qu’il en fust sorty de la substance de cerveau, ains seulement -que le cerveau avoit esté blessé: Ne, de celuy qu’il vist guery -en Smyrne (comme il recite au huitiesme de <i>l’Usage</i>), il -ne dit pas qu’il en sortit de la substance du cerveau, ains -qu’il fust blessé en l’un des ventricules gemeaux. Et avec ce -on pensoit qu’il fust guery par le vouloir de Dieu. Car si tous -deux eussent esté blessez, il n’eust gueres duré, comme il dit: -et de ce il conclud l’utilite de la duplication de quelques -instruments, ainsi qu’a esté dit cy dessus en l’anatomie. Et -tant de cettui-cy, que de ceux-là, la guerison rare est fort -rarement faite, comme il est dit au commentaire dessus allegué.</p> -</div> - -<p>There are many places in Guy’s treatise where his description of a -surgical condition, or of the proper measures to adopt for the relief -or cure of such condition, would doubtless prove interesting to our -readers, and would in any event aid them materially in forming an -independent judgment as to the man’s character in general and also<span class="pagenum" id="Page_302">[302]</span> -with regard to his qualifications as a surgeon. But all of these -descriptions, when rendered in their entirety into English, occupy much -space, and for this reason I shall be obliged to furnish here merely a -few extracts from some of the more interesting portions of the text.</p> - -<p>In the chapter which Guy devotes to wounds of nerves, cords and -ligaments—all of which structures were classed by him, as well as by -Galen, as belonging to the category of nerves—this author divides them -into punctured and incised wounds, bruises and concussions. As to the -first variety he says that they may be divided into closed punctured -and open punctured wounds.</p> - -<div class="blockquot"> - -<p>In the incised wounds two kinds may be distinguished: those in -which the nerve is incised in the direction of its length and -those in which the cut is made across the fibres. A further -subdivision is practicable, viz., into wounds accompanied by -more or less destruction of the substance of the nerve or its -envelopes, and those in which such loss has not occurred. Among -other differences worthy of mention are these: pain, spasmodic -phenomena, and abscess formation are present in certain cases -and absent in others. From all of which symptoms useful -indications as to the treatment needed may be deduced.</p> -</div> - -<p>In the section relating to the treatment of such traumatic affections -of nerves, Guy makes the remark that the measures called for are, for -the most part, the same as those required for wounds involving simply -the fleshy parts of the body.</p> - -<div class="blockquot"> - -<p>The element of pain, however, is one of the factors which -distinguish wounds of a nerve from ordinary flesh wounds, and -it may necessitate some slight modification of the treatment. -Aside from this, one of the first things that should be done is -to remove from the wound all foreign substances; after which -the edges of the cavity should be brought together and held -firmly in this position by appropriate means. Last of all, care -should be taken to protect the parts. These are the general -principles which are to guide the surgeon’s action. As to the -special details, they must depend upon the different conditions -presented by each individual case. Thus, for example, if we are -dealing with a punctured wound of a nerve, there will be no -edges of an excavation to bring together.</p> - -<p><span class="pagenum" id="Page_303">[303]</span></p> - -<p>If the object which produced the puncture is still lodged in the -tissues, it must, as a matter of course, be withdrawn. After -which, the further measures to be adopted may be enumerated -under the following heads: careful regulation of the manner of -living; removal from the system of all material which—attracted -to the wounded part by the pain—might there cause irritation or -inflammation; and protection of the body against any harm that -might come to it through the occurrence of convulsions. These -three measures are indicated for all wounds of nerves. But, in -the case of a punctured wound, still other procedures should be -employed, as will be discussed under a fourth head.</p> -</div> - -<p>The four heads mentioned by Guy may be briefly stated in the following -terms: I. The patient should be put upon a light and very simple diet; -and, in addition, he should be given a bed that is soft and humid -(“<i>humidus et mollis</i>”). His surroundings should be kept quiet, -and nothing should be permitted to disturb his peace of mind. II. To -protect his tissues from the injurious influence of any superfluous -matters of an irritating nature that may be circulating in the blood -(<i>i.e.</i>, cacochyme), a vein on the opposite side of the body -should be opened and a certain amount of this fluid withdrawn. In -certain cases, furthermore, it may be well, in addition, to administer -an aperient remedy. III. If convulsions develop, the head, neck and the -entire back should be anointed with well-warmed linseed oil or common -(? olive) oil, as recommended by Galen. IV. Special measures should be -adopted for providing a free outlet for any pus that may form in the -deeper parts of the wound; and here again Galen recommends for this -purpose the employment of one of several medicinal preparations which -he enumerates. “But the more certain course,” Guy adds, “is to make an -opening in the skin either with the razor or with the actual cautery -(which latter, according to Henri de Mondeville, is the better plan of -the two), and then to apply some subtle drying remedy which possesses -the power to penetrate into the deepest recesses of the injured -nerve—for example, savin oil.” (Guy has a good deal more to say on the -subject of wounds of nerves, but the few extracts given above should -suffice.)</p> - -<p><span class="pagenum" id="Page_304">[304]</span></p> - -<p>It is now a well-known fact that Guy de Chauliac was in the habit of -treating fractures of the thigh by the employment of the weight and -pulley as means of keeping up a continuing extension of the damaged -limb. As his description of the method in question is very brief, it -may not seem out of place to reproduce it here. Translated into English -it reads as follows:—</p> - -<div class="blockquot"> - -<p>As to the plan which I employ, it is this: After making fast -to the fractured thigh splints which extend down as far as the -feet, I reinforce the support which they give, either by placing -the limb in a box or by applying to its sides bundles of straw -(<i>appuyements</i>). [These are shown in the left-hand lower -corner of Fig. 12.] I then attach to the foot a mass of lead as -a weight, taking care to pass the cord which supports the lead -over a small pulley in such a manner that it shall pull upon the -leg in a longitudinal direction. And if it then be found that -there is not complete equality between the fractured limb and -its fellow as regards length, the discrepancy may be corrected -by gently pulling upon the former. Every nine days the limb -should be cautiously handled; and at the end of about fifty days -it will be found that firm union has taken place.</p> -</div> - -<p>One more remark seems to be called for in reference to the fact that -Guy de Chauliac, although he was avowedly a surgeon, managed to win -as great a reputation and as high a social position as was possessed -by any physician of that period. The medical practitioner, it will be -remembered, held himself, during the Middle Ages, and was universally -held, to be a much higher type of man than the surgeon. The relative -standing of the two is well shown in the accompanying sketch (Fig. -13), in which all the details (attitude, head gear, gown, etc.) have -evidently been carefully studied by the artist. Guy, however, through -the sheer force of his character, and also probably because he was -known to have won the highest medical honor (the grade of “Master of -Medicine”) which it was in the power of the university to confer, -pushed his way to the top, and held, for a period of twenty years, the -position of private physician to three Popes in succession—Clement -VI., Innocent VI. and Urban V. In other words, the prevailing -<span class="pagenum" id="Page_305">[305]</span>prejudices and jealousies were not sufficiently powerful to block the -triumphant career of this man of solid merit and high character.</p> - - <div class="figcenter" id="i_fp304" style="width: 750px"> - <img - class="p2" - src="images/i_fp304.jpg" - alt="" /> - <p class="center p0 sm">FIG. 12. ONE OF THE WARDS IN THE HÔTEL-DIEU OF PARIS.</p> - <p class="center p0 sm">As it appeared in the sixteenth century.</p> - <p class="center p0 sm">(From <i>Chirurgie de Pierre Franco</i>, edited by E. Nicaise, Paris, 1895.)</p> - </div> - -<p><i>The State of Medicine and Surgery in Countries Other than Italy -and France During the Later Portion of the Middle Ages.</i>—From the -account given by Neuburger it appears that the seeds planted by the -famous teachers of medicine and surgery in Italy and France during -the thirteenth and fourteenth centuries had begun to take root in -England and in the Low Countries to the north of France, and were -in fact already producing some good fruit in those lands. Thus, for -example, there have been handed down to our time the names of four -physicians who attained a certain degree of eminence in England during -the thirteenth and fourteenth centuries—Gilbertus Anglicus, John of -Gaddesden, John Mirfeld and John Arderne.</p> - -<p><i>Gilbertus Anglicus</i>, who was the first English medical writer -to secure a certain degree of celebrity among the physicians of -continental Europe, wrote a compendium of medicine that was commonly -called the “<i>Laurea anglica</i>.” The book contains, along with some -good original observations and the records of his own experience, not a -few wearisome theoretical discussions; and at the same time it reveals -the fact that the author was inclined to favor remedial measures -of a superstitious nature. In the last chapter of his compendium, -however, he makes the very practical suggestion that distillation may -be resorted to when one desires to purify water that is contaminated. -Gilbertus, after obtaining his preliminary training in England -in the early part of the thirteenth century, visited some of the -leading schools on the continent, among others those of Salerno and -Montpellier, in which latter city he appears to have practiced medicine -for a certain length of time.</p> - -<p><i>John of Gaddesden</i>, who is also spoken of as Johannes Anglicus, -was born about 1280 A. D. and died in 1361. He was therefore a -contemporary of Guy de Chauliac. He is said to have been a Fellow of -Merton College, Oxford, and to have held the positions of Prebendary -of St. Paul’s,<span class="pagenum" id="Page_306">[306]</span> London, and of private physician to the royal family. -He was also the author of a medical treatise which was generally known -by the title, “<i>Rosa Anglica</i>” (first printed in 1492). Neuburger -speaks of this book as being an imitation of Gourdon’s “<i>Lilium -Medicinae</i>,” but of a somewhat inferior grade, and he quotes two -or three passages which show that medicine was in a very low stage of -development in England at the beginning of the fourteenth century. -Gaddesden, for example, advises his confrères to adopt the rule of -always securing their honorarium before they undertake the treatment of -a sick person. In another part of the book he states that he treated -one of the sons of Edward II. for small-pox and secured excellent -results, not merely as regards the perfect restoration of his health, -but also as regards the complete prevention of any pitting of his face. -He attributes this success to the fact that he enveloped the patient in -a red cloth and took pains to have every object in the vicinity of the -bed draped in red.<a id="FNanchor_71" href="#Footnote_71" class="fnanchor">[71]</a></p> - -<p><i>John Mirfeld</i>, who lived during the second half of the fourteenth -century, completed his medical studies in Oxford, then entered -the Monastery of St. Bartholomew’s in London, and devoted himself -thenceforward to work in connection with the hospital belonging to that -institution. Among the books which he wrote there are a few that deal -with matters of interest to the physician. Such, for example, are a -glossary which bears the title “<i>Synonyma Bartholomaei</i>,” a work -called the “<i>Breviarium Bartholomaei<span class="pagenum" id="Page_307">[307]</span></i>,” and a shorter treatise -on prognosis—the “<i>Speculum</i>.” None of these, however, possesses -any special importance.</p> - - <div class="figcenter" id="i_fp306" style="width: 750px"> - <img - class="p2" - src="images/i_fp306.jpg" - alt="" /> - <p class="center p0 sm">FIG. 13. THE PHYSICIAN, THE SURGEON AND THE PHARMACIST.</p> - <p class="p0 sm">Reproduction of a miniature at the head of Guy de Chauliac’s -<i>La Grande Chirurgie</i>, edited by E. Nicaise, Paris, 1890.</p> - </div> - -<p><i>John Arderne</i> was born in England 1307 A. D., probably obtained -his medical training in Montpellier, accompanied the English Army to -France in the character of a “Sergeant-Surgion,” and was present at the -battle of Crécy (1346 A. D.). During the succeeding twenty-four years -he practiced medicine in Wiltshire and Newark, and then settled for -the remainder of his life in London. Although his practice included -both internal diseases and those which required surgical treatment, the -great reputation which he acquired was based chiefly upon his success -in the latter field. Most of his writings, it appears, are still in the -form of manuscript. They deal chiefly with surgery and are accompanied -by drawings of the instruments which he employed. They possess one -feature which distinguishes them from the majority of medical writings -of the Middle Ages, viz., they abound in reports of cases observed and -treated by the author; and, furthermore, the methods of treatment which -he recommends are in most instances rational and of a relatively simple -nature. The only one of Arderne’s treatises which has been printed -is that relating to <i>fistula in ano</i>. It bears the title, “John -Arderne—Treatises of Fistula in Ano, Haemorrhoids, and Clysters; from -an early fifteenth-century manuscript translation,” and is edited by -D’Arcy Power, Early English Text Society, Original Series, 139; London -and Oxford, 1910. Arderne, we are told by Neuburger, puts forward two -claims: 1, that he succeeded in curing a large number of cases of anal -fistula, in proof of which he gives the names of the persons upon whom -he operated successfully, many of whom are high up in the social scale; -and, 2, that no other surgeon of whom he has any knowledge, either in -England or on the continent of Europe, is able to cure the disease.</p> - -<p>The three English physicians of whom I have here given very brief -accounts, can scarcely be said to compare favorably with those men -who, during the same period, brought fame to the medical schools of -Bologna, Padua,<span class="pagenum" id="Page_308">[308]</span> Montpellier and Paris; and this fact suggests the -question, Do these men really represent the best type of physicians who -lived in England during the fourteenth century? The great English poet -Chaucer, in his “Canterbury Tales” (written at about the same period -of time), furnishes us with a portrait of a man who appears to have -been well informed with regard to the earlier Greek and Arabian medical -authorities as well as with the leading physicians of his own time, -and who in addition was clever both in ascertaining the causes and -nature of his patients’ maladies and in prescribing for them the proper -remedies. As this physician’s name is not mentioned, we cannot be sure -that he was not one of the three to whom reference has just been made. -By the description given by the poet, who probably was personally -acquainted with the man whose portrait he draws, one is tempted to -believe that he was a physician of a higher type than any one of the -three named above. Chaucer’s account reads as follows:—</p> - - <div class="poetry-container"> - <div class="poetry"> - <div class="stanza"> - <div>There was also a Doctor of Phisik,</div> - <div>In al this worlde was ther non him like</div> - <div>To speke of phisik and of surgerye;</div> - <div>For he was grounded in astronomye.</div> - <div>He kepte his pacient wondrously and we</div> - <div>In all houres by his magik natural.</div> - <div>Well coude he gesse the ascending of the star</div> - <div>Wherein his patientes fortunes settled were.</div> - <div>He knew the cause of every maladye,</div> - <div>Were it of cold, or hete, or moyst, or drye,</div> - <div>And where they engendered, and of what humour;</div> - <div>He was a very parfit practisour.</div> - <div>The cause once knowen and his right mesúre,</div> - <div>Anon he gaf the syke man his cure.</div> - <div>Ful redy hadde he his apothecaries,</div> - <div>To sende him drugges, and electuaries,</div> - <div>For eche of them made the other for to wynne;</div> - <div>Their friendshipe was not newe to begynne.</div> - <div>Wel knew he the old Esculapius,</div> - <div>And Discorides, and eek Rufus;</div> - <div>Old Ypocras, Haly and Galien;</div> - <div>Serapyon, Razis, and Avycen;<span class="pagenum" id="Page_309">[309]</span></div> - <div>Averrois, Damascen, and Constantyn;</div> - <div>Bernard, and Gatisden, and Gilbertyn.</div> - <div>Of his diete mesuráble was he,</div> - <div>For it was of no superfluitee,</div> - <div>But of gret norishing and digestible.</div> - </div> - </div> - </div> - -<p>With the names of the three English physicians mentioned above, there -should be associated that of Jehan Yperman, who was born in Ypern, -Flanders, during the latter half of the thirteenth century, obtained -his professional training in Paris under Lanfranchi, and then, in -1303 or 1304, accepted the position of Physician to the Hospital of -Belle, a small Flemish town. In 1318 he settled permanently in Ypern, -his native city, and in a comparatively short time won completely the -confidence and esteem of his fellow townsmen through his attentiveness -to their wants when they were ill and through the great skill which he -manifested in his work as a surgeon. He died 1329 A. D.</p> - -<p>Yperman’s writings deal with both medical and surgical topics. Of -those which have been translated from the Latin into French are: “La -chirurgie de maitre J. Yperman,” Anvers, 1863; “Traité de médecine -pratique de maitre J. Yperman,” Anvers, 1863; and “Traité de médecine -pratique de maitre J. Yperman,” Anvers, 1867. A perusal of these -works, says Neuburger, easily convinces one that Yperman was not only -a skilful and clever surgeon, but also a physician of independent -judgment and wide experience.</p> - -<p><i>Revival of the Practice of Dissecting Human Bodies.</i>—It was in -Italy that dissecting was carried on during the fourteenth century more -vigorously than elsewhere in Europe. At first the only persons who made -such investigations for scientific purposes were individual physicians -or groups of physicians; and, in addition, they were obliged to carry -on the work in a secret manner—that is, by stealing from recently -dug graves the corpses which were necessary for such studies. It is -related, for example, that in 1319 one of the teachers in the Medical -School at Bologna and four of his pupils were brought before the Court -of Law under the charge of having clandestinely<span class="pagenum" id="Page_310">[310]</span> disinterred, for -purposes of dissection, the body of a man who had been hung for some -crime. At first the authorities merely winked at such transgressions, -but at the same time they made no attempts to have the law against -dissecting annulled or at least modified. Then, at a somewhat later -period, the conviction became general among the intelligent members -of the community that, unless work of this nature were officially -sanctioned, no real advance in the knowledge of human anatomy could -be made, and—what was probably of even greater importance in their -estimation—that Bologna might at the same time lose a good deal of its -superiority over its rivals as a centre of learning; and accordingly -it was found practicable to grant the desired sanction with many -modifying restrictions attached. Then, with the further lapse of time, -other medical schools fell into line and secured from the authorities -similar privileges for their teachers and pupils. Thus, in 1368, the -Senate of Venice authorized the medical school of that city to make a -public dissection of a human body once every year; and, eight years -later, the University of Montpellier acquired the same privilege. In -1391 John I. of Spain was equally generous in his treatment of the -Medical School at Lerida. After the opening of the fifteenth century -no further difficulties of a serious nature were experienced by the -teachers of anatomy in procuring at least some material for dissecting -purposes, and with each succeeding year such facilities steadily -increased. Unfortunately, however, there did not follow a corresponding -increase in the knowledge of human anatomy. As a matter of fact, it -was not until during the sixteenth century that any really valuable -work was accomplished in this branch of medicine. Guy de Chauliac, -in the first chapter of his treatise (“<i>La Grande Chirurgie</i>”), -gives the following description of the manner in which Bertrucius -taught anatomy in Bologna at the beginning of the fourteenth century, -and from this account it is easy to understand why the additions to -our stock of information in this department of medicine were so few -and so unimportant during this long period. The so-called dissecting, -it clearly appears, was in reality a not very<span class="pagenum" id="Page_311">[311]</span> profitable combination -of purely anatomical work of a primitive character and a search -for evidences of pathological changes. The clinical history of the -individual whose body was undergoing examination does not seem to have -played any part in the investigation. Here is De Chauliac’s account:—</p> - -<div class="blockquot"> - -<p>After placing the dead body on a bench, my master proceeded with -his instructions, devoting thereto four separate sittings. At -the first of these he passed in review those parts or organs -which are concerned in nutrition; his reason for considering -them first being that they are the earliest to undergo -decomposition. At the second sitting he devoted himself to the -spiritual organs of the body; at the third, to the animal parts; -and at the fourth, to the extremities. Following the example -furnished by Galen in his commentary on the book entitled “The -Sects,” he maintained that there were nine things which should -be taken into consideration when one examines the different -parts of the body, to wit: their situation; their nature, -color, bulk, number, and shape; their connections or relations; -their actions and their utility; and the diseases which may -affect them. Conducted in this manner the study of anatomy, he -maintained, may prove helpful to the physician in recognizing -diseases, in making prognoses, and in selecting a suitable plan -for treatment.</p> -</div> - -<p>Puschmann, quoting from Hyrtl, says that when Professor Galeazzo di -Santa Sofia, who had been called from Padua to Vienna to fill the -Chair of Anatomy in the medical school of that city, made his first -public dissection of a human body (1404 A. D.) in the Bürgerspital, -the sittings covered a period of eight days; at the end of which time -he collected as much money as he could from those who had attended -the course, and turned it over to the treasurer of the Faculty. Then -followed a period of twelve years during which not a single public -dissection of a human body was made in Vienna. In 1440 the Faculty were -greatly rejoiced over the prospect of receiving from the authorities -the body of a criminal who was to be hung on a certain day; but, when -the time arrived and the body had actually been delivered to them, -they were grievously disappointed by the sudden coming to life of the -supposed<span class="pagenum" id="Page_312">[312]</span> corpse. Instead of dissecting him for the benefit of science, -the doctors bestirred themselves in the man’s behalf, obtained a pardon -in due form, and sent him back to his home in Bavaria under the escort -of the college janitor. Not very long afterward, however, he committed -a fresh crime, and this time was effectively hung. History does not -state whether the dissection then came off, or not.</p> - -<p>The Medical Faculty of the University of Tübingen established the rule -in 1497 that one human body should be publicly dissected every three -or four years; it being understood that during the progress of the -dissection the professor should read aloud to the class appropriate -portions of Mondino’s treatise on anatomy. The instruction in this -department of medical science was of the same general character in -all the other universities of Germany at that period. Anatomical -drawings, of a very crude type, were employed as substitutes for actual -dissection.</p> - -<p>At Padua, in Northern Italy, the science of medicine had already before -the end of the first half of the fifteenth century made a decided -advance, in proof of which several circumstances may be mentioned. In -the first place, the importance of the study of anatomy had by this -time become so generally recognized that no special difficulty appears -to have been encountered in securing the erection, in 1446, of an -anatomical theatre; and during this same period several physicians -connected with the medical school acquired considerable celebrity by -their publication of important treatises on topics belonging to the -domain of general pathology and therapeutics, and by the wide influence -which they exerted as teachers. Among the number of those who helped -in these ways to spread the fame of the Medical School of Padua may -be mentioned Hugo Benzi, Antonio Cermisone, Giovanni Savonarola and -Bartolommeo Montagnana.</p> - -<p><i>Hugo Benzi</i> (or Hugo of Siena) taught philosophy as well as -medicine in different institutions of learning—at Pavia, Piacenza, -Florence, Bologna, Parma, Padua and Perugia. His death probably -occurred at Ferrara about the year 1439. In addition to commentaries -on Hippocrates,<span class="pagenum" id="Page_313">[313]</span> Galen and Avicenna, he wrote several practical works -(“<i>Consilia</i>”) on such topics as periodical insanity, stomachic -vertigo, naso-pharyngeal polypi, epilepsy, lachrymal fistula, etc.</p> - -<p><i>Antonio Cermisone</i> was a native of Padua, became a teacher of -medicine first in Pavia and afterward in Padua, wrote several useful -treatises about various diseases, and finally died about 1441.</p> - -<p><i>Giovanni Michele Savonarola</i>—the grandfather of the celebrated -Girolamo Savonarola, who was burned at the stake for heresy 1498 A. -D.—held the Chair of Medicine in Padua from about 1390 to 1462, and -also subsequently for a certain length of time in Ferrara. He was the -author of a number of treatises on practical medical topics—such, -for example, as fevers (first published in Venice in 1498), the art -of preparing simple and compound <i>aqua vitae</i> (Basel, 1597), an -introduction to the practice of medicine (1553), the baths of Italy and -of the rest of the world (Venice, 1592), the different kinds of pulse, -etc. (Venice, 1497)—and he also wrote a large work covering the entire -field of medicine and modeled on the pattern of Avicenna’s “Canon.” -The book is divided into six parts, each of which is preceded by an -introduction that is devoted to the anatomico-physiological bearings -of that particular part; and here, in addition, there are to be found -scattered throughout the text references to surgical procedures. -Among the references of this character the following deserve to be -mentioned as worthy of some notice: the description of a speculum for -use in operations upon the interior of the nose; a reference to direct -laryngoscopy; the description of an instrument closely resembling the -well-known syringotome; the treatment of curvature of the spine by -mechanical means, etc. The book also reveals the fact that, already at -this period of the history of medicine (the middle of the fifteenth -century), physicians were beginning to take a more active part than -they had previously done in the management of confinement cases, which -as a rule were left entirely to the care of midwives. The records -also show that medical men were interesting<span class="pagenum" id="Page_314">[314]</span> themselves more and -more, as time went on, in sanitary science as applied to municipal -affairs. In most communities the need for such was indeed most urgent -at that time. The reforms of this nature were pushed with special -vigor in those parts of Italy which were governed by that enlightened -ruler of the Hohenstaufen family, Frederic II., King of Sicily and -Roman Emperor. The cultivation of personal hygiene was also pursued -very systematically during the later Middle Ages, the <i>Regimen -Salernitanum</i> serving as the guide in such matters.</p> - -<p>Taken all together the conditions in the physician’s world were in -anything but a promising state toward the end of the fifteenth century; -but the dawn of better times, of modern medicine, was near at hand, -and already signs of its approach were beginning to be recognizable in -different parts of Western Europe.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_315">[315]</span></p> - -<h3>CHAPTER XXV<br /> -<span class="subhed1">BRIEF HISTORY OF THE ALLIED SCIENCES—PHARMACY, CHEMISTRY AND -BALNEOTHERAPEUTICS</span></h3></div> - -<p>During the excavations carried on at the site of Pompeii, there were -discovered three houses which bore every appearance of having been -occupied by apothecaries. Among the objects found in these buildings -were: A bronze box equipped with the apparatus required for mixing -ointments; a few surgical instruments; several glass receptacles -which had evidently at some earlier period contained fluid or -semi-fluid pharmaceutical preparations, but which, at the time when -the excavations were made, presented merely a deposit of some solid -but easily friable substance at the bottom of the vessel; and quite -a variety of drugs in the form of pills, tablets, powders, etc. At -first, the impression prevailed that these must have been the houses -of apothecaries, but subsequently the discovery, in each instance, of -the house sign representing a snake with a pine cone in its mouth (the -symbol of Aesculapius) satisfied the authorities that these particular -buildings had belonged to physicians. Indeed, as a matter of fact, no -good reasons have thus far been found for believing that apothecaries, -in the modern acceptation of the term, existed in even the largest -cities of Greece and Italy until a much later date.</p> - -<p><i>Pharmacy in Its Infancy.</i>—All through the Hippocratic period and -during the years when Alexandria was at the height of its prosperity -as the great centre of medical activity, it was customary for the -physicians to prepare their own drugs. The same is true of the best -physicians<span class="pagenum" id="Page_316">[316]</span> belonging to the Augustan period; they were not willing to -put their trust in the drugs which had been prepared in the shops where -such things were usually sold.</p> - -<p>In the second century of the present era Galen gave the definition -that a remedial drug, or “Pharmakon,” was something which, when taken -into the living body, produces an alteration in its component tissues -or organs, whereas foods or nutrient elements simply cause an increase -of the parts. He attached great importance to such characteristics as -purity, freshness, care in handling, etc. It was his custom to prepare -with his own hands the different combinations of simple remedial agents -which he administered to his patients, and he kept these combinations, -as well as the simple drugs of the more costly kinds, carefully stored -in locked wooden boxes in a room which was devoted to this special -purpose and which was termed the “Apotheke.” Originally, therefore, -the “apothecary” was simply the person who had charge of this room -in which the drugs and spices were carefully “placed to one side” -(ἀπό, τίθημι) for safe keeping. At a later period, when the -caretaker became also the compounder of drugs, another word of a more -comprehensive significance—that of “pharmacist”—gradually supplanted -the term apothecary.</p> - -<p>There is another word, “antidote,” which has very materially changed -its significance during the lapse of centuries. Galen, for example, -employed this word as a synonym of pharmakon—a simple remedial agent, -and medical writers continued using the term in this sense during -the following thirteen or fourteen centuries. The word commonly -employed, by mediaeval physicians, to signify “pharmacopoeia,” was -“antidotarium.” In modern times the word “antidote” signifies only an -agent which neutralizes a poison.</p> - -<p>Galen took a very great interest in everything relating to the -subject of drugs, and sometimes made long journeys for the purpose -of securing certain plants or roots which he was unable to procure -near home or which he was very anxious to obtain in a more perfect -condition than was possible when they were purchased from the regular -dealers.<span class="pagenum" id="Page_317">[317]</span> “Simple remedies,” he declared, “are pure and unadulterated, -and produce effects in only one direction. It is the business of -pharmacology to combine drugs in such a manner—according to their -elementary qualities of heat, cold, moistness and dryness—as shall -render them effective in combating or overcoming the conditions which -exist in the different diseases.” Galen’s interest in pharmacology -materially aided the advance of medical science in other ways. He -systematized the existing knowledge of materia medica and infused some -measure of orderliness into the therapeutics of his day. The success -of his efforts in this direction did not become manifest until after -he had been dead about fifty years; but, if his ideas were slow in -meeting with general acceptance, they took such deep root in the minds -of physicians that to-day in Persia Galen’s system of therapeutics is -the only one generally received as authoritative. Although the facts do -not warrant our making the same statement with regard to Western and -Southern Europe, it is nevertheless true that our dispensatories still -continue to honor the memory of this great physician by bestowing the -name of “Galenical Preparations” on a large group of pharmaceutical -combinations.</p> - -<p>It is scarcely possible to state with any degree of positiveness at -what date pharmacists, in the modern sense of the term, came to be -recognized as constituting a separate and honorable class in every -well-organized community. It is known, however, that in Syria and -Persia, during the eighth and ninth centuries of the present era, not -a few of the leading physicians were the sons of apothecaries. Honein, -for example, of whose career I furnished a brief sketch in Chapter -XIX., was the son of an apothecary; and the careful manner in which he -was educated during his youth justifies the belief that his father must -have been a man of some cultivation and not at all like the general -average of that class of men of whom Galen speaks so disparagingly. But -even at that early period there certainly were individuals who were -skilled in the pharmaceutic art, for Berendes (<i>op. cit.</i>) tells -us that Dioscorides (<i>circa</i> 100 A. D.) describes minutely the<span class="pagenum" id="Page_318">[318]</span> -manner of preparing “Oisypum.” Oisypum is identical with the modern -“Lanolin” or “Lanolinum,” and is a pure fat of wool. Mention is made of -the preparation by four different authors of medical treatises during -the following sixteen centuries—viz., by Aëtius in the sixth, by -Paulus Aegineta in the seventh, by Nicolaus Myrepsus in the thirteenth, -and by Valerius Cordus in the seventeenth. Subsequently to the latter -date no further mention of the preparation is to be found in any of -the pharmacopoeias except the French Codex of the year 1758, in which -it is classed among the simple remedies under the title of “Oesipe.” -Finally Liebreich, toward the end of the nineteenth century, brought -the preparation once more into favor under the name of “lanolin.” The -fact that it remained in complete oblivion for such very long periods -of time is easily explained by the statement which Berendes makes: -“It was a troublesome ointment to manufacture, and consequently the -apothecaries disliked it and resorted to all sorts of falsifications.”</p> - -<p>With the advance of the Arab Renaissance pharmacy gradually became a -regular established occupation in every fairly large city in the East. -It is known, for example, that the first public apothecary shop in the -city of Bagdad was established during the eighth century of the present -era under the caliphate of Almansur; and about the same time, probably -a little earlier, there existed at Djondisabour a similar pharmacy in -connection with the school and hospital of the Bakhtichou family. The -training of an apothecary in those days was probably the same as that -of the physician. Originally pharmacists were called “Szandalani,” -probably because they dealt largely in sandal wood.</p> - -<p>The materia medica furnished by the Arab physician Rhazes in the -different works which he has written, is unusually rich in simple -elements, the majority of which are always drugs of a rather mild -action; Greece, Persia, Syria, East India and Egypt were the sources -from which they were derived. Beside the simple elements, Rhazes -mentions a number of composite preparations of drugs.<span class="pagenum" id="Page_319">[319]</span> As not a few -of the latter required very careful manipulation, it may safely be -inferred that the Arabian apothecaries of the ninth century had already -acquired considerable skill and experience in their special field of -work.</p> - -<p>At Salerno, during the first half of the twelfth century, pharmacy -began to assume a position of considerable importance. The work -which was prepared by Nicolaus Praepositus, and which was known as -an “Antidotarium,” furnished quite full information with regard to -the characters and therapeutic uses of nearly 150 different drugs. -According to Berendes this work served for several centuries as the -basis of later pharmacopoeias. One of its notable features is the -importance which the author attaches to the duty of weighing very -carefully each of the drugs that enter into the composition of a given -preparation, of gathering certain vegetable products at the right -season, and of paying strict attention to their quality and to the -manner of preserving them.</p> - -<p>In 1140 A. D., Roger, King of Naples and Sicily, promulgated a law -which defined what should be the proper relations between physicians -and apothecaries; and about one hundred years later (1241 A. D.) -Frederick II. amplified and gave greater precision to this law, thus -establishing what was practically an Institute of Apothecaries. The -following provisions constitute the essential features of the law:—</p> - -<div class="blockquot"> - -<p>1. The physician and the apothecary shall have no business -interests in common.</p> - -<p>2. The physician shall not himself conduct an apothecary shop.</p> - -<p>3. In each department of the kingdom two respectable men, -selected by the Faculty at Salerno, shall be assigned the duty -of furnishing sworn statements to the effect that all the -electuaries, syrups, and other preparations of drugs kept for -sale in a given apothecary shop, have been made according to the -established prescriptions and are offered for sale only in that -state.</p> - -<p>4. In the case of those preparations which ordinarily do not -keep for a longer time than one year without spoiling, the price -at which they are to be sold shall be at the rate of 3 Tarreni -(about<span class="pagenum" id="Page_320">[320]</span> 30 cents) per ounce; while those which ordinarily remain -unchanged during a longer period, shall be valued at 6 Tarreni -per ounce.</p> -</div> - -<p>At the time which we are now considering, it was not the custom, owing -largely to the expensiveness of writing paper, to deliver to the -pharmacist a written prescription. Instead, the physician first gave -his instructions in person, and then, after he had seen the mixing and -other steps of the apothecary’s work properly performed, he carried the -preparation to the patient’s house.</p> - -<p>Long before the middle of the fifteenth century apothecaries had become -thoroughly well established throughout Central and Western Europe. -Among the statutes of the Medical Faculty of Erfurt, Germany, there has -been found one which dates back to the year 1412 and which says:—</p> - -<div class="blockquot"> - -<p>The student of medicine, before he applies for the Bachelor’s -Degree, should spend one month in the spring of the year, in an -apothecary’s establishment, in order that he may familiarize -himself with the proper manner of preparing clysters, -suppositories, pessaries, syrups, electuaries and other things -necessary for a physician to know.</p> -</div> - -<p>The first work which was really worthy of being termed a treatise on -materia medica was published in 1447. It bore the title, “Compendium -Aromatariorum,” and was written by Saladin of Ascolo, the private -physician of Prince Antonio de Balza Ossino of Tarentum. Berendes says -that it was a work of much practical value.</p> - -<p><i>The First Indications of the Beginning of Chemistry.</i>—Up to a -comparatively recent date it has been customary to speak of Geber as -the first practical chemist and the first writer among the ancients -who appreciated the important part which chemistry was likely to take -in medicine and philosophy at no distant period of time. But to-day, -as appears from the researches made by M. Berthelot about 1893, we are -compelled to abandon the belief that such a person as Geber existed, -and shall have to adopt the more commonplace view that the science -of chemistry represents a gradual development from the much older -alchemy. We<span class="pagenum" id="Page_321">[321]</span> may define the latter branch of knowledge as the science -of transforming copper and brass into gold and silver. During the first -two or three centuries of the Christian era there existed a firm belief -that such a transformation had actually been accomplished, and in -confirmation of the correctness of this statement it may be said that -Zosimos of Panopolis, one of the leading philosophers of Alexandria -during the fourth century of the present era, and a man who was -considered by his contemporaries, as well as by all later alchemists, -to be perhaps the greatest authority in this branch of knowledge, -speaks in unmistakable terms in his cyclopaedic work on alchemy (28 -volumes), of a certain tincture which possesses the power of changing -silver into gold, and also of a “divine water” or fluid which is -capable of effecting many different transmutations. There can therefore -be no reasonable doubt that in the earlier centuries of the Middle Ages -the learned men of Alexandria accepted alchemy as a well-established -agency of great power. From the sixth century to the thirteenth this -science was cultivated with great assiduity by the Arabs in the -academies which they established in Cordova and other cities of Spain; -and it was from the latter region that the belief in alchemy spread to -all the countries of Western Europe, gradually gaining strength up to -perhaps the fifteenth century.</p> - -<p>It was during the thirteenth century that the so-called “philosophers’ -stone” came to be considered the most effective agent in transmuting -the baser metals into silver and gold, and there were not a few who -even believed that this as yet non-existent stone possessed the power -to increase longevity, to confer health, and to give a prosperous -issue to one’s undertakings. It was not the rabble, but the very -best and most highly educated men in the community who, during the -thirteenth century, took the most active interest in alchemy and the -philosophers’ stone. Arnold of Villanova, Raymund Lullus, Roger Bacon, -Albertus Magnus, and, to a lesser degree, the famous theologian Thomas -Aquinas were all believers in the art of the magician. And even more -extraordinary than this is the fact<span class="pagenum" id="Page_322">[322]</span> that in Germany men of this stamp -continued for two or three centuries longer to cherish a belief in the -reality of alchemistic processes. Even Martin Luther (1483–1546), the -great reformer, did not hesitate to express his approval of “the black -art,” as is shown by the following quotation from one of his writings:—</p> - -<div class="blockquot"> - -<p>The art of alchemy is commendable and belongs in truth to -the philosophy of the ancient wise men, a fact which pleases -me greatly, not merely because of the intrinsic merits and -usefulness of the art in the matter of distillations of -vegetables and oily fluids and sublimation of metals, but also -because it serves as such a noble and beautiful symbol of the -resurrection of the dead at the last day of judgment. (Berendes.)</p> -</div> - -<p>Another celebrated character who dabbled in the black art was Johannes -Faust, who was born in 1485, obtained his degree of Bachelor of Arts at -the University of Heidelberg, and died in 1540 in Staufen in Breisgau. -Professor Scherer of Berlin says that “he was a great braggart, never -failed to create a sensation wherever he went, and had the conceit and -effrontery to pass himself off as a scientist among the learned men of -his day. He called himself the philosopher of philosophers, a second -Magus. He maintained that he was both a physician and an astrologer, -and claimed that he could restore the dead to life, and could predict -future events from a mere inspection of fire, air and water.”</p> - -<p>But although the persistent and wonderfully energetic activities of -the alchemists failed to find the philosophers’ stone, or to transmute -the baser metals into silver and gold, they placed in the hands of man -the key to a knowledge of chemistry, that branch of science which was -destined in later years to play such an important part in pharmacy, -in agriculture and in other industries. Thus we owe to alchemists the -discovery of many processes and the invention of many apparatus which -serve as the groundwork of modern chemistry. Some of the more important -of these are the following: The use of the spirit lamp; the invention -of tubular retorts; the production of potash and<span class="pagenum" id="Page_323">[323]</span> soda by burning -the hard deposit which collects in wine casks as well as various -marine plants; the oxidizing of certain metals (iron, lead, copper, -quicksilver and antimony); the making of metallic arsenic, of wine of -antimony, of sulphate of iron, of chloride of silver, of acetic acid -and of many other chemical products; the purification of metals by the -use of lead, etc.</p> - -<p><i>Supplementary Data Relating to Balneotherapeutics.</i>—I have -referred to this subject on several occasions in the course of the -earlier chapters of this history, but always without entering very much -into details. This policy was adopted, partly because the facts upon -which a satisfactory sketch of the growth of balneotherapeutics might -be based were not very numerous, and partly because of the necessity of -gaining space for more important matters.</p> - -<p>The principal facts to which I made reference were: First, that before -the Christian era the employment of baths in a variety of different -ways for therapeutic purposes was universal in the East; and, second, -that in the city of Rome during the centuries immediately following the -birth of Christ, facilities for this kind of treatment were provided -on a most lavish scale—as in the baths of Agrippa (27 A. D.), of -Titus (79 A. D.), of Caracalla (211 A. D.), and of Diocletian (302 A. -D.). I may now add that the warm springs of Aachen (Aix-la-Chapelle), -Baden-Baden and Wiesbaden, in Central Europe, and Bath, in England, -were known to the ancient Romans, and were utilized by them to some -extent for therapeutic purposes; but it was not until a much later -period that they and the less well-known springs of Schwalbach, -Driburg, Warmbrunn, Goeppingen and Gastein began to be actively -frequented for remedial purposes. By the beginning of the sixteenth -century it had become a very popular thing for sufferers from all sorts -of ailments to resort to these and other European springs. The history -of the therapeutic employment of mineral waters belongs, however, to -the period of modern medicine rather than to that which I have been -considering in the present volume.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_325">[325]</span></p> - -<h2>PART III<br /> -<span class="subhed">MEDICINE DURING THE RENAISSANCE</span></h2></div> - -<div class="chapter"> -<p><span class="pagenum" id="Page_327">[327]</span></p> - -<h3>CHAPTER XXVI<br /> -<span class="subhed1">IMPORTANT EVENTS THAT PRECEDED THE RENAISSANCE—EARLY ATTEMPTS -TO DISSECT THE HUMAN BODY</span></h3></div> - -<p><i>Important Events Immediately Preceding the Renaissance.</i>—Three -hundred years before the Christian era Erasistratus and Herophilus -made, at Alexandria, Egypt, an attempt to develop a correct knowledge -of anatomy by means of dissections of human corpses, but the political -and religious conditions at that time were not favorable to scientific -work, and therefore the success attained was of a very restricted -character. Then, during the succeeding three or four centuries, this -early movement gradually died out, and no further contributions to -our knowledge of human anatomy were made until toward the end of the -second century of the present era, at which time Claudius Galen, a -man of giant intellect and tireless energy, did his best to supply -the anatomical knowledge so urgently needed. But the deeply rooted -prejudices of that age against dissections of the human body lay like -an insurmountable barrier across his path and forced him to confine his -efforts to the dissection of those animals whose bodily construction -resembled more or less closely that of man. Galen believed that the -anatomy which he thus evolved for the guidance of his professional -brethren would satisfy all their legitimate wants of this nature, -and he proceeded to build upon this faulty and unstable foundation -an equally faulty physiology. History records the extraordinary fact -that Galen’s belief in the sufficiency of his anatomy and physiology -for all the reasonable needs of physicians and surgeons was so well -grounded that during the following<span class="pagenum" id="Page_328">[328]</span> thirteen or fourteen centuries -nobody dared to cast the slightest suspicion upon the trustworthiness -of these foundations of the science of medicine. Then followed, during -the fourteenth and fifteenth centuries, an awakening which seemed to -affect all departments of human activity. This movement, which is -commonly termed the “Renaissance,” developed at first very slowly, and -reached a noteworthy degree of momentum only toward the middle of the -fifteenth century, about which time there occurred several events that -contributed greatly to strengthen and perpetuate the movement. Such -were, for example, the employment of gunpowder in the wars of Western -Europe; the invention of a method of manufacturing paper—a discovery -which led to the abandonment of the much more expensive parchment, and -prepared the way for the invention of printing in its different forms; -the taking of Constantinople by the Turks in 1453; the discovery of -America in 1492; and, finally, the Reformation inaugurated by Martin -Luther. Let us pass in review very briefly each of these events, in -order that we may the better appreciate how the science of medicine, -in the short space of time represented by a couple of centuries, made -a greater advance than it had previously made in the course of several -hundred years.</p> - -<p>The employment of gunpowder in warfare robbed the knight of the -protection which he had previously enjoyed from the wearing of metal -armor, and thenceforward his life was as much imperiled in battle -as was that of the foot-soldier, who was not permitted to protect -his person in this manner. Thus were the two upper classes of the -community, the nobles and the bourgeois, in any conflict which might -arise between them, placed more nearly upon a footing of equality. The -ultimate result showed itself in an increased importance, an increased -prosperity, of the middle class or <i>bourgeoisie</i>, from which the -physicians chiefly came. Indeed, feudalism from this time forward -rapidly ceased to exist.</p> - -<p>The discovery of paper, an excellent and relatively cheap substitute -for parchment, facilitated wonderfully the spread<span class="pagenum" id="Page_329">[329]</span> of knowledge. -Parchment, the material upon which books were written, was expensive -and was at times difficult to obtain; both of which circumstances -rendered books so costly that only a few physicians were able to -become the owners of the important standard medical works of that -period—such, for example, as the Hippocratic writings, Galen’s -treatises, the surgical manuals of de Mondeville and Guy de Chauliac, -the pharmacopoeia of Dioscorides, and still other books of lesser -value. And, if a satisfactory method of manufacturing paper had not -first been discovered, the benefits growing out of the invention of -printing in 1467 would have been far less than they actually proved to -be. Some idea of the magnitude of these benefits may be formed from the -following statement of facts. The demand for books, after the invention -of printing, became so great that the presses were kept almost -constantly busy. At first, according to the record furnished by Haeser, -Venice and Rome took the lead in supplying this great demand for books; -the former city printing 2978 and the latter 972 volumes between the -years 1467 and 1560; but, during a later period (1500–1536), Paris -outstripped Venice with a total of 3056 volumes, and Strassburg -advanced to the second place with a showing of 1021 volumes printed -during the same period of time. Thanks to the great diminution in the -market price of books that resulted from the two inventions named—the -manufacture of paper and the introduction of printing—almost every -physician in fairly prosperous circumstances was able at that period -to purchase the relatively few medical treatises which issued from the -presses; and, besides, new authors were thenceforth stimulated to put -their experiences into print.</p> - -<p>Among the very first medical books printed the following deserve to be -mentioned:—</p> - -<div class="blockquot"> - -<p>(In Germany.) <i>Buch der Bündth-Erznei</i>, by Heinrich von -Volsprundt, 1460.—<i>Das buch der wund Artzeny. Handwirckung -der Cirurgia von Jyeronimo brunschwick</i>, 1508.—<i>Das -Feldtbuch der Wundtartzney</i>, by Hans von Gerssdorff, 1517.</p> - -<p>(In Italy.) <i>Avicennae opera, arabice</i>, 1473.—<i>Guillelmi -de Saliceto cyrurgia</i>, 1475. (A French translation was -published at<span class="pagenum" id="Page_330">[330]</span> Lyons in 1492.)—<i>Celsi de medicina liber</i>, -etc., 1478.—<i>Guidonis de Cauliaco cyrurgia</i>, 1490. (A -French version was printed in Lyons in 1498.)</p> - -<p>(In France.) <i>Christophori de Barzizus de febribum cognitione -et cura</i>, 1494.—<i>Bernard de Gourdon, traduction de son -“Lilium medicinae,”</i> 1495.</p> -</div> - -<p>When Constantinople fell into the hands of the Turks in 1453, many of -its Greek inhabitants, and particularly those belonging to the more -highly educated classes, fled to Western Europe in order to escape from -the tyranny of the invaders. Not a few of these refugees brought with -them to Italy and France copies of the works of the classical Greek -authors, and on this account, as well as because of their willingness -to give instruction in their native tongue, they met with a cordial -welcome wherever they took up their new abodes. Their arrival in -Italy happened at a most propitious time, for the interest in Greek -literature was at that period just beginning to develop among Italian -scholars. Previously, Greek had been an almost unknown tongue in Italy. -Petrarch, for example, is reported to have said in 1360 that he did -not know of ten educated men in that country who understood Greek; and -there is no evidence to show that the number of such men increased -between 1360 and the time when the refugees from Constantinople -arrived. Many of the works of greatest importance to physicians—such, -for example, as the writings of Hippocrates, of Galen, of Rufus -of Ephesus, of Oribasius, of Alexander of Tralles, and of several -other classical medical authors of antiquity—were accessible (in -the original) only to those who were familiar with the Greek tongue. -Consequently the arrival of these refugees from Constantinople -constituted a most important event in the history of European medicine.</p> - -<p>The discovery of America by Christopher Columbus in 1492 owed its -origin in part to the restless spirit of adventure which was abroad -in Spain and Italy at that time, and also, in perhaps still larger -measure, to the hope of gain which might be expected to follow the -discovery of a shorter and more direct route to India. As regards the<span class="pagenum" id="Page_331">[331]</span> -attainment of the latter object, the great explorer failed, but his -discovery of a new continent resulted eventually in bringing great -wealth to the rulers of Spain, in stimulating maritime commerce, and in -broadening men’s views with regard to every phase of human activity. -The addition of a few new drugs to the pharmacopoeia was a further -result of some importance. Luther’s efforts to reform the government -and doctrines of the Church undoubtedly gave a great impetus to the -Renaissance and therefore to the growth of the science of medicine. -Men learned to use their reasoning powers with greater freedom, and as -a result our knowledge of the structure of the human body (anatomy) -and of the working of its complicated machinery, both in health -(physiology) and in disease (pathology), made astounding advances. And -it is to the consideration of these fundamental branches of medical -knowledge that we must now turn our attention.</p> - -<p><i>Early Attempts to Dissect the Human Body.</i>—Already as early as -during the first half of the fourteenth century physicians began to -appreciate the fact that further progress in the knowledge of medicine -was not to be attained otherwise than by a more profound study of human -anatomy than had been made up to that time; and they realized that it -was only by means of actual dissections that this more profound study -might be made. Various influences, however, co-operated to hinder such -study. In the first place, the people at large were thoroughly imbued -with the idea that dissecting a human corpse was an act of desecration, -and consequently it was by no means safe for a physician to do any -work of this character except in the most secret manner. Then, in -addition, it was commonly believed-and this belief persisted even up to -a comparatively recent date—that the bull which Pope Boniface VIII. -issued in 1300—and which declared that whoever dared to cut up a -human body or to boil it, would fall under the ban of the church—was -intended to cover dissections for purposes of anatomical study. The -recent investigations of Corradi, however, show (Haeser, p. 736 of the -third edition) that this bull was not intended to apply to dissections<span class="pagenum" id="Page_332">[332]</span> -for scientific purposes, but simply to put an end to the practice of -cutting up human corpses and boiling the separate sections in order to -obtain the bony framework in a condition suitable for transportation -from Palestine to Europe,—a practice which had grown to be very common -among the Crusaders.</p> - -<p>Mondinus’ “Anatomy,” which was published in 1314, reveals the fact -that, during the early part of the fourteenth century, several private -dissections were made. As might be expected, from the primitive -character of the illustrations that accompany the text of Mondinus’ -work, these dissections were carried out in a very imperfect manner, -for—to mention only a single example—this author admits that he made -no attempt to investigate the deeper structures of the ear, as such -an examination would necessitate the employment of violent measures, -“which would be a sinful act.”</p> - -<p>The archives of the Bolognese School of Medicine contain an item which -reveals the active interest taken in anatomy by the students of that -day. It reads as follows: “At Bologna, in 1319, several of the Masters -stole from a grave the corpse of a woman who had been buried two days -before, and then turned it over to Master Albertus to dissect in the -presence of a large number of students.” At the Medical School of -Montpellier, in the south of France, the Faculty obtained permission -in 1376 to dissect the corpse of an executed criminal once every -year; and the records show that the school actually availed itself of -this privilege in the years 1377, 1396 and 1446. Felix Platter, who -afterward became one of the most distinguished physicians of Basel, -Switzerland, pursued his early medical studies at the latter university -during the years 1552–1557; and, in the diary which he faithfully -kept during this period, he reveals in an interesting manner what -difficulties as well as dangers he experienced, first, in reaching -Montpellier from his home in the eastern part of Switzerland, and, -second, in obtaining greater opportunities for acquiring a genuine -knowledge of anatomy than the school itself afforded in its official -course. Although,<span class="pagenum" id="Page_333">[333]</span> owing to lack of space, I shall not be able to quote -in full the appropriate portions of this most interesting narrative, I -will furnish an abridged English translation of the story as it appears -in Platter’s journal or diary. In all its more important details the -account reads as follows:—</p> - -<div class="blockquot"> - -<p>Our little party was composed of three persons, viz., Thomas -Schoepfius, the schoolmaster of St. Pierre; a Parisian by -the name of Robert who happened to be passing then through -Basel on his way to Geneva; and myself, a lad of sixteen. We -traveled on horseback and all three of us were armed with -rapiers. My outfit, which was handed to me by my father shortly -before our departure, consisted of two extra shirts and a few -pocket-handkerchiefs, wrapped up in a piece of waxed cloth. -In the matter of funds for the journey I received from my -father three crowns in silver and four gold pieces which, -for further security, he sewed into my vest. In addition, -he presented me with a rare piece of silver money which had -been issued by the Cardinal Mathieu Schiner, of the Canton de -Valais, who personally commanded the Swiss soldiers in their -successful combat with the troops of Louis the Twelfth, at -Marignan. It was a coin, therefore, which possessed considerable -historical value. My mother also bestowed upon me a gold coin (a -<i>couronne</i>). As a last injunction my father begged me not -to forget that, in order to procure the money which he had just -placed in my hands, as well as that which he had already paid -for my horse, he had been obliged to mortgage his property.</p> - -<p>We left the city at nine o’clock on the morning of Oct. 10th, -1552, and at the same moment the news reached us that the Plague -had made its appearance in Basel. This was a most depressing -piece of intelligence, especially as we were already in great -fear that the army of the Emperor Charles the Fifth, which was -at that time on its way to the siege of Metz, would utterly -destroy our city.</p> - -<p>We arrived at Berne early on the morning of Oct. 12th, and, -after leaving our horses at the inn, The Falcon, lost no time -in visiting the objects of interest in that ancient city, not -forgetting the bear pit, in which there were at that time six -of these creatures. In the afternoon we resumed our journey -toward Fribourg, and very soon overtook a newly married couple. -As they were traveling on horseback like ourselves, and were -following the same route for a certain distance, we all agreed -to keep together. While passing along a shady part of the road -the bride’s dress became so firmly entangled in the branches of -an apple tree that, failing<span class="pagenum" id="Page_334">[334]</span> to stop the horse, she was left -suspended in the air by her skirts. I immediately dismounted and -helped her to regain her feet, to adjust her disordered dress, -and to resume her seat in the saddle. On arriving at Fribourg -we put up at the inn called <i>La Croix Blanche</i>, and soon -discovered that almost everybody in the town spoke French, a -language with which Thomas and I, who were Germans, were not -familiar; but, thanks to our companion Robert, the Parisian, we -experienced no difficulty whatever in making all our wants known -and in securing all the information that we desired.</p> - -<p>On the following day, Oct. 13th, it was raining hard when we -left Fribourg, and we were soon wet to the skin. After passing -through several small villages we stopped for refreshment at -an inn in the picturesque town of Romont, and at the same time -availed ourselves of the opportunity to have our clothes dried. -Then, having satisfied our appetites, we resumed our journey -in the direction of Lausanne; but we did not get very far on -our way before we discovered that Thomas had disappeared. We -were of course obliged to wait for him, and, by the time he had -rejoined the party, darkness and a thick fog combined to render -further progress very difficult, and we soon realized that we -had lost our way. We wandered up and down for some time without -encountering a barn or building of any kind in which we might -find shelter from the rain and secure a measure of protection -from the robbers who, according to common report, infested that -part of the country. Finally, however, we discovered a small -village; but, when we applied for a night’s lodging, not one -of the householders was willing to receive us. So we engaged -the services of a young peasant to act as our guide, and with -his assistance we finally reached a mean-looking inn in a -village called Mézières, which was composed of a few widely -scattered houses. We entered the tavern and found several -Savoyard peasants and some beggars seated at the long table of -the bar-room; they were engaged in eating roasted chestnuts and -black bread, which they washed down with copious draughts of a -liquor called <i>piquette</i>. They unceremoniously examined -our weapons and acted with great rudeness toward us in other -respects. The woman who kept the house said she had no other -room which she could place at our disposal, and our first -impulse therefore was to resume our journey immediately after we -had finished our meal of black bread and chestnuts; but, after -careful reflection, we came to the conclusion that such a course -might prove fraught with considerable danger. So we decided to<span class="pagenum" id="Page_335">[335]</span> -remain awake and watch for an opportunity to make our escape. -Very soon afterward these half-intoxicated men lay down on the -floor before the fire in the adjoining hall-way or vestibule -and fell into a sound sleep. Our guide then confessed to us -that, while at work in the stable, he had heard them planning -to waylay us on the highway at an early hour of the following -day. As soon, therefore, as we heard them all snoring lustily -we very quietly slipped out of the house. Our score having -already been paid earlier in the evening, and our horses having -been left saddled and bridled in the stable, we mounted and -took our departure by a road which led at first in a direction -different from that in which we were supposed to be traveling. -We experienced no further trouble on this part of our journey -and in due time reached Lausanne. When we told the people at the -inn about our experience at Mézières they replied that we might -consider ourselves most fortunate, as almost every day there -occurred, in the forest through which we had passed (<i>la Forêt -du Jorat</i>), a murder or some other deed of violence.<a id="FNanchor_72" href="#Footnote_72" class="fnanchor">[72]</a> It -was plain, therefore, that we had had a narrow escape from death.</p> - -<p>In the further course of our journey along the north shore -of the lake we reached the city of Geneva on Oct. 15th. When -I called upon John Calvin, to whom my father had given me a -letter of introduction, he said to me: “My Felix, you arrive at -the right moment, for I am now able to give you an excellent -traveling companion for the remainder of your journey—<i>to -wit</i>, Dr. Michel Heronard, a native of Montpellier.” This Dr. -Heronard, as I learned subsequently, was a Protestant who played -a prominent part in the religious disorders which, a few years -later, greatly disturbed the peace of that city.</p> - -<p>On the 30th of October—just twenty days after we set out from -Basel—we entered the city of Montpellier, and I lost no time -in hunting up Laurent Catalan, the apothecary, at whose house I -expected to reside during my stay in that city.</p> -</div> - -<p>Platter had now, after a long and dangerous journey, reached one of the -three greatest medical schools of that<span class="pagenum" id="Page_336">[336]</span> period, and it was his hope -and expectation that he would here be able to acquire a correct and -intimate knowledge of human anatomy. He was already aware that this -knowledge could be satisfactorily obtained in only one way—that is, -by dissecting the human body; and accordingly he availed himself of -every possible opportunity, during the five years which he spent at -Montpellier, to accomplish this purpose. From the somewhat superficial -examination which I have made of the record furnished by the diary, -it appears that only five or six official lessons or demonstrations -were given by the professor of anatomy during the period of time -named; but—as every student of medicine knows—instruction of this -character is of relatively small value; and Platter himself seems to -have realized fully the truth of this statement, for during the second -year of his stay at Montpellier he joined a secret band of nocturnal -grave-robbers who were determined at all hazards to obtain the material -needed for self-instruction. The following brief description of one of -the raids made by this band of eager searchers after knowledge will -convey a good idea of the manner in which the work was conducted:—</p> - -<div class="blockquot"> - -<p>Our first excursion of this kind was made on Dec. 11th, 1554. As -soon as it was really dark our fellow student Gallotus guided -us, along the road that leads to Nîmes, to the Augustinian -Monastery, which is situated about half-way between Castelnau -and the Verdanson brook. Here we were received by a monk called -Brother Bernard, a bold and determined fellow, who had disguised -himself for the business in hand. At midnight, after we had -partaken of food and drink, we started out, sword in hand, for -the cemetery which is located close to the church of Saint -Denis. Here we dug up with our hands a corpse which had been -interred that very day; and, having lifted it out of the pit by -means of ropes, and wrapped our cloaks around it, we carried the -body on two canes as far as Montpellier. Then, having concealed -our load close to the postern, alongside the city gateway, we -summoned the keeper and begged him to get us some wine, as -we were dying of thirst and very tired. While he was absent -in search of the wine three of our party slipped in through -the passage and carried the corpse safely to Gallotus’ house, -which was only a short distance<span class="pagenum" id="Page_337">[337]</span> from the gate. The gate-keeper -returned in due time with the wine, and did not appear to have -the slightest suspicion of the trick that we had played upon -him. It was now three o’clock in the morning.</p> -</div> - -<p>The control exercised by the authorities over the practice of -dissecting human corpses differed very appreciably at different dates -in different parts of Europe. Thus, for example, orders were issued to -the Italian bishops during the latter part of the fourteenth century to -put a stop to further dissections, and for a period of over one hundred -years these orders accomplished the purpose desired. On the other -hand, the Emperor Charles the Fourth adopted a more liberal course: -from the year 1348 on he permitted dissections of human corpses to be -made without hindrance in Prague, Bohemia, but his liberality in this -particular appears to have been of little use, for there is no evidence -to show that the knowledge of anatomy made any appreciable advance -anywhere in Europe until after the beginning of the sixteenth century.</p> - -<p>Gabriel Zerbi of Verona (1468–1505) published at Venice in 1502 the -first modern treatise on human anatomy that deserves to receive special -mention. Pagel speaks of it as containing fairly good descriptions of -different parts of the body. Zerbi held the Chair of Medicine, Logic -and Philosophy in the University of Padua, and lectured first in that -city, next at Bologna, and finally at Rome. One incident in his career -may prove of interest to the reader as showing the fearful risks to -which a practicing physician in those days was sometimes exposed. The -incident was of this nature:—</p> - -<div class="blockquot"> - -<p>A wealthy pacha in Constantinople, failing to obtain relief from -his malady at the hands of the native Turkish doctors, summoned -an Italian physician from Venice. Zerbi, whom the ruling -Doge invited to accept the summons, sailed immediately for -Constantinople in company with his two sons who were mere lads. -The treatment which he inaugurated proved promptly successful, -and Zerbi, having been handsomely remunerated for his services, -was already on his way back to Venice when his ship was -overhauled by a swift-sailing caique on board of which were -the sons of his recent<span class="pagenum" id="Page_338">[338]</span> patient, who—as the story goes—had -celebrated his recovery by eating and drinking to excess. -This debauch promptly caused his death—probably by cerebral -apoplexy; but the sons were convinced that it was the result of -poison administered by Zerbi, and accordingly they lost no time -in starting out to capture the supposed murderer. Their first -act, on reaching the vessel which they were pursuing, was to -kill the younger of the two sons, in the presence of the father, -by sawing his body in two lengthwise. Then they killed Zerbi -himself in the same manner.</p> -</div> - -<p>Tiraboschi, the first historian of Italian literature (1731–1794), is -mentioned by Dezeimeris as his authority for this terrible tale. The -events here narrated occurred in 1505.</p> - -<p>At the beginning of the sixteenth century—the period with which our -history now has to deal—the only available knowledge of anatomy -was that which had been supplied by Galen in the third century of -the Christian era, and which had been handed down through all the -intervening centuries as something absolutely correct and not to be -challenged. But the time had arrived when men were no longer willing -to accept as truth the teachings of any individual until they had -subjected them afresh to the most searching investigations; and thus -it came about that a group of remarkably able men devoted all their -energies, during the greater part of the sixteenth century, to a very -critical study of human anatomy. As the work accomplished by these -men constitutes a very important chapter—perhaps the most important -chapter—in the history of medicine, I may be pardoned if I devote a -disproportionately large amount of space to the consideration of the -careers of the more prominent of these founders of modern anatomy, and -to an enumeration of the details of the work which they accomplished, -and which furnished the most complete verification of the truth stated -by Francis Bacon, Lord Verulam (1561–1626), in the following words -(<i>translation</i>):—</p> - -<div class="blockquot"> - -<p>Man has no other means of getting at and revealing the truth -than by induction coupled with a never-tiring, unprejudiced -observation of nature and an imitation of her operations. -Actual<span class="pagenum" id="Page_339">[339]</span> facts must first be collected, and not created by a -process of speculation.</p> -</div> - -<p>One of the earliest and most thorough students of human anatomy was -Marc Antonio della Torre (1473–1506), who belonged to an honorable -family of Verona, several members of which had attained distinction -as physicians. He planned to publish a treatise on anatomy, and, with -this object in view, secured the assistance of Leonardo da Vinci -(1452–1515), the celebrated painter, architect and civil engineer, to -make life-size pictures of the parts which he had dissected with such -care. But, after the latter had completed many of the drawings which -were intended to serve as illustrations for the projected treatise, -Della Torre unexpectedly died, and the book was never finished. Quite -a number of the drawings, however, found their way to England, and for -many years past they have been carefully treasured at Windsor Castle -and in certain private collections. If Della Torre’s life had been -spared it is highly probable that his treatise on anatomy, equipped -with illustrations copied from this great artist’s drawings, would have -constituted a formidable rival of Vesalius’ famous work.</p> - -<p>Not long after this event it became the rule, among the leading -painters and sculptors of the Renaissance period, to pay a great deal -of attention to the study of human anatomy. The museums of Central and -Southern Italy contain quite a large number of anatomical drawings that -were made by Michael Angelo, by Raphael and by other great masters -of that period. Doubtless many of my readers recall seeing, in the -Cathedral of Milan, Marco Agrate’s (1562) extraordinary masterpiece, -in the form of a life-size black marble statue which represents Saint -Bartholomew standing erect, and carrying on one arm the folded skin of -his entire body. In this statue all the muscles and bony prominences -are modeled with perfect accuracy. It is a remarkable work of art.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_340">[340]</span></p> - -<h3>CHAPTER XXVII<br /> -<span class="subhed1">THE FOUNDERS OF HUMAN ANATOMY AND PHYSIOLOGY</span></h3></div> - -<p>Among the earliest physicians of this period to inculcate the -importance of substituting a correct knowledge of anatomy for the -frequently incorrect descriptions that had been prepared by Galen and -handed down through the succeeding centuries, were the following: -Jacques DuBois of Paris (1478–1555), who was perhaps better known by -his latinized name of “Sylvius”; Guido Guidi (died in 1569), who was -also known as “Vidus Vidius”; and Winther of Andernach, a small city -on the Rhine. These three men, all of whom taught anatomy at Paris, -were commonly considered the best anatomists of that early period. -DuBois was further entitled to the credit of having been the first -physician to inject blood-vessels with a material that renders them -more easily visible, and also the first person in Paris to dissect a -human corpse. It was from these men that Vesalius, who afterward became -such a famous anatomist, received his first practical instruction in -this branch of medical science. Nothing further need be said here of -DuBois, but brief sketches of Guido Guidi and of Berengarius of Carpi, -another contemporary anatomist of considerable distinction, deserve to -find places in our history of this period. Vesalius’ facetious remark -that “Winther of Andernach never used a knife except for the purpose -of dissecting his food” absolves us from the duty of saying anything -further about his career as an anatomist.</p> - -<p>In 1542 Francis the First, King of France, gave a great impulse to the -study of medicine by calling Guido Guidi from Florence, Italy, to teach -that science in the <i>Collége<span class="pagenum" id="Page_341">[341]</span> de France</i>, an institution which -he had founded at Paris in 1530. Guidi, upon his arrival in Paris, -was at once most cordially received, both by those who were to be his -colleagues and by the King. Francis bestowed upon him a suitable gift, -appointed him to the position of First Physician (Archiater) at his -Court, and assured him that he would receive an ample salary during -his residence in the French metropolis. In 1547, after the death of -Francis the First, Guidi returned to his home in Florence, where Cosimo -dei Medici, at that time the head of the Florentine Republic and a -little later Grand Duke of Tuscany (Cosimo III.), made him his First -Physician and gave him the appointment of Professor of Philosophy in -the University of Pisa. Not long afterward Guidi was transferred to the -Chair of Medicine. He retained this position almost up to the time of -his death (May 26, 1569), and during this long period Cosimo bestowed -upon him various ecclesiastic honors, which not only increased his -social rank but added materially to his financial resources.</p> - -<p>Dezeimeris says that, while Guidi does not deserve to be placed, as -an anatomist, in the same rank with Vesalius and Fallopius,<a id="FNanchor_73" href="#Footnote_73" class="fnanchor">[73]</a> he -merits full credit for the very important service which he rendered the -physicians of his day by placing within their reach translations of -certain Greek treatises relating to surgical topics—such treatises, -for example, as those of Hippocrates on ulcers, on wounds of the -head, on the joints and on fractures (with Galen’s comments), Galen’s -treatise on fasciae, and that of Oribasius on ligatures and other -surgical contrivances.</p> - -<p>Apart from his merits as a worker in the field of medical science, -Guidi occupies a creditable place in the history of medicine as a -fine type of the well-educated and kindly disposed physician, as the -following testimony given by Benvenuto Cellini, the distinguished -Florentine sculptor, shows:—</p> - -<div class="blockquot"> - -<p>On the occasion of my visit to Paris I made the acquaintance -of Messer Guidi, and I wish to state in what a very friendly -manner<span class="pagenum" id="Page_342">[342]</span> I was received by that noble citizen of Florence and -excellent physician, the most virtuous, the most lovable, and -the most domestic man whom I have ever met.</p> -</div> - -<p>Guidi’s treatise on anatomy was first published at Venice (under the -editorship of his nephew) in 1611—<i>i.e.</i>, forty-two years after -his death. His translations from the Greek treatises of Hippocrates, -Galen and Oribasius will be found in the work which bears the title -“<i>Collectio Chirurgica Parisina</i>,” Paris, 1544.</p> - -<p>Berengarius of Carpi (a small town in Northern Italy), who died in -1530, is pronounced by Kurt Sprengel a worthy predecessor of Vesalius. -He was Professor of Anatomy, first at Pavia and then at Bologna (from -1502 to 1527), and he is reported to have dissected more than one -hundred(!) cadavers during that period. Fallopius and Eustachius were -among his pupils, and it was their opinion that he did more than -anybody else to revive the interest in anatomical work. The famous -sculptor, Benvenuto Cellini (1500–1571), is authority for the statement -that Berengarius was not only an experienced anatomist and practicing -physician, but also a very skilful draughtsman; the three works which -he published being illustrated with a certain number of original -woodcuts that are not without interest both to the anatomist and to the -lover of art.</p> - -<p>Andreas Vesalius (1514–1564) was born at Brussels, of German parents -whose home was located at Wessels on the Rhine,—whence the name -“Vesalius.” His father was the apothecary of the Princess Margaretha, -Charles the Fifth’s aunt, and several of his ancestors had been -physicians of considerable distinction. At Louvain he received, in -early youth, a thorough training in the Latin, Greek and Arabic -languages and also in mathematics. When he was about eighteen years -of age, he visited Montpellier and afterward Paris, at which latter -city he received practical instruction in anatomy from the three -men whose names I have mentioned in the preceding paragraph—viz., -Guido Guidi, Jacques DuBois and Winther of Andernach. The instruction -in anatomy given in Paris at that period (about 1533) consisted -in interpretations of Galen’s teachings, in dissections<span class="pagenum" id="Page_343">[343]</span> of a few -animals, and in occasional demonstrations—which never lasted longer -than three days—of the easily accessible parts of a human cadaver. -Scanty as were these sources of information, Vesalius cultivated -them with the greatest zest. From time to time his teacher, DuBois, -noting the interest which his pupil took in anatomy, and recognizing -his fitness for imparting instruction, assigned to him the special -duty of rehearsing, in the auditorium, before his fellow students, -the essential facts of the day’s lecture. After war had been declared -between the Emperor Charles the Fifth and Francis the First, King of -France, Vesalius left Paris and returned to Louvain, where he began -lecturing on anatomy. These lectures constituted the very first attempt -at anything like systematic instruction in anatomy that is known -to have been made at that ancient university. It was while he was -engaged in this work that Vesalius, in order to become the possessor -of an entire human skeleton,—a thing of which he felt a very great -need,—ventured to remove from the gallows, outside the city, the -cadaver of a criminal. This, as Haeser declares, was an act of great -boldness and full of peril.</p> - -<p>The life of a military surgeon attached to the army of Charles the -Fifth, which was the life that Vesalius led during the following year -or two, was not sufficiently attractive to divert his mind seriously -from his favorite study; and it is therefore not surprising that -we find him, at the age of twenty-three, accepting from the Senate -at Venice the appointment of the professorship of anatomy at the -University of Padua. When he entered upon this new work Vesalius felt -considerable uncertainty as to the correctness of the anatomy which -he was then teaching, and it is therefore easy to understand why his -first three lectures were based entirely upon the teachings of Galen; -but, before he had finished the third one of the series, he made up his -mind that he would cut loose from the anatomy of the ape and confine -himself to that of the human subject, as was then being revealed to -him more and more perfectly from his own dissections. The stock of -knowledge which he had thus begun to accumulate, increased steadily -until, after<span class="pagenum" id="Page_344">[344]</span> seven years of teaching at Padua, Bologna and Pisa, at -each of which schools of medicine he gave courses in anatomy of seven -weeks’ duration, and after conducting the most painstaking dissections -of a number of human cadavers, he finally declared that he was ready to -publish his great treatise on anatomy. Some of his friends, foreseeing -clearly what a storm of protest the new book would arouse among the -followers of Galen, urged him to postpone for a time its publication; -but a few others agreed with him that it should be issued without -further delay. Accordingly Vesalius sent the manuscript of his work at -once to the printers at Basel, and the book was finally published in -June, 1543, before its author had attained his twenty-ninth year. Its -title was “<i>De corporis humani fabrica</i>,” and it was provided with -exceptionally fine pictorial illustrations, most of which were drawn, -as is generally believed, by John de Calcar, one of Titian’s pupils. A -second edition, superior in every respect to the first, was published -in 1555. In comparison with this great work the few treatises written -by Vesalius in later years are of minor importance.</p> - -<p>Vesalius may rightly be considered the founder of modern anatomy, -for he was the first to furnish correct information, based on actual -dissections of the human cadaver, respecting quite a large number of -the more important anatomical relations; and by this very act he won -the further credit of having dealt the first effective blow toward the -dethronement of Galen, the man who, next to Hippocrates,—probably even -more than Hippocrates,—had exercised, by his teachings in nearly every -department of medical science, almost despotic sway over physicians -for considerably more than one thousand years. At this distance of -time, it is hard to realize what a startling effect was produced by the -announcement of the discovery of so many errors in Galen’s scheme of -anatomy. Albert von Haller, the great authority on medical literature, -speaks of Vesalius’ book as an “immortal work”; and, although its title -would lead one to suppose that it deals only with the construction of -the human body, an examination of its <span class="pagenum" id="Page_345">[345]</span>contents reveals the fact that -it contains in addition quite full information regarding physiology and -pathological anatomy, as well as many details relating to comparative -anatomy. Perhaps the most marvelous thing about this book is the -fact that its author completed his work before he had reached his -twenty-eighth year. It may also interest the reader to learn that, -prior to 1914, the University of Louvain possessed a copy of Vesalius’ -great work printed on vellum and illustrated with many drawings in -colors; but I am unable to say whether this beautiful volume did or did -not escape destruction at the hands of the ruthless men who invaded -Belgium during the summer of that memorable year.</p> - - <div class="figcenter" id="i_fp344" style="width: 506px"> - <img - class="p2" - src="images/i_fp344.jpg" - alt="" /> - <p class="center p0 sm">FIG. 14. ANDREAS VESALIUS.</p> - <p class="p0 sm">(After the portrait by Van Calcar in the Royal College of -Surgeons, London.)</p> - <p class="p0 sm">Copied from the reproduction published in the <i>Nederlandsch -Tijdschrift voor Geneeskunde</i>, Jan. 2, 1915.</p> - </div> - -<p>When the human mind has adjusted itself, in the course of years, to -consider certain beliefs and ideas as settled truths, it comes as a -painful shock to be told that these beliefs are erroneous and that -new ones must take their places. This is precisely what happened when -Vesalius’ book was first published. From one end of Europe to the -other there was a very great stir among the well-educated physicians; -the more liberal-minded being ready to accept at once the genuineness -of the new anatomy, whereas others,—and possibly they represented -the larger number,—acting under the influence of personal jealousy -or perhaps blinded by the belief that it was impious not to accept -without questioning the descriptions made by Galen, were scandalized -by the boldness of Vesalius in asserting that many of the statements -made by this great medical authority were incorrect. Jacques DuBois, -whose name has been mentioned by me on a previous page, was one of the -most bitter of Vesalius’ assailants. In a pamphlet which he published -in Paris in 1551 he even went so far as to speak of his late pupil as -“a crazy fool who is poisoning the air of Europe with his vaporings.” -On account of their former pleasant relations, and also because DuBois -was at that time an old man, Vesalius made no reply to these attacks; -but when Bartholomaeus Eustachius, Professor of Anatomy at Rome, one -of the most celebrated anatomists of that period, and a man of his own -age, entered<span class="pagenum" id="Page_346">[346]</span> the lists as the champion of Galen, Vesalius took up the -challenge, left the work upon which he was then engaged, and began a -tour of visits to the universities of Padua, Bologna and Pisa, for the -express purpose of disproving, by the aid of numerous dissections, -the statements made by his antagonists. Throughout this tour he was -received everywhere with enthusiasm, the older men among the teachers -of anatomy vying with the younger in manifesting the strength of their -approval. The entire journey, says Haeser, was from beginning to end -a series of the most brilliant triumphs. But, notwithstanding this -vindication, which most men would have accepted with the greatest -satisfaction, Vesalius returned to his home in Brussels only to find -that the bitter attacks made by his enemies had not ceased. This -depressed him greatly, for he was not philosophical enough to recognize -the facts that jealousy was at the bottom of this ill feeling toward -him, and also that sufficient time had not yet elapsed for the news -of his triumphant vindication to travel from Italy to Belgium. While -suffering from this fit of the blues he committed to the flames all his -books and manuscripts. These latter, it appears, contained not only -the fruits of many years of laborious anatomical and physiological -research, but also a large number of memoranda relating to pathological -anatomy.</p> - -<p>In 1556, complaints having reached the ears of Charles the Fifth to -the effect that the sin of dissecting human corpses was greatly on the -increase, this monarch decided to refer the question to the Theological -Faculty of the University of Salamanca, in the northwestern part of -Spain, for an authoritative opinion. The reply which these broad-minded -theologians sent to the Emperor was most satisfactory. It is reported -to have been expressed in the following words: “The dissection of -human cadavers serves a useful purpose and is therefore permissible to -Christians of the Catholic Church.” This decision did not of course -put an immediate end to the harsh criticisms and petty persecutions of -the bigots; but, as the years went by, it was noted that the work of -scientific research in human<span class="pagenum" id="Page_347">[347]</span> anatomy and physiology acquired greater -freedom of action, and it is fair to assume that this result was -largely due to the famous decision to which I have just referred.</p> - -<p>Shortly after Vesalius had retired, as stated above, from active -participation in anatomical research work, he was called by Charles the -Fifth to serve him in the capacity of private physician. During this -service, which lasted for several years, he visited, in company with -the Emperor, many of the principal cities of Europe; and then, when the -latter abdicated the throne of Spain,—for Charles was not only Emperor -of the Holy Roman Empire but also King of Spain,—Vesalius became the -private physician of Philip the Second, Charles’ son and successor on -the Spanish throne. This long period is largely a blank in the history -of Vesalius. Toward the end he got into trouble with the Inquisition -and was obliged, as a means of escaping the punishment of death, to -undertake a voyage to the Holy Sepulchre in Jerusalem. While he was -in that city he received an official invitation from the Senate at -Venice to fill the Chair of Anatomy at Padua. He then at once turned -his steps toward Italy, doubtless very happy over the prospect of once -more engaging in anatomical work; but he was shipwrecked on the coast -of the Island of Zante, October 2, 1564. Thirteen days later, before he -had completed his fiftieth year, he died from starvation and exposure. -A memorial tablet was placed in one of the neighboring churches on the -island, and in 1847 his Belgian compatriots erected a suitable monument -to his memory in the city of Brussels.</p> - -<p>Admirable as was Vesalius’ treatise on human anatomy, it was soon -discovered that it was deficient in certain particulars. Not a few of -the descriptions, for example, were incomplete, and there were also a -number of parts or organs for which no descriptions whatever had been -provided. Many of these deficiencies were supplied by contemporary -anatomists, nearly all of whom were Italians. First and foremost among -this secondary but yet very important group of laborers in the field of -original<span class="pagenum" id="Page_348">[348]</span> research work, the names of Fallopius and Eustachius deserve -to be mentioned.</p> - -<p>Gabriele Fallopius, who was born in Modena in 1523, was appointed to -the Chair of Anatomy at Ferrara when he was only twenty-four years -of age. Subsequently he taught at the University of Pisa. At the -time of his death in 1563 he was Professor of Anatomy, Surgery and -Botany at Padua. He made many important discoveries in anatomy, more -particularly in relation to foetal osteology and the distribution -of the blood-vessels. His work in the latter department is all the -more remarkable from the fact that it was accomplished at a time when -the art of injecting blood-vessels with some opaque material was -unknown in Italy. His name has been perpetuated in connection with -the Fallopian tube. As a man Fallopius was much liked because of his -kindly disposition and absence of conceit. The only treatise which he -published was that entitled “<i>Observationes anatomicae</i>,” Venice, -1561.</p> - -<p>Bartholomaeus Eustachius, born at San Severino, in the Marches of -Ancona, in the early part of the sixteenth century, was one of the most -distinguished physicians of his day. He taught anatomy at the famous -University of Sapienza at Rome, and devoted a great deal of time and -thought to the preparation of a large work which was to bear the title -“On the Dissensions and Controversies Relating to Anatomy”; but death -overtook him before he had completed this undertaking. It appears, -however, that in 1564—that is, ten years before he died—he published -a smaller work containing separate chapters on the kidneys, the organ -of hearing, the movements of the head, the vena azygos, the vena -profunda of the arm, and on certain questions relating to osteology; -and he introduced, as illustrations for the text, eight plates of -octavo size. These plates and thirty-eight others, which were to have -served as illustrations for the great work, were all completed as early -as during the year 1552. The artist Pini, who made the drawings that -served as the originals from which the plates were made, was related in -some degree to Eustachius, and upon the latter’s death the metal plates -became his<span class="pagenum" id="Page_349">[349]</span> property by inheritance. But nothing further was heard of -them until they were discovered, early in the eighteenth century, by -Lancisi, the Pope’s attending physician, in the possession of Pini’s -descendants. They were published for the first time in 1714. Haeser -says that these pictures are true to nature, but that in artistic merit -they are not equal to those which belong to the treatise published by -Vesalius. The name Eustachius is permanently connected with the channel -which leads from the tympanum to the nasal cavities—the Eustachian -tube.</p> - -<p>Only the briefest possible mention may here be made of those anatomists -who, following immediately in the footsteps of the three great leaders -mentioned above, played parts of greater or less importance in building -up the science of anatomy. Each one of them did creditable work in -correcting the errors made by their predecessors or in supplying -descriptions of structures or structural relations which these pioneers -had overlooked. Thus, long before the sixteenth century came to an end, -the gross anatomy of the human being had attained a large measure of -the completeness which it possesses to-day. The names of some of the -more prominent men among those to whom I have just referred are the -following: Giovanni Filippo Ingrassia, Matthaeus Realdus Columbus, -Julius Caesar Arantius, Constantius Varolius, Volcher Koyter and -Hieronymus Fabricius ab Acquapendente.</p> - -<p>Ingrassia (1510–1580), a Sicilian physician, cultivated osteology -assiduously, and is entitled to special credit for having first -described the stapes, the third one of the ossicles of hearing, and -for having made valuable contributions to our knowledge of epidemic -diseases. He was a professor in the University of Naples, and, after -the year 1563, held the position of Archiater in Palermo, Sicily. His -descriptions of the different bones of the skeleton were made with such -care and thoroughness that later anatomists found very little for them -to discover or to alter.</p> - -<p>Matthaeus Realdus Columbus (or simply Realdus Columbus), who died in -1559, was born in Cremona, Northern Italy. He served for some time as -Prosector<span class="pagenum" id="Page_350">[350]</span> to Vesalius at Padua, and then succeeded him in the Chair -of Anatomy, first at Padua and afterward at Pisa. The last teaching -position which he held was that of Professor of Anatomy in Rome, in -which city he counted Michael Angelo among his intimate friends. -The discoveries which he made in anatomy were quite numerous and of -considerable importance, and his descriptions were distinguished by -an unusual degree of accuracy and clearness. Unfortunately, he did -not hesitate, at the same time, to exalt the value of his own work by -disparaging that of his famous teacher.</p> - -<p>Arantius, who also was one of the pupils of Vesalius, occupied the -Chair of Anatomy in his native city of Bologna during the latter half -of the century. His death occurred in 1589. The particular department -in which he gained considerable fame was that of the foetus, the -placenta, the uterus, etc. His descriptions of these structures are -written with very great care. Blumenbach gives him credit for having -been the first anatomist to furnish a description of the pregnant -uterus in its different stages. His earliest published work bears the -title “<i>De humano foetu opusculum</i>” Rome, 1564.</p> - -<p>Constantinus Varolius, whose name is imperishably connected with that -part of the brain which is known as the “Pons Varolii,” was born in -Bologna in 1543. He was appointed Professor of Anatomy in the Academy -of his native city at an early age, and soon distinguished himself by -the careful studies which he made of the human brain and nervous system -in general. Before his untimely death at the age of thirty-two he was -chosen the attending physician of Pope Gregory the Thirteenth. His -earliest published work bears the title “<i>De nervis opticis, etc., -epistola</i>,” Padua, 1573.</p> - -<p>Volcher Koyter, who was born at Groningen, North Holland, in 1534, -studied under Fallopius and Guillaume Rondelet (1507–1566), to whom -the University of Montpellier was indebted for its anatomical theatre, -and to whom (rather than to Gaspard Bauhin of Basel) is due the honor -of discovering the ileo-caecal valve. Koyter was<span class="pagenum" id="Page_351">[351]</span> one of the earliest -workers in the field of comparative anatomy—a department of knowledge -to which Vesalius had already made some creditable additions; and -his two most important published treatises bear these titles: “<i>De -ossibus et cartilaginibus corporis humani tabulae</i>” (Bologna, 1566), -and “<i>Externarum et internarum principalium humani corporis partium -tabulae</i>” (Nuremberg, 1573). He died in 1600.</p> - -<p>Hieronymus Fabricius was born in 1537 at Acquapendente, a small city -of Etruria, about fifty miles northwest of Rome. He studied anatomy -at Padua under Fallopius, and, after the latter’s death, was assigned -to the duty of making the necessary dissections and anatomical -demonstrations before the class. In 1565 he was appointed Professor -of Surgery, with the understanding that he was to continue giving his -demonstrations in anatomy. The salary which he received for this double -work was 100 ducats, but it was increased from time to time until -finally he was paid 1100 ducats yearly. At the end of thirty-six years -he was retired upon a pension of 1000 ducats for the remainder of his -life, and was allowed the privilege of appointing his successor in the -Chair of Surgery. He gave the place to Julius Casserius in 1609. To -distinguish him from another Fabricius, who gained great distinction in -the field of surgery, it has always been customary for later historical -writers to speak of him as “Fabricius ab Acquapendente.” His namesake -is known as “Fabricius Hildanus.”</p> - -<p>As a teacher of anatomy, especially in its relations to physiology, -Fabricius was held in the highest esteem. Albert von Haller speaks of -him as being one of the glories of the Italian school of medicine. -Pupils came in flocks from all parts of Europe to attend his lectures, -and among them were some who, like William Harvey of England, afterward -attained great celebrity for the effective work which they did in -advancing the science of medicine. One of the attractive features of -Fabricius’ teaching was to be found in his practice—something quite -new at that period—of showing to the students, not only the particular -organ<span class="pagenum" id="Page_352">[352]</span> (human) upon which he happened then to be lecturing, but also -the corresponding organ in one or several of the animals; thus enabling -them to learn what were the features possessed in common by all the -species, and what were those in respect of which the species differed. -As time went on, the number of those who came to witness his anatomical -demonstrations increased so greatly that he felt impelled to build, -at his own expense, a new and larger amphitheatre. But even this, in -a short time, proved to be too small, and then the Senate at Venice, -which exercised a governing control over the University of Padua, -erected (in 1593) a much larger and more complete amphitheatre, upon -the walls of which there was placed an inscription stating that it had -been built in honor of Fabricius. Among the other distinctions which -were conferred upon him at this time he was raised to the rank of -Knight of the Order of Saint Mark and made an honorary citizen of Padua.</p> - -<p>Fabricius ab Acquapendente added to our stock of anatomical knowledge -by his researches on the structure of the oesophagus, stomach and -intestines, the eye, ear, larynx and foetus. One of his chief claims to -distinction, however, rests upon the fact that he wrote an elaborate -monograph on the valves of the veins. Although these structures had -been seen and described at an earlier date by Charles Estienne, -Berengarius, Vesalius, Cannani and others (Fra Paolo Sarpi, for -example), nobody had yet offered a satisfactory explanation of their -probable use or had traced them through the venous system at large. -In 1574 Fabricius demonstrated their presence in all the veins of the -extremities.</p> - -<p>But Fabricius ab Acquapendente was not merely a good anatomist and -physiologist; he was also a most distinguished surgeon and general -practitioner. From far and from near patients came to consult him -about their ailments, and he appears to have been immensely popular -among all classes of the community. His home, situated on the River -Brenta, just outside the city of Padua, was most attractive, and it was -there that he dispensed hospitality in a princely fashion. One of his -peculiarities was that in many cases<span class="pagenum" id="Page_353">[353]</span> he was unwilling to accept a fee -for his services. As a natural result, gifts of all sorts, many of them -of considerable value, were showered upon him. He devoted one of the -rooms of his residence to the purposes of a cabinet or museum, in which -all those gifts which were suited to such display might be properly -exposed to view, and over the doorway of the room he placed this -inscription, “<i>Lucri neglecti lucrum</i>,” which I venture to render -into English by the following, “Costly gifts representing unproductive -wealth.”<a id="FNanchor_74" href="#Footnote_74" class="fnanchor">[74]</a></p> - -<p>Fabricius remained a bachelor all his life, and at the time of his -death (May 21, 1619, at the age of eighty-two) his fortune, which he -bequeathed to his brother’s daughter, amounted to 200,000 ducats—a -very large sum in those days.</p> - -<p>The writings of Fabricius were published at Leipzig in a single volume -in 1687, but Johann Bohn, who edited the collection, omitted the -different prefaces which Fabricius had written. In the Leyden edition -of 1737 this defect has been remedied.</p> - -<p>To furnish here even a much abbreviated account of the important -discoveries made in anatomy and physiology during the sixteenth century -would call for a much larger amount of space than can possibly be given -to these two branches of medical science. Our modern text books on the -subject of anatomy alone are, in a certain sense, catalogues of these -very discoveries, and every physician knows what a vast amount of space -they occupy. I have already made mention of a few of these discoveries, -and, when I come to consider the splendid work done by William Harvey -in the early part of the seventeenth century, I shall have<span class="pagenum" id="Page_354">[354]</span> occasion -to recapitulate briefly the more important discoveries made by his -predecessors in this particular field. In this way I shall be able to -supply information regarding several of the discoveries which I am now -obliged to pass over in silence, but which, under other circumstances, -would more properly receive consideration in the present chapter.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_355">[355]</span></p> - -<h3>CHAPTER XXVIII<br /> -<span class="subhed1">FURTHER DETAILS CONCERNING THE ADVANCE IN OUR KNOWLEDGE OF -ANATOMY—DISSECTING MADE A PART OF THE REGULAR TRAINING OF -A MEDICAL STUDENT—IATROCHEMISTS AND IATROPHYSICISTS—THE -EMPLOYMENT OF LATIN IN LECTURING AND WRITING ON MEDICAL TOPICS</span></h3></div> - -<p><i>Further Details Concerning the Advance in Our Knowledge of Gross -Anatomy.</i>—In the preceding chapter I have given some account of -the efforts made during the sixteenth century by certain physicians -to lay solidly the foundations of a gross anatomy of the human body. -The time was ripe for such a movement, and the right sort of men took -charge of it and pushed it forward to such a stage of successful -accomplishment that we physicians of to-day are able to continue in -the direction indicated, and under the impulse communicated, by these -master builders. These men, it should be remembered, did something more -than merely to lay solid and durable foundations in the form of an -accurate anatomy, they also taught the correct methods of procedure for -the erection of the superstructure of the science of medicine.</p> - -<p>Up to the end of the sixteenth century almost all the work done in -anatomy was effected with the aid of the scalpel alone, the object -being to isolate and expose clearly to view the larger tissues and -organs, such as muscles, arteries, veins, nerves, etc. In a very few -instances more elaborate methods were devised, even as early as during -the fifteenth<span class="pagenum" id="Page_356">[356]</span> century, by men of exceptional cleverness. Thus, for -example, in 1490, Alexander Benedetti, Professor of Anatomy at Padua, -invented a method of preserving muscles, nerves and blood-vessels as -permanent dry specimens, and it is said that he sold such preparations -for large sums of money. As already stated on a previous page, the -injection of blood-vessels with certain fluids was also employed to a -very limited extent at this early period as a means of distinguishing -them more easily from the surrounding structures; but this practice -gave place, during the seventeenth century, to the better method of -employing, as an injecting material, a semi-fluid preparation which -became quite solid soon after it had penetrated well into the interior -of the vessels, and to which any desired opaque color might be given. -This method was invented by the Hollander, John Swammerdam (1627–1680) -and perfected by Van Horne. It was largely by the employment of this -procedure that Friedrich Ruysch of Amsterdam (1638–1731), Professor -of Anatomy and Botany in the university of his native city, gained -such celebrity throughout Europe for the great beauty of his permanent -anatomical preparations. Hyrtl mentions the fact that Peter the Great -of Russia, who resided for a certain length of time at Zaandam, near -Amsterdam, in order that he might familiarize himself with the art of -ship-building, was in the habit of visiting Ruysch from time to time -in his museum and laboratory; and finally (in 1717) bought from him, -for the sum of 30,000 florins, his entire collection of specimens, -together with the formula of the mixture which he employed in making -his injections. The collection itself, it should be stated, contained -not only specimens illustrative of normal human anatomy (<i>e.g.</i>, -the various solid and hollow organs, the organs of special sense, -and objects belonging to the vascular, muscular, nervous and osseous -systems), but also many specimens illustrating pathological and -comparative anatomy, and a great variety of monstrosities.</p> - -<p>Ruysch also attained remarkable success in restoring the rosy color -and soft flexibility of the skin and the natural facial expression -in certain dead bodies by the employment<span class="pagenum" id="Page_357">[357]</span> of a preservative fluid -widely known as “<i>Liquor balsamicus</i>.” Tradition says that in one -instance, that of a child whose corpse had been treated in this manner -by Ruysch, the face presented such a perfectly life-like appearance -that the Czar, as he passed near the object, thought he was looking -upon a sleeping child and gave it a kiss.</p> - -<p>The aged professor lived to be ninety-three, and continued giving his -lectures on anatomy almost up to the day of his death, which resulted -from accidental injuries. When it became clear that these were of so -serious a nature that he could not possibly recover, he asked to be -carried on a stretcher into the assembly room in order that he might -say a farewell to the students who had been attending his lectures.</p> - -<p>Although some critics have intimated that Ruysch should be ranked -merely as a very clever mechanic in the domain of anatomy, there are -certain well-established facts which show that this estimate of the man -is unfair. It is known, for example, that he was the first anatomist -to call attention to the features which distinguish the male from the -female skeleton (<i>e.g.</i>, the differences in the form of the pelvis -and of the thorax). Ruysch also advanced our knowledge of the vascular -system by means of the improvements which he effected in the method of -injecting blood-vessels. His skill in this special work was so great -that people were wont to say of him that he possessed the fingers of -a fairy and the eyes of a lynx. It was Ruysch too who furnished the -first descriptions of the bronchial blood-vessels and of the vascular -plexuses of the heart. Finally, the term “<i>membrana Ruyschiana</i>,” -in connection with the choroid of the eye, bears testimony to the fact -that he was also an original worker in this very difficult corner of -the field of human anatomy.</p> - -<p>The crowning event in the life of Ruysch—an event which shows -how wasteful many of us men are of our productive powers when we -deliberately retire from all participation in active work, physical or -mental, at the comparatively early age of sixty-five—occurred in 1717, -when he had attained the age of seventy-nine. Peter the Great had<span class="pagenum" id="Page_358">[358]</span> -hardly left the premises with the great collection of specimens for -which he had paid such a fabulous price, when Ruysch began the making -of a new collection; and at this task he worked so diligently that in -less than ten years he was able to deliver to John Sobieski, King of -Poland, the greater part of the new collection (for which he received -the sum of 20,000 florins). Then followed a period of about three years -during which he continued active work as a teacher of anatomy, death -alone seeming to possess the power to arrest his extraordinary energy.</p> - -<p>Ruysch’s only published works are the following: Catalogue of the -Specimens contained in his Museum, Amsterdam, 1691; and a <i>Thesaurus -Anatomicus</i>, in 10 volumes, Amsterdam, 1701–1715.</p> - -<p>In reading over the account which I have given of the discoveries -made in gross anatomy and in physiology during the sixteenth and -seventeenth centuries, I find that I have omitted some that may just as -appropriately be mentioned in this section as in that which I intend to -devote to work done in the domain of minute anatomy. I shall therefore -refer to them briefly now, and then pass on to the consideration of the -latter branch of my subject.</p> - -<p>Eustachius, the famous Italian anatomist, deserves special credit -for the experimental methods which he devised and employed in his -efforts to gain a better knowledge of the anatomy and physiology of -the kidneys. Moritz Hofmann of Fürstenwald discovered in 1641, in the -turkey gobbler, the outlet duct of the pancreas, and a short time -afterward George Wirsung, a Bavarian, discovered the same structure in -the human being. Then, in 1651, Olaus Rudbeck, Professor of Anatomy -in the University of Upsala, Sweden, discovered the lymphatics of -the intestines, and established (at a later date) the fact that they -are a separate system from that of the chyle ducts. Francis Glisson -(1597–1677) of Cambridge University, England, one of Harvey’s pupils, -made two series of anatomical investigations of a most creditable -character—the first concerning the relationship which exists -between the intestinal lymphatics and the alimentary canal, and the<span class="pagenum" id="Page_359">[359]</span> -second regarding the internal construction of the liver (“capsule of -Glisson”). Thomas Wharton (1610–1673), a native of Yorkshire, England, -and a London practitioner of medicine, discovered the outlet channel -of the submaxillary salivary gland, now known as “Wharton’s duct,” -and he also published the first exhaustive treatise on the structure -of glands in general (thymus, pancreas, submaxillary, etc.). About -the middle of the seventeenth century Nathanael Highmore of Oxford, -England (1613–1685), discovered and adequately described the cavity -in the superior maxilla which bears his name (“antrum of Highmore”), -and which in comparatively recent years has assumed such importance -from the viewpoint of the practical surgeon. A Danish anatomist, -who is known to us English-speaking physicians as Nicholas Steno -(1638–1686), but to his own countrymen as Niels Stensen, discovered -the outlet duct of the parotid gland (“Steno’s duct”). Stephen -Blancaard (1650–1702), a practicing physician of Amsterdam, made the -first successful injections of capillary blood-vessels; and Domenico -de Marchettis (1626–1688), Professor in the University of Padua, -employing Blancaard’s technique, succeeded in proving that the finest -ramifications of both veins and arteries communicate the one with the -other. To Conrad Victor Schneider, a professor at the University of -Wittenberg, Germany (1614–1680), we are indebted for putting an end -forever to the erroneous doctrine that the nasal mucus is produced -in the brain. He did not, however, have the good fortune to discover -the glands from which this mucus actually comes; the credit for -this discovery being due to Niels Stensen. Among the host of other -successful discoverers in the domain of anatomy during the seventeenth -century the following men deserve at least to be mentioned by name: -Johann Conrad Peyer (1653–1712) of Schaffhausen, Switzerland; Johann -Conrad Brunner (1653–1727), also a native of Switzerland; Theodor -Kerckring (1640–1693) of Hamburg, Germany; Anton Nuck (1650–1692), -Professor of Anatomy at the University of Leyden, Holland; Reignier -de Graaf (1641–1673), a native of the<span class="pagenum" id="Page_360">[360]</span> Netherlands; and Thomas Willis -(1622–1675) and William Cowper (1666–1709), both of them Englishmen.</p> - -<p>And, finally, it may be stated that all the leading anatomists of the -sixteenth century devoted a great deal of time to the study of the -manner in which the nerves are distributed throughout the body and -to ascertaining the arrangement of the intracranial and intraspinal -nervous structures. To give even the most superficial account of what -these men accomplished would occupy far more space than can well be -spared for this purpose. Kurt Sprengel is my authority for saying -that, of all the workers in this particular field during the period in -question, Fallopius is entitled to receive the greatest credit for what -he accomplished.</p> - -<p><i>The First Beginnings of Minute or Microscopic Anatomy.</i>—The -anatomy of the tissues—microscopic anatomy—begins with Marcello -Malpighi (1628–1694), a native of Crevalcuore, near Bologna, Italy. -It is not positively known who was the inventor of the compound -microscope. First employed about the year 1620, the instruments of this -type came into fairly general use toward the middle of the seventeenth -century. But the early compound microscopes were not very satisfactory, -and consequently preference was given, for a long time, to those of -the simple type. Achromatic instruments were not purchasable until -1780, when the famous German physicist, Leonhard Euler, succeeded in -overcoming the obstacles which had up to that time stood in the way of -their successful manufacture.</p> - -<p>In 1661 Malpighi, who was in the habit of manufacturing his own -microscopes, was able, by aid of one of these instruments, to exhibit -the blood, loaded with its corpuscular bodies, passing rapidly from -one capillary vessel to another in the frog’s lung. Then in 1683 -Guillaume Molyneux, in 1690 Anton van Leeuwenhoek, and in 1697 William -Cowper, witnessed the same phenomenon in warm-blooded animals. Among -the other anatomists of this period who contributed in varying degrees -to our knowledge of the minute anatomy of the different tissues and -organs the following deserve to be mentioned: J. Riolan<span class="pagenum" id="Page_361">[361]</span> (1577–1657), -Boselli of Naples (1608–1679), Lower of Oxford, England (1631–1691), -Vesling of Minden, Germany (1598–1649), Regnier de Graaf of Delft, -Holland (1641–1673), who gained so great distinction by his accurate -description of the ovarian follicles (“Graafian follicles”); and -James Douglas (1676–1742), the English anatomist, who ascertained and -described the precise limits of the peritoneum.</p> - -<p>Of all the men whom I have mentioned above, Malpighi and Leeuwenhoek -are probably the best known to our readers for the large number -and important character of the contributions which they made to -microscopic anatomy. The list of Malpighi’s achievements, for example, -includes the following, in addition to the demonstration of the blood -in actual circulation, as already mentioned: contributions to our -knowledge of the finer structure of plants; the demonstration of -the minute anatomy of the skin (“<i>rete mucosum</i>” or “<i>rete -Malpighi</i>”); the amplification of our knowledge of the structure -of the teeth; the discovery that the lungs are composed to a large -extent of terminal vesicles, the walls of which are richly supplied -with blood-channels.; the demonstration that certain glands possess -an acinous structure (<i>i.e.</i>, an outlet channel springing from -numerous small sacs, the whole group resembling a cluster of grapes); -more complete details regarding the structure of the spleen and -the kidneys (“Malpighian bodies or corpuscles”); additions to our -knowledge of the structure of the white and the gray substances of -the brain and the demonstration that fibres from the spinal cord pass -on into the brain; the declaration that the papillae of the tongue -are organs of taste and the papillae of the skin are organs of the -sense of touch; and not a few other contributions of greater or less -importance. During his long life Anton Leeuwenhoek (1632–1723) of -Delft, Holland, made a great many additions to microscopic anatomy, -some of the more important of which are the following: he was the -first to discover and to describe the many varieties of Infusoria -(the animalcules found in stagnant collections of water); to him is -also due the credit of first observing the faceted<span class="pagenum" id="Page_362">[362]</span> arrangement in -the eyes of insects; he made original investigations into the origin -and mode of development of several species of the lower organisms; he -was the first to observe the canaliculated mode of construction in -bone, and he also noted the existence of the so-called bone-corpuscles -(afterward rediscovered and more accurately described by Purkinje); he -discovered the striated condition of the bundles of muscular fibres, -and was also the first person to teach the doctrine that the growth -of muscles is effected by an enlargement of the primitive bundles of -fibres and not by a multiplication of these structures; he taught -further that muscle-substance consists of numberless small spheres; he -was the first to describe the crystalline lens as a structure composed -of fibres which are arranged in layers or sheets; in association with -Guillaume Molyneux he studied, under the microscope, the speed with -which the blood-current travels in the blood-vessels; he made valuable -observations on the nature of the spermatozoa; and, finally, the very -first studies in bacteriology appear to have been made by Leeuwenhoek. -As a result of his discovery of “round, rod-shaped, thread-like and -corkscrew-shaped bacteria” between the teeth of a human being, the -theory was set forth that probably many diseases owe their origin to -such “little animals.”<a id="FNanchor_75" href="#Footnote_75" class="fnanchor">[75]</a></p> - -<p>The same idea, as will be shown farther on, occurred to the -distinguished medical practitioner of Verona, Italy,—viz., -Fracastoro,—one hundred years earlier (1546). Leeuwenhoek, it should -here be stated, possessed a very great advantage over his rivals in -the field of minute anatomy, for he was in the habit of using, in -his investigations, microscopes which he himself had made, and which -magnified from 160 to 270 diameters, whereas those utilized by the -others were capable of magnifying, at the maximum, only 143 diameters. -While a large part of the work which he performed shows plainly that -he was a skilful and careful anatomist and endowed with good mental -powers,<span class="pagenum" id="Page_363">[363]</span> Leeuwenhoek nevertheless manifested certain mean traits of -character. Daremberg says that these “consisted in his disposition -to conceal his technical methods from his associates, and in his -jealousy of others—as manifested, for example, toward Leibnitz, who -had established a similar laboratory for research work in minute -anatomy. These traits of character showed that fundamentally he was -not a true lover of science, but rather an artisan. And yet, with all -these faults, he does not appear to have placed an inordinately high -value upon his discoveries or to have been unreasonably sure of the -correctness of his conclusions.” The first monograph published by -Leeuwenhoek bears the date 1673. It is a study of the minute anatomy -of the bee’s sting. He was the first to declare that the blood is the -nutritive fluid <i>par excellence</i>, and that it is to be found in -the entire series of organisms belonging to the animal kingdom. He -divided blood into two parts—the red, or the solid portion, and the -serum. The corpuscles which float in the serum and give to the whole -fluid its red color, are called by him “particles,” in the case of -blood from birds, reptiles and fishes, and “globules” in that from -quadrupeds. He employed this term “globules” because he believed that -these bodies were exactly spherical in shape. According to Daremberg, -Leeuwenhoek’s studies cover the entire field of human histology, and -his findings are for the most part correct.</p> - -<p><i>The Founding of Organizations for the Advancement of Medical -Science.</i>—During the seventeenth century there were formed a number -of associations which had for their object the promotion of scientific -knowledge, and these organizations contributed greatly to stimulate -original researches in anatomy and physiology and to secure accuracy in -the published results. Perhaps the most important institution of this -kind was the French <i>Académie des sciences</i>, which was founded in -1666, and which deserves the credit of having taken a very important -part in the perfecting of our knowledge of anatomy and physiology. -The Royal Society of London, founded in 1645, possesses a splendid -record of valuable work accomplished. The<span class="pagenum" id="Page_364">[364]</span> following organizations also -deserve to be honorably mentioned in this place: the <i>Accademia dei -Lincei</i> at Rome, founded in 1603; the <i>Académie des Curieux de -la Nature</i>, 1652; and the <i>Accademia del Cimento</i>, founded at -Florence in 1657. New universities were also founded in Germany.</p> - -<p>During the second half of the seventeenth century there were three -French physicians who deserve credit for the excellence of the work -which they did in the departments of anatomy and physiology, viz., -Vieussens, du Verney and Dionis.</p> - -<p>Raymond Vieussens (1641–1716), a native of Rovergue, was Professor of -Anatomy at the University of Montpellier, in Southern France. Some idea -of the extraordinary industry displayed by this anatomist may be gained -from the fact that he is credited with having dissected more than five -hundred bodies. His more important published works relate to the heart, -the nervous system and the structures of the organ of hearing. Pagel -speaks of him as being entitled to the name of founder of the pathology -of diseases of the heart.</p> - -<p>Jean Guichard du Verney (1648–1730), who held the Chair of Anatomy -in the University of Paris, gained a large part of his fame as -an anatomist from the excellence of his investigations into the -complicated structures of the internal ear.</p> - -<p>Pierre Dionis, who died in 1718, was Demonstrator of Anatomy and -Surgery at the Jardin du Roi in Paris during the latter part of the -seventeenth century and early part of the eighteenth. In 1690 he -published a treatise on anatomy which remained the standard book on -this subject for a number of years. In course of time it was translated -into the Latin, English, German and Chinese languages.</p> - -<p><i>Dissecting Made a Part of the Regular Training of a Medical -Student.</i>—The opportunities for dissecting human bodies varied -greatly in different parts of Europe during the period of which I am -now treating. Vieussens, as we have just seen, dissected no fewer than -five hundred bodies during his long professorship at Montpellier; -and Joseph Lieutaud, Professor of Anatomy at Paris, dissected<span class="pagenum" id="Page_365">[365]</span> more -than twelve hundred bodies during the continuance of his connection -with that institution. So far as I have been able to learn from my -examination of the literature, the professors and their immediate -official assistants were the only persons who had, up to this time, -derived the principal benefits that flow from work of this nature; the -students merely listened to the instructor’s remarks upon the objects -which had previously been exposed to view by dissection. But toward -the end of the period—a little before or shortly after the beginning -of the eighteenth century—facilities were provided in some of the -medical schools, and before long in all of the leading ones, for the -students themselves to participate in this highly important part of a -physician’s education. The value of such training was emphasized by -the statement made by the English philosopher, John Locke (1632–1704), -toward the end of his life, viz., that all human understanding is based -upon experience. He wrote that at birth the human soul is like a clean -sheet of paper upon which all the objects perceived by the senses are -recorded as experiences, and there they remain until by the aid of -reflexion—<i>i.e.</i>, by the aid of the understanding, which Locke -calls the inner sense—they are combined into conceptions or ideas. -Locke, it should be remembered, was educated as a physician, but he -never took his degree, nor did he ever practice medicine.</p> - -<p>The first stimulating effects of the Renaissance upon the devotees -of the science of medicine were felt in Italy toward the end of the -fifteenth century, and these effects rapidly gained in intensity -during the following century. First France and afterward Switzerland, -Belgium, Holland and England were almost simultaneously brought under -the same influence; and in all these countries the students manifested -a remarkable eagerness to acquire all the knowledge they possibly -could. In Germany, however, the influence of the Renaissance did not -make itself felt until a much later date, and the thirst for knowledge -was very much slower in developing than was the case in any of the -other countries mentioned. Thus Puschmann, in his “History of Medical -Education,” makes the following<span class="pagenum" id="Page_366">[366]</span> statement which shows clearly that in -Germany the university students of that period must have been a very -rough set of men: “In 1625 the Senate of the University of Leipzig was -obliged to warn its students that they must cease disturbing wedding -festivals and handling the guests roughly, that they must no longer -make obscene remarks to married women and maidens, etc. And in 1631 a -physician named Lotichius, in writing to a friend, made the statement -that ‘in our German high schools the students seem to prefer strife to -the reading of books, daggers to copy-books, swords to pens, bloody -encounters to learned discussions, incessant boozing and noisy reveling -to the quiet pursuit of their studies, and public-houses and brothels -to students’ work-rooms and libraries.’” In 1660 the students at Jena, -on one occasion, carried on a regular battle with the police, and as -a result of this encounter several persons were killed. In the light -of this evidence, therefore, it is not surprising that the science of -medicine made comparatively little advance in Germany until after the -eighteenth century was reached.</p> - -<p><i>Iatrochemists and Iatrophysicists.</i>—During the seventeenth -century there was a great deal of disputing among physiologists about -the nature of certain processes like assimilation and retrograde -metamorphosis, about the manner in which blood is formed, about -digestion, and about the rôle played by the lymph vessels. According to -Haeser a large proportion of the physicians of that day were confident -that chemistry was entirely competent to solve these riddles, and -yet, on the other hand, there were not a few who believed that the -science of physics, which was then much further advanced than that -of chemistry, was quite as competent to explain all the phenomena. -At first the split into these two factions was confined to men who -were interested in questions of a purely physiological nature, but in -a short time the practitioners of medicine were also drawn into the -controversy; and from that time onward it became customary to employ -the terms, “iatrochemists” and “iatrophysicists” in speaking of the -partisans of the two schools of medicine (the iatrochemical<span class="pagenum" id="Page_367">[367]</span> and -the iatrophysical or iatromechanical). The iatrochemists described -digestion as an act that is essentially chemical in character, a form -of fermentation; and by the latter term the more advanced members of -this school—François Deleboë Sylvius (1614–1672), who was born in -Hanau, Prussia, of Dutch parents, and who took his doctor’s degree in -Basel in 1637, and Thomas Willis of London (1622–1675)—understood -something quite different from our modern conception of fermentation. -Their interpretation was as follows: “An internal chemical movement -of matter which is set agoing and continued in action in the stomach -and intestinal canal through the agency of certain chemical reagents.” -(Haeser.) They attributed an important influence to the saliva, the -pancreatic juice and the bile in effecting the changes mentioned. The -iatrophysicists, on the other hand, and more particularly Archibald -Pitcairn of Edinburgh, Scotland (1652–1713), and Giorgio Baglivi of -Ragusa, Italy (1668–1707), described digestion as a purely mechanical -breaking up of the elements of the food partaken—a “trituration.” As -to the further fate of the resulting chyle (its mode of reaching the -blood, for example) the two schools were in perfect accord.</p> - -<p>Sprengel mentions it as an actual fact that, during the seventeenth -century, there were several physicians who combined the two careers -of teacher of medicine and hydraulic engineer (iatrophysicists or -iatromathematicians).<a id="FNanchor_76" href="#Footnote_76" class="fnanchor">[76]</a> Several events conduced to the formation, -in Italy and in Great Britain, of a distinct iatromathematical -school. Among them may be mentioned, first and foremost, Harvey’s -discovery of the circulation of the blood; second, the spread of the -doctrines taught by Descartes favored in a marked degree the union -of medicine and mathematics (physiology, the iatromathematicians -claimed, was only a branch of applied mathematics); and, third, the -formation at Florence, in the middle of the seventeenth century, -of an association of the pupils of Galileo. The objects of this<span class="pagenum" id="Page_368">[368]</span> -association were to cultivate their master’s philosophy, to carry on -the work of experimental physics, and to apply its principles in every -department of natural science. Alphonso Borelli (1608–1679), Professor -of Mathematics first at Messina and afterward at Pisa, the author of -the famous treatise on “The Movements of Animals,” and the founder -of the iatromathematical school, was a member of the association. In -this connection it is important to mention another zealous worker -in the field of iatromathematics, viz., Sanctorius Sanctorinus, of -Capo d’Istria (1561–1636). His work was done quite independently of -any general movement among scientific investigators and at a much -earlier period than that during which the school flourished. He was -quite successful, for example, in his attempts to measure the actual -amount of imperceptible evaporation, and to determine the influence -which this process exerts upon health and disease. In the course of -these investigations in what he called “static medicine,” Sanctorinus -invented a number of unusual instruments.</p> - -<p>The phenomenon of the formation of schools or sects, the members of -which were keenly interested in the maintenance and promulgation -of certain physiological, pathological, or therapeutic doctrines, -manifested itself anew, as I have shown above, in the seventeenth -century. In the early years of the Christian era the partisans of -different medical doctrines formed schools of this nature which -flourished for a certain period of time and then died out completely. -Such, for example, were the sects of the Dogmatists, the Methodists, -the Pneumatists, etc. The mere fact of the existence of these different -schools or sects showed unmistakably that the science of medicine -was alive at that time and that its devotees were making vigorous -efforts to increase their stock of knowledge. Then followed the long -period of the Middle Ages, a series of many centuries, during which -medicine made only slight gains; but at last came the Renaissance,—the -fifteenth, sixteenth and seventeenth centuries,—and here again we have -a recurrence of the same phenomenon of sects in medicine; but note the -great difference between the earlier manifestations<span class="pagenum" id="Page_369">[369]</span> and those which -I have just outlined. The present group, it is proper to remark, is -merely the forerunner of several similar movements that are to occur -during the eighteenth and nineteenth centuries, movements that are all -based, in varying degrees, upon the truth.</p> - -<p><i>The Employment of Latin in Lecturing and Writing on Medical -Topics.</i>—In all the countries of Europe, but more particularly -in Germany, there existed during the sixteenth and seventeenth -centuries—and for a long time subsequently—the practice of delivering -all the lectures on medical topics in the Latin tongue—<i>i.e.</i>, -in a language which at best could not be easily understood by more -than a small proportion of the students. Even the lecturers themselves -must have been hampered in the full expression of their thoughts by -this rule, which was practically compulsory. Paracelsus (1493–1534), -the famous Swiss physician, tried—a full century earlier, as will be -shown farther on—to break up this seemingly harmless but in reality -objectionable custom; his example, however, was not followed, and the -practice was continued without interruption for at least two centuries -longer. The use of Latin as the language in which all medical knowledge -was to be taught was undoubtedly based upon the idea that it was -necessary for the educated physician to be reasonably familiar with -that particular tongue, for the simple reason that it was the only -one in which, in those early days in Western Europe, the writings of -Galen were accessible, for nobody but a few expert scholars had yet -acquired any useful knowledge of Greek, the language in which all of -Galen’s works were originally written. But it is quite likely that -with this motive, which certainly was intended to produce good and -useful fruit, there was coupled the further idea that the great mass -of irregular practitioners—the quacks, the early barber-surgeons -(<i>Wundaerzte</i>), and the peripatetic physicians—would in this -way be debarred from entering the ranks of the regularly trained -physicians. It was only after the custom of using the Latin for -lecturing and writing purposes had become thoroughly rooted in the -minds of medical men as something right and<span class="pagenum" id="Page_370">[370]</span> proper, that it began to -dawn upon the minds of some of the brighter men that this practice was -harmful to the advance of medicine beyond the standards established -by Galen. Vesalius, who was a contemporary of Paracelsus, fully -appreciated how serious an obstacle to further progress in anatomical -knowledge the teachings of Galen were, and it was he who made the first -really successful attack on this great hindrance to further progress; -but there is no evidence to show that he had the slightest idea that -lecturing and writing about medical topics in Latin played any part in -the perpetuation of the evil which he was fighting. To Paracelsus alone -belongs the credit, so far as I know, of endeavoring, through the force -of example and by spoken arguments, to break up the practice which we -are here considering. I may be mistaken in the view which I have here -expressed, but it is difficult for me not to believe that the habitual -use of Latin as the proper vehicle for the transmission of facts and -ideas belonging to the domain of medicine must have materially hindered -the advancement of that science; for such use certainly tended to keep -men’s minds moving in fixed ruts, and those ruts all led straight -toward the faulty teachings of Galen.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_371">[371]</span></p> - -<h3>CHAPTER XXIX<br /> -<span class="subhed1">THE CONTRIBUTIONS MADE BY DIFFERENT MEN DURING THE RENAISSANCE, -AND MORE PARTICULARLY BY WILLIAM HARVEY OF ENGLAND, TO OUR -KNOWLEDGE OF THE CIRCULATION OF THE BLOOD, LYMPH AND CHYLE</span></h3></div> - -<p>Among the earliest known doctrines relating to the nature of the blood -and its mode of distribution throughout the body are those attributed -to Erasistratus and Galen; for the still more ancient ones, of which -Diogenes of Apollonia, Aristotle and the Hippocratic writers are -reputed to be the authors, are too incomplete to call for serious -consideration in this place.</p> - -<p><i>(a) The Doctrine Taught by Erasistratus.</i>—Erasistratus, who -was born at Julis in the Island of Ceos (Aegean Sea) during the third -century before Christ, held the belief that the arteries contain -only air, which is drawn into the lungs by way of the trachea and -bronchi, whence it enters the pulmonary vein (called by him the “venous -artery”). In its further course this air passes from the pulmonary -vein into the left ventricle of the heart, and is then conveyed from -that organ through the arteries to the different tissues of the body. -Erasistratus further taught that the smallest subdivisions of both the -arteries and the veins lie side by side in the tissues, and that, in -certain abnormal bodily conditions, they communicate the one with the -other through anastomoses; but that, in a normal condition of the body, -no communication takes place between the two. In common with all other -physicians of that time, he believed that only the veins carry blood. -Here, then, we<span class="pagenum" id="Page_372">[372]</span> find the first glimmering of the truth with regard -to the nature of the circulating medium and also with regard to the -course which it pursues in one part of its circuit—that part, namely, -where the two kinds of vessels become capillary in character. His -substitution of air for blood in the arteries is plainly the principal -error in his scheme.</p> - -<p><i>(b) The Teaching of Galen and of Caesalpinus with Regard to the -Nature of the Blood and Its Mode of Distribution.</i>—Galen, in the -second century of the present era, disputed the correctness of the -doctrine taught by Erasistratus. His objections are thus stated: -“Inasmuch as blood flows from an artery when it is wounded, one of two -things must be the truth. Either blood was already contained in the -vessel before it was wounded, or it must have found its way in from the -outside. But, if the blood comes from the outside into a vessel which -contains only air, then air must necessarily escape from that vessel -(when wounded) before blood does—which is contrary to the fact, as -blood alone flows out. Therefore arteries contain only blood.” As a -further proof of the correctness of his statement Galen carried out the -following experiment: In a living animal he placed two ligatures around -an artery at points situated not far apart, and then made an opening -in the vessel between the two ligatures. The intervening section of -the artery, it was thus found, contained only blood. This experiment, -it might reasonably be supposed, would have definitely settled the -question; but such was not the case. The followers of Erasistratus -immediately raised this objection: If the arteries contain blood, how -may the air which is drawn into the lungs find its way to all parts -of the body? Galen replied that the inhaled air does not pass through -the lungs, but is rejected by them after it has cooled the blood. This -refrigerating process, he claimed, constitutes the sole purpose of the -respiratory act.</p> - -<p>Although Galen’s idea regarding the true function of respiration is -not in harmony with the doctrine taught by modern physiologists, it -nevertheless represents a marked advance over the belief previously -maintained. Even as<span class="pagenum" id="Page_373">[373]</span> recently as in the time of Albert von Haller -(approximately 1760–1780) physicians still continued to believe that -it was the function of respiration to cool the blood; and indeed it -was scarcely possible before 1800 to offer a more correct physiology -of the act of breathing, for it was not until after the lapse of many -centuries that the advance in our knowledge of chemistry reached a -point at which it became possible to find a satisfactory solution of so -complicated a problem.</p> - -<p>As to the nature of the blood itself Galen believed, as I have already -stated more fully in Part I. (“Ancient Medicine”), that there are two -kinds—spirituous blood (or spirit) and venous blood. He gave the name -of spirituous blood to that which is found circulating in the arteries, -and which is appreciably brighter in color than that which fills the -veins. According to Flourens, the distinguished French physiologist -of the nineteenth century, Galen was the first among the ancient -anatomists to make this distinction of two different kinds of blood. To -the spirituous variety Galen ascribed the function of nourishing the -more delicately constructed organs like the lungs, while he claimed -that the venous blood is suited to nourish only the coarser ones, like -the liver, spleen, etc.</p> - -<p>In his further development of a physiology of the circulation of the -blood Galen, who as a rule expresses his ideas with great clearness, -makes statements which I find it extremely difficult to comprehend. -I am therefore tempted to assume that the copyists, to whom we are -indebted for handing down his actual words from age to age, are the -persons upon whom should be cast the blame for the obscurity of which -I complain. However this may be, it is an unquestionable fact that -the ablest physiologists, were they to be confronted to-day with the -duty of solving this problem of the circulation under the conditions -of knowledge which existed during the third century of our era, would -surely not be able to provide a more correct solution than that which -is credited to Galen. The problem was attacked repeatedly by some -of the brightest and best-equipped minds of the Renaissance period, -but not one of<span class="pagenum" id="Page_374">[374]</span> these exceptionally clever men was able to offer an -entirely acceptable solution. Harvey alone, as will appear farther on -in this account, solved the riddle once and for all.</p> - -<p>The “spirit”—the purest part of the blood—is lodged, according to -Galen, in the left ventricle; and, inasmuch as even the venous blood, -if it is to fulfil in some degree the function of a nourishing fluid, -must possess a certain proportion of “spirit,” it is clear that the -two ventricles should communicate the one with the other; for how -otherwise—thought Galen—is it possible for a certain amount of -“spirit” to commingle with the venous blood? The locality at which -this communication was assumed to exist was the interventricular -septum; and, as nobody was able to find anything like a foramen in this -membrane, it was asserted that the communication is effected through -an infinite number of pores. For over one thousand years physicians -accepted this porous character of the interventricular septum as an -established fact. In his commentaries on Mondino’s “Anatomy” (1521), -Berengarius of Carpi timidly ventured the statement that the openings -of communication are not distinctly visible, and this apparently was -the first feeble expression of doubt concerning the correctness of the -prevailing doctrine. Vesalius, on the other hand, boldly denied their -existence altogether.</p> - -<p>According to Galen’s teaching the liver is the source of origin of all -the veins, just as the heart is the starting-point of all the arteries. -It is quite remarkable, says Flourens, that physicians who performed -almost daily the operation of venesection should, during a long series -of years, have failed to observe that this doctrine of blood flowing -through the veins from the liver to the different parts of the body, -could not possibly be true, inasmuch as at each such operation the -vein always became distended with blood <i>below</i> (<i>i.e.</i>, on -the distal side of) the ligature which they applied to the part (arm, -for example) before opening the vessel. This phenomenon, of course, -indicated clearly that the blood in the veins flowed <i>toward the -heart</i>, and not from any centrally located spot or organ <i>toward -the extremities</i>. And yet—he adds—even so bright and<span class="pagenum" id="Page_375">[375]</span> thoughtful -a man as Vesalius does not appear to have noticed this fact. Andreas -Caesalpinus (1519–1603), on the other hand, did observe and correctly -interpret the phenomenon; and he made the further observation that -physicians were habitually applying the ligature <i>above</i> the -spot which they expected to bleed, regardless of the fact that in so -doing they were not acting in harmony with their belief concerning the -circulation of blood in the veins. Caesalpinus also states, in one part -of his writings, that “the blood, carried to the heart by the veins, -receives in that organ its last transformation toward perfection, -and is then—in this perfected state—transported by the arteries to -the remotest parts of the body.” So far as it relates to the general -movement of the blood this statement is correct, but it errs, as will -be shown presently, in mentioning the heart as the locality where the -perfecting process takes place. In his final remarks regarding the -anatomical relations which exist in the two chambers of the heart -Caesalpinus makes the following statement:—</p> - -<div class="blockquot"> - -<p>Each ventricle possesses two vessels—one through which the -blood reaches that chamber, and a second one which serves to -carry it out of the ventricle. The vessel through which the -blood enters the right ventricle is called the <i>vena cava</i>, -and that by which it leaves this same chamber is called the -pulmonary artery. The vessel through which the blood arrives -in the left ventricle is called the pulmonary vein, and that -through which it leaves this left chamber of the heart is known -as the aorta.</p> -</div> - -<p><i>The Circulation of the Blood as Elucidated by Michael -Servetus.</i>—Michael Servetus, a native of Villanueva, Spain, -who in 1553 was burned alive at the stake near the city of Geneva, -Switzerland, because of his heretical teachings, is not infrequently -mentioned as the individual to whom credit is due for having furnished -the first description of the lesser or pulmonary circulation. There -is no question whatever regarding the justice of according to him -at least a part of this honor, but one should be careful to specify -that Servetus is entitled only to the credit of having been the first -to teach that the blood, in its journey from<span class="pagenum" id="Page_376">[376]</span> the right to the left -side of the heart, must pass entirely through the lungs. So far, his -doctrine is correct; but he also taught at the same time that the -fluid which enters the aorta from the left ventricle is not blood but -perfected “vital spirit” (Galen), and that it becomes genuine blood -only after it has tarried for a few brief instants in the ventricular -chamber and has there been subjected to some unknown influence -exerted by the heart itself. This second erroneous part of Servetus’ -description seems to me to diminish very materially the credit to which -he is otherwise entitled; and I cannot help feeling that Dezeimeris is -right when he claims that Realdus Columbus, whose more perfect account -of the lesser circulation was written only a little later than that of -Servetus, is perhaps better entitled to the honor in question.</p> - -<p>It is an interesting fact that Servetus introduces his disquisition -on the circulation of the blood in the very midst of a treatise which -bears the title “Restitution of Christianity,”—in other words, in a -treatise which would never, under ordinary circumstances, be consulted -by physicians in their search for information regarding an important -problem in physiology like that of the circulation of the blood. In -this physiologico-theological treatise Servetus, who—as I omitted to -state—was a theologian as well as a physiologist, used the following -expressions:—</p> - -<div class="blockquot"> - -<p>The soul, says Holy Writ, is in the blood; as a matter of fact, -the soul is the blood. And since the soul is in the blood, one -should—if one wishes to learn how the soul is formed—endeavor -to learn how the blood is formed; and, in order to learn how -the blood is formed, it is necessary to ascertain how it moves. -(Flourens.)</p> -</div> - -<p>I am unable to state whether it was this particular chapter, or -the work taken as a whole, which appeared to the ecclesiastical -authorities—first those of France and afterward those of Geneva—to -warrant the author’s condemnation as a heretic. And, when we are -disposed to blame severely those bigots who, in the fifteenth and -sixteenth centuries, manifested such a keen desire to destroy<span class="pagenum" id="Page_377">[377]</span> -“heretics,” let us remember, with a proper sense of shame, that -we still have in our midst, in this twentieth century and in this -“land of freedom,” men of high social standing who are as virulent -heresy-hunters as ever were the enemies of Servetus.</p> - -<p><i>Experiments of Realdus Columbus.</i>—Matthaeus Realdus Columbus, -who was born at Cremona, Northern Italy, in the early part of the -sixteenth century, acted for some time as Vesalius’ prosector, and -must therefore have had ample opportunities for acquiring a thorough -knowledge of the experimental method of studying questions in -physiology. He wrote a description of the pulmonary circulation which -was more lucid and nearer to the truth than any which his predecessors -had furnished. This description, which will be found in his treatise -on anatomy (Venice, 1559), was based largely upon experiments that he -carried out upon living dogs. As rendered into English from the French -version supplied by Dezeimeris, it reads as follows:—</p> - -<div class="blockquot"> - -<p>When the heart dilates the blood passes from the vena cava into -the right ventricle; from the latter chamber it is pushed into -the arterial vein (the pulmonary artery), along which channel -it is carried to the lung, there to be properly thinned and -mixed with air. Ultimately the blood passes on into the venous -artery (= the pulmonary vein), the function of which vessel is -to carry this fluid, now charged with air through the action of -the lung, into the left ventricle of the heart. Then follows -the contraction (systole) of this organ, as a result of which -action the tricuspid valves rise up into position and form a dam -that prevents the return of the blood into the vena cava and -the pulmonary veins. Simultaneously with this action the valves -placed at the opening which represents the commencement of the -aorta (left ventricle), and those placed at the opening which -corresponds to the beginning of the pulmonary artery (right -ventricle), yield and thus open the way for the distribution of -the blood throughout the rest of the body.</p> -</div> - -<p>The reader will, I believe, admit that this description, while perhaps -not faultless, is distinctly superior to that given by Servetus.</p> - -<p>Columbus’ experimental studies threw considerable light upon other -matters relating to the physiology of the heart.<span class="pagenum" id="Page_378">[378]</span> He demonstrated, -for example, that the fluid which enters the left ventricle from the -lungs is genuine blood, and he also learned by the same method of -investigation the true nature of the systole and diastole of the heart -and the relations of these acts to the pulse and to the changes in the -position of the heart. The discovery of all these facts constituted -a material advance in our knowledge of the physiology of that organ; -but, from this time onward, for a period of nearly three-quarters of a -century, no further advance was made until William Harvey of England -appeared on the scene. The explanation of the failure of such able -investigators as Realdus Columbus, Vesalius, Servetus and others to -push their researches still further is to be found largely in the fact -that they were all still in bondage to the doctrines taught by Galen -centuries earlier, and probably more particularly to that dogma which -maintains that blood—if it is to be accepted as genuine or fully -formed blood—must first have been elaborated in the depths of the -liver. The impossibility of harmonizing such a dogma with the facts -which by that time were well established, is too plainly evident to -warrant further discussion in these pages.</p> - -<p><i>Discovery of Valves in the Larger Veins by Fabricius ab -Acquapendente.</i>—The discovery of the presence of valves in the -interior of the larger veins is credited by some to Cannani (1546) -and by others to Fabricius ab Acquapendente (1574), but the best -authorities appear to favor the claim of Fabricius to this honor. -There are also a few authorities who maintain that Fra Sarpi, the -celebrated monk and scientist of Venice, is entitled to be considered -the discoverer of the valves in veins, but Tiraboschi, the historian of -Italian literature, makes it clear that this claim is unfounded.</p> - -<p>Although it was known to Fabricius that these valves are inclined -toward the heart, he does not appear to have appreciated the fact that -this arrangement is entirely incompatible with Galen’s doctrine that -the flow of venous blood is from the liver toward the extremities; nor -did any other anatomist, so far as I am able to learn, discover this<span class="pagenum" id="Page_379">[379]</span> -incompatibility before it was pointed out by Harvey nearly fifty years -later.</p> - -<p><i>William Harvey, Who is Universally Acknowledged to be the Real -Discoverer of the Circulation of the Blood.</i>—William Harvey was -born at Folkstone, England, in 1578, received his academic education at -Caius College, Cambridge, and became a doctor of medicine in 1602, at -the age of twenty-four. Four or five years before this event he went -to Padua, Italy, to study medicine under Fabricius ab Acquapendente, -who was considered at that period to be the ablest and most inspiring -teacher of anatomy and physiology in Europe. It was from him, it may -safely be assumed, that Harvey learned the importance of studying -Nature herself, rather than books, when one is desirous of learning her -secrets. Equipped with a thorough knowledge of the methods that may -best be employed in making studies of this character, Harvey returned -to England at the end of his long stay at Padua. He was soon afterward -made a member of the College of Physicians of London, and in 1615 was -elected to the Chair of Anatomy and Surgery in that institution. Later -still, he was appointed one of the physicians of St. Bartholomew’s -Hospital. He also held for several years the position of Court -Physician, first to James the First and then to Charles the First. It -was during this period of his professional career that he began working -in earnest upon the problem of the circulation of the blood, and he -kept steadily at this work throughout a period of several years. Among -the manuscripts preserved in the British Museum there is one bearing -the date of 1616 which shows that Harvey had already at this time -reached conclusions which, in all essential respects, agree with those -which appear in his final treatise published in 1628. The title of the -latter work is, “<i>Exercitatio anatomica de motu cordis et sanguinis -in animalibus</i>” (Frankfort, 1628).</p> - -<p>Although, as I have shown above, several of the links in the chain -of proofs bearing upon this question of the circulation had already -been discovered before Harvey began his researches, he was not -willing to accept them as proven facts until he had himself tested -them thoroughly<span class="pagenum" id="Page_380">[380]</span> by the experimental method. Furthermore, they were -often disconnected, and this lack of continuity obliged him to supply -missing links at several points; in other words, nobody had as yet -demonstrated the important fact that the blood travels regularly in an -unbroken circuit, and it was to this great task that Harvey devoted -himself at the period which we are now considering. He carried out -all these investigations with the most painstaking care and made -public announcement of his discoveries only after the lapse of an -extraordinary length of time; his chief object being that ample -opportunity might thereby be afforded for complete verification. The -following are among the more important questions which he investigated -and to which he furnished satisfactory solutions. He learned, for -example, that the auricle and ventricle of each side of the heart do -not contract simultaneously but in succession. When the right auricle -contracts the blood which it then contains passes into the right -ventricle; and when the right ventricle contracts the blood is driven -into the pulmonary artery. From this vessel it passes ultimately into -the pulmonary vein, and from the latter into the left auricle, which -then contracts and drives the blood into the left ventricle. The -latter chamber next contracts and forces the blood into the aorta, -whence it is carried into all the arteries of the body. From these, in -turn, it passes into the veins and thence back to the right auricle -of the heart—the point from which it started. He corroborated the -finding—by other anatomists who had preceded him—of membranous valves -at the spots where the blood passes from one chamber to the other; -and he compared these valves to little doors which open to permit the -passage of the blood in one direction, but which close when there is -any tendency for it to pass in the opposite direction. The valves -of the right auricle, for example, allow the blood to pass into the -right ventricle, but prevent it from returning into the auricle. Then, -further, the valves of the right ventricle permit the blood to pass -into the pulmonary artery, but prevent it from returning into the -ventricle. The valves of the left auricle permit the blood <span class="pagenum" id="Page_381">[381]</span>to pass -into the left ventricle, but do not permit it to return into the left -auricle. Finally, the valves of the left ventricle allow the blood to -pass into the aorta, but prevent it from regurgitating into the same -ventricle. The valves with which the veins are equipped permit the -blood to travel onward toward the heart, but do not permit it to back -up into the arteries.</p> - - <div class="figcenter" id="i_fp380"> - <img - class="p2" - src="images/i_fp380.jpg" - alt="" /> - <p class="center p0 sm">FIG. 15. WILLIAM HARVEY.</p> - <p class="center p0 sm">(After the portrait by Cornelius Jonson.)</p> - </div> - -<p>Galen taught that the arteries pulsated by reason of a “pulsific power” -which they derive in direct continuity from the tunics of the heart. -He tried to prove the correctness of his doctrine by experimental -methods, but in this he failed. Harvey was convinced that the arteries -do not pulsate by reason of their own inherent power, but by a force -of impulsion communicated to the blood at the heart. He refers to this -question in the following terms: “When an artery is opened the blood -escapes in jets of unequal force; the alternate jets being stronger -than the intermediate, and the stronger jets corresponding in time of -occurrence, not with the systoles but with the diastoles of the artery. -The artery, therefore, must be distended by impulsion, by the shock of -the blood. If the artery dilates by reason of its own inherent power, -the blood would not be expelled with the maximum force at the very -moment when this dilatation occurs.” As evidence of the non-existence -of Galen’s assumed “pulsific power,” Harvey mentions the fact that, in -the case of a patch-shaped calcification of the crural artery which -came under his observation, the pulsation took place as usual, but at a -point below (distal to) the edge of the patch. The intervening patch of -rigid calcareous matter was not able to prevent the traveling onward of -the propelling power.</p> - -<p>Harvey next takes up the consideration of the veins, and, after -showing that they permit a flow of the contained blood in only one -direction,—viz., that from the extremities toward the heart,—he calls -attention to certain experiences which he has had: (1) When a cord is -tied lightly around a limb the flow of blood is arrested <i>only in -the veins</i>, because these vessels are located near the surface of -the skin; but, if the cord is tied more tightly, the flow of blood -is also<span class="pagenum" id="Page_382">[382]</span> arrested in the arteries, which lie at a relatively great -depth. (2) When a vein is tied the resulting distension manifests -itself <i>only below</i> (<i>i.e.</i>, on the distal side of) the -ligature; whereas, when an artery is similarly tied, the distension -takes place <i>above</i> (<i>i.e.</i>, on the proximal side of) the -ligature. It is therefore plain that in the veins the blood flows from -the individual parts toward the heart, but that in the arteries the -flow is in the reverse direction—<i>i.e.</i>, from the heart toward -the individual parts. “If one reflects upon the nature of the movement -of the blood,” says Flourens, “one will promptly realize how speedy it -is. Scarcely has the blood entered the heart before it is hurried into -the arteries; and then from these vessels it passes in an instant into -the veins, from which, with almost equal speed, it finally travels back -to the heart again. It is this never-ending movement from one channel -into another, and then eventually back to the starting-point, which -constitutes the circulation of the blood.... Modern physiology dates -from the discovery of the circulation of the blood. Up to the time of -this discovery physiologists followed the ancients; they did not dare -to walk alone. Harvey had discovered the most beautiful phenomenon in -the animal economy.... From this time forward, instead of swearing by -Galen and by Aristotle, one had to swear by Harvey!”</p> - -<p>Despite the great care which Harvey took to back up his scheme of the -circulation of the blood with unimpeachable proofs of its correctness, -he was obliged to pass through the same sort of experience as that to -which Vesalius and scores of other pioneers in the field of scientific -inquiry had been subjected. Two hostile forces stood constantly -ready, during that fruitful period of the Renaissance, to attack with -merciless bitterness all those who ventured to add new facts to our -stock of knowledge in the domain of medicine. On the one side were the -many men of small calibre, men filled with jealousy over the successes -gained by co-workers in the same field; and on the other was marshaled -the host of those who honestly believed that all medical wisdom ended -with Galen. Before his death, however (hardly<span class="pagenum" id="Page_383">[383]</span> thirty years later), -Harvey had the satisfaction of witnessing the almost unanimous -acceptance of his dogma concerning the circulation of the blood. Louis -the Fourteenth, King of France at this period, was so appreciative of -the importance of Harvey’s discoveries that he appointed Dionis, the -distinguished French anatomist, to demonstrate to the students of the -Medical School of the Jardin des Plantes at Paris the circulation of -the blood and other recent discoveries. Descartes (1596–1650), the -celebrated French philosopher, paid an even greater compliment to the -high character of the work accomplished by Harvey. His words, as quoted -by Flourens, are as follows:—</p> - -<div class="blockquot"> - -<p>If I am asked why the supply of venous blood does not become -exhausted in flowing thus unceasingly into the heart, and why -the arteries—since all the blood that passes through the -heart must travel along these vessels—do not become filled to -overflowing, I can see no good reason why I should not give -to this question the very same answer that William Harvey, an -English physician, to whom praise is due for having taught ..., -has already given. [Then follows the text of Harvey’s reply.]</p> -</div> - -<p>Our readers have doubtless noted the fact that, while Harvey, as I have -endeavored to show in the preceding account, has clearly established -his right to be considered the discoverer of the circulation of the -blood in all its most essential features, his scheme fails to furnish -any information concerning the composition of the blood and the manner -in which it is built up into a life-giving fluid. In the minds of some -this may seem to be an omission. A moment’s reflection, however, will -satisfy any reasonable person that questions of this nature do not form -a legitimate part of the problem which Harvey was engaged in solving, -and that they therefore should receive separate consideration. Thus, -for example, Harvey’s scheme fails to furnish satisfactory information -concerning those portions of the circuit where the blood is obliged -to travel through a system of communicating capillary channels, as -happens in the lungs and in the tissues generally throughout the body. -But Harvey had no means at his command<span class="pagenum" id="Page_384">[384]</span> for investigating a question -of this nature. Capillary blood-vessels are invisible to the naked -eye, and may be studied only with the aid of a microscope; but this -instrument was not available until long after the time (1605–1616) -when Harvey was engaged in carrying out his investigations into the -circulation of the blood.</p> - -<p><i>Other Discoveries Relating to the Vascular System.</i>—To Vesalius -is due the credit of having discovered the fact that anastomoses exist -between the carotids and the vertebral arteries, thus explaining how a -man may continue to live even after both carotids have been severed or -ligated. His great rival, Fallopius, described these anastomoses in the -most detailed manner, and he noted the further fact that an anastomosis -with the basilar artery exists.</p> - -<p>By the end of the sixteenth century a certain amount of progress had -been made toward a correct knowledge of the lymphatics. Bartholomaeus -Eustachius, for example, discovered the existence (in horses) of the -thoracic duct, but he supposed it to be a vein. His description of this -vessel reads as follows:—</p> - -<div class="blockquot"> - -<p>In these animals there is a large vessel which extends downward -from the inner aspect of the clavicular vein (= left subclavian -vein). At the point where it joins the vein it is closed by -means of a semicircular valve. This vessel is of a whitish -color and it contains a scanty watery fluid. Not far from its -starting-point it divides into two branches which very soon, -however, join together again, and then, as a single trunk from -which no further branches are given off, it passes down along -the left side of the spinal column, penetrates the diaphragm, -spreads itself out over the aorta, and ends in a manner unknown -to me.</p> -</div> - -<p>About one hundred years later (1647), Jean Pecquet of Dieppe, France, -professor in the Medical School of Montpellier, rediscovered (in a -dog) this same duct, with its tributary chyle ducts and also its point -of entrance into the left subclavian vein; and, as he had rightly -interpreted its nature, anatomists by common agreement accorded him the -rights of discoverer.</p> - -<p><span class="pagenum" id="Page_385">[385]</span></p> - -<p>At a still earlier date (1622) Caspar Aselli of Cremona, Northern -Italy, professor in the Medical School of Pavia, discovered the chyle -ducts. This discovery was made under the following circumstances, which -reveal the fact that good luck sometimes plays an important part in -the work of the searcher after truth in the departments of anatomy and -physiology:—</p> - -<div class="blockquot"> - -<p>Aselli was studying the distribution of the recurrent nerves and -the movements of the diaphragm in a well-nourished living dog, -when his attention was drawn to the presence of a large number -of delicate white threads coursing as it were over the surface -of the mesentery. Following the accidental injuring of one of -these threads there escaped from the wounded structure quite -a large quantity of chyle. Aselli, who instantly appreciated -the full significance of what had happened, exclaimed, in the -presence of the bystanders, “Eureka!” At the time he supposed -that these chyle vessels terminated in the liver and contributed -in some manner to the elaboration of the blood (in harmony with -Galen’s universally accepted theory of sanguification); but -later, after he had carried out a carefully conducted series -of experiments, he was able to rectify this erroneous belief. -(Haeser.)</p> -</div> - -<p>Galen’s theory of sanguification may be stated as follows: The chyle is -received into the veins of the intestinal wall and carried thence to -the liver, in which organ they are all gathered together into a single -venous trunk which has received the name of “<i>vena portae</i>”—the -vein of the gateway. Everything that is destined to enter the liver -passes through this portal vein. In the organ itself the chyle -undergoes certain modifications, the result of which is, first, to -deprive it of its impurities and then, in addition, to effect other -changes that convert it into blood. Aselli’s glory, then, consists in -his having shown that chyle is taken up from the intestinal mucous -membrane by a set of its own vessels, and not by the veins, as taught -by Galen.</p> - -<p>In 1651 Olaus Rudbeck of Arosen, Sweden, discovered the lymphatics of -the intestinal canal and followed their distribution into the lymph -nodes; he also established their relations with the thoracic duct and -with the venous system.</p> - -<p>Thus, thanks to the series of brilliant discoveries made<span class="pagenum" id="Page_386">[386]</span> by William -Harvey, Realdus Columbus, Fabricius ab Acquapendente, Pecquet, Aselli -and a few others, the doctrine of the circulation of the blood and of -the part played by the accessory chyle and lymphatic vascular systems, -became firmly established before the end of the seventeenth century.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_387">[387]</span></p> - -<h3>CHAPTER XXX<br /> -<span class="subhed1">ADVANCES MADE IN INTERNAL MEDICINE AND IN THE COLLATERAL -BRANCHES OF BOTANY, PHARMACOLOGY, CHEMISTRY AND PATHOLOGICAL -ANATOMY</span></h3></div> - -<p><i>General Remarks.</i>—In the fundamental branches of medical -knowledge—anatomy and physiology—advances of a very decided character -were accomplished during the sixteenth and seventeenth centuries; and -in the preceding chapters I have endeavored to give my readers some -idea of the nature of these advances, of the men who were instrumental -in effecting them, and of the extent to which the way was made easy, -during this period, for the accomplishment of still further advances. -In carrying on the work of correcting the many errors which were found -to exist in the two departments mentioned, it was soon discovered that -the obstacles to be overcome were of a serious character, and that -the most formidable one of the group was what is universally known as -Galenism. If I now refer to this subject once more, perhaps for the -second or third time in the course of this history, it is because I -fear that my remarks with regard to the harmful influence exerted by -Galenism may not be rightly interpreted. For Galen’s personal character -I entertain, as I have already stated in the section relating to -Ancient and Mediaeval Medicine, the deepest respect, and I am filled -with great admiration for what he accomplished in advancing the science -of medicine; but at the same time I cannot overlook the fact that he -was hemmed in by insurmountable limitations. No single human being, -living at the beginning of the present era and surrounded, as Galen -was, by a herd of<span class="pagenum" id="Page_388">[388]</span> jealous rivals, could have successfully bid defiance -to those who considered it sacrilegious to dissect the dead body of a -fellow man; and yet, without the knowledge which may only in this way -be gained, how was it practicable for any individual, no matter how -clever he might be, to lay the foundations for a further advance in -medical knowledge? It seems to me therefore plain that Galen did all -that lay in his power to advance the science of medicine; and whatever -words of condemnation I may have employed in the text, when speaking -of the Galenists, refer solely to those physicians of later centuries -who were of such a narrow-minded type, so rigidly crystallized in the -belief that Galen’s teachings had reached the limit of all possible -knowledge in the science of medicine, that they did not hesitate to -class the efforts of men like Vesalius as acts of unpardonable impiety. -Galenism, then, refers to the very widely prevalent tendency among -physicians of the fifteenth, sixteenth and seventeenth centuries to -uphold the teachings of Galen as the <i>only</i> trustworthy code upon -which they should depend for their guidance. In short, Galenism, at the -period named, meant for medicine a complete arrest of development.</p> - -<p>I have now arrived at a point in the history of medicine where, owing -to the limited amount of space at my command, the difficulty of -deciding as to what subjects and what individual workers in the field -of medicine—a field now grown to very great proportions—shall receive -consideration in my sketch. Having decided from the very outset that my -best efforts shall be directed, consistently with a strict adherence -to historical truth, toward making my account readable, I now find it -absolutely necessary to jettison—if I may be permitted to use such a -nautical expression—much really valuable cargo, and to put ashore, -before continuing our voyage, many passengers of undoubted worth. -Nobody need bemoan the loss of all these valuable treasures, for the -great majority of them, I am confident, will be cared for properly by -those authors who are privileged to treat this whole subject with some -degree of thoroughness; and the reader, if he is familiar with<span class="pagenum" id="Page_389">[389]</span> German, -will even now find, in the excellent general treatises of Haeser, von -Gurlt, Pagel, Puschmann, Baas-Henderson and Neuburger, great stores -of the most satisfactory information concerning the thousand and one -details about which I am obliged to remain silent.</p> - -<p><i>Internal Pathology.</i>—During the fifteenth century the -practitioners of medicine in Italy and France were still strongly -under the influence of the teachings of the Arabian medical authors. -One of the first writers in Italy to place the doctrines of internal -medicine upon a firmer footing was Antonius Benevienus, a native of -Florence (1440–1502). His treatise on some of the unusual causes of -disease, which was printed in Florence in 1506, is said to be written -in very clear language and to be based entirely upon cases which came -under his own observation. According to Haeser the first improvements -in the doctrines relating to pathological anatomy may be credited to -Benevienus, who also taught that pathological phenomena should be -studied by direct observation rather than from books.</p> - -<p>Johannes Manardus of Ferrara (1462–1536) was a very sturdy opponent -of astrology, and, in general, did all in his power to weaken the -prevailing blind trust in the authority of the Arabian medical authors. -But the two physicians who, next to Fabricius ab Acquapendente, stand -out most conspicuously among their Italian contemporaries of the -sixteenth and seventeenth centuries, are Fracastoro and Lancisi—the -former a native of Northern and the latter of Southern Italy.</p> - -<p>Hieronymus Fracastoro of Verona (1483–1553) ranks very high among the -physicians of the first half of the sixteenth century for his valuable -contributions to our knowledge of internal pathology. In the treatise -which he published in 1546 on contagious maladies, he states in plain -language his belief that the causes of diseases of this nature are to -be found in living germs that are endowed with the power of propagating -themselves. He divides these diseases into the following three groups:—</p> - -<div class="blockquot"> - -<p>1, Those which infect only by contact; 2, Those which not -only infect by contact, but at the same time leave behind a -centre or<span class="pagenum" id="Page_390">[390]</span> focus of infection—in which category he places -tuberculosis, elephantiasis, and similar diseases; and 3, Those -which infect not only by direct contact, or through the agency -of a residuary centre or focus of infection, but also those -which are capable of spreading their infective elements over -wide areas—for instance, the pestilential fevers, certain -ophthalmias, variola, etc. (From Viktor Fossel’s version of -Fracastoro’s treatise published in Leipzig in 1910.)</p> -</div> - -<p>Speaking of tuberculosis (called by him “phthisis”), Fracastoro says -that it is astonishing for how great a length of time the virus of this -disease retains its infective power. “It has been noted, for example, -that in quite a number of instances the clothes worn by a tuberculous -patient have communicated the disease to a healthy individual as late -as two years subsequently to the date at which they were removed from -the original tuberculous individual.” The same power of communicating -infection, he continues, may reside in such other objects as the bed, -the walls and the floor of the room in which a tuberculosis patient has -died. Under these circumstances, he adds, we are obliged to assume that -germs of this infective disease have remained attached to the different -objects mentioned.</p> - -<p>Fracastoro was born in Verona, Italy, of parents who belonged to the -patrician class and were in easy circumstances. He studied mathematics -and philosophy at the University of Padua, and was quite prepared, -on reaching the age of twenty, to pass the examinations required of -candidates for the degree of Doctor of Medicine. Just at this time, -however, Padua was not a safe place of residence, owing to the war -that was threatened between the Emperor Maximilian the First and the -Republic of Venice. Accordingly Fracastoro took his degree at the -newly established Academy of Pordenone, in what is known to-day as the -Province of Udine (northeast of Venice); and shortly afterward, upon -the death of his father, he returned to Verona and began the practice -of medicine. As he quickly gained the confidence of the people, he -very soon found himself in a sufficiently prosperous condition to -warrant him in retaining possession of the family residence, which<span class="pagenum" id="Page_391">[391]</span> -was charmingly located at the foot of Monte Incaffi, midway between -the Adige River and the Lake of Garda. Here it was that Fracastoro -did a large part of his literary work, for he was a poet as well as -a physician. Pope Paul the Third appointed him to the position of -Physician-in-Ordinary to the Council of Trent, and it was by his advice -that, upon the appearance of the Plague in that city, the sittings -of the Council were thereafter held for a short season at Bologna. -Later, still other honors fell to his lot. He enjoyed the esteem of the -Emperor Charles the Fifth and of Francis the First, King of France; and -the latter’s highly cultivated sister, Margaret of Navarre, offered him -every inducement to settle at her Court, but the attractions of his own -home made it easy for him to decline all these offers. He died at his -villa on August 6, 1553, and six years later the city of Verona erected -in his honor a marble memorial tablet.</p> - -<p>Fossel, in his biographical sketch of Fracastoro, says that the most -popular of his poetical writings was that entitled, “<i>Syphilis sive -morbus Gallicus</i>.” It was published in several successive editions, -and was translated into nearly all the languages of European countries. -I shall have occasion to refer to it again in a later chapter.</p> - -<p>Giovanni Maria Lancisi was born at Rome on October 26, 1654. Like -Boerhaave he began his university studies under the service of the -Church, but, as time went on, his leaning toward the profession of -medicine became more and more pronounced, and he soon took up in -earnest the study of that science at the University of Sapienza, -devoting a large share of his time to dissecting and to clinical work -in the hospitals. In 1672, when he was only eighteen years old, he was -given the degree of Doctor of Medicine; and four years later, after a -competitive examination, he was appointed an assistant at the Hospital -of the Holy Ghost. In 1678 he was permitted, as a special honor, to -enrol himself as a student in the Collège de Saint-Sauveur. During -the following five years he enjoyed at this institution exceptional -facilities for studying medical literature, and was thus able to -accumulate an immense<span class="pagenum" id="Page_392">[392]</span> mass of useful extracts from the writings of the -best authors. In 1684 he was assigned to the duty of teaching anatomy -at the Sapienza, and for thirteen years he filled this post with great -credit to himself; Malpighi being one of those who took pleasure in -following his lectures. He had scarcely attained his thirtieth year -when he was honored by being appointed Physician-in-Chief and Privy -Councilor to Pope Innocent the Eleventh; and soon afterward he was made -a Canon of the Church of Saint Lawrence, the main purpose of which -appointment was to provide him with a suitable income. On the death -of the Pope in 1689 he resigned the latter office, in order that he -might have more leisure and freedom to pursue his professional duties. -Subsequently he became the regular medical attendant, first of Pope -Innocent the Twelfth and afterward of Pope Clement the Eleventh. He -died on January 21, 1720.</p> - -<p>Von Haller speaks of Lancisi as “a physician who was most highly -esteemed by Pope Clement the Eleventh, who was very learned and very -philanthropic, and who loved to give aid to the afflicted and to -prevent litigation by wise counsels.” It was Lancisi also, as I have -stated on a previous page, who discovered at Rome, in the possession of -the heirs of the artist Pini who made the original drawings, the copper -plates which Eustachius had ordered nearly two hundred years earlier, -and which were to have been used by this celebrated anatomist in the -production of a most beautiful set of anatomical illustrations.<a id="FNanchor_77" href="#Footnote_77" class="fnanchor">[77]</a></p> - -<p>The two most important original treatises published by Lancisi bear the -following titles: “<i>De motu cordis et aneurysmatibus</i>” (on the -movements of the heart and on aneurysms), Rome, 1728 (a later edition -in 1745); and “<i>De subitaneis mortibus Libri II</i>” (on sudden -deaths), Rome, 1707 (also later editions).</p> - -<p><i>Botany and Botanical Gardens.</i>—The Egyptians, the Persians, the -inhabitants of India and China, and the ancient Greeks accumulated a -great mass of information<span class="pagenum" id="Page_393">[393]</span> relating to plants which might be utilized -in the treatment of different diseases. Then, in the early part of the -present era, Galen contributed not a little to our further knowledge -on this subject; but from that time forward, until the sixteenth -century, pharmacology practically remained unchanged. The beginnings of -a systematic study of all plants—in other words, modern botany—may -be traced to the establishment of botanical gardens, first in Italy -and afterward in Holland and France. According to Berendes the very -earliest attempt in relatively modern times to cultivate such a garden -was made at Salerno by Matthaeus Silvaticus. Then Master Gualterus, in -1333, was permitted by the Governing Council of Venice to make use of -a certain plot of ground for the cultivation of the plants in which he -was specially interested. So far as one may judge, however, both of -these were private undertakings. In 1545, at the request of Francesco -Buonafrede, Professor of Therapeutics at the University of Padua, the -Senate of that city laid out a garden for his uses in teaching. This -appears to be the earliest instance of the establishment of a botanical -garden in connection with a regularly organized medical school. Then, -in fairly quick succession, similar gardens were established at Pisa -(1547), Bologna (1567), Leyden, Holland (by Boerhaave in 1577), and -Heidelberg (1593). In France the University of Montpellier received -its first botanical garden in the year last named. Thus it appears -that about the middle of the sixteenth century botany began to receive -attention as a branch of knowledge which, as was then believed, it was -important for physicians to study; and from that time forward, for -more than two centuries, it formed a regular part of the curriculum in -all the leading medical schools. The two chairs of botany and anatomy -were not infrequently combined. Fallopius, for example, held the Chair -of Anatomy, Surgery and Botany in the University of Padua, and so -also did Vesling in the same university at a somewhat later date. The -first systematic works on botany were also published in the sixteenth -century. They were all written by German or Swiss authors, the most -noteworthy<span class="pagenum" id="Page_394">[394]</span> one of the collection being that of Conrad Gesner of Zürich -(1516–1565), who is spoken of by Haeser as “a man of noble birth, of -extraordinary industry, of extensive knowledge in every department -of natural history, and the author of a large number of treatises, -which, by reason of their intrinsic value, cannot fail to perpetuate -the memory of this distinguished scientist throughout all time.” He -had much to contend with throughout his short but eventful life. In -the first place, he was very poor—so poor that both he and his young -wife were obliged to support themselves during the early years of their -married life by teaching school. Then he studied medicine at Basel, and -afterward accepted the professorship of Greek, first at Lausanne and -then in turn at Basel and at Zürich. From the beginning to the end of -his career he was hampered by poverty and by frequent illnesses. But, -despite these obstacles and also notwithstanding the fact that he was -an indefatigable worker in matters relating to natural history, he is -reported to have played one of the most influential parts in the drama -of the Reformation. Only a man of exceptionally strong character and -of unusual ability would have found it possible to attain the success -which Gesner attained in these different undertakings and under such -unfavorable circumstances. Andreas Caesalpinus, whom I have already -mentioned as one of the earliest investigators of the question of -the circulation of the blood, also interested himself in the science -of botany. Puschmann speaks of him as the greatest botanist of the -sixteenth century. For several years he was Professor of Philosophy and -Medicine in the University of Pisa, but at a later date Pope Clement -the Eighth chose him to be his private physician and also appointed him -Professor of Medicine in the University of Sapienza at Rome. His death -occurred in the latter city in 1603.</p> - -<p>Before dismissing all further consideration of the part played by -Italian and Spanish physicians during the sixteenth century in the -advancement of the science of medicine, I shall briefly mention a -few additional discoveries in botany and pharmacy that may serve to -render the present<span class="pagenum" id="Page_395">[395]</span> account more complete. In 1518 the monk Romano Pane -published the first account of the discovery of tobacco in America. -In 1560 Jean Nicot, a French diplomatist, brought back with him from -Portugal (to which country he had been sent as an ambassador) a small -supply of the seeds of the plant. To commemorate this service the -alkaloid found in the leaves of the tobacco plant was given the name of -<i>nicotine</i>. Capsicum was made known to the world by Dr. Chanca, a -companion of Christopher Columbus on the occasion of his second voyage -(1493) to America. Balsam of Copaiva was discovered by a Portuguese -monk in Brazil at some time between the years 1570 and 1600. It is -mentioned for the first time in the Amsterdam Pharmacopoeia of 1636. -Monardes described the Peruvian and Tolu balsams in 1565. Cacao was -first made known to Europeans by Fernando Cortez in 1519. About the -year 1550 coca was introduced as a drug that possesses the power of -allaying hunger and of enabling one to endure the fatigues attending -prolonged expeditions. Sarsaparilla came into use at about the same -date. Then followed jalap in 1556 and sassafras toward the end of the -century.</p> - -<p>In Germany and in the Netherlands there were, during the sixteenth -century, very few physicians who manifested any marked degree of -learning in the science of medicine. The teachings of Paracelsus met -with a favorable reception in these parts of Europe and they continued -to hold supreme sway over the minds of men during a long period of -time. There were some physicians, however, who had received their early -professional training in Italy and France, and who for this reason -were less ready to accept unreservedly the doctrines of Paracelsus; -and, among these more independent spirits, Rembert Dodoens (Dodonaeus, -1517–1586) of Malines, near Antwerp, distinguished himself by making a -number of valuable contributions to the science of medicine. He held -the Chair of Medicine at the University of Leyden and was also the -personal physician of the Emperors Maximilian the Second and Rudolphus -the Second. He was a very accurate observer, and his writings are -particularly rich in matters relating to pathological<span class="pagenum" id="Page_396">[396]</span> anatomy; for -which reason not a few authorities are inclined to credit him with the -honor of being the founder of this department of medical science. Felix -Platter of Basel, Switzerland, of whose experiences as a student at the -University of Montpellier I have given a brief account on a previous -page, and who was at this time Professor of Medicine in his native -city, was also greatly interested in pathological anatomy. Haeser gives -him credit for publishing a number of valuable contributions to this -department of medical knowledge, and also for making the first attempt -at a classification of diseases.</p> - -<p>Before I close this chapter it seems only fair that I should add a -few comments upon the careers of two physicians whose professional -attainments entitle them to some consideration. The men to whom I have -reference are Marcello Donato and Raymond Minderer.</p> - -<p>Marcello Donato was a distinguished medical practitioner of the city of -Mantua, Northeastern Italy, who died about the year 1600. He was one of -the few who, at that early period, taught that it was very important to -study disease from nature—<i>i.e.</i>, from direct observation—and -not from books. His description of the epidemic of small-pox of 1567 -(published at Mantua in 1569) is worthy of commendation. His chief -work, however, is that which bears the title “<i>De medica historia -mirabili etc.</i>” (Mantua, 1586.) It contains a remarkably large and -complete collection of rare and extraordinary cases belonging to every -department of medicine, and in his descriptions Donato pays particular -attention to the pathologico-anatomical aspects of each case. He -reports, for example, the instance of a Caesarian section performed on -a living woman in 1540 by Christopher Bain; the child being found dead. -Another interesting case reported by Donato is that of a child in whose -ear a cherry pit had been allowed to remain undisturbed until it began -to sprout; after which it was found easy to remove the impacted object. -In a somewhat similar case which Donato also reports, the sprouting -of the seed of Anagyris was hastened by the presence of a purulent -discharge from the ear. In both instances all<span class="pagenum" id="Page_397">[397]</span> attempts to extract the -foreign body had failed until the sprouting had caused the seed to -split. Finally, there is recorded the case of a young man into whose -nasal passage a leech had penetrated, while he was bathing, and had -then taken up its abode far back in the canal. Donato, by aid of direct -sunlight, “discovered the creature in that part where the nasal channel -merges into the oral cavity.” Presumably he succeeded in removing the -animal, but the text quoted by von Gurlt (Vol. II., p. 517) furnishes -no further particulars.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_398">[398]</span></p> - -<h3>CHAPTER XXXI<br /> -<span class="subhed1">CHEMISTRY AND EXPERIMENTAL PHARMACOLOGY</span></h3></div> - -<p>The experiments which were carried out by Antonius Musa Brassavola, in -the early part of the sixteenth century, upon animals and criminals, -for the purpose of learning the effects produced by certain drugs when -administered internally, afford one of the earliest instances of a -genuine experimental pharmacology. The account of these experiments, -which was published at Rome, in 1536, under the title “<i>Examen omnium -simplicium, quorum usus est in publicis officinis</i>,” deserves -honorable mention. An even more remarkable evidence of the research -spirit which was abroad at that period is to be found in the work done -by Fortunatus Fedelis, a native of Palermo, Sicily, and an ardent -champion of the direct method of observation as applied to therapeutics.</p> - -<p>Van Helmont, of whose life and contributions to the science of medicine -I now propose to furnish a sketch, represents in a certain sense -Paracelsus’ successor; and, as a matter of fact, he was even more -closely associated with the development of chemistry as an independent -science than was his predecessor.</p> - -<p>Jean Baptiste Van Helmont was born at Brussels in 1577. His parents, -who belonged to the nobility, possessed ample financial means and -were therefore able to give their son every opportunity to secure a -liberal education. While still a lad he enrolled himself among the -students of the University of Louvain, and advanced so rapidly in his -studies that, already at the early age of seventeen, he had passed -all the examinations required of applicants for the degree of Master -of Philosophy. He was not willing,<span class="pagenum" id="Page_399">[399]</span> however, to receive this honor -at that time, feeling that he had not acquired sufficient knowledge -to justify such acceptance; and from that date forward he turned his -attention to the study of other branches of learning. Finally, in 1599, -he accepted from the same university the degree of Doctor of Medicine, -and soon afterward left Belgium with a large party of his friends to -make an extensive tour through the Alps of Switzerland and Savoy. After -his return home in 1602 he devoted his attention chiefly to chemical -researches; but in a very short time he started off again on a journey -to Spain and France, and eventually to England, where he spent nearly a -year in the city of London, returning to Belgium in 1605. He married, -about this time, a rich heiress of Wilworde, in the neighborhood of -Brussels, and resumed with great zest his labors in chemistry and -alchemy. He was thus enabled to manufacture many remarkable remedies -with which—as he himself declared—he succeeded in curing myriads -of patients who had failed to receive any benefit whatever from the -ordinary resources of medical science. He died on December 30, 1644.</p> - -<p>I do not feel equal to the task of expounding Van Helmont’s often very -obscure theories regarding the physical and psychological processes -that take place in the human being; regarding the distinctions which he -makes between the “<i>archaeus influus</i>”—the regulating principle -which governs all the psychical and physiological processes in the -body—and the “<i>archaeus insitus</i>”—the subsidiary power which -resides in each individual part of the body, but which at the same time -is under the control of the “<i>archaeus influus</i>”; and regarding -the doctrine that disease is the result of an “<i>idea morbosa</i>” of -the “<i>archaeus influus</i>.” August Hirsch says that in developing -these theories Van Helmont puts forward many bright ideas, which -unfortunately lead one into a wilderness of fantastic, theosophic -concepts. If sufficient time and space were at my command it might -be interesting to separate some of these bright thoughts from the -extravagances in which they are buried, and thus demonstrate the truth -of the statements<span class="pagenum" id="Page_400">[400]</span> made by both Hirsch and Dezeimeris to the effect -that Van Helmont, in matters relating to physiology and pathology, was -unquestionably a precise and critical observer, a sound thinker, and a -correct interpreter; but the plan of the present work will not permit -me to enter into all these details. I can only quote a few of the -teachings or sayings to which Hirsch refers:—</p> - -<div class="blockquot"> - -<p>Digestion does not, as Galen maintains, depend upon heat, but -upon a certain ferment existing in the gastric juice.</p> - -<p>Heat is not, as has hitherto been taught, the cause of life, but -rather one of its products.</p> - -<p>The final cause of the sensory phenomena of life is the -<i>archaeus influus</i>, which, while it is inseparably -united with matter, nevertheless does not represent the soul -itself, but rather the organ of the soul, and is seated in the -“duumvirate” of the spleen and the stomach.</p> - -<p>Disease, in order to acquire sufficient power to antagonize -life effectively, must unite its forces with the <i>archaeus -influus</i>.</p> -</div> - -<p>It is claimed that Van Helmont, more than any other teacher -of medicine, was instrumental in giving the deathblow to the -practice—which prevailed in all the medical schools of that day—of -teaching the obsolescent Galenic doctrines, and that for this valuable -service alone he deserves full recognition at the hands of the medical -profession of to-day. But, as we learn from Ernest von Meyer’s history -of chemistry, Van Helmont has a much stronger claim for recognition in -the fact that he made many important contributions to iatrochemistry -and also to fundamental or pure chemistry. Taking one thing with -another, says von Meyer, we may safely assert that Van Helmont’s -useful contributions to the medical and chemical sciences by far -outweigh those which are of a fantastic or useless nature. It was he, -for example, who materially increased our knowledge of the nature of -carbonic acid. He demonstrated how it may be extracted from limestone -or from potash by the aid of acids, from burning coal, and from wine -and beer while they are undergoing fermentation. He also showed that -it is present in the stomach, in various<span class="pagenum" id="Page_401">[401]</span> mineral waters, and in -hollows in the earth. He gave it the name of “<i>gas sylvestre</i>.” -He would doubtless have carried his discoveries much farther along if -he had possessed the apparatus which is required for such researches. -However, despite the lack of these facilities, he was able to describe -hydrogen and marsh gas as special varieties which do not possess the -same composition as ordinary air. Finally, in his treatise entitled -“<i>Pharmacopolium ac dispensatorium modernum</i>” will be found -a goodly number of useful instructions as to the proper manner of -preparing drugs.</p> - -<p>A complete collection of his writings was published at Amsterdam by his -son, in 1648, under the title “<i>Ortus medicinae vel opera et opuscula -omnia</i>.”</p> - -<p>Theophrast von Hohenheim—who is known everywhere throughout the -world as “Paracelsus”—was the son of Wilhelm Bombast von Hohenheim, -a physician who belonged to one of the noble families of the Duchy -of Württemberg. He was born in 1493 at a spot called “<i>Das Hohe -Nest</i>” (the lofty nest) in the Canton of Schwyz, about one hour’s -distance from the celebrated monastery or cloister of Einsiedeln, of -which institution his father was the official physician. Switzerland, -therefore, has a right to claim Paracelsus as one of her sons. In 1502 -his father transferred his home to Villach, in Carinthia (to the east -of Tyrol), and continued to live there up to the time of his death in -1534. It is not known where the son obtained his degree of Doctor of -Medicine. It is a well-established fact, however, that he received the -first part of his training as a chemist from Johann Trietheim, the -Prior of Sponheim, and his subsequent education in the laboratory of -Sigmund Fugger, the cultivated owner of wines at Schwatz in the Tyrol. -He traveled all over Europe, going from one university to another and -making the acquaintance of people who were well informed in matters -relating to natural history, chemistry and metallurgy; and during all -this time he appears to have absorbed a great deal of information -relating to almost every department of human knowledge. Finally in -1526, soon<span class="pagenum" id="Page_402">[402]</span> after he had returned to Switzerland, he received, through -the aid of certain influential citizens, two important official -positions in Basel,—that of City Physician and that of Professor of -Medicine and Surgery in the University. To the surprise of all, and -contrary to long-established custom, he delivered his lectures in -German and not in Latin. This action on his part called forth bitter -criticism from the university authorities, but at first it met with the -approval of the students. During the following two years, however, he -gradually became unpopular with all classes of the community, and was -finally obliged to leave Basel. Haeser attributes this unpopularity -to Paracelsus’ rough manners, to his intolerance of the opinions of -his colleagues, and to his tirades against the apothecaries for their -excessive charges. It is very difficult to determine how far jealousy -was responsible for the state of affairs which I have just described. -Cabanès, the author of an admirable biography of Paracelsus (<i>Revue -Scientifique</i>, Paris, May 19, 1894), gives his own estimate of this -remarkable man’s character in the following terms: “Poor, miserable, -and persecuted during his lifetime, he was misunderstood even after -his death, and was calumniated by history.” Paracelsus evidently -believed it to be his bounden duty to destroy the then prevailing cult -of Aristotle, Galen and Avicenna as the great teachers in medicine; -and, filled with this idea, he prophesied the growth of a new science -of medicine on the ruins of their teachings. It is stated that the -students, after one of these excited lectures, made a bonfire and -burned a number of copies of the works of these famous authors, thus -showing that Paracelsus was sufficiently eloquent to infuse some of -his own reforming spirit into the minds of his auditors. He made -a great mistake, however, when he attacked in a similarly violent -manner the shortcomings of many of his contemporaries. “The medical -profession,” he said, “has become a mere money-making business.” As a -natural result of such tirades, Paracelsus was forced to leave Basel. -He fled first to Colmar in Alsace and at a later date took refuge in -St. Gall, Switzerland; and it was while he resided in that city that<span class="pagenum" id="Page_403">[403]</span> -he published three books of his “<i>Paramirum</i>.” Then in 1535 he -once more resumed his wandering life, in the course of which he visited -Poland, Lithuania, Illyria, etc. On reaching Salzburg, in Austria, he -fell ill and died on September 24, 1541, at the age of forty-eight.</p> - -<p>Paracelsus was a prolific writer. To all the treatises which he -published he gave extravagant titles. To his principal work, for -example, he gave that of “<i>Paramirum</i>”—The Surprising Marvel; -to another, that of “<i>Paragranum</i>”—Grain of Superior Quality; -and to a third, that of “<i>Archidoxia</i>,”—Transcendental Science. -He wrote treatises on syphilis, on the plague, on epidemics, on the -diseases of grave-diggers, on ore-smelters, etc. It is admitted by all -his critics that he devoted altogether too much time and thought to -alchemy, demonology, necromancy, etc. Cabanès quotes Cruveilhier as -saying that Paracelsus believed in the reality of beings of a fantastic -nature, but attached little or no importance to them. Then Cabanès -himself adds: “The thing which more than anything else absorbed his -thoughts was the irresistible desire to overthrow the Galenic idol -and substitute for it the science of experience, of observation pure -and simple.” Bordes-Pagès, another distinguished French physician, -says of this extraordinary man: “The great glory of Paracelsus is to -be found in the facts that he cast off the yoke of a former epoch, -more speculative than practical; that he summoned physicians to resume -their allegiance to experience; and that he opened a long career -for the alchemists, upon whom he urged the duty thenceforward of -making new remedies the principal object of their researches.... He -simplified and spiritualized therapeutics.” Some of Paracelsus’ own -sayings are worth preserving: “Without air all living creatures would -perish from suffocation.” “Man is the supreme animal, the one last -created.” “<i>Alterius non sit, qui suus esse potest</i>” [He who is -able to be his own master should not allow himself to be led blindly by -another]. When he was accused of being coarse-grained and of deceiving -the people, he replied: “By nature and also owing to the kind of<span class="pagenum" id="Page_404">[404]</span> -people with whom I associated in my youth I am not of a finely-spun -texture.... We were not nourished with figs and white bread, but with -cheese, milk and black bread-food that does not make delicate lads.... -They say of me that I lead the people astray, that I am possessed of a -devil, that I am a sorcerer, and that I am a magician. Whatever truth -there may be in these charges, one thing is certain: You are all of you -unworthy to unloose the latchets of my shoes.” (From <i>Paragranum</i>, -II., 120.)</p> - -<p>Oporinus, who acted for a long time as Paracelsus’ assistant, made the -following statements with regard to some of the methods of his former -master:—</p> - -<div class="blockquot"> - -<p>He always kept several preparations stewing on his furnace—as, -for example, a sublimate of oil or of arsenic, a mixture -of saffron and iron, or his marvelous Opedeldoch. He never -prescribed a special diet nor any hygienic measures. As a purge -he gave a precipitate of theriaca or of mithridate, or simply -the juice of cherries or grapes, in the form of granules (about -the size of the droppings of mice), and he was careful always -to give them in uneven numbers (1, 3, or 5). He was bitterly -opposed to the polypharmacy which prevailed so widely in his day.</p> -</div> - -<p>Cabanès says that we probably owe to Paracelsus an increased knowledge -of the virtues possessed by the different preparations of antimony, -mercury and iron, and by salines. It was he who created the distinction -between officinal and magistral preparations. To our list of -pharmaceutical preparations, he added tincture of hellebore, compound -tincture of aloes, digestive ointment, the tincture of metals (“Lilium” -of Paracelsus), the “Saffron of Mars,” etc. He was the inventor of the -precious preparation known as “<i>la mumie</i>,” a preparation which -was popularly believed to possess marvelous healing powers. Ambroise -Paré, toward the end of his career, was greatly blamed because he did -not employ this remedy, and he was finally compelled in self-defense to -write a pamphlet on the subject. (The text is reprinted in Malgaigne’s -“<i>Ambroise Paré</i>,” under the title of “<i>Traité de la mumie et de -la licorne</i>.”)</p> - -<p><span class="pagenum" id="Page_405">[405]</span></p> - -<p>Adolphe Gubler of Paris credits Paracelsus with the distinction of -having been the first physician to give an impetus to the movement -which had for its object the application of chemistry to the perfection -of medicinal preparations. He also maintains that Paracelsus should be -looked upon as in a large degree the originator of specific remedies, -and that he is justly entitled to the distinction of having been the -first publicly to announce the “quintessences”—that is, the active -principles (vegetable alkaloids)—of drugs. According to this claim -it is understood that Paracelsus taught that each drug contained a -specially active elementary body which it was possible to extract -as a separate substance. Acting upon this belief Paracelsus did not -hesitate to give the preference to the pharmaceutical preparations -known as “tinctures”—that is, alcoholic extracts. Great credit is -also due to Paracelsus for his rejection of the doctrine that guaiac -is an efficient remedy against syphilis, and for his insistence that -mercury is the only useful agent in curing that disease. Tartar emetic -(potassium antimonyl tartrate) is one of the drugs the introduction of -which into our pharmacopoeia should be credited to Paracelsus.</p> - -<p>One of the earliest references to genuine diphtheria is to be found in -the writings of Paracelsus, who speaks of the disease in the following -terms:—</p> - -<div class="blockquot"> - -<p>When this disease is located in an external wound it not -infrequently spreads to the muscles of the larynx; and, <i>vice -versa</i>, when a person has the disease in his throat, and at -the same time happens to have an external wound, the malady is -likely to spread to the wound.</p> -</div> - -<p>Paracelsus’ idea of the existence of an “<i>archaeus</i>,” a power -which presides over all physiological actions as well as over all -the operations of medicinal drugs, resembles very closely the “vital -force,” or “animism” so strongly championed by Stahl in the seventeenth -century.</p> - -<p>From all that I have said above regarding the excitable nature of -Paracelsus it seems almost a waste of time to tell our readers that his -contributions to the science of<span class="pagenum" id="Page_406">[406]</span> surgery were of very slight value. He -despised the study of anatomy, claiming that a knowledge of this branch -of medical science was not essential to a proper acquaintance with the -human body. “To dissect,” he once remarked, “was a peasant’s manner of -procedure.” (Cabanès.) His surgery, as one may imagine, showed clearly -the bad effects of such beliefs.</p> - -<p>During the latter part of the nineteenth century there developed -among the leading men of the medical profession a sentiment in favor -of honoring the memory of Paracelsus by the erection of a suitable -monument at Basel, Switzerland, the city in which he made his first -public appearance. The project met with a favorable reception and the -statue is now an accomplished fact. This is a remarkable instance of -tardy justice being rendered to the memory of a physician who, for -three hundred years, was almost universally looked upon as a vain, -half-crazy man.</p> - -<p>The next advances of any special importance in the department of -chemistry were made in Great Britain by Robert Boyle, who was born -at Lismore, County of Cork, Ireland, on January 25, 1626. He was the -fourteenth child of the Earl of Cork. His early training was obtained -at Eton, and then afterward he spent two years at Geneva, Switzerland, -in prosecuting his scientific studies. In 1654 he entered Oxford -University and became intimately acquainted with some of the most -learned men of that day. While he was a student at the university he -became a member of what was known as “The Invisible College,” a society -which was influential in bringing about the founding of “The Royal -Society,” of which organization he was president from the year 1680 to -the time of his death in 1691.</p> - -<p>Boyle was endowed with a noble character—modest, religious and -generous. He gained distinction as a chemist in several departments. -Applied chemistry is indebted to him for a number of important -contributions; he added to our knowledge of chemical combinations and -to the methods of analyzing them; he enriched the chemistry of gases -and also pharmacology; and he gave a clear and easily intelligible<span class="pagenum" id="Page_407">[407]</span> -definition of what a “chemical element” is. He laid stress upon the -doctrine that a chemical combination represents the union of two -component elements, and that this combination possesses characteristics -quite different from those possessed by either of the two component -elements. Before his day there was practically no such thing as -analytical chemistry, and it is to Boyle that we owe the establishment -of a clear conception of what the terms “chemical reaction” and -“chemical analysis” signify. The part played by atmospheric air in -combustion was made by him the subject of numerous experiments which -proved later to be of great assistance in the final solution of the -problem.</p> - -<p>In one of his writings Boyle says in substance that if men would devote -their energies to carrying out experiments and collecting observations, -rather than to the constructing of theories without having previously -tested with thoroughness the grounds upon which they believe them to -be based, the world would be greatly the gainer. The promulgation -and insistence upon the importance of this doctrine for the growth -of the science of chemistry constitute—so those competent to judge -claim—Boyle’s greatest merit in scientific work and his most important -contribution to chemistry.</p> - -<p>Among the chemical treatises which Boyle wrote and published the -following deserve to receive special mention: “Sceptical Chymist,” -1661; “<i>Tentamina quaedam physiologica</i>,” 1661; “<i>Experimenta -et considerationes de coloribus</i>,” 1663; and “Medical Experiments,” -1692–1698. Although Boyle was not an avowed follower of Bacon, he -carried out thoroughly the principles which the latter taught.</p> - -<p>Raymond Minderer, a practicing physician in Augsburg, Germany -(1570–1621), deserves the credit of having added to our stock of -remedies the acetate of ammonia (<i>liquor ammonii acetatis</i>). -Diluted with an equal quantity of water it is still employed to-day as -a remedy under the name of “Spirit of Mindererus.” He was the compiler, -in 1613, of the Augsburg Pharmacopoeia.</p> - -<p><span class="pagenum" id="Page_408">[408]</span></p> - -<p><i>General Therapeutics.—Transfusion.—The Discovery of Cinchona -and Ipecacuanha.</i>—In the department of general therapeutics, as -we learn from Berendes, several important new measures were brought -forward during the seventeenth century; and among these the following -deserve to receive brief mention in this place: the operation of -transfusing blood from a healthy individual to one who is ill; the -introduction of cinchona into the European pharmacopoeia as an -efficient remedy in the treatment of certain fevers; the similar -introduction of another South American drug—viz., ipecacuanha; and -the invention of many medico-chemical products and the improvement of -others that were already in common use.</p> - -<p>As regards the operation of transfusion, from which great things were -expected, Sir Christopher Wren (1632–1723), the famous architect and -astronomer of London, is reported to have been the first person to -urge a trial of this procedure. On the other hand, Robert Boyle, the -chemist, actually performed the operation on animals. He followed the -method suggested by Richard Lower (1631–1691) of England, viz., by -allowing the blood to flow from the carotid artery of one animal into -the jugular vein of a second animal; while Edmund King adopted the -plan of allowing the blood to pass from the jugular vein of one animal -into the corresponding vein of a second animal. Upon a human being the -operation was probably performed for the first time (in 1666) by Denys, -Professor of Philosophy and Mathematics in Paris. Repetitions of the -operation were made, two or three years later, in London and in Rome, -but they produced no good effects and in some instances they terminated -in the death of the individual for whose benefit the operation had -been performed. In 1668 the French Parliament and the Papal Government -forbade a repetition of the operation.</p> - -<p>In 1638—so the story runs—the wife of Count Cinchon, Viceroy of Peru, -was cured of a stubborn intermittent fever by the native physicians, -who employed, in their treatment of the malady, the bark of the tree -now universally known by the name of “Cinchona.” In 1640 Juan del -Vego, the<span class="pagenum" id="Page_409">[409]</span> regular medical attendant of Count Cinchon, introduced -the new remedy into Spain, but it was not until after the lapse of -about fourteen years that the drug found its way into England and -Central Europe. The price at which it could be purchased was at first -very high; it was almost literally “worth its weight in gold.” Even -as late as 1680 the bark sold in England for £8 sterling per pound. -Notwithstanding the generally recognized value of the drug in the -treatment of certain fevers there were not a few men who continued -for many years to oppose its use. Thus, Johann Kanold, a practitioner -of medicine in Breslau, Germany, is reported to have said, on his -death-bed in 1729, that he would rather die than be cured by a remedy -the action of which was so opposed to all the principles which he -considered right in therapeutics.</p> - -<p>Ipecacuanha, another very important drug, was added to our stock of -remedial agents toward the end of the seventeenth century. It was -brought into France from Brazil, in 1672, by a French physician named -Le Gras, but its value as a remedy for the cure of dysentery did not -begin to be appreciated until after Helvetius, a semi-quack, had sold -to Louis the Fourteenth, for one thousand louis-d’or (about $4000), -the formula for the preparation which he (Helvetius) had been using -with great success during the recent epidemic of that disease, and -which moreover had effected a remarkably rapid cure in the case of -the King’s own son—the Dauphin. After the purchase had been made by -Louis the Fourteenth, in the interest of the French people in general, -it was ascertained that the only active reagent among the ingredients -of the formula was ipecac, a drug with which the Paris physicians had -long been more or less familiar. Ipecac, it will also doubtless be -remembered, constitutes the important element in what is known as the -East Indian treatment of dysentery.</p> - -<p>Probably the earliest modern treatise on matters connected -with pharmacy is that which bears the title “<i>Onomasticon -Latino-Germanico-Polonicum rerum ad artem pharmaceuticam -pertinentium</i>.” It was published about the year 1600, and its author -was Paul Guldinus.</p> - -<p><span class="pagenum" id="Page_410">[410]</span></p> - -<p>One of the most important iatrochemical authorities of the seventeenth -century was Johann Rudolf Glauber (1604–1668), to whom we are indebted -for the invention or improvement of a large number of medico-chemical -products. The well-known “Glauber’s salt” may be named as one of these -products, and chloride of iron as another.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_411">[411]</span></p> - -<h3>CHAPTER XXXII<br /> -<span class="subhed1">SOME OF THE LEADERS IN MEDICINE IN ITALY, FRANCE AND ENGLAND -DURING THE SIXTEENTH AND SEVENTEENTH CENTURIES</span></h3></div> - -<p><i>Eminent French Physicians.</i>—Among the physicians of France who -attained a widespread and well-grounded celebrity throughout Europe -during the sixteenth century, Pierre Brissot deserves to be given -the first place. He was born in 1478 at Fontenay-le-Comte, not far -from Rochelle, and was a professor of medicine at Paris. He attained -considerable distinction, during the sixteenth century, by his advocacy -of the superiority of the Hippocratic method of bloodletting over that -introduced—or, rather, perpetuated—by the practitioners of that day -in Central Europe. The rule which was laid down by Hippocrates was -to the effect that, in venesection, the blood should be drawn from -the vein lying nearest to the part inflamed. The Greek physicians -of a later period forgot all about this rule and adopted in its -place one that was based on the doctrine that venesection practiced -in the vicinity of a focus of inflammation favors a determination -of blood to that part and therefore does only harm; and they -accordingly—especially in cases of pleuritis—abstracted blood from -the arm on the side opposite to that on which the disease was located, -or from one of the veins of the foot. This new rule was subsequently -adopted by the Arabian physicians, and it remained in full force up to -the end of the sixteenth century. A wide experience in the treatment of -the epidemic pleuritis which raged in Paris in 1514 confirmed Brissot -in the belief that the Hippocratic method is the one to be preferred; -but, despite his pleadings, the Parisian<span class="pagenum" id="Page_412">[412]</span> physicians refused to adopt -the method which he advocated and used their influence in securing from -the French Parliament an order forbidding him to continue employing it -in Paris. Discouraged by the treatment which he experienced in that -city, Brissot removed to Lisbon in Portugal, and soon had occasion -(in the epidemic which raged at Evora in 1516) further to satisfy -himself that the Hippocratic rule is the correct one. But here too he -encountered bitter opposition on the part of the Portuguese physicians; -his most active opponent being Dionysius, the Physician-in-Ordinary -to the King. Brissot then wrote an elaborate defense of the method -which he advocated, and this treatise was submitted to the judgment of -the Medical Faculty of the University of Salamanca. When the decision -of this learned body was given in Brissot’s favor, his opponents, -dissatisfied with the result, made still another effort to gain -their point, viz., by appealing to the Emperor Charles the Fifth. -They assured his Majesty that the Brissot Heresy, as they termed it, -was fully as dangerous to the cause of humanity as that championed -by Luther. But here again they failed. This final victory, however, -brought no satisfaction to Brissot, who died of dysentery in 1522, -just before the decision was rendered. Haeser speaks of this unusually -bitter dispute as one of the last of the violent battles which occurred -between the adherents of the Arabian physicians and the supporters of -the teachings of Hippocrates, and which terminated in “a most brilliant -victory of experience over Arabian dogmatism.”</p> - - <div class="figcenter" id="i_fp412" style="width: 556px"> - <img - class="p2" - src="images/i_fp412.jpg" - alt="" /> - <p class="center p0 sm">FIG. 16. “THE LOVESICK MAIDEN.”</p> - <p class="center p0 sm">(After the painting by Jan Steen, 1626–1679.)</p> - <p class="p0 sm">One of this famous Dutch artist’s objects, in painting the scene -here represented, was to satirize the practice, which was very -prevalent among certain physicians of that period, of pretending -to diagnose all sorts of maladies from the mere naked-eye -inspection of his patient’s urine.</p> - <p class="p0 sm">(Courtesy of Dr. Eugen Hollander, author of <i>Die Medizin in -der klassischen Malerei</i>, Stuttgart, 1903.)</p> - </div> - -<p>During the first half of the sixteenth century there developed a -belief, among the more ignorant physicians, that, in many cases of -illness, important information may be derived from a simple naked-eye -inspection of the patent’s urine as exposed to view in a flask-shaped -glass vessel. In the Hippocratic writings no adequate grounds for -such a belief are discoverable, but in one of Galen’s treatises there -have been found statements which appear(?) to give some sanction to -this new idea. However this may be, it is an established fact that -uroscopy was taken up at the time named with great zeal by all the -quacks in the <span class="pagenum" id="Page_413">[413]</span>land and by large numbers of practitioners of medicine -who saw in this procedure an easy and safe method of bettering their -fortunes. The public at large were greatly impressed with this new and -wonderful manner of detecting disease, and for a long period—indeed, -for more than half a century—this piece of clap-trap charlatanry -continued to thrive, and to reflect only discredit upon the medical -profession. There came a time, however, when people generally began -to suspect that uroscopy was not all that the charlatans claimed it -to be, and these suspicions were voiced in the popular saying, “The -pulse is good, the urine is normal, and yet the patient dies.” The -writers who were the most active in showing up the hollowness of -the claims of the uroscopists were Scribonius of Marburg, Germany, -Peter Foreest (1522–1597) of Alkmaar, Holland, and Leonardo Botallo -of Asti, in Piedmont (born in 1530). The latter authority, it may be -recalled, owes his chief distinction to the fact that he rediscovered -what has been erroneously named in his honor the “<i>foramen -Botalli</i>”—<i>i.e.</i>, the <i>ductus arteriosus</i> in the foetus. -He also attained some distinction in another direction. He revived -the violent disputes about venesection by recommending a resort to -this therapeutic procedure in nearly all illnesses. He went so far -as to advocate four or five bloodlettings in the course of an acute -attack, in each one of which operations from three to four pounds -of blood should, as he believed, be abstracted. Indeed, he claimed -that in an extreme case it might be perfectly proper to abstract as -much as <i>seventeen pounds</i>(!). Inasmuch as Botallo’s practice -was largely confined to the strong soldiers of Northern Italy it is -easier to understand how such extravagant bloodletting did not more -often prove fatal than it did. When, soon afterward, the Paris Faculty -condemned the practice in the strongest possible terms, Botallo’s -followers characterized sarcastically the French physicians as “pigmy -bloodletters” (<i>petits saigneurs</i>).</p> - -<p>But the efforts of Scribonius, Botallo and others to put an end to the -uroscopy scandal were—I fully believe—not the only or perhaps even -the most potent factors in<span class="pagenum" id="Page_414">[414]</span> bringing about the suppression of the evil. -As many of our readers will remember, the art collections of European -capitals contain admirably painted specimens of Dutch and Flemish -genre pictures representing every phase of this uroscopic fraud, and -these striking masterpieces, revealing, as they undoubtedly did to the -community at large, the ridiculous character of the claims made by the -charlatans, could scarcely have failed to give a deadly blow to the -fraud. (See Fig. 17.)</p> - -<p>In the early part of the sixteenth century Jean Fernel of Amiens -(1497–1558) was one of the leading medical authorities of France. -After receiving his degree of Doctor of Medicine at Paris, in 1530, -he settled in that city and soon acquired considerable reputation, -not only as a practitioner but also as a lecturer. In 1545 he was -called upon to take charge, professionally, of Diane de Poitiers, the -mistress of Henry, the son of Francis the First, King of France. About -the same time he was asked to serve as First Physician to the Dauphin, -but he was not disposed to accept the latter position, as he disliked -the duties of the office and also because he feared that they would -interfere with his favorite studies. He pleaded poor health, and his -excuse was accepted as valid. That Fernel was held in very high esteem -by the royal family is evident from the events which succeeded this -refusal. In the first place, it was insisted that he should accept -the stipend (600 livres) attached to the office, as a mark of the -royal favor; and then, in 1547, when Henry was crowned king (Henry the -Second), Fernel was urged to become his First Physician; but again he -declined the honor, this time on the ground that Louis de Bourges, -who had held the position with great credit under Francis the First -(Henry’s father), was entitled to be retained in office. The King -yielded to Fernel’s generous intervention in behalf of de Bourges. -But in 1556, when the latter died, Fernel felt obliged to accept the -position which had then become vacant; and from that time forward, -until the time of his death on April 26, 1558, he accompanied the -King on all his military expeditions. As he did not possess a robust -constitution,<span class="pagenum" id="Page_415">[415]</span> his health suffered not a little from the frequent -exposures to hardships of all sorts to which he was subjected; and, in -addition, during this long period he saw very little of his wife to -whom he was devotedly attached.</p> - -<p>Fernel is universally admitted by French physicians to have been one -of the most cultivated teachers and practitioners of medicine of his -day. He was a very clear writer, and would doubtless have made a number -of valuable additions to the science if he had not been carried off by -illness at a comparatively early age.</p> - -<p>Of his published writings the following are reckoned the most -important: “<i>Universa medicina</i>,” Paris, 1567; “<i>De abditis -rerum causis</i>,” Paris, 1548, and “<i>Therapeutices universalis seu -medendi rationis libri VII.</i>,” Paris, 1554. (Many editions of each -of these works were published.)</p> - -<p>In his discussion of various questions relating to physiology Fernel -maintains that the component elements of the body are vivified by means -of heat, and he elaborates this idea very much in the same manner as -Hippocrates does that of the “<i>callidum innatum</i>.” The spiritual -life, he says, is presided over by the soul (“<i>anima</i>”). When he -comes, however, to consider the individual powers of the soul, Fernel -treats the subject exactly as does Galen. He gives expression to one -rather bright idea: “The specific functions of each of the different -organs may be inferred in large measure from the character of the -structural elements of which they are composed.”</p> - -<p>In his scheme of pathology Fernel divides diseases into <i>simple</i> -(“<i>similares</i>”)—diseases of the tissues; <i>compound</i> -(“<i>organici</i>”)—diseases involving entire organs; and -<i>complicated</i> (“<i>communes</i>”)—diseases in which the normal -relations between the different parts are broken up.</p> - -<p>In the chapter which Fernel devotes to the subject of therapeutics, -there is a section relating to venesection which, according to Haeser, -is well worth reading, as it reveals the power of the writer to grasp -the leading points and to reason correctly from them.</p> - -<p><i>Two English Physicians Who Became Famous During the Sixteenth -Century.</i>—In the early part of the sixteenth<span class="pagenum" id="Page_416">[416]</span> century the medical -profession of Great Britain was in a most unsatisfactory state. -Humbuggery, ignorance and superstition were at that period of time -the most prominent characteristics of the majority of physicians -upon whom the people at large had to depend for the relief or -cure of their bodily ailments, and there were very few and very -untrustworthy measures in force for the production of a better class of -practitioners. Just at this juncture there appeared on the scene a man -who was eminently well equipped to rescue England from this lamentable -state of affairs and to put her on the high road to the acquisition of -an honorable body of medical men and of a corps of apothecaries who -could be trusted to dispense pure drugs properly compounded. I refer -to Thomas Linacre, who was born at Canterbury in 1461 or 1462, was a -Fellow of All Souls College, Oxford, and a graduate of the University -of Padua, and whose biography is sketched by John Freind (1675–1728) in -such an admirably clear, concise and appreciative manner that I cannot -do better—in view of the great importance of this event in the history -of medicine in England—than to reproduce it here in considerable -fulness of detail.</p> - -<div class="blockquot"> - -<p>Thomas Linacre was a man of a bright genius and a clear -understanding, as well as unusual knowledge in different parts -of learning: ... and, being very desirous to make further -improvements by travelling, he thought he could no where succeed -in his designs so well as by going to Italy, which began then -to be famous for reviving the ancient Greek and Roman learning. -There he was treated with extraordinary kindness by Lorenzo -de Medicis, one of the politest men in his age and a great -patron of letters; who favoured him so far in his studies as -to give him the privilege of having the same preceptors with -his own sons. Linacre knew how to make all his advantages of -so lucky an opportunity; and accordingly, by the instructions -of Demetrius Chalcondylas, a native of Greece, he acquired a -perfect knowledge of the Greek tongue; and so far improved under -his Latin master Politian, as to arrive to a greater correctness -of style than even Politian himself....</p> - -<p>Having laid in such an uncommon stock of learning, he applied -himself to the study of natural philosophy and physick; -particularly<span class="pagenum" id="Page_417">[417]</span> he made it his business, and was the first -Englishman who ever did so, to be well acquainted with the -original works of Aristotle and Galen. He translated and -published several tracts of the latter....</p> - -<p>In his own Faculty he distinguished himself so much that, soon -after his return, he was pitched upon by that wise king, Henry -the Seventh, as the fittest person to be placed about Prince -Arthur, and to take care both of his health and his education. -He was afterward made successively Physician to that king, to -his successor Henry the Eighth, and to the Princess Mary.... -And indeed, as he was perfectly skilled himself in his own art, -so he always shewed a remarkable kindness for all those who -bent their studies that way; and wherever he found, in young -students, any ingenuity, learning, modesty, good manners, and a -desire to excel, he assisted them with his advice, his interest, -and his purse. And to give a still stronger proof, how much he -had the good of his own Profession and that of the Publick at -heart, he founded two <i>Lectures of Physick</i> in Oxford, and -one at Cambridge....</p> - -<p>But he had still further views for the advantage of our -Profession: he saw in how low a condition the practice of -Physick then was, that it was mostly engrossed by illiterate -monks and empiricks, who in an infamous manner imposed on the -Publick; the Bishop of London or the Dean of St. Paul’s for the -time being, having the chief power in approving and admitting -the practitioners in London, and the rest of the bishops in -their several dioceses. And he found that there was no way -left of redressing this grievance, but by giving encouragement -to men of reputation and learning, and placing this power of -licensing in more proper hands. Upon these motives he projected -the foundations of our College [of Physicians]; and using -his interest at Court, particularly with that great patriot -and munificent promoter of all learning, Cardinal Wolsey, he -procured Letters Patent from the King, which were confirmed -by Parliament, to establish a corporate Society of Physicians -in this city, by virtue of which authority the College, as a -corporation, now enjoys the sole privilege of admitting all -persons whatever to the practice of physick, as well as that -of supervising all prescriptions. And it is expressly declared -that no one shall be admitted to exercise physick in any of -the dioceses in England, out of London, till such time that he -be examined by the President and three of the Elects, and have -letters testimonial from them, unless he be a graduate in either -University, who, as such, by his very Degree, has a right to -practice all over England,<span class="pagenum" id="Page_418">[418]</span> except within seven miles of London, -without being obliged to take any license from the Bishop....</p> - -<p>By other Acts another weighty affair is committed to the care of -the College, [viz.,] the visiting of shops and the inspection of -medicines; a thing surely of as much consequence at least to the -patient as to the prescriber....</p> - -<p>Linacre was the first president of his new-erected college, and -held that office for the seven years he lived after.... And -perhaps no Founder ever had the good fortune to have his designs -succeed more to his wish; this society has constantly produced -one set of men after another, who have done both credit and -service to their country by their practice and their writings.</p> -</div> - -<p>If further evidence be needed to show what was the type of mind -possessed by this remarkable English physician, I may be permitted to -quote here a single brief statement made by his friend Erasmus, the -famous Dutch scholar and theologian, in a letter addressed to John -Fisher, Chancellor of Cambridge University: “Linacre is as deep and -acute a thinker as I have ever met with.”</p> - -<p>In England, during the seventeenth century, there appeared on the scene -only one practicing physician of such conspicuous ability and of so -marked personal traits of character as to place his name, after the -lapse of a few years from the time of his death, and by the almost -unanimous assent of his associates, high up on the roll of honor. I -refer to the famous physician Sydenham.</p> - - <div class="figcenter" id="i_fp418" style="width: 515px"> - <img - class="p2" - src="images/i_fp418.jpg" - alt="" /> - <p class="center p0 sm">FIG. 17. THOMAS SYDENHAM.</p> - <p class="center p0 sm">(After the portrait in the hall of All Souls’ College, Oxford.)</p> - </div> - -<p>Thomas Sydenham was born at Wynford Eagle, Dorsetshire, England, in -1624. At the age of eighteen he entered Magdalen College, Oxford, -and remained there until 1644, when he enlisted in the Parliamentary -Army. After a brief military service, he resumed his studies at the -university and received his Bachelor’s degree in 1648. It was only at -a much later date (1676), however, that he was given (after he had -pursued the prescribed course of studies) the degree of Doctor of -Medicine,—and then not by Oxford, but by Cambridge. After leaving -the university he first spent a few months at the Medical School of -Montpellier, France, and then settled (1666) in London as a practicing -physician, the necessary license having been <span class="pagenum" id="Page_419">[419]</span>granted him by the -College of Physicians. His first medical treatise, which bore the title -“<i>Methodus Curandi Febres</i>” [Method of Treating Fevers], was -published in 1666. The third edition of this work was issued ten years -later, but with the title changed to “<i>Observationes Medicae</i> -etc.” Between 1666 and 1683 he published several other treatises, -the more important of which deal with epidemic diseases—syphilis, -small-pox, hysteria and gout.</p> - -<p>During the later period of Sydenham’s career he attained great -celebrity as a physician; but this celebrity would have been -short-lived if it had rested on nothing more substantial than mere -cleverness and professional success. As a matter of fact he had brought -about, by his teaching and also by his example, a most important -revolution in medicine, and it was the appreciation of this fact which -led the physicians of England to bestow upon him, after his death, the -appellation of “The English Hippocrates,” and which ultimately gave him -so highly honorable a position in the history of medicine in general. A -brief review of the state of medicine in England during the seventeenth -century will enable the reader to understand the full importance of the -change which Sydenham was instrumental in bringing about.</p> - -<p>The physicians of that period were split up into three sects: the -followers of Galen, with whom should be classed the Graeco-Arabists; -the iatrochemists; and the iatrophysicists.</p> - -<p>The Galenists were largely intent upon the strictest interpretation of -the teachings of Hippocrates, Galen and some of the Arabian authors. -Instead of studying disease itself they devoted their time and thoughts -largely to the interpretation of the words used by these fathers in -medicine—<i>i.e.</i>, to philology. Real progress in the science -of medicine was not possible along this route. Accepting without -dispute the dogma of the four humoral qualities, together with the -different temperaments which result from the predominance of any one -of them, they combated these different temperaments or constitutions -by prescribing<span class="pagenum" id="Page_420">[420]</span> drugs in a very great variety of combinations -(polypharmacy).</p> - -<p>The iatrochemists, attaching small importance to simple dietetic -measures, prescribed without stint all the most active substances -belonging to the mineral kingdom and all the new remedies which the -chemists had evolved from their furnaces.</p> - -<p>Finally, the iatrophysicists directed their efforts to the removal or -diminution of all bodily conditions that appeared to act as mechanical -hindrances to health.</p> - -<p>Sydenham, who possessed a rare degree of common sense, cast aside -all these hypotheses, disregarded the prevailing routine methods of -treatment, and refused to accept the therapeutic novelties of the day. -“Nature is to be my guide,” he declared, and from that time forward he -studied disease at the bedside, and watched carefully, and with a mind -free from prejudice, the effects of the remedies which he employed. -Thus, pursuing the methods advocated by the great master Hippocrates, -he was able to place his medical brethren once more on the pathway -which leads to an increase in knowledge of the healing art. Practical -medicine, which had previously been falling into an almost moribund -condition, was by his efforts made again a living and growing science. -That Sydenham had a perfectly clear conception of what was needed at -that time to renew the vitality of the medical profession of England -is plainly shown by the following statement which he makes in the -dedication of one of his writings to Dr. Mapletoft:—<a id="FNanchor_78" href="#Footnote_78" class="fnanchor">[78]</a></p> - -<div class="blockquot"> - -<p>After studying medicine for a few years at the University of -Oxford, I returned to London and entered upon the practice of -my profession. As I devoted myself with all possible zeal to -the work in hand it was not long before I realized thoroughly -that the best way of increasing one’s knowledge of medicine is -to begin applying, in actual practice, such principles as one -may already have acquired; and thus I became convinced that -the physician<span class="pagenum" id="Page_421">[421]</span> who earnestly studies, with his own eyes,—and -not through the medium of books,—the natural phenomena of -the different diseases, must necessarily excel in the art of -discovering what, in any given case, are the true indications as -to the remedial measures that should be employed. This was the -method in which I placed my entire faith, being fully persuaded -that if I took Nature for my guide, I should never stray far -from the right road, even if from time to time I might find -myself traversing ground that was wholly new to me.</p> -</div> - -<p>In the brief account which I have thus far given of the part played by -Sydenham in advancing the science of medicine, I have called attention -only to the general character of the services which he rendered. It -may now be interesting to furnish here a few details that will aid -in completing the picture of this great English physician,—details -relating to his life and personal character, to his views regarding -certain diseases and the remedies which he was in the habit of -employing for their relief or cure, and to his later writings.</p> - -<p>Throughout the greater part of his professional career Sydenham was -a frequent sufferer from gout, some of the attacks being of a severe -type and occasionally of long duration. During the winter of 1676, for -example, he was seriously ill from renal calculus, haematuria being -brought on by the slightest movements of his body. All through the year -1677 he continued to experience frequent attacks of pain, and on one -occasion he was unable to leave the house for a period of three months.</p> - -<p>Speaking of the epidemic of the Plague in 1665, during the progress of -which he left London, Sydenham says: “When I saw that the danger was -in my immediate neighborhood I listened to the advice of my friends -and joined the crowd of those who were fleeing to the country. A -little later, when the epidemic had further increased in severity, -and before any of my neighbors had returned, I yielded to the calls -of those who had need of my services, and went back to London.” It is -worthy of remark, says Laboulbène, who fully appreciated the heroism -which prompted this last decision, that we should never have<span class="pagenum" id="Page_422">[422]</span> known -of Sydenham’s weakness in regard to facing his duty, if he himself -had not stated the facts. This famous epidemic, as is well known, was -accompanied by an appalling mortality.</p> - -<p>Andrew Browne, a Scotch physician of good standing, entertained serious -objections to some of the advice given by Sydenham in the treatise -entitled “<i>Schedula monitoria de novae febris ingressu</i>,”<a id="FNanchor_79" href="#Footnote_79" class="fnanchor">[79]</a> -and, in order to learn more precisely what the author’s views on the -subject really were, he decided to run down to London for a day or two. -Sydenham gave him such a cordial reception and made his stay in the -metropolis so pleasant that he remained there several months—instead -of a day or two. “And when I returned to Scotland I felt contented and -joyful as if I were carrying back with me a valuable treasure.”</p> - -<p>As an instance of his thoughtful kindness, it is related that Sydenham -had occasion to treat a poor man who lived in his neighborhood for an -obstinate bilious colic, but his employment of narcotics did not effect -very much in the way of relief. “I felt moved by pity for this poor -man in his misery; and accordingly I loaned one of my horses to him in -order that he might take long excursions on horseback.”</p> - -<p>Sydenham had no eagerness for professional honors, although he -appreciated highly those which came to him spontaneously. As already -stated at the beginning of this sketch, the degree of Doctor of -Medicine was not conferred upon him by Cambridge as a mere honorary -affair, but was won by him after he had passed through the regular -course of training required of all candidates for this degree. His -case, however, was peculiar in one respect: he waited until after he -had been in active practice several years before he decided to pass -through the course of training required. He was not a member of the -College of Physicians of London, and he held no official position at -Court.</p> - -<p>The following summary may serve to convey some idea of Sydenham’s views -regarding pathology and treatment.<span class="pagenum" id="Page_423">[423]</span> He defines an acute disease as “a -helpful effort made by Nature to drive out of the body or system, in -every way possible, the morbific material.” As regards the latter he -makes the following remarks:—</p> - -<div class="blockquot"> - -<p>Certain diseases are caused by particles which are disseminated -throughout the atmosphere, which possess qualities that are -antagonistic to the humors of the body, and which—when once -they gain an entrance into the system—become mingled with the -blood and thus are distributed throughout the entire organism. -Certain other diseases owe their origin to fermentations or -putrefactions of the humors, which fermentations vary in their -nature—in some cases the humors being excessive in quantity, -while in others they are bad in quality; and in either event the -body finds itself incapable of first assimilating them and then -excreting them—a state of affairs which cannot continue beyond -a certain length of time without producing further harmful -effects.</p> -</div> - -<p>According to Sydenham the fever, in the acute diseases, assists -Nature by separating from the general (total) mass of the blood those -particles which have undergone putrefaction or have been rendered -unassimilable. Then they are driven out of the body by the route of the -sweat-glands, by diarrhoea, by eruptions upon the skin, etc. On the -other hand, in chronic diseases the morbific material is not of such a -nature as to produce fever, which is a mechanism for securing complete -purification. It is therefore deposited in one part or another of the -body where no force exists which is capable of ejecting it; or its -final transformation is not completed until after the lapse of a long -period of time.</p> - -<p>In some of Sydenham’s writings one is occasionally surprised to find -teachings which seem to be strongly at variance with the advice which -he was so fond of giving—namely, that physicians should be careful -not to set up hypotheses which are not based upon observed facts. A -conspicuous instance of such a disregard of his own rule may be found -in his setting up of a pathological process to which he gives the name -of “inflammation of the blood.” This process, he maintains, is the -active cause of quite a large number of diseases, especially those -of an epidemic<span class="pagenum" id="Page_424">[424]</span> nature—such, for example, as pleurisy, pneumonia, -rheumatism, erysipelas, scarlet fever, etc. It is well-nigh impossible -for us moderns to comprehend how so practical and clear-headed a man as -Sydenham could have formulated such a purely hypothetical pathology, a -doctrine so completely lacking in anything like a solid foundation of -fact.</p> - -<p>Sydenham excelled in the description of the clinical manifestations of -certain diseases, as, for example, small-pox, hysterical affections, -the encystment of a renal calculus, and the gout—a disease from which, -as already stated, he was a very frequent sufferer throughout a large -portion of his life. All his published works are in the Latin language, -but translations have been made into English, French, German, Flemish -and Italian. At All Souls College, Oxford, where Sydenham spent eight -years of his life, it was a fixed rule that all its members should -habitually converse and write in Latin.</p> - -<p>Sydenham’s remarks upon liquid laudanum are worth recording:—</p> - -<div class="blockquot"> - -<p>Of all the remedies which a kind Providence has bestowed upon -mankind for the purpose of lightening its miseries there is not -one which equals opium in its power to moderate the violence -of so many maladies and even to cure some of them.... Medicine -would be a one-arm man if it did not possess this remedy.... -Laudanum is the best of all the cordials; indeed, it is the only -genuine cordial that we possess to-day. [This was written in the -middle of the seventeenth century.]</p> -</div> - -<p>The laudanum employed by Sydenham was made according to the following -formula: Spanish wine, 400 grammes; Opium, 62 grammes; Saffron, 31 -grammes; Powder of Canella and Powder of Clove, of each 4 grammes.</p> - -<p>After much suffering and extreme weakness, Sydenham died on December -31, 1689.</p> - -<p>Andrew Browne, the Scotch physician of whom mention has already been -made on an earlier page, makes the following comments on the closing -days of Sydenham’s career: “It is a difficult matter to believe, -and yet it is the truth: This great physician, who throughout his -life<span class="pagenum" id="Page_425">[425]</span> gave the clearest proof of nobility of soul, generosity and -clear-sightedness, died with the accusation hanging over his head that -he was ‘an impostor and an assassin of humanity.’” Laboulbène adds: -“After years of self-sacrifice in behalf of his fellow men Sydenham -received as his final earthly reward calumny and ignominy, and the -jealousy of many professional brethren.”</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_426">[426]</span></p> - -<h3>CHAPTER XXXIII<br /> -<span class="subhed1">THE THREE LEADING PHYSICIANS OF GERMANY DURING THE LATTER HALF -OF THE SEVENTEENTH CENTURY: FRANZ DE LE BOË SYLVIUS, FRIEDRICH -HOFFMANN AND GEORG ERNST STAHL</span></h3></div> - -<p>The seventeenth century, says Berendes, was one of the saddest periods -in the history of Germany; but, during the greater part of this time, -the neighboring countries—Holland, France, England and Italy—still -continued to enjoy many of the blessings of the Renaissance,—such, -for example, as an uninterrupted activity of artistic efforts, of -scientific work, and of commerce;—but in Germany everything seemed to -be in a state of confusion. A bloody religious war was at this period -devastating the land, and the best powers of the people were being -wasted. Instead of increasing cultivation of manners and sentiments, -there was a steady growth of savagery. The Protestants, although they -probably were numerically superior, were split up into factions. The -Catholics, on the other hand, were united, and their power steadily -increased. In 1618 the disturbances, which previously had been -scattered in character, took on the form of what in time came to be -known as “The Thirty Years’ War,” a struggle which proved to be most -sanguinary, costing Germany a great deal in every respect. Finally, -the war was brought to an end by the signing of the Westphalian Treaty -of Peace at Lützen, in 1648. Some idea of the terribly destructive -nature of this long war may be gathered from the fact that the -population of Germany, which previously had been<span class="pagenum" id="Page_427">[427]</span> estimated at twenty -millions, was found to have been reduced to about six millions. Whole -towns and villages were laid in ashes, and as a consequence those -who had survived the disaster lost confidence in themselves and were -not able, at least for several years, to undertake anything in art, -literature or science; and this depressing atmosphere affected in some -degree the people of the Netherlands. Toward the end of the century, -however, there came a marked awakening among the younger generation of -physicians, and in the course of twenty or thirty years four men, only -three of whom, however, were of German birth, succeeded in attaining -a decided leadership in this department of science. The names of the -Germans are Franz de le Boë (commonly spoken of as Sylvius), Friedrich -Hoffmann and Georg Ernst Stahl. I shall now attempt to furnish, as -nearly as possible in proper chronological order, very brief sketches -of the lives of these distinguished physicians, together with an -account of the contributions which they made to the science of medicine.</p> - -<p><i>Franz de le Boë (Sylvius).</i>—Franz de le Boë (Sylvius) was born -at Hanau, Prussia, in 1614, of parents who belonged to the nobility -and were wealthy, and who consequently were able to give their son -every opportunity for acquiring an excellent education. Thus Franz -first received a thorough training in philosophy and the classics and -afterward visited in turn all the leading universities of Holland, -France and Germany before he finally took his degree of Doctor of -Medicine at Basel, Switzerland, in 1637. From this time forward, for a -period of twenty-three years, he devoted himself to the practice of his -profession, first in his native city and then in Leyden and Amsterdam. -In 1660 he accepted an invitation to occupy the Chair of Medicine -in the University of Leyden, and this position he held during the -remainder of his life. He died in 1672.</p> - -<p>As a teacher Sylvius was very popular, Boerhaave alone, at a later -period, finding greater favor among the crowds of medical students and -physicians who frequented this<span class="pagenum" id="Page_428">[428]</span> university. Haeser and Haller both -attribute some portion of this popularity to the fact that Sylvius -combined genuine eloquence with a wonderful charm of manner and a -profound knowledge of chemistry, pharmacy and pathological anatomy. -In the practice of medicine he followed Van Helmont very closely, -but he was not willing to accept his teachings about an “<i>archaeus -insitus</i>” and an “<i>archaeus influus</i>.” The system which he -advocated was of a very simple character, and this fact undoubtedly -contributed much to his popularity among the students. His therapeutic -methods were also of a thoroughly practical nature.</p> - -<p>Of the works which Sylvius published the following deserve to receive -special mention: “<i>Disputationes medicae</i>,” a book in which are -set forth his views regarding the fundamental principles of the science -of medicine—physiology in particular; “<i>De methodo medendi</i>,” a -treatise on therapeutics; and “<i>Praxeos medicae idea nova</i>,” a new -idea concerning the practice of medicine.</p> - -<p>Sylvius was one of the earliest defenders of Harvey’s great discovery, -and he was also one of the first to call attention to the part played -by chemistry in elucidating some of the problems in physiology and -pathology. At the same time he was always ready to acknowledge the -importance of the part played by mechanics in respiration, in the -circulation of the blood, in the movements of the intestines, etc., in -which respects he was in entire agreement with the iatrophysicists or -iatromathematicians.<a id="FNanchor_80" href="#Footnote_80" class="fnanchor">[80]</a></p> - -<p>Finally, there is one more respect in which Sylvius is entitled to -great credit: he paid most careful attention to the work of giving -clinical instruction. Recognizing, as I do, the importance of this -branch of medicine, I shall not hesitate to devote here a page or two -to a brief review of the manner in which it came to hold the honorable -position which it occupies to-day in all the best schemes for medical -education.</p> - -<p>During the sixteenth century, as Puschmann assures us, an attempt was -made at Padua, Italy, to render clinical<span class="pagenum" id="Page_429">[429]</span> instruction an essential -part of the physician’s education, but the difficulties which were -encountered proved so much greater than was anticipated that it was -soon found necessary to abandon the plan; and then for many years no -further effort was made, either at Padua or at any of the other Italian -medical schools, to introduce clinical teaching. After the lapse of -nearly a century, Johannes Heurnius (1543–1601), Professor of Medicine -at the University of Leyden, made an effort to introduce the plan of -teaching medicine at the bedside; and a few years later (1630) two -other professors of the same university—viz., Otho Heurnius, son of -Johannes, and E. Schrevelius—formally introduced clinical instruction -at the city hospital. The plan which they adopted was the following: -The students in turn were permitted first to question the patient about -his ailment and then afterward to make whatever physical examination -appeared to be necessary; next, each one of them stated briefly what -he believed to be the nature of the malady, and also gave his views as -to the prognosis, symptoms and treatment; after which the professor -commented on these different reports, pointing out both the correct and -the incorrect features in each case. After a short trial of the plan -it became clear that it would have to be abandoned, for the students -did not like to have attention called in such a public manner to their -mistakes. Then, a few years later, Sylvius, who at that time was the -Professor of Medicine, introduced a system of clinical teaching which -is thus briefly described by his colleague, Lucas Schacht:—</p> - -<div class="blockquot"> - -<p>When, followed by his pupils, he approached the bedside of a -patient, he assumed the air of one who is entirely ignorant -of the nature of that person’s malady, of the accompanying -symptoms, and of the treatment which was being carried out. -Then he began to ask first one and then another of the students -a great variety of questions respecting the case that was -under consideration,—questions which at first seemed to have -been propounded in a haphazard fashion, but which in reality -were so cleverly formulated as to elicit from the class all -the information needed for the making of a correct diagnosis, -while leaving on the minds of the<span class="pagenum" id="Page_430">[430]</span> students the impression that -they, and not the professor, had worked out the problem to a -successful result.</p> -</div> - -<p>This system, if such it may be termed, proved extremely successful, and -the knowledge of this success spread rapidly from one end of Europe -to the other, causing students and physicians to flock to Leyden from -Russia, Poland, Hungary, Germany, Denmark, Sweden, France, Italy and -England. So long as this particular university continued to possess, as -a member of its faculty, a professor of medicine who was clever enough -to carry on clinical instruction with the same profound knowledge -of human nature as had been displayed by Sylvius, just so long did -this institution remain without a rival in this part of the field of -medical education. Then Sylvius was followed, in the work of clinical -teaching, by Boerhaave, a man admirably fitted, both by nature and by -the training which he had received, to keep the University of Leyden -in the first rank of medical schools as regards this most useful -form of discipline. After 1738, the year in which Boerhaave died, -other universities besides that of Leyden began to provide fairly -satisfactory facilities for clinical study, and among the number of -such institutions those of Utrecht, Rome, Edinburgh, Paris and Halle -deserve to be mentioned. The lack of funds and doubtless also the lack -of the right sort of teachers were the principal reasons why these -schools were not able to vie with Leyden in furnishing the facilities -needed for clinical instruction. That the fault—at least in the case -of the University of Halle—was not to be attributed to a failure -on the part of the Medical Faculty to appreciate the value of such -instruction is clearly shown by the saying attributed to Friedrich -Hoffmann, who at that period was the Professor of Medicine:—</p> - -<div class="blockquot"> - -<p>By a mere attendance upon medical lectures no man will ever -succeed in becoming a properly equipped practitioner of that -art; it is indispensable, in addition, that he should receive -clinical instruction.</p> -</div> - -<p>The fairly permanent establishment of this fundamental branch of -medical teaching was not effected until about the<span class="pagenum" id="Page_431">[431]</span> middle of the -eighteenth century, when Van Swieten, one of Boerhaave’s most -distinguished pupils, was given full authority by the Empress Maria -Theresa to furnish, at the University of Vienna, all the facilities -required for successfully carrying on such instruction. From that -time onward, to a quite recent date, Vienna has been the Mecca of all -the younger physicians who aspired to become fully equipped in the -practical branches of the science of medicine.</p> - -<p><i>Georg Ernst Stahl.</i>—Georg Ernst Stahl was born at Anspach, -Germany, in 1660. Little is known about his early life beyond the -fact that he pursued his studies at the University of Jena, received -the degree of Doctor of Medicine from that institution in 1684, and -shortly afterward began giving private courses in medicine which proved -to be very popular and soon brought him into public notice. In 1687 -he was given the position of Court Physician at Weimar. In 1694, upon -the recommendation of Friedrich Hoffmann, who was at that time the -incumbent of the regular Chair, he was appointed Associate Professor of -Medicine in the recently founded University of Halle, Prussian Saxony; -the understanding being that he was to devote his attention more -particularly to the physiological, pathological, chemical and botanical -aspects of the subject. He held this position up to the year 1716, when -he was appointed one of the attending physicians of Frederick William -the First, King of Prussia, and thereafter was obliged to reside in -Berlin, in which city he died in 1734.</p> - -<p>Stahl was a tireless worker, and wrote a large number of treatises -(two hundred and forty-four in all) on physiological and pathological -topics—all of them in Latin. Albert Lemoine, who has written an -elaborate monograph on one of these treatises (that relating to -animism), says that, despite the obscure style in which this and most -of his other treatises are written, one may, upon careful study, -satisfy himself that Stahl is a very close reasoner and possesses a -clear mind. His most conspicuous faults, Lemoine adds, are these: he -is opinionated and vain, and objects strongly to any criticisms that -his opponents make;<span class="pagenum" id="Page_432">[432]</span> and yet he is careful to take up these criticisms -one by one and subject them to a close analysis. His vanity led him to -maintain that he was the only person then living who was capable of -lifting medicine out of the rut in which it was at that time rigidly -held. He manifested a sovereign contempt, not only for the men whose -opinions differed from his, but also for those who complained of the -difficulty of comprehending the Latin in which his treatises are -written. Finally, Lemoine states that Stahl is addicted to mysticism, -as is shown by the invocations of all sorts with which he begins and -ends most of his writings. Haeser adds that Stahl possessed a gloomy, -reticent and overbearing spirit, in striking contrast with the charming -sweetness of temper of his colleague Hoffmann.</p> - -<p>Among Stahl’s numerous contributions to medical literature there -is only one in which our readers are likely to take any particular -interest; I refer to the treatise which bears the title “<i>Theoria -medica vera</i>”—the true theory upon which the science of medicine -is based. It is in this work more particularly that Stahl expounds -the doctrine of animism. As I have tried in vain to obtain a really -satisfactory conception of this doctrine, which occupied so great a -place in the thoughts of the physicians of the period between 1650 and -1750, I have decided to rest satisfied with merely reproducing here -the interpretation which William Cullen of Edinburgh, one of Stahl’s -contemporaries and also one of the greatest English physicians of -that period, gives in his celebrated “First Lines of the Practice of -Physic”:—</p> - -<div class="blockquot"> - -<p>What is frequently spoken of as the power of nature—the “<i>vis -conservatrix et medicatrix naturae</i>”—resides entirely in -the rational soul. Stahl supposes that upon many occasions the -soul acts independently of the body, and that, without any -physical necessity arising from that state, the soul, purely -in consequence of its intelligence, perceiving the tendency of -noxious powers threatening, or of disorders any ways arising in -the system, immediately excites such motions in the body as are -suited to obviate the hurtful or pernicious consequences which -might otherwise take place.</p> -</div> - -<p><span class="pagenum" id="Page_433">[433]</span></p> - -<p>Barthélemy St. Hilaire of Paris (1805–1895) in one of his writings -says: “I am convinced that the central idea in Stahl’s physiology was -suggested to him by the reading of Aristotle’s ‘<i>De anima</i>,’ in -which this great philosopher states that the soul nourishes the body, -and also that nutrition is one of the four ways in which the soul -manifests itself.”</p> - -<p>Speaking of the effect of Stahl’s doctrines upon the actual practice -of medicine as a whole, Cullen says that it was of a controlling -character, leading physicians to propose the “art of curing by -expectation”; the natural result of which was that they advocated for -the most part the employment of only very inert and frivolous remedies. -On the other hand, they zealously opposed the use of some of the most -efficacious drugs, such as opium and the Peruvian bark, and resorted -to bleeding and to the administration of emetics only in exceptional -cases. Cullen adds that:—</p> - -<div class="blockquot"> - -<p>The Stahlian system has often had a very baneful influence on -the practice of physic, as either leading physicians into, or -continuing them in, a weak and feeble practice, and at the same -time superseding or discouraging all the attempts of art.... -The opposition to chemical medicines in the sixteenth and -seventeenth centuries, and the noted condemnation of antimony by -the Medical Faculty of Paris, are to be attributed chiefly to -those prejudices which the physicians of France did not entirely -get the better of for near a hundred years after. We may take -notice of the reserve it produced in Boerhaave with respect to -the use of the Peruvian bark.</p> -</div> - -<p>Stahl, after taking up his residence in Berlin, devoted himself -energetically to the increase and spread of the knowledge of chemistry. -The thing which brought him the greatest celebrity, both in his own -lifetime and also during the years following his death, was his -propounding of the “phlogiston” theory. This theory was to the effect -that all combustible materials or substances contain (as he assumed) -an element to which he gave the name of <i>phlogiston</i>. He was not -able, however, to demonstrate the actual existence of this element; -he simply assumed that<span class="pagenum" id="Page_434">[434]</span> it existed. At the same time the fact should -here be stated that the terms “oxidation” and “reduction,” which came -into use during the following century, developed out of this theory of -phlogiston.</p> - -<p><i>Friedrich Hoffmann.</i>—Friedrich Hoffmann was born at Halle, -Prussian Saxony, February 19, 1660, and received his medical education -in his native city, largely under the direction of his father, who was -himself a physician. In 1678 he attended lectures at the University -of Jena, and in the following year visited Erfurt in order to -benefit from the instruction of Caspar Cramer, who was at that time -a distinguished authority in chemistry. At the end of two years he -returned to Jena, took his degree of Doctor of Medicine, and acquired -the right to deliver public lectures. Then, during the following three -years, he visited Holland and England, and, upon his return in 1685, -settled at Minden, Westphalia, as a general practitioner of medicine. -In 1686 he was appointed District Physician of the Principality of -Minden and also Court Physician of the Prince Elector; and two years -later he accepted the position of District Physician at Halberstadt. -After the inauguration of the new university at Halle, July 12, 1694, -Hoffmann appears as one of the earliest professors chosen to serve the -institution. In 1701, when Frederick the Third, Electoral Prince of -Prussia, assumed the crown under the title of Frederick the First, King -of Prussia, he extended to Hoffmann an invitation to come to Berlin and -accept the position of Private Physician to His Majesty. Hoffmann was -not at first willing to accept the invitation, but in 1708, when the -King, who had then become seriously ill, renewed his request, Hoffmann -accepted, on condition that he might retain his professorship. In 1712 -he returned to Halle and remained there until he died in 1742.</p> - -<p>Before Hoffmann’s time very little was known concerning the nature of -carbonous (or carbonic) oxide and concerning the fatal effects which -may be produced by inhalation of this gas. It was a common belief, -for example, that the gas was given off by freshly plastered walls; -and—as an even worse error—the theological authorities showed an -inclination,<span class="pagenum" id="Page_435">[435]</span> in many of the fatal instances which probably were due -to inhalation of carbonous oxide, but in which no recognizable cause -of death had been discovered, to explain the event as due to the -malign interference of the Devil. In our time it is well understood -in the community that the fumes of carbonous oxide constitute the -most dangerous gas that one is liable to encounter, but in Hoffmann’s -day the people appear to have been less well informed concerning this -danger than they were in ancient times. In the treatise on this subject -which Hoffmann published in 1716,<a id="FNanchor_81" href="#Footnote_81" class="fnanchor">[81]</a> several of the earliest known -instances of such poisoning are narrated, the first one being that -mentioned very briefly by Aristotle (384–322 B. C.). Then follow two -very short references to this subject in the “<i>De rerum natura</i>” -of the Roman poet Titus Lucretius Carus (95–52 B. C.). They read as -follows: (1) “The fumes of burning charcoal easily affect the brain if -thou hast not first taken a drink of water.” (Book VI., verse 803.) (1) -“If the fumes of the night lamp,<a id="FNanchor_82" href="#Footnote_82" class="fnanchor">[82]</a> after it has been extinguished, -are inhaled rather deeply the effect experienced will be the same as if -one had been struck down by a blow on the head.” (Book VI., verse 792.) -The idea that the previous drinking of water is competent to prevent -the effects of poisoning by charcoal fumes is declared by Neuburger, -the translator of Hoffmann’s treatise, to be erroneous.</p> - -<p>The earliest really satisfactory description of an instance of -non-fatal poisoning by the fumes of burning charcoal is credited by -Hoffmann to the Roman Emperor, Julian the Apostate, who reigned from -361 A. D. to 363 A. D. Before he was made Emperor, Julian was intrusted -by Constantius II., in 355 A. D., with the government of the Province -of Gaul, and in 357 he won a great battle against the Alamanni at -Strassburg; after which he took up his residence in the little city of -Lutetia, the present Paris. It was undoubtedly<span class="pagenum" id="Page_436">[436]</span> soon after this event -that he wrote the Greek satire which bears the title “Misopogon,” and -from which Hoffmann quotes the following account of Julian’s narrow -escape from death through the poisonous effects of carbonous oxide:—</p> - -<div class="blockquot"> - -<p>The little city which the Celts call Lutetia is built upon a -small island in the midst of a river, and access to it from -both sides is gained by means of wooden bridges. Ordinarily the -winter climate in this region is mild, owing—as the people -of the place claim—to the proximity of the Ocean. Good wine -is produced there, and even fig-trees flourish provided care -be taken to wrap them well in wheat straw or some similar -protective material during the winter season. But my visit -happened to have been made during an exceptionally severe -winter, and as a result things which looked like slabs of -Phrygian marble, closely packed together, were constantly -floating down the river with the current, and, soon becoming -jammed, they formed a sort of natural bridge. Although most of -the houses—the one I occupied among the number—were provided -with fireplaces and chimney-flues, and might therefore readily -be heated, I was not willing that a fire should be kindled in my -bedroom. I was very little sensitive to cold, and, in addition, -I was desirous of becoming more and more hardened to its -influence.... As the severity of the weather, however, showed no -signs of letting up, I permitted the attendants to bring into -the room a few glowing coals, just enough to render the air of -the chamber less chilly. But, notwithstanding the very small -degree of heat which these few burning coals supplied, it proved -to be sufficient to draw out from the damp walls exhalations -that caused my head to feel as if it were tightly held in a -vice and also produced a sensation as if I were choking. I was -immediately removed from the room, and the physicians who were -promptly summoned administered an emetic which enabled me to -get rid of the food which I had eaten a short time before. Soon -afterward I had a refreshing sleep and was able on the following -day to resume my work as usual. [Translated from the German -version printed in Neuburger’s monograph.]</p> -</div> - -<p>As will be seen from the reports which I have just quoted, there -existed among the Germans, early in the eighteenth century, no fixed -belief as to the real cause of death in many of these unexplained fatal -cases; and it was therefore no<span class="pagenum" id="Page_437">[437]</span> small public service which Hoffmann -rendered when he, in whose judgment about such matters the people at -large placed the greatest confidence, published such a clear and simple -explanation of the real cause of these deaths as that which is given in -this interesting monograph.</p> - -<p>Hoffmann also added not a little to his fame by the invention of -a remedy which was first known as “Hoffmann’s drops,” but which -to-day appears in the United States Pharmacopoeia under the name -of “Hoffmann’s anodyne” or “<i>spiritus aetheris compositus</i>” -(sulphuric ether, 325; alcohol, 650; ethereal oil, 25).</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_438">[438]</span></p> - -<h3>CHAPTER XXXIV<br /> -<span class="subhed1">HERMANN BOERHAAVE OF LEYDEN, HOLLAND, ONE OF THE MOST -DISTINGUISHED PHYSICIANS OF THE SEVENTEENTH CENTURY</span></h3></div> - -<p>Hermann Boerhaave, who was born at Voorhont, near Leyden, Holland, on -December 31, 1668, was the son of a poor but highly educated clergyman; -and it was owing to this circumstance that he received in early youth -a most careful training in Latin and Greek and in belles-lettres. At -the age of fourteen he entered the public school of Leyden, and made -such rapid progress in his studies—history, mathematics, the different -branches of natural philosophy, Hebrew and Chaldean languages, and -metaphysics—that he was soon able to follow regularly the lectures -given at the university. He was only fifteen at the time when his -father died, leaving him absolutely penniless; but Van Alphen, the -Burgomaster of Leyden, befriended him and furnished all the funds -needed for a continuance of his studies at the university. But young -Boerhaave, who was not willing to be entirely dependent on the aid thus -provided, contributed to his own support not a little by giving private -instruction to young students of the wealthy class. In 1690 he received -the degree of Doctor of Philosophy, the subject of his dissertation -being a refutal of the doctrines of Epicurus, Hobbes and Spinosa. -His original intention had been to prepare himself for the ministry, -but, after continuing his studies in theology for a short time, he -determined that the better course for him would be to choose the career -of physician. Accordingly he began, at the age of twenty-two, to study -the anatomical treatises of Vesalius, Fallopius and Bartholinus, and at -the same time he followed a course of instruction in dissecting,<span class="pagenum" id="Page_439">[439]</span> under -the guidance of the anatomist Nuck, and also occasionally attended the -lectures given by Drelincourt, who at that time was Professor of the -Theory of Medicine. In his reading of medical literature he showed a -decided preference for the writings of Hippocrates and Sydenham; and -he devoted a large portion of his time to the study of botany and -chemistry, two branches of the science of medicine in which he took a -very strong interest all through life. In 1693 he received the degree -of Doctor of Medicine from the University of Harderwyk.<a id="FNanchor_83" href="#Footnote_83" class="fnanchor">[83]</a> In 1701 -he was appointed Associate Professor of the Theory of Medicine in -the University of Leyden, and it was in this capacity that he began -building up that great reputation which in a very few years brought -crowds of students from all parts of the world to Leyden. As already -stated on a previous page, he owed a large part of his fame to the -admirable manner in which he conducted his clinical teaching. To show -how widely he was known throughout Europe the story is told that a -letter which had been sent to him from a mandarin living in China and -which bore the address, “To the illustrious Boerhaave, Physician in -Europe,” reached him in due course.</p> - -<p>Soon after his first appointment at Leyden, he received other most -flattering offers, such as that of William the Third, Hereditary Prince -of the Netherlands, to accept the position of Court Physician at The -Hague, and a call from the University of Groningen (1703) to occupy -the Chair of Medicine. He declined these offers as he preferred to -remain at Leyden; but, a few years later, in 1709, he accepted the -full professorship of the Practice of Medicine in the institution -with which he was already connected. From the vantage ground of this -more responsible position he was able most successfully to teach the -students the best methods of observing, identifying and treating the -different diseases; and as a further result of this promotion in rank -his private practice grew rapidly, monarchs and princes<span class="pagenum" id="Page_440">[440]</span> coming from -every country in Europe to consult him about their maladies. Boerhaave -was also most popular among his fellow townsmen. It is related of -him, for example, that on one occasion, after he had been confined to -the house for about six months by an illness of a gouty nature, the -citizens of Leyden manifested their joy at his recovery by inaugurating -a general illumination of the town during the evening of the day on -which he made his first appearance on the street. He had two relapses -of the gouty affection, one in 1727 and another in 1729, and he finally -died from disease of the heart on September 23, 1738. The monument -raised in his honor by the city of Leyden bears the inscription: -“<i>Salutifero Boerhaavii genio sacrum</i>” (Sacred to the memory of -the health-giving genius of Boerhaave).</p> - -<p>Some idea of the lucrative character of Boerhaave’s private practice -may be gained from the fact that he left to his only child, a daughter, -the sum of about four million francs. And yet he was noted for the -generous gifts which he made during his lifetime to all sorts of -scientific and benevolent objects.</p> - -<p>Boerhaave, says Dezeimeris, exercised during his career, and also for a -long time after his death, an immense influence upon medical thought. -He is justly ranked, he adds, among the iatromathematicians, and it -is correct to say that he was largely instrumental in overthrowing -the chemical system which de le Boë (Sylvius) had developed. His own -treatise on this branch of knowledge (“Elementa Chemiae”), which was -published toward the end of his life, soon became the standard work -on this subject, and it retained its popularity for many years. “It -is to be regretted that, possessing as Boerhaave unquestionably did, -remarkable powers of observation, he should have allowed himself, in -opposition to the very principles which he advocated so strongly, -to indulge in the making of systems and hypotheses. He commenced by -advocating with enthusiasm the method of Hippocrates, and ended by -following the brilliant but not very trustworthy example of Galen.” -(Dezeimeris.)</p> - -<p><span class="pagenum" id="Page_441">[441]</span></p> - -<p>The number of treatises which Boerhaave published is quite large, -the most important among them being the following: “<i>Oratio de -commendando studio Hippocratico</i>,” 1701; “<i>Institutiones medicae -in usus annuae exercitationis domesticos</i>,” 1708; “<i>Aphorismi -de cognoscendis et curandis morbis in usum doctrinae medicae</i>,” -1709 (English version printed in London in 1742); and “<i>Elementa -chemiae</i>,” 1732 (English translation by Peter Shaw, London, 1741).</p> - -<p>Of the “Aphorisms,” one of the most widely known of Boerhaave’s -published treatises, I shall take the liberty of saying a few words. -This work is in reality a very concise statement of the author’s views -regarding pathology, pathological anatomy and therapeutics, and I -believe that the following paragraphs, although few in number, will -suffice to give our readers a fair idea of the general character of the -book. At the same time I must confess that I have not found it an easy -matter to understand and satisfactorily digest many of the individual -aphorisms, the text of which has been compressed into such a small -space. It therefore does seem surprising to learn from one critic that, -if one wishes to ascertain what Boerhaave’s views are with regard to -the science of medicine, one should read by preference the Commentaries -of Van Swieten, who was Boerhaave’s favorite pupil and assistant.</p> - -<p>The following four or five aphorisms are typical specimens belonging to -the earlier sections of the book:—<a id="FNanchor_84" href="#Footnote_84" class="fnanchor">[84]</a></p> - -<div class="blockquot"> - -<p>(7.) A disease when present in a body, must needs be the bodily -effect of a particular cause directed to that body.</p> - -<p>(8.) Which effect being entirely removed, health is recovered.</p> - -<p>(9.) It may be removed by correcting the illness itself in -particular, <i>viz.</i>, by the applications of medicines -to the particular diseased part, or by some remedies which -operate equally upon the whole: the first we’ll call a -<i>particular</i>, the latter a <i>general</i> cure.</p> - -<p>(10.) The way to both is discovered either <i>by -observation</i>, or <i>by comparing</i> one case with another, -or <i>by a true reasoning</i> from them both.</p> - -<p>(13.) He who doth, with the greatest exactness imaginable, weigh -every individual thing that shall happen or hath happened<span class="pagenum" id="Page_442">[442]</span> to -his patient and may be known from the observations of his own -or of others, and who afterward compareth all these with one -another, and puts them in an opposite view to such things as -happen in an healthy state; and lastly, from all this, with the -nicest and severest bridle upon his reasoning faculty, riseth -to the knowledge of the very first cause of the disease, and of -the remedies fit to remove them; <i>he</i>, and <i>only he</i>, -deserveth the name of <i>a true physician</i>.</p> -</div> - -<p>Then Boerhaave proceeds to make a classification of diseases, and among -the very first groups which one finds in this classified list are the -following: “Distempers of a lax and weak fibre”; “Distempers of the -stiff and elastic fibre”; “Distempers of the less and larger vessels”; -“Distempers of weak and lax entrails”; “Distempers of the too strong -and stiff entrails”; etc.—from which it is apparent that the old -doctrine of the <i>strictum</i> and the <i>laxum</i>, which was taught -by the Methodists in the early centuries of our era, has here been -adopted by Boerhaave in all its essential characters; and also that the -treatment which he recommends for some of these classes of maladies -does not materially differ from that advocated by this ancient school -of medicine. The following extracts, I believe, will suffice to give -the reader a fairly clear understanding of what Boerhaave means by the -expressions “distempers of the solid simple fibre,” “distempers of a -lax and weak fibre,” and “distempers of the stiff and elastic fibre,” -and will at the same time show what methods he employed for overcoming -these distempers. At the time when Boerhaave made use of the term -“fibre” (<i>fibra</i>) in the very uncertain sense in which he here -employs it, Leeuwenhoek and Malpighi were demonstrating, by aid of the -newly perfected microscope, that the so-called simple tissues were in -reality quite complex structures; and one’s first impulse, therefore, -is to express surprise that a physician of such high standing as our -author should have used the term. But we moderns must not forget that, -in those early days, it took decades for knowledge of this nature -to spread even a very short distance, as from Delft to Leyden, and -then to exert its legitimate influence upon medical<span class="pagenum" id="Page_443">[443]</span> thought—that -is, to be digested and afterward permanently appropriated. There can -be scarcely any doubt that, at the time (1709) when Boerhaave wrote -these aphorisms, he had already heard about the existence and the -capabilities of the recently perfected microscope, but it is not at all -likely that he had as yet digested the gains in anatomical knowledge -which had been acquired through the assistance of this instrument. The -extracts referred to above are the following:—</p> - -<div class="blockquot"> - -<h4>DISTEMPERS OF THE SOLID SIMPLE FIBRE</h4> - -<p>(21) Those parts (which, being separated from the fluid -contained in the vessels, are applied and sticking to each other -by the strength of the living body, and make the least fibre) -are the least, the simplest, earthy, and hardly changeable from -or by virtue of any cause, which are found in our living bodies.</p> - -<h4>DISTEMPERS OF A LAX AND WEAK FIBRE</h4> - -<p>(24) The weakness of the fibre is that cohesion of the minutest -parts described (21), which is so loosely linked that it may be -pulled asunder even by that degree of motion which is requisite -in healthy bodies, or not much exceeding it.</p> - -<p>(26) The weakness produceth easily a stretching and a breaking -of the small vessels made up of those weak fibres (24), and -consequently abates of their power over the fluids therein -contained; from which distensions arise tumors, from the -stagnating or extravasated liquids putrefactions, and, farther, -all such innumerable ills as are the consequences of them both.</p> - -<p>(28) [In distempers of a lax and weak fibre] the cure must -be obtained, 1. By aliments that abound in such matter as -is described in section 21, and which [should] be almost so -prepared beforehand as they are in a strong and healthy body; -such are milk, eggs, flesh-broths, panadoes<a id="FNanchor_85" href="#Footnote_85" class="fnanchor">[85]</a> rightly prepared -of well-fermented bread; and rough wines. All which must be -given in small quantities, but often. 2. By increasing and -invigorating the motion of the solids and fluids by means of -frictions with a flesh-brush, or with flannel; by riding on -horseback, and in a coach, or by being carried in a boat; and -lastly by walking, running and other bodily exercises. 3. By a -gentle pressure or a bandage upon the vessels, and a moderate -repelling of the liquids therein contained. 4. By medicines<span class="pagenum" id="Page_444">[444]</span> -both acid and austere, or such as are spirituous and well -fermented, but applied with great caution and gentleness. 5. By -any means that will remove and remedy the too great pulling of -them.</p> -</div> - -<p>[That Boerhaave belonged to the iatrophysical or iatromechanical school -appears very clearly throughout these quotations.]</p> - -<div class="blockquot"> - -<h4>DISTEMPERS OF THE STIFF AND ELASTIC FIBRE</h4> - -<p>(35) [In distempers of this group] the cure is effected, 1. -By such meat and drink as is thin and watery, without any -roughness, chiefly by the continued use of milk-whey, of -the softest herbs and salads, barley-water, thin gruel, and -unfermented liquors. 2. By avoiding of exercise, and dwelling in -a moist, coolish air, and taking long sleeps. 3. By the taking -or outwardly applying watery, lukewarm, tasteless medicines, and -such as contain the lightest and softest oils.</p> -</div> - -<p>In the second half of the volume I find abundant evidence of -Boerhaave’s ability to treat efficiently some of the acute and chronic -maladies; and, after a perusal of the text which deals with these -affections, I have no difficulty in understanding how he came to be -looked upon as one of the leading medical practitioners of the period -during which he lived. I should be glad to reproduce here such portions -of the aphorisms as would corroborate the statement that I have just -made, but unfortunately the small amount of space that I can command -does not permit me to do this. At every step, as I advance, I am warned -against the danger of exceeding the limits permitted, and I shall, -therefore, in the present instance, have to rest satisfied with quoting -the larger part of a single paragraph in which is given an account of -the treatment employed in a case of acute pleurisy.</p> - -<div class="blockquot"> - -<p>(890) ... If the same pleurisy be recent before the end of the -third day, yet violent from the many and strong symptoms, and -dry, in a strong, exercised, dry body, without the hopes of -the presence of (887 and 888) [a resolution or a concoction -and excretion of the cause], then let the patient immediately -be blooded<span class="pagenum" id="Page_445">[445]</span> largely, with a quick running stream out of a -great vessel, and a large orifice, keeping his body quiet and -leaning backwards, enforcing his breathing all the while with -coughing or panting, fomenting the side at the same time, and -gently rubbing it; which bleeding ought to be continued till the -pain seems to abate pretty considerably, unless a fainting fit -forces you to leave off sooner; at whose approach the vein must -immediately be stopped. Bleeding ought to be repeated according -as these symptoms do return upon whose account it was done the -first time; and when that skin doth not any longer appear upon -the surface of the blood, it is time to forbear more bleeding.</p> - -<p>From the beginning ought to be used fomentations, bathings, warm -streams, liniments, plaisters, and the like; which may be of use -as they loosen, resolve, mitigate, and avert....</p> -</div> - -<p>As only extracts of considerable length would suffice to give our -readers a satisfactory idea of the attractive manner in which Boerhaave -deals with the subject of chemistry, I prefer to omit them altogether, -and to recommend to those who are specially interested in this -branch of science, that they consult Peter Shaw’s excellent English -translation of the “<i>Elementa Chemiae</i>.”</p> - -<p>Albert von Haller, the celebrated Swiss physiologist and historian of -medical literature, speaks of Boerhaave as “my beloved preceptor, a man -of refined taste and a speaker or lecturer so logical and charming that -one more gifted can hardly be imagined.”</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_446">[446]</span></p> - -<h3>CHAPTER XXXV<br /> -<span class="subhed1">GENERAL REMARKS ON THE DEVELOPMENT OF SURGERY IN EUROPE DURING -THE FIFTEENTH AND SIXTEENTH CENTURIES</span></h3></div> - -<p>In the early period of the Renaissance surgery was apparently the -first of the practical branches of medicine to spring forward into -active life. Anatomy,—that is, human anatomy,—the foundation that is -absolutely necessary to the solid growth of surgery, scarcely existed -before the beginning of the sixteenth century; and it is therefore -not surprising that the records of the past reveal to us so very few -instances of men who attained any eminence as surgeons. When this -fact is taken into consideration I cannot help feeling that, in the -sketches which I drew, on earlier pages, of Theodoric of Cervia, -William of Saliceto, Lanfranchi of Milan (and later of France), Henri -de Mondeville and Guy de Chauliac, I gave to these men only a small -fraction of the credit to which they were justly entitled. Indeed, -the excellence of the work done by them and recorded in the treatises -which they published, is so great as to arouse the suspicion that they -had clandestinely acquired more knowledge of human anatomy than they -dared to admit. The life of a dissector of human bodies, it should be -remembered, was by no means safe in those days.</p> - -<p>But the lack of a trustworthy knowledge of anatomy was not the only -hindrance to a healthy development of the art of surgery. There were -other obstacles which, up to a comparatively late period in the -sixteenth century, continued to block the advance of this art. Of -these, the principal one was perhaps the custom—not by any means -considered at that period professionally dishonorable—of<span class="pagenum" id="Page_447">[447]</span> keeping -secret the technique of certain operative procedures like that of -cutting for stone in the bladder or that of the radical cure of hernia. -Such knowledge was treated as private property, and was very carefully -handed down from father to son, or was sold for a large sum of money to -certain surgeons who engaged, under oath, not to reveal the details to -others. Thus we are assured by Haeser that two such eminent surgeons as -Ambroise Paré and Fabricius of Hilden were obliged to pay handsomely -for the information which they received from certain specialists -concerning their particular methods of procedure. It is from such -scraps of information which come to our knowledge casually that we -often learn the actual truth concerning the advance made at a given -period of time by a certain department of medical science. Although it -is not possible to fix the date when the custom to which I have just -referred was definitely abandoned, it may be stated as a fact that -after the seventeenth century very few instances of such ownership of -surgical secrets are discoverable in the records.</p> - -<p>Inasmuch as at the very beginning of the Renaissance surgery was looked -upon, in the southern and central parts of Europe, as an occupation of -a somewhat menial character, the regularly organized medical schools -made very inadequate provision for the proper education and training of -those young men who were disposed to adopt a surgical career. During -the fourteenth and fifteenth centuries surgery was still tolerated at -Montpellier, but after the papal seat had been removed from Avignon -to Rome—that is, after 1479,—the pupils of that university were -forbidden to do any surgical work. In 1490, however, a course in -surgery was provided for the exclusive use of barbers. At first the -instruction was given in Latin, but, as these men did not understand -this language, the professor was soon compelled to employ a barbaric -Latin (half French and half Latin) in making his comments upon the -text of the lecture. This state of affairs lasted for more than a -century. In fact, it was not until after Paré, Franco and Wuertz had -demonstrated by their remarkable careers<span class="pagenum" id="Page_448">[448]</span> how honorable was this branch -of the science of medicine, that provision was made at Montpellier (in -1597) for regular instruction in surgery. But even then, for a period -of several years, it was found to be a very difficult matter to keep -the peace between the two groups of students—the medical and the -surgical; the governing authorities being finally obliged, in order -to prevent the encounters which frequently took place between the -rival bodies, to appoint four a.m. as the hour when the instruction in -surgery was to be given. Those students who were pursuing the course in -medicine looked upon the surgical pupils as intruders, as men unworthy -to associate with them, and they availed themselves of every possible -opportunity for making their connection with the university unpleasant.</p> - -<p>In Paris, during the twelfth and thirteenth centuries the surgeons -formed themselves into corporations. Minor surgery was left entirely -in the hands of the barbers (a word which is derived from the Latin -“<i>barbarus</i>,” uncultivated) and barber-surgeons. They were -largely itinerant practitioners and army surgeons. As they traveled -from one city to another, the more enterprising ones announced their -approach by means of a sort of herald who proclaimed loudly the cures -which his chief was able to accomplish. In the course of time the -surgeons who lived in Paris formed themselves into the so-called -“College of Surgeons.” At a later date (1255) there was established -in that city by Jehan Pitard, the surgeon of Louis the Ninth (“Saint -Louis,” 1215–1270), a more perfect organization under the name of -the “College of Saint Cosmas,” which was placed under the protection -of Saints Cosmas and Damian. The members of this Brotherhood were -known as “Surgeons of the Long Robe,” to distinguish them from the -Barber-Surgeons or “Surgeons of the Short Robe”; and they were also -known as “<i>Maitres Chirurgiens Jurés</i>.” Through the influence of -Pitard this organization received from the King a set of governing -rules or constitution.</p> - -<p>It may prove interesting to learn who Cosmas and Damian were, how they -came to be canonized, and for what reasons the organizers of the new -brotherhood preferred<span class="pagenum" id="Page_449">[449]</span> them to all others, as guardian saints. Cosmas -and Damian were the youngest of five brothers who belonged to a family -of some distinction in Arabia. They chose the career of peripatetic -physicians, and gave their services free to those who might have need -of them. They spent some time in the Province of Cilicia, Asia Minor, -and while in that country they met the death of martyrs, somewhere -about 287 A. D., during the persecutions of the Christians which -occurred in the reign of Diocletian. In the church pictures they are -represented as physicians, each one of whom holds in his hand either -a vessel containing a remedial preparation, or a staff around which -the emblematic serpent is twined, or (less frequently) a surgical -instrument of some kind. During the time of the Crusades there existed -an Order of Knights of Saint Cosmas and Saint Damian, who devoted -themselves specially to the care of sick pilgrims and to the freeing of -those who were held as prisoners.</p> - -<p>In all the large cities of France there existed, during the fourteenth -and fifteenth centuries, corporations of surgeons, the great majority -of whom belonged to the class or grade of barbers. These men were not -permitted by their rules to use the knife, and, as a result, great -jealousy existed between them and the few who, having passed the -required examination, were authorized to perform cutting operations -and to assume the title of “Masters in Surgery.” In 1493, as the -result of an effort made by the barbers of Paris as a body, to gain -some knowledge of medical science, they obtained from the university -permission to purchase a corpse which had not yet been removed from the -gallows. They had, it appears, engaged a doctor of medicine to give -them instruction in anatomy, and it was upon a dissection of this body -that the teaching was to be based. In 1494 the Faculty made provision -for giving the barbers a regular course of lectures on surgery; and, -eleven years later (1505), additional privileges having in the meantime -been granted them by the university, they organized the “Corporation -of Barber Surgeons, or Surgeons of the Short Robe.” In the oath -which the members of this organization were obliged to take, it is -expressly stated, among other<span class="pagenum" id="Page_450">[450]</span> things, that “they will give due honor -and reverence to the Faculty, and will not administer any laxative or -alterative drug.”</p> - -<p>From 1601 to 1731, when the <i>Académie de Chirurgie</i> was founded, -there was an almost continuous series of squabbles between the surgeons -and the barbers, on the one hand, and the Medical Faculty of the -University, on the other. At a still earlier period, dating back even -to the fourteenth century, the quarrels were between the surgeons -(École de St. Côme) and the barbers, but, during the seventeenth -century and the early part of the eighteenth, the surgeons and the -barbers seem to have harmonized their interests and to have made common -cause against the Faculty. An edict was issued by Louis the Twelfth -in 1613 to the effect that the two corporations (the surgeons and -the barbers) should be fused into a single organization; and, even -before this, it had become customary to employ the words “surgeon” and -“barber” as synonymous terms. Finally, in the years 1644, 1645 and -1656, further agreements were entered into by the two bodies. After the -founding of the Academy of Surgery in 1731 nothing further is heard of -barber-surgeons.</p> - -<p>In the account which I have thus far given of the agencies that were -available during the Renaissance for the perpetuation and increase of -medical knowledge, I make reference only to the established medical -schools and to the less pretentious but much more practical teaching -organizations furnished by the guilds or brotherhoods. In my remarks -I have said little or nothing about hospitals, which—potentially, at -least,—have a great deal to do with the advance of medical knowledge, -especially in the department of surgery. Unfortunately, my efforts to -procure information relating to this subject have not been rewarded -with much success and I shall therefore not be able to furnish more -than a few disconnected and very imperfect details.</p> - -<p>At the beginning of the sixteenth century the city of Lyons possessed -(and it still possesses) the oldest hospital in France—viz., the -Hôtel-Dieu,—which was founded by Childebert the First in 542 A. D. -The city itself was at<span class="pagenum" id="Page_451">[451]</span> that period second in importance only to -Paris, and in some respects it was the equal of the metropolis in -celebrity. The art of printing was introduced there in 1472, and the -presses of that city were soon reckoned the best in Europe. Many -medical books were published at Lyons. François Rabelais (1483–1553), -the celebrated author of the humorous and satirical works “Gargantua” -and “Pantagruel,” was a regularly educated physician, and during his -residence at Lyons he edited various works of Hippocrates and Galen. -Michael Servetus, who displayed such marked ability by his researches -in regard to the circulation of the blood, was also a resident of Lyons -from 1530 to 1543. Some idea of the way in which a large hospital was -managed in those early days may be gained from the following statement -of facts: In 1619 as many as five patients were permitted to occupy -one bed in Hôtel-Dieu at Lyons. Although the hospital possessed -accommodations for a total of five hundred and forty-nine patients -(including pilgrims and poor people), there was only one medical man -whose duty it was to look after the surgical cases, and he resided -outside the building. At a somewhat later date there was provided a -“<i>chirurgien principal</i>,” whose duty it was to give the needed -surgical care to this class of patients, and who was obliged to -reside in the hospital. When this chief surgeon required assistance -in the dressing of wounds, etc., he was authorized to make use of -the “apothecary’s boy.” The stock of surgical instruments possessed -by the hospital in 1543 comprised the following items: One uterine -speculum; one trephine, which was composed of thirteen separate -parts; one mouth-plug, for use in keeping the jaws separated; one -ear speculum; and one elevatorium. All these facts, taken together, -furnish strongly corroborative evidence of the statement made by von -Gurlt in his <i>Geschichte der Chirurgie</i>, viz., that in France, -during the sixteenth century, the occupation of surgeon was considered -by the community but little better than that of a hair-cutter. It -is therefore not surprising that the great hospital of Lyons should -have been managed at that time in accordance with such a low sanitary -standard and with<span class="pagenum" id="Page_452">[452]</span> an almost total disregard of the purposes for which -a hospital exists. So far as I am able to learn, the conditions just -described were not peculiar to the city of Lyons. “During the reign of -Francis the First (1515–1547) there were in the main room (thirty-six -feet wide) of the Infirmary of Hôtel-Dieu at Paris,” says Boisseau, -“six rows of beds (three feet wide), each one of which accommodated -ordinarily three (at times even four) sick persons, who necessarily -were very uncomfortable. This is not all; for there were also in this -same infirmary seven or eight beds which were designed to accommodate -from twenty-five to thirty infants or young children, the great -majority of whom died from the poor quality of air which they had to -breathe in that institution.” I do not need to furnish additional -proofs in corroboration of the truth of the statement that during the -Renaissance the French civil hospitals contributed practically nothing -to the advance of medical science. It is possible that in Italy these -institutions may have been better managed, for, in the account which he -gives of his trip to Rome, Luther speaks of having visited a hospital -which particularly attracted his notice by reason of its orderliness -and the conspicuous cleanliness of every part of the building. As an -offset, however, to this favorable testimony I should state that in -some documents discovered in comparatively recent times there are -memoranda relating to the duties of the medical staff in the civil -hospital of Padua (1569)—a city in which was located the most famous -medical school to be found anywhere in Europe during the sixteenth -century. These memoranda read as follows: “There shall be a doctor of -physic upon whom rests the duty of visiting all the poor patients in -the building, females as well as males; a doctor of surgery whose duty -it is to apply ointments to all the poor people in the hospital who -have wounds of any kind; and a barber who is competent to do, for the -women as well as for the men, all the other things that a good surgeon -usually does.” (The word “surgeon” is evidently employed here in the -sense of barber-surgeon, and not in the modern sense of the word.) This -testimony and that furnished on a preceding<span class="pagenum" id="Page_453">[453]</span> page with regard to the -management at the two leading civil hospitals in France amply justify -the statement that during the sixteenth century medicine received no -aid whatever from these institutions in its efforts to advance.</p> - -<p>For the sake of orderliness I shall, from this point onward, arrange -the information which I may find it desirable to furnish, under the -headings of the different countries of Europe; and in carrying out -this plan I shall begin with Germany, as it was there that the oldest -fifteenth-century treatises on practical surgery were first printed.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_454">[454]</span></p> - -<h3>CHAPTER XXXVI<br /> -<span class="subhed1">SURGERY IN GERMANY AND SWITZERLAND DURING THE FIFTEENTH AND -SIXTEENTH CENTURIES</span></h3></div> - -<p>There were five men in Germany and German Switzerland who, during the -Renaissance, attained distinction as surgeons, and who at the same -time contributed, by their published writings as well as by the force -of example, to the advancement of medical science. The names of these -five surgeons are: Pfolspeundt, Brunschwig, von Gerssdorff, Fabricius -of Hilden and Felix Wuertz. The first three mentioned were born in the -early part of the fifteenth century, and all five of them derived their -practical knowledge of surgery in large measure from their experience -in warfare. Individual sketches of these men will be furnished farther -on, but I believe that these will be better understood if a brief -account of the state of medical education in general throughout -Germany, at the period which I am now considering, be first supplied.</p> - -<p><i>State of Medical Education in General Throughout Germany -(1400–1600).</i>—The University of Heidelberg was founded in 1386, -but it was not until about 1550 that the first beginnings of medical -teaching made their appearance in that institution. Equally feeble -attempts were made, twenty years later, to organize the teaching of -medicine at the University of Wuertzburg; but very little appears to -have been accomplished during the immediately following years, as may -be judged from the official announcement, in 1587, of what things -the Professor of Surgery would teach in the three-years’ course. -“<i>First year</i>: Lectures on the subject of tumors, in accordance -with the teachings<span class="pagenum" id="Page_455">[455]</span> of Galen; <i>Second year</i>: Lectures on the -subjects of wounds and ulcers, in accordance with the teachings of -Galen and Hippocrates and the Arabian medical writers; <i>Third -year</i>: Lectures on fractures and dislocations, in accordance with -the teachings of Galen and Hippocrates. Then, if sufficient time -is available during this last year of the course, a certain amount -of anatomy is to be taught (during the winter season) from Galen’s -writings on this subject. In the summer time the subject of simple -remedies may be taken up advantageously, and botanical demonstrations -may also be given.” Von Gurlt quotes Koelliker as his authority for -the statement that throughout the seventeenth century the medical and -surgical teaching at the University of Wuertzburg was very defective, -“almost nothing worthy of mention being accomplished during that long -period in the departments of anatomy and physiology.” In the University -of Basel, Switzerland, which was founded in 1460, medical teaching -was as barren as it was in all the German universities at that early -period. It was only in 1542 that the first public dissection of a -human body took place there. Vesalius was visiting the city at that -time for the purpose of superintending the printing of his great work -on anatomy, and the university authorities availed themselves of the -opportunity to secure from him not only this single demonstration, but -also in addition a course of lectures on anatomy. Fifteen years later, -Felix Platter, a native of Basel and a man of exceptional ability -(see sketch on pp. 332 <i>et seq.</i>), made the first postmortem -examination known to have been made in that city. Two years later -still (1559), following in the footsteps of Vesalius, he made a public -dissection of a criminal’s corpse in the Church of St. Elizabeth. -From 1581 onward, with occasional omissions, a public dissection of -the corpse of a criminal was made by the professor of anatomy once -every year. In 1590 the question was discussed by the Faculty whether -it “might not also be practicable to secure from the hospital, for -dissection, an occasional corpse.” The first body obtained from this -source was dissected in 1604, but it was not until 1669 that a second -one was available.<span class="pagenum" id="Page_456">[456]</span> There was no museum of anatomy and the medical -school owned only two human skeletons—one male, that had been set -up by Vesalius, and one female which had been prepared by Platter. -During the first two hundred years of the existence of this university, -only twenty-three copies of the different writings of Hippocrates, of -Galen, of Dioscorides and of Paulus Aegineta were available for the -instruction of the medical students. “These books should be diligently -read aloud to the young men if their contents are to furnish the -maximum of useful information.” As for clinical instruction, each -student was expected to secure for himself, by private arrangement -with some active practitioner, the position of assistant, or to obtain -from the Archiater or City Physician an occasional opportunity of -seeing patients at the hospital. According to the rules established by -the Faculty the students were permitted to take private courses with -different physicians. Another and very valuable source of information -that was within the reach of these young men, was supplied by the -public disputations which were held quite frequently.</p> - -<p>The preceding brief account, which I have compiled from von Gurlt’s -work, will serve, as I believe, to convey a fairly clear idea of the -primitive and very limited opportunities of acquiring a knowledge of -medicine and surgery which were afforded the student in Germany during -the fifteenth and sixteenth centuries. (It should be borne in mind that -Basel, although located in Switzerland, was in nearly all respects a -German city.) It was not until a much later period that the schools of -that country, in nearly every department of human knowledge, caught -up with and eventually surpassed—at least for a number of years—the -similar institutions in Italy and France.</p> - - <div class="figcenter" id="i_p457" style="width: 642px"> - <img - class="p2" - src="images/i_p457.jpg" - alt="" /> - <p class="center p0 sm">FIG. 18. CONSULTATION BY THREE PHYSICIANS UPON A CASE OF -WOUND IN THE CHEST.</p> - <p class="center p0 sm">(From a woodcut in the <i>Surgery of Hieronymus Brunschwig</i>, -Strassburg, 1508.)</p> - <p class="p0 sm">This treatise, which was written by the author in 1497, passed -through nine successive editions, the last one in 1539. Probably -no woodcuts of a higher order of merit than those represented in -this and the two following illustrations (Figs. XIX and XX) are -to be found in medical literature.</p> - </div> - -<p><i>Hieronymus Brunschwig.</i>—Hieronymus Brunschwig was born at -Strassburg during the early part of the fifteenth century, the exact -date not being known. It is believed that he attained a great age, some -even claiming that he was one hundred and ten years old at the time of -his death. His treatise on surgery, bearing the simple title “<i>Das -buchler Wund Artzeny</i>,” <span class="pagenum" id="Page_457">[457]</span>was first published in 1497, -when he was already an old man, and it passed through nine editions -during the following forty-two years. It was also twice translated -into English. Up to the time of the discovery<span class="pagenum" id="Page_458">[458]</span> of Pfolspeundt’s work -it was believed to be the oldest German treatise on surgery known. It -was very freely illustrated with original woodcuts, not a few of which -possess considerable artistic merit. (See accompanying reproduction.) -The following headings of some of the more important chapters will -convey at least a fair idea of the character of the book: “Definition -of the Word ‘Surgeon’”; “Anatomy”; “Fatality of Wounds in Different -Parts of the Body”; “Different Kinds of Wounds”; “Different Kinds of -Surgical Instruments”; “Different Modes of Ligating Blood-Vessels”; -“Wounds of Blood-Vessels and Nerves”; “Methods of Arresting Bleeding”; -“Foreign Bodies in Wounds”; “Treatment of Wounds Inflicted by Poisoned -Arrows”; “Bruised or Crushed Wounds”; “Stab Wounds”; “Bites and -Stings”; “Wounds of the Head”; “Operations for Hare-Lip”; and several -other chapters on wounds and pathological conditions of other parts of -the body. Syphilis is not once mentioned in the book; and from this -circumstance von Gurlt infers that a knowledge of the existence of -this disease had not yet, at that early date (1497), reached Germany. -In Brunschwig’s <i>Liber pestilentialis, etc.</i>, however, which was -printed three years later, syphilis is incidentally mentioned as the -“<i>malefrancose</i>” or “<i>malum mortuum</i>.” That Brunschwig was -well informed in the earlier surgical literature is shown by the fact -that he quotes from the writings of Theodoric, Guillaume de Saliceto, -Guy de Chauliac, Henri de Mondeville, and many others. A hasty and -necessarily very superficial perusal of the text of a few of the more -important chapters of this remarkable book satisfies me that Brunschwig -deserves to be classed among the really great surgeons of the fifteenth -and sixteenth centuries. A copy of this rare book may be seen in the -Surgeon-General’s Library at Washington, D. C.</p> - -<p><i>Heinrich von Pfolspeundt.</i>—The earliest German treatise -relating to surgery is that which bears the title “<i>Buch der -Bündth-Ertznei</i>,” by Heinrich von Pfolspeundt, “<i>Bruder des -deutschen Ordens</i>.” It was written in 1460, and was first published -in printed form in 1868 by H. Haeser and<span class="pagenum" id="Page_459">[459]</span> A. Middeldorpf, Berlin. -The text of this very early German work on the practice of surgery -furnishes ample evidence to show that the author was worthy to be -ranked among the leading surgeons of the fifteenth century. At page -fifty-seven, says von Gurlt, may be read the remarkable statement that, -in the case of a wound of the intestinal canal, one may cut through -that organ at the point of injury and then introduce into the opposite -ends of the divided bowel a silver tube the margins of which have been -carefully bent so as not to offer at any point a cutting edge. The -tube may then be tied in place with thread of green silk. (Von Gurlt -speaks of this as the forerunner of Murphy’s button.) Speaking of -wounds caused by arrows, Pfolspeundt says that, to insure the patient’s -recovery, the planet under which he happens at that time to be, should -be in favorable conjunction. In one case which came under Pfolspeundt’s -care he was obliged to pay an astrologer the sum of fifty gulden in -order to ascertain whether the planet in question was or was not in a -favorable conjunction.</p> - -<p>There is only one place in the entire book, says von Gurlt, where a -gunshot wound is mentioned, and then only incidentally; but this is -positively the first reference (about the middle of the fifteenth -century) to such wounds discoverable in medical literature.</p> - -<p>Among the topics which are treated quite fully and in such a manner as -to show clearly that the author was well versed in at least this part -of operative surgery, those relating to rhinoplasty deserve to receive -special mention. From the viewpoint of history, this part of the book -is of very great importance. In no other treatise, says von Gurlt, do -we find an equally detailed and satisfactory account of the operative -method employed by the Two Brancas (father and son, from Catania, -Italy), who were contemporaries of Pfolspeundt. The latter learned this -method from an Italian surgeon, whose name he does not mention, and -he was particularly careful not to divulge the essential details to -anybody except two of his brethren in the Order to which he belonged.</p> - -<p>For anaesthetic purposes in operative cases, Pfolspeundt<span class="pagenum" id="Page_460">[460]</span> was in the -habit of employing sponges saturated with the juices of opium, Atropa -mandragora, Conium maculatum, Hedera helix or arborosa, Lactuca and -Daphne mezereum; his technique resembling very closely that employed by -Guy de Chauliac, Theodoric and others. (See the appropriate chapters in -the earlier part of this volume.)</p> - -<p>In his remarks upon the manner of bringing about the healing of an open -wound, Pfolspeundt says that “in all cases he tries to dispense with -stitches, but that, when he finds such support necessary, he first -spreads a thick layer of adhesive material over both margins of the -wound and afterward introduces the threaded needle through the mass -into the skin. Then, in order to bring the edges of the wound together, -he draws the thread taut and makes it fast by means of a very small -knot.... Whether the sharp fever which sometimes sets in afterward as -a complication, is due to simple inflammation or to erysipelas, is a -question which cannot always be decided; and it is still more difficult -to determine whether the thin watery secretion which sometimes develops -in a wound may not signify—as some writers maintain—the beginning of -suppuration in a joint.”</p> - -<p>Were it not for the difficulty which one experiences in translating -correctly the ancient provincial German of Pfolspeundt’s text, I might -readily furnish further examples of his surgical pathology and methods -of treatment. The few, however, which I have already given will have to -suffice.</p> - - <div class="figcenter" id="i_p461" style="width: 497px"> - <img - class="p2" - src="images/i_p461.jpg" - alt="" /> - <p class="center p0 sm">FIG. 19. BARBER-SURGEON (<i>WUNDARZT</i>) EXTRACTING -AN ARROW FROM A WOUNDED SOLDIER’S CHEST WHILE THE BATTLE IS STILL IN -PROGRESS.</p> - <p class="p0 sm">(From the <i>Feldbuch der Wundarznei</i> of Hans von Gerssdorff, first -published in 1517; many later editions followed.)</p> - </div> - -<p><i>Hans von Gerssdorff.</i>—Hans von Gerssdorff, who was also called -“Schielhans” (squint-eyed Hans), was born in Strassburg about the -middle of the fifteenth century. He was a bold and skilful surgeon, -and acquired a wide experience and great self-confidence from his long -service in connection with the army. He was present, for example, at -the famous battles of Grandson (1476, in Switzerland) and Nancy (1477, -in France), in both of which the slaughter was very great, and in both -also Charles the Bold, Duke of Burgundy, was badly beaten. In 1517 von -Gerssdorff published at Strassburg a treatise on military surgery,<span class="pagenum" id="Page_462">[462]</span> -under the title: “<i>Feldbuch der Wundartzney</i>.” This book, which -is illustrated with exceptionally good woodcuts, two specimens of -which are here reproduced (Figs. 19 and 20), contains the earliest -discussion of gunshot wounds; and, in his remarks on the proper manner -of treating such wounds, von Gerssdorff leads one to infer that he -shared, although somewhat hesitatingly, the at that time prevailing -belief that these wounds are poisoned. He was a pronounced advocate of -the use of the red-hot cautery in cases of serious hemorrhage from a -wound. When it was found that the ball had penetrated the flesh to some -depth, he recommended that it be cut out; and if, after the removal -of the missile, the patient complained of much pain in the wound, hot -oil was to be poured into it freely. Before the employment of firearms -in warfare, amputation of a limb was rarely performed—that is, only -in cases where gangrene had developed in the corresponding hand or -foot. But von Gerssdorff assures us that, up to the time of writing -his “<i>Feldbuch</i>,” he had personally performed “nearly two hundred -amputations.” This great increase in the frequency of performing this -operation is clearly to be attributed to the increased use of the new -agent—gunpowder—in warfare. In this operation, according to his own -declaration, von Gerssdorff was not in the habit of suturing the flaps. -Instead, he brought the opposing edges together and then covered the -stump thus formed with the bladder of some animal. There are a number -of other interesting details relating to von Gerssdorff’s manner of -conducting this important operation, but it is not practicable to give -up the space that would be required for a satisfactory description of -them. There is one point, however, to which I may be permitted to refer -very briefly in this place, viz., the manner in which the surgeons of -this and even much earlier periods secured a fairly satisfactory degree -of local anaesthesia when they had occasion to perform an amputation. -They produced insensibility of the part by tying a band tightly around -the limb a short distance above the spot at which the amputation was -to be performed. At a somewhat later period, as in the middle<span class="pagenum" id="Page_464">[464]</span> of the -seventeenth century, artificial anaesthesia was also effected through -the application of snow or ice to the part.</p> - -<p>The date of von Gerssdorff’s death is not known.</p> - - <div class="figcenter" id="i_p463" style="width: 502px"> - <img - class="p2" - src="images/i_p463.jpg" - alt="" /> - <p class="center p0 sm">FIG. 20. AMPUTATION OF THE LEG.</p> - <p class="center p0 sm">(From Hans von Gerssdorff’s <i>Feldbuch der Wundarznei</i>.)</p> - <p class="p0 sm">Von Gurlt says that this is the earliest known pictorial -illustration of the amputation of a limb.</p> - </div> - -<p><i>Fabricius of Hilden.</i>—Fabricius Hildanus—or Fabricius of -Hilden, near Düsseldorf—was born in 1560 and received his early -training in surgery from Cosmas Slotanus, a pupil of Vesalius and the -first barber-surgeon of Duke Wilhelm of Guelich-Cleve-Berg (eighteen -miles northeast of Aix-la-Chapelle). In 1585 he visited Geneva, -Switzerland, and continued his studies in that city under the guidance -of Jean Griffon, one of the most distinguished surgeons of that period. -After leaving Geneva he practiced medicine at Cologne, and during that -period (1591–1596) steadily increased his reputation as a skilful -surgeon, particularly well versed in anatomy. But he appears to have -acquired a strong liking for Switzerland and for the professional -friends whom he had gained in that country; and consequently it is not -surprising to learn that, during the later years of his life, he spent -long periods of time in Geneva, Lausanne and Berne, in the last of -which cities he filled the office of City Physician. He died in 1634, -at the age of seventy-four, full of honors and greatly beloved by all -who knew him.</p> - -<p>Fabricius of Hilden laid great stress upon the importance, to the -surgeon, of a thorough grounding in anatomy. He had been profoundly -impressed by the fact that his instructor at Geneva, Jean Griffon, -never undertook an important operation until after he had refreshed -his memory by a dissection of the region involved. He was also much -interested in pathological anatomy, and always availed himself of every -possible opportunity for making a postmortem examination. As evidence -of the slowness with which news of important scientific discoveries, -particularly in the domain of medicine, traveled in those days I may -mention here the fact that, up to the time of his death in 1634, -Fabricius had not heard of Harvey’s great discovery of the circulation -of the blood (1628). Although he gained distinction in more than one -field of medicine his greatest reputation was unquestionably gained in -that of<span class="pagenum" id="Page_465">[465]</span> surgery; and his success in this field was to be ascribed to -his profound knowledge of anatomy, to his inventive genius, and to his -great technical skill. He insisted very strongly upon the importance, -for the surgeon, of possessing good instruments and well-constructed -apparatus.</p> - -<p>If we compare Fabricius of Hilden with Ambroise Paré we are obliged -to admit that the latter, although decidedly inferior to his rival in -scientific training, was the greater surgeon of the two. It is perhaps -worth recording that Paracelsus and Wuertz were Fabricius’ bitter -opponents.</p> - -<p>Of his published contributions to surgical literature, the most -important are to be found in the work entitled: “<i>Observationum et -curationum chirurgicarum centuriae VII.</i>,” published at Lyons in -1641.</p> - -<p><i>Felix Wuertz.</i>—Felix Wuertz was born at Zurich, Switzerland, -between the years 1500 and 1510 (the exact date is not known). As to -his early life and surroundings I am only able to say that his father -was a painter, that he himself took service under a barber, and that -at the end of two or three years, after he had learned the details of -this branch of work, he started out on his travels over Europe in the -character of a barber’s apprentice, as was, in those days, the regular -custom with apprentices of all trades or occupations. In this way he -visited such cities as Bamberg, Pforzheim, Nuernberg, Padua and Rome, -in each of which he spent a certain length of time as an aid to those -surgeons who were willing to employ him. It is not unlikely that it was -during this wandering period of his life that he gained some experience -in the treatment of gunshot wounds. In 1536, after an absence of -four or five years, he returned to his native city and was regularly -enrolled as a member of the barbers’ guild. During the following twenty -years he carried on the practice of medicine and surgery, but more -particularly the latter, with ever-increasing success. In 1559, for -reasons which are not mentioned by any of his biographers, he left -Zurich and established himself in Strassburg; and then, at the end of -another ten or twelve years, he again changed his residence, this time -giving the preference to Basel, a Swiss city located at the boundary<span class="pagenum" id="Page_466">[466]</span> -line between Germany and Switzerland. The exact date of Wuertz’s -death is not known, but—from various facts which he mentions in his -book—it may be inferred that it occurred in 1576, and that he was -residing at the time in the house of his son, who had the same name -as himself and was also a surgeon. The title of the treatise which he -wrote and which passed through a number of editions between the years -1563 and 1651,—not to mention translations into the French and Dutch -languages—was: “<i>Practica der Wundarznei</i>” (The Treatment of -Surgical Affections).</p> - -<p>Malgaigne—says von Gurlt, in his History of Surgery—does not hesitate -to speak of Wuertz as one of the three greatest surgeons of the -sixteenth century (Franco and Ambroise Paré being the other two); and -von Gurlt adds that Wuertz’s “<i>Practica</i>” is rich in facts which -he had gathered from his own experience in everyday practice, and upon -which he makes comments that really represent his own views and not -those of various other authors. The leading principles which guided -Wuertz in his treatment of wounds of all kinds are thus formulated by -him:—</p> - -<div class="blockquot"> - -<p>Keep them as neat and clean as possible, and disturb them as -little as you can; so far as may be practicable, exclude the -air; favor healing under a scab; and do not give the patient a -lowering diet, but feed him as you would a woman recovering from -her confinement.</p> -</div> - -<p>According to von Gurlt, Wuertz attached relatively small importance -to healing by first intention, and only in rare cases did he make -special efforts to secure this result. On the other hand, he availed -himself of every opportunity to enter his protest against some of -the bad tendencies which had somewhat suddenly made their appearance -in the practice of surgery in his day, and more especially “against -the almost universal employment of caustics and the red-hot iron for -arresting bleeding; against the uncalled-for and positively harmful -habit of repeatedly probing a wound; against the unreasonable practice -of inserting tents into wounds; against the uncontrolled application -of<span class="pagenum" id="Page_467">[467]</span> mushy poultices to wounds; and against the excessive employment of -bloodletting in the treatment of wounds.” He exhibited his conservatism -in still other ways. Thus, for example, he was very slow in reaching a -decision to amputate a limb or to remove splinters or larger portions -of loose bone from a wound, for he put greater trust in the reparative -powers of Nature than did most of the surgeons of that day. Wuertz was -also slower than were most of them in resorting to the operation of -trephining the skull. His ideas with regard to the nature of gunshot -wounds were not very clear, for he still believed that the projectile -caused some burning and a certain degree of poisoning of the wound; -but he condemned all unnecessary efforts at extraction, especially by -means of complicated instruments. It was better, he said, to wait until -the bullet or other missile manifested its presence at some easily -accessible spot in the body.</p> - -<p>The statements made above bring out some of the good features -of Wuertz’s treatise. This work, however, says von Gurlt, also -contains not a few bad features, and among them he mentions the fact -that it abounds in repetitions and in evidences of the author’s -superstitiousness.</p> - -<p>Some of Wuertz’s comments on the symptoms which occasionally develop in -cases of injury to the head, and the suggestions which he makes as to -the treatment that should be adopted, throw considerable light upon his -mode of procedure in the presence of certain surgical phenomena. The -following clinical lesson is based upon three hypothetical developments -in a case of cranial injuries:—</p> - -<div class="blockquot"> - -<p>(1) The patient’s wound in the head, let us suppose, has to -all appearances healed, when it unexpectedly becomes swollen -and painful and begins to discharge again. What measures are -indicated under these circumstances? The wound should at once -be freely reopened, for it may confidently be assumed that such -a lighting up of the local symptoms is due either to a loose -splinter of bone that is trying to escape or to the presence of -a small area of bone caries. If, under these circumstances, you -should not establish a free opening a large abscess will surely -collect in that region and will soon make for itself a new -outlet.</p> - -<p><span class="pagenum" id="Page_468">[468]</span></p> - -<p>(2) If the patient complains that he has constant pain in his -head on the same side as that on which the injury was originally -inflicted, that the pain is steadily increasing in severity, -and that in addition he feels a sensation of pulsation in his -head; and if, furthermore, you inspect closely the site of -the original wound, and pass your finger cautiously over the -spot, but fail to discover any appreciable external swelling, -you may feel almost certain that a splinter or a spicule of -bone projects from the inner table of the skull cap into the -substance of the brain. Then, when the surgeon believes that -the condition as just described truly represents the existing -intracranial lesions, he should not hesitate to make an opening -in the calvarium over the affected spot and remove the offending -splinter.</p> - -<p>(3) If the patient, after the external wound has healed, -complains of a throbbing and roaring in his head, not merely in -the region of the actual injury but involving the entire head, -and if the symptoms tend rather to increase than to diminish, -and eventually become so severe that the patient is almost -beside himself with the pain, then is the surgeon justified in -believing that a clot of blood is imprisoned somewhere beneath -the cranium and is gradually being converted into an abscess or -a condition of ulceration. And if at the same time some swelling -appears in the vicinity of the eyes, or if a bloody and purulent -discharge begins to flow from the nose or the ears, he may not -merely entertain a belief that his diagnosis is correct, but -may assert with positiveness that the lesions just named really -exist. And then the proper treatment for him to adopt is [in -essentials] the following: The head having first been shaved -over the site of the original wound, make a crucial incision -through the scalp and pericranium, turn the flaps back, apply -a strong, sharp-edged chisel to the surface of the bone, and -remove enough of the cranium to afford a satisfactory view -of the underlying parts. [Among the effects first observed] -probably pus will well up into the opening, and the patient will -then experience relief; and if a spicule of bone comes into -view, remove it forthwith. The plan of treatment here suggested -is the only one which can be trusted to effect a cure in a -case like that which is now being considered.... If a boring -instrument is employed for making an opening in the bone, be -careful not to allow any of the chips made by the borer to enter -or remain in the cranial cavity. Some surgeons teach that, if -pus be not found at the first opening, a second one should be -made at the distance of a finger’s breadth from the first, and -that the intervening<span class="pagenum" id="Page_469">[469]</span> bone should be broken down with a strong -and sharp knife so as to convert the two into a single opening. -[Wuertz adds that he had never found it necessary to act in -accordance with this advice.] After the pus or clot of blood -has been removed, one may as a rule readily discover the true -cause of the pain and other symptoms. As a final step, suitable -dressings should be applied to the wound.</p> -</div> - -<p>Another important department of practical surgery, in which Wuertz -appears to have gained special distinction, is that which relates to -wounds and certain diseases of the abdomen. Owing to lack of space it -will not be practicable to reproduce here any histories of the cases of -this nature which came under his observation, but I believe that the -following brief extracts from his remarks upon the best way of treating -them may in some measure answer the same purpose:—</p> - -<div class="blockquot"> - -<p>Penetrating wounds of the abdomen are universally admitted to -be very dangerous, no matter what organs (stomach, intestines, -liver, gall-bladder, spleen or kidneys) be involved in the -injury. In the case of a wound of the liver or spleen it is not -advisable to employ sutures; instead, one may use some kind of -sticking plaster for bringing the edges of the wound together. -Proper regulation of the diet plays an important part in the -treatment of these conditions, and so also may venesection. When -an intestine is the organ wounded I adopt the plan of treatment -recommended by most authorities; that is, I stitch together the -opposite edges of the wound and I cleanse the surface of the -bowel carefully with milk that has been well saturated with the -juice of anise seeds.</p> -</div> - -<p>In his remarks about the treatment of suppurative processes involving -the thigh in the vicinity of the knee, Wuertz gives the following -advice:—</p> - -<div class="blockquot"> - -<p>Do not allow the knee to remain quiet, but stretch the -surrounding parts and manipulate them as much as you can, in -order that the joint may not become permanently rigid; for if -you wait until the healing is completed before you resort to -these measures you will often find that it is already too late.</p> -</div> - -<p>Separate chapters are devoted to such topics as would to-day receive -the designations “pyaemia,” “hospital<span class="pagenum" id="Page_470">[470]</span> gangrene,” and “septicaemia”; -and in a separate short treatise which deals with the various ailments -of young children, Wuertz mentions the fact that he once suffered -greatly for ten days from an attack of migraine (hemicrania) and that -he experienced marked and permanent relief only after the operation -of arteriotomy had been performed upon his left temporal artery. In -another part of the volume he expresses himself in terms which justify -the belief that he must have performed amputation of the thigh on -one or more occasions. He does not, it is true, furnish any details -regarding the indications that point to the necessity of resorting -to this operation, nor does he state how it should be carried out; -he simply makes the remark, while speaking of the employment of the -red-hot cautery iron in arresting hemorrhage, that “it is useful in -amputation of a limb, particularly in the thicker part of the thigh, -and occasionally in other places, as in the removal of a tumor by the -use of the knife.” So far as I am aware, Celsus was the first among -ancient writers on surgery to say anything about amputations, and what -he does say on this subject consists simply of quotations from still -earlier writers—from Archigenes, Leonides and Heliodorus, surgeons -whose writings no longer exist except in the form of detached extracts -that appear in more modern treatises. The portions of text which Celsus -quotes show clearly that the surgeons whom I have just named were in -the habit of making flap operations in cases of amputation above the -elbow and above the knee; and Archigenes even taught the advisability -of first ligating the larger supply blood-vessels before one proceeds -to the amputation of a limb.</p> - -<p>From the remarks which Wuertz makes in one or two places it is easy -to see that he was often not a little annoyed by the criticisms which -his professional brethren made with regard to some of his methods of -procedure. Thus, for example, he boldly declares that one’s experience -is of much greater value than any rule that may have been laid down by -the ancients.</p> - -<div class="blockquot"> - -<p>There can be no doubt, he says, that the ancients occasionally -displayed great ignorance and great want of judgment, just as<span class="pagenum" id="Page_471">[471]</span> -happens in our own time.... How much do you suppose I care -whether Galen’s, or Avicenna’s, or Guy de Chauliac’s opinion -does or does not agree with mine? Every such opinion—it should -be remembered—was, at one time or another in their day, a new -[and therefore unproved] opinion.... In practical surgery much -more importance attaches to the manner in which one carries out -one’s manipulations, and to the amount of experience which one -may have acquired, than to the length of time which one devotes -to windy consultations.</p> -</div> - -<p>Fortune conferred very few favors upon Wuertz in the course of his -career; the aid granted by kings and princes played no part in the -moulding of his character; his greatness was entirely due to his -own unaided efforts. Paré, on the other hand, was certainly one of -Fortune’s favorites. He, too, like Franco and Wuertz, began his -professional life as a barber’s apprentice, but, as he was made of -a much finer clay, the ultimate product of his development was a -princely surgeon, perhaps no more efficient or skilful than his two -distinguished contemporaries, but unquestionably more many-sided, -more lovable than either of them. On the other hand, Wuertz rendered -a most valuable service to the science of surgery by his close and -patient study of certain symptoms which his confrères had overlooked -or incorrectly interpreted (such, for example, as pyaemia, hospital -gangrene and septicaemia); and he thus established the fact that these -were in reality independent diseases.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_472">[472]</span></p> - -<h3>CHAPTER XXXVII<br /> -<span class="subhed1">THE DEVELOPMENT OF SURGERY IN ITALY DURING THE RENAISSANCE</span></h3></div> - -<p>During the latter part of the fifteenth, all of the sixteenth and the -early part of the seventeenth centuries quite a large number of Italian -surgeons attained honorable distinction by the contributions which they -made to the science of medicine; and even in the neighboring Latin -countries of Spain and Portugal,—countries in which the force of the -revival of all departments of learning had made itself felt to a much -feebler degree, and in which at the same time the opposition to such -revival was much more active,—several surgeons succeeded in winning -creditable places for themselves in the history of their art. The names -of the Italian surgeons are as follows: Giovanni da Vigo, Bartolommeo -Maggi, Marianus Sanctus, Fallopius, Carcano Leone, Fabricius ab -Acquapendente, Aranzi and Tagliacozzi. I will now add brief notices of -the careers of all these men, in order to convey at least some idea of -the grounds upon which their claim to honorable distinction rests.</p> - -<p>Giovanni da Vigo—perhaps more frequently referred to in literature -by the French form of his name, “Jean de Vigo”—was born at Rapallo, -near Genoa, Italy, about the year 1460. He was the son of Bernardo di -Rapallo, who was also a surgeon; and he himself was the founder of a -school which sent out quite a number of practical surgeons. In 1485 he -began the practice of his profession at Saluzzo, a small town about -forty miles south of Turin; and ten years later he settled at Savona, -which is located on the Mediterranean, a short distance to the west -of Genoa. In 1503 he was chosen the personal physician of Cardinal<span class="pagenum" id="Page_473">[473]</span> -Giuliano della Rovere, who resided at Savona, and he continued to hold -this position after the cardinal was elected to the papal office under -the name of Julius the Second.</p> - -<p>Da Vigo’s great treatise on surgery (“<i>Practica in arte chirurgica -copiosa continens novem libros</i>,” Rome, 1514) owed its celebrity, -during the early part of the sixteenth century, chiefly to the fact -that he was the first author to write somewhat thoroughly upon syphilis -and upon gunshot wounds—two surgical disorders of great importance -at that time. As to gunshot wounds, da Vigo was one of the first to -maintain that they were poisoned wounds; and for a long time afterward -this was the generally accepted opinion. Like all his contemporaries, -da Vigo was not willing to undertake such operations as those for the -cure of stone in the bladder, for the relief of cataract, and for the -cure of hernia. He left these, says Haeser, to the itinerant surgeons. -But he gained well-merited credit by his employment of ligatures for -the arrest of bleeding in a variety of conditions—not, however, -in amputations, as he appears to have avoided cutting operations. -According to the same authority, the circular pattern of trephine (the -kind which the surgeons of the present day prefer) was first introduced -by da Vigo. The following passage copied from his “<i>Practica</i>” -shows that he was familiar with the use of the ear speculum: “... -<i>si ad solem speculo instrumento aure ampliata</i>.” Da Vigo died -soon after 1517.</p> - -<p>Bartolommeo Maggi, who was born at Bologna either in 1477 (Haeser) -or in 1516 (von Gurlt), held the Chair of Anatomy and Surgery in the -medical school of his native city, and then at a later date accepted -the position of private physician to Pope Julius the Third (1550–1555). -He held this position, however, only for a short time, as he found that -the climate of Rome did not agree with him. His posthumous fame rests -largely on the treatise which he wrote on gunshot wounds and which -was published by his brother a short time after the former’s death. -His treatise, says von Gurlt, is one of the best of those which<span class="pagenum" id="Page_474">[474]</span> were -published on this subject during the sixteenth century. Henry the -Second, King of France, expressed his gratitude to Maggi for the care -which he took of the wounded French soldiers who fell into the hands of -the papal troops at the sieges of Parma and Mirandola. Maggi maintained -firmly the belief that gunshot wounds are either poisoned or burned. -His death occurred in 1552. The title of his treatise on gunshot wounds -is: “<i>De vulnerum bombardarum etc.</i>,” Bologna, 1552.</p> - -<p>Marianus Sanctus of Barletta near Naples (born in 1489, died at some -unknown date after 1550) is credited with having been the first to -publish a description of the so-called “<i>apparatus magnus</i>”—the -name given in those early days to the method of extracting a calculus -from the urinary bladder through an incision in the perineum after a -grooved sound or director had first been passed into this organ by -way of the urethra. The title of the book in which this description -is given is the following: “<i>De lapide renum liber et de lapide ex -vesica per incisionem extrahendo</i>,” Venice, 1535. Marianus, however, -does not claim to have been the inventor of this method. Some writers -give the credit for this to Jean da Vigo’s father, Bernardo di Rapallo, -who communicated a knowledge of the method to Giovanni de Romanis, -who in turn instructed Marianus Sanctus. It is believed, furthermore, -by some writers that Giovanni de Romanis was the inventor of -lithontripsy<a id="FNanchor_86" href="#Footnote_86" class="fnanchor">[86]</a>—the operation of crushing a stone in the bladder or -urethra. Laurent Colot, the famous French lithotomist of the eighteenth -century, obtained his knowledge from a certain Octavianus de Villa, a -friend of Marianus Sanctus, and then kept the matter secret for many -years.</p> - -<p>Fallopius, the famous anatomist of the early part of the sixteenth -century, does not appear to have attained equal distinction in the -field of surgery. So far as one may judge from the portions of the -text selected from his writings by von Gurlt, Fallopius was a very -conservative if not a very timid surgeon, in this respect being not -unlike Fabricius<span class="pagenum" id="Page_475">[475]</span> ab Acquapendente. In the text to which reference has -just been made, I find a brief mention of a case which passed under -Fallopius’ observation and which, perhaps, is of sufficient interest -to be recorded here. The patient’s—a German student’s—finger had -been nearly severed by some cutting instrument, and the greater part -of the member remained attached to the hand only by a narrow strip of -flesh. “I stitched together the separated edges, and at the end of -three or four days I was astonished to find that firm union between the -separated parts had already taken place. This result seemed to me like -something miraculous.”</p> - -<p>Carcano Leone was born at Milan in 1536, his parents being people of -good social standing. After receiving a thorough classical education, -he began his medical studies in his native city, under the guidance -of Pietro Martire, a pupil of Vesalius. He next continued his studies -at the University of Pavia, but eventually went to Padua, where he -enrolled himself among the pupils of Fallopius. After a residence of -two years in that city, he returned to Milan and opened a medical -school of his own. Upon the occasion of the death of the Cardinal and -Archbishop Carlo Borromeo, whose remains now rest in the cathedral of -Milan, it was Carcano Leone who was invited to make the postmortem -examination. He carried on the practice of his profession during a -period of about twenty-eight years, his death occurring—so far as may -now be learned—in 1606.</p> - -<p>Carcano Leone’s reputation as a surgeon rests mainly on the treatise -which he wrote on the wounds of the head, and which was published at -Milan in 1583. From among the numerous cases of this character which -came under his observation, and of which a certain number are reported -by von Gurlt, I have selected the very brief histories of three that -seem to me well adapted to serve as examples of Leone’s knowledge of -surgery and also of his ability to cope with problems of so serious -a character. They reveal the fact that he was a surgeon of excellent -judgment, most persevering, and very resourceful. Briefly told, the<span class="pagenum" id="Page_476">[476]</span> -accounts of the three cases to which I have referred read as follows:—</p> - -<div class="blockquot"> - -<p>Case I.—A small boy was hit on the right temple by a stone -that had been thrown by one of his companions. Unconsciousness -resulted and lasted for six days. On the seventh day signs of -returning consciousness manifested themselves, but inability to -speak persisted. By the end of another week the boy had already -made some efforts to speak, but his speech was incomprehensible. -After the twentieth day it was possible to understand a little -of what the boy was trying to say; and from this time onward -steady improvement in this respect was recognizable from day -to day; but the boy’s speech did not become quite normal until -after the lapse of about a year.</p> - -<p>When Carcano Leone was called to see the patient he found that -the entire temporal muscle had been crushed and that almost the -entire right side of the head was occupied by a fluctuating -swelling. By making a free incision in the swelling Leone gave -exit to a large quantity of black coagulated blood. On the -following day, when he made an examination with the probe, he -found that the entire squamous portion of the temporal bone was -in a fractured state, one part of it overriding the rest. By the -aid of elevators he succeeded in lifting up the depressed part -of the bone, but the accomplishment of this result left a large -gap between the opposite edges of the fragments, and through -this opening one could see the movements of the dura mater. -Complete healing took place only after the lapse of twelve -months.</p> - -<p>When Leone reported the case to his former teacher, Fallopius, -the latter replied that he would not have had the courage to -adopt the course which his former pupil had pursued.</p> - -<p>Case II.—In another case the patient, a full-grown man, was -struck on the right temple by a highwayman with a heavy cane -which broke in two in the middle under the great force which -the assailant had employed. He was left lying on the roadside -in a state of unconsciousness until some passers-by discovered -him and carried him to his home. He remained unconscious for -several days. Before the physician was summoned all sorts of -measures had been resorted to for the purpose of dissipating the -swelling in the temporal region, but without success. Leone, on -arriving upon the scene, made a free incision which afforded -escape to a large quantity of decomposing blood that appeared to -be collected, not between the muscle and the skin, but between -the muscle and<span class="pagenum" id="Page_477">[477]</span> the bone. The latter was found to be fractured -transversely and depressed; and, in order to lift it back to -its proper level, it became necessary first to incise the -muscle transversely. At the end of three months the wound had -completely healed and the patient had regained his health.</p> -</div> - -<p>Speaking of the cases just narrated and of others of a similar nature, -Leone remarks that he has never had any experience that would justify -the fear expressed by Hippocrates that convulsions are likely to result -from dividing the temporal muscle.</p> - -<p>With reference to the value of trephining the skull in cases of injury -to the head, Leone narrates the following experience:—</p> - -<div class="blockquot"> - -<p>Case III.—A man was struck by a heavy stone on the upper part -of the forehead close to where the hair grows, and was thrown -to the ground by the force of the blow. Here he lay as if dead. -When Leone was called, a short time afterward, to see the -patient he found the skin unbroken except at one small spot, -and from this point he made an incision of such length that he -was thereby enabled to explore the surface of the skull. In -this way he discovered that there was a fracture which appeared -to extend through the entire thickness of the skull. He then, -without further delay, trephined the cranium over the line -of the fracture. This was followed by such a copious flow of -blood that Leone was obliged to adopt measures for arresting -any further hemorrhage. During the following fourteen days (the -summer season then being at its height) large quantities of -decomposed and evil-smelling blood escaped from the wound; but -the dura mater gradually assumed a more natural appearance, many -splinters of bone were ejected, and finally—at the end of forty -days—the wound healed. (As no further details are given in the -text, it is fair to assume that there were no sequelae of an -unfavorable nature.)</p> -</div> - -<p>The whole subject of injuries to the skull is treated in a most -thorough manner by Leone, and the book is pronounced by Scarpa -(1752–1832), the famous anatomist, the best that, up to his time, had -been written on the subject. The three histories of cases which I have -here reproduced and which furnish such striking proof of what surgery -may accomplish when practiced by a man of good courage<span class="pagenum" id="Page_478">[478]</span> as well as of -good judgment, certainly justify the favorable opinion expressed by -Scarpa upon Leone’s work.</p> - -<p>Fabricius ab Acquapendente, of whom I have already given some account -on a previous page, was distinguished not only as an anatomist and as a -physiologist, but also—which was true of his instructor, Fallopius—as -a surgeon. From his published writings, however, it appears very -clearly that, like Fallopius, he had a decided aversion to the use -of the knife; his activities as a surgeon being restricted largely -to the improvement of certain of the more bloodless operations (for -example, tracheotomy and thoracentesis and operations for the relief -of stricture of the urethra). He also invented several new surgical -instruments and devised a number of machines for use in orthopaedic -practice. He attached great value to the teachings of Celsus and Paulus -Aegineta, his writings containing frequent and copious references -to these authorities and relatively few data based upon his own -experience. In the section which he devotes to the subject of wounds of -the abdomen, Fabricius confirms the opinion very generally held by the -ancients, viz., that a wound of the small intestine is invariably fatal.</p> - -<p>Gaspare Tagliacozzi was born at Bologna in 1546. He studied medicine -under Girolamo Cardano, Professor of Medicine, first at Pavia and -afterward at Bologna, and received his degree (“Doctor of Philosophy -and Medicine”) in 1570. Very soon afterward he began teaching surgery, -and a little later he also taught anatomy and the theoretical part of -medicine. In this work he was so successful that in 1576 he was made -a member of the Faculty. He died on November 7, 1599, at the age of -fifty-three.</p> - -<p>The Italian method of performing plastic operations, says von Gurlt, -had already flourished for about one hundred and fifty years before -Tagliacozzi took up the subject in serious earnest and attained results -of decided scientific value. There are some doubts, however, as to the -precise degree of credit that should be awarded Tagliacozzi for his -share in the development of the operation which<span class="pagenum" id="Page_479">[479]</span> bears his name. The -facts which throw some light upon this question may be stated in the -following paragraphs:—</p> - -<div class="blockquot"> - -<p>(1.) Tagliacozzi’s Latin is not easy to understand, and he -certainly does not furnish satisfactory information as to the -manner in which he learned the details of the operation which we -are here considering. Vesalius, Paré and other surgical authors -of that period throw no light upon that question and furnish -erroneous descriptions of the steps of the operation. Apparently -they had never witnessed one of that character. (Von Gurlt.)</p> - -<p>(2.) The records seem to warrant the statement that, about -the middle of the fifteenth century a surgeon by the name of -Branca, who lived in the city of Catania on the southeast coast -of Sicily, devoted himself largely to the reconstruction of -damaged or defective noses. At first he transplanted a flap from -the forehead or cheek; but afterward his son sought to improve -the method by utilizing a flap of skin taken from the arm. By -this plan the disfiguring of the patient’s face was avoided. -The son employed the same method in repairing the lips and the -ears. Pupils of the latter carried a knowledge of the method to -the Bojano (Vianea or Vieneo) family in Tropea, Calabria, and -from them it was transmitted, about the middle of the sixteenth -century, to Tagliacozzi and eventually to the medical profession -in every part of the world.</p> - -<p>(3.) In 1581 there was published at Cracow, Galicia (formerly -Poland), a book which bore the title “Przymiot” and which gave -a most complete account of the disease syphilis in all its -manifestations and complications. This book, in its original -form, is to-day one of the greatest bibliographical rarities; -but a reprint of the work was published in 1881 by the Warsaw -Surgical Society. In this volume Wojciech Oczko, the personal -physician and secretary of the Polish kings Stephan Bathory and -Sigismund the Third, discusses other surgical topics beside -syphilis. He states, for example, that Aranzio (or Arantius), -who was Professor of Surgery at Bologna at the time (1569) when -he frequented that medical school, was successful in making a -new nose by transplanting a flap of skin from the patient’s -arm; and that he performed this operation without injuring the -muscles of the arm, and also with perfect success as regards -the creation of a straight and shapely nose. “This statement,” -says von Gurlt, “coming as it does from an eye-witness who was -at Bologna several years before Tagliacozzi’s time, furnishes -satisfactory proof that rhinoplasty was successfully performed -in that city several years before the<span class="pagenum" id="Page_481">[481]</span> date of publication -(1586) of Tagliacozzi’s earliest comments on the subject, -and that the credit for first bringing the operation to the -knowledge of European surgeons is due to Aranzio rather than -to Tagliacozzi.” The latter’s famous treatise on rhinoplasty -(“<i>De chirurgia curtorum per insitionem</i>”) was published at -Venice in 1597.</p> - - <div class="figcenter" id="i_p480" style="width: 486px"> - <img - class="p2" - src="images/i_p480.jpg" - alt="" /> - <p class="center p0 sm">FIG. 21. THE MANNER IN WHICH THE SO-CALLED -TAGLIACOTIAN OPERATION FOR REPAIRING A DEFECTIVE NOSE SHOULD BE -CARRIED OUT.</p> - <p class="center p0 sm">(From the treatise published by Tagliacozzi, Venice, 1597.)</p> - </div> - -<p>(4.) Fabricius of Hilden, the distinguished German surgeon -of the sixteenth century, assures us that his teacher, Jean -Griffon, at that time the leading surgeon of Lausanne (but, at -an earlier period, of Geneva), performed the same operation in -1592. The patient was a young Genevese woman whose nose had been -cut off by some soldiers belonging to the army of the Duke of -Savoy who were enraged at the resistance which she offered to -their familiarities; and the operation proved most successful, -“the new nose eliciting the admiration of all who saw it.” -Fabricius adds that during the winter seasons, up to the year -1613, the tip of this nose presented a somewhat purplish hue. -The woman married in 1603.</p> - -<p>(5.) During the short lifetime of Tagliacozzi several tablets, -on which laudatory inscriptions were engraved, were erected in -the high school (<i>archiginasio</i>) of Bologna, and after his -death a bust that represented him holding a nose in his hand was -erected in the same building. Corradi, the medical historian -(1833–1892), writes that in his time both bust and tablets had -disappeared. Tagliacozzi’s remains were temporarily lodged in -the cloisters of the church of San Giovanni Battista, and the -report was circulated that, a few weeks after his death, a -voice was heard saying that he was among the damned. Thereupon -the remains were removed to the walls of the city, and the -Tagliacotian method was soon forgotten, to be revived only after -the lapse of many years.</p> -</div> - -<p>All the data which I have reproduced in the preceding paragraphs -seem to point to the conclusion suggested by von Gurlt, viz., that -Tagliacozzi was willing to accept for himself a credit which belonged -in reality to another, and that there would be more justice in calling -the famous rhinoplastic method of procedure “the Arantian operation” -than the Tagliacotian; especially as our knowledge of the method -adopted by the younger Branca is entirely too vague to justify us in -bestowing this honor upon him.</p> - -<p>Giulio Cesare Aranzio (or Arantius) was born at Bologna about the year -1530. He studied medicine first in his native<span class="pagenum" id="Page_482">[482]</span> city, under the guidance -of his uncle, Bartolommeo Maggi, and then afterward went to Padua, -where he may possibly have been one of Vesalius’ pupils. In 1548 he -made, at Padua, his first anatomical discovery—that of the <i>musculus -levator palpebrae superioris</i>. Before he was twenty-seven years -old he was chosen Professor of Medicine, Surgery and Anatomy in the -University of Bologna, and he filled the position with distinction up -to the time of his death on April 7, 1589—<i>i.e.</i>, during a period -of thirty-three years.</p> - -<p>The part taken by Aranzio in the advancement of surgery was apparently -of small importance. He succeeded, it is true (see remarks on page -479), in reviving the interest of contemporary surgeons in the -possibility of restoring damaged parts of the human face by means -of flaps taken from the patient’s arm. But I have not been able -to discover that he made any other material contributions to this -department of the science of medicine. It is possible, however, that -his plan of illuminating the interior of the nose and of operating upon -nasal polypi may possess some measure of originality; but I do not -feel competent to decide this question. As regards the procedure just -referred to, it may be stated briefly that Aranzio was in the habit, -when operating within the nasal cavity, of using by preference, for -illuminating purposes, the direct rays of the sun, which were allowed -to enter the room through a slit or hole in the wooden window blind; -and, when sunlight was not available, he used as a source of light -the rays emanating from a lighted wax candle. In the latter case he -increased the brilliancy of the illumination by interposing between the -flame of the candle and the illuminated field, a glass globe filled -with water,—an idea which probably originated with the goldsmiths or -the shoemakers. The employment of light reflected from a concave mirror -supplanted this method somewhere about the year 1866.</p> - -<p>In Italy, during the sixteenth century, there were several -surgeons—uneducated empirics—who contributed not a little to our -knowledge of the radical cure of hernia; and of this number the -members of the Norsa family (from Norsa, a small town in the district -of Naples) were<span class="pagenum" id="Page_483">[483]</span> undoubtedly the best known and most experienced -operators. Horazio Norsa, for example, is reputed to have performed the -radical operation (in combination with castration) no less than two -hundred times. It was this same Horazio Norsa who, in the latter part -of his career, complained to Fabricius ab Acquapendente that, since the -wearing of trusses had become so common a custom as it then was, the -number of operations for the cure of hernia had greatly diminished.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_484">[484]</span></p> - -<h3>CHAPTER XXXVIII<br /> -<span class="subhed1">THE DEVELOPMENT OF SURGERY IN SPAIN AND PORTUGAL DURING THE RENAISSANCE</span></h3></div> - -<p>According to the authority of Morejon, who published (1842–1852) an -elaborate history of medicine in Spain and Portugal, these countries -almost rivaled Italy, during the sixteenth century, in the number and -excellence of their physicians. But, so far as I am able to judge -from the record, very few of these men appear to have taken a strong -interest in surgery, and of these few there are only three—Daza -Chacon, Francisco Arceo and Amatus Lusitanus—who left behind them -treatises which seem to call for a brief notice.</p> - -<p>Dionisio Daza Chacon, who was born in 1503 at Valladolid, about one -hundred miles north of Madrid, received his early training partly in -his native city and partly at the University of Salamanca. After being -engaged for some time in private practice he joined the imperial army -(Charles the Fifth) in the capacity of a field surgeon in charge of a -corps of three thousand men. In addition to these troops there were -six thousand English archers, in the pay of the Emperor. At the two -sieges in which these men participated—the siege of Landrecy in 1543 -and that of Saint Dizier in 1544—Daza Chacon acquired an extensive -experience in the treatment of both arrow and gunshot wounds, for the -number of those injured on those occasions was very great. In 1545, -after he had been chosen personal physician of Charles the Fifth, he -returned home by way of Madrid, and distinguished himself greatly in -1547 by his self-sacrificing attendance upon the victims of the Plague -in his native city. In 1557 he offered himself as a candidate for the -position of Surgeon-in-Chief of the hospital at Valladolid,<span class="pagenum" id="Page_485">[485]</span> and, after -passing with great credit the competitive examination, he was given the -appointment. During the following six years he served that institution -with conspicuous ability, and then accepted the position of private -physician to Prince Don Carlos, the son of Philip the Second, King of -Spain. Four years later he entered the service of Don Juan of Austria -(the natural brother of Philip the Second), and accompanied this prince -on his sea voyages to various parts of the Mediterranean; being with -him, for example, on the occasion of the bloody sea fight in the Gulf -of Lepanto in 1571. On reaching the age of seventy, Daza Chacon retired -from active practice and devoted himself to the writing of his great -work on surgery—“<i>Practica y teorica de cirujia, en Romance y en -Latin</i>,” Valladolid, 1600; and several later editions. The date -of Chacon’s death is not known, but it certainly occurred before the -publication of his book.</p> - -<p>Von Gurlt says that Chacon’s treatise is distinguished by the -systematic and clear manner in which the author treats the subjects -with which he deals, and it shows him to be well versed in the -teachings of other writers on surgery, that he is ready at all times -to give them full credit for any contributions which they may have -made to this branch of medicine, and that he is remarkably free from -the superstitiousness which was so prevalent in his day. Of all the -treatises on surgery which have been written by Spaniards, either -during the sixteenth century or at a more recent date, this work, says -von Gurlt, is unquestionably the best.</p> - -<p>The edition of the treatise published at Madrid in 1626 contains 922 -pages—a large work. Among the reports of cases published in Part II., -there are several which possess features of considerable interest, but -I shall be able to reproduce only one of them here:—</p> - -<div class="blockquot"> - -<p>The young prince, Don Carlos, aged seventeen, while residing -temporarily at Alcalá de Henares, plunged head foremost, in -the dark, down a steep staircase and struck his head against a -closed door. When the lad was picked up it was found that, at -the back of his head, there was an open wound about the size of -a man’s thumbnail, that the surrounding scalp showed evidences -of being<span class="pagenum" id="Page_486">[486]</span> bruised, and that the pericranium in this region -had been laid bare. During the first three days following the -accident the patient manifested only a moderate degree of fever, -but on the fourth day the fever became more pronounced. The -wound, which by this time was discharging actively, presented at -first a healthy appearance, but it soon acquired an unhealthy -aspect, and the patient began to complain of numbness in the -right leg. Vesalius, the private physician of Charles the Fifth, -the boy’s grandfather, was one of the many physicians who were -called in to consult about the treatment of this case; he was -sent for on the eleventh day following the accident. On the -seventeenth day the wound was enlarged and the bone carefully -examined, but no evidence of a fracture or a fissure was -discovered. On the following day erysipelas manifested itself on -the head and neck and extended downward until it had involved -both arms. At the same time the fever increased very markedly, -and for five days the patient was delirious. As by this time -there was ample reason for suspecting that some intracranial -injury had occurred, it was decided to trephine the skull. The -operation was performed on the twenty-first day, but nothing of -importance was discovered. The patient’s life was now evidently -in great peril, and an unfavorable prognosis was pronounced. -Four days later, however, complete consciousness returned. -On the twenty-ninth day a quantity of pus was evacuated from -the very much swollen eyelids; and, three days later still, -the patient was found to be quite free from fever. On the -forty-sixth day he left his bed for the first time, and at the -end of ninety-three days the wound was found to have firmly -cicatrized.</p> - -<p>[Some interesting details concerning the subsequent life of Don -Carlos will be found in Motley’s “Rise of the Dutch Republic.” -They suggest the possibility that his attacks of violent temper -may have resulted from the lesions produced by the accident -narrated above.]</p> -</div> - -<p>Francisco Arceo was born, about the year 1493, at Fregenal in the -Province of Badajoz, Spain. It is not known at what university or other -educational institution he received his early training in the science -of medicine. It is a well-established fact, however, that at quite an -early stage of his professional career he acquired great celebrity for -his skill in treating both surgical and internal maladies, and that, -as a consequence, patients flocked in large numbers<span class="pagenum" id="Page_487">[487]</span> from all parts of -Spain to consult him. Rather late in life he wrote two treatises—one -on the treatment of wounds, as well as on ulcers and syphilis, and -another on the management of fevers. These two works were published at -Antwerp, in the year 1574, as a single volume, the author being at that -time, despite his advanced age (eighty), still in vigorous health and -able to practice with skill both branches of the science of medicine. -In 1658 a second edition of Arceo’s two treatises was published -at Amsterdam; and even at an earlier date there were published an -English translation (1588) and a German version (1614). A perusal of -the chapter which he devotes to the treatment of clubfoot gives the -impression that Arceo was an excellent surgeon—eminently practical -in his choice of means for securing certain results, and thoroughly -familiar with the extent to which he might depend upon the powers of -Nature to aid his efforts. The date of his death is not known.</p> - -<p>Amatus Lusitanus is the name by which the Portuguese medical writer, -Juan Rodriguez de Castel Bianco, is commonly known. He was born in the -Province of Beira, Portugal, in 1511, of Jewish parents, and studied -medicine at the University of Salamanca. After doing duty as a surgeon -in two of the hospitals of that city, he took up his residence, for -short periods of time, first in Antwerp and then in Ragusa, Dalmatia, -on the eastern coast of the Adriatic. At this period of our history -the Inquisition was extremely active throughout the domains that were -under the rule of Charles the Fifth, and as a result Amatus soon -found himself obliged to abandon all his books, instruments, etc., -and flee for his life to Northern Greece. As the Turks, who were in -possession of that country, were perfectly indifferent with regard to -the religious beliefs of the Jews, Amatus was allowed to settle down -quietly for the rest of his life at Thessalonica, in Macedonia.</p> - -<p>During the later years of his career he published several books on -topics relating to the science of medicine—two of them on materia -medica and two on the cases of special interest which had come under -his personal observation<span class="pagenum" id="Page_488">[488]</span> during the course of his practice. The -latter work, which is entitled “<i>Curationum medicinalium centuriae -VII.</i>,”<a id="FNanchor_87" href="#Footnote_87" class="fnanchor">[87]</a> was printed in its entirety in Venice, in 1556 (2 -vols.). Von Gurlt speaks of Amatus as a cultivated scholar and an -excellent observer. Of the seven hundred cases reported in this work -only a very few are of interest to the surgeon. Von Gurlt calls -attention to the fact that, during the earlier years of his practice, -Amatus devoted a fair share of his attention to surgery, but that -subsequently he performed no operations whatever; it being his rule to -intrust this work entirely to a regular surgeon or to a specialist.</p> - -<p>In my search among the dozen or more histories of cases selected by -von Gurlt from the seven “Centuries” (700) of the complete treatise -as suitably illustrating Amatus’ manner of reporting the cases which -he had seen in practice, the various methods of treatment which he -adopted in his efforts to relieve the diseases or injuries that came -under his observation, and the demeanor of the man in the presence of -the ever-changing problems presented to the physician, I have succeeded -in finding only four that seem to furnish in even a slight degree the -information which I have just outlined. Unsatisfactory as these four -reports are in certain respects,—especially in their failure to reveal -to us the more strictly surgical capabilities of Amatus,—they at least -show that he was an able and conscientious practitioner, and to this -extent they possess value.</p> - -<div class="blockquot"> - -<p>The first case reported in Century I. is that of a peasant girl, -aged thirteen, who, while walking barefooted in a field was -bitten by a viper. Amatus did not see the patient until three -hours later, but already at this early stage he observed many -blue and red patches, scattered over the leg and thigh of the -side on which the bite had been inflicted. Near the base of -the foot there were two quite black spots corresponding to the -bites of the reptile; and from the fact that there were only two -such spots Amatus inferred that the snake must have been a male -viper, which has only two poison fangs and is therefore less -dangerous than the female which has four. The symptoms which -the girl experienced were faintness, trembling and dizziness. -As regards the treatment adopted,<span class="pagenum" id="Page_489">[489]</span> the skin in the immediate -neighborhood of the bites was scarified and suction by the means -of cupping glasses was employed; afterward a plaster, which was -composed in part of theriaca, was applied to this region. The -patient made a complete recovery.</p> - -<p>In Century V., Amatus gives an account of a fatal case of ear -disease. The patient, a sickly-looking boy of eight who had -been affected for a long time with a discharge from one ear, -presented a non-sensitive lump on the side of the head. “As he -began to show signs of feverishness it was decided to incise the -lump; and when the incision had been made, it was found that a -large part of the skull in this region had been destroyed by -caries, as a result of which there was left a cavity in the side -of the head, and this cavity was filled with a foul-smelling -pus, débris, and granulation tissue that apparently rested on -the dura mater. Three days later the surgeon<a id="FNanchor_88" href="#Footnote_88" class="fnanchor">[88]</a> succeeded in -removing from the cavity only a small quantity of the sanious -material. On the fourth day, after an attack of convulsions, the -patient died.”</p> - -<p>In Century VII. there is given an account of a man of the -wealthy class who had been exposed to an excessive degree of -cold for so long a time that he was literally almost half -frozen. “As he was being carried into the village he gave orders -that an ox should be slaughtered and that he himself should be -snugly stowed away inside the carcass of the animal as soon -as its interior furnishings had been removed. Thus he escaped -freezing to death.”</p> - -<p>In the same century Amatus speaks of having seen a rather -interesting case of <i>Filaria Medinensis</i> (called by the -Arabs “<i>vena medena</i>”) in a negro boy, eighteen years old, -who had come to Thessalonica from Memphis, Egypt. “The worm -had caused the production of an ulcer close to the boy’s heel, -and in this the creature’s head, which looked very much like a -vein, was recognizable. After the Turks had correctly diagnosed -the nature of the trouble an Arabian physician, who had managed -to secure a purchase on the worm, began rolling it up on a -small stick. Gradually, after the lapse of several days, he -succeeded in uncoiling the animal in its entire length (three -cubits), as shown by the construction of the end of the tail, -and thus permanently freed the boy from his trouble. The ancient -authors express doubts as to the true nature of the object found -in these ulcers, but I, Amatus, having examined the slender -white creature and having witnessed its curved outlines as it -projected itself outside the opening, do vouch for the fact that -it possesses all the characteristics of a true worm.”</p> -</div> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_490">[490]</span></p> - -<h3>CHAPTER XXXIX<br /> -<span class="subhed1">THE DEVELOPMENT OF SURGERY IN FRANCE DURING THE RENAISSANCE.—PIERRE -FRANCO</span></h3></div> - -<p>Von Gurlt speaks of Pierre Franco as “one of the most skilful surgeons -and at the same time one of the most original medical writers of the -sixteenth century.” He and his contemporary, Ambroise Paré, were -of French birth, and to France therefore belongs the conspicuous -distinction of having contributed to medical science during the -Renaissance two of its most illuminating and efficient laborers. These -men, who were the leading operative surgeons in France during the -first half of the sixteenth century, did not owe their education as -physicians to the official training provided by the Medical Faculty, -but partly to the men who were classed as barbers and surgeons, or -barber-surgeons (<i>Collège de St. Côme</i>), and still more to -their own efforts. They gathered practical knowledge wherever they -might—largely from their official connection with armies during the -progress of different wars. Further details with regard to their -personal characters and the principal events of their professional -careers will be furnished in the following brief sketches.</p> - -<p><i>Pierre Franco.</i>—Pierre Franco was born in the village of -Turriers, in Provence (now the Department of Basses-Alpes), about -the year 1500. He received his instruction in surgery from itinerant -lithotomists, operators for cataract, hernia-healers and men of -that class; and it is quite likely that, in the early days of his -professional career in Provence, he was himself a practitioner of this -humble type. At a somewhat later date he left the southern part of -France and took up his residence in Switzerland, first at Berne and -then at Lausanne. He probably left Provence<span class="pagenum" id="Page_491">[491]</span> because, in the early -part of the sixteenth century, the Protestants of that region were -being subjected to every form of persecution; and it is almost certain -that Franco belonged then to the Reformed Church, for he accepted the -salaried office of City Surgeon at Berne, the authorities of which city -were bitterly opposed to everybody and everything connected with the -Roman Catholic Church. Franco held the office named during a period -of ten years, the first part of the time at Berne, and afterward at -Lausanne, which latter city was then under the control of the Bernese -Government. He was a very close observer, a most enthusiastic student -of his art, and a man of intensely religious nature. Malgaigne, the -distinguished editor of the modern edition of Paré’s writings, speaks -thus of Franco: “I have no intention of writing here the history of -this man who was endowed with such a fine surgical genius; I may say, -however, that his was a life devoted entirely to the advancement of -surgery as a science.”</p> - -<p>As an operative surgeon, says Edouard Nicaise, Franco ranked higher -than any of his contemporaries. Strange as it may appear, Ambroise Paré -frequently refused to take charge of cases in which an operation for -stone in the bladder, for hernia, or for cataract was required, whereas -Franco owed much of his reputation to the success which he had in -operating upon these three classes of cases. The latter, furthermore, -did most of his work on patients who belonged to the middle class, and -consequently his operations were characterized by very little of the -éclat which marked a large part of the work done by Paré, who from the -very beginning was befriended by Royalty and the Court circle. At the -same time, says Nicaise, Franco did more than any other man of that -period to enrich surgery with new discoveries.</p> - -<p>Franco has written only two treatises. The first one, which was -published in Lyons, France, in 1556, bears the title: “A Small -Treatise on the Operative Treatment of Hernia”—one of the most -important departments of surgery (a book of 144 pages, 8vo). The second -work, which was issued in 1561, also at Lyons but by a different -publisher,<span class="pagenum" id="Page_492">[492]</span> bears the title: “<i>Traité des hernies contenant une -ample déclaration de toutes leurs espèces, etc.</i>” (a book of 554 -pages, 8vo). This work goes very thoroughly into the subject of hernia -in all its bearings, and also deals with several other important -surgical topics, such as genito-urinary diseases (in both the male -and the female), affections of the eyes, hare-lip, tumors, wounds in -general, dislocations, fractures, amputations, etc.; in short, it is -a fairly complete and decidedly original treatise on general surgery. -When Franco wrote the smaller work (that of 1556), he was settled at -Lausanne; but in 1561 he was living in Orange, which at that time was -the capital of a Principality that belonged to the House of Nassau.<a id="FNanchor_89" href="#Footnote_89" class="fnanchor">[89]</a> -A few brief citations from the larger of the two treatises will suffice -to give our readers some idea of the manner in which Franco deals with -the subject-matter of the book.</p> - -<p>Franco, says von Gurlt, was one of the first surgeons—perhaps the -very first—to perform the operation required for the relief of -strangulated hernia and at the same time to furnish a description of -the manner in which it should be performed. After mentioning the fact -that the strangulation of a portion of the intestine is attended with -considerable danger to the patient’s life, Franco proceeds to consider -the subject in greater detail:—</p> - -<div class="blockquot"> - -<p>Owing to the large amount of the fecal matter and gas contained -within the portion of the intestine that is imprisoned in -the scrotum, and also owing to the inflamed condition of -the parts, it is frequently not possible to push the bowel -back through the narrow aperture in the peritoneum; and this -condition of things is apt to be aggravated by the constipation -or by the efforts at vomiting that frequently accompany such -strangulation. The vomiting, it is true, may in certain cases -facilitate the desired reduction, but in others it does harm, -especially by forcing more fecal matter into the scrotum. If -the conditions described are permitted to continue unrelieved, -death may certainly be expected to result. In a few cases the -timely administration of medicine internally may overcome the -difficulty, but, if this measure fail to produce the desired<span class="pagenum" id="Page_493">[493]</span> -result, recourse must be had to surgery—not, however, if -already the scrotum and neighboring genital parts have changed -their color to a black, livid, bluish or some other unnatural -hue, or if the hernial tumor manifest a round rather than an -elongated shape, for all these signs are harbingers of death; -and, as further unfavorable signs, should be reckoned a livid -or black mucous membrane of the patient’s mouth, contracted -nostrils, and an appreciably sunken condition of the eyes. But -if, on the other hand, the scrotum possess a natural color and -if it have not a spherical form but rather an oval shape, then -it is proper, after a failure to secure the desired reduction by -the internal use of medicine, to resort to a surgical operation.</p> - -<p>For the proper performance of this operation the surgeon -should be provided with a nicely rounded metal staff, flat on -one side, and a little larger than a goose’s quill. [Paré’s -grooved sound or director, says von Gurlt, had not yet at that -time been invented, and this staff was intended to serve, in -a crude fashion, the same purpose.] The first step is to make -an incision in the upper part of the scrotum, the direction in -which it is to be carried being toward the symphysis pubis. When -the hernial sac is reached the staff is introduced into the slit -and pushed upward between the wall of the sac and the fleshy -part of the penis, the flat side of the instrument being kept -uppermost, as it is upon this surface that the cutting with the -scalpel or the razor is to be done. After the end of the staff -has been pushed well upward the flesh of the scrotum is to be -divided upon the flat surface of this instrument; all danger -of injuring the intestine being thus avoided. Then the attempt -should cautiously be made to reduce or replace the intestinal -folds. But if these efforts fail,—owing to the excessive -distension of the bowel or because the constricting band has -not yet been sufficiently relaxed,—then the following steps -should be taken:—Grasp the spermatic cord (“<i>didymis</i>”), -lift up its enveloping membranes one by one with hooks, and -divide each one of them completely upon one’s finger nail, up -to the point where the intestine is encountered. Then, having -established, between the intestinal wall and the membranous -coverings of the cord, an aperture large enough to admit the end -of the metal staff, push the instrument onward and upward while -at the same time it is held as it were balanced in the air, so -that early warning may be communicated to the holding fingers in -case the instrument, as it travels onward, should become caught -in the folds of the intestine—an accident, however, which the -slippery nature of the outer surface<span class="pagenum" id="Page_494">[494]</span> of the intestine renders -improbable, but which nevertheless may occur if at any point -there happen to be a break in the continuity of the tissues. As -the next step in the operation the cord should be completely -divided high up (the incision being made upon the staff) close -to the opening in the peritoneum through which the folds of the -intestine forced their way, in the first instance, into the -scrotum; but the surgeon must, without fear of doing harm, and -remembering that he is dealing with conditions of a desperate -nature, see to it that the opening made in the peritoneum is -amply large. Finally, with the aid of a soft piece of linen -he should return the folds of the intestine to the peritoneal -cavity, etc. [The remaining portions of the description are of -minor importance and may well be omitted here.]</p> -</div> - -<p>Franco, speaking of those cases in which a portion of the omentum is -found projecting into the hernial sac, lays great stress upon the -importance of “not doing what many a surgeon has done in the past -and what not a few are still doing in our time, viz., simply cutting -off the imprisoned distal portion of this membrane and returning -the remainder to the peritoneal cavity without first ligating the -divided blood-vessels and then cauterizing the cut surface; the -danger being that a failure to take these steps frequently leads to -a fatal hemorrhage into the peritoneal cavity—an occurrence which -actually happened to one of our most experienced surgeons in a case of -enterepiplocele.”</p> - -<p>There were certain operative procedures in which Franco took a greater -interest than in others. Thus, for example, he was particularly fond of -operating for the relief of cataract, and the results which he obtained -were exceptionally favorable (180 cures out of a total of 200 cases -subjected to operation). Von Gurlt quotes him as saying:—</p> - -<div class="blockquot"> - -<p>If I had to choose between operations for the cure of cataract -and abandoning all the rest of my surgical practice, I should -prefer to adopt the latter course, so highly do I estimate the -amount of good which I can do in this line of work, so very -important does it appear to me, and so small is the amount of -labor and worry which it entails.</p> -</div> - -<p>Franco was also greatly interested in the cure of stone in the bladder, -and it was while treating cases of this<span class="pagenum" id="Page_495">[495]</span> character that he invented the -very important surgical procedure known in France as the “Franconian -operation for stone in the bladder” (hypogastric cystotomy, suprapubic -lithotomy). Here is the account which he gives of the circumstances -under which he was led to devise this method of removing a stone from -the bladder:—</p> - -<div class="blockquot"> - -<p>I will mention here an experience which I had on one occasion -when I tried to remove a calculus from the bladder of a boy -about ten years of age. The stone was about as large as a -hen’s egg and resisted all my efforts to extract it by way of -the incision made in the perinaeum. Being in a quandary as to -how I should proceed next, and the parents and friends being -greatly demoralized by the suffering to which I was unavoidably -subjecting their child,—they maintained, I should add, that -they would rather have him die than be subjected to such awful -suffering;—and being influenced also by the thought that I -could not afford to have it charged against me that I was not -able to extract the calculus, I deliberately decided that I -would make an opening above the pubic bone, and would remove -the stone in this manner. Accordingly I incised the skin above -the pubes, a little to one side of the base of the penis, and -carried the knife through the soft tissues down to the calculus, -which I had simultaneously pushed upward by pressing the fingers -of my left hand against the perinaeum, while at the same time -my assistant made counter-pressure against the stone by firmly -compressing the abdominal wall above the object. This method of -extraction proved successful.</p> - -<p>In due time the wounds healed firmly and the patient was -relieved of his trouble, but only after a long and most serious -illness.</p> -</div> - -<p>Franco does not appear to have performed the suprapubic operation -for the extraction of a cystic calculus more than once (the case -just narrated), and he carefully refrains from recommending it to -other physicians. Most surgical authors, says Edouard Nicaise, blame -Franco very strongly for not having dared to recommend his suprapubic -operation. “But I do not agree with this judgment; Franco should rather -be praised for his prudence in not immediately announcing to the world -his invention of an important surgical operation.”<a id="FNanchor_90" href="#Footnote_90" class="fnanchor">[90]</a></p> - -<p><span class="pagenum" id="Page_496">[496]</span></p> - -<p>The subsequent history of suprapubic lithotomy shows that Franco was -laboring under an exaggerated idea of the dangers attending this -operation. The comments of Pascal Baseilhac—a nephew of “Brother -Cosmas” (the famous French lithotomist of the early part of the -eighteenth century) and himself a skilled lithotomist—are worthy -of being repeated here. He says (p. 318 of his “<i>Traité sur la -lithotomie</i>,” Paris, 1804): “Franco based his unwillingness to -recommend the operation of suprapubic lithotomy on the belief which -was then widely prevalent, and which still persists even in our time -(middle of the eighteenth century), that the making of an incision into -the main body of the urinary bladder is sure to prove fatal, a belief -which experience and observation have now shown to be unwarranted.”</p> - -<p>The Franconian operation, the great value of which was not sufficiently -appreciated by its inventor nor by contemporary surgeons, was revived -in 1719 by an Englishman, John Douglas, the distinguished surgeon of -Westminster Hospital, London, and the brother of James Douglas—the -anatomist who in 1730 described so minutely the relations of the -peritonaeum to the bladder (Douglas’ cul-de-sac).</p> - -<p>In the case the history of which has just been narrated, the -circumstances attending the invention of the operation known to-day as -suprapubic cystotomy<a id="FNanchor_91" href="#Footnote_91" class="fnanchor">[91]</a> or “suprapubic lithotomy,” were certainly of -such an unfavorable character as to call for the display of an unusual -degree of courage, wisdom, patience and manual skill on the part of -the surgeon in charge; and it was through a careful consideration of -these facts that Edouard Nicaise was led to award such high praise to -Franco for the work which he had done. Scarcely less remarkable is -the talent which the latter<span class="pagenum" id="Page_497">[497]</span> displayed in the invention of a forceps -(Fig. 22) strong enough to crush all but the hardest calculi and -yet so cleverly planned that it is practicable, while the crushing -end of the instrument is lying inside the bladder, to separate the -blades sufficiently far apart to render possible the grasping of the -stone between the jaws of the instrument without at the same moment -injuriously crushing the soft parts in the narrow channel of the wound -or opening.<a id="FNanchor_92" href="#Footnote_92" class="fnanchor">[92]</a></p> - - <div class="figcenter" id="i_p497" style="width: 476px"> - <img - class="p2" - src="images/i_p497.jpg" - alt="" /> - <p class="center p0 sm">FIG. 22. PIERRE FRANCO’S FORCEPS FOR CRUSHING CALCULI IN -THE URINARY BLADDER.</p> - <p class="center p0 sm">(From Edouard Nicaise’s <i>Pierre Franco</i>, Paris, 1895.)</p> - <p class="center p0 sm"><i>a</i>, closed; <i>b</i>, open.</p> - </div> - -<p><span class="pagenum" id="Page_498">[498]</span></p> - -<p>In Franco’s day the belief was widely prevalent that there were -remedies which possessed the power of dissolving a cystic calculus. -His own opinion in regard to this matter is expressed in the following -words: “I am astonished that there should be many men who do not -hesitate to undertake the disintegration and pulverization of a stone -in the bladder by the employment of remedies which are either to be -administered by the mouth or to be injected <i>per urethram</i> into -that organ.” He adds that a remedy strong enough to dissolve even the -softer stones would become so changed and weakened in passing through -the various organs which it must traverse on its journey from the -mouth to the bladder that it could not possibly produce the desired -effect; nor could a chemical solution strong enough to dissolve such -a calculus be injected into the bladder by way of the urethra without -either causing inflammation and ulceration of the walls of that organ -or promptly exciting muscular contraction that would effectively expel -the solution.</p> - -<p>This seems to be an appropriate place in which to state that lithotrity -was practiced at an earlier date by Antonio Beniveni (1440–1502), a -Florentine physician whose writings reveal him to have been a man of -a very practical and unprejudiced type of mind, a very clear writer, -and a practitioner of wide experience. He also deserves credit for -having been the first surgeon to revive the operation of tracheotomy, a -procedure which was carried out by Antyllus fourteen centuries earlier, -but which appears to have been forgotten during this long interval. He -saved a patient’s life by means of the operation.</p> - -<p>The date of Franco’s death is not known.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_499">[499]</span></p> - -<h3>CHAPTER XL<br /> -<span class="subhed1">THE DEVELOPMENT OF SURGERY IN FRANCE (Continued).—AMBROISE PARÉ</span></h3></div> - -<p>Ambroise Paré was born, about the year 1517, at Laval, a small town in -the Department of Mayenne, France. His father was probably the valet -and barber of the Count of Laval. He went to Paris in early manhood -and spent three years, at this period, in fitting himself for the -career of a surgeon. He attended lectures on anatomy and surgery, did a -certain amount of dissecting, served for over two years as a surgeon’s -assistant in the great hospital of Hôtel-Dieu, made notes of some of -the cases which he saw, and was occasionally permitted to prescribe -for patients and even to perform some minor operations. From 1536 -onward, nearly up to the time of his death, he was almost continuously -engaged, in the capacity of a surgeon, in accompanying different -French armies on their military expeditions. His professional title -at first was that of “barber,” but he doubtless very soon discovered -that, if he wished to advance, it would be absolutely necessary for -him to secure a higher title. Accordingly, in 1541, he and his friend -Thierry de Héry presented themselves for, and passed successfully, -the required examination and were accepted as “master-barbers.” It is -an interesting fact that, during his long professional career, Paré -was Chief Surgeon to four Kings of France in succession—first to -Henry the Second (1547–1559), next to Francis the Second (1559–1560), -then to Charles the Ninth (1560–1574), and finally to Henry the Third -(1574–1589). The last-named King bestowed upon him the additional -honor of “Councilor to his Majesty.” He also served, during a certain -period of his career, as an attending surgeon at Hôtel-Dieu.<span class="pagenum" id="Page_500">[500]</span> The three -large volumes of Paré’s writings (Malgaigne’s edition) are filled with -the rich experience which this great surgeon gained in the course -of a large private practice and in the field expeditions and sieges -conducted during the reigns of these Kings. Interspersed among the -reports of cases and descriptions of operations are to be found not a -few comments of a more general character and some biographic details -which add greatly to the charm of the work as a whole, and which at -the same time make it possible to form a general idea of Paré’s traits -of character. On almost every page one finds statements which reveal -the fact that he weighed almost all the duties of his daily life in a -profoundly religious manner. He showed himself warmly sympathetic for -all those whose ailments he was called upon to treat, and he was always -as ready to bestow his best services upon the Roman Catholics as upon -the Huguenots—to which latter denomination (if we may so call it) he -himself is commonly reported to have belonged. It seems to me more -probable, however, that he was a liberal-minded Roman Catholic rather -than a Protestant, for there is trustworthy evidence showing that all -his ten children were baptized in that faith and that he himself, -nineteen years before the night of Saint Bartholomew (August 24, 1572), -held the office of “<i>Pathe</i>” in the church of the parish in which -he lived. Another prominent trait of Paré’s character was the modest -estimate which he placed upon his own professional achievements. One of -his sayings, which occurs a number of times in his writings and which -has since become famous, is this:—</p> - - <div class="poetry-container"> - <div class="poetry"> - <div class="stanza"> - <div><i>Je le pansay, et Dieu le guarist.</i></div> - <div>[I dressed his wound and God caused it to heal.]</div> - </div> - </div> - </div> - -<p>Some of the other sayings attributed to his pen and printed under the -heading “Surgical Canons and Rules,” at the end of Book XXVI., are -characterized by a homely type of wisdom which seems to have -secured for them a permanent place in French literature. I give here -in the form of English translations six or seven of the more striking -specimens:—</p> - -<p><span class="pagenum" id="Page_501">[501]</span></p> - -<div class="blockquot"> - -<p>Mere knowledge without experience does not give the surgeon much -self-confidence.</p> - -<p>Small will be the influence exerted by him who chooses surgery -as a career simply for what he may make out of it.</p> - -<p>The frequent changing of physicians is not likely to bring -comfort to the patient.</p> - -<p>The facts already discovered are few in comparison with those -which are yet to be brought to light. We must not allow -ourselves to lie down or fall asleep under the impression -that the ancients knew all or have divulged all that is worth -knowing. What they have accomplished should be utilized by us as -a sort of scaffolding from which a more extensive view may be -obtained.</p> -</div> - -<p>In another place Paré expresses the same sentiment in a somewhat -different form, as follows:—</p> - -<div class="blockquot"> - -<p>My professional brethren must not expect to find any new and -startling facts [Paré is speaking here of his treatise on -surgery], but simply here and there some little addition to -our previous stock of knowledge; for the good Guy de Chauliac -has taught us that we are like the child who sits astride the -giant’s neck; that is, we can see all that he sees and just a -little more—or, in other words, we are able, through the aid -afforded by the writings of our predecessors, to learn all that -they have learned, and may at the same time acquire a little -further knowledge through our own observations.</p> - -<p>A remedy that has been thoroughly tested is better than one -recently invented.</p> - -<p>An injury which opens a large blood-vessel is likely to lead the -victim of such a wound to the tomb.</p> - -<p>It is always wise to hold out hope to the patient, even if the -symptoms point strongly to a fatal issue.</p> -</div> - -<p>All through his professional career, but more especially during the -later years, Paré was repeatedly annoyed by the efforts which the -Medical Faculty made to bring him into disrepute. These men were -bitterly jealous of him on account of the great favor which he enjoyed -at Court, and so they adopted every possible means to injure his -reputation. When the complete collection of his writings was published -in 1575, they petitioned the authorities not to allow these “works of -a very impudent and ignorant man”<span class="pagenum" id="Page_502">[502]</span> to be sold until they should have -received the official sanction of the Faculty. One of Paré’s chief -offenses, as it appears, was that of not writing his treatises in -Latin, and among the twenty-nine specifications of his shortcomings was -that of plagiarism. (See remarks on this subject further on.)</p> - -<p>In his efforts to extend his knowledge of the science of medicine, and -in particular to learn what the ancients had written on the subject, -Paré soon discovered that many obstacles stood in his way. He did not -allow himself, however, to be discouraged by this fact, but set to -work, without delay and in his usual resolute fashion, to remove them. -He found, in the first place, that all the available treatises of the -ancient medical authors were written in Latin, a language of which he -possessed scarcely any knowledge. So he was obliged to hire men to -translate for his own use large portions of these books. Then, at a -later date, after he had begun to accumulate notes for the treatises -in which he proposed to publish his own experiences and his own views -about the surgical topics in which he was interested, he saw clearly -that suitable pictorial illustrations would add materially to the -value of the written text, and he therefore did not hesitate to spend -a considerable sum of money—Malgaigne says three thousand livres—in -having the needed drawings made. Paré was also in no small degree -a public benefactor, for he purchased the formulae of some of the -more valuable of the remedies employed by the leading charlatans, in -order that he might print them and so place them within the reach of -everybody.</p> - -<p>Paré gives the following picturesque account of his first experiences -as an army surgeon in actual warfare:—</p> - -<div class="blockquot"> - -<p>In 1536, he says, I accompanied the large army sent to Turin by -Francis the First, King of France, to retake certain castles and -fortifications which were held at that time by the troops of -the Emperor Charles the Fifth. My official position was that of -surgeon to the foot soldiers; and when our men took possession -of Susa, after the enemy had been defeated, I was among the -first to enter the city. Our horses rode rough-shod over the -dead bodies lying on the roadway, and over the bodies of many -who were simply<span class="pagenum" id="Page_503">[503]</span> wounded. It excited my compassion strongly -to hear the cries of those who were thus subjected to great -additional suffering, and I could not help wishing that I had -never left Paris. Once actually in the city, I began to look -around for a stable in which the horses of myself and my orderly -might find shelter. The one I entered contained the corpses of -four soldiers who had presumably died there, and three badly -wounded men who were still alive, but whose faces were greatly -disfigured by the wounds which they had received, and who—as we -soon learned—were unable to see, hear or speak. An old soldier -who entered the stable at that moment, and whose pity was -excited by what he saw, asked me if it would be possible to save -the lives of the men who were so badly injured. I replied “No.” -He thereupon proceeded, without the least excitement and with -due gentleness, to cut the throats of all three. At the sight of -this act, of what seemed to me to be great cruelty, I exclaimed, -“You are a wicked man!” His reply was: “I pray God that, if it -should ever be my fate to be situated as these three men were -when I entered the stable, there may be somebody at hand who -will do to me what I have just done to these men, and will save -me from a lingering and painful death.”</p> - -<p>When the fighting was entirely over, we surgeons had much work -to do. I had not yet had any personal experience with the -treatment of gunshot wounds, but I had read in Giovanni da -Vigo’s work that such injuries should be considered poisoned -wounds, by reason of their contact with gunpowder, and that the -correct way of treating such wounds was to cauterize them with -oil of sambucus (elder flowers) that was actually boiling and -to which a little theriaca had been added. At first I hesitated -somewhat about carrying out this practice, but after watching -the other surgeons, in order to learn exactly how they applied -the boiling oil, I plucked up my courage and did exactly what -they did. My supply of oil, however, soon gave out, and I then -decided to use as a substitute a healing preparation composed of -yolk of egg, oil of roses, and turpentine. I slept badly that -night, as I greatly feared that, when I came to examine the -wounded on the following morning, I should find that those whose -wounds I had failed to treat with boiling oil had died from -poisoning. I arose at a very early hour, and was much surprised -to discover that the wounds to which I had applied the egg and -turpentine mixture were doing well; they were quite free from -swelling and from all evidence of inflammatory action; and the -patients themselves, who showed no signs of feverishness, said -that they had experienced little or no pain and had slept quite -well.</p> - -<p><span class="pagenum" id="Page_504">[504]</span></p> - -<p>On the other hand the men to whose wounds I had applied the -boiling oil said that they had experienced during the night, and -were still suffering from, much pain at the seat of the injury; -and I found that they were feverish and that their wounds were -inflamed and swollen. After thinking the matter over carefully, -I made up my mind that thenceforward I should abstain wholly -from the painful practice of treating gunshot wounds with -boiling oil.</p> -</div> - -<p>In 1545, when he was about twenty-eight years of age, Paré was sent as -a military surgeon to Boulogne-sur-Mer, which at that moment was being -besieged by the French. In 1544 the city had been captured by the army -of Henry the Eighth of England, and fighting of a desultory character -was in progress between the besiegers and the besieged at the time of -Paré’s arrival. He had not been there a long time when he was asked to -see professionally Francis of Lorraine, Duke of Guise, who had been -seriously wounded by a lance in a recent encounter with the enemy. The -metal head of the weapon, under the impulse of a glancing blow, had -penetrated the skin just above the right eye, had then traveled toward -the left side and in a slightly downward direction, along the surface -of the skull, and had finally come to rest at a point behind and below -the left ear, near the nape of the neck. When the lance had penetrated -thus far the wooden shaft broke in two, leaving the metal head in its -entirety and a part of the shaft so firmly lodged in the wound that -great force had to be employed before it was found possible, with the -aid of strong pincers, to extract it from its bed. An examination of -the injured parts then showed that there had been some fracturing of -the bony structures and extensive laceration of the arteries, veins, -nerves, etc., but that the left eye had apparently not been seriously -damaged. The onlookers were naturally impressed with the belief that -the Duke could not possibly recover from such a slashing of the face -and head; and Paré himself was careful at first not to commit himself -to a prognosis of too favorable a nature. However, he treated the -wound with the greatest care and in the course of a few weeks had the -satisfaction of seeing his patient restored to perfect health, but with -a deeply scarred face.</p> - -<p><span class="pagenum" id="Page_505">[505]</span></p> - -<p>As can readily be imagined, this experience proved a splendid triumph -for Paré, and speedily brought him into great favor at Court and among -the nobility throughout France.</p> - -<p>For several years subsequent to these events, Paré continued to serve -actively as a surgeon in the frequent wars which took place between -the royal troops of France and the armies of other European monarchs. -In 1552, when he was thirty-five years of age, his rank in the army -was raised to that of “Surgeon to the King,” the entire medical staff -of that period consisting of twelve surgeons of this rank. In 1554 he -was admitted to the <i>Collège de Saint Côme</i> in Paris, the highest -professional honor to which a barber-surgeon might aspire; and in 1563, -after the siege of Rouen, he received the appointment of “First Surgeon -to Charles the Ninth.” After the latter’s death, Henry the Third also -appointed Paré to the same position in his Court. Thus, from almost the -very beginning of his professional career to the time of his death, -Paré was honored in every possible way by four successive Kings of -France. It was Charles the Ninth, however, who appears to have taken -a greater interest in Paré’s prosperity than did either of the other -three Kings. It was at Charles the Ninth’s request, for example, that -the brother-in-law of the Duke of Ascot, the Marquis of Auret, sent -for Paré to undertake the treatment of a wound which he had received -from a harquebus ball seven months previously. Paré gives the following -account of this interesting case which foreshadows—for example, in the -changing of the patient’s bed and linen and keeping him entertained -during convalescence—the best modern hospital nursing:—</p> - -<div class="blockquot"> - -<p>On arriving at the Chateau of Auret, writes Paré, which is -located not far from Mons in Belgium, I learned that the -harquebus ball had entered the thigh near the knee, had done -considerable damage to the soft parts, and had fractured the -femur. When I was ushered into his bedchamber, I found the -Marquis very much emaciated, his eyes deeply sunken in their -sockets, his skin hot and of a yellowish hue, and his voice -feeble like that of man very near to death.... The leg was drawn -up against the wall of<span class="pagenum" id="Page_506">[506]</span> the abdomen, and two large bedsores -were visible posteriorly—one near the root of the spine and -the other somewhat higher up. Thus it was impossible for the -patient to assume any posture in which he would be free from -suffering.... All things considered, it did not seem to me that -the Marquis could possibly recover from such a combination of -bodily ills. Nevertheless, to give him some encouragement,—for -he was very low in spirits,—I told him that, with the aid of -God and the assistance of his regular medical attendants, I -would soon have him on his feet again....</p> - -<p>After dinner, in the presence of the Duke of Ascot, a few -friends of the family, and the assembled physicians and -surgeons, I expressed considerable surprise that free openings -had not been made in the Marquis’s wounded thigh, in which bone -caries and decomposition of the resulting discharge were already -well established. The medical attendants replied that the -patient was unwilling to submit to any such measures, and that -he had even forbidden them to substitute clean linen bedclothes -for those which were soiled and which had not been changed -during the previous two months....</p> - -<p>When the consultation had come to an end and the local medical -attendants had given their full approval of the different -measures which I recommended, ... I proceeded to carry them out -without further delay.</p> - -<p>Two or three hours after the completion of this operative work I -instructed the house servants who were in immediate attendance -upon the Marquis to place alongside his bed a second one -equipped with a soft mattress, over which a fresh linen sheet, -etc., had been spread. The transfer from one bed to the other -was easily effected by a strong attendant, and when the change -had been made the Marquis manifested great contentment. Two -feather pillows were so placed under his back and loins that no -pressure whatever would be made upon his bedsores. A refreshing -sleep of four hours’ duration followed the adoption of these -different measures, and there was much rejoicing in the entire -household.</p> -</div> - -<p>After a course of treatment lasting several weeks, Paré says:—</p> - -<div class="blockquot"> - -<p>Under this treatment the fever steadily diminished, the pain -grew less and less, and the patient’s strength increased. When -the proper moment arrived, I advised the Marquis to engage the -services of some musicians (players on stringed instruments) -and one or two comedians, in order that his spirits might be -cheered by occasional entertainments of this character. Already -at the end of one month<span class="pagenum" id="Page_507">[507]</span> we found it practicable to carry him -in a chair into the garden and as far as the entrance gate, -where he could watch the passers-by. When it became known among -the peasants that he was in the habit of sitting close to the -highway, they came from far and near to sing and dance in groups -for his entertainment. He was greatly loved by both the common -people and the nobility.</p> - -<p>At the end of six weeks the Marquis was able to get about on -crutches, and two weeks later still I bade him good bye and -returned to Paris. Before I left he presented me with a gift of -great value, and the Duchess of Ascot insisted on my accepting -a beautiful diamond ring as a mark of her appreciation of the -services which I had rendered her brother.</p> -</div> - -<p>Among the varied experiences which fell to the lot of Paré during -his association with Charles the Ninth, there is one which throws a -little additional light upon the man’s manner of promptly dealing with -an event which, without such promptness of action, might have led to -serious consequences.</p> - -<p>He was passing through Montpellier one day in company with the King, -when he stopped for a few minutes at the shop of an apothecary for the -purpose of ascertaining how he preserved alive the vipers which he used -in compounding the remedy which is called “theriaca,” and which has -been used from time immemorial as an antidote to the poison of venomous -serpents. The apothecary placed before him a glass jar in which were -kept a number of these reptiles; and, when Paré took one of them up in -his fingers in order to obtain a better view of his fangs, the reptile -bit him near the tip of his index finger, between the nail and the -flesh. The pain which immediately followed was severe, partly, as Paré -explains, because the tip of the finger is a very sensitive part, and -probably also on account of the irritating effect of the venom. Then, -to quote Paré’s own words, “after making firm pressure upon the soft -parts above the wound, to prevent the poison from traveling upward, I -crowded the skin downward in the hope of forcing as much of the venom -as possible out of the finger. While doing these things I instructed -the apothecary’s assistant to mix some old theriaca with brandy, and -then to apply a pledget<span class="pagenum" id="Page_508">[508]</span> of cotton, saturated with the mixture, over -the wound. In the course of a few days, and with no other treatment, -all effects of the bite disappeared.”</p> - -<p>In 1536, two years after his first experience with actual warfare in -the vicinity of Susa, Italy, and while he was still very young to -assume so great a responsibility, Paré—as we learn from the text of -Chapter 28, Book X., of Malgaigne’s edition—performed the operation -of exarticulation of the elbow-joint (the first recorded instance of -this operation, says von Gurlt). The case was that of a common soldier -who had been shot through the forearm, a little above the wrist, who -had been treated unsuccessfully by other surgeons, and who, at the -time when he came under Paré’s care, was suffering from a variety of -complications—viz., gangrene extending as high up as the shoulders, -extensive inflammation of the integuments on the adjacent side of -the thorax, and other symptoms that pointed toward a fatal issue. To -complicate matters, it was winter and the only approximately warm -shelter available was a cow-stable. At this early date, in the history -of surgery, the practice of ligating the blood-vessels which had been -divided in the course of an amputation had not yet been adopted, and -consequently the red-hot cautery had to be employed for arresting -the bleeding which followed the operation. (See also page 512.) In -addition to the amputation it was found necessary to make a number of -long and deep incisions into the inflamed tissues and to apply the -actual cautery freely “for the purpose of drying up and destroying -the virulent matters that had penetrated these parts.” Then, fourteen -days later, the patient, who had been lying all this time, exposed to -draughts of air, upon a receptacle intended for the storage of grain, -and who was protected from the cold by only the scantiest coverings, -developed trismus (lockjaw). When this new complication appeared Paré, -already at his wits’ end to find means with which to overcome the -difficulties which surrounded the case, decided first to have the man -removed to an adjacent stall in which there were several cows, the -presence of which in such a confined space might be counted upon to -increase appreciably<span class="pagenum" id="Page_509">[509]</span> the warmth of the surrounding air. Next, he gave -orders to rub briskly the back of the patient’s neck, as well as the -shoulders, the uninjured arm and the legs, with heated cloths which -were immediately afterward to be wrapped around him; and then, for -an outside covering, he utilized the straw and cows’ dung which were -plentifully within reach. In addition, two braziers which had been -procured from a neighboring dwelling, were charged with coals and kept -burning close to him. During three successive days and nights these -measures were kept up faithfully, and from time to time a mixture of -milk and soft egg was introduced into the patient’s mouth through a -suitable tube, after the jaws had first been pried open by a bit of -willow wood. The effect of these measures was to make the patient -perspire copiously and to induce a gentle action of the bowels; and, -as a further effect, the trismus was also overcome. For some time -afterward, in addition to the ordinary dressing of the healing wounds, -it was thought best to apply the red-hot cautery regularly at certain -intervals to the end of the bone of the upper arm. (This practice was -abandoned by Paré at a later date.) Final and perfect healing took -place after several large splinters of bone had been exfoliated.</p> - -<p>At the end of his account of what one is tempted to call the wonderful -victory of a surgeon over the death that threatened to carry off this -gravely wounded soldier, Paré adds one of his characteristic appeals to -the oncoming younger generation of physicians:—</p> - -<div class="blockquot"> - -<p>Both God and Nature constantly remind the surgeon that, no -matter how poor, in a given case, the prospect of a cure may -seem, he should not for one moment cease doing his full duty; -for Nature often accomplishes what the surgeon believes to be -impossible. Cornelius Celsus [about the time of Jesus Christ] -says: “<i>Contingunt in morbis monstra, sicut et in natura</i>.” -[Marvels are observed in diseases, very much in the same manner -as they are frequently encountered in nature.]</p> -</div> - -<p>In the two preceding histories of actual cases treated,—one of these -patients being a wealthy officer of high rank and birth, and the other -a common soldier of the peasant<span class="pagenum" id="Page_510">[510]</span> class,—we obtain the best of evidence -that Paré was not influenced by the wealth, rank or social position of -his patients. Upon both classes he bestowed freely the fruits of his -knowledge, experience and skill.</p> - -<p>The first mention, in medical literature, of a fracture through the -neck of the femur close to the joint, is to be found in Chapter 21, -Book XIII., of Paré’s treatise (page 753, Vol. II., of Malgaigne’s -edition). Furthermore, the first published account of a case of -diaphragmatic hernia is that given by Paré. (Von Gurlt.)</p> - -<p>In 1538, during a visit to Turin in the capacity of surgeon to the -Mareschal de Montjean, Paré was asked by the latter to take charge of -one of his pages who had been wounded by a stone which struck him on -the right side of the head, causing a fracture of the parietal bone, -with escape of a portion of the brain substance from the external -wound. The subsequent history of this case is given by Paré in the -following words:—</p> - -<div class="blockquot"> - -<p>As soon as I fully realized the true nature of the injury and -had examined the mass of tissue (about the size of a small nut) -which had been expelled from the wound, I predicted that the -patient would probably not recover. A young surgeon who happened -to come into the room at this moment, examined the mass of -tissue which had escaped from the wound and at once pronounced -it to be fat. I assured him that, if he would wait until I had -finished dressing the patient’s wound, I would prove to him that -the mass was in reality cerebral tissue and not fat.... If this -substance, I said, is fat, it will float on the water; but, if -it is brain tissue, it will sink at once to the bottom of the -dish. And, again, if it is fat it will promptly melt on exposure -to heat, whereas brain substance will simply become desiccated. -These tests were applied and it was shown that the tissue -consisted, as I had declared, of brain substance.</p> - -<p>Notwithstanding the apparently serious damage which had been -inflicted upon his brain the page made a good recovery, but -remained permanently deaf in the right ear.</p> -</div> - -<p>Among Paré’s numerous reports of cases there is one which possesses, -as I believe, sufficient interest—as well from the viewpoint of the -pathologist as from that of the<span class="pagenum" id="Page_511">[511]</span> surgeon—to justify me in reproducing -it, in a somewhat condensed form, in the present chapter.</p> - -<p>Henry the Second, King of France, while tilting (June 30, 1559) -with Gabriel, Count of Montgomery, an officer of that sovereign’s -Scottish Lifeguard, received injuries which soon afterward proved -fatal. Montgomery’s lance—so Paré’s account states—struck the King’s -vizor and, breaking off at the spot where the metal tip or head is -attached to the wooden shaft, carried away this part of the helmet. -Then, impelled by the force which had originally been communicated -to the lance, the splintered end of its shaft struck the King’s now -unprotected head with great violence just above the right eyebrow, -tore up the skin and underlying muscular tissue of the forehead as -far as the outer angle of the left orbit, and finally destroyed the -adjacent eye. Five or six of the most experienced surgeons of France -were immediately summoned, and Philip the Second, King of Spain, sent -Vesalius from Brussels to aid them in their efforts to save the injured -King’s life. But all the measures adopted proved of no avail. Henry the -Second died on the eleventh day following the injury. Although in the -published account no statement is made to the effect that Paré was one -of the surgeons who attended the King during his illness, Malgaigne -expresses the opinion that he was probably present in the capacity of -a consultant; and the interesting comments which he (Paré) makes on -the nature and extent of the injury inflicted certainly justify this -opinion. No evidence of fracture of the skull was discovered either -before death or at the postmortem examination, and the most conspicuous -symptoms appear to have been fever and a comatose condition. At -the autopsy there was found, on the left side posteriorly, in the -occipital region, a clot of blood lying between the pia and the dura -mater. The brain substance in the immediate vicinity of the clot was -of a yellowish tinge and showed evidences of having already begun to -undergo decomposition. Paré’s diagnosis, in this case, was that of -violent concussion of the brain with rupture of meningeal vessels by -<i>contre-coup</i> at a point opposite to that at which the blow<span class="pagenum" id="Page_512">[512]</span> -was originally inflicted by the lance. He did not believe that the -immediate damage done to the frontal portion of the cranium and to the -left eye had anything to do with the fatal issue.</p> - - <div class="figcenter" id="i_p512" style="width: 420px"> - <img - class="p2" - src="images/i_p512.jpg" - alt="" /> - <p class="center p0 sm smcap">FIGS. 23 and 24.</p> - <p class="center p0 sm">FORCEPS DEVISED IN 1552 BY AMBROISE PARÉ FOR DRAWING OUT THE CUT -ENDS OF ARTERIES AFTER THE AMPUTATION OF A LIMB, AND HOLDING -THEM WHILE THE LIGATURE IS BEING APPLIED.</p> - <p class="center p0 sm">(From von Gurlt’s <i>Geschichte der Chirurgie</i>, Berlin, 1898.)</p> - <p class="center p0 sm"><span class="smcap">Fig. 23</span> represents the earlier; <span class="smcap">Fig. 24</span> the -later pattern (see text.)</p> - </div> - -<p>One of the greatest discoveries made by Paré in the domain of surgery -is his method of promptly, effectively and safely arresting the -bleeding from the divided vessels of the stump after the amputation of -a limb. This discovery was made between the years 1552 and 1564, before -which period it had been customary to arrest the bleeding by applying -the red-hot cautery iron to the exposed ends of the divided vessels. -The new method consisted in tying a ligature (preferably doubled) -around the free or cut end of the blood-vessel, and allowing it to -remain undisturbed <i>in situ</i> until, as the result of a localized -suppuration, it should be cast off. The accompanying cuts (Figs. 23 and -24) which have been copied from an earlier edition (1585) of Paré’s -work, represent the kind of forceps which he employed in separating -the free end of the artery or vein from the soft tissues in which it -was imbedded—a preliminary procedure which enabled him to tie the -ligature firmly around the vessel. The earlier pattern of forceps (Fig. -23) was not equipped with a spring, the purpose of which was to keep -the opposing blades separated, but the later pattern (Fig. 24) has -this useful addition. Another instrument which owes its origin to the -inventive genius of Paré is the grooved director—an instrument that -is of great value to the surgeon, particularly in operations for the -relief of strangulated hernia.</p> - -<p><span class="pagenum" id="Page_513">[513]</span></p> - -<p>Besides the two inventions to which a brief reference has just been -made, Paré describes and pictures in his great treatise scores of -instruments and apparatus of all sorts, many of them doubtless products -of his own inventive genius. But to assign to these contrivances their -true value calls for a degree of expert knowledge which I do not -possess. Rather than to attempt any such appraisal, I prefer to furnish -here a summary of the more important of Paré’s achievements in surgery; -for such an enumeration—although it may prove to be in some measure -a recapitulation of things that have already been mentioned in the -preceding account—may be found useful for purposes of reference:—</p> - -<div class="blockquot"> - -<p>The discovery of improved methods of caring for the wounded -on the battle-field and of transporting them to a hospital or -other refuge; the introduction of better methods of treating -wounds inflicted in warfare—especially gunshot wounds; the -correction of the idea, universally accepted at the beginning -of the sixteenth century, that bullets are sufficiently hot, -upon penetration of the skin, to affect injuriously the wounds -which they inflict;<a id="FNanchor_93" href="#Footnote_93" class="fnanchor">[93]</a> the substitution of ligation of bleeding -vessels (of an amputation stump) for the prevailing practice of -applying to them the red-hot cautery iron; the abandonment of -the practice of applying the heated cautery iron to the surface -of section of a sawed bone; the performance, for the first -time, of exarticulation of the elbow-joint; the demonstration -of the usefulness of more frequently employing orthopaedic -apparatus and prosthetic contrivances; and the introduction of -improvements in the operation of trephining the skull.</p> -</div> - -<p>It was a very common practice among the medical authors of the -sixteenth century—and, indeed, among authors generally—to utilize -the writings of their predecessors without giving them proper credit -for their work; and Paré, it appears, was not entirely free from this -fault. Von Gurlt mentions a few of the more glaring instances of such -sinning, and among them the following: Paré’s two chapters on tumors -are taken from the “<i>De institutione<span class="pagenum" id="Page_514">[514]</span> chirurgica</i>” of Jean Tagault -(Paris, 1543), who in turn is charged with having borrowed the data -from Guy de Chauliac’s treatise; in his chapter on wounds in general, -Paré has also borrowed largely from the same work; and the chapter -which he devotes to the subject of special wounds is taken from the -writings of Hippocrates; and, finally, he has transferred almost -bodily Philippe de Flesselle’s “<i>Introduction pour parvenir à la -vraie cognoissance de la chirurgie rationelle</i>.” Before we condemn -Paré for plagiarism, and although the facts as stated by von Gurlt are -undeniable, we should take several things into careful consideration. -It is fitting, for example, that we should make some sort of an -estimate of the value of the text thus appropriated, in order that we -may be able to measure the seriousness of Paré’s sinning; and, if we do -this, we cannot fail to be struck with its insignificance in comparison -with the admittedly valuable character of all the remaining text of -these three huge volumes—text which bears every mark of being the -product of Paré’s brain. Paré himself, in speaking of his borrowings -from other authors, says that his acts of this nature are “as harmless -as the lighting of one candle from the flame of another.” Then, again, -there are several of these borrowings which are evidently the handiwork -of a rather dull person, and this fact alone makes one bold to assert -that Paré, who was certainly not lacking in brains or in a desire -to follow the golden rule in his treatment of the property of such -writers, could scarcely have been guilty of such clumsily contrived -interpolations. Inasmuch, however, as many important facts bearing -upon the question at issue are not within my reach, I am obliged, in -my attempt to defend the memory of Paré, to fall back upon speculative -reasoning. The medical profession at large has long since heard this -charge of plagiarism and it refuses to attach any importance to it as -affecting the personal character of Paré. It prefers to believe that -he is guiltless and that somebody else—at a time, perhaps, when Paré, -being well advanced in years, was too ill to revise the manuscript of -the “Collection of his Writings” edited by Guillemeau—thoughtlessly -yielded to <span class="pagenum" id="Page_515">[515]</span>the impulse to remedy, by borrowing from other sources, -the trivial defects or omissions noted in the text. In any case, -whatever the actual truth may be, I am, I believe, justified in -maintaining that Paré is not rightly chargeable with the guilt of -plagiarism.</p> - - <div class="figcenter" id="i_fp514" style="width: 538px"> - <img - class="p2" - src="images/i_fp514.jpg" - alt="" /> - <p class="center p0 sm">FIG. 25. AMBROISE PARÉ, THE FAMOUS FRENCH SURGEON OF THE -SIXTEENTH CENTURY.</p> - <p class="center p0 sm">(From von Gurlt’s reproduction of the portrait published by Le -Paulmier, Paris, 1885.)</p> - </div> - -<p>Strange as it might appear, if history did not furnish many examples -of the same character, Paré’s merits as a man and as a surgeon were -not as fully appreciated as they deserved to be until after the -lapse of nearly two centuries. In 1812 the <i>Société de Médecine de -Bordeaux</i> offered a prize for the best eulogy of Ambroise Paré, -and it was awarded to Vimont. Finally, in 1840, a fine bust of the -distinguished surgeon was completed by the sculptor David of Angers, -and set up in bronze in Laval, Paré’s birthplace. The portrait here -reproduced from the engraving in von Gurlt’s work represents the bust -in question (Fig. 25).</p> - -<p>A complete collection of the writings of Paré has been prepared by -J. F. Malgaigne, the distinguished French surgeon, and published in -three very large volumes (Paris, 1840–1841). This collection is based -on a careful comparison and collation of all the previously published -editions. The contents of these volumes cover very nearly the entire -range of surgery.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_516">[516]</span></p> - -<h3>CHAPTER XLI<br /> -<span class="subhed1">SURGERY IN GREAT BRITAIN DURING THE SIXTEENTH AND SEVENTEENTH CENTURIES</span></h3></div> - -<p>In Great Britain the cultivation of the science of medicine began at -a much later date than it did on the continent of Europe, and, so far -as may be judged from the facts within our reach, there were, in the -early part of the sixteenth century, very few Englishmen who could -justly lay claim to the possession of more than the rudiments of -the art of surgery. Two centuries earlier, as I have already stated -in a previous chapter, there were three men in England who gained -considerable fame in this department of medicine. They were Gilbert -“the Englishman” (1210), John of Gaddesden (1320), the author of the -famous book entitled “Rosa Anglica,” and John of Ardern (<i>circa</i> -1350); but afterward, for a period of nearly two hundred years, the -records fail to reveal to us a single surgeon of any note. Then during -the sixteenth century the only English surgeons whose names deserve to -be perpetuated are Gale, Clowes and Woodall, of whom I shall presently -give brief accounts. They were all at one time or another, as in the -case of the leading continental surgeons of that period, officially -connected with the army. Some idea of the unsatisfactory state of the -medical service in the English army of that period may be gathered from -the statements made by Gale regarding this matter. From his account it -appears that in 1544 the army was accompanied by a miscellaneous crowd -of men who were supposed to be in some measure physicians, but who in -reality were uneducated quacks, vendors of all sorts of dressings and -washes for wounds, of infallible cures for gunshot injuries, etc. The -mortality<span class="pagenum" id="Page_517">[517]</span> in the English camp was, as might readily be expected, very -heavy. The same state of things existed, at a somewhat later date, in -the fleet sent against the Spanish Armada. It is not to be wondered -at, therefore, that very few of the educated surgeons were willing to -accept service in the English army or the English fleet, especially as -the pay which they received was no greater than that of the drummers -and trumpeters. Toward the end of the century much greater attention -was paid to the care of the wounded and crippled, and, in corroboration -of this, it may be stated that Henry the Fourth, King of France,—who, -it may safely be assumed, was influenced to take this step by the -enlightened advice of Ambroise Paré,—ordered the establishment of -military hospitals for the use of the army which was at that time -besieging Amiens. And again, at a later date (1603), there was -established at Paris a retreat for old and infirm or mutilated officers -and soldiers.</p> - -<p>It is an interesting fact that during the year 1544, while Henry the -Eighth of England, in alliance with the German Emperor Charles the -Fifth, was carrying on the war against Francis the First, King of -France, there were present, on the soil of the latter country, all the -leading European surgeons of that period—viz., Ambroise Paré, with -the French army which was laying siege to Boulogne-sur-Mer (captured -a few months earlier by the English troops); Thomas Gale, the most -famous surgeon of that day in England, with the army of the besieged; -and Vesalius and Daza Chacon with the troops of Charles the Fifth -at Landrecy (near the Belgian boundary, south of Brussels) and at -St. Didier (in the northeastern part of France). I have already, in -preceding chapters, given brief accounts of the lives and professional -accomplishments of all these surgeons with the exception of Gale, and -it only remains now to supply such information as may be obtainable -concerning the latter and also concerning his contemporaries, the -English surgeons Clowes and Woodall.</p> - -<p><i>Thomas Gale.</i>—Thomas Gale was born in London in 1507, practiced -medicine for some years in that city, and then, in the capacity of -a surgeon, entered the service of the army<span class="pagenum" id="Page_518">[518]</span> under Henry the Eighth. -At a later date he joined the army of Philip the Second of Spain. In -1544 he was present at the battle of Montreuil in France, and he was -also present at the siege of St. Quentin, in 1557. Two years later he -returned to London and became a member of the Barber-Surgeons’ Company. -His death occurred in 1587.</p> - -<p>Gale was the author of several books on surgical subjects, the most -important of these works being that which deals with gunshot wounds. -His views regarding wounds of this nature agree in the main with the -teachings of Ambroise Paré; and yet, according to von Gurlt, he appears -to have formed his opinions independently, for he does not once mention -that surgeon’s name. He was not only a skilful surgeon, but also a man -of scientific and literary tastes, as shown by his translations of some -of Galen’s writings and of Giovanni da Vigo’s treatise on surgery, and -also by his own published works. His book on gunshot wounds, to which -reference has already been made, is the one which reflects the greatest -credit upon the author. One of its chief merits is to be found in the -fact that it enabled the physicians of England to keep in some measure -abreast of their brethren on the continent, at least in the matter of -treatment by surgical means. In one part of the work he makes reference -to the belief, which was held at that time by many surgeons, that the -bullet not only scorched the flesh of the wound which it inflicted but -also introduced into it a poisonous element. I quote here one or two -extracts from the comments to which I have just referred:—</p> - -<div class="blockquot"> - -<p>The usuall Gonnepouder is not venemous, nother the shotte -of such hoteness as is able to warme the fleshe, much lesse -to make an ascar.... Hange a bagge ful of Gonnepouder on a -place convenient: and then stand so far of as your peece wil -shote leavell, and shote at the same, and you shall see the -Gonnepouder to bee no more set on fyer with the heat of the -stone [used as a bullet] than if you caste a cold stone at it.</p> -</div> - -<p>An English translation of Paré’s book, says von Haller, was not -published until 1577. It is therefore not strange that Gale, whose book -was printed fourteen years earlier<span class="pagenum" id="Page_519">[519]</span> (<i>i.e.</i>, in 1563), should -have made no mention of that author’s method of applying ligatures -to the bleeding vessels of an amputation stump. The first reference -(in English) to this plan of preventing hemorrhage from the divided -blood-vessels in an amputation stump occurs—so far as I have been able -to discover—in the treatise published in London by William Clowes, in -1588, under the title “A prooved practise for all young chirurgians -etc.” Clowes, however, erroneously gives the credit for this important -procedure to Guillemeau, one of Paré’s pupils.</p> - -<p>In one of his writings Gale states, after witnessing the surgical -practice at the Royal hospitals of St. Bartholomew and St. Thomas in -1562, “that it was saide that Carpinters, women, weuvers, coblers and -tinkers did cure more people than the chirurgians.” (South.)</p> - -<p><i>William Clowes.</i>—William Clowes was born, about the year 1540, -at Kingsbury, in Warwickshire, and received his early training in -surgery under George Keble of London. In 1563 he accepted the position -of surgeon in the army which was under the command of Earl Ambrose -of Warwick and was stationed at that time in France. Six years later -he settled in London, and was made a member of the Barber-Surgeons’ -Company. In 1575 he received an appointment on the Surgical Staff of -St. Bartholomew’s Hospital and six years later still he was promoted to -the rank of full surgeon, a position which he already held in Christ’s -Hospital. In 1585 he resigned his appointment at St. Bartholomew’s and -accepted an invitation to serve in the Earl of Leicester’s army, which -was at that time in the Netherlands. During this war Clowes acquired -a rich and varied experience in the treatment of wounds. Soon after -his return to London in 1588 he joined the fleet which vanquished the -Spanish Armada. Later, he was given the appointment of Surgeon to the -Queen. His death took place at Plaistow, County of Essex, in August, -1604. Von Gurlt does not hesitate to qualify him as one of the most -distinguished English surgeons of his day.</p> - -<p>Of the four surgical treatises which were written by Clowes, and of -which several editions were published<span class="pagenum" id="Page_520">[520]</span> between the years 1575 and 1637, -there is only one to which I shall refer in this brief account, viz., -that which, in the edition of 1637, bears the title: “A profitable and -necessarie Book of Observations, for all those that are burned with the -flame of Gun-Powder.” This book is full of brief histories of cases -which came under the author’s personal observation, and it therefore -furnishes an excellent and truthful picture of the kind of wounds which -the highwaymen and soldiers of that day inflicted, and of the treatment -which was employed by the best English surgeons. The following may -serve as sufficient examples:—</p> - -<p>(1) A clothier, who had been assailed by robbers, received a dangerous -wound in the left thigh. It was about four inches long and of such a -depth that “the rotula or round bone of the knee did hang downe very -much.” Clowes first removed a clot of blood from the wound and then, -“with a sharp and square-pointed needle, armed with a strong, even and -smooth silke thred, well waxed, introduced five stitches, one good -inch distant betweene every stitch, leaving a decent place for the -wound to purge at.” He then applied a suitable bandage. The patient’s -friends were not at all pleased that Clowes, having pronounced the -wound dangerous, should not have been willing to state how much time -would elapse before it would be healed. So they called in a charlatan, -who on the following day removed the dressings and cut through all -the stitches. Seven days later, Clowes was once more asked to see -the case. He found the wound gaping widely and in a bad state. After -adopting such measures as were most urgently required, he brought -the edges of the wound together by the application of three strips -of sticking-plaster. In due time healing took place, “but the motion -perished: for the patient had the imperfection of a stiff knee, which -constrained him to use a leather strap, fastened unto the toe of his -shooe, and again made fast unto his body; and so he remaineth unto this -day.”</p> - -<p>(2) The history of the second case may be given here in the following -brief outlines. The patient, a ship’s gunner, was wounded in the lower -part of the abdomen by<span class="pagenum" id="Page_521">[521]</span> what was probably a partially spent ball. The -wound made by the missile was of such a nature that it permitted a -large portion of the “zirbus” (omentum), together with some of the -intestinal canal, to protrude from the opening. After making a careful -examination of the parts, Clowes was satisfied that the intestine was -still uninjured.</p> - -<div class="blockquot"> - -<p>Then with a strong double thread I did tie fast the zirbus as -close unto the wound as possible wel I might, and within a -finger bredth or thereabouts I did cut off that part of the -zirb that hanged out of the wound, and so I cauterized it with -a hot iron almost to the knot; all this being done, I put again -into the body that part of the zirb which I had fast tied, and -I left the peece of thred hanging out of the wound: which, -within four or five days after, nature cast forth, the thred -as I say being fast tied; then presently I did take a needle -with a double strong silke thred waxed, wherewith I did thrust -thorow both mirach [skin, adipose layer and muscular tissue] -and ziphach [peritoneum] on the right side of the wound, but -on the left side of the wound I did put the needle but thorow -mirach only, and so tied these three fast together with a very -strong knot, and presently I did cut of the thred.... All which -is according to Weckers<a id="FNanchor_94" href="#Footnote_94" class="fnanchor">[94]</a> and other learned men’s opinions -and practices, who also say that the stitches of the one side -must be higher than on the other side. [The usual dressings were -afterward applied and were renewed three days later. At the end -of twenty-one days the wound was found to be completely healed.]</p> -</div> - -<p>In chapter 27 of the same work there is given a list of the medicaments -and instruments with which a field-or ship’s-surgeon should be equipped -before he engages in active service. From this list I select the -following items as showing—at least in some measure—in what respect -the tools employed by surgeons four hundred years ago differ from -the modern ones of a similar character: “Small and long waxe candles -to search the hollownesse or depth of a wound.” “Small buttons or -cauterizing irons meete to stay the flux of an artery or veine.” “A -trepan.” “Needles two or three, some eight inches, some ten or twelve -inches in length, having a decent eye in it guttered like a Spanish<span class="pagenum" id="Page_522">[522]</span> -needle, and point or end blunt or round, that it offend not in the -going in of it, made fit to draw a Flammula, or a pece of fine lawne -or linnen cloth through the body or member that is wounded.” “As for -stitching quils and other instruments, that a Surgeon ought always to -carry about him, I leave unspoken of.”</p> - -<p>In praise of one of the plasters enumerated in the list, Clowes -narrates the following incident which occurred near Arnheim in the -Netherlands: “A horseman was wounded with a pike neere the middle of -his right thigh; the weapon so passing upwards that by good fortune it -rested upon the os pubis, otherwise he had been slaine.” As the first -step in the treatment, the copious bleeding was arrested; after which -warm <i>oleum hyperici</i> [oil of St. John’s wort] was injected into -the wound, then a short tent was introduced, and the sticking plaster -was applied on the outside. “Thus he was cured in fourteene days, and -so was ready to serve in the field again.”</p> - -<p><i>John Woodall.</i>—John Woodall or Woodhall was born in England -about 1569, and was sent as a military surgeon to France by Queen -Elizabeth with the troops which Her Majesty placed at the disposal -of the French King, Henry the Fourth. After his return to England, -Woodall was made a surgeon of St. Bartholomew’s Hospital and also -Surgeon-General of the East India Company. He was already at that time -a member of the Company of Barber-Surgeons of London. Woodall must have -had a very extensive experience in the practice of surgery, for he -states that he had performed the operation of amputation of a limb more -than one hundred times. The date of his death is not known.</p> - -<p>Von Gurlt calls attention to the fact that the first notice printed -in English of Ambroise Paré’s method of ligating blood-vessels after -an amputation is to be found in the treatise written by John Woodall -and published in London in 1639, under the title: “The Surgeon’s Mate, -or Military and Domestic Surgery.” As the first edition of this book, -which was published in 1617, says nothing about Paré’s method, it seems -permissible to infer that the news of this<span class="pagenum" id="Page_523">[523]</span> improvement, one of the -most important made in surgery (1552), reached England from France only -after the lapse of eighty-seven years! There can be scarcely any doubt, -however, that individual English surgeons had already learned about -Paré’s improved method at a much earlier date.</p> - -<p><i>State of Surgery in England During the Seventeenth -Century.</i>—Before I pass on to the consideration of the state of -surgery in England during the seventeenth century it seems desirable -that I should say a few words with regard to the relative standing of -the two branches of the medical profession—the physicians and the -surgeons—in the esteem of their fellow Englishmen at this period -of history. In France, it will be remembered, a surgeon was looked -upon, even as recently as during the first half of the sixteenth -century, as a man of inferior social standing, perhaps a shade better -than an apothecary, but certainly far below his more highly educated -associate—the physician. The favors extended by French Royalty to -Ambroise Paré and the very high esteem in which he was held by French -society in general effected a great change in the relative status of -the two classes of practitioners in France; and, as a result of this -change in public opinion, medical practitioners, subsequent to 1560 or -1570, were led to realize that a surgeon, if sufficiently educated, -if earnestly devoted to his professional work, and if intent upon -helping his fellow men rather than upon accumulating a fortune, might -confidently aspire to a position of equality with the best physicians -of the community in which he lived. In England a similar change of -opinion in regard to the honorableness of the career of surgeon -took place about this time, probably in consequence of the great -reputation gained by Gale, Clowes and Woodall. In both countries the -change occurred slowly, and in France what was gained during Paré’s -lifetime seemed afterward to be lost for a period of several years. -But eventually the prevailing opinion again became favorable to the -surgeons, and from that time to the present they have enjoyed an -ever-increasing esteem in public opinion. But there was a brief period, -early in the seventeenth<span class="pagenum" id="Page_524">[524]</span> century, when it must have been very galling -to the pride of an honorable and experienced surgeon to be placed as -it were under the tutelage of the physicians who were his official -associates in certain hospitals—as, for example, in St. Bartholomew’s, -London. The following extracts<a id="FNanchor_95" href="#Footnote_95" class="fnanchor">[95]</a> from the “Orders” or “Articles” of -that institution (1633) explain more precisely what is meant by the use -of the word “tutelage”:—</p> - -<div class="blockquot"> - -<p>9. That no surgeon or his man do trepan the head, pierce the -body, dismember or do any great operation on the body of any but -with the approbation and by the direction of the Doctor (when -conveniently it may be had) and the surgeons shall think it -needful to require.</p> - -<p>13. That every surgeon shall follow the directions of the Doctor -in outward operations for inward causes, for recovery of every -patient under their several cures, and to this end shall once in -the week attend the Doctor, at the set hour he sitteth to give -directions for the poor.</p> - -<p class="r2 p-min">(From St. Bartholomew’s Hospital Reports, Vol. XXII., 1886.)</p> -</div> - - -<p>Among the English surgeons of the seventeenth century there appears to -have been only one who attained some degree of eminence, viz., Richard -Wiseman, who is often spoken of as the Ambroise Paré of England. -Haeser mentions 1625 as the date of his birth, and at the same time -states that he was in the service of the Stuart Kings from Charles -the First to James the Second. It seems to me highly probable that -this statement regarding the date of Wiseman’s birth is erroneous; for -if it be accepted as correct, then he (Wiseman) must have been only -fifteen years of age when he first started out with the prince (in -1640) on the latter’s wanderings through France and the Low Countries. -On the other hand, if Wiseman was really born in 1625, then we shall be -justified in assuming that he traveled with the prince at first simply -as his companion and not in a professional capacity; and we shall be -further justified in assuming that he acquired his medical and surgical -training during his residence on the continent.</p> - -<p><span class="pagenum" id="Page_525">[525]</span></p> - -<p>In 1650 Wiseman returned with the prince to Scotland. At the battle -of Worcester he was taken prisoner by the Parliamentary army under -Cromwell and did not regain his liberty until 1652, at which time he -settled permanently in London. After the Restoration in 1660, his -practice increased very greatly and, so far as one may judge from the -large number of cases which he reports in his work on surgery that -was first published in 1676, it must have been very extensive and of -a most varied character. I have read many of these reports of cases -that occurred in Wiseman’s practice, and have been much impressed with -the thoroughly practical character of the treatment which he adopted -in the majority of instances, and also with the very clear and concise -manner in which he narrates the attendant circumstances—the nature of -the malady or of the injuries received, the treatment which he adopted, -and the final results attained. In the belief that they may furnish -corroborative evidence of the statements which I have just made, I now -take the liberty of reproducing here two of these reports of cases:—</p> - -<div class="blockquot"> - -<p>(1) Whilst I was a prisoner at Chester (1651), after the battel -of Worcester, I was carried by Colonel Duckinfield’s order to a -man that out of much zeal to the Cause, pursuing our scattered -forces, was shot through the joint of the elbow; the bullet -entering in at the external part of the <i>os humeri</i>, and -passing out between the <i>ulna</i> and <i>radius</i>. He had -been afflicted with great pain the space of six weeks. I found -the wound undigested,<a id="FNanchor_96" href="#Footnote_96" class="fnanchor">[96]</a> and full of a loose, soft, white -flesh, the bones fractured, and not likely to unite, many -shivers lying included within the joints, and incapable of -being drawn out. The lower part of the arm was oedematous to -the fingers’ ends as full as the skin could well contain, and -the upper part was inflamed; also about the <i>os humeri</i> -and <i>axilla</i> a perfect phlegmon was formed. The patient -thus tired with pain, desired to be cured or have his arm cut -off. To which purpose he had procured the Governor’s leave for -my staying with him. But, while that phlegmon was upon the -upper parts, there was no hope of a prosperous amputation, nor -of cure while those shivers of bone lay pricking the nervous -parts within the joint. The phlegmon<span class="pagenum" id="Page_526">[526]</span> was too forward for -repercussion,<a id="FNanchor_97" href="#Footnote_97" class="fnanchor">[97]</a> and yet not likely to suppurate in less than -a week’s time. Wherefore I endeavored by emollients and some -discutients to succour the grieved shoulder and parts thereabout -by hindering the increase of the phlegmon, and to give some -perspiration to the part. Then with good fomentations I -corroborated the weak and oedematous member below; in which end -I also raised his hand nearer to his breast. Also by detergents -and bandage I disposed the wounds and fractured part to a better -condition, made way for discharge of matter, and endeavored to -extract the shivers of bones; then applied medicaments to remove -the <i>caries</i>. After some days the abscess suppurated in -the upper part of the shoulder and in the armpit; and while the -matter discharged from thence, the tumour discussed, and that -upper orifice cured soon after. But the continual pain in the -fractured joint kept that opening in the axilla from healing. -The patient growing weaker, and without hopes of cure, I was -necessitated to proceed to amputation. To which purpose I sent -to Chester to Mr. Murry, a knowing chirurgeon (since Mayor of -that city), to come with instruments and other necessaries, -whereby I might the better do the work. He accordingly came, and -we prepared dressings ready; which were stupes or pledgits of -fine short tow well worked, some like <i>splenia</i> [bandages], -others were round, and bigger or less. We wetted them all in -oxycrate [water and vinegar], and dried them; et cetera....</p> - -<p>The apparatus thus made, and the patient some while before -refreshed with a good draught of caudle [a hot drink made of -spiced and sugared wine], his friends took him out of his bed, -and placed him in a chair toward the light. One of his servants -held his arm; another of his friends held his other hand. Then -Mr. Murry drew up the skin and museulous flesh of the arm -towards the shoulder, whilst I made a strong bandage, some three -or four fingers’ breadth, above the affected part. Then with a -good knife I cut off the flesh by a quick turn of my hand, Mr. -M. pulling up the flesh, whilst I bared the bones.<a id="FNanchor_98" href="#Footnote_98" class="fnanchor">[98]</a> After -which, with as few motions of my saw [as possible], I separated -the bone[s], the patient not so much as whimpering the while. -After this Mr. Murry thrusting his hands downwards with the -museulous flesh and skin which he had drawn upwards, I passed -a strong needle and thread through the middle of the flesh and -skin on both sides, within half<span class="pagenum" id="Page_527">[527]</span> an inch of the edges, and -brought the lips close within a narrow compass; and having tied -that ligature fast, and cut off the string, I passed the needle -again through the two contrary sides, which I tied as close; -then loosened the ligature above, and applied the little round -stupes of tow spread with a quantity of Galen’s powder mixed -with egg albumen. The long pledgits were applied from the middle -of the stump each way upwards along the arm, over which I put on -a bladder and a cross cloth, then rowled up the stump, and made -the bandage [pass] under his other arm and over his neck.... He -being thus dressed up, we put him into his bed. The third day -we took off his dressings, and found the stump well digested, -and at least two spoonfuls of matter discharged.... During which -the bone exfoliated, and the stump soon after cicatrized. Then -having procured a pass to come to London, I hastened away.</p> - -<p>(2) A lady coming to town with a swelling in her left breast, -consulted some of our Profession, and at last me. She said she -had some years since kernels in her breast, which were judged -the “King’s Evil”; upon consideration of which she was presented -to His Majesty, and touched. In progress of time they swelled, -and her breast being extremely painful, she desired my judgment -of it. The swelling was large and round, and greatly inflamed, -under which it was soft and seemed to have matter in it. The -parts more distant were hard, and several tubercles lying -under the skin made it unequal; yet the breast was not fixed. -She urged me instantly to deliver my thoughts of it; which to -decline I turned from her, and told her friend it was a cancer, -and that I saw no hopes to save her life but by cutting it off. -He wished me to consider how I delivered such judgment of it, -two chirurgeons having lately assured her the contrary, they -taking it for a phlegmon. But I, not being used to guide my -judgment by what others delivered, confirmed to him what I had -before said by a sad prediction, which befel her in few weeks -after. And indeed there was no way then to deal with it but by -cutting off her breast.</p> -</div> - -<p>One is not a little startled, after reading a number of case-histories -like the two which I have just reproduced, to discover other portions -of text (Vol. I., pp. 384 and 385) which show clearly that Wiseman, -although a surgeon of the most practical character and a man equipped -with excellent reasoning powers when he was placed in the presence -of most of the problems which are constantly<span class="pagenum" id="Page_528">[528]</span> being submitted to -physicians for solution, was nevertheless the victim of a belief that -supernatural powers may reside in certain human beings. Speaking -of the cure of the “King’s Evil”—also called by him “struma” and -“scrofula”—Wiseman, in the chapter which he devotes to this subject, -makes the following statement:—</p> - -<div class="blockquot"> - -<p>But when upon trial he (the chirurgeon) shall find the -contumaciousness of the disease, which frequently deluded his -best care and industry, he will find reason of acknowledging the -goodness of God; who hath dealt so bountifully with this Nation -in giving the Kings of it, at least from Edward the Confessor -downwards (if not for a longer time), an extraordinary power in -the miraculous cure thereof.... I myself have been a frequent -eye-witness of many hundreds of cures performed by his Majesty’s -touch alone, without any assistance of chirurgery; and those, -many of them, such as had tired out the endeavors of able -chirurgeons before they came thither.</p> -</div> - -<p>Some years before his death, which occurred in 1686, Wiseman was given -the title of Serjeant-Chirurgeon to King Charles the Second.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_529">[529]</span></p> - -<h3>CHAPTER XLII<br /> -<span class="subhed1">REFORMS INSTITUTED BY THE ITALIAN SURGEON MAGATI IN THE -TREATMENT OF WOUNDS.—FINAL ENDING OF THE FEUD BETWEEN THE -SURGEONS AND THE PHYSICIANS OF PARIS.—REVIVAL OF INTEREST IN -THE SCIENCE OF OBSTETRICS</span></h3></div> - -<p><i>Reforms Instituted by Magati.</i>—Cesare Magati, who was born in -1579 at Scandiano, in the Duchy of Règgio, studied medicine at the -University of Bologna and received the degree of Doctor of Medicine -from that institution in 1597. Immediately afterward he went to Rome -and devoted himself particularly to the study of anatomy and surgery. -Then, upon his return to his native land, he quickly acquired so great -a reputation as a surgeon that the Duke of Bentivoglio, who was a man -of enlightened views and ambitious to promote in every possible way the -best interests of the University of Ferrara, offered Magati the Chair -of Surgery in that institution. The offer was accepted in 1612, and -Magati continued to hold the position for several years, his services -being highly appreciated both by the authorities of the university and -by the students. But, when his health began to break down,—he was -affected with stone in the bladder,—he decided that his best course -was to resign his professorship, retire from active practice, and -become a Capuchin monk. When he took this step he obtained permission -from the head of the Chapter to which he belonged, to resume in a -limited measure the surgical work which he was so well fitted to do. -But in the year 1647 his sufferings became so acute that he was obliged -to<span class="pagenum" id="Page_530">[530]</span> visit Bologna in the hope of obtaining relief through operative -interference. The operation, however, did not prove successful, and -death occurred shortly afterward.</p> - -<p>Magati effected, in a quiet and unostentatious manner, a number of -desirable reforms in surgical procedures. Thus, for example, he pointed -out how undesirable it is, in most cases, to change the dressings of -a wound so frequently as was, at that period, the common practice. -The process of cicatrization, he insisted, is not effected by the -efforts of the surgeon, but is fundamentally the work of Nature. Then, -in addition, he protested against the practice of introducing wicks -and pledgets of lint into wounds. These criticisms and this advice, -says von Gurlt, had been given many times before by different ancient -authors, but they undoubtedly had to be repeated from time to time.</p> - -<p>The treatise in which Magati has written these things bears the -following title: “<i>De rara medicatione vulnerum, seu de vulneribus -raro tractandis, libri duo</i>,” Venice, 1616 and 1676; also Nuremberg, -1733.</p> - -<p><i>Final Extinguishment of the Long-standing Feud between the Surgeons -and the Physicians in Paris.</i>—At several points in the course of -this sketch of the history of medicine, I have called attention to the -fact that, during the centuries preceding those which are reckoned by -certain authors as belonging to modern times, surgeons as a class were -generally looked upon, especially in the larger cities of France, as -decidedly inferior to physicians. The first attempt at something like -systematic instruction in surgery was made by the Brotherhood of Saint -Cosmas and Saint Damian at Paris. This organization, which was founded -by Jean Pitard about the middle of the thirteenth century, was composed -of a group of barbers who felt a strong desire to secure for themselves -a better training than was obtainable by the generality of barbers in -those days. The latter were known as “surgeons of the short gown,” -while the more ambitious men, who belonged to the group mentioned -above, were known as “surgeons of the long gown.” With the progress of -time this smaller group of barbers really succeeded in making better -surgeons of themselves, but in<span class="pagenum" id="Page_531">[531]</span> accomplishing this they intensified -at the same time the jealousy which the physicians as a class felt -toward them, a jealousy which repeatedly manifested itself in the form -of downright persecution. The data for a complete account of this -persecution, that persisted through centuries, are lacking, and even -if I possessed them I should not care to devote the time that would -be required for a proper presentation of the subject. It is pleasant, -however, to be able to record the fact that these plucky barbers -never entirely lost courage, but fought on, year after year, until -they eventually succeeded—with the help of a strongly sympathetic -public—in making the St. Côme Medical School the nursery of some -of the best surgeons in France during the sixteenth and seventeenth -centuries. It was here, for example, that Paré, Guillemeau, Thierry -de Héry and other men of distinction obtained their early training, -and it was doubtless through their influence that some of the wealthy -patients whom they had treated successfully, were induced to contribute -liberally to the support of the school. The final event in the history -of this institution was the complete overthrow of the opposing -physicians and the merging of the two surgical schools—that of the -regular Faculty and the St. Côme School—into one, under the direction -of de Lapeyronie, of whom I shall now furnish a brief sketch.</p> - -<p><i>François de Lapeyronie.</i>—François de Lapeyronie was born at -Montpellier on January 15, 1678, and he enjoyed the privilege of -receiving a most careful preliminary education. He was only seventeen -years of age when the academic degree which corresponds to our Master -of Arts was bestowed upon him. As the next step he visited Paris for -the purpose of perfecting his knowledge of surgery, the branch of -science in which he was specially interested; and upon his return -to Montpellier he began giving instruction in anatomy and surgery. -In a short time he was chosen Surgeon-in-Chief of the Montpellier -Hôtel-Dieu. In 1714 he was called to Paris to take charge of the Duc -de Chaulnes, whose malady had not yielded to the treatment adopted -by the surgeons of that city; and in this case the measures which he -employed proved so efficacious that de<span class="pagenum" id="Page_532">[532]</span> Lapeyronie decided to settle -permanently in the metropolis. He taught anatomy in the Collège de -Saint-Côme, and in a short time was chosen Head Surgeon of the Charité, -one of the largest hospitals of Paris. In 1731 he became one of the -founders of the Royal Academy of Surgery, and he took a most prominent -part in the struggle which was then actively going on between the -physicians and surgeons of Paris,—one of the last and most serious -of the attempts made by the former to render the surgeons subordinate -to the physicians. The surgeons won the battle (April 23, 1743), and -Dezeimeris says that the part taken by de Lapeyronie in this struggle -may be looked upon as one of the most honorable achievements recorded -in the history of medicine. De Lapeyronie died on April 25, 1747, after -a long and painful illness. In his will he made most liberal provision -for the promotion of medical science; establishing funds for the giving -of annual prizes, for the founding of a medical library, for the -building of an anatomical amphitheatre, etc. In his treatise on anatomy -Hyrtl, the distinguished professor at the University of Vienna, makes -the following brief statement with reference to a certain dissecting -room in Paris, but he does not state in what part of the city the -room in question is located, nor does he mention any other facts that -might enable his readers to fix its location. In the absence of more -precise information concerning this matter, I shall take the liberty of -suggesting that Hyrtl’s discovery was made in the Anatomical Institute -which de Lapeyronie founded. Hyrtl’s statement reads as follows:—</p> - -<div class="blockquot"> - -<p>Over the entrance doorway of a dissecting room in Paris I read -this inscription: <i>Hic locus est ubi mors gaudet succurrere -vitae.</i> [Here is the spot where Death rejoices to render -assistance to Life.] No more beautiful or fitting words could -be employed for inspiring the student, upon his first entrance -into the room, with respect for the work in which he is about to -engage.</p> -</div> - -<p>And yet, a few pages beyond that on which the above statement is -printed, Hyrtl quotes Vicq d’Azyr as saying: “Among all the sciences -anatomy is perhaps the one the<span class="pagenum" id="Page_533">[533]</span> usefulness of which has been most -highly lauded, but at the same time the one for which the least has -been done to favor its advancement.”</p> - -<p><i>The Revival of Interest in Obstetrics.</i>—With Soranus, the -early Greek writer on obstetrics, this science seemed to come to -a standstill, and during all the intervening centuries, up to the -sixteenth, not a single work of any special value was published on -this subject; for it is safe to say that nobody would claim for the -one or two obstetrical treatises that were written by teachers in -the Medical School of Salerno during the ninth or tenth century, -that they contributed materially to advance our knowledge in regard -to this branch of medicine. It therefore seems fitting, as suggested -by Haeser, that during the century which gave birth to such immortal -works as those of Vesalius and Paré, there should appear somebody who -possessed the inclination to stir once more into life the dying embers -of the science of midwifery; and such a man was found in the person of -Eucharius Roesslin, the elder, more commonly known—says Dezeimeris—by -the Greek name of “Rhodion.” He lived during the first half of the -sixteenth century, his death occurring about the year 1526, and his -was the first modern treatise especially devoted to obstetrics. He -began the practice of medicine in the city of Worms, in the central -part of Germany, and then moved to Frankfort-on-the-Main, where he -filled the salaried office of City Physician. Midwifery, at that time, -was left entirely in the hands of ignorant old women; and it was only -in response to the wishes of Catherine, the Duchess of Brunswick and -Lüneberg, that Rhodion undertook to prepare a manual from which these -ignorant and careless women might learn to conduct their midwifery work -in a more efficient, safe and acceptable manner. This little treatise, -which was first published at Worms in 1513, passed through a number -of editions and was translated into Latin, French, Dutch and English. -Von Siebold says that Rhodion compiled its text from various ancient -sources, and added practically nothing from his own experience. The -woodcuts,<span class="pagenum" id="Page_534">[534]</span> which are supposed to represent the different positions of -the foetus in the uterus, are not at all in accordance with the truth, -and show the most marvelous products of the artist’s fancy. Von Siebold -states, however, that the prejudices which at that time existed in the -minds of the people against the slightest participation of males in the -operations of midwifery were so strong that Rhodion would not have been -permitted to do anything toward learning the truth by the employment of -direct observation and careful examination—the only possible way in -which the actual facts might have been learned.</p> - -<p>Rhodion’s book, notwithstanding the defects to which I have just -referred, accomplished much good. It also restored the operation of -podalic version to the position which it deserved, and it improved -the service of the midwives,—which was what the Duchess chiefly -desired,—and it undoubtedly emphasized the fact that the time had -arrived when obstetrics should receive the same degree of scientific -study that was being bestowed on all the other departments of medicine.</p> - -<p>The title of Rhodion’s (or Roesslin’s) little book reveals the fact -that he possessed no small degree of humor. It reads: “Garden of Roses -for Pregnant Women and for Midwives,” Worms, 1513.</p> - -<p><i>The Operation Known as Caesarian Section.</i>—The following -statements relating to the operation known as “Caesarian section” -have been compiled from Haeser’s <i>Geschichte der Medizin</i>:—This -operation, which owes its name to the erroneous idea that Caesar -was brought into the world by its aid, is commonly believed to have -been practiced on different occasions throughout antiquity, but -there has not yet been found in the records of history any account -which shows clearly that the operation was performed upon a living -woman, and also that the incision extended not merely through the -abdominal integuments, but also through the actual uterine wall. At -Siegershausen, in Switzerland,—according to the report of Caspar -Bauhin in the treatise (“<i>Gynaecia</i>”) which he published at Basel -in 1586,—a man named Jacob Nufer performed (about<span class="pagenum" id="Page_535">[535]</span> 1500) what was -believed to be a Caesarian section on his own wife, and delivered a -living child. Both mother and child did well; the child growing up -to the age of seventy-seven and the mother giving birth to living -children, <i>per vias naturales</i>, several times afterward. In this -instance it is generally believed that the case was one of abdominal -pregnancy and that the wall of the uterus had not been incised.</p> - -<p>The first separate treatise on Caesarian section was written by -François Rousset, and in it are reported several cases in which the -operation was said to have been performed successfully. But both von -Siebold and Kurt Sprengel do not seem willing to accept these reports -as genuine, and we are therefore compelled to assume that the first -trustworthy account of a Caesarian section successfully performed by -a Dr. Trautmann of Wittenberg (in 1610) is that given by Sennert in a -communication which was printed early in the seventeenth century.</p> - -<p><i>Invention of the Obstetrical Forceps.</i>—After the publication of -Roesslin’s “Garden of Roses,” the book of which I gave a brief sketch -on a previous page, nothing worthy of special note was done for a -period of several years to advance the existing knowledge of midwifery -or even to systematize that which had already accumulated. Then there -began to appear evidences of an awakening among those physicians who -recognized the importance of this department of medical science, and as -a result there were soon placed upon record accounts of two or three -advances of real and permanent value. One of the first of these gains, -for example, was the revival and general acceptance of the practice of -podalic version, or version by internal manipulations,—that is, the -operation of changing the faulty position of the foetus <i>in utero</i> -in such a manner that the feet shall be the parts which protrude into -the vagina. Podalic version—as it appears from the account given by -von Siebold—was known to the ancients, both Celsus and Aëtius having -described it in their treatises, but it was afterward forgotten or -neglected until Ambroise Paré, in 1550, again recommended it in one of -his writings. At the<span class="pagenum" id="Page_536">[536]</span> same time Paré states, at the very beginning of -his monograph on this subject, that his colleagues, Thierry de Héry -and Nicole Lambert, had both of them already carried out the method in -certain cases. This fact, however, does not detract from the credit due -Paré for having been the first, after the lapse of several centuries, -to bring the operation to the knowledge of the medical profession; and -from that day to the present it has held a fixed place in the science -of obstetrics. As will be readily understood, this is not the proper -place in which to furnish details with regard to the operation itself. -When Paré was asked whether it would be permissible for the midwives -to undertake this operation of podalic version, he replied that it -would be, provided the individual who assumed this responsibility -felt convinced that she possessed the requisite degree of skill -and experience in work of this nature, and provided also that—as -soon as she began to suspect her inability to finish the operation -successfully—she would promptly call to her aid a skilful surgeon, one -who had acquired considerable experience in obstetrical operations. -Paré’s favorite pupil, Jacques Guillemeau (1550–1630), a native of -Orleans, France, made several important additions to our knowledge of -the operation of podalic version, and he was also in other respects an -important promoter of the science of operative obstetrics. His treatise -on this branch of practical medicine, which was originally written in -French and published at Paris in 1609, was soon translated into English -(“Childbirth, the Happy Deliverance of Women,” London, 1612). In the -opinion of von Siebold, podalic version may justly be considered the -most important contribution that was made to obstetrical science during -the sixteenth century.</p> - -<p>One of the French midwives of this period, Louise Bourgeois (or -Boursier), attained considerable celebrity by the excellence of the -treatise which she wrote on obstetrics. She was born at Paris about -the year 1564. In 1588 she began to fit herself for the career of -midwife, and in the course of a few years, after passing successfully -the required examinations, she was admitted by the authorities<span class="pagenum" id="Page_537">[537]</span> as a -“sworn midwife” of the city of Paris. She gained steadily in experience -and public favor, and the record states that already as early as 1601 -she had the good fortune to officiate at the delivery of Henry the -Fourth’s wife (Marie de Medicis) of a son—the Dauphin (later, Louis -the Thirteenth). Her royal patrons were much pleased with the services -which she rendered on this occasion, and, as a further evidence of -the confidence which she inspired, they asked her—as each of these -occasions approached—to preside at the births of five other children.</p> - -<p>One of the meritorious features of the treatise which Louise Bourgeois -wrote,<a id="FNanchor_99" href="#Footnote_99" class="fnanchor">[99]</a> says von Siebold, is to be found in the fact that she -championed most earnestly podalic version. The book was translated into -both German (1644) and Dutch (1658).</p> - -<p>François Mauriceau (1637–1709), who was indisputably the most -distinguished writer on obstetrics of the seventeenth century, was -born in Paris. During the early part of his career he was simply a -general surgeon, but, after the lapse of a few years, he gave up all -his other work and confined himself strictly to midwifery. For quite a -long period he held the position of Chief Obstetrician at Hôtel-Dieu, -and at the same time he conducted an extensive private practice in -cases of confinement. Worn out by the excessive amount of work which he -performed during the most active period of his career, he was finally -obliged to retire from practice several years before his death.</p> - -<p>Mauriceau did not invent any remarkable obstetric instruments or -procedures, but he was the first to set forth in clear and precise -terms the principles of this science and art and to expound the rules -required for putting them into practice. The titles of his two most -celebrated treatises are the following: “<i>Traité des maladies des -femmes grosses</i>,” Paris, 1668; and “<i>Observations sur la grossesse -et l’accouchement</i>,” Paris, 1695. In 1706, three years before his -death, he also published “<i>Dernières observations sur les maladies -des femmes grosses</i>.”</p> - -<p>The first of the three books mentioned passed through five<span class="pagenum" id="Page_538">[538]</span> editions -during Mauriceau’s lifetime, and there were two reprintings after his -death. A noticeable feature of the work, says von Siebold, is the care -which the author takes to preface all his lectures with a detailed -exposition of the anatomical relations of the region concerning which -he is about to speak; and this custom, which he was the first to -introduce, has since then been followed by the great majority of those -who have written on the subject of midwifery.</p> - -<p>In the book which hears the title “<i>Observations sur la grossesse, -etc.</i>,” Mauriceau gives an account of his first and only interview -with the English obstetrician, Hugh Chamberlen, to whom is commonly -accorded the credit of having invented the first pattern of the -obstetric forceps. From this account it appears that on August 19, -1670, Mauriceau was called to see a primiparous woman, thirty-eight -years old, who had already been in labor for several days, but -who had not yet been able, owing to the extreme narrowness of her -pelvis, to give birth to her child. (The case was one of head -presentation.) As Mauriceau was not at all willing to perform a -Caesarian section,—which alone, as he believed, promised a way out -of the difficulty,—Chamberlen, who happened to be in Paris at that -moment, was asked to see the patient. He came at once, made a hasty -examination, and declared that he needed only six or seven minutes for -effecting, by means of the method which he had invented, the delivery. -The patient was placed under his charge and he proceeded to apply his -method. Instead of a few minutes, he spent three hours in the attempt -to accomplish this purpose, but without success; and then admitted -that it was impossible, in this particular case, to effect delivery. -At the end of twenty-four hours the woman was dead. A postmortem -examination revealed the fact that the uterus was torn in several -places and perforated at one spot, all of which lesions had evidently -been produced by the instrument or instruments employed by Chamberlen. -“To complete this story,” adds Mauriceau, “it should be remembered -that, six months before the occurrence of the events just narrated, -this physician had come to Paris<span class="pagenum" id="Page_539">[539]</span> from England, and boasted that he -possessed a secret method by means of which he could, even in the most -desperate cases of labor, promptly effect the delivery of the child, -and had told the King’s Physician-in-Ordinary that he would sell the -knowledge of this secret for the sum of 10,000 Thalers (about $7500).”</p> - -<p>One naturally hesitates about giving any measure of credit to a -physician whose professional conduct, as revealed in his relations to -Mauriceau’s patient, is clearly that of a charlatan. At the same time -we are obliged to bear in mind that in 1670 it was still possible for -a physician or surgeon to own a secret method of treatment and yet not -forfeit all consideration on the part of his professional brethren. -But at no time in the history of medicine has such conduct as that -attributed to Hugh Chamberlen (apart from the question of ownership -of a secret process) been considered otherwise than reprehensible. -However, as there does not appear to have been an earlier claimant for -the honor of having invented the obstetric forceps,—crude as it must -have been in its first form,—it seems only fair that Chamberlen should -be granted undisputed possession of this honor. During the eighteenth -century—a period with which the present volume has no concern—the -obstetric forceps underwent many alterations, and finally was given, by -Levret and Baudelocque in France, by Smellie in England, and possibly -also by Palfyn in Holland, practically the form which it possesses -to-day.</p> - -<p>Before I finally dismiss the allied topics of obstetrics and -gynaecology, it seems desirable that I should add a few remarks -concerning two French surgeons who attained considerable eminence in -this special field, viz., Portal and Dionis.</p> - -<p><i>Paul Portal.</i>—Paul Portal, a native of Montpellier, France, was -a contemporary of Mauriceau and an excellent obstetrician. He received -his training under the best teachers at Paris, and more particularly -under the guidance of René Moreau, Dean of the Paris Faculty of -Medicine (1630 and 1631) and Royal Professor of Medicine and Surgery. -He died in 1703. In the treatise which he published<span class="pagenum" id="Page_540">[540]</span> at Paris in 1685 -(“<i>La pratique des accouchements, etc.</i>”) he lays down very -strongly the maxim that the surgeon or the midwife who has charge of -a case of labor should make no attempt to accelerate the efforts of -Nature until it becomes plainly evident that artificial assistance is -absolutely necessary. Portal cultivated the art of digital exploration -to a very high degree of excellence. In Chapter VI., according to von -Siebold, he expounds with great clearness the dangers which result from -a prolapse of the umbilical cord. When this condition is discovered, no -time should be lost in delivering the child. “In narrating some of his -most remarkable cases Portal uses very simple and clear language, and -he puts on record many things which in later years have been published -as entirely new discoveries. But, unfortunately, his immediate -successors were not disposed to profit from Portal’s admirable -teachings.” (Von Siebold.) The only translations of his treatise into -foreign languages that have been published are one in Dutch (1690) and -another in Swedish by Van Hoorn (1723).</p> - -<p><i>Pierre Dionis.</i>—Pierre Dionis, who was born at Paris in the -early part of the seventeenth century, was in some degree related to -Mauriceau, the famous Parisian accoucheur. In 1673 he was appointed -Royal Demonstrator of Anatomy and Surgery at the institution known -as the “<i>Jardin-du-Roi</i>,” and from this date onward, up to -the year 1680, he gave instruction regularly in these branches of -medical knowledge to large classes of students. He was particularly -distinguished for the clear and methodical manner in which he handled -the subjects upon which he lectured. In the year last mentioned he was -called to Vienna to fill the position of Physician-in-Ordinary to Maria -Theresa, Empress of Austria, but von Siebold, who is my authority for -the present sketch, does not say for what length of time he continued -to hold this position. His death occurred in 1718.</p> - -<p>The earliest work published by Dionis bears the title: “<i>Histoire -anatomique d’une matrice extraordinaire</i>,” Paris, 1685. (Description -of a case of extra-uterine<span class="pagenum" id="Page_541">[541]</span> pregnancy.) Five years later he published -the treatise on human anatomy (“<i>L’anatomie de l’homme, etc.</i>,” -Paris, 1690) upon which his celebrity largely rests. This book passed -through numerous editions and was translated into Latin, Dutch and -English (1723), and also Chinese; this last piece of work being -done by the Jesuit missionary, Father Parrenin, at the request of -Cam-Hi, Emperor of China, who died in 1723. Another treatise, which -perhaps contributed, even more than did his Anatomy, to render Dionis -celebrated, is that which bears the title: “<i>Cours d’opérations de -chirurgie démontrées au Jardin-du-Roi</i>,” Paris, 1707; and later -translations into German, Dutch and English. This book covers the -entire field of operative surgery, and its subject-matter is most -methodically arranged. It contains a large number of precepts which -are as sound to-day as they were two hundred years ago. From the -frequent mention which Dionis makes of the diseases to which the teeth -are liable, and from his descriptions of the operations that may be -performed for the cure or relief of these disorders, one is justified -in drawing the conclusion that, at that early period, this branch of -surgery was not, as many suppose, abandoned entirely to charlatans.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_542">[542]</span></p> - -<h3>CHAPTER XLIII<br /> -<span class="subhed1">THE FIRST APPEARANCE OF SYPHILIS IN EUROPE AS AN EPIDEMIC -DISEASE.—MEDICAL JOURNALISM.—THE BEGINNINGS OF A MODERN -PHARMACOPOEIA.—ITINERANT LITHOTOMISTS</span></h3></div> - -<p>Toward the end of the fifteenth and during the early part of the -sixteenth centuries accounts concerning syphilis began to be published -in the medical literature of Spain, Italy and France. The word -“syphilis,” it is true, does not appear in any of these records, for -it had not yet been coined; but the accounts themselves leave no room -for doubt that this was the disease to which the authors of these -records referred. The prevailing views with regard to the origin and -nature of syphilis differed somewhat in the three countries named. In -Spain, for example, it was a common belief that the disease originated -in an unfavorable conjunction of the stars<a id="FNanchor_100" href="#Footnote_100" class="fnanchor">[100]</a> and yet at the same -time it was generally admitted that it was a disease which belonged -in the category of luxuries and might be avoided if one were careful -not to have intercourse with dissolute women. For a brief period of -time there were physicians in all three of the Latin countries who -maintained that syphilis had been imported, in the first instance, -from America by the men who made the voyage with Columbus and by the -earliest Spanish explorers of South America; but it was soon shown -that this theory was not compatible<span class="pagenum" id="Page_543">[543]</span> with certain known facts—such, -for example, as the published reports made by the Spanish physicians -Pintor and Torrella,<a id="FNanchor_101" href="#Footnote_101" class="fnanchor">[101]</a> who describe cases of syphilis which they had -treated prior to 1493 (the year in which the first discoverers returned -from America). In Italy, according to Giovanni da Vigo, the author -of an excellent treatise on surgery (“<i>Practica in arte chirurgica -copiosa</i>,” Rome, 1514), the disease was first observed in Europe in -December, 1494, soon after the arrival of Charles the Eighth’s (France) -army at Naples; and only a short time elapsed before there developed, -as a result of this great accession of French soldiers, a veritable -epidemic of what then began to be known quite generally as “<i>morbus -gallicus</i>” or “the French disease.” The King himself, it is stated, -was among the number of those who contracted the infection.</p> - -<p>So far as I am able to discover, the term “syphilis” was first -introduced into medical literature by Fracastoro, the distinguished -physician of Verona, who published in 1530 a Latin poem bearing the -title: “<i>Syphilis sive morbus gallicus</i>.” These verses were -received everywhere with great favor, were translated into several -modern languages, and speedily put an end forever to the employment of -the insulting term “<i>morbus gallicus</i>.”</p> - -<p>A few more words with reference to the origin and distribution of -syphilis throughout the world may not seem inappropriate in this -place. J. K. Proksch, the author of the most recent history of this -disease,<a id="FNanchor_102" href="#Footnote_102" class="fnanchor">[102]</a> says it has been fully proved that syphilis existed among -the inhabitants of India as long ago as during the Middle Ages, and he -adds that the evidence thus far collected justifies the further belief -that it was not an uncommon malady among the ancient Greeks and Romans, -and even among the Babylonians and Assyrians. Doubtless a good deal -of what was called “leprosy” in early times was in reality syphilis. -Another syphilographer—Raphael Finckenstein—makes the following -sensible remarks about the<span class="pagenum" id="Page_544">[544]</span> efforts that have been made to ascertain -the precise date when this disease first appeared in Europe:—<a id="FNanchor_103" href="#Footnote_103" class="fnanchor">[103]</a></p> - -<div class="blockquot"> - -<p>It is just as foolish to suppose that the date of the first -appearance of syphilis may be discovered as it is to hope -that the disease will ever entirely disappear. As long as -wealth and idleness continue to exist, as long as there are -men who remain unmarried and women whose moral character is of -a yielding nature, and as long as it is not possible for the -police to creep into every nook and corner, just so long will -licentiousness and indulgence in fleshly lusts continue to -disturb the peace of the community. These are the conditions -necessary to the development and spread of syphilis.</p> -</div> - -<p>Some account of the treatment of this form of venereal disease comes -next in order. It is commonly believed, says the author just quoted, -that it was from the Spanish physicians of the sixteenth century -that we learned how to treat syphilis by the methodical employment -of mercurial preparations. (See footnote at the bottom of page 542.) -He adds that there was published by Juan Almenar at Venice, in 1502, -a book which bears the title: “A treatise on the Morbus Gallicus, -in which it is demonstrated how the patient may be treated in such -a successful manner that the disease will never return, nor will -any objectionable lesions develop in the mouth; and yet, during the -progress of the treatment, the patient is not required to remain -in bed.” The author of this book, who was a resident of Valencia, -Spain, was a man of noble birth. His treatise passed through eight -successive editions, the last of which was printed at Basel in 1536. -Almenar’s plan of treatment was to employ mercurial inunctions in such -moderate doses as not to induce salivation. If, at the end of a few -days, he saw evidences of an approach of this symptom, he substituted -baths and evacuant remedies (rhubarb and senna) for a short time, -and also prescribed a more nourishing diet and the taking of various -internal remedies. Then, later, the inunctions were resumed. The -exact duration of such a course of treatment is not stated. So far as -I am able to judge from the account given by Finckenstein, Almenar -found it necessary in some cases<span class="pagenum" id="Page_545">[545]</span> to repeat the series of mercurial -inunctions as many as four times. His aim, in other words, was to -accomplish a radical cure of the disease, whereas his contemporaries, -who were mainly ignorant and uneducated physicians, were satisfied to -carry out a purely symptomatic treatment. Morejon, the historian of -Spanish medicine, expresses the belief that Almenar was the first to -use steam baths in the treatment of syphilis. Both Hensler and Simon, -the best modern authorities with regard to the history of syphilis, -agree that Almenar’s inunction method of treating this disease forms, -notwithstanding its crudeness in certain respects, the basis of all -modern methods of the same general character. Unfortunately, the -physicians of a later period did not follow the relatively mild and -safe inunction method advocated by Almenar, but so modified it for the -worse that it became a common thing for men to say that the cure was -worse than the disease.</p> - -<p><i>A Few Special Advances Worthy of Note.</i>—The beginnings of -medical journalism belong to the second half of the seventeenth -century. In 1665, for example, there appeared for the first time, -a medical article in the “<i>Journal des Scavans</i>,” and during -the same year similar articles were printed in the “Philosophical -Transactions of the Royal Society of London.” According to August -Hirsch the earliest periodical that was devoted entirely to the -interests of the medical profession was the “<i>Journal des découvertes -en médecine</i>,” which was first published in 1679 and continued, -in 1680, under the title of “<i>Le Temple d’Esculape</i>.” Then -followed soon afterward: “<i>Le Journal des Nouvelles Découvertes en -Médecine</i>” (1681–1683); “<i>Le Mercure Savant</i>” (1684); “<i>Le -Zodiacus Medico-Gallicus</i>” (1680–1685), which was published in Latin -in Geneva, by Bonet; etc.</p> - -<p>In addition to the more important advances in anatomy and physiology -that have already been mentioned on previous pages, the following -deserve to receive at least a passing notice: In the department -of anatomy and physiology, William Briggs (1642–1704), one of the -physicians of St. Thomas’ Hospital, London, published at<span class="pagenum" id="Page_546">[546]</span> Cambridge in -1676, under the title of “<i>Ophthalmographia</i>,” a most important -contribution to the anatomy and physiology of the eye; and there were -four other English anatomists who, during the seventeenth century, -gained well-merited credit by the original work which they did in the -fields of anatomy and physiology—viz., Thomas Willis (1622–1675), -Francis Glisson (1597–1677), Thomas Wharton (1610–1673), and Nathaniel -Highmore (1613–1684). The part played by Germany in these gains in -anatomy and physiology, during the period now under consideration, was -chiefly that of a sympathetic recipient; for the political conditions -at that time were entirely unfavorable to any active participation on -the part of the physicians of that country. Early in the eighteenth -century, however, they began in earnest to do their share of work in -advancing the science of medicine.</p> - -<p>The relationship of the physical sciences to the theory and practice -of medicine is not of an intimate nature, and it will therefore not -be necessary for me to do more than briefly to enumerate the more -important of the discoveries of this character which occurred during -the sixteenth and seventeenth centuries.</p> - -<p>Galileo (1564–1642), a native of Pisa, Italy, was the creator of the -science of motion, and he gave the first satisfactory demonstration -of equilibrium on an inclined plane. He devised an imperfect -species of thermometer, a proportional compass, and the refracting -telescope, by means of which latter instrument he made a number of -other important discoveries in the domain of astronomy. His pupil, -Evangelista Torricelli (1608–1647), also a native of Italy, discovered -the barometer, and in addition arrived at many fundamental truths -in mechanics and hydrostatics. Otto von Guericke (1602–1686), a -native of Magdeburg, Germany, invented the air pump. Sir Isaac Newton -(1642–1727), born at Woolsthorpe, Lincolnshire, one of the world’s -greatest authorities in natural philosophy, was the first to formulate -clearly the law of gravitation. Edme Mariotte (1620–1684), a native -of Burgundy, France, was the discoverer of what is commonly known as -“Mariotte’s<span class="pagenum" id="Page_547">[547]</span> law”—<i>i.e.</i>, a law of elastic fluids, according to -which the elastic force is exactly in the inverse proportion of the -space which the mass of fluid occupies. He also discovered that the -part of the retina at which it meets the optic nerve is not capable of -conveying the impression of sight. Finally, Denis Papin (1647–1710), -a Frenchman, invented the first steam engine, of an embryonic and not -very practical type; for in this apparatus the piston floated on the -water in a separate cylinder.</p> - -<p>The inventions which I have here briefly enumerated represent the more -important discoveries that were made in physical science during the -sixteenth and seventeenth centuries.</p> - -<p><i>The Beginnings of a Modern Pharmacopoeia, and One of the Last -Attempts of the Disciples of Galen to Maintain Their Ascendancy in -Therapeutics.</i>—In the domain of pharmacology the first attempt in -modern times to organize this department of practical medicine was -made by an apothecary in Barcelona in 1497, and was published by him -in printed form in 1521. (Von Gurlt.) This pharmacopoeia was doubtless -wholly unknown beyond the borders of Spain. Not far from one hundred -years later,—<i>i.e.</i>, in the early part of the seventeenth -century,—Theodore Turquet de Mayerne, who was born in 1573, in a -small village near the city of Geneva, made the second attempt in -modern times to organize the pharmacological department of practical -medicine. After showing quite early in life a fondness for the study -of chemistry, he devoted himself particularly to the investigation -of the remedies that are produced in the chemist’s laboratory; the -preparations of antimony attracting his especial interest. A little -before this time the physicians of Paris were split up into two -strongly antagonistic parties as regards the propriety of administering -this metal in any form as a remedy; but those who opposed its -therapeutic employment finally managed to secure from Parliament, in -1566, a decree prohibiting its use. While this quarrel was in progress, -de Mayerne visited Paris (1602) and established himself in that city -as an independent lecturer on chemistry. As<span class="pagenum" id="Page_548">[548]</span> the regular faculty still -held the belief that the teachings of Galen were the only safe guide -for physicians to follow, de Mayerne’s action must have appeared to -them like an impudent challenge. In one of his writings he strongly -recommended the employment of antimonial preparations,—remedies -introduced originally by the much-hated Paracelsus,—and he even -went so far as to offer some for sale. This was too much for the -disciples of Galen to bear without a protest, and consequently in -1603 the Parliament issued a new decree, in accordance with which de -Mayerne was prohibited from practicing medicine in Paris. This measure -appears to have proved successful in putting a stop effectively to -his obnoxious teachings, for we learn that shortly afterward he was -known to be living in London, where, in 1611, he was appointed the -Physician-in-Ordinary to King James the First, and later to Charles the -First. He died in 1655.</p> - -<p>Jean Astruc, the distinguished French medical author of the eighteenth -century, speaks rather disparagingly of de Mayerne’s attempt to -organize a pharmacopoeia. An earlier, more successful, and much -more creditable attempt of this nature was made by Valerius Cordus, -whose “<i>Dispensatorium pharmacorum omnium</i>” was first published -at Nürnberg in 1535. This work, which subsequently bore the title -“<i>Pharmacopoeia Augustana</i>,” up to the year 1627 passed through -at least seven editions and was utilized to a greater or less extent -by the authors or editors of nearly all later pharmacopoeias. To -go still further back, the most ancient pharmacopoeia of which we -have any knowledge is that which bears the title of “<i>Antidotarium -Nicolai</i>,” the author of which work was Nicolaus, the President or -Dean of the Medical School at Salerno. The book was written originally -during the first half of the twelfth century, but it did not appear in -print, at Venice, until the year 1471, and then only in an incomplete -form. Quite recently a French translation of the book has been -made and published (1896) by Paul Dorveaux, of the Paris School of -Pharmacy. Most of the preparations there described have long since been -abandoned, but a few of<span class="pagenum" id="Page_549">[549]</span> them—such, for example, as citrine ointment, -honey of roses, oxymel, and oil of roses—are still to be found in the -pharmacopoeias of some nations.</p> - -<p><i>Itinerant Lithotomists.</i>—For an unknown number of years -preceding the sixteenth century it had been a well-established custom -for members of the medical profession in France, and also, doubtless, -in neighboring countries, to intrust—as the Hippocratic oath -enjoined—all cases of stone in the bladder to expert lithotomists. -Such special knowledge and skill were not easily acquired, and so it -came about that there were very few individuals who were acknowledged -to be experts and who were really capable of teaching the art, and -these few guarded most carefully the knowledge which they had gained. -During the period of time which we are now considering, certain -members of the Collot and Pineau families were the most distinguished -lithotomists in France, and the records show that in the year 1600 -Jehan Paradis and Nicolas Serre petitioned the Government for official -recognition of their special rights to enjoy a monopoly of operative -work of this character. “We ask that you give orders that all poor -patients who may apply to Hôtel-Dieu (the great city hospital of Paris) -or to the Bureau-of-the-Poor for relief from stone in the bladder, be -turned over to our care for proper treatment. The poor will receive -this treatment gratis, and those who can afford to pay will be charged -a very reasonable fee. And you will do well if you prohibit all other -persons from meddling with such cases in any manner.” In a document -bearing the date 1646 mention is made of four lithotomists—Philippe -and Charles Collot, Jacques Girault and Antoine Ruffin—who had erected -in the Faubourg Saint-Antoine, Paris, a building which was intended -to serve as a hospital “in which, at any time during the entire year, -those who are afflicted with stone in the bladder may be lodged, fed, -nursed and subjected to proper treatment,—the poor without charge of -any kind, and the well-to-do at a proper rate of remuneration.”</p> - -<p>In Franco’s time (middle of the sixteenth century) cutting for stone -in the bladder was by no means an<span class="pagenum" id="Page_550">[550]</span> uncommon operation, and was almost -always performed by itinerant lithotomists (“<i>inciseurs</i>”). The -Collots had, for many years, possessed almost a monopoly of this -business. Laurent Collot, who was the first one of the family to engage -in the work, was Royal Lithotomist in 1556, and handed down to his son -all the knowledge on this subject which he had acquired through long -experience. François Tolet was another of these popular lithotomists -who flourished in Paris during the sixteenth and seventeenth centuries. -He died in 1724 at the age of seventy-seven. His treatise on lithotomy, -which was published in Paris in 1681, and subsequently passed through -several editions, is said by Dezeimeris to contain the records of a -large number of his own cases and to show clearly that he was a surgeon -of sound judgment. No better treatise on this subject, he adds, was -published during that period of the history of medicine.</p> - -<p>In addition to those whom I have just mentioned there were two French -monks who gained wide celebrity as operators for stone in the bladder, -viz., Frère Jacques de Beaulieu and Frère Côme. The last-named belongs -to the early part of the eighteenth century, and should therefore—in -accordance with the plan which I have been following—not receive -consideration in the present account; but, in view of the fact that -these are the only two monks who, during the Renaissance and the period -immediately following, gained conspicuous credit for the honorable and -efficient service which they rendered, not merely to the science of -medicine but also to the cause of humanity, I believe that I cannot do -better than to place the two sketches together as if they both belonged -strictly to one and the same period of time.</p> - - <div class="figcenter" id="i_fp550" style="width: 541px"> - <img - class="p2" - src="images/i_fp550.jpg" - alt="" /> - <p class="center p0 sm">FIG. 26. FRÈRE JACQUES DE BEAULIEU.</p> - <p class="center p0 sm">Born in 1651 in the village of Létendonne, Franche-Comté, France.</p> - <p class="p0 sm">(From the steel engraving in the treatise <i>De la Taille -Latérale par le Périnée</i>, etc., by Pascal Baseilhac, nephew -of Frère Côme, Paris, 1804.)</p> - </div> - -<p>(<i>a</i>) Frère Jacques—or Brother James, who was born in 1561 at the -village of Létendonne, near Lons-le-Saulnier, Central France,—learned -the art of operating for stone in the bladder from an Italian surgeon -named Paulony, and acted as his assistant or associate up to the time -when he became a monk of the Order of Saint Francis—that is, of that -branch of the Order which had its chapter house at <span class="pagenum" id="Page_551">[551]</span>Feuillants in -Languedoc. He traveled about the country offering to treat gratuitously -all persons affected with stone in the bladder who were willing to -trust him, and he made it a rule, whenever such a thing was possible, -always to operate in the presence of one or more physicians or -surgeons. He was also ready at all times to give instruction to those -who wished to learn his method of procedure. He never asked to be -remunerated, but was always pleased to receive from his patients a -written testimonial of what he had done for them. Out of the moneys -which he received from the rich he retained only that which he required -for his own support and for the purchase of such instruments as he from -time to time required; the balance he distributed among the poor. He -was very faithful in performing his religious duties, and he succeeded -in gaining the good will and esteem of everybody with whom he had any -dealings.</p> - -<p>For a long time it was customary in France to credit Frère Jacques -(Fig. 26) with the invention of the lateral method of operating for -stone in the bladder. This, however, was an error, for Franco, on page -95 of E. Nicaise’s reproduction of the 1561 edition, describes this -operation clearly. It must therefore have been invented a long time -before Frère Jacques was born. The text (rendered into English) reads -as follows: “... the incision should be made between the anus and the -testicles, two or three finger-breadths to one side of the commissure -or perinaeum [median line of the perinaeum].” This is said to be the -earliest clear description of the first step of the lateral operation -of which we have any knowledge.</p> - -<p>In 1697, when Frère Jacques visited Paris, he had already attained -wide celebrity as a lithotomist; the number of his successful -operations—all of which had been performed according to the lateral -method of procedure—having reached a grand total of several thousand. -He therefore had a right to suppose that his visit would prove -acceptable to the physicians of that metropolis; but the published -account of this visit reveals plainly the fact that the surgeons of -that city were not at all pleased that an itinerant lithotomist from -one of the provinces should have the<span class="pagenum" id="Page_552">[552]</span> effrontery to request permission -of the authorities to exhibit his method before the Medical Faculty of -Paris. His request, however, was granted, and he was allowed to operate -on a man, forty years old, at Hôtel-Dieu. He performed the operation -before a large assembly of physicians, and, after the stone had been -successfully extracted, the patient made a prompt recovery. A short -time afterward he operated upon another patient at Fontainebleau in the -presence of several physicians, one of whom was Monsieur Félix, the -First Surgeon of the King, Louis the Fourteenth. In this case also, as -well as in several later cases, Frère Jacques was entirely successful, -and he now began to be treated by the public with marked consideration. -But, in a short time, owing to the jealousy exhibited by a large clique -of Paris surgeons, who were encouraged to pursue this course by Mery, -the Head Surgeon of Hôtel-Dieu, Frère Jacques was finally forced to -leave Paris. I cannot follow him on his further wanderings throughout -Europe, from the leading cities of Holland, Belgium and Switzerland to -Vienna and Rome. In 1716 he retired to Besançon and lived there quietly -up to the time of his death in 1719. But even then his enemies—men to -whom he had never done the slightest harm—did their best to destroy -the last traces of his existence. A visit made to Besançon by one of -his acquaintances not long after our Franciscan monk’s death, revealed -the fact that his name had been erased from the church registry of -deaths. The lateral method of operating for stone, which had been -revived and thoroughly developed by him, still finds favor among the -best surgeons of our own day; and the names of those mean-spirited men -who tried so hard to injure him have long since passed into complete -oblivion.</p> - - <div class="figcenter" id="i_fp552" style="width: 447px"> - <img - class="p2" - src="images/i_fp552.jpg" - alt="" /> - <p class="center p0 sm">FIG. 27. JEAN BASEILHAC, COMMONLY KNOWN IN FRANCE AS -FRÈRE CÔME.</p> - <p class="center p0 sm">(From the steel engraving in Pascal Baseilhac’s treatise.)</p> - </div> - - <div class="figcenter" id="i_p553" style="width: 750px"> - <img - class="p2" - src="images/i_p553.jpg" - alt="" /> - <p class="center p0 sm">FIG. 28. CONCEALED LITHOTOME INVENTED BY FRÈRE CÔME IN 1748.</p> - <p class="center p0 sm">(From the steel engraving in Pascal Baseilhac’s treatise.)</p> - </div> - -<p>(<i>b</i>) Frère Jean de Saint-Côme,—or Brother John of Saint -Cosmas,—whose real name was Jean Baseilhac, was born in 1703 at -Poyestruc, Department of Hautes-Pyrenées, France. He received his -instruction in the principles of medicine from his father and his -grandfather, both of whom were regularly enrolled Masters in Surgery. -In 1722, when there could no longer be any doubt about young -<span class="pagenum" id="Page_554">[554]</span>Baseilhac’s settled purpose to fit himself for the practice of -medicine, his father sent him to Lyons, where his uncle, who was -himself a surgeon, would be able to superintend the boy’s further -training. Through the latter’s influence, young Baseilhac was allowed -to enter the Hôtel-Dieu of that city as one of its regular pupils. -At the end of two years—<i>i.e.</i>, in 1724—he left Lyons and -went to Paris, where he hoped to add materially to his stock of -professional knowledge. His first step, after reaching the metropolis, -was to enter the service of a surgeon in active practice; and then, -aided by the latter’s influence, he succeeded (in 1726) in entering -the Paris Hôtel-Dieu as one of the regular pupils. Soon after he -had completed his term of service at the hospital, he was appointed -Physician-in-Ordinary to the Prince-Bishop of Bayeux, in Normandy. The -death of the latter in 1728, less than two years after Baseilhac had -entered his service, came as a great blow to the young surgeon, for he -had learned to esteem him very highly. In his will the Bishop left a -small legacy to Baseilhac—that is, a sum of money sufficient to pay -for the regular course of instruction at the Medical School of Saint -Cosmas in Paris, and also to procure a complete outfit of surgical -instruments. In 1740 he became a member of the Feuillants Branch of -the Franciscan monks, it being understood, however, that he was to be -allowed the special privilege of practicing surgery among the poorer -classes. Through accidental circumstances he was led gradually to drop -general surgery and to confine his work to operations for stone. His -official name at this time was “Frère Jean de Saint-Côme,” or simply -“Frère Côme.” (Fig. 27.) As he gained in experience as a lithotomist, -he became convinced that the method which his predecessor, Frère -Jacques, had practiced with such great success, was preferable to the -more complicated and more dangerous plan commonly pursued by surgeons -at that time, and thereafter he adopted it in all his cases. But he -modified the procedure to a certain extent; that is, he invented an -instrument by means of which the actual cutting of the perinaeum was -accomplished with a concealed knife (see Fig. 28). The<span class="pagenum" id="Page_555">[555]</span> chief advantage -to be gained by the employment of this instrument consisted—as was -claimed by Frère Jean and his nephew, Pascal Baseilhac,—in the fact -that in this way the danger of making the incision in the wrong place, -or of too great length, was materially diminished.</p> - -<p>The first patient upon whom the new instrument was tried (October 8, -1748), was a dealer in lime, sixty years of age and in rather delicate -health. In less than three weeks after the operation, he was entirely -cured. Subsequently the instrument was employed in a large number of -instances, and the method was found to be most satisfactory; successful -results being obtained—on the average—in twelve out of thirteen -cases, whereas the best results previously obtained by the method -commonly employed at that period was 50 per cent of cures. At a still -later date the statistics showed even better results—viz., 96 cures in -one group of 100 cases, and 316 cures in a second group of 330 cases.</p> - -<p>Owing to the rapidly increasing number of patients affected with stone -in the bladder who wished to be operated upon by Frère Jean himself, he -established in Paris in 1753, near the Saint Honoré gateway, a special -hospital for lithotomy cases, and kept it in active service up to the -time of his death. The laboring classes, and the poor in general, were -not expected to pay any fees, and indeed money was often bestowed -upon these people when they left the hospital, to enable them to -return comfortably to their villages; those in moderate circumstances -were asked to pay only the expenses that had been incurred in their -behalf; and the well-to-do made such voluntary contributions as they -thought proper toward the support of the hospital. The registers of the -institution showed that, first and last, over one thousand operations -had been performed there, either by Frère Jean or by his nephew, Pascal -Baseilhac. Our monk’s death occurred on July 8, 1781.</p> - - -<p class="center p2">THE END</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_557">[557]</span></p> - -<h2 class="smaller2">LIST OF THE MORE IMPORTANT AUTHORITIES CONSULTED</h2> -</div> - -<p>ARISTOTLE: <span class="smcap">History of Animals</span>, translated by Richard -Cresswell, London, 1902.</p> - -<p>ASCHOFF, L.: <span class="smcap">Kurze Uebersichtstabelle zur Geschichte der -Medizin</span>; forms the second part of Schwalbe’s treatise -(<i>q.v.</i>).</p> - -<p>BAAS-HANDERSON: <span class="smcap">History of Medicine</span>, New York, 1910.</p> - -<p>BASEILHAC, PASCAL: <span class="smcap">De la Taille Latérale par la Périnée, -et celle de l’Hypogastre, ou Haut Appareil</span>, Paris, 1804. -(Includes an account of the career of Frère Côme.)</p> - -<p>BERENDES, J.: <span class="smcap">Das Apothekenwesen</span>, Stuttgart, 1907.</p> - -<p>BOERHAAVE: <span class="smcap">A New Method of Chemistry</span>, translated by -Peter Shaw, M.D., London, 1741; <span class="smcap">Aphorisms</span>, etc., -English translation, London, 1742.</p> - -<p>BOTTEY, F.: <span class="smcap">Traité théorique et pratique d’hydrothérapie -médicale</span>, Paris, 1895.</p> - -<p>BROUSSAIS, F. J. V.: <span class="smcap">Examen des doctrines médicales</span>, -troisième edition (4 vols.), Paris, 1829–1834.</p> - -<p>CABANÈS: <span class="smcap">Paracelse—L’homme et l’œuvre</span>, article in -<i>La Revue Scientifique</i>, Paris, May 19, 1894.</p> - -<p>CASALIS: <span class="smcap">De profanis Romanorum ritibus</span>; Chapter VII., -<span class="smcap">de Aesculapio</span>, Rome, 1644.</p> - -<p>CELSE, A. C.: <span class="smcap">Traité de Médecine</span>; traduction par le Dr. -A. Védrènes, Paris, 1876.</p> - -<p>CHEREAU: <span class="smcap">Les Anciennes Écoles de Médecine de la Rue de la -Bucherie</span>, Paris, 1866.</p> - -<p>CULLEN, WILLIAM: <span class="smcap">First Lines of the Practice of -Medicine</span>, Edinburgh, 1802. (2 vols.)</p> - -<p>DAREMBERG, CHARLES: <span class="smcap">Œuvres anatomiques, physiologiques et -médicales de Galien</span>, 2 vols., Paris, 1854–1856; <span class="smcap">État -de la médecine entre Homère et Hippocrate</span>, Paris, 1869; -<span class="smcap">Histoire des sciences médicales</span>, 2 vols., Paris, 1870.</p> - -<p>DEZEIMERIS, OLLIVIER ET RAIGE-DELORME: <span class="smcap">Dictionnaire Hist. de -la Méd. Anc. et Mod.</span>, 3 vols., Paris, 1828–1837.</p> - -<p><span class="pagenum" id="Page_558">[558]</span></p> - -<p>DIOSKURIDES, PEDANIOS: <span class="smcap">Arzneimittellehre</span>, Uebersetzung -von Dr. J. Berendes, Stuttgart, 1902.</p> - -<p>DORVEAUX, PAUL: <span class="smcap">L’Antidotaire Nicolai</span> (<span class="smcap">Nicolaus -Praepositus</span>), Paris, 1896.</p> - -<p>FALK: <span class="smcap">Galen’s Lehre vom gesunden und kranken -Nervensysteme</span>, Leipzig, 1871.</p> - -<p>FINCKENSTEIN: <span class="smcap">Zur Geschichte der Syphilis</span>, Breslau, -1870.</p> - -<p>FOSSEL, VIKTOR: <span class="smcap">Hieronymus Fracastoro; drei Buecher -von den Contagien, den kontagioesen Krankheiten und deren -Behandlung</span> (1546), Leipzig, 1910.</p> - -<p>FRANCO, PIERRE: <span class="smcap">Chirurgie</span>, Nouvelle édition par E. -Nicaise, Paris, 1895.</p> - -<p>FREIND, J.: <span class="smcap">The History of Physick</span>, 2d edition, London, -1727. (2 vols.)</p> - -<p>FRIEDLAENDER, L. H.: <span class="smcap">Vorlesungen ueber die Geschichte der -Heilkunde</span>, Leipzig, 1839.</p> - -<p>FROELICH, H.: <span class="smcap">Galen ueber Krankheitsvortaeuschungen</span>, -in Friedrich’s Blaetter fuer Gerichtliche Medicin, I. Heft, -vierzigster Jahrgang, Nuernberg, 1889.</p> - -<p>GERMAIN, A.: <span class="smcap">L’École de Médecine de Montpellier</span>, -Montpellier, 1880.</p> - -<p>GUERINI: <span class="smcap">A History of Dentistry</span>, etc., Philadelphia and -New York, 1909.</p> - -<p><span class="smcap">von GURLT</span>: <span class="smcap">Geschichte der Chirurgie</span>, Berlin, -1898. (3 vols.)</p> - -<p>GUY DE CHAULIAC: <span class="smcap">La Grande Chirurgie</span>, edited by Edouard -Nicaise, Paris, 1890.</p> - -<p>HAESER, H.: <span class="smcap">Lehrbuch der Geschichte der Medicin</span>, zweite -Ausgabe, Jena, 1868. (3d edition, 1875.)</p> - -<p><span class="smcap">von HALLER, ALBERT</span>: <span class="smcap">Bibliotheca medicinae -practicae</span>, Basel, 1776. (4 vols.)</p> - -<p>HERODOTUS: <span class="smcap">History</span>, translated by George Rawlinson, -M.A. (2 vols.)</p> - -<p>HIPPOCRATES: <span class="smcap">Saemmtliche Werke</span>, translated into German -by Dr. Robert Fuchs (3 vols.), Munich, 1895–1900.</p> - -<p>HIRSCH, AUGUST: <span class="smcap">Geschichte der med. Wissenschaften in -Deutschland</span>, Muenchen und Leipzig, 1893.</p> - -<p>HOLLAENDER, EUGEN: <span class="smcap">Die Medizin in der klassischen -Malerei</span>, Stuttgart, 1903; <span class="smcap">Plastik und Medizin</span>, -Stuttgart, 1912.</p> - -<p><span class="pagenum" id="Page_559">[559]</span></p> - -<p>HOMER: <span class="smcap">The Iliad and the Odyssey</span>, published by Dent & -Sons, London. (2 vols.)</p> - -<p>HYRTL, JOSEPH: <span class="smcap">Lehrbuch der Anatomie des Menschen</span>, -Vienna, 1846.</p> - -<p>JUSSERAND, J. J.: <span class="smcap">English Wayfaring Life in the Middle -Ages</span> (14th century), G. P. Putnam’s Sons, New York and -London, 1889.</p> - -<p>LABOULBÈNE, M. A.: <span class="smcap">Syndenham et son oeuvre</span>, article in -the <i>Revue Scientifique</i>, Tome XLVIII, November 28, 1891.</p> - -<p>LE CLERC, DANIEL: <span class="smcap">Histoire de la Médecine</span>, Amsterdam, -1723.</p> - -<p>LE CLERC, LUCIEN: <span class="smcap">Histoire de la Médecine Arabe</span> (2 -vols.), Paris, 1876.</p> - -<p>LEMOINE, ALBERT: <span class="smcap">Le Vitalisme et l’Animisme de Stahl</span>, -Paris, 1864.</p> - -<p>MALGAIGNE: <span class="smcap">Oeuvres complètes d’Ambroise Paré</span>, -1840–1841, (3 vols.)</p> - -<p>MEYER-STEINEG: <span class="smcap">Cornelius Celsus ueber Grundfragen der -Medizin</span>, Leipzig, 1912; <span class="smcap">Kranken-Anstalten im -griechischroemischen Altertum</span>, Jena, 1912.</p> - -<p><span class="allsmcap">VON</span> MEYER, E.: <span class="smcap">Geschichte der Chemie</span>, 3d -edition, Leipzig, 1905.</p> - -<p>MOMMSEN, THEODORE: <span class="smcap">The History of Rome</span>, translated from -the German by W. P. Dickson and published by Dent & Sons, London.</p> - -<p>MUENZ, ISAAC: <span class="smcap">Ueber die juedischen Aerzte im -Mittelalter</span>, Berlin, 1887.</p> - -<p>NEUBURGER, ALBERT: <span class="smcap">Friedrich Hoffmann ueber das -Kohlenoxydgas</span>, Leipzig, 1912.</p> - -<p>NEUBURGER, MAX: <span class="smcap">Geschichte der Medizin</span>, Vol. I. and -Vol. II., zweiter Theil, 1906–1911.</p> - -<p>OPITZ, KARL: <span class="smcap">Die Medizin im Koran</span>, Stuttgart, 1906.</p> - -<p>ORDRONAUX, JOHN: <i>Regimen sanitatis Salernitanum</i>, -translated into English verse, Philadelphia, 1871.</p> - -<p>PAGEL, JULIUS: <span class="smcap">Einfuehrung in die Geschichte der -Medicin</span>, Berlin, 1898.</p> - -<p>PESSINA <span class="allsmcap">VON</span> CECHOROD, W. M.: <span class="smcap">Heilige Aerzte und -Pfleger der Kranken</span>, Prag, 1859.</p> - -<p><span class="pagenum" id="Page_560">[560]</span></p> - -<p>PETERSEN, JULIUS: <span class="smcap">Hauptmomente in der geschichtlichen -Entwickelung der medicinischen Therapie</span>, Copenhagen, 1877.</p> - -<p>PLATO: <span class="smcap">The Republic, Timaeus, and Critias</span>, translated -by Henry Davis, London, 1911.</p> - -<p>PLATTER, FELIX ET THOMAS, à Montpellier (1552–1557; 1595–1599), -Montpellier, 1892.</p> - -<p>PRISCIANUS, THEODORUS: uebersetzt von Dr. Meyer-Steineg, Jena, -1909.</p> - -<p>PUSCHMANN, THEODOR: <span class="smcap">The Original Greek Text and a German -translation of Alexander of Tralles</span>, Vienna, 1878; and -<span class="smcap">Geschichte des medicinischen unterrichts</span>, Leipzig, 1889.</p> - -<p>RUFUS D’EPHÉSE: <span class="smcap">Oeuvres</span>, traduites par Daremberg et -Ruelle, Paris, 1879.</p> - -<p>RENAN, ERNEST: <span class="smcap">Averroès et l’Averroisme</span>, 2me édition, -Paris, 1861.</p> - -<p>SALICET, GUILLAUME DE: <span class="smcap">Chirurgie</span>, traduction par Paul -Pifteau, Toulouse, 1898.</p> - -<p>SCHWALBE, ERNST: <span class="smcap">Vorlesungen ueber Geschichte der -Medizin</span>, 2te Auflage, Jena, 1909.</p> - -<p><span class="smcap">SIEBOLD, E. von</span>: <span class="smcap">Versuch einer Geschichte der -Geburtshuelfe</span> (2 vols.), Berlin, 1839.</p> - -<p>SOUTH, JOHN FLINT: <span class="smcap">Memorials of the Craft of Surgery in -England</span>, edited by D’Arcy Power, M.A. Oxon., F.R.C.S. Eng., -1886.</p> - -<p>SPIESS, G. A.: <span class="smcap">J. B. Van Helmont’s System der Medicin</span>, -Frankfort am Main, 1840.</p> - -<p>SPRENGEL, KURT: <span class="smcap">Versuch einer pragmatischen Geschichte der -Arzneikunde</span> (5 vols.), Halle, 1821–1828.</p> - -<p>TACITUS: <span class="smcap">The Annals</span>, edited by E. H. Blankeney, Dent & -Sons, London.</p> - -<p>TSINTSIROPOULOS, CONSTANTIN: <span class="smcap">La médecine Grecque depuis -Asclépiade jusqu’ à Galien</span>, Paris, 1892.</p> - -<p>WELLMANN, MAX: <span class="smcap">Die pneumatische Schule</span>, Berlin, 1895.</p> - -<p>WISEMAN, RICHARD: <span class="smcap">Eight Surgical Treatises</span>, 5th -edition, London, 1719.</p> - - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_563">[563]</span></p> -<h2 class="smaller2">GENERAL INDEX</h2> -</div> - -<p class="p-index">A</p> - -<ul> - - <li><span class="smcap">Abdomen</span>, penetrating wounds of, - <a href="#Page_469">469</a></li> - - <li><span class="smcap">Abella</span>, teacher of medicine at Salerno, - <a href="#Page_245">245</a></li> - - <li class="hangingindent"><span class="smcap">Abou Bekr</span>, distinguished Arab physician in Spain, - <a href="#Page_232">232</a></li> - - <li><span class="smcap">Abou Sahl el Messihy</span>, distinguished Persian physician, - <a href="#Page_223">223</a></li> - - <li><span class="smcap">Abscess</span>, mediastinal, - <a href="#Page_229">229</a></li> - - <li><span class="smcap">Abulcasis</span>, famous Arab surgeon, - <a href="#Page_226">226</a></li> - - <li><span class="smcap">Abulpharagius</span>, - <a href="#Page_184">184</a></li> - - <li><span class="smcap">Académie de Chirurgie</span>, Paris (1731), - <a href="#Page_450">450</a></li> - - <li><span class="smcap">Académie des Curieux da la Nature</span>, - <a href="#Page_364">364</a></li> - - <li><span class="smcap">Académie des Sciences</span>, - <a href="#Page_363">363</a></li> - - <li><span class="smcap">Accademia dei Lincei</span>, Rome, - <a href="#Page_364">364</a></li> - - <li><span class="smcap">Accademia del Cimento</span>, Florence, - <a href="#Page_364">364</a></li> - - <li><span class="smcap">Acrabadin Kebir</span>, - <a href="#Page_209">209</a></li> - - <li><span class="smcap">Acupressure</span>, - <a href="#Page_143">143</a></li> - - <li><span class="smcap">Adams, Frederick</span>, - <a href="#Page_89">89</a></li> - - <li><span class="smcap">Aegidius Corboliensis</span>, - <a href="#Page_255">255</a></li> - - <li><span class="smcap">Aeneas</span>, wounded in groin, - <a href="#Page_49">49</a></li> - - <li><span class="smcap">Aesculapius</span>, - <a href="#Page_47">47</a>, - <a href="#Page_49">49</a></li> - <li class="i1">symbol of, - <a href="#Page_315">315</a></li> - <li class="i1">temple of, at Cos, - <a href="#Page_514">514</a></li> - - <li><span class="smcap">Aëtius</span>, - <a href="#Page_194">194</a>, - <a href="#Page_318">318</a></li> - - <li><span class="smcap">Afflacius, John</span>, - <a href="#Page_245">245</a>, - <a href="#Page_248">248</a></li> - - <li><span class="smcap">Agathinus</span>, - <a href="#Page_142">142</a></li> - - <li><span class="smcap">Agrate, Marco</span>, - <a href="#Page_339">339</a></li> - - <li><span class="smcap">Aigle</span>, daughter of Aesculapius, - <a href="#Page_50">50</a></li> - - <li><span class="smcap">Alae nasi</span>, Galen’s comments on movements of, - <a href="#Page_173">173</a></li> - - <li><span class="smcap">Albert von Bollstedt</span> (Albertus Magnus), - <a href="#Page_269">269</a></li> - - <li><span class="smcap">Alcmaeon</span>, - <a href="#Page_73">73</a>, - <a href="#Page_79">79</a></li> - - <li><span class="smcap">Alderotti, Thaddeus</span>, - <a href="#Page_272">272</a></li> - - <li><span class="smcap">Alexander of Tralles</span>, - <a href="#Page_195">195</a></li> - - <li><span class="smcap">Alexander Philalethes</span>, - <a href="#Page_115">115</a></li> - - <li><span class="smcap">Alexander the Great</span>, - <a href="#Page_100">100</a></li> - - <li><span class="smcap">Alexandria, Egypt</span>, - <a href="#Page_100">100</a>, - <a href="#Page_116">116</a></li> - - <li><span class="smcap">Alhazen</span>, researches in optics, - <a href="#Page_233">233</a></li> - - <li><span class="smcap">Alkaloids</span> (quintessences of Paracelsus), - <a href="#Page_405">405</a></li> - - <li><span class="smcap">Almansur</span>, Caliph of Bagdad, - <a href="#Page_184">184</a>, - <a href="#Page_203">203</a></li> - - <li><span class="smcap">Almenar, Juan</span>, - <a href="#Page_544">544</a></li> - - <li><span class="smcap">Alphanus II.</span>, Abbot of Monte Cassino, - <a href="#Page_239">239</a></li> - - <li><span class="smcap">Alsaharavius</span>, - <a href="#Page_227">227</a></li> - - <li><span class="smcap">Alu</span>, - <a href="#Page_13">13</a></li> - - <li><span class="smcap">Amatus Lusitanus</span>, - <a href="#Page_484">484</a>, - <a href="#Page_487">487</a></li> - - <li><span class="smcap">Ambrosia</span>, antidote for poisons, - <a href="#Page_112">112</a></li> - - <li><span class="smcap">Amputation of leg</span> (Fig.), - <a href="#i_p463">463</a></li> - - <li><span class="smcap">Amrou</span>, - <a href="#Page_116">116</a>, - <a href="#Page_185">185</a></li> - - <li><span class="smcap">Amulets</span> and other magical remedies, - <a href="#Page_197">197</a></li> - - <li class="hangingindent"><span class="smcap">Anaesthesia, Surgical</span>, from employment of soporific sponges, - <a href="#Page_253">253</a>, - <a href="#Page_462">462</a></li> - - <li><span class="smcap">Anatomical demonstrations</span> at Salerno, - <a href="#Page_253">253</a></li> - - <li><span class="smcap">Anatomical specimens</span>, preservation of, - <a href="#Page_356">356</a></li> - - <li class="hangingindent"><span class="smcap">Anatomy and physiology</span>, important discoveries during 16th century, - <a href="#Page_353">353</a></li> - - <li><span class="smcap">Anatomy</span>, importance of study of, - <a href="#Page_312">312</a></li> - - <li><span class="smcap">Anatomy, microscopic</span>, - <a href="#Page_360">360</a></li> - - <li><span class="smcap">Anaximander</span>, - <a href="#Page_72">72</a></li> - - <li><span class="smcap">Anaximenes</span>, - <a href="#Page_72">72</a></li> - - <li><span class="smcap">Andreas of Carystus</span>, - <a href="#Page_114">114</a></li> - - <li><span class="smcap">Animism</span>, - <a href="#Page_405">405</a>, - <a href="#Page_432">432</a></li> - - <li><span class="smcap">Antidotarium</span>, early name for pharmacopoeia, - <a href="#Page_319">319</a></li> - - <li><span class="smcap">Antidotarium Nicolai</span>, - <a href="#Page_548">548</a></li> - - <li><span class="smcap">Antimony</span>, curative action of, - <a href="#Page_158">158</a>, - <a href="#Page_548">548</a></li> - - <li><span class="smcap">Antiochus</span>, cured by Erasistratus, - <a href="#Page_106">106</a></li> - - <li><span class="smcap">Antoninus Pius</span>, - <a href="#Page_57">57</a></li> - - <li><span class="smcap">Antrum of Highmore</span>, - <a href="#Page_359">359</a></li> - - <li><span class="smcap">Antyllus</span>, - <a href="#Page_143">143</a>, - <a href="#Page_201">201</a></li> - - <li><span class="smcap">Apes</span>, dissection of, - <a href="#Page_164">164</a></li> - - <li><span class="smcap">Apollo</span>, the god of medicine, - <a href="#Page_18">18</a>, - <a href="#Page_50">50</a></li> - - <li><span class="smcap">Apollonius Mus</span>, - <a href="#Page_111">111</a></li> - - <li><span class="smcap">Apothecary</span>, - <a href="#Page_316">316</a>, - <a href="#Page_319">319</a></li> - - <li class="hangingindent"><span class="smcap">Apparatus magnus</span> (operation for stone in the bladder), - <a href="#Page_474">474</a></li> - - <li><span class="smcap">Apuleius, Lucius</span>, - <a href="#Page_120">120</a>, - <a href="#Page_126">126</a></li> - - <li><span class="smcap">Aqua vitae</span>, how prepared, - <a href="#Page_313">313</a></li> - - <li><span class="smcap">Arabian physicians</span>, dogmatism of, - <a href="#Page_412">412</a></li> - - <li><span class="smcap">Arab renaissance</span>, - <a href="#Page_203">203</a>, - <a href="#Page_217">217</a>, - <a href="#Page_233">233</a>, - <a href="#Page_259">259</a></li> - - <li class="hangingindent"><span class="smcap">Arantian operation</span>, a substitute for Tagliacotian operation, - <a href="#Page_481">481</a></li> - - <li><span class="smcap">Aranzio</span> or <span class="smcap">Arantius</span>, - <a href="#Page_349">349</a>, - <a href="#Page_481">481</a></li> - - <li><span class="smcap">Arceo, Francisco</span>, - <a href="#Page_484">484</a>, - <a href="#Page_486">486</a></li> - - <li><span class="smcap">Archaeus influus</span> and <span class="smcap">Archaeus insitus</span>, - <a href="#Page_399">399</a></li> - - <li><span class="smcap">Archagathus</span>, - <a href="#Page_119">119</a></li> - - <li><span class="smcap">Archigenes</span>, - <a href="#Page_142">142</a>, - <a href="#Page_174">174</a></li> - <li class="hangingindent1">on ligation of larger blood-vessels before amputation of a limb, - <a href="#Page_470">470</a></li> - - <li><span class="smcap">Archimathaeus</span>, - <a href="#Page_248">248</a></li> - - <li><span class="smcap">Arderne, John</span>, - <a href="#Page_307">307</a></li> - - <li><span class="smcap">Aretaeus</span>, - <a href="#Page_144">144</a></li> - - <li><span class="smcap">Aristophanes</span>, - <a href="#Page_58">58</a></li> - - <li><span class="smcap">Aristotle</span>, - <a href="#Page_73">73</a>, - <a href="#Page_102">102</a>, - <a href="#Page_433">433</a></li> - <li class="i1">commentary by Averroes, - <a href="#Page_229">229</a></li> - - <li><span class="smcap">Arnold</span>, of Villanova, - <a href="#Page_292">292–296</a></li> - - <li class="hangingindent"><span class="smcap">Arrow, extraction of</span>, from chest during battle (Fig.), - <a href="#i_p461">461</a></li> - - <li><span class="smcap">Ars parva</span>, of Galen, - <a href="#Page_248">248</a></li> - - <li class="hangingindent"><span class="smcap">Arteries</span>, ligaturing of divided, after an amputation, - <a href="#Page_289">289</a></li> - - <li><span class="smcap">Arteriotomy</span>, for relief of hemicrania, - <a href="#Page_470">470</a></li> - - <li><span class="smcap">Artery forceps</span> devised by Ambroise Paré, - <a href="#Page_512">512</a></li> - - <li class="hangingindent"><span class="smcap">Asakku</span>, the demon who produces fever in the head, - <a href="#Page_13">13</a></li> - - <li class="hangingindent"><span class="smcap">Asclepiades</span>, founder of a new sect at Rome, - <a href="#Page_116">116</a>, - <a href="#Page_119">119</a>, - <a href="#Page_122">122</a></li> - - <li><span class="smcap">Asclepieia</span>, - <a href="#Page_50">50</a>, - <a href="#Page_52">52</a>, - <a href="#Page_57">57</a></li> - - <li><span class="smcap">Asclepieion</span> at Cos (Figs.), - <a href="#i_fp054">53</a></li> - <li class="i1">at Epidaurus, - <a href="#Page_52">52</a></li> - - <li><span class="smcap">Aselli, Caspar</span>, - <a href="#Page_385">385</a></li> - - <li><span class="smcap">Assyrian medicine</span>, - <a href="#Page_11">11</a></li> - - <li><span class="smcap">Astringents</span>, - <a href="#Page_133">133</a></li> - - <li><span class="smcap">Astrologer</span>, a typical, - <a href="#Page_12">12</a></li> - - <li><span class="smcap">Astrologers</span> in Babylonia, - <a href="#Page_14">14</a></li> - - <li><span class="smcap">Astruc, Jean</span>, - <a href="#Page_548">548</a></li> - - <li><span class="smcap">Athenaeus</span>, founder of sect of Pneumatists, - <a href="#Page_141">141</a></li> - - <li><span class="smcap">Athens</span>, a great medical centre, - <a href="#Page_96">96</a></li> - <li class="i1">epidemic of the Plague at, - <a href="#Page_96">96</a></li> - - <li><span class="smcap">Athletic exercises</span> as a therapeutic measure, - <a href="#Page_69">69</a></li> - - <li><span class="smcap">Athotis</span>, - <a href="#Page_17">17</a></li> - - <li class="hangingindent"><span class="smcap">Augustus</span>, Roman Emperor, cured of gout by hydrotherapy, - <a href="#Page_129">129</a></li> - - <li class="hangingindent"><span class="smcap">Auricles of the heart</span>, comments on, by H. de Mondeville, - <a href="#Page_290">290</a></li> - - <li><span class="smcap">Auscultation</span> of the chest, - <a href="#Page_20">20</a>, - <a href="#Page_159">159</a></li> - - <li><span class="smcap">Austrichildis</span>, King Guntram’s wife, - <a href="#Page_240">240</a>, - <a href="#Page_241">241</a></li> - - <li><span class="smcap">Authors</span>, numerous in Cordova in 12th century, - <a href="#Page_232">232</a></li> - - <li><span class="smcap">Averroes</span>, pupil of Avenzoar, - <a href="#Page_229">229</a></li> - - <li><span class="smcap">Averroism</span>, - <a href="#Page_267">267</a></li> - - <li><span class="smcap">Avenzoar</span>, - <a href="#Page_228">228</a></li> - - <li><span class="smcap">Avicenna</span>, - <a href="#Page_221">221</a></li> -</ul> - -<p class="p-index">B</p> - -<ul> - <li><span class="smcap">Babylonia</span>, genuine remedial agents employed in, - <a href="#Page_13">13</a></li> - - <li><span class="smcap">Babylonian astrologers</span>, - <a href="#Page_14">14</a></li> - - <li class="hangingindent"><span class="smcap">Babylonians</span>, strange beliefs held by, in regard to human anatomy and physiology, - <a href="#Page_13">13</a></li> - - <li><span class="smcap">Bacon, Francis</span>, - <a href="#Page_338">338</a></li> - - <li><span class="smcap">Bacon, Roger</span>, - <a href="#Page_271">271</a></li> - - <li><span class="smcap">Bacteriology</span>, first studies in, - <a href="#Page_362">362</a></li> - - <li class="hangingindent"><span class="smcap">Bagdad</span>, a second great hospital founded at, in A. D. 914, - <a href="#Page_219">219</a></li> - - <li><span class="smcap">Bain, Christopher</span>, - <a href="#Page_396">396</a></li> - - <li><span class="smcap">Bakhtichou ben Djordis</span>, - <a href="#Page_205">205</a>, - <a href="#Page_207">207</a></li> - - <li><span class="smcap">Bakhtichou, George</span>, - <a href="#Page_205">205</a></li> - - <li><span class="smcap">Barbaric Latin</span>, - <a href="#Page_262">262</a></li> - - <li><span class="smcap">Barbers</span>, the earliest surgeons in France, - <a href="#Page_530">530</a></li> - - <li><span class="smcap">Barbers and Barber-Surgeons</span>, - <a href="#Page_282">282</a>, - <a href="#Page_369">369</a>, - <a href="#Page_449">449</a>, - <a href="#Page_464">464</a></li> - - <li><span class="smcap">Barber-Surgeons’ Company</span>, of London, - <a href="#Page_519">519</a></li> - - <li><span class="smcap">Bartholomaeus</span>, - <a href="#Page_245">245</a></li> - - <li><span class="smcap">Baseilhac, Jean</span>, - <a href="#Page_552">552</a></li> - - <li><span class="smcap">Baseilhac, Pascal</span>, - <a href="#Page_496">496</a></li> - - <li><span class="smcap">Basel</span>, public dissection of human body at, - <a href="#Page_455">455</a></li> - <li class="i1">visited by Vesalius in 1542, - <a href="#Page_455">455</a></li> - - <li><span class="smcap">Baths</span> extensively used by ancients, - <a href="#Page_157">157</a>, - <a href="#Page_323">323</a></li> - - <li><span class="smcap">Baudelocque</span>, - <a href="#Page_539">539</a></li> - - <li class="hangingindent"><span class="smcap">Bede, The Venerable</span>, believed in cures by supernatural means, - <a href="#Page_241">241</a></li> - - <li class="hangingindent"><span class="smcap">Belladonna</span>, when first used for dilating the pupils, - <a href="#Page_157">157</a></li> - - <li><span class="smcap">Benedictine monastery</span> on Monte Cassino, - <a href="#Page_238">238</a></li> - - <li><span class="smcap">Beniveni, Antonio</span>, - <a href="#Page_389">389</a>, - <a href="#Page_498">498</a></li> - - <li><span class="smcap">Benvenuto Cellini</span>, - <a href="#Page_341">341</a></li> - - <li><span class="smcap">Berendes</span>, - <a href="#Page_159">159</a>, - <a href="#Page_317">317</a>, - <a href="#Page_322">322</a>, - <a href="#Page_426">426</a></li> - - <li><span class="smcap">Berengarius of Carpi</span>, - <a href="#Page_342">342</a>, - <a href="#Page_374">374</a></li> - - <li><span class="smcap">Bernardo di Rapallo</span>, - <a href="#Page_472">472</a></li> - - <li><span class="smcap">Bertharius</span>, abbot of Monte Cassino, - <a href="#Page_239">239</a></li> - - <li><span class="smcap">Berthelot</span>, on Geber, - <a href="#Page_320">320</a></li> - - <li><span class="smcap">Bertrucius</span>, - <a href="#Page_310">310</a></li> - - <li><span class="smcap">Bile</span>, black and yellow, - <a href="#Page_86">86</a></li> - <li class="i1">manner of production, - <a href="#Page_109">109</a></li> - - <li><span class="smcap">Bladder</span>, tuberculous ulceration of, - <a href="#Page_200">200</a></li> - - <li><span class="smcap">Blancaard, Stephen</span>, - <a href="#Page_359">359</a></li> - - <li><span class="smcap">Blood</span>, inflammation of (Sydenham), - <a href="#Page_423">423</a></li> - <li class="i1">production of, according to Erasistratus, - <a href="#Page_109">109</a></li> - <li class="i1">spirituous, - <a href="#Page_373">373</a></li> - <li class="i1">transfusion of, - <a href="#Page_408">408</a></li> - - <li><span class="smcap">Bloodletting</span>, comments on, by Celsus, - <a href="#Page_152">152</a></li> - <li class="i1">from a vein, technique, - <a href="#Page_152">152</a></li> - <li class="i1">how practice first originated, - <a href="#Page_6">6</a></li> - <li class="i1">rule of Hippocrates regarding, - <a href="#Page_411">411</a></li> - <li class="i1">under what circumstances advisable, - <a href="#Page_133">133</a></li> - - <li><span class="smcap">Blood-vessels, Capillary</span>, circulation in, - <a href="#Page_383">383</a></li> - <li class="i1">when first injected artificially, - <a href="#Page_356">356</a>, - <a href="#Page_359">359</a></li> - - <li><span class="smcap">Boerhaave, Hermann</span>, - <a href="#Page_144">144</a>, - <a href="#Page_438">438</a>, - <a href="#Page_441">441</a></li> - <li class="i1">gives clinical instruction at Leyden, - <a href="#Page_430">430</a></li> - <li class="hangingindent1">treatise on chemistry the standard for many years, - <a href="#Page_440">440</a></li> - - <li class="hangingindent"><span class="smcap">Boiling of drinking water</span> practiced by ancient Persians, - <a href="#Page_26">26</a></li> - - <li><span class="smcap">Bologna Medical School</span>, - <a href="#Page_272">272</a>, - <a href="#Page_281">281</a>, - <a href="#Page_332">332</a></li> - - <li class="hangingindent"><span class="smcap">Boniface VIII., Pope</span>, successfully treated for stone in the bladder, - <a href="#Page_293">293</a></li> - - <li><span class="smcap">Books</span>, great demand for, in 15th century, - <a href="#Page_329">329</a></li> - - <li><span class="smcap">Borelli, Alphonso</span>, - <a href="#Page_368">368</a></li> - - <li><span class="smcap">Botallo, Leonardo</span>, - <a href="#Page_413">413</a></li> - - <li><span class="smcap">Botanical gardens</span>, - <a href="#Page_17">17</a>, - <a href="#Page_392">392</a>, - <a href="#Page_393">393</a></li> - - <li><span class="smcap">Bougies, urethral</span>, - <a href="#Page_495">495</a></li> - - <li><span class="smcap">Bourgeois, Louise</span>, - <a href="#Page_536">536</a></li> - - <li><span class="smcap">Boyle, Robert</span>, a distinguished chemist, - <a href="#Page_406">406</a></li> - - <li class="hangingindent"><span class="smcap">Branca</span>, father and son, skilled in rhinoplasty, - <a href="#Page_459">459</a></li> - - <li><span class="smcap">Brassavola</span>, experimental pharmacologist, - <a href="#Page_398">398</a></li> - - <li><span class="smcap">Breviarium, Arnold’s</span>, - <a href="#Page_294">294</a></li> - - <li><span class="smcap">Briggs, William</span>, - <a href="#Page_545">545</a></li> - - <li><span class="smcap">Brissot, Pierre</span>, - <a href="#Page_411">411</a></li> - - <li><span class="smcap">Bronze surgical knives</span>, - <a href="#Page_16">16</a></li> - - <li><span class="smcap">Browne, Andrew</span>, the friend of Sydenham, - <a href="#Page_422">422</a>, - <a href="#Page_424">424</a></li> - - <li><span class="smcap">Brunner, Johann Conrad</span>, - <a href="#Page_359">359</a></li> - - <li><span class="smcap">Brunschwig, Hieronymus</span>, - <a href="#Page_456">456</a></li> - - <li><span class="smcap">Brunus</span>, - <a href="#Page_277">277</a></li> - - <li><span class="smcap">Bullets</span> not hot when they enter the flesh, - <a href="#Page_513">513</a></li> - - <li><span class="smcap">Burinna</span>, name of spring on the Island of Cos, - <a href="#Page_54">54</a></li> - - <li class="hangingindent"><span class="smcap">Byzantium</span>, the new capital of the Roman Empire, - <a href="#Page_180">180</a></li> -</ul> - -<p class="p-index">C</p> - -<ul> - <li><span class="smcap">Cabanès</span>, - <a href="#Page_402">402</a></li> - - <li><span class="smcap">Cacao</span>, - <a href="#Page_395">395</a></li> - - <li><span class="smcap">Caelius Aurelianus</span>, - <a href="#Page_132">132</a>, - <a href="#Page_159">159</a></li> - - <li class="hangingindent"><span class="smcap">Caesar, Julius</span>, liberality of, toward foreign physicians settled in Rome, - <a href="#Page_119">119</a></li> - - <li><span class="smcap">Caesalpinus, Andreas</span>, - <a href="#Page_372">372</a>, - <a href="#Page_375">375</a>, - <a href="#Page_394">394</a></li> - - <li><span class="smcap">Caesarian section</span>, - <a href="#Page_396">396</a>, - <a href="#Page_534">534</a></li> - - <li class="hangingindent"><span class="smcap">Cairo physicians</span> distinguished ophthalmologists, - <a href="#Page_225">225</a></li> - - <li><span class="smcap">Calcar</span>, Vesalius’ draughtsman, - <a href="#Page_344">344</a></li> - - <li class="hangingindent"><span class="smcap">Calculus</span> in the bladder may not be dissolved by internal remedies, - <a href="#Page_498">498</a></li> - - <li><span class="smcap">Callidum innatum</span> of Hippocrates, - <a href="#Page_415">415</a></li> - - <li><span class="smcap">Calvin, John</span>, visited by Felix Platter, - <a href="#Page_335">335</a></li> - - <li><span class="smcap">Cancer of breast</span>, sculptured in marble (Fig.), - <a href="#i_fp068b">68</a></li> - - <li><span class="smcap">Cancer, ulcerated</span>, not to be cauterized, - <a href="#Page_285">285</a></li> - - <li><span class="smcap">Cannani</span>, - <a href="#Page_378">378</a></li> - - <li><span class="smcap">Canon, the</span>, of Avicenna, - <a href="#Page_222">222</a></li> - - <li><span class="smcap">Capsicum</span>, - <a href="#Page_395">395</a></li> - - <li><span class="smcap">Caraka</span>, East Indian medical author, - <a href="#Page_31">31</a></li> - - <li class="hangingindent"><span class="smcap">Carbonic acid</span>, nature of, expounded by Van Helmont, - <a href="#Page_400">400</a></li> - - <li><span class="smcap">Carbonous oxide</span>, - <a href="#Page_434">434</a></li> - - <li><span class="smcap">Carcano Leone</span>, - <a href="#Page_475">475</a>, - <a href="#Page_476">476</a></li> - - <li><span class="smcap">Case histories</span> recorded on tablets, - <a href="#Page_67">67</a></li> - - <li><span class="smcap">Cassiodorus</span>, - <a href="#Page_238">238</a></li> - - <li><span class="smcap">Castor oil</span>, perfected by Apollonius Mus, - <a href="#Page_111">111</a></li> - - <li><span class="smcap">Cataract operations</span> of Pierre Franco, - <a href="#Page_494">494</a></li> - - <li><span class="smcap">Cato, Marcus Porcius</span>, - <a href="#Page_117">117</a>, - <a href="#Page_235">235</a></li> - - <li><span class="smcap">Caustics</span>, too freely used as haemostatics, - <a href="#Page_466">466</a></li> - - <li class="hangingindent"><span class="smcap">Cauterization</span> of ulcerated cancer not approved by Lanfranchi, - <a href="#Page_285">285</a></li> - - <li><span class="smcap">Cauterizing instruments</span>, - <a href="#Page_279">279</a></li> - - <li><span class="smcap">Celsus, Aulus Cornelius</span>, - <a href="#Page_150">150</a>, - <a href="#Page_151">151</a>, - <a href="#Page_155">155</a></li> - - <li class="hangingindent"><span class="smcap">Cerebral nerves</span>, crossing of, in relation to paralysis of one side of the body, - <a href="#Page_144">144</a></li> - - <li><span class="smcap">Cermisone, Antonio</span>, - <a href="#Page_313">313</a></li> - - <li><span class="smcap">Chamberlen, Hugh</span>, - <a href="#Page_538">538</a></li> - - <li><span class="smcap">Chaldean doctrine of numbers</span>, - <a href="#Page_74">74</a></li> - - <li><span class="smcap">Charcoal</span>, fumes of burning, - <a href="#Page_435">435</a></li> - - <li><span class="smcap">Chaucer’s account</span> of a clever physician, - <a href="#Page_308">308</a></li> - - <li><span class="smcap">Chemical element</span> defined, - <a href="#Page_407">407</a></li> - - <li><span class="smcap">Chemistry</span> in ancient Egypt, - <a href="#Page_17">17</a></li> - <li class="i1">modern, developed gradually from alchemy, - <a href="#Page_320">320</a></li> - - <li class="hangingindent"><span class="smcap">Chicory</span> an effective remedy in abdominal diseases, - <a href="#Page_109">109</a></li> - - <li class="hangingindent"><span class="smcap">Chinese conceptions</span> concerning human physiology, - <a href="#Page_41">41</a></li> - - <li><span class="smcap">Chinese medicine</span>, - <a href="#Page_38">38</a>, - <a href="#Page_39">39</a></li> - - <li><span class="smcap">Chiron</span>, - <a href="#Page_48">48</a></li> - - <li class="hangingindent"><span class="smcap">Christianity</span>, influence of, upon evolution of medicine, - <a href="#Page_179">179</a></li> - - <li><span class="smcap">Chrysippus</span>, - <a href="#Page_141">141</a></li> - - <li class="hangingindent"><span class="smcap">Chyle</span>, distribution of, after it leaves the stomach, - <a href="#Page_109">109</a></li> - - <li><span class="smcap">Chyle ducts</span>, discovery of, - <a href="#Page_385">385</a></li> - - <li class="hangingindent"><span class="smcap">Cicero’s interpretation</span> of the expression “gods” as employed by the ancients, - <a href="#Page_18">18</a></li> - - <li><span class="smcap">Cinchona</span>, discovery of, - <a href="#Page_408">408</a></li> - - <li class="hangingindent"><span class="smcap">Circa instans</span>, the title commonly given to treatise of Matthew Platearius, - <a href="#Page_253">253</a></li> - - <li><span class="smcap">Circulation of blood</span>, Galen’s physiology of, - <a href="#Page_373">373</a></li> - <li class="i1">de Mondeville’s comments, - <a href="#Page_289">289</a></li> - - <li class="hangingindent"><span class="smcap">Citizenship</span>, rights of, bestowed by Julius Caesar on all foreign physicians practicing in Rome, - <a href="#Page_119">119</a>, - <a href="#Page_130">130</a></li> - - <li><span class="smcap">Civitas Hippocratica</span>, - <a href="#Page_243">243</a></li> - - <li class="hangingindent"><span class="smcap">Claudius</span>, Roman Emperor, merciful action of, toward slaves, - <a href="#Page_235">235</a></li> - - <li><span class="smcap">Clemens</span>, of Alexandria, Egypt, - <a href="#Page_17">17</a></li> - - <li><span class="smcap">Clement IV., Pope</span>, protects Roger Bacon, - <a href="#Page_272">272</a></li> - - <li class="hangingindent"><span class="smcap">Clement V., Pope</span>, removes papal seat from Rome to Avignon, - <a href="#Page_293">293</a></li> - - <li><span class="smcap">Clinical instruction</span> at Leyden Hospital, - <a href="#Page_429">429</a></li> - - <li><span class="smcap">Clowes</span>, William, - <a href="#Page_519">519</a></li> - - <li><span class="smcap">Cnidian school of medicine</span>, - <a href="#Page_81">81</a></li> - - <li><span class="smcap">Cnidus</span>, in Caria, Asia Minor, - <a href="#Page_51">51</a></li> - - <li><span class="smcap">Coca</span>, - <a href="#Page_395">395</a></li> - - <li><span class="smcap">Cold</span>, exposure to, unusual treatment of, - <a href="#Page_489">489</a></li> - - <li><span class="smcap">College of Physicians</span>, London, - <a href="#Page_417">417</a></li> - - <li><span class="smcap">College of Saint Cosmas</span>, Paris, - <a href="#Page_283">283</a>, - <a href="#Page_284">284</a>, - <a href="#Page_448">448</a></li> - - <li class="hangingindent"><span class="smcap">Colliget</span>, title of treatise written by Averroes, - <a href="#Page_229">229</a></li> - - <li><span class="smcap">Colot, Laurent</span>, famous French lithotomist, - <a href="#Page_474">474</a></li> - - <li><span class="smcap">Columbus, Realdus</span>, - <a href="#Page_349">349</a></li> - <li class="i1">experiments relating to physiology of heart, - <a href="#Page_377">377</a></li> - - <li><span class="smcap">Côme, Frère</span>, - <a href="#Page_550">550</a></li> - - <li class="hangingindent"><span class="smcap">Communities</span>, term employed by the Methodists for designating the two conditions “laxum” and “strictum,” - <a href="#Page_130">130</a></li> - - <li class="hangingindent"><span class="smcap">Compendium aromatariorum</span>, the first modern treatise on materia medica, - <a href="#Page_320">320</a></li> - - <li><span class="smcap">Compendium Salernitanum</span>, - <a href="#Page_246">246</a></li> - - <li class="hangingindent"><span class="smcap">Conciliator</span>, title of one of Pietro d’Abano’s great works, - <a href="#Page_266">266</a>, - <a href="#Page_267">267</a></li> - - <li class="hangingindent"><span class="smcap">Constantinople</span>, taking of, by the Turks, an important aid to the advance of medicine, - <a href="#Page_328">328</a></li> - - <li><span class="smcap">Constantinus the African</span>, - <a href="#Page_239">239</a>, - <a href="#Page_248">248</a>, - <a href="#Page_260">260</a></li> - - <li><span class="smcap">Contagion, innate</span>, - <a href="#Page_220">220</a></li> - - <li class="hangingindent"><span class="smcap">Contagious diseases</span>, Fracastoro’s classification of, - <a href="#Page_390">390</a></li> - - <li><span class="smcap">Continens</span>, title of Rhazes’ great work, - <a href="#Page_220">220</a>, - <a href="#Page_262">262</a></li> - - <li class="hangingindent"><span class="smcap">Contraria contrariis</span>, principle of, in therapeutics, - <a href="#Page_132">132</a></li> - - <li><span class="smcap">Cosmas and Damian</span>, - <a href="#Page_282">282</a>, - <a href="#Page_449">449</a></li> - - <li><span class="smcap">Copaiva, Balsam of</span>, - <a href="#Page_395">395</a></li> - - <li><span class="smcap">Cophon</span>, teacher of medicine at Salerno, - <a href="#Page_245">245</a></li> - - <li class="hangingindent"><span class="smcap">Cordova, Spain</span>, centre of great intellectual activity, - <a href="#Page_218">218</a>, - <a href="#Page_232">232</a></li> - - <li class="hangingindent"><span class="smcap">Corpse</span>, the touching of a, believed by the Persians to produce a special contamination, - <a href="#Page_25">25</a></li> - - <li><span class="smcap">Cos, Island of</span> (Figs.), - <a href="#i_fp052">53</a></li> - - <li><span class="smcap">Costa ben Luca</span>, - <a href="#Page_215">215</a>, - <a href="#Page_216">216</a></li> - - <li><span class="smcap">Costanza Calenda</span>, - <a href="#Page_245">245</a></li> - - <li><span class="smcap">Cowper, William</span>, - <a href="#Page_360">360</a></li> - - <li><span class="smcap">Croke, A.</span>, - <a href="#Page_250">250</a></li> - - <li><span class="smcap">Cronos</span>, - <a href="#Page_19">19</a></li> - - <li><span class="smcap">Crotona, Italy</span>, - <a href="#Page_51">51</a></li> - - <li><span class="smcap">Cullen, William</span>, - <a href="#Page_432">432</a></li> - - <li><span class="smcap">Curtis, John G.</span>, - <a href="#Page_72">72</a>, - <a href="#Page_140">140</a></li> - - <li><span class="smcap">Cyrene</span>, in Lybia, Africa, - <a href="#Page_51">51</a></li> - - <li><span class="smcap">Cystotomy, hypogastric</span>, - <a href="#Page_495">495</a></li> -</ul> - -<p class="p-index">D</p> - -<ul> - <li class="hangingindent"><span class="smcap">Damascus</span>, an active medical centre in the 13th century, - <a href="#Page_225">225</a>, - <a href="#Page_232">232</a></li> - - <li><span class="smcap">Daremberg</span>, - <a href="#Page_50">50</a>, - <a href="#Page_75">75</a>, - <a href="#Page_240">240</a>, - <a href="#Page_420">420</a></li> - - <li><span class="smcap">Darius I.</span>, King of the Persians, - <a href="#Page_26">26</a>, - <a href="#Page_75">75</a></li> - - <li class="hangingindent"><span class="smcap">David’s harp-playing</span>, effect of, on King Saul’s melancholia, - <a href="#Page_27">27</a></li> - - <li><span class="smcap">Da Vinci, Leonardo</span>, - <a href="#Page_339">339</a></li> - - <li><span class="smcap">Daza Chacon</span>, - <a href="#Page_484">484</a></li> - - <li><span class="smcap">De le Boë, Franz</span>, - <a href="#Page_427">427</a></li> - - <li><span class="smcap">De Marchettis, Domenico</span>, - <a href="#Page_359">359</a></li> - - <li><span class="smcap">Demetrius, of Apamea</span>, - <a href="#Page_114">114</a></li> - - <li><span class="smcap">Democedes</span>, - <a href="#Page_73">73</a>, - <a href="#Page_75">75</a></li> - - <li><span class="smcap">Democritus</span>, - <a href="#Page_82">82</a></li> - - <li><span class="smcap">Demosthenes, of Marseilles</span>, - <a href="#Page_115">115</a></li> - - <li><span class="smcap">Denys, of Paris</span>, - <a href="#Page_408">408</a></li> - - <li><span class="smcap">Desiderius</span>, Abbot of Monte Cassino, - <a href="#Page_239">239</a></li> - - <li><span class="smcap">Dezeimeris</span>, - <a href="#Page_341">341</a>, - <a href="#Page_400">400</a></li> - - <li><span class="smcap">Dietetics of pregnant women</span>, - <a href="#Page_199">199</a></li> - - <li><span class="smcap">Dieting and athletic exercises</span>, - <a href="#Page_69">69</a></li> - - <li class="hangingindent"><span class="smcap">Dietz, Reinhold</span>, discoverer of an early Greek manuscript of Soranus, - <a href="#Page_138">138</a></li> - - <li class="hangingindent"><span class="smcap">Digestion</span>, physiology of, according to Erasistratus, - <a href="#Page_108">108</a></li> - <li class="i1">according to Aretaeus, - <a href="#Page_144">144</a></li> - - <li><span class="smcap">Diocles</span>, of Carystos, - <a href="#Page_103">103</a></li> - - <li class="hangingindent"><span class="smcap">Dionis, Pierre</span>, distinguished French anatomist, - <a href="#Page_41">41</a>, - <a href="#Page_364">364</a>, - <a href="#Page_383">383</a>, - <a href="#Page_540">540</a></li> - - <li><span class="smcap">Dioscorides, Pedanius</span>, - <a href="#Page_157">157</a>, - <a href="#Page_317">317</a></li> - - <li class="hangingindent"><span class="smcap">Diphtheria, genuine</span>, recognized by Paracelsus, - <a href="#Page_405">405</a></li> - - <li class="hangingindent"><span class="smcap">Diphtheria, pharyngeal</span>, known in 2d century as Syriac ulcer, - <a href="#Page_144">144</a></li> - - <li><span class="smcap">Diseases</span> mentioned in the papyrus Ebers, - <a href="#Page_20">20</a></li> - - <li class="hangingindent"><span class="smcap">Dislocation of shoulder</span>, successfully reduced by Gabriel Bakhtichou, - <a href="#Page_207">207</a></li> - - <li class="hangingindent"><span class="smcap">Dissecting of human bodies</span>, early attempts, - <a href="#Page_309">309</a>, - <a href="#Page_327">327</a>, - <a href="#Page_331">331</a></li> - <li class="hangingindent1">practice approved by University of Salamanca, - <a href="#Page_346">346</a></li> - <li class="hangingindent1">practice made obligatory in the medical schools early in 18th century, - <a href="#Page_364">364</a></li> - - <li class="hangingindent"><span class="smcap">Distempers</span> of the stiff and elastic fibres (Boerhaave), - <a href="#Page_442">442</a></li> - - <li><span class="smcap">Divine water</span> of the alchemists, - <a href="#Page_321">321</a></li> - - <li class="hangingindent"><span class="smcap">Djondisabour</span>, early establishment of a medical school at, - <a href="#Page_184">184</a>, - <a href="#Page_204">204</a></li> - - <li><span class="smcap">Doctor</span>, when first employed as a title, - <a href="#Page_280">280</a></li> - - <li><span class="smcap">Dodoens, Rembert</span> (Dodonaeus), - <a href="#Page_395">395</a></li> - - <li><span class="smcap">Dogmatists</span>, sect of the, - <a href="#Page_101">101</a>, - <a href="#Page_103">103</a>, - <a href="#Page_149">149</a></li> - - <li><span class="smcap">Donato, Marcello</span>, - <a href="#Page_396">396</a></li> - - <li><span class="smcap">Don Carlos, of Spain</span>, skull severely injured, - <a href="#Page_485">485</a></li> - - <li><span class="smcap">Dorveaux, Paul</span>, - <a href="#Page_548">548</a></li> - - <li><span class="smcap">Douglas, James</span>, - <a href="#Page_361">361</a></li> - - <li><span class="smcap">Drachma</span>, value of, - <a href="#Page_207">207</a></li> - - <li><span class="smcap">Draco, son of Hippocrates</span>, - <a href="#Page_82">82</a></li> - - <li><span class="smcap">Dracunculus medinensis</span>, - <a href="#Page_233">233</a></li> - - <li><span class="smcap">Drugs</span>, enumerated by Homer in the Odyssey, - <a href="#Page_18">18</a></li> - <li class="i1">enumerated by Dioscorides, - <a href="#Page_18">18</a></li> - <li class="i1">remedial effects of, - <a href="#Page_398">398</a></li> - - <li><span class="smcap">Dry treatment of wounds</span>, - <a href="#Page_275">275</a>, - <a href="#Page_285">285</a></li> - - <li><span class="smcap">DuBois, Jacques</span> (Sylvius), the anatomist, - <a href="#Page_340">340</a>, - <a href="#Page_345">345</a></li> - - <li><span class="smcap">Dysentery</span>, East Indian treatment of, - <a href="#Page_409">409</a></li> -</ul> - -<p class="p-index">E</p> - -<ul> - <li><span class="smcap">Ear</span>, cherry pit in, - <a href="#Page_396">396</a></li> - <li class="i1">fatal disease of, - <a href="#Page_489">489</a></li> - - <li class="hangingindent"><span class="smcap">East Indian surgeons</span> performed suprapubic cystotomy before the Christian era, - <a href="#Page_497">497</a></li> - - <li class="hangingindent"><span class="smcap">Eben el Khammar</span>, a distinguished Persian physician, - <a href="#Page_222">222</a></li> - - <li><span class="smcap">Ebers papyrus</span>, the, - <a href="#Page_20">20</a></li> - - <li><span class="smcap">Eclectics, the</span>, - <a href="#Page_142">142</a>, - <a href="#Page_149">149</a></li> - - <li><span class="smcap">Egypt, ancient</span>, practice of medicine in, - <a href="#Page_16">16</a>, - <a href="#Page_17">17</a></li> - <li class="i1">process of embalming in, - <a href="#Page_17">17</a></li> - <li class="hangingindent1">temples were used as hospitals and as medical schools, as well as for purposes of worship, - <a href="#Page_19">19</a></li> - - <li class="hangingindent"><span class="smcap">Egyptians, the ancient</span>, surgical instruments used by, - <a href="#Page_21">21</a></li> - <li class="i1">surgical methods employed by, - <a href="#Page_21">21</a></li> - <li class="i1">therapeutics of, - <a href="#Page_20">20</a></li> - <li class="i1">they were good sanitarians, - <a href="#Page_23">23</a></li> - <li class="hangingindent1">they were the originators of many of the Mosaic laws, - <a href="#Page_27">27</a></li> - - <li><span class="smcap">Eleatic school of philosophy</span>, - <a href="#Page_73">73</a></li> - - <li><span class="smcap">Elbow-joint, exarticulation of</span>, - <a href="#Page_508">508</a></li> - - <li class="hangingindent"><span class="smcap">Electric ray</span>, shocks communicated by, utilized in treatment of severe headache, - <a href="#Page_155">155</a></li> - - <li class="hangingindent"><span class="smcap">Elisha the prophet</span> cures Naaman’s so-called leprosy, - <a href="#Page_27">27</a></li> - - <li><span class="smcap">Embalming</span>, Egyptian process of, - <a href="#Page_17">17</a></li> - - <li class="hangingindent"><span class="smcap">Emir Adhad Eddoula</span> founds a great hospital at Bagdad, - <a href="#Page_219">219</a></li> - - <li class="hangingindent"><span class="smcap">Empedocles</span> (444 B. C.) places the seat of the hearing in the labyrinth of the temporal bone, - <a href="#Page_80">80</a></li> - - <li><span class="smcap">Empirics</span>, sect of the, - <a href="#Page_101">101</a>, - <a href="#Page_111">111</a>, - <a href="#Page_149">149</a></li> - - <li><span class="smcap">Encyclopaedists</span>, the, - <a href="#Page_156">156</a></li> - - <li><span class="smcap">Epicureans</span>, the, - <a href="#Page_102">102</a></li> - - <li><span class="smcap">Epidaurus</span>, in Argolis, Greece, - <a href="#Page_51">51</a></li> - - <li><span class="smcap">Epione</span>, wife of Aesculapius, - <a href="#Page_50">50</a></li> - - <li><span class="smcap">Erasistratus</span>, - <a href="#Page_104">104</a>, - <a href="#Page_106">106</a>, - <a href="#Page_110">110</a></li> - <li class="hangingindent1">teachings of, with regard to nature of the blood and the circulation, - <a href="#Page_371">371</a></li> - - <li><span class="smcap">Erasmus</span>, on Linacre, - <a href="#Page_418">418</a></li> - - <li><span class="smcap">Étienne, Robert</span>, - <a href="#Page_197">197</a></li> - - <li><span class="smcap">Euenor</span>, - <a href="#Page_99">99</a></li> - - <li><span class="smcap">Euler, Leonhard</span>, - <a href="#Page_360">360</a></li> - - <li><span class="smcap">Euporista</span>, title of Oribasius’ treatise, - <a href="#Page_192">192</a></li> - - <li><span class="smcap">Euporiston</span>, title of treatise by Priscianus, - <a href="#Page_193">193</a></li> - - <li><span class="smcap">Eustachius, Bartholomaeus</span>, - <a href="#Page_345">345</a>, - <a href="#Page_348">348</a>, - <a href="#Page_358">358</a>, - <a href="#Page_384">384</a></li> - - <li class="hangingindent"><span class="smcap">Evil spirits</span>, part played by, in producing disease, - <a href="#Page_8">8</a></li> - - <li class="hangingindent"><span class="smcap">Exercise</span>, physical, not absolutely necessary to persons in normal health, - <a href="#Page_125">125</a></li> - - <li class="hangingindent"><span class="smcap">Experience</span>, great value attached to, by Hippocrates, - <a href="#Page_148">148</a></li> -</ul> - -<p class="p-index">F</p> - - -<ul> - <li class="hangingindent"><span class="smcap">Fabiola</span>, the widow, established the first hospital in Rome, - <a href="#Page_235">235</a></li> - - <li><span class="smcap">Fabricius ab Acquapendente</span>, - <a href="#Page_349">349</a>, - <a href="#Page_351">351</a>, - <a href="#Page_378">378</a>, - <a href="#Page_478">478</a></li> - - <li><span class="smcap">Fabricius of Hilden</span>, - <a href="#Page_464">464</a></li> - - <li class="hangingindent"><span class="smcap">Facial hemiparesis</span>, sculptured in marble (Fig.), - <a href="#i_fp070">68</a></li> - - <li class="hangingindent"><span class="smcap">Fallopius</span> or <span class="smcap">Falloppius, Gabriele</span>, - <a href="#Page_341">341</a>, - <a href="#Page_348">348</a>, - <a href="#Page_360">360</a>, - <a href="#Page_393">393</a>, - <a href="#Page_474">474</a>, - <a href="#Page_478">478</a></li> - - <li><span class="smcap">Farragut</span>, of Girgenti, Sicily, - <a href="#Page_262">262</a></li> - - <li><span class="smcap">Faust, Johannes</span>, - <a href="#Page_322">322</a></li> - - <li><span class="smcap">Fedeles, Fortunatus</span>, - <a href="#Page_398">398</a></li> - - <li><span class="smcap">Fees, medical</span>, in Babylonia, - <a href="#Page_15">15</a></li> - - <li><span class="smcap">Fever, nature of</span>, as taught by Sydenham, - <a href="#Page_423">423</a></li> - - <li class="hangingindent"><span class="smcap">Feldbuch der Wundartzney</span>, von Gerssdorff’s, - <a href="#Page_462">462</a></li> - - <li><span class="smcap">Femur, fracture of</span>, - <a href="#Page_510">510</a></li> - - <li class="hangingindent"><span class="smcap">Ferment in blood</span> the cause of small-pox (Rhazes), - <a href="#Page_220">220</a></li> - - <li><span class="smcap">Fernel, Jean</span>, - <a href="#Page_414">414</a></li> - - <li class="hangingindent"><span class="smcap">Filaria Medinensis</span>, removal of, from boy’s leg, - <a href="#Page_489">489</a></li> - - <li><span class="smcap">Finckenstein</span>, - <a href="#Page_543">543</a></li> - - <li><span class="smcap">Fistula in ano</span>, John Arderne’s treatise on, - <a href="#Page_307">307</a></li> - - <li><span class="smcap">Flammula</span>, - <a href="#Page_522">522</a></li> - - <li><span class="smcap">Flint knives</span>, - <a href="#Page_9">9</a></li> - - <li><span class="smcap">Flos Medicinae</span>, title of medical treatise, - <a href="#Page_251">251</a></li> - - <li><span class="smcap">Flourens</span>, - <a href="#Page_374">374</a></li> - - <li><span class="smcap">Foramen Botalli</span>, - <a href="#Page_413">413</a></li> - - <li class="hangingindent"><span class="smcap">Forceps</span> for crushing stone in the bladder (Fig.), - <a href="#i_p497">497</a></li> - - <li><span class="smcap">Forceps</span>, obstetrical, invention of, - <a href="#Page_535">535</a></li> - - <li><span class="smcap">Foreest, Peter</span>, - <a href="#Page_413">413</a></li> - - <li><span class="smcap">Formulary</span> of Sabour ben Sahl, - <a href="#Page_209">209</a></li> - - <li><span class="smcap">Fossel</span>, - <a href="#Page_391">391</a></li> - - <li><span class="smcap">Fra Sarpi</span>, - <a href="#Page_378">378</a></li> - - <li><span class="smcap">Fracastoro, Hieronymus</span>, - <a href="#Page_221">221</a>, - <a href="#Page_362">362</a>, - <a href="#Page_389">389</a>, - <a href="#Page_391">391</a></li> - - <li><span class="smcap">Franco, Pierre</span>, - <a href="#Page_490">490</a>, - <a href="#Page_494">494</a>, - <a href="#Page_495">495</a>, - <a href="#Page_497">497</a></li> - - <li class="hangingindent"><span class="smcap">Franconian operation</span>, revived in 1719 by John Douglas of London, - <a href="#Page_496">496</a></li> - - <li class="hangingindent"><span class="smcap">Frederick II.</span>, King of Sicily, promotes work of translating from the Arabic, - <a href="#Page_261">261</a></li> - - <li><span class="smcap">Freind, John</span>, - <a href="#Page_184">184</a>, - <a href="#Page_195">195</a>, - <a href="#Page_416">416</a></li> - - <li><span class="smcap">Frère Jacques de Beaulieu</span>, - <a href="#Page_550">550</a></li> - - <li><span class="smcap">Friedlaender</span>, - <a href="#Page_3">3</a></li> -</ul> - -<p class="p-index">G</p> - -<ul> - <li class="hangingindent"><span class="smcap">Gabriel</span>, the most distinguished member of the Bakhtichou family, - <a href="#Page_207">207</a></li> - - <li class="hangingindent"><span class="smcap">Gaius, of Naples</span>, a distinguished ophthalmologist, - <a href="#Page_115">115</a></li> - - <li><span class="smcap">Gale, Thomas</span>, - <a href="#Page_517">517</a></li> - - <li class="hangingindent"><span class="smcap">Galeazzo di Santa Sofia</span>, Professor of Anatomy at Vienna, - <a href="#Page_311">311</a></li> - - <li><span class="smcap">Galen, Claudius</span>, - <a href="#Page_74">74</a>, - <a href="#Page_160">160</a>, - <a href="#Page_316">316</a>, - <a href="#Page_344">344</a></li> - <li class="i1">on the nature of the blood, - <a href="#Page_372">372</a></li> - <li class="i1">on the true function of respiration, - <a href="#Page_372">372</a></li> - <li class="i1">on the treatment of wounds, - <a href="#Page_275">275</a></li> - <li class="i1">treatises written by, - <a href="#Page_167">167</a></li> - - <li><span class="smcap">Galenic doctrines</span>, - <a href="#Page_400">400</a></li> - - <li><span class="smcap">Galenical preparations</span>, - <a href="#Page_317">317</a></li> - - <li><span class="smcap">Galenism</span>, meaning of the term, - <a href="#Page_388">388</a></li> - - <li><span class="smcap">Galenists, English</span>, in 17th century, - <a href="#Page_419">419</a></li> - - <li class="hangingindent"><span class="smcap">Galen’s system</span> of therapeutics still used in Persia, - <a href="#Page_317">317</a></li> - - <li><span class="smcap">Galileo</span>, - <a href="#Page_546">546</a></li> - - <li class="hangingindent"><span class="smcap">Gallu</span>, the demon who causes diseases of the hand, - <a href="#Page_13">13</a></li> - - <li><span class="smcap">Gariopontus</span>, a teacher at Salerno, - <a href="#Page_245">245</a>, - <a href="#Page_247">247</a></li> - - <li><span class="smcap">Gas sylvestre</span>, - <a href="#Page_401">401</a></li> - - <li class="hangingindent"><span class="smcap">Geber</span>, credited with being the founder of chemistry, - <a href="#Page_233">233</a></li> - <li class="i1">now believed to be a mythical personage, - <a href="#Page_320">320</a></li> - - <li><span class="smcap">Gentile da Foligno</span>, - <a href="#Page_266">266</a></li> - - <li><span class="smcap">Gerard of Cremona</span>, - <a href="#Page_227">227</a>, - <a href="#Page_261">261</a></li> - - <li class="hangingindent"><span class="smcap">Germ origin</span> of certain febrile diseases suspected by Rhazes, - <a href="#Page_221">221</a></li> - - <li><span class="smcap">Germany</span>, devastated during the 17th century, - <a href="#Page_426">426</a></li> - <li class="i1">medical education in (from 1400 to 1600), - <a href="#Page_454">454</a></li> - - <li><span class="smcap">Gerssdorff, Hans von</span>, - <a href="#Page_460">460</a></li> - - <li><span class="smcap">Gesner, Conrad</span>, - <a href="#Page_394">394</a></li> - - <li><span class="smcap">Gilbertus Anglicus</span>, - <a href="#Page_305">305</a>, - <a href="#Page_516">516</a></li> - - <li><span class="smcap">Gilles de Corbeil</span>, on urology, - <a href="#Page_255">255</a></li> - - <li><span class="smcap">Gladiators, schools for</span>, - <a href="#Page_68">68</a></li> - - <li><span class="smcap">Glauber’s salt</span>, - <a href="#Page_410">410</a></li> - - <li><span class="smcap">Glisson, Francis</span>, - <a href="#Page_358">358</a>, - <a href="#Page_546">546</a></li> - - <li><span class="smcap">Glossulae quatuor magistrorum</span>, - <a href="#Page_280">280</a></li> - - <li><span class="smcap">Gordonius</span>, - <a href="#Page_296">296</a></li> - - <li><span class="smcap">Gourdon, Bernard de</span> (Gordonius), - <a href="#Page_296">296</a></li> - - <li><span class="smcap">Gout</span>, remedy for, recommended by Aëtius, - <a href="#Page_195">195</a></li> - - <li><span class="smcap">Graaf, Reignier de</span>, - <a href="#Page_359">359</a>, - <a href="#Page_361">361</a></li> - - <li class="hangingindent"><span class="smcap">Grapheus, Benevenutus</span>, celebrated eye surgeon of the 12th century, - <a href="#Page_256">256</a></li> - - <li class="hangingindent"><span class="smcap">Graves, robbing of</span>, for dissecting material, - <a href="#Page_309">309</a>, - <a href="#Page_332">332</a>, - <a href="#Page_336">336</a></li> - - <li class="hangingindent"><span class="smcap">Great Britain</span>, condition of surgery in, during 16th and 17th centuries, - <a href="#Page_516">516</a></li> - - <li><span class="smcap">Greek proverbs</span> relating to medicine, - <a href="#Page_77">77</a></li> - - <li><span class="smcap">Gregory, Bishop of Tours</span>, - <a href="#Page_241">241</a></li> - - <li><span class="smcap">Griffon, Jean</span>, distinguished Genevese surgeon, - <a href="#Page_464">464</a></li> - - <li><span class="smcap">Guaiac</span>, inefficient anti-syphilitic remedy, - <a href="#Page_405">405</a></li> - - <li><span class="smcap">Guainerio</span>, of Pavia, - <a href="#Page_496">496</a></li> - - <li><span class="smcap">Guarna, Rebecca</span>, - <a href="#Page_245">245</a></li> - - <li><span class="smcap">Guericke, Otto von</span>, - <a href="#Page_546">546</a></li> - - <li><span class="smcap">Guido Guidi</span> (Vidus Vidius), the anatomist, - <a href="#Page_340">340</a></li> - - <li><span class="smcap">Guillemeau, Jacques</span>, - <a href="#Page_536">536</a></li> - - <li><span class="smcap">Guiscard, Robert</span>, a resident at Salerno, - <a href="#Page_240">240</a></li> - - <li><span class="smcap">Guldinus, Paul</span>, - <a href="#Page_409">409</a></li> - - <li class="hangingindent"><span class="smcap">Gunpowder</span>, first employment of, in European warfare, - <a href="#Page_328">328</a></li> - - <li><span class="smcap">Gunshot wounds</span>, - <a href="#Page_467">467</a>, - <a href="#Page_473">473</a></li> - - <li><span class="smcap">Gurlt, von</span>, - <a href="#Page_455">455</a></li> - - <li><span class="smcap">Guy de Chauliac</span>, - <a href="#Page_227">227</a>, - <a href="#Page_263">263</a>, - <a href="#Page_298">298</a>, - <a href="#Page_299">299</a>, - <a href="#Page_310">310</a></li> - <li class="i1">founder of didactic surgery, - <a href="#Page_300">300</a></li> - <li class="i1">manner of treating injured nerves, - <a href="#Page_302">302</a></li> - <li class="i1">manner of treating fractures of the thigh, - <a href="#Page_304">304</a></li> - - <li class="hangingindent"><span class="smcap">Gymnastic exercises</span>, institutions for cultivating, - <a href="#Page_68">68</a></li> - - <li><span class="smcap">Gynaecologists, early</span>, - <a href="#Page_115">115</a></li> - - <li class="hangingindent"><span class="smcap">Gynaecology</span> successfully practiced by Soranus, - <a href="#Page_140">140</a></li> -</ul> - -<p class="p-index">H</p> - -<ul> - <li><span class="smcap">Haller, Albert von</span>, - <a href="#Page_142">142</a>, - <a href="#Page_344">344</a></li> - - <li class="hangingindent"><span class="smcap">Haly, Abbas</span>, a Persian physician and the author of the famous -treatise called “Al-Maleky”—“The Royal Book,” - <a href="#Page_223">223</a></li> - - <li class="hangingindent"><span class="smcap">Hammurabi’s law</span> with reference to physicians’ fees in Babylonia, - <a href="#Page_15">15</a></li> - - <li><span class="smcap">Harderwyk, University of</span>, - <a href="#Page_439">439</a></li> - - <li><span class="smcap">Haroun Alraschid</span>, - <a href="#Page_206">206</a></li> - - <li class="hangingindent"><span class="smcap">Harvey, William</span>, discoverer of the circulation of the blood, - <a href="#Page_379">379</a></li> - - <li><span class="smcap">Head, injuries of</span> (Wuertz), - <a href="#Page_467">467</a></li> - - <li class="hangingindent"><span class="smcap">Heart</span>, anatomy of, according to de Mondeville, - <a href="#Page_289">289</a></li> - <li class="i1">physiology of, - <a href="#Page_377">377</a></li> - - <li><span class="smcap">Heidelberg, University of</span>, - <a href="#Page_454">454</a></li> - - <li><span class="smcap">Heliodorus</span>, - <a href="#Page_202">202</a></li> - - <li><span class="smcap">Helvetius</span>, - <a href="#Page_409">409</a></li> - - <li class="hangingindent"><span class="smcap">Hemorrhage from a wound</span>, different means of arresting, - <a href="#Page_154">154</a>, - <a href="#Page_277">277</a></li> - - <li><span class="smcap">Henry the Second</span>’s manner of death, - <a href="#Page_511">511</a></li> - - <li><span class="smcap">Henschel</span>, researches of, - <a href="#Page_246">246</a></li> - - <li><span class="smcap">Herakleides, of Tarentum</span>, - <a href="#Page_111">111</a></li> - - <li><span class="smcap">Hercules</span> an ancestor of Hippocrates, - <a href="#Page_81">81</a></li> - - <li><span class="smcap">Hermetic books</span> relating to medicine, - <a href="#Page_18">18</a></li> - - <li class="hangingindent"><span class="smcap">Hernia, radical cure of</span>, by members of the Norsa family, - <a href="#Page_482">482</a></li> - - <li><span class="smcap">Hernia-healers</span>, - <a href="#Page_490">490</a></li> - - <li><span class="smcap">Herodicus</span>, of Selymbria, - <a href="#Page_69">69</a></li> - - <li class="hangingindent"><span class="smcap">Herodotus</span>, a different person from the famous historian, - <a href="#Page_26">26</a>, - <a href="#Page_142">142</a></li> - - <li class="hangingindent"><span class="smcap">Herophilus</span>, a distinguished physician of Chalcedon, - <a href="#Page_104">104</a></li> - - <li><span class="smcap">Herzog</span>, excavations made by, at Cos, - <a href="#Page_55">55</a></li> - - <li><span class="smcap">Hesychios</span>, - <a href="#Page_201">201</a></li> - - <li class="hangingindent"><span class="smcap">Heurnius, Johannes</span>, clinical teacher at Leyden, - <a href="#Page_429">429</a></li> - - <li class="hangingindent"><span class="smcap">High operation</span> for stone in the bladder (<i>le haut appareil</i>), - <a href="#Page_495">495</a>, - <a href="#Page_496">496</a></li> - - <li><span class="smcap">Highmore, Nathaniel</span>, - <a href="#Page_359">359</a>, - <a href="#Page_546">546</a></li> - - <li class="hangingindent"><span class="smcap">Hindu physicians</span> held very crude ideas about pathology, - <a href="#Page_31">31</a></li> - - <li><span class="smcap">Hippocrates the Great</span>, - <a href="#Page_81">81</a>, - <a href="#Page_82">82</a>, - <a href="#Page_98">98</a>, - <a href="#Page_411">411</a></li> - - <li><span class="smcap">Hippocratic oath</span>, - <a href="#Page_71">71</a></li> - - <li class="hangingindent"><span class="smcap">Hippocratic writings</span>, French version of Littré, - <a href="#Page_83">83</a></li> - <li class="i1">German version of Fuchs, - <a href="#Page_84">84</a></li> - <li class="i1">short extracts, - <a href="#Page_89">89</a></li> - - <li><span class="smcap">Hirsch, August</span>, - <a href="#Page_399">399</a>, - <a href="#Page_545">545</a></li> - - <li><span class="smcap">Hobeïch</span>, - <a href="#Page_215">215</a></li> - - <li><span class="smcap">Hofmann, Moritz</span>, - <a href="#Page_358">358</a></li> - - <li><span class="smcap">Hoffmann, Friedrich</span>, - <a href="#Page_431">431</a>, - <a href="#Page_434">434</a></li> - - <li><span class="smcap">Hoffmann’s anodyne</span>, - <a href="#Page_437">437</a></li> - - <li class="hangingindent"><span class="smcap">Homeric poems</span> probably written about B. C. 800, - <a href="#Page_46">46</a></li> - - <li><span class="smcap">Homer’s familiarity with anatomy</span>, - <a href="#Page_48">48</a></li> - - <li><span class="smcap">Honein</span>, - <a href="#Page_208">208</a>, - <a href="#Page_212">212</a>, - <a href="#Page_214">214</a>, - <a href="#Page_317">317</a></li> - - <li><span class="smcap">Hospital gangrene</span>, Wuertz’s views regarding, - <a href="#Page_469">469</a></li> - - <li><span class="smcap">Hospitals</span> in the Middle Ages, - <a href="#Page_219">219</a>, - <a href="#Page_235">235</a></li> - - <li class="hangingindent"><span class="smcap">Hôtel-Dieu at Lyons</span> founded in the 6th century, - <a href="#Page_236">236</a>, - <a href="#Page_450">450</a></li> - - <li class="hangingindent"><span class="smcap">Hôtel-Dieu at Paris</span> over-crowded in early part of 16th century (Fig.), - <a href="#Page_452">452</a></li> - - <li><span class="smcap">Hrabanus Maurus</span>, Abbot of Fulda Monastery, - <a href="#Page_241">241</a></li> - - <li><span class="smcap">Hugo Benzi</span> (Hugo of Siena), - <a href="#Page_312">312</a></li> - - <li><span class="smcap">Hugo of Lucca</span>, - <a href="#Page_275">275</a></li> - - <li><span class="smcap">Hydrotherapy</span> at the Cos <i>Asclepieion</i>, - <a href="#Page_54">54</a></li> - <li class="i1">in the treatment of gout, - <a href="#Page_129">129</a></li> - - <li><span class="smcap">Hygieia</span>, daughter of Aesculapius, - <a href="#Page_50">50</a></li> - - <li class="hangingindent"><span class="smcap">Hyoscyamus</span>, when first used for dilating the pupils, - <a href="#Page_157">157</a></li> - - <li><span class="smcap">Hyrtl, Joseph</span>, - <a href="#Page_311">311</a>, - <a href="#Page_356">356</a>, - <a href="#Page_532">532</a></li> -</ul> - -<p class="p-index">I</p> - -<ul> - <li><span class="smcap">Iatreia</span>, or small private hospitals, - <a href="#Page_68">68</a></li> - - <li class="hangingindent"><span class="smcap">Iatrochemists</span> and <span class="allsmcap">IATROPHYSICISTS</span> in 17th century, - <a href="#Page_366">366</a></li> - - <li><span class="smcap">Ibrahim</span>, pupil of George Bakhtichou, - <a href="#Page_206">206</a></li> - - <li><span class="smcap">Idea morbosa</span> (Van Helmont), - <a href="#Page_399">399</a></li> - - <li><span class="smcap">Ileo-caecal valve</span>, discovery of, - <a href="#Page_350">350</a></li> - - <li class="hangingindent"><span class="smcap">Iliad and Odyssey</span>, references in, to medicine, - <a href="#Page_47">47</a></li> - - <li><span class="smcap">India, ancient</span>, rich in skilful surgeons, - <a href="#Page_35">35</a></li> - - <li class="hangingindent"><span class="smcap">India</span>, great mortality in, from bites of venomous serpents, - <a href="#Page_64">64</a></li> - <li class="i1">the medicine of, - <a href="#Page_31">31</a></li> - - <li><span class="smcap">Ingrassia</span>, - <a href="#Page_349">349</a></li> - - <li><span class="smcap">Innocent XI., Pope</span>, - <a href="#Page_392">392</a></li> - - <li class="hangingindent"><span class="smcap">Inoculation</span> against small-pox practiced by the Chinese in the 11th century, - <a href="#Page_43">43</a></li> - - <li><span class="smcap">Intention</span>, healing by first, - <a href="#Page_277">277</a></li> - - <li><span class="smcap">Intestine</span>, wounds of, - <a href="#Page_255">255</a>, - <a href="#Page_459">459</a></li> - - <li><span class="smcap">Ionian School of Philosophy</span>, - <a href="#Page_72">72</a></li> - - <li><span class="smcap">Ipecacuanha</span>, discovery of, - <a href="#Page_408">408</a>, - <a href="#Page_409">409</a></li> - - <li><span class="smcap">Isaac, son of Honein</span>, - <a href="#Page_215">215</a></li> - - <li><span class="smcap">Isis</span>, - <a href="#Page_19">19</a></li> - - <li><span class="smcap">Isola San Bartolommeo</span>, - <a href="#Page_51">51</a></li> - - <li><span class="smcap">Israelites</span>, medicine of the, - <a href="#Page_26">26</a>, - <a href="#Page_27">27</a></li> - - <li><span class="smcap">Issa ben Chalata</span>, - <a href="#Page_205">205</a></li> - - <li><span class="smcap">Itinerant lithotomists</span>, - <a href="#Page_549">549</a></li> -</ul> - -<p class="p-index">J</p> - -<ul> - <li><span class="smcap">Jacobus Psychrestos</span>, - <a href="#Page_201">201</a></li> - - <li><span class="smcap">Jalap</span>, - <a href="#Page_395">395</a></li> - - <li><span class="smcap">Jamerius</span>, author of “Chirurgia Jamati,” - <a href="#Page_255">255</a></li> - - <li><span class="smcap">Janiscus</span>, son of Aesculapius, - <a href="#Page_50">50</a></li> - - <li><span class="smcap">Japanese physicians</span>, modern, - <a href="#Page_45">45</a></li> - - <li><span class="smcap">Jardin-du-Roi</span>, - <a href="#Page_540">540</a></li> - - <li><span class="smcap">Jaso</span>, daughter of Aesculapius, - <a href="#Page_50">50</a></li> - - <li><span class="smcap">Jean de Vigo</span>, - <a href="#Page_472">472</a>, - <a href="#Page_473">473</a></li> - - <li class="hangingindent"><span class="smcap">Jewish medical students</span>, numerous at Montpellier, - <a href="#Page_265">265</a></li> - - <li><span class="smcap">John</span> of Arderne, - <a href="#Page_516">516</a></li> - <li class="i1">of Capua, - <a href="#Page_261">261</a></li> - <li class="i1">of Gaddesden, - <a href="#Page_305">305</a>, - <a href="#Page_516">516</a></li> - <li class="i1">of Salisbury, - <a href="#Page_264">264</a></li> - <li class="i1">the Grammarian, of Alexandria, - <a href="#Page_185">185</a></li> - - <li><span class="smcap">Journalism, medical</span>, beginnings of, - <a href="#Page_545">545</a></li> - - <li><span class="smcap">Julian the Apostate</span>, Roman Emperor, - <a href="#Page_236">236</a>, - <a href="#Page_435">435</a></li> - - <li><span class="smcap">Jusserand</span>, - <a href="#Page_306">306</a></li> -</ul> - -<p class="p-index">K</p> - -<ul> - <li><span class="smcap">Kerckring, Theodor</span>, - <a href="#Page_359">359</a></li> - - <li><span class="smcap">King, Edmund</span>, - <a href="#Page_408">408</a></li> - - <li class="hangingindent"><span class="smcap">Kitab al-kullidschat</span> (= “Colliget”), title of Averroes’ treatise, - <a href="#Page_229">229</a></li> - - <li><span class="smcap">Koelliker</span>, - <a href="#Page_455">455</a></li> -</ul> - -<p class="p-index">L</p> - -<ul> - <li><span class="smcap">Laboulbène</span>, comments on Sydenham, - <a href="#Page_425">425</a></li> - - <li><span class="smcap">Labyrinth</span> of temporal bone, - <a href="#Page_80">80</a></li> - - <li><span class="smcap">Lancisi, Giovanni Maria</span>, - <a href="#Page_349">349</a>, - <a href="#Page_391">391</a></li> - <li class="hangingindent1">discovers copper plates intended for Eustachius’ “Anatomy,” - <a href="#Page_392">392</a></li> - - <li><span class="smcap">Lanfranchi</span>, - <a href="#Page_282">282</a>, - <a href="#Page_284">284</a></li> - - <li class="hangingindent"><span class="smcap">Languages, learned</span>, importance of acquiring a knowledge of them, - <a href="#Page_271">271</a></li> - - <li class="hangingindent"><span class="smcap">Lanolin</span>, described by Dioscorides in A. D. 100, - <a href="#Page_318">318</a></li> - - <li><span class="smcap">Lapeyronie, François de</span>, - <a href="#Page_531">531</a></li> - - <li class="hangingindent"><span class="smcap">Laryngoscopy, direct</span>, mentioned by Savonarola, - <a href="#Page_313">313</a></li> - - <li><span class="smcap">Latin</span>, barbaric, - <a href="#Page_262">262</a>, - <a href="#Page_300">300</a></li> - <li class="hangingindent1">commonly employed by teachers of medicine in 16th and 17th centuries, - <a href="#Page_369">369</a></li> - <li class="hangingindent1">habitually spoken at Oxford and Cambridge in 17th century, - <a href="#Page_424">424</a></li> - - <li><span class="smcap">Laudanum, Sydenham’s liquid</span>, formula for, - <a href="#Page_424">424</a></li> - - <li class="hangingindent"><span class="smcap">Laurea Anglica</span>, title of treatise written by Gilbertus Anglicus, - <a href="#Page_305">305</a></li> - - <li class="hangingindent"><span class="smcap">Laxatives</span>, a term originated by the Methodists, - <a href="#Page_133">133</a></li> - - <li><span class="smcap">Laxum and strictum</span>, - <a href="#Page_130">130</a></li> - - <li><span class="smcap">Le Clerc, Daniel</span>, - <a href="#Page_73">73</a>, - <a href="#Page_171">171</a></li> - - <li><span class="smcap">Le Clerc, Lucien</span>, - <a href="#Page_217">217</a></li> - - <li><span class="smcap">Leech</span> lodged in the naso-pharynx, - <a href="#Page_397">397</a></li> - - <li class="hangingindent"><span class="smcap">Leeches</span>, therapeutic employment of, first mentioned by Themison, - <a href="#Page_133">133</a></li> - - <li><span class="smcap">Leeuwenhoek, Anton van</span>, - <a href="#Page_360">360</a></li> - - <li><span class="smcap">Leg, amputation of</span> (Fig.), - <a href="#i_p463">463</a></li> - - <li><span class="smcap">Leibnitz</span>, - <a href="#Page_363">363</a></li> - - <li><span class="smcap">Leonides</span>, - <a href="#Page_201">201</a></li> - - <li><span class="smcap">Leonine versification</span>, - <a href="#Page_251">251</a></li> - - <li><span class="smcap">Levret</span>, - <a href="#Page_539">539</a></li> - - <li class="hangingindent"><span class="smcap">Libraries, public</span>, seventy possessed by Spain during the 12th century, - <a href="#Page_232">232</a></li> - - <li class="hangingindent"><span class="smcap">Liebreich</span>, originator of the term “lanolin,” - <a href="#Page_318">318</a></li> - - <li class="hangingindent"><span class="smcap">Ligatures</span> applied to blood-vessels by Archigenes in the early part of 2d century, - <a href="#Page_143">143</a></li> - <li class="i1">employment of, by Jean de Vigo, in 1460, - <a href="#Page_473">473</a></li> - <li class="i1">used on amputation stumps, - <a href="#Page_519">519</a></li> - - <li><span class="smcap">Linacre, Thomas</span>, - <a href="#Page_416">416</a></li> - <li class="i1">founded two “lectures of physick” at Oxford, - <a href="#Page_417">417</a></li> - <li class="hangingindent1">instrumental in securing the foundation of the College of Physicians at London, - <a href="#Page_417">417</a></li> - - <li><span class="smcap">Liquor balsamicus</span>, - <a href="#Page_357">357</a></li> - - <li class="hangingindent"><span class="smcap">Lithontripsy</span>, Giovanni de Romanis supposed to be the inventor of, - <a href="#Page_474">474</a></li> - - <li><span class="smcap">Lithotome of Frère Côme</span> (Fig.), - <a href="#i_fp552">553</a></li> - - <li><span class="smcap">Lithotomists, itinerant</span>, - <a href="#Page_490">490</a>, - <a href="#Page_549">549</a></li> - - <li><span class="smcap">Lithotomy, suprapubic</span>, - <a href="#Page_495">495</a></li> - - <li class="hangingindent"><span class="smcap">Lithotrity</span> practiced first by Beniveni in the 15th century, - <a href="#Page_498">498</a></li> - - <li class="hangingindent"><span class="smcap">Louis de Bourges</span>, First Physician to Francis I., - <a href="#Page_414">414</a></li> - - <li><span class="smcap">Louvain, University of</span>, - <a href="#Page_345">345</a></li> - - <li><span class="smcap">Lower, Richard</span>, - <a href="#Page_408">408</a></li> - - <li><span class="smcap">Lucius Verus, Roman Emperor</span>, - <a href="#Page_165">165</a></li> - - <li class="hangingindent"><span class="smcap">Lucrum neglectum</span>, probable meaning of the expression, - <a href="#Page_353">353</a></li> - - <li><span class="smcap">Luke, “the beloved physician,”</span> - <a href="#Page_30">30</a></li> - - <li><span class="smcap">Lutetia, Gaul</span>, the present city of Paris, - <a href="#Page_435">435</a></li> - - <li class="hangingindent"><span class="smcap">Luther, Martin</span>, a believer in the “black art,” - <a href="#Page_322">322</a></li> - - <li><span class="smcap">Lymphatics, intestinal</span>, - <a href="#Page_385">385</a></li> - - <li class="hangingindent"><span class="smcap">Lyons, France</span>, founding of the Hôtel-Dieu in that city (6th century), - <a href="#Page_236">236</a></li> -</ul> - -<p class="p-index">M</p> - -<ul> - <li class="hangingindent"><span class="smcap">Machaon and Podalirius</span>, sons of Aesculapius, - <a href="#Page_47">47</a>, - <a href="#Page_50">50</a></li> - - <li><span class="smcap">Magati, Cesare</span>, - <a href="#Page_529">529</a></li> - - <li><span class="smcap">Maggi, Bartolommeo</span>, - <a href="#Page_473">473</a></li> - <li class="hangingindent1">discoverer of the fact that a bullet is not hot at moment of inflicting a wound, - <a href="#Page_513">513</a></li> - - <li><span class="smcap">Magical remedies</span>, - <a href="#Page_197">197</a></li> - - <li><span class="smcap">Magnus</span>, disciple of Athenaeus, - <a href="#Page_142">142</a></li> - - <li><span class="smcap">Magreb</span>, - <a href="#Page_218">218</a></li> - - <li class="hangingindent"><span class="smcap">Maimonides</span>, esteemed the greatest Jew after Moses, - <a href="#Page_230">230</a></li> - - <li class="hangingindent"><span class="smcap">Malevolent spirits</span>, capable of producing disease, - <a href="#Page_8">8</a></li> - - <li><span class="smcap">Malpighi</span>, - <a href="#Page_360">360</a>, - <a href="#Page_361">361</a></li> - - <li><span class="smcap">Manardus, Johannes</span>, - <a href="#Page_389">389</a></li> - - <li><span class="smcap">Manfred, King of Sicily</span>, - <a href="#Page_262">262</a></li> - <li class="i1">founds a university at Naples in 1258 A. D., - <a href="#Page_257">257</a></li> - - <li class="hangingindent"><span class="smcap">Manuscripts, medical</span>, transcribing of, at Monastery of Saint Gall, - <a href="#Page_244">244</a></li> - - <li><span class="smcap">Marc Antonio della Torre</span>, - <a href="#Page_339">339</a></li> - - <li><span class="smcap">Marcus Aurelius</span>, Roman Emperor, - <a href="#Page_165">165</a></li> - - <li><span class="smcap">Marianus Sanctus</span>, - <a href="#Page_474">474</a></li> - - <li><span class="smcap">Mariotte, Edme</span>, - <a href="#Page_546">546</a></li> - - <li><span class="smcap">Martyrdom of Christian physicians</span>, - <a href="#Page_180">180</a></li> - - <li><span class="smcap">Master of Medicine</span>, grade of, - <a href="#Page_304">304</a></li> - - <li><span class="smcap">Materia medica</span>, early Greek, - <a href="#Page_158">158</a></li> - <li class="i1">first modern treatise on (1447), - <a href="#Page_320">320</a></li> - - <li><span class="smcap">Mauriceau, François</span>, - <a href="#Page_537">537</a></li> - - <li><span class="smcap">Maurus</span>, teacher of medicine at Salerno, - <a href="#Page_245">245</a></li> - - <li><span class="smcap">Mayerne, Turquet de</span>, - <a href="#Page_547">547</a></li> - - <li class="hangingindent"><span class="smcap">Meaux Saint-Marc</span>, translator of “Schola Salernitana” into French, - <a href="#Page_250">250</a></li> - - <li><span class="smcap">Mediastinitis</span>, case of, - <a href="#Page_228">228</a></li> - - <li><span class="smcap">Medical teaching</span> in Ancient Greece, - <a href="#Page_70">70</a>, - <a href="#Page_85">85</a></li> - <li class="i1">in the Asclepieia, - <a href="#Page_69">69</a></li> - - <li class="hangingindent"><span class="smcap">Medical treatises, Greek</span>, destruction of, in Rome, during the 5th century, - <a href="#Page_185">185</a></li> - - <li><span class="smcap">Medicine</span>, beginnings of a rational system of, - <a href="#Page_67">67</a></li> - <li class="hangingindent1">development of different sects, after the death of Hippocrates, - <a href="#Page_101">101</a></li> - <li class="hangingindent1">evolution of, as affected by the Arab Renaissance, - <a href="#Page_203">203</a>, - <a href="#Page_233">233</a></li> - <li class="i1">God of, - <a href="#Page_50">50</a></li> - <li class="i1">influence of the Italian Renaissance upon, - <a href="#Page_260">260</a></li> - <li class="i1">mediaeval, - <a href="#Page_191">191</a></li> - <li class="i1">practice of, at Rome, in century preceding Christian era, - <a href="#Page_117">117</a></li> - <li class="i1">pre-Homeric period of, in Greece, - <a href="#Page_46">46</a></li> - <li class="i1">relation of monasteries to, - <a href="#Page_238">238</a></li> - <li class="i1">slowness of development of, - <a href="#Page_3">3</a></li> - - <li class="hangingindent"><span class="smcap">Medicine man</span> of the Indian tribes the earliest type of the physician, - <a href="#Page_8">8</a></li> - - <li><span class="smcap">Medina worm</span> discovered by Abulcasis, - <a href="#Page_233">233</a></li> - - <li><span class="smcap">Membrana Ruyschiana</span>, - <a href="#Page_357">357</a></li> - - <li><span class="smcap">Menelaüs</span> wounded at siege of Troy, - <a href="#Page_48">48</a></li> - - <li class="hangingindent"><span class="smcap">Menocritus</span>, physician, honored by a marble column in Greece, - <a href="#Page_99">99</a></li> - - <li><span class="smcap">Mercuriade</span>, teacher of medicine at Salerno, - <a href="#Page_245">245</a></li> - - <li><span class="smcap">Mesopotamia</span>, medicine in, - <a href="#Page_11">11</a></li> - - <li><span class="smcap">Mesué, John, the Elder</span>, - <a href="#Page_209">209</a></li> - - <li class="hangingindent"><span class="smcap">Metasyncrisis</span>, a term originated by Thessalus, - <a href="#Page_136">136</a></li> - - <li><span class="smcap">Methodists</span>, school of the, - <a href="#Page_129">129</a>, - <a href="#Page_138">138</a>, - <a href="#Page_149">149</a></li> - - <li><span class="smcap">Meyer, Ernest von</span>, - <a href="#Page_400">400</a></li> - - <li class="hangingindent"><span class="smcap">Meyer-Steineg</span>, of Jena, Germany, - <a href="#Page_16">16</a>, - <a href="#Page_52">52</a>, - <a href="#Page_53">53</a>, - <a href="#Page_68">68</a>, - <a href="#Page_120">120</a>, - <a href="#Page_129">129</a>, - <a href="#Page_134">134</a>, - <a href="#Page_142">142</a></li> - - <li><span class="smcap">Michael Scotus</span>, - <a href="#Page_262">262</a></li> - - <li class="hangingindent"><span class="smcap">Microscopic anatomy</span>, first beginnings of, - <a href="#Page_360">360</a>, - <a href="#Page_362">362</a></li> - - <li><span class="smcap">Migraine</span> relieved by arteriotomy, - <a href="#Page_470">470</a></li> - - <li><span class="smcap">Mikrotechne</span> of Galen, - <a href="#Page_248">248</a></li> - - <li><span class="smcap">Minderer, Raymond</span>, - <a href="#Page_407">407</a></li> - - <li class="hangingindent"><span class="smcap">Mineral waters</span> employed extensively by the ancients in the form of baths, - <a href="#Page_157">157</a></li> - - <li><span class="smcap">Mirach</span>, - <a href="#Page_521">521</a></li> - - <li><span class="smcap">Mirfeld, John</span>, - <a href="#Page_306">306</a></li> - - <li class="hangingindent"><span class="smcap">Misopogon</span>, title of satire written by Julian the Apostate, - <a href="#Page_436">436</a></li> - - <li><span class="smcap">Mithridates</span>, - <a href="#Page_127">127</a></li> - - <li><span class="smcap">Mithridaticum</span>, composition of, - <a href="#Page_112">112</a></li> - - <li><span class="smcap">Mixtum</span>, term employed by the Methodists, - <a href="#Page_131">131</a></li> - - <li><span class="smcap">Mommsen</span>, - <a href="#Page_235">235</a></li> - - <li><span class="smcap">Monasteries</span> in the Middle Ages, - <a href="#Page_181">181</a>, - <a href="#Page_235">235</a></li> - <li class="i1">relation of, to medicine, - <a href="#Page_238">238</a></li> - - <li><span class="smcap">Mondeville, Henri de</span> (Fig.), - <a href="#Page_287">287</a>, - <a href="#i_fp288">288</a>, - <a href="#Page_289">289</a>, - <a href="#Page_291">291</a></li> - - <li><span class="smcap">Mondino</span>, the anatomist, - <a href="#Page_274">274</a>, - <a href="#Page_280">280</a>, - <a href="#Page_312">312</a>, - <a href="#Page_332">332</a></li> - - <li class="hangingindent"><span class="smcap">Monks</span> obliged to practice medicine during the Middle Ages, - <a href="#Page_141">141</a>, - <a href="#Page_154">154</a></li> - - <li class="hangingindent"><span class="smcap">Monte Cassino</span>, founding of Benedictine monastery on, - <a href="#Page_238">238</a>, - <a href="#Page_239">239</a></li> - - <li><span class="smcap">Montpellier</span>, Medical School of, - <a href="#Page_264">264</a>, - <a href="#Page_292">292</a>, - <a href="#Page_332">332</a></li> - - <li><span class="smcap">Morbus gallicus</span>, - <a href="#Page_543">543</a></li> - - <li class="hangingindent"><span class="smcap">Mosaic laws</span>, the, related particularly to social hygiene, - <a href="#Page_26">26</a></li> - - <li><span class="smcap">Moschion</span>, pupil of Soranus, - <a href="#Page_139">139</a></li> - - <li><span class="smcap">Motassem, Caliph</span>, - <a href="#Page_210">210</a></li> - - <li><span class="smcap">Moxae, moxibustion</span>, - <a href="#Page_44">44</a></li> - - <li class="hangingindent"><span class="smcap">Murphy’s button</span>, Pfolspeundt’s (15th century) prototype of, - <a href="#Page_459">459</a></li> - - <li class="hangingindent"><span class="smcap">Musa, Antonius</span>, physician of Emperor Augustus, - <a href="#Page_129">129</a></li> - - <li><span class="smcap">Musandinus</span>, - <a href="#Page_245">245</a>, - <a href="#Page_254">254</a></li> - - <li class="hangingindent"><span class="smcap">Musulmans</span> as zealous as the Christians in establishing hospitals, - <a href="#Page_237">237</a></li> -</ul> - -<p class="p-index">N</p> - -<ul> - <li class="hangingindent"><span class="smcap">Naaman’s so-called leprosy</span> cured by the prophet Elisha, - <a href="#Page_27">27</a></li> - - <li><span class="smcap">Namtar</span>, the special demon of the Plague, - <a href="#Page_13">13</a></li> - - <li class="hangingindent"><span class="smcap">Naples</span>, university established at, in 1258 A. D., - <a href="#Page_257">257</a></li> - - <li><span class="smcap">Nasal cavity</span>, illuminating the, - <a href="#Page_482">482</a></li> - - <li><span class="smcap">Neo-Latin</span>, - <a href="#Page_262">262</a></li> - - <li class="hangingindent"><span class="smcap">Neolithic age</span>, state of medical knowledge during the, - <a href="#Page_9">9</a></li> - - <li><span class="smcap">Nepenthes</span>, - <a href="#Page_49">49</a></li> - - <li class="hangingindent"><span class="smcap">Nerves, wounds of</span>, comments of Guy de Chauliac upon, - <a href="#Page_302">302</a></li> - - <li class="hangingindent"><span class="smcap">Neuburger, Max</span>, - <a href="#Page_24">24</a>, - <a href="#Page_41">41</a>, - <a href="#Page_51">51</a>, - <a href="#Page_84">84</a>, - <a href="#Page_132">132</a>, - <a href="#Page_222">222</a>, - <a href="#Page_228">228</a>, - <a href="#Page_231">231</a>, - <a href="#Page_249">249</a></li> - - <li><span class="smcap">Newton, Sir Isaac</span>, - <a href="#Page_546">546</a></li> - - <li><span class="smcap">Nicaise, Edouard</span>, - <a href="#Page_228">228</a>, - <a href="#Page_263">263</a>, - <a href="#Page_282">282</a>, - <a href="#Page_287">287</a>, - <a href="#Page_300">300</a></li> - - <li class="hangingindent"><span class="smcap">Nicholas, the monk</span>, sent by the Emperor Romanus to Cordova as an interpreter of Dioscorides, - <a href="#Page_226">226</a></li> - - <li><span class="smcap">Nicolaus Myrepsus</span>, - <a href="#Page_318">318</a></li> - - <li><span class="smcap">Nicolaus Praepositus</span>, Antidotarium of, - <a href="#Page_253">253</a></li> - - <li><span class="smcap">Nicotine</span>, the alkaloid found in tobacco, - <a href="#Page_395">395</a></li> - - <li class="hangingindent"><span class="smcap">Norsa family</span>, celebrated as operators for the radical cure of hernia, - <a href="#Page_482">482</a></li> - - <li><span class="smcap">Nuck, Anton</span>, the anatomist, - <a href="#Page_359">359</a>, - <a href="#Page_439">439</a></li> - - <li><span class="smcap">Nufer, Jacob</span>, - <a href="#Page_534">534</a></li> -</ul> - -<p class="p-index">O</p> - -<ul> - <li><span class="smcap">Oath, Hippocratic</span>, - <a href="#Page_71">71</a></li> - - <li class="hangingindent"><span class="smcap">Obstetric methods</span>, rational, of Soranus, - <a href="#Page_138">138</a>, - <a href="#Page_139">139</a></li> - - <li><span class="smcap">Obstetrical forceps</span>, - <a href="#Page_535">535</a></li> - - <li><span class="smcap">Obstetrics</span>, practice of, in ancient Egypt, - <a href="#Page_17">17</a></li> - - <li><span class="smcap">Odyssey</span>, reference to drugs in the, - <a href="#Page_18">18</a></li> - - <li><span class="smcap">Oil of St. John’s wort</span>, - <a href="#Page_522">522</a></li> - - <li class="hangingindent"><span class="smcap">Oisypum (lanolin)</span>, first described by Dioscorides (100 A. D.), - <a href="#Page_318">318</a></li> - - <li><span class="smcap">Old Testament</span>, medicine of the, - <a href="#Page_26">26</a></li> - - <li><span class="smcap">Oleum Hyperici</span>, - <a href="#Page_522">522</a></li> - - <li class="hangingindent"><span class="smcap">Onasilos</span>, a physician, bronze tablet in honor of (5th century B. C.), found in Island of Cyprus, - <a href="#Page_99">99</a></li> - - <li><span class="smcap">Opedeldoch</span>, - <a href="#Page_404">404</a></li> - - <li><span class="smcap">Ophthalmologists, early</span>, - <a href="#Page_115">115</a></li> - - <li><span class="smcap">Ophthalmology</span>, important contributions to, - <a href="#Page_546">546</a></li> - - <li class="hangingindent"><span class="smcap">Opium</span>, probably the drug referred to by term “nepenthes,” - <a href="#Page_49">49</a></li> - <li class="hangingindent1">proper manner of obtaining, first described by Scribonius Largus, - <a href="#Page_155">155</a></li> - <li class="hangingindent1">Sydenham’s opinion with regard to the value of, - <a href="#Page_424">424</a></li> - - <li><span class="smcap">Oporinus</span>, Paracelsus’ assistant, - <a href="#Page_404">404</a></li> - - <li><span class="smcap">Ordronaux, John</span>, - <a href="#Page_250">250</a>, - <a href="#Page_252">252</a></li> - - <li><span class="smcap">Oribasius</span>, - <a href="#Page_191">191</a></li> - - <li><span class="smcap">Oriental medicine</span>, - <a href="#Page_11">11</a></li> - - <li><span class="smcap">Osiris</span>, or Serapis, - <a href="#Page_19">19</a></li> - - <li class="hangingindent"><span class="smcap">Over-eating</span>, according to the ancient Egyptians, is the cause of the majority of diseases, - <a href="#Page_22">22</a></li> -</ul> - -<p class="p-index">P</p> - -<ul> - <li><span class="smcap">Padua Medical School</span>, - <a href="#Page_267">267</a>, - <a href="#Page_352">352</a></li> - - <li><span class="smcap">Pagel</span>, - <a href="#Page_57">57</a></li> - - <li class="hangingindent"><span class="smcap">Palermo, Sicily</span>, a great centre of literary activity, - <a href="#Page_261">261</a></li> - - <li><span class="smcap">Panadoes</span>, how prepared, - <a href="#Page_443">443</a></li> - - <li><span class="smcap">Panakeia</span>, daughter of Aesculapius, - <a href="#Page_50">50</a></li> - - <li class="hangingindent"><span class="smcap">Pancreas</span>, outlet duct of, discovered in 1641, - <a href="#Page_358">358</a></li> - - <li><span class="smcap">Paper, invention of</span>, - <a href="#Page_328">328</a></li> - - <li><span class="smcap">Papin, Denis</span>, - <a href="#Page_547">547</a></li> - - <li><span class="smcap">Paracelsus</span>, - <a href="#Page_369">369</a>, - <a href="#Page_401">401</a>, - <a href="#Page_405">405</a>, - <a href="#Page_465">465</a></li> - <li class="i1">monument in honor of, at Basel, - <a href="#Page_406">406</a></li> - <li class="i1">pharmaceutical preparations of, - <a href="#Page_404">404</a></li> - <li class="i1">sayings of, - <a href="#Page_403">403</a></li> - <li class="i1">treatises published by, - <a href="#Page_403">403</a></li> - - <li><span class="smcap">Paracentesis abdominis</span>, - <a href="#Page_110">110</a>, - <a href="#Page_124">124</a></li> - - <li class="hangingindent"><span class="smcap">Paramirum</span>, title of Paracelsus’ principal treatise, - <a href="#Page_403">403</a></li> - - <li class="hangingindent"><span class="smcap">Parchment</span> invented at Pergamum in 3d century B. C., - <a href="#Page_101">101</a></li> - - <li><span class="smcap">Paré, Ambroise</span> (Figs.), - <a href="#Page_404">404</a>, - <a href="#Page_499">499</a>, - <a href="#Page_500">500</a>, - <a href="#Page_502">502</a>, - <a href="#i_fp514">515</a></li> - <li class="i1">abandons use of boiling oil, - <a href="#Page_503">503</a></li> - <li class="hangingindent1">arrests bleeding from divided blood-vessels by use of ligatures, - <a href="#Page_512">512</a></li> - <li class="i1">bitter jealousy shown by his contemporaries, - <a href="#Page_501">501</a></li> - <li class="hangingindent1">charge of plagiarism against him not sustained, - <a href="#Page_514">514</a></li> - <li class="hangingindent1">devises artery forceps and other surgical apparatus, - <a href="#Page_512">512</a></li> - <li class="hangingindent1">exarticulation of elbow-joint performed by him, - <a href="#Page_508">508</a></li> - <li class="i1">some of his sayings, - <a href="#Page_500">500</a>, - <a href="#Page_501">501</a></li> - <li class="hangingindent1">summary of his more important achievements in surgery, - <a href="#Page_513">513</a></li> - <li class="hangingindent1">treatise on surgery not published in English until 1577, - <a href="#Page_518">518</a></li> - - <li><span class="smcap">Paris Medical School</span>, - <a href="#Page_282">282</a></li> - - <li><span class="smcap">Parmenides</span>, - <a href="#Page_73">73</a></li> - - <li><span class="smcap">Parrenin, Father</span>, Jesuit missionary, - <a href="#Page_541">541</a></li> - - <li class="hangingindent"><span class="smcap">Pason</span> (= <span class="smcap">Apollo</span>), who invented the art of medicine, - <a href="#Page_18">18</a></li> - - <li class="hangingindent"><span class="smcap">Passavant</span>, Dean of the Collège de St. Côme at Paris, - <a href="#Page_284">284</a></li> - - <li class="hangingindent"><span class="smcap">Passionarius</span>, title of Gariopontus’ treatise, - <a href="#Page_247">247</a></li> - - <li><span class="smcap">Pathology</span>, Fernel’s scheme of, - <a href="#Page_415">415</a></li> - <li class="i1">views held by Hippocrates, - <a href="#Page_86">86</a></li> - - <li><span class="smcap">Pathology, internal</span>, - <a href="#Page_389">389</a></li> - - <li class="hangingindent"><span class="smcap">Patroclus</span> dresses the wound of Eurypylus, - <a href="#Page_49">49</a></li> - - <li class="hangingindent"><span class="smcap">Paul, the Apostle</span>, bitten by a poisonous snake on the Island of Melita, - <a href="#Page_29">29</a></li> - - <li><span class="smcap">Paulus Aegineta</span>, - <a href="#Page_199">199</a>, - <a href="#Page_227">227</a>, - <a href="#Page_318">318</a></li> - - <li class="hangingindent"><span class="smcap">Pecquet, Jean</span>, rediscovers thoracic duct (in a dog), - <a href="#Page_384">384</a></li> - - <li class="hangingindent"><span class="smcap">Pericardium, abscess in the</span>, Avenzoar refers to its actual occurrence, - <a href="#Page_229">229</a></li> - - <li><span class="smcap">Periodeuts</span> or ambulant physicians, - <a href="#Page_75">75</a></li> - - <li><span class="smcap">Persians, the ancient</span>, medicine of, - <a href="#Page_25">25</a></li> - <li class="i1">took very little interest in surgery, - <a href="#Page_26">26</a></li> - - <li class="hangingindent"><span class="smcap">Peter the Great</span> purchases Ruysch’s anatomical collection, - <a href="#Page_356">356</a></li> - - <li class="hangingindent"><span class="smcap">Petroncellus</span>, a teacher of medicine at Salerno, - <a href="#Page_245">245</a></li> - - <li><span class="smcap">Peyer, Johann Conrad</span>, - <a href="#Page_359">359</a></li> - - <li><span class="smcap">Pfolspeundt, Heinrich von</span>, - <a href="#Page_458">458</a>, - <a href="#Page_460">460</a></li> - - <li><span class="smcap">Pharmacist</span>, early use of the term, - <a href="#Page_316">316</a></li> - - <li class="hangingindent"><span class="smcap">Pharmacology</span>, earliest treatise on, published by Dioscorides in 77 A. D., - <a href="#Page_158">158</a></li> - - <li><span class="smcap">Pharmacopoeia</span>, modern term for antidotarium, - <a href="#Page_319">319</a></li> - <li class="i1">Augsburg, compiled by Minderer, - <a href="#Page_407">407</a></li> - <li class="i1">modern, beginnings of, - <a href="#Page_547">547</a></li> - <li class="i1">of India, very rich, - <a href="#Page_33">33</a></li> - - <li><span class="smcap">Pharmacy</span>, in its infancy, - <a href="#Page_315">315</a></li> - <li class="i1">first regularly established in the 8th century, - <a href="#Page_318">318</a></li> - - <li class="hangingindent"><span class="smcap">Pharmakon</span>, term employed by Galen for a remedial drug, - <a href="#Page_316">316</a></li> - - <li><span class="smcap">Philinus of Cos</span>, - <a href="#Page_111">111</a></li> - - <li><span class="smcap">Philosophers’ stone</span>, - <a href="#Page_321">321</a></li> - - <li class="hangingindent"><span class="smcap">Philosophy, schools of</span>, in Greece and its colonies, - <a href="#Page_72">72</a></li> - - <li><span class="smcap">Physicians</span>, consultation of (Fig.), - <a href="#i_p457">457</a></li> - <li class="i1">honored publicly in ancient Greece, - <a href="#Page_98">98</a>, - <a href="#Page_99">99</a>, - <a href="#Page_100">100</a></li> - <li class="hangingindent1">more highly esteemed than surgeons in 14th century, - <a href="#Page_304">304</a></li> - <li class="i1">suffered martyrdom for their Christian faith, - <a href="#Page_180">180</a></li> - - <li><span class="smcap">Physiology, human</span>, views held by Hippocrates, - <a href="#Page_86">86</a></li> - - <li><span class="smcap">Pietro d’Abano</span>, - <a href="#Page_266">266</a></li> - - <li><span class="smcap">Pineau family</span>, lithotomists, - <a href="#Page_549">549</a></li> - - <li><span class="smcap">Pini</span>, anatomical draughtsman, - <a href="#Page_348">348</a>, - <a href="#Page_392">392</a></li> - - <li><span class="smcap">Pitard, Jehan</span>, Surgeon of Louis IX., - <a href="#Page_448">448</a>, - <a href="#Page_530">530</a></li> - - <li><span class="smcap">Pitcairn, Archibald</span>, - <a href="#Page_367">367</a></li> - - <li><span class="smcap">Plague at Athens</span>, history of, by Thucydides, - <a href="#Page_96">96</a></li> - - <li><span class="smcap">Plague, the</span>, avoidance of, by Galen, - <a href="#Page_164">164</a></li> - - <li><span class="smcap">Plants, medicinal virtues of</span>, - <a href="#Page_157">157</a></li> - - <li class="hangingindent"><span class="smcap">Platearius</span>, John and Matthew, teachers of medicine at Salerno, - <a href="#Page_245">245</a></li> - - <li><span class="smcap">Plato</span>, - <a href="#Page_73">73</a>, - <a href="#Page_78">78</a></li> - <li class="i1">views of, with regard to women physicians, - <a href="#Page_77">77</a></li> - - <li><span class="smcap">Platter, Felix</span>, - <a href="#Page_336">336</a>, - <a href="#Page_396">396</a>, - <a href="#Page_455">455</a></li> - <li class="i1">early experiences at Montpellier, - <a href="#Page_332">332</a></li> - - <li><span class="smcap">Pleurisy</span>, Boerhaave’s manner of treating it, - <a href="#Page_444">444</a></li> - - <li><span class="smcap">Pliny the Elder</span>, - <a href="#Page_155">155</a></li> - - <li class="hangingindent"><span class="smcap">Pneuma</span>, or breath, plays the most important rôle in the mechanism of life, - <a href="#Page_108">108</a></li> - <li class="i1">or vital spirit, - <a href="#Page_141">141</a></li> - - <li class="hangingindent"><span class="smcap">Pneumatism</span> not popular with the physicians of Rome, - <a href="#Page_142">142</a></li> - - <li><span class="smcap">Pneumatists</span>, the, - <a href="#Page_141">141</a></li> - - <li><span class="smcap">Podalic version</span>, - <a href="#Page_535">535</a>, - <a href="#Page_537">537</a></li> - - <li><span class="smcap">Podalirius</span>, - <a href="#Page_47">47</a></li> - - <li class="hangingindent"><span class="smcap">Poisonous snakes</span>, loss of life caused by the bites of, - <a href="#Page_64">64</a></li> - - <li><span class="smcap">Polybus</span>, son-in-law of Hippocrates, - <a href="#Page_82">82</a></li> - - <li><span class="smcap">Pompeii</span>, physicians’ houses disinterred at, - <a href="#Page_315">315</a></li> - - <li><span class="smcap">Pons Varolii</span>, - <a href="#Page_350">350</a></li> - - <li class="hangingindent"><span class="smcap">Pores</span>, system of, for conveyance of tissue juices, - <a href="#Page_122">122</a></li> - - <li><span class="smcap">Portal, Paul</span>, - <a href="#Page_539">539</a></li> - - <li><span class="smcap">Poultices</span>, too free use of, condemned, - <a href="#Page_467">467</a></li> - - <li><span class="smcap">Power, D’Arcy</span>, - <a href="#Page_307">307</a></li> - - <li><span class="smcap">Practica chirurgiae</span> of Roger, - <a href="#Page_254">254</a></li> - - <li><span class="smcap">Practica oculorum</span> of Benevenutus Grapheus, - <a href="#Page_256">256</a></li> - - <li><span class="smcap">Practica</span> of Bartholomaeus, - <a href="#Page_248">248</a></li> - - <li><span class="smcap">Practica</span> of Cophon the Younger, - <a href="#Page_249">249</a></li> - - <li class="hangingindent"><span class="smcap">Practitioners</span>, improper behavior of, in the sick room, - <a href="#Page_193">193</a></li> - - <li><span class="smcap">Praepositus</span>, meaning of the term, - <a href="#Page_253">253</a></li> - - <li><span class="smcap">Praxagoras of Cos</span>, - <a href="#Page_103">103</a></li> - <li class="hangingindent1">probably the first to distinguish the difference between arteries and veins, - <a href="#Page_103">103</a></li> - - <li class="hangingindent"><span class="smcap">Prayer formulae</span> employed by the Babylonians as protective remedies, - <a href="#Page_13">13</a></li> - - <li><span class="smcap">Pregnant women</span>, dietetics of, - <a href="#Page_199">199</a></li> - - <li><span class="smcap">Prehistoric period</span> of science of medicine, - <a href="#Page_4">4</a></li> - - <li><span class="smcap">Pre-Homeric period</span> of medicine in Greece, - <a href="#Page_46">46</a></li> - - <li class="hangingindent"><span class="smcap">Prescription writing</span> first employed about A. D. 1400, - <a href="#Page_320">320</a></li> - - <li class="hangingindent"><span class="smcap">Printing, invention of</span>, favored advance of science of medicine, - <a href="#Page_328">328</a></li> - - <li><span class="smcap">Priscianus, Theodorus</span>, - <a href="#Page_192">192</a></li> - - <li><span class="smcap">Proksch</span>, - <a href="#Page_543">543</a></li> - - <li class="hangingindent"><span class="smcap">Przymiot</span>, title of early Polish treatise on syphilis, - <a href="#Page_479">479</a></li> - - <li class="hangingindent"><span class="smcap">Ptolemies</span>, learning greatly prospered under their reign, - <a href="#Page_100">100</a></li> - - <li><span class="smcap">Ptolemy Euergetes, or Physcon</span>, - <a href="#Page_116">116</a></li> - - <li><span class="smcap">Pulse</span>, meaning of, according to Athenaeus, - <a href="#Page_142">142</a></li> - - <li><span class="smcap">Pulsific power of arteries</span> (Galen), - <a href="#Page_381">381</a></li> - - <li><span class="smcap">Purkinje’s bone-corpuscles</span>, - <a href="#Page_362">362</a></li> - - <li class="hangingindent"><span class="smcap">Puschmann</span>, - <a href="#Page_70">70</a>, - <a href="#Page_107">107</a>, - <a href="#Page_196">196</a>, - <a href="#Page_232">232</a>, - <a href="#Page_257">257</a>, - <a href="#Page_311">311</a>, - <a href="#Page_365">365</a>, - <a href="#Page_394">394</a></li> - - <li><span class="smcap">Pyaemia</span>, Wuertz’s views regarding, - <a href="#Page_469">469</a></li> - - <li><span class="smcap">Pythagoras</span>, - <a href="#Page_73">73</a>, - <a href="#Page_74">74</a></li> - <li class="i1">medical doctrines propounded by, - <a href="#Page_147">147</a></li> - - <li class="hangingindent"><span class="smcap">Python</span>, Aesculapius represented in the presence of a, - <a href="#Page_65">65</a></li> -</ul> - -<p class="p-index">Q</p> - -<ul> - <li><span class="smcap">Quintessences of Paracelsus</span>, - <a href="#Page_405">405</a></li> - - <li><span class="smcap">Quintus</span>, one of Galen’s teachers, - <a href="#Page_162">162</a></li> -</ul> - -<p class="p-index">R</p> - -<ul> - <li class="hangingindent"><span class="smcap">Rabelais, François</span>, celebrated humorous writer, was a physician, - <a href="#Page_451">451</a></li> - - <li class="hangingindent"><span class="smcap">Rabisu</span>, the demon who causes diseases of the skin, - <a href="#Page_13">13</a></li> - - <li class="hangingindent"><span class="smcap">Raphael’s celebrated painting</span> showing Plato and Aristotle, - <a href="#Page_102">102</a></li> - - <li class="hangingindent"><span class="smcap">Rational system of medicine</span>, beginnings of, in Greece, - <a href="#Page_67">67</a></li> - - <li class="hangingindent"><span class="smcap">Recipes, books of</span>, take the place of physicians in Rome, - <a href="#Page_117">117</a></li> - - <li class="hangingindent"><span class="smcap">Red-hot cautery iron</span> too freely used for arresting bleeding, - <a href="#Page_466">466</a></li> - - <li class="hangingindent"><span class="smcap">Refraction</span>, researches of Alhazen in regard to, - <a href="#Page_233">233</a></li> - - <li><span class="smcap">Regimen sanitatis Salernitanum</span>, - <a href="#Page_246">246</a></li> - <li class="i1">Arnold’s commentary on, - <a href="#Page_294">294</a></li> - - <li class="hangingindent"><span class="smcap">Relics, saintly</span>, universal faith in their power to heal diseases, - <a href="#Page_241">241</a></li> - - <li class="hangingindent"><span class="smcap">Remedial agents, genuine</span>, employed in Babylonia, - <a href="#Page_13">13</a></li> - - <li><span class="smcap">Remedies, household</span>, Cato’s collection of, - <a href="#Page_123">123</a></li> - - <li class="hangingindent"><span class="smcap">Renaissance</span>, influence of, upon progress of medicine in Western Europe, - <a href="#Page_259">259</a></li> - - <li><span class="smcap">Renan, Ernest</span>, - <a href="#Page_229">229</a>, - <a href="#Page_231">231</a></li> - - <li class="hangingindent"><span class="smcap">Renzi, de</span>, on books written by physicians at Salerno, - <a href="#Page_246">246</a></li> - - <li><span class="smcap">Repercussion</span>, - <a href="#Page_526">526</a></li> - - <li class="hangingindent"><span class="smcap">Respiration</span>, physiology of, according to Erasistratus, - <a href="#Page_108">108</a></li> - <li class="i1">according to Aretaeus, - <a href="#Page_144">144</a></li> - - <li><span class="smcap">Rete Malpighi</span>, - <a href="#Page_361">361</a></li> - - <li><span class="smcap">Rhazes</span>, illustrious Persian physician, - <a href="#Page_219">219</a>, - <a href="#Page_318">318</a></li> - - <li><span class="smcap">Rhinoplasty</span> in Italy in the 15th century, - <a href="#Page_459">459</a></li> - - <li><span class="smcap">Rhodion</span>, - <a href="#Page_533">533</a></li> - - <li><span class="smcap">Riolan, J.</span>, - <a href="#Page_360">360</a></li> - - <li><span class="smcap">Roesslin, Eucharius</span>, - <a href="#Page_533">533</a></li> - - <li class="hangingindent"><span class="smcap">Roger’s Practica</span>, the oldest treatise on surgery written in Italy during the Middle Ages, - <a href="#Page_254">254</a></li> - - <li class="hangingindent"><span class="smcap">Rokitansky</span>, the famous Viennese pathologist, advice of, to those about to study medicine, - <a href="#Page_3">3</a></li> - - <li><span class="smcap">Roland of Parma</span>, - <a href="#Page_254">254</a>, - <a href="#Page_279">279</a></li> - - <li class="hangingindent"><span class="smcap">Roman physicians</span>, of foreign birth, awarded rights of citizenship by Julius Caesar, - <a href="#Page_130">130</a></li> - - <li class="hangingindent"><span class="smcap">Romano Pane</span> publishes first account of discovery of tobacco, - <a href="#Page_395">395</a></li> - - <li class="hangingindent"><span class="smcap">Rome</span>, state of medicine at, after the death of Asclepiades, - <a href="#Page_129">129</a></li> - - <li><span class="smcap">Rosa anglica</span>, title of treatise written by John of Gaddesden, - <a href="#Page_306">306</a></li> - - <li><span class="smcap">Rousset, François</span>, - <a href="#Page_535">535</a></li> - - <li><span class="smcap">Royal Society of London</span>, founding of, - <a href="#Page_363">363</a></li> - - <li><span class="smcap">Rudbeck, Olaus</span>, - <a href="#Page_358">358</a>, - <a href="#Page_385">385</a></li> - - <li><span class="smcap">Rufus of Ephesus</span>, - <a href="#Page_145">145</a>, - <a href="#Page_146">146</a></li> - - <li><span class="smcap">Ruysch, Friedrich</span>, the anatomist, - <a href="#Page_356">356</a>, - <a href="#Page_358">358</a></li> -</ul> - -<p class="p-index">S</p> - -<ul> - <li><span class="smcap">Sabour ben Sahl</span>, - <a href="#Page_209">209</a></li> - - <li><span class="smcap">Sage femme</span>, possible origin of the term, - <a href="#Page_247">247</a></li> - - <li><span class="smcap">Saint Bartholomew’s Hospital</span>, London, - <a href="#Page_524">524</a></li> - - <li class="hangingindent"><span class="smcap">Saint Basil</span>, founder of a hospital at Caesarea, - <a href="#Page_236">236</a></li> - - <li><span class="smcap">Saint Côme, Collège de</span>, - <a href="#Page_490">490</a></li> - - <li class="hangingindent"><span class="smcap">Saint Cosmas and Saint Damian</span>, Brotherhood of, - <a href="#Page_530">530</a></li> - - <li class="hangingindent"><span class="smcap">Saladin of Ascolo</span>, author of first modern treatise on materia medica, - <a href="#Page_320">320</a></li> - - <li><span class="smcap">Saladin, Sultan of Egypt</span>, - <a href="#Page_225">225</a></li> - - <li><span class="smcap">Salamanca, University of</span>, - <a href="#Page_346">346</a></li> - - <li><span class="smcap">Salerno Medical School</span>, - <a href="#Page_243">243</a>, - <a href="#Page_244">244</a>, - <a href="#Page_265">265</a></li> - <li class="i1">women teachers at, - <a href="#Page_245">245</a></li> - - <li><span class="smcap">Saliceto, William of</span>, - <a href="#Page_277">277</a></li> - - <li class="hangingindent"><span class="smcap">Salmouïh ben Bayan</span>, a distinguished pupil of the Djondisabour school, - <a href="#Page_210">210</a></li> - - <li class="hangingindent"><span class="smcap">Salvino degli Armati</span> of Florence, reputed inventor of spectacles, - <a href="#Page_297">297</a></li> - - <li><span class="smcap">Sanctorius Sanctorinus</span>, - <a href="#Page_368">368</a></li> - - <li class="hangingindent"><span class="smcap">Sandwith, Dr. F. M.</span>, concerning the most ancient surgical implements thus far discovered, - <a href="#Page_9">9</a></li> - - <li><span class="smcap">Sanguification</span>, Galen’s theory of, - <a href="#Page_385">385</a></li> - - <li><span class="smcap">Sanitary science</span> in the 15th century, - <a href="#Page_314">314</a></li> - - <li><span class="smcap">Sapienza, University of</span>, at Rome, - <a href="#Page_391">391</a></li> - - <li><span class="smcap">Sarsaparilla</span>, - <a href="#Page_395">395</a></li> - - <li><span class="smcap">Savonarola, Giovanni Michele</span>, - <a href="#Page_313">313</a></li> - - <li><span class="smcap">Schielhans</span>, nickname of Hans von Gerssdorff, - <a href="#Page_460">460</a></li> - - <li><span class="smcap">Schneider, Conrad Victor</span>, - <a href="#Page_359">359</a></li> - - <li><span class="smcap">School of Salerno</span>, title of poem, - <a href="#Page_250">250</a></li> - - <li><span class="smcap">Schools</span>, significance of the term, - <a href="#Page_74">74</a></li> - - <li><span class="smcap">Scotus or Scottus</span>, - <a href="#Page_262">262</a></li> - - <li><span class="smcap">Scribonius Largus</span>, - <a href="#Page_155">155</a>, - <a href="#Page_413">413</a></li> - - <li><span class="smcap">Sects in Medicine</span>, - <a href="#Page_101">101</a>, - <a href="#Page_147">147</a>, - <a href="#Page_149">149</a></li> - - <li><span class="smcap">Septicaemia</span>, Wuertz’s views regarding, - <a href="#Page_470">470</a>, - <a href="#Page_471">471</a></li> - - <li><span class="smcap">Serapion the Elder</span>, - <a href="#Page_210">210</a></li> - - <li><span class="smcap">Serapis or Osiris</span>, - <a href="#Page_19">19</a></li> - - <li class="hangingindent"><span class="smcap">Serpent</span>, significance of the, in the statues and votive tablets exposed to view in the Aesculapian temples, - <a href="#Page_62">62</a></li> - - <li><span class="smcap">Servetus, Michael</span>, - <a href="#Page_375">375</a></li> - <li class="i1">on the circulation of the blood, - <a href="#Page_376">376</a></li> - - <li class="hangingindent"><span class="smcap">Shoulder, dislocation of</span>, cured by Gabriel Bakhtichou, - <a href="#Page_207">207</a></li> - - <li><span class="smcap">Simon Januensis</span>, - <a href="#Page_261">261</a></li> - - <li><span class="smcap">Sismondi, the historian</span>, - <a href="#Page_116">116</a></li> - - <li><span class="smcap">Skull, fractures of</span>, - <a href="#Page_286">286</a>, - <a href="#Page_476">476</a></li> - - <li class="hangingindent"><span class="smcap">Slaves sold by Romans</span> when they became old and feeble, - <a href="#Page_235">235</a></li> - - <li class="hangingindent"><span class="smcap">Sleep-walking</span>, instance of, narrated by Alderotti, - <a href="#Page_273">273</a></li> - - <li><span class="smcap">Small-pox</span> described by Herodotus, - <a href="#Page_142">142</a></li> - <li class="i1">earliest treatise upon, - <a href="#Page_220">220</a></li> - <li class="i1">Gaddesden’s successful treatment of, - <a href="#Page_306">306</a></li> - <li class="i1">prophylactic inoculation against, - <a href="#Page_43">43</a></li> - - <li><span class="smcap">Smith, Sir William</span>, - <a href="#Page_103">103</a></li> - - <li><span class="smcap">Snake, poisonous</span>, treatment of bite by, - <a href="#Page_110">110</a></li> - - <li class="hangingindent"><span class="smcap">Snakeroot</span>, an antidote for poisoning by the bite of a snake, - <a href="#Page_7">7</a></li> - - <li class="hangingindent"><span class="smcap">Sobieski, King of Poland</span>, purchases Ruysch’s second anatomical collection, - <a href="#Page_358">358</a></li> - - <li class="hangingindent"><span class="smcap">Social hygiene</span>, the Mosaic laws relate particularly to, - <a href="#Page_26">26</a></li> - - <li><span class="smcap">Socrates</span>, - <a href="#Page_73">73</a></li> - - <li><span class="smcap">Soporific sponges</span>, - <a href="#Page_253">253</a></li> - - <li><span class="smcap">Soranus of Ephesus</span>, - <a href="#Page_138">138</a>, - <a href="#Page_139">139</a>, - <a href="#Page_159">159</a></li> - <li class="i1">rational obstetric methods of, - <a href="#Page_139">139</a></li> - - <li><span class="smcap">Soul, spirit of the</span>, - <a href="#Page_291">291</a></li> - - <li class="hangingindent"><span class="smcap">Soul, the</span>, is the blood, according to Servetus, - <a href="#Page_376">376</a></li> - - <li class="hangingindent"><span class="smcap">Spain</span>, medicine flourished in, during the 10th century, - <a href="#Page_226">226</a></li> - - <li><span class="smcap">Spanish surgeons</span> of the 16th century, - <a href="#Page_484">484</a></li> - - <li><span class="smcap">Specialization</span> in medicine, - <a href="#Page_114">114</a></li> - - <li class="hangingindent"><span class="smcap">Spectacles</span>, use of, first mentioned by Gordonius (A. D. 1285), - <a href="#Page_297">297</a></li> - - <li><span class="smcap">Speculum</span>, aural, employed by Jean de Vigo, - <a href="#Page_473">473</a></li> - <li class="i1">majus, of Vincent Beauvais, - <a href="#Page_270">270</a></li> - <li class="i1">vaginal, of Paulus Aegineta, - <a href="#Page_201">201</a></li> - - <li><span class="smcap">Spine, curvature of</span>, - <a href="#Page_313">313</a></li> - - <li><span class="smcap">Spirit, the</span>, - <a href="#Page_291">291</a>, - <a href="#Page_374">374</a></li> - <li class="i1">disorders of, - <a href="#Page_141">141</a></li> - <li class="i1">of Mindererus, - <a href="#Page_407">407</a></li> - - <li><span class="smcap">Splenia</span>, - <a href="#Page_526">526</a></li> - - <li><span class="smcap">Splints</span> made with bundles of straw, - <a href="#Page_304">304</a></li> - - <li><span class="smcap">Sprengel, Kurt</span>, - <a href="#Page_342">342</a></li> - - <li><span class="smcap">Springs, European</span>, in 16th century, - <a href="#Page_323">323</a></li> - - <li><span class="smcap">Stahl, Georg Ernst</span>, - <a href="#Page_431">431</a></li> - <li class="i1">doctrine of animism, - <a href="#Page_432">432</a></li> - <li class="i1">his “phlogiston,” - <a href="#Page_433">433</a></li> - <li class="i1">treatise on “theoria medica vera,” - <a href="#Page_432">432</a></li> - - <li><span class="smcap">Steno, Nicholas</span> (Niels Stensen), - <a href="#Page_359">359</a></li> - - <li><span class="smcap">Stibium</span>, - <a href="#Page_158">158</a></li> - - <li><span class="smcap">Stoics, the</span>, - <a href="#Page_102">102</a></li> - - <li><span class="smcap">Stone in the bladder</span>, cutting for, - <a href="#Page_494">494</a></li> - <li class="i1">Gaddesden’s peculiar method of treating, - <a href="#Page_306">306</a></li> - <li class="hangingindent1">method of operating kept a secret by lithotomists, - <a href="#Page_447">447</a></li> - - <li><span class="smcap">Strangulated hernia</span>, Franco’s operation for, - <a href="#Page_492">492</a></li> - - <li><span class="smcap">Straton</span>, a skilful gynaecologist, - <a href="#Page_115">115</a></li> - - <li><span class="smcap">Straw splints</span>, for use in fractures, - <a href="#Page_304">304</a></li> - - <li class="hangingindent"><span class="smcap">Strictum and laxum</span>, terms employed by the Methodists, - <a href="#Page_130">130</a></li> - <li class="i1">Boerhaave adopts the doctrine, - <a href="#Page_442">442</a></li> - - <li><span class="smcap">Styrus</span>, one of Galen’s teachers, - <a href="#Page_162">162</a></li> - - <li><span class="smcap">Suggestion</span>, power of, over the human mind, - <a href="#Page_241">241</a></li> - - <li class="hangingindent"><span class="smcap">Superstitious beliefs</span> constitute one of the most extraordinary characteristics of the human race, - <a href="#Page_10">10</a></li> - - <li class="hangingindent"><span class="smcap">Surgeon</span>, characteristics which he should possess, - <a href="#Page_285">285</a></li> - - <li class="hangingindent"><span class="smcap">Surgeons of the long robe</span>, a name given to members of the Collège de St. Côme, - <a href="#Page_448">448</a></li> - - <li class="hangingindent"><span class="smcap">Surgery</span>, considered a menial occupation during the Renaissance (Fig.), - <a href="#Page_306">306</a>, - <a href="#Page_447">447</a></li> - <li class="i1">early, in Great Britain, - <a href="#Page_516">516</a>, - <a href="#Page_523">523</a></li> - <li class="hangingindent1">strong prejudice against among French physicians of the 15th century, - <a href="#Page_300">300</a></li> - <li class="hangingindent1">systematic instruction in, first given at Montpellier in 1597, - <a href="#Page_448">448</a></li> - - <li class="hangingindent"><span class="smcap">Surgical operations</span> in the age of primitive medicine, - <a href="#Page_8">8</a></li> - - <li class="hangingindent"><span class="smcap">Susruta</span>, celebrated East Indian medical author, - <a href="#Page_31">31</a></li> - - <li><span class="smcap">Swammerdam, John</span>, - <a href="#Page_356">356</a></li> - - <li><span class="smcap">Sydenham, Thomas</span>, - <a href="#Page_418">418</a></li> - <li class="i1">a great sufferer from gout, - <a href="#Page_421">421</a></li> - <li class="i1">describes an “inflammation of the blood,” - <a href="#Page_423">423</a></li> - <li class="hangingindent1">experience with the great epidemic of the Plague, - <a href="#Page_421">421</a></li> - <li class="i1">on the nature of fever, - <a href="#Page_423">423</a></li> - <li class="i1">treatises published by, - <a href="#Page_419">419</a></li> - - <li><span class="smcap">Sylvius</span> (Franz de le Boë), - <a href="#Page_367">367</a>, - <a href="#Page_427">427</a></li> - <li class="hangingindent1">clinical instruction cultivated by him at Leyden, - <a href="#Page_428">428</a>, - <a href="#Page_429">429</a></li> - <li class="i1">treatises published by him, - <a href="#Page_428">428</a></li> - - <li><span class="smcap">Sylvius, the anatomist</span>, - <a href="#Page_340">340</a></li> - - <li><span class="smcap">Syphilis</span>, - <a href="#Page_473">473</a>, - <a href="#Page_542">542</a></li> - <li class="i1">poem relating to, - <a href="#Page_391">391</a></li> - - <li class="hangingindent"><span class="smcap">Syriac ulcer</span> (known to-day as pharyngeal diphtheria), - <a href="#Page_144">144</a></li> - - <li class="hangingindent"><span class="smcap">Syringe</span>, earliest reference to use of, to be found in Abulcasis’ treatise on surgery, - <a href="#Page_227">227</a></li> - - <li><span class="smcap">Syringotome</span>, - <a href="#Page_313">313</a></li> - - <li><span class="smcap">Szandalani</span>, Arabic name for pharmacists, - <a href="#Page_318">318</a></li> -</ul> - -<p class="p-index">T</p> - -<ul> - <li><span class="smcap">Tagliacotian operation</span>, the so-called, - <a href="#Page_478">478</a>, - <a href="#i_p480">480</a></li> - - <li><span class="smcap">Tagliacozzi, Gaspare</span>, - <a href="#Page_478">478</a></li> - - <li class="hangingindent"><span class="smcap">Talismans</span>, amulets, etc., as means of protection against evil spirits, - <a href="#Page_9">9</a>, - <a href="#Page_13">13</a></li> - - <li class="hangingindent"><span class="smcap">Teissir, the</span>, Avenzoar’s great medical work, - <a href="#Page_228">228</a>, - <a href="#Page_230">230</a></li> - - <li><span class="smcap">Telesphorus</span>, son of, Aesculapius, - <a href="#Page_50">50</a></li> - - <li><span class="smcap">Temple priests</span> in ancient Egypt, - <a href="#Page_17">17</a></li> - - <li><span class="smcap">Temple sleep</span> at the Asclepieia, - <a href="#Page_57">57</a></li> - - <li><span class="smcap">Temples, Aesculapian</span>, their chief purpose, - <a href="#Page_51">51</a></li> - - <li class="hangingindent"><span class="smcap">Tents, practice of employing</span>, in the treatment of wounds, condemned, - <a href="#Page_466">466</a></li> - - <li class="hangingindent"><span class="smcap">Tesrif, the</span>, written by Abulcasis (= Alsaharavius), - <a href="#Page_227">227</a></li> - - <li class="hangingindent"><span class="smcap">Tetanus, traumatic</span>, Lanfranchi’s treatment of, - <a href="#Page_285">285</a></li> - - <li><span class="smcap">Thaddeus Alderotti</span>, - <a href="#Page_272">272</a></li> - - <li><span class="smcap">Thales</span>, of Miletus, - <a href="#Page_72">72</a></li> - - <li class="hangingindent"><span class="smcap">Themison</span>, founder of the sect of the Methodists, - <a href="#Page_130">130</a></li> - <li class="hangingindent1">the first to mention the employment of leaches, - <a href="#Page_133">133</a></li> - - <li><span class="smcap">Theodoric of Lucca</span>, - <a href="#Page_276">276</a></li> - - <li><span class="smcap">Theodorus</span>, a disciple of Athenaeus, - <a href="#Page_142">142</a></li> - - <li><span class="smcap">Thessalus, son of Hippocrates</span>, - <a href="#Page_82">82</a>, - <a href="#Page_133">133</a></li> - - <li class="hangingindent"><span class="smcap">Thessalus, of Tralles</span>, in Asia Minor, a prominent Methodist, - <a href="#Page_133">133</a></li> - - <li><span class="smcap">Thierry de Héry</span>, - <a href="#Page_499">499</a></li> - - <li class="hangingindent"><span class="smcap">Thigh</span>, amputation of, probably performed in early part of Christian era, - <a href="#Page_470">470</a></li> - <li class="i1">fractures of, - <a href="#Page_304">304</a></li> - - <li><span class="smcap">Thirty Years’ War, the</span>, - <a href="#Page_426">426</a></li> - - <li class="hangingindent"><span class="smcap">Thomas Aquinas</span>, a believer in the art of the magician, - <a href="#Page_321">321</a></li> - - <li><span class="smcap">Thoracic duct</span>, - <a href="#Page_384">384</a></li> - - <li class="hangingindent"><span class="smcap">Thot or Thoüt</span> (Hermes), the god, author of the hermetic books, - <a href="#Page_18">18</a>, - <a href="#Page_19">19</a></li> - - <li><span class="smcap">Thucydides</span>, - <a href="#Page_96">96</a></li> - - <li><span class="smcap">Tiraboschi</span>, - <a href="#Page_338">338</a>, - <a href="#Page_378">378</a></li> - - <li><span class="smcap">Tobacco</span>, - <a href="#Page_395">395</a></li> - - <li class="hangingindent"><span class="smcap">Toledo, Spain</span>, richly stocked with manuscript treasures of Arabic literature, - <a href="#Page_261">261</a></li> - - <li><span class="smcap">Tolet, François</span>, - <a href="#Page_550">550</a></li> - - <li><span class="smcap">Tolu, balsam of</span>, - <a href="#Page_395">395</a></li> - - <li><span class="smcap">Torcular Herophili</span>, - <a href="#Page_105">105</a></li> - - <li><span class="smcap">Torricella</span>, - <a href="#Page_546">546</a></li> - - <li><span class="smcap">Tosorthos</span>, - <a href="#Page_17">17</a></li> - - <li><span class="smcap">Touching</span>, for the “King’s evil,” - <a href="#Page_527">527</a>, - <a href="#Page_528">528</a></li> - - <li class="hangingindent"><span class="smcap">Tracheotomy</span> performed by Asclepiades (90 B. C.), - <a href="#Page_124">124</a></li> - <li class="hangingindent1">revived by Antonio Beniveni in the 15th century, - <a href="#Page_498">498</a></li> - - <li><span class="smcap">Transfusion of blood</span>, - <a href="#Page_408">408</a></li> - - <li><span class="smcap">Transmutation of baser metals into gold</span>, - <a href="#Page_321">321</a></li> - - <li><span class="smcap">Trautmann</span>, of Wittenberg, - <a href="#Page_535">535</a></li> - - <li><span class="smcap">Trephine</span>, circular pattern of, - <a href="#Page_473">473</a></li> - - <li class="hangingindent"><span class="smcap">Trephining the skull</span> a very ancient surgical operation, - <a href="#Page_9">9</a></li> - <li class="i1">Wuertz slow in resorting to the operation, - <a href="#Page_467">467</a></li> - - <li><span class="smcap">Trikka, Thessaly</span>, - <a href="#Page_51">51</a></li> - - <li><span class="smcap">Trotula</span>, a teacher of medicine at Salerno, - <a href="#Page_245">245</a></li> - - <li class="hangingindent"><span class="smcap">Tuberculosis</span>, virus of, long-lived, according to Fracastoro, - <a href="#Page_390">390</a></li> - - <li><span class="smcap">Turquet de Mayerne</span>, - <a href="#Page_547">547</a></li> - - <li><span class="smcap">Tydides</span>, who smote Aeneas, - <a href="#Page_49">49</a></li> -</ul> - -<p class="p-index">U</p> - -<ul> - <li class="hangingindent"><span class="smcap">Ulcers</span>, treatment of, according to the method of Thessalus, - <a href="#Page_135">135</a></li> - - <li class="hangingindent"><span class="smcap">Uroscopy</span> eagerly adopted by charlatans in 16th century (Fig.), - <a href="#Page_412">412</a></li> - <li class="hangingindent1">strongly denounced by Scribonius, Botallo and others, - <a href="#Page_413">413</a></li> - - <li class="hangingindent"><span class="smcap">Utukku</span>, the demon who causes diseases of the throat, - <a href="#Page_13">13</a></li> -</ul> - -<p class="p-index">V</p> - - -<ul> - <li class="hangingindent"><span class="smcap">Vagbhata</span>, a celebrated East Indian medical author, - <a href="#Page_31">31</a></li> - - <li><span class="smcap">Valerius Cordus</span>, - <a href="#Page_318">318</a></li> - - <li><span class="smcap">Valves, discovery of, in the larger veins</span>, - <a href="#Page_378">378</a></li> - - <li><span class="smcap">Van Helmont</span>, - <a href="#Page_398">398</a></li> - <li class="i1">“archaeus influus” and “archaeus insitus,” - <a href="#Page_399">399</a></li> - <li class="i1">characteristic sayings, - <a href="#Page_400">400</a></li> - <li class="i1">remarkable remedies manufactured by him, - <a href="#Page_399">399</a></li> - - <li class="hangingindent"><span class="smcap">Van Swieten</span> introduces clinical instruction at the University of Vienna, - <a href="#Page_431">431</a></li> - - <li><span class="smcap">Varolius</span>, - <a href="#Page_349">349</a></li> - - <li class="hangingindent"><span class="smcap">Vein</span> should be opened longitudinally in venesection, - <a href="#Page_286">286</a></li> - - <li><span class="smcap">Vena portae</span>, - <a href="#Page_385">385</a></li> - - <li class="hangingindent"><span class="smcap">Venesection</span>, Celsus’ description of technical details, - <a href="#Page_152">152</a></li> - <li class="i1">quantity of blood that may be withdrawn, - <a href="#Page_413">413</a></li> - <li class="hangingindent1">spot from which blood should preferably be taken, - <a href="#Page_411">411</a></li> - - <li><span class="smcap">Venous artery</span> (pulmonary vein), - <a href="#Page_371">371</a></li> - - <li><span class="smcap">Venous blood, function of</span>, - <a href="#Page_373">373</a></li> - - <li><span class="smcap">Versification</span> employed in medical treatises, - <a href="#Page_251">251</a></li> - - <li><span class="smcap">Version, podalic</span>, - <a href="#Page_535">535</a></li> - - <li><span class="smcap">Vesalius</span>, - <a href="#Page_340">340</a>, - <a href="#Page_342">342</a>, - <a href="#Page_345">345</a>, - <a href="#Page_347">347</a>, - <a href="#Page_370">370</a>, - <a href="#Page_374">374</a>, - <a href="#Page_456">456</a></li> - - <li><span class="smcap">Vicq d’Azyr</span>, - <a href="#Page_532">532</a></li> - - <li><span class="smcap">Victor III., Pope</span>, - <a href="#Page_239">239</a></li> - - <li><span class="smcap">Vidus Vidius</span>, - <a href="#Page_340">340</a></li> - - <li><span class="smcap">Vieussens, Raymond</span>, - <a href="#Page_364">364</a></li> - - <li><span class="smcap">Villalobos</span>, - <a href="#Page_542">542</a></li> - - <li><span class="smcap">Vincent of Beauvais</span>, - <a href="#Page_270">270</a></li> - <li class="i1">encyclopaedia of, - <a href="#Page_263">263</a></li> - - <li><span class="smcap">Vindicianus</span>, - <a href="#Page_192">192</a></li> - - <li><span class="smcap">Viper</span>, cases of persons bitten by, - <a href="#Page_488">488</a>, - <a href="#Page_507">507</a></li> - - <li class="hangingindent"><span class="smcap">Vis conservatrix et medicatrix naturae</span> (Stahl), - <a href="#Page_432">432</a></li> - - <li><span class="smcap">Vital force</span>, Stahl’s, - <a href="#Page_405">405</a></li> - - <li><span class="smcap">Vital spirit</span>, Galen’s, - <a href="#Page_376">376</a></li> - - <li class="hangingindent"><span class="smcap">Vivisection of criminals</span> utilized at Alexandria, Egypt, for scientific purposes, - <a href="#Page_107">107</a></li> - - <li class="hangingindent"><span class="smcap">Vizir Ali ben Issa</span> founds a great hospital at Bagdad in A. D. 914, - <a href="#Page_219">219</a></li> - - <li><span class="smcap">Volcher Koyter</span>, - <a href="#Page_349">349</a></li> -</ul> - -<p class="p-index">W</p> - -<ul> - <li class="hangingindent"><span class="smcap">Water, contaminated</span>, purification of, by distillation, - <a href="#Page_305">305</a></li> - <li class="hangingindent1">of river Choaspes, ready boiled for use and stored in flagons of silver, carried by King Cyrus on his campaigns, - <a href="#Page_26">26</a></li> - - <li><span class="smcap">Wecker, Johann Jacob</span>, - <a href="#Page_521">521</a></li> - - <li class="hangingindent"><span class="smcap">Weight-and-pulley treatment</span> of thigh fractures, Guy de Chauliac’s, - <a href="#Page_304">304</a></li> - - <li><span class="smcap">Wharton, Thomas</span>, - <a href="#Page_359">359</a>, - <a href="#Page_546">546</a></li> - - <li><span class="smcap">William of Saliceto</span>, - <a href="#Page_277">277</a></li> - - <li><span class="smcap">William the Conqueror</span> a patient at Salerno, - <a href="#Page_245">245</a></li> - - <li><span class="smcap">Willis, Thomas</span>, - <a href="#Page_360">360</a>, - <a href="#Page_367">367</a>, - <a href="#Page_546">546</a></li> - - <li><span class="smcap">Wine</span>, Galen’s use of, in dressing wounds, - <a href="#Page_163">163</a></li> - <li class="hangingindent1">proper employment of, according to Asclepiades, - <a href="#Page_125">125</a></li> - <li class="i1">Thalassite, - <a href="#Page_126">126</a></li> - - <li><span class="smcap">Winter, of Andernach</span>, - <a href="#Page_340">340</a></li> - - <li class="hangingindent"><span class="smcap">Wirsung, George</span>, discovers outlet duct of human pancreas, - <a href="#Page_358">358</a></li> - - <li><span class="smcap">Wiseman, Richard</span>, - <a href="#Page_524">524</a></li> - - <li class="hangingindent"><span class="smcap">Women instructors in medicine</span> highly esteemed at Salerno, - <a href="#Page_246">246</a></li> - - <li class="hangingindent"><span class="smcap">Women physicians</span> among the Arabs in Spain, during the 12th century, - <a href="#Page_232">232</a></li> - - <li><span class="smcap">Woodall, John</span>, - <a href="#Page_522">522</a></li> - - <li><span class="smcap">Wounds, dry method of treating</span>, - <a href="#Page_275">275</a>, - <a href="#Page_285">285</a></li> - <li class="i1">too frequent probing of, condemned, - <a href="#Page_466">466</a></li> - - <li><span class="smcap">Wren, Sir Christopher</span>, - <a href="#Page_408">408</a></li> - - <li><span class="smcap">Wuertz, Felix</span>, - <a href="#Page_465">465</a></li> - <li class="hangingindent1">condemns universal employment of chemical caustics and the red-hot iron for arresting bleeding, - <a href="#Page_466">466</a></li> - <li class="hangingindent1">remarks on pyaemia, hospital gangrene and septicaemia, - <a href="#Page_469">469</a>, - <a href="#Page_471">471</a></li> - <li class="hangingindent1">remarks on treatment of penetrating wounds of abdomen, - <a href="#Page_469">469</a></li> - - <li><span class="smcap">Wundaerzte</span>, - <a href="#Page_369">369</a></li> -</ul> - -<p class="p-index">X</p> - -<ul> - <li class="hangingindent"><span class="smcap">Xenodochia</span>, institutions for the care of slaves, - <a href="#Page_235">235</a></li> - - <li><span class="smcap">Xenophon, C. Stertinius</span>, - <a href="#Page_54">54</a></li> -</ul> - -<p class="p-index">Y</p> - -<ul> - <li class="hangingindent"><span class="smcap">Yperman, Jehan</span>, a distinguished Flemish physician of 14th century, - <a href="#Page_309">309</a></li> -</ul> - -<p class="p-index">Z</p> - -<ul> - <li><span class="smcap">Zend-Avesta, the</span>, - <a href="#Page_25">25</a></li> - - <li><span class="smcap">Zeno</span>, founder of the Stoic philosophy, - <a href="#Page_103">103</a></li> - - <li class="hangingindent"><span class="smcap">Zerbi, Gabriel</span>, professional visit of, to Constantinople, cost him his life, - <a href="#Page_337">337</a></li> - - <li class="hangingindent"><span class="smcap">Zeuxis</span>, organizer of a medical school at Laodicea, - <a href="#Page_111">111</a></li> - - <li><span class="smcap">Zirhach</span>, - <a href="#Page_521">521</a></li> - - <li><span class="smcap">Zirbus</span>, - <a href="#Page_521">521</a></li> - - <li class="hangingindent"><span class="smcap">Zopyrus</span> classified drugs according to the effects which they produce, - <a href="#Page_111">111</a></li> - - <li><span class="smcap">Zosimos</span>, of Panopolis, - <a href="#Page_321">321</a></li> -</ul> - - -<div class="footnotes"><h2 class="smaller2">FOOTNOTES:</h2> - -<div class="footnote"> - -<p><a id="Footnote_1" href="#FNanchor_1" class="label">[1]</a> A third volume is in course of preparation, but the -probable date of its publication has not been announced. An English -translation of the first volume (by Ernest Playfair) was published by -Hodder and Stoughton, of London, in 1910.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_2" href="#FNanchor_2" class="label">[2]</a> Book I., section 197, of Rawlinson’s translation.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_3" href="#FNanchor_3" class="label">[3]</a> From the statements just quoted it appears that a -certain kind of bronze (an alloy of copper and tin, with the addition -perhaps of a little zinc) was used in Assyria, in the manufacture of -surgical knives, as early as during the twenty-third century B. C. Dr. -Meyer-Steineg, Professor of the History of Medicine in the University -of Jena, Germany, assures the writer that knives made of this material -are susceptible of being given as keen a cutting edge as are those made -of the best of steel. At least one such bronze knife may be seen in the -collection of ancient surgical instruments, votive offerings, etc., -which he is making for the benefit of the University.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_4" href="#FNanchor_4" class="label">[4]</a> A Christian ecclesiastical writer who lived about the year -200 A. D.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_5" href="#FNanchor_5" class="label">[5]</a> Lines 285–292 of Book IV. of the Earl of Derby’s -translation, first published in 1864.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_6" href="#FNanchor_6" class="label">[6]</a> Pason is the same as Apollo, who was believed by the -Greeks to have been the inventor or discoverer of the art of medicine.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_7" href="#FNanchor_7" class="label">[7]</a> See Le Clerc’s <i>Histoire de la Médecine</i>, Amsterdam, -1723.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_8" href="#FNanchor_8" class="label">[8]</a> At bottom of p. 15 of his <i>Histoire de la Médecine</i>.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_9" href="#FNanchor_9" class="label">[9]</a> Papyros Ebers, aus dem Aegyptischen zum ersten Male -vollständig ubersetzt von H. Joachim, Berlin, 1890.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_10" href="#FNanchor_10" class="label">[10]</a> Book I., p. 96, of George Rawlinson’s translation.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_11" href="#FNanchor_11" class="label">[11]</a> Neuburger speaks of the growth of medical knowledge in -India as a development that ran parallel with that of ancient Greece.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_12" href="#FNanchor_12" class="label">[12]</a> <i>From Neuburger.</i>—Equally crude are their ideas -respecting the causes of disease, as shown by the following items -selected from quite a long list of etiological factors: errors in -diet and in the habits of life, climatic influences, psychic factors, -heredity, poison, supernatural influences like the anger of the -gods, the evil powers of demons, etc. For purposes of diagnosis the -earlier Indian physicians utilized not only inspection, palpation -and auscultation, but also the senses of taste and smell. They noted -the losses and increases in the weight of the body, changes in the -appearance of the skin, the tongue and the excretions, alterations in -the configuration of the body, the form and other characteristics of -swellings, etc. They also noted changes in the patient’s voice, in the -character of the breathing, in the noises accompanying movements of -the joints and the twistings of the intestines. The crepitus caused by -the rubbing together of the roughened ends of a fractured bone did not -escape their notice. At a later period, doubtless through the influence -of the teachings of foreign physicians, they attached great importance -to the examination of the pulse.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_13" href="#FNanchor_13" class="label">[13]</a> Nepenthes, believed to be opium, is the word employed in -the original.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_14" href="#FNanchor_14" class="label">[14]</a> Aesculapius was held to be the son of Apollo, the god of -medicine, and to have been instructed in the art of healing by Chiron, -one of the centaurs. Beside his famous sons, Machaon and Podalirius, he -had four daughters whose names—Hygieia, Jaso, Panakeia and Aigle—have -come down to us through the ages. His wife’s name was Epione, and those -of his two younger sons were Telesphorus and Janiscus, but all three of -these names are rarely mentioned by the Greek writers.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_15" href="#FNanchor_15" class="label">[15]</a> “Kranken-Anstalten im griechisch-römischen Altertum,” -von Dr. med. et jur. Theodor Meyer-Steineg, a. o. Professor an der -Universität Jena; Verlag von G. Fischer, 1912.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_16" href="#FNanchor_16" class="label">[16]</a> “Kranken-Anstalten im griechisch-romischen Altertum,” in -<i>Jenaer medizin.-historische Beiträge</i>, Jena, 1912.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_17" href="#FNanchor_17" class="label">[17]</a> All important traces of the earlier structures seem to -have disappeared.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_18" href="#FNanchor_18" class="label">[18]</a> The Emperor Antoninus Pius, in order to provide properly -for these patients, erected at Epidaurus a special building in which -confinement cases and those likely to end fatally might be lodged.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_19" href="#FNanchor_19" class="label">[19]</a> The slave of Chremulos.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_20" href="#FNanchor_20" class="label">[20]</a> To save space the head of the god alone has been -reproduced in Fig. 5.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_21" href="#FNanchor_21" class="label">[21]</a> <i>Histoire de la Médecine</i>, Amsterdam, 1723.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_22" href="#FNanchor_22" class="label">[22]</a> The word “school,” when employed in the strictly modern -sense of that term, means an establishment regularly organized for -the purpose of giving instruction. Here, however, it is intended to -signify simply that certain places, like Cos, Crotona, Cnidus, etc., -had become the rendezvous of men who desired to cultivate—some as -teachers, others as disciples or pupils—certain branches of knowledge, -or certain doctrines. At a later period (third century B. C.) there was -established at Alexandria, Egypt, a well-organized school of medicine -closely resembling those of modern times.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_23" href="#FNanchor_23" class="label">[23]</a> All of these are translations from the French.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_24" href="#FNanchor_24" class="label">[24]</a> The city of Cnidus was situated very close to the Island -of Cos, on a peninsula that projects from the coast of Caria, Asia -Minor.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_25" href="#FNanchor_25" class="label">[25]</a> Black bile, it was believed, comes from the spleen, while -the yellow variety is a product of the liver.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_26" href="#FNanchor_26" class="label">[26]</a> Daremberg (<i>Hist. de la Méd.</i>) makes the following -comments on this sentence: “How many are the occasions when we -physicians would have it in our power to avert death, or at least to -postpone it for a few hours, if we would only engrave upon our memories -these words of the old man of Cos! ‘What a cruel responsibility -rests upon those whose duty it is to summon the doctor at the proper -moment! And how great must be the remorse if he fails to arrive in -time!’ On the other hand, how wise is the remark of Celsus: ‘The best -practitioner is he who never loses sight of his patients.’”</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_27" href="#FNanchor_27" class="label">[27]</a> After Alexandria first came under Roman rule (about 30 -B. C.) membership in the Museum was granted to athletes and other men -of no education, and it is said that even before that time Ptolemy -Euergetes, who had reopened the schools during the latter part of his -reign, bestowed some of the important positions upon men who were -simply his favorites. The library of the Museum was seriously damaged -by fire at the time when Julius Caesar was being besieged in Alexandria -by the inhabitants of that city, and was at last wholly destroyed by -Amrou, the Lieutenant of the Caliph Omar, in A. D. 651. The truth of -this extraordinary tale regarding the burning of books belonging to -the library at Alexandria in the seventh century is seriously doubted -by Sismondi (<i>Histoire de la Chute de l’Empire Romain</i>, Vol. -II., p. 57). “It was,” he says, “published for the first time, by -Abulpharagius, about six centuries after the event is supposed to have -occurred. And yet the contemporaneous national historians, Entychius -and Elmacin, make no mention of it whatever. An act of this nature, -furthermore, would be in direct conflict with the precepts of the -Koran and with the profound respect which the Mohammedans habitually -entertain for every scrap of paper on which the name of God happens to -be written.”</p> - -<p>Under the later rule of the Romans, Alexandria regained a good deal of -its literary importance and also became a chief seat of Christianity -and theological learning; but as a centre of medical influence its -glory had long since departed.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_28" href="#FNanchor_28" class="label">[28]</a> Asclepiades was not a descendant of Aesculapius, as one -would naturally infer from the name which he bore.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_29" href="#FNanchor_29" class="label">[29]</a> It would not be easy to fix, even approximately, the -date when remedies of this character ceased to find acceptance in -the popular mind of Europeans, but there can be no doubt that they -were employed rather frequently even as late as during the eighteenth -century;—indeed, measures that strongly smack of superstition are now -and then looked upon with favor by the well-educated members of our -modern society. For many centuries, however, they have been abandoned -by all physicians excepting those who are unworthy to bear that honored -title.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_30" href="#FNanchor_30" class="label">[30]</a> Neither Haller nor Dezeimeris furnishes any biographical -information with regard to Musa.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_31" href="#FNanchor_31" class="label">[31]</a> Antoninus Pius, however, established the rule that these -privileges were not to be granted to all physicians indiscriminately, -but only to a limited number; and, later still, it was decided that -only the parish physicians were entitled to receive them.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_32" href="#FNanchor_32" class="label">[32]</a> It seems almost unnecessary to call attention to the -fact that the subject of these remarks is not to be confounded with -Thessalus, the son of Hippocrates.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_33" href="#FNanchor_33" class="label">[33]</a> Ἰατρονίκης is the word employed in the original -Greek.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_34" href="#FNanchor_34" class="label">[34]</a> The word “metasyncrisis,” as we are assured by Le -Clerc, was employed first by Cassius, one of the earlier disciples -of Methodism, and then, long after the time of Thessalus, by Galen, -Oribasius, Aëtius and Paulus Aegineta.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_35" href="#FNanchor_35" class="label">[35]</a> Le Clerc calls attention to the -incorrectness—etymologically speaking—of the use of the word -“Eclectics” in connection with a school or sect. The members of such -a body are not, he says, “the chosen ones” as the term signifies, but -“the choosers.”</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_36" href="#FNanchor_36" class="label">[36]</a> Boerhaave, the famous clinician of Leyden, Holland -(eighteenth century), was instrumental in having an excellent Latin -translation made of this work; and in 1858 a German translation by A. -Mann was published in Halle.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_37" href="#FNanchor_37" class="label">[37]</a> Translated from <i>Oeuvres de Rufus d’Éphèse</i>; édition -Grecque et Française, par Daremberg et Ruelle, Paris, 1879.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_38" href="#FNanchor_38" class="label">[38]</a> The term “dogmatists” is also employed by some -authorities to designate those physicians who laid great stress upon -the importance of following the teachings of Hippocrates and Galen.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_39" href="#FNanchor_39" class="label">[39]</a> The majority of the writings of Galen are reported to -have been kept, for safe preservation, in the Temple of Peace, near the -Forum; and the destruction of this building by fire, during the latter -half of the second century, entailed the loss of all these valuable -works.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_40" href="#FNanchor_40" class="label">[40]</a> Book VI., Chapter XVII. (page 441 of Vol. I. of -Daremberg’s version).</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_41" href="#FNanchor_41" class="label">[41]</a> In his Commentaries on the works of Hippocrates (Epidemic -Diseases, III., t. XVII. B. § 4) Galen states that he has often -observed this to-and-fro movement of the alae nasi in certain cases of -illness and that he has interpreted it as indicating the existence of -some serious disorder of the respiratory tract. (Daremberg.)</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_42" href="#FNanchor_42" class="label">[42]</a> Hippocrates, Herophilus, Erasistratus, Asclepiades, -Themison, Celsus, Soranus and Athenaeus. Daremberg calls attention to -the fact that, although we possess to-day only a few fragments of the -writings of Archigenes, those few are of such a degree of excellence -that we may well ask ourselves whether Galen was not perfectly -justified in placing such a high estimate as he appears to have done -upon the merits of this writer,—and that, too, notwithstanding the -unfavorable criticism which he makes in the present paragraph about the -author’s failure at times to write with sufficient clearness on medical -subjects.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_43" href="#FNanchor_43" class="label">[43]</a> John the Grammarian, whose nativity is not stated by -Le Clerc, was at first a simple boatman who ferried back and forth -those who attended a school which was located on one of the islands -at Alexandria. As a result of his frequent talks with these men, he -became enamored with philosophy and decided, notwithstanding his age -(forty years), to devote himself entirely to the study of the subject. -Accordingly, he sold his boat and attended the lectures regularly, -becoming at last an expert in philosophy. He wrote several important -treatises and commentaries, some of them dealing with medical topics, -and he also made a number of translations from the Greek into Arabic.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_44" href="#FNanchor_44" class="label">[44]</a> Third edition, London, 1726.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_45" href="#FNanchor_45" class="label">[45]</a> Anthemius is also credited with being the inventor of the -principle of dome construction in architecture.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_46" href="#FNanchor_46" class="label">[46]</a> Also written Paulus Aeginetes.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_47" href="#FNanchor_47" class="label">[47]</a> The account which is given in this and the following -chapters is based largely on Dr. Lucien Le Clerc’s <i>Histoire de la -Médecine Arabe</i>, Paris, 1876.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_48" href="#FNanchor_48" class="label">[48]</a> Le Clerc and Freind mention both Nishapur and -Djondisabour as the name of the capital of the Province of Khorassan in -northeast Persia.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_49" href="#FNanchor_49" class="label">[49]</a> The drachma was a silver coin worth about 9¾ pence -English money. The fee paid to Gabriel for his surgical services -amounted, therefore, to a little less than £2000 or $10,000.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_50" href="#FNanchor_50" class="label">[50]</a> To distinguish him from Mesué the Younger, who lived -at Cairo, Egypt, about one hundred years later, and who attained -considerable celebrity on account of the treatises which he wrote on -materia medica.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_51" href="#FNanchor_51" class="label">[51]</a> For further remarks concerning the origin of the Teïssir -see page 229.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_52" href="#FNanchor_52" class="label">[52]</a> According to tradition the medical school at Salerno was -founded by four physicians—Adela, an Arab; Helinus, a Jew; Pontus, a -Greek; and Salernus, a Latin.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_53" href="#FNanchor_53" class="label">[53]</a> Perhaps the French title “sage-femme” originated from -this.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_54" href="#FNanchor_54" class="label">[54]</a> There can be no question, says Neuburger (in agreement -with Daremberg), about the truth of the statement that Constantinus -allowed the authorship of several of the treatises issued at Salerno -under his name to be attributed to himself—as, for example, the -“<i>Liber Pantegni</i>” (<i>Pantechni</i>), which is in reality the -“<i>Liber Regalis</i>” of Haly Abbas; the “<i>Pieticum</i>,” which is -fundamentally the work of Ibn-al-Dschezzar; the “<i>De Oculis</i>,” -which is based upon Honein ben Ischak’s treatise on opthalmology; and -still other works which it is not necessary to specify.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_55" href="#FNanchor_55" class="label">[55]</a> Under the heading “<i>Epilogus</i>” on pages 268 and 269 -of Meaux Saint-Marc’s version.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_56" href="#FNanchor_56" class="label">[56]</a> Examples of leonine versification: “Contra vim -<i>mortis</i>, nulla est herba in <i>hortis</i>”; (p. 155 of -Saint-Marc’s version) and (from Shelley’s <i>Cloud</i>) “I am the -<i>daughter</i> of the earth and <i>water</i>.”</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_57" href="#FNanchor_57" class="label">[57]</a> The term “praepositus” means the president or the dean of -the school with which the person named is connected.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_58" href="#FNanchor_58" class="label">[58]</a> The Opus majus, ed. J. H. Bridges, Oxford, 1897 (2d -edition, 1900); opera hactenus inedita, ed. B. Steele, Fasc. I., -London.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_59" href="#FNanchor_59" class="label">[59]</a> Aurei. The aureus is said to have been worth about 16 -shillings, English money.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_60" href="#FNanchor_60" class="label">[60]</a> A church official to whom was intrusted the duty of -granting dispensations; “Almoner” is perhaps the equivalent term in -English.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_61" href="#FNanchor_61" class="label">[61]</a> “Non enim est necesse saniem—sicut Rogerius et Rolandus -scripserunt et plerique eorum discipuli docent, et fere omnes cururgici -moderni servant—in vulneribus generare. Iste enim error est major quam -potest esse. Non est enim aliud, nisi impedire naturam, prolongare -morbum, prohibere conglutinationem et consolidationem vulneris.” (II., -cap. 27.)</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_62" href="#FNanchor_62" class="label">[62]</a> The most recent edition of this work is a French -translation made by P. Pifteau and published at Toulouse, in 1898.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_63" href="#FNanchor_63" class="label">[63]</a> According to Daremberg (<i>Histoire des Sciences -Médicales</i>, Vol. I., p. 264) the title “Doctor” appears for the -first time in the Preface of Roger’s treatise (1180 A. D.).</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_64" href="#FNanchor_64" class="label">[64]</a> “<i>La Grande Chirurgie de Guy de Chauliac</i>,” Paris, -1890.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_65" href="#FNanchor_65" class="label">[65]</a> The distinguishing sign of the barbers was the shaving -dish, made of <i>pewter</i> and hung up at the door of the shop; that -employed by the surgeons was also a shaving dish, but made of polished -brass. Those surgeons who had received their training at the school of -Saint Cosmas and Saint Damian were permitted to display at the window a -banner bearing the coat of arms of this institution.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_66" href="#FNanchor_66" class="label">[66]</a> The surgeons Cosmas and Damian were chosen patron saints -of the new organization. They were born in Arabia in the third century, -and are said to have been educated there. After having practiced -medicine for a certain length of time in Sicily, they were tortured -and killed, because of their Christian faith, by order of the Emperor -Diocletian, 303 A. D. Hence the title “Saints.”</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_67" href="#FNanchor_67" class="label">[67]</a> Guy de Chauliac, who wrote a treatise on surgery in the -latter half of the fourteenth century, also speaks of the value of this -diagnostic sign.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_68" href="#FNanchor_68" class="label">[68]</a> See remarks on the subject of amulets, etc., on pages -197, 198.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_69" href="#FNanchor_69" class="label">[69]</a> A small town in the Department of Lot, France. The -earliest Norman ancestors of the Gurdon family in England are said to -have derived their name from that of this town.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_70" href="#FNanchor_70" class="label">[70]</a> Introduction to the “Oeuvres d’Ambroise Paré,” Paris, -1840.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_71" href="#FNanchor_71" class="label">[71]</a> “Gaddesden had for a long time been troubled how to cure -stone: ‘At last,’ says he, in his <i>Rosa Anglica</i>, ‘I thought of -collecting a good quantity of those beetles which in summer are found -in the dung of oxen, also of the crickets which sing in the fields. I -cut off the heads and the wings of the crickets and put them with the -beetles and common oil into a pot; I covered it and left it afterwards -for a day and night in a bread oven. I drew out the pot and heated it -at a moderate fire, I pounded the whole and rubbed the sick parts; -in three days the pain had disappeared;’ under the influence of the -beetles and the crickets the stone was broken into bits. It was almost -always thus, by a sudden illumination, that this doctor discovered his -most efficacious remedies: Madame Trote [Trotula] of Salerno never -confided to her agents in various parts of the world the secret of more -marvelous and unexpected recipes.” (From Jusserand’s “English Wayfaring -Life in the Middle Ages.”)</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_72" href="#FNanchor_72" class="label">[72]</a> Some weeks later our fellow voyager, Thomas Schoepfius, -wrote to me that, on the return journey, he learned at Berne that “Long -Peter,” the leader of the Mézières robbers, had been apprehended by the -authorities and executed for his crimes; and that, when stretched on -the rack, he had confessed, among other things, that he had tried to -murder and rob some students who passed through Mézières on their way -to Lausanne.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_73" href="#FNanchor_73" class="label">[73]</a> Also often spelled “Falloppius.”</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_74" href="#FNanchor_74" class="label">[74]</a> The meaning of this Latin inscription can best be -appreciated by those physicians who have, through a long period of -years, practiced their profession largely among the well-to-do classes -of a metropolitan city. They alone, I believe, would understand the -significance of “<i>lucrum neglectum</i>” as applied to a large -proportion of the gifts which a practitioner of medicine receives from -grateful patients; and it is not at all likely that a layman who is -not familiar with this aspect of a physician’s life would, under the -circumstances mentioned, have the slightest suspicion that the device -quoted above could possibly bear the meaning that I have given to it.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_75" href="#FNanchor_75" class="label">[75]</a> See F. Loeffler: “Vorlesungen uber die geschichtliche -Entwickelung der Lehre von den Bakterien,” Leipzig, 1887, Th. 1; and -also p. 310 of Puschmann’s “Geschichte des Medicinischen Unterrichts,” -Leipzig, 1889.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_76" href="#FNanchor_76" class="label">[76]</a> The iatrophysicists and the iatromathematicians -constituted apparently two kindred branches of the same school.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_77" href="#FNanchor_77" class="label">[77]</a> An edition of the completed set of these plates was -published by Lancisi at Rome in 1714.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_78" href="#FNanchor_78" class="label">[78]</a> Translated from the French version printed by Daremberg -in his <i>Histoire de la Médecine</i>, Vol. II, p. 706. The originals -of Sydenham’s writings are all in Latin.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_79" href="#FNanchor_79" class="label">[79]</a> Pronounced by Haeser to be a compilation, and not one of -Sydenham’s genuine writings.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_80" href="#FNanchor_80" class="label">[80]</a> Physicians who maintain that all physiological and -pathological phenomena may be explained by the laws of physics.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_81" href="#FNanchor_81" class="label">[81]</a> “Gründliches Bedenken und physicalische Anmerkungen von -dem tödtlichen Damff der Holzkohlen,” Halle, 1716.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_82" href="#FNanchor_82" class="label">[82]</a> Probably this refers simply to a brazier containing -burning charcoal, the light emitted by which would doubtless be -sufficient to answer the purpose of a night lamp.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_83" href="#FNanchor_83" class="label">[83]</a> A small seaport town located on the Zuider Zee, about -thirty miles northeast of Amsterdam. The university, which was founded -there in 1648, was abandoned in 1818.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_84" href="#FNanchor_84" class="label">[84]</a> Quoted from the English translation mentioned above.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_85" href="#FNanchor_85" class="label">[85]</a> Bread boiled in water to the consistence of pulp.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_86" href="#FNanchor_86" class="label">[86]</a> The modern operation known as litholapaxy.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_87" href="#FNanchor_87" class="label">[87]</a> The word “<i>centuria</i>” is employed here in the sense -of “a group of one hundred.”</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_88" href="#FNanchor_88" class="label">[88]</a> Not Amatus, but a specialist. See remark near the top of -page 488.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_89" href="#FNanchor_89" class="label">[89]</a> Orange, which is only a short distance from Avignon and -Turriers, was ceded to France in 1713.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_90" href="#FNanchor_90" class="label">[90]</a> In the absence of a more fitting place in which to -speak of the employment of urethral bougies, it seems permissible to -state here that the first mention (in medical literature) of these -instruments occurs in Chapter XV. of the treatise of Guainerio, -Professor of Medicine at the University of Pavia. This work, which -was first published in 1439, bears the title: “<i>Practica Antonii -Guainerii</i>,” and a later edition was issued at Venice in 1508. -Speaking of a case of stone in the bladder, Guainerius says: “And -if the urine does not flow from the bladder ... introduce a slender -flexible rod of tin or silver into the urethra.”</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_91" href="#FNanchor_91" class="label">[91]</a> Franco calls it the “high operation” or “hypogastric -lithotomy.”</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_92" href="#FNanchor_92" class="label">[92]</a> After I had written the preceding description of Franco’s -new method of extracting a calculus from the urinary bladder, I -learned, from Haeser’s account of the surgical writings of Susrutas -in the Ayur-Veda (Sanscrit), that already before the Christian era -(the exact date is not known) the surgeons of East India had performed -this very operation. This fact, however, could not possibly have been -known to Franco, who—so far as modern surgeons are concerned—should -continue to be looked upon as the real inventor of suprapubic -cystotomy.—<span class="smcap">Author.</span></p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_93" href="#FNanchor_93" class="label">[93]</a> The fact that bullets are not hot when they inflict a -wound was proven experimentally by Bartolommeo Maggi several years -earlier, but Paré makes no reference to this fact.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_94" href="#FNanchor_94" class="label">[94]</a> Johann Jacob Wecker (1528–1586), born at Basel, -Switzerland, and author of a treatise entitled “<i>Practica medicinae -generalis</i>” (Basel, 1585).</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_95" href="#FNanchor_95" class="label">[95]</a> In this instance I have thought it best to modernize the -spelling of several of the words.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_96" href="#FNanchor_96" class="label">[96]</a> Not healing in a healthy manner.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_97" href="#FNanchor_97" class="label">[97]</a> Driving back.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_98" href="#FNanchor_98" class="label">[98]</a> Haeser speaks of Wiseman as having gained considerable -distinction by the careful manner in which he made provision for the -flaps in his amputations.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_99" href="#FNanchor_99" class="label">[99]</a> “<i>Observations diverses sur la stérilité, etc.</i>,” -Paris, 1609.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_100" href="#FNanchor_100" class="label">[100]</a> For a confirmation of this statement see the poem on -syphilis (“<i>Enfermedad de las Bubas</i>”) written by the Spanish -physician Francesco Lopez de Villalobos and published by him in 1498 at -Salamanca. The employment of mercurial inunctions is also mentioned in -this poem.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_101" href="#FNanchor_101" class="label">[101]</a> Physicians who had served at Rome as the regular medical -attendants of Pope Alexander the Sixth.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_102" href="#FNanchor_102" class="label">[102]</a> “Die Geschichte der venerischen Krankheiten,” Bonn, -1895.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_103" href="#FNanchor_103" class="label">[103]</a> “Zur Geschichte der Syphilis,” Breslau, 1870.</p> - -</div> -</div> - - -<p class="transnote">Transcriber’s Notes:<br /> - -1. Obvious printers’, punctuation and spelling errors have been corrected silently.<br /> - -2. Some hyphenated and non-hyphenated versions of the same words have been -retained as in the original.</p> - -<div style='display:block; margin-top:4em'>*** END OF THE PROJECT GUTENBERG EBOOK THE GROWTH OF MEDICINE FROM THE EARLIEST TIMES TO ABOUT 1800 ***</div> -<div style='text-align:left'> - -<div style='display:block; margin:1em 0'> -Updated editions will replace the previous one—the old editions will -be renamed. -</div> - -<div style='display:block; margin:1em 0'> -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the United -States without permission and without paying copyright -royalties. Special rules, set forth in the General Terms of Use part -of this license, apply to copying and distributing Project -Gutenberg™ electronic works to protect the PROJECT GUTENBERG™ -concept and trademark. 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